Diet Pills

Too much of a miracle?

Forget aspirin, penicillin or tranquilizers. The true wonder drug, in the eyes of all too many people, is one that promotes weight loss. For a while amphetamines seemed to provide that miracle, until doctors began warning of their severe side effects, which include increased blood pressure and heart rate, a dependency on the drugs, and bouts of depression when the pills are withdrawn. Now magical diet potions are being promoted in a new and, according to some doctors, alarming form. To make matters worse, they can be had for the asking at almost any drug counter.

These widely advertised nonprescription products contain two familiar ingredients, benzocaine and phenylpropanolamine (PPA). Benzocaine is a local anesthetic that has long been used to soothe skin irritations and itching. Added to special chewing gums or candy, it presumably dulls the taste buds and discourages eating. PPA, a drug related to the amphetamines, has enjoyed a long history as a nasal decongestant in cold remedies. In such popular diet pills as Dexatrim, Prolamine, Spantrol and Appedrine (which also contain caffeine), manufacturers say that it depresses the brain's "appetite center" in the hypothalamus.

But do the drugs really work? Yes, say the pharmaceutical houses, which got strong support earlier this year from a special advisory panel to the Food and Drug Administration. After reviewing drug company data, the study group found that benzocaine and PPA apparently were "safe and effective." It was a tentative finding, to be sure, and must still be accepted by the FDA, but manufacturers pressed ahead with intensified ad campaigns.

Yet many doctors are unconvinced by the blitz. The Medical Letter, a highly regarded bulletin for physicians, notes that in one published study of 66 obese patients, the greatest weight loss was achieved not by anyone on PPA but by someone who had been given a placebo. Says Letter Consulting Editor Dr. Martin Rizack: "If somebody really wants to lose weight, you can give them almost anything and probably get an effect."

Doctors are especially concerned because people can obtain PPA without prescriptions. The drug companies themselves acknowledge that it should not be taken by anyone with heart disease, hypertension, diabetes or thyroid disease. These conditions often afflict the overweight, in many instances without their knowledge. PPA, alone or together with other drugs, such as monoamine oxidase inhibitors (antidepressants) or indomethacin (an antiarthritic), can induce severe episodes of hypertension. There has also been a case of kidney failure in a woman who had been taking a PPA preparation for a few weeks along with a few tablets of aspirin and acetaminophen.

Most specialists still feel that the real answer to shedding pounds is changing lifestyles. Says Dr. Victor Vertes, director of the weight loss clinic at Cleveland's Mt. Sinai Hospital: "These drugs are not going to burn calories. You've got to curb your caloric intake. And for long-term weight control, they're completely useless. You can't take them for the rest of your life."

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