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Saturday, April 12, 2008

A young woman, I'd say she was around 23 years old, recently filled a prescription for Adipex, an amphetamine derived appetite suppressor. Adipex--or rather phentermine, the generic, as nobody gets the brand anymore--is a fairly powerful suppressant of the appetite, and isn't bad for starting a diet. [An aside: phentermine was FDA approved in 1959...my birthday!!] The problem is that after several months of use it doesn't do much; there isn't any study that I know of that shows successful weight loss with the drug for longer periods of time. It used to be hugely popular in the early nineties, as part of the Fenfluramine-Phentermine combo (Phen-Fen), taken off the market because of valvular heart ailments. Even with the combination, long term weight loss was iffy. Phentermine is now somtimes used off-label with Prozac (or one of the many "me-too" Prozacs like Celexa, Effexor, Zoloft, Lexapro).

Anyway, there seems to be a resurgence in Phentermine use, as our script count for the drug is rising, at least in southwestern Vermont. Why? Well, why would it become more popular? Either it really works--which no one can prove, as the studies show--or it benefits the prescriber. One of the two has to be true, does it not? Either the one receiving the prescription benefits, the practitioner benefits, or no one does, which we can eliminate, since at the very least the prescriber gets paid.

So...since the patient doesn't benefit--studies prove that--then how does the prescriber benefit? I'd say in the following ways:
  • returning patient office visits
  • perceived caring on the part of the prescriber (if the patient doesn't get a piece of paper after a half hour office visit for which she pays dearly for...unhappy patient)
  • sometimes it is just easier to hand a prescription for a stimulant anorexiant than to counsel weight loss in a responsible manner: faster patient visits mean more $$'s for practitioner.
Now, am I being too cynical? The young woman I just gave that phentermine to, do you know what she looked like? A model. Beautiful woman, wonderful figure.

And it wasn't because of the phentermine she was taking. She just wanted a drug to assure herself that she wouldn't look fat in front of her boyfriend/husband. She didn't need any drug--heck, she didn't need to be on a diet. Period. But this doctor felt it was necessary to give her this stimulant, take her money, and book someone else for the same half hour fee. Nice.

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