Talk:Fenfluramine/phentermine

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Alternative diet drug[edit]

I will not do it myself, but I propose that the "Alternative Diet Drug" link be taken down. There are many alternatives to Fen-Phen out there and listning this link is misleading.

Cleaned up; I personally thought that only the second link counted as spam. IolakanaT 11:52, 3 September 2006 (UTC)

Disease?[edit]

Why would fen-phen produce valvular heart disease? Does it do something to the immune system that allows bacteria to multiply on the valves? The article needs some clarification about this. -Rolypolyman (talk) 16:57, 26 May 2008 (UTC)

I believe that Rothman of the NIH concluded that FEN excessively promotes the activity of 5-HT(2B) receptors in the cardiac valvulopathy associated with fenfluramine and other serotonergic medications PMID 11104741.
FEN/PHEN also remits craving for alcohol and stimulant drugs. The preliminary data has been published in peer review journals.
I am close to illiterate in Wiki editing. If I do figure out a beginner skill, I will be come back. If anybody more versed wants to help me out, be in touch at phitz96 at gmail.

PietrH (talk) 22:48, 28 June 2011 (UTC)

A disease is basically anything that goes wrong in the body. Diseases are defined more by their symptoms than their causes. I suspect you're confusing "disease" with infection. —DragonHawk (talk|hist) 22:04, 27 May 2008 (UTC)

Fen-phen settlements are now being paid for those that have mitral valve repair or replacement. Easy to find on an internet search or email me: Removed email address as per WP:PROMO - CompliantDrone (talk) 16:45, 22 October 2011 (UTC) —Preceding unsigned comment added by 66.91.195.107 (talk) 02:14, 10 December 2009 (UTC)

A recently published review at PMID 21440001 helps to explain the role of seritonergic receptors, particularly agonism of 5-HT2B receptors, in the cardiac pathologies associated with Fen-phen. The Rothman et al. publication mentioned above can be found at PMID 11104741. I agree that the pathology is inadequately explained in this article. — Scientizzle 13:32, 29 June 2011 (UTC)

Tort Fraud[edit]

Maybe somebody would like to add to this article talking of the fraud over the tort settlements in Kentucky. A few attorneys defrauded clients out of 42 million dollars. I don't know if this is relevant but I am watching a TV show on this right now and it seems kind of relevant for at least a link.

Thehotshotpilot (talk) 02:51, 7 August 2010 (UTC)

Tags[edit]

The article mischaracterizes the American Lawyer article, and understates Wyeth's payout. In addition, there is no mention of the substantial multi-billion dollar fraud committed by plaintiffs' attorneys in "mass screenings" of claims. See, e.g., http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1217620&partid=472662&did=31848&eid=44273317. Finally, the Kentucky fen-phen fraud needs to be updated. THF (talk) 02:40, 28 February 2009 (UTC)


Correction of Connolly NEJM quotation[edit]

I have edited the information re the association with heart disease. The article cited did not discuss pulmonary hypertension, was not case-controlled, did not demonstrate a 24-fold increase. It was actually 24 case reports referred to the Mayo Clinic, a center drawing widely across the midwest. The authors concluded that they meant to raise a concern. Subsequently, further data suggests that their conclusion was correct. Unfortunately, the article did not suggest that excessive doses of fenfluramiine and other serotonin agonists may have aggravated the condition.

I have also removed a redundant citation of the same articl

PietrH (talk) 20:04, 29 June 2011 (UTC)

Inadequate citations[edit]

This page cites one book not available on internet for 7 or 8 citations. I do not feel that is adequate for a controversial subject. Some of the most contentious has out of date or no citations at all. — Preceding unsigned comment added by PietrH (talkcontribs) 21:09, 29 June 2011 (UTC)

Conflict of Interest Statement[edit]

I am a retired physician who coined the term fen-phen two decades ago. I was the first to report that this combination could remit alcohol and certain drug cravings. I have made some edits on the above page fully understanding the need to present a neutral position. Any statements I make there will be fully referenced. I would appreciate it if anybody thinks that what I write is biased. I admit to having a strong personal opinion that I will try to avoid expressing here. PietrH (talk) 22:57, 29 June 2011 (UTC)

Major revision[edit]

I have now created new sections levels, revised extensively and hope that I have not offended anybody. Since I am new at this, I hope you can show how to improve my revisions. More to come if I am not stomped on. PietrH (talk) 17:46, 30 June 2011 (UTC)

Rating[edit]

I am rating this article per request from User:PietrH. I'll leave it at Start for the moment. Here are some comments:

  • I have moved the page to the scientific names (INN) per WP:MOSMED and done some minor copyediting. This includes removing the word "unfortunately" referring to the study that was not performed. While I agree this is unfortunate, we are an encyclopaedia and do not judge, only report.
  • Also, we do not usually mention journals, hospitals and people in the article text unless it is necessary for a specific reason. I suggest removing these – eg. "In 1984, a double-blind, controlled clinical trial... was performed..." instead of "In 1984, Michael Weintraub, MD, and collaborators at the University of Rochester Medical Center reported that...". I won't do it myself because I don't want to sound rude by removing your name, PietrH, from the article.
  • Your citation looks perfectly fine to me.
  • "As of 2011, Fen-phen is no longer widely available" seems to contradict the lead which says it has been withdrawn. Which is correct?
  • I cannot judge whether the "outdated" banner is still appropriate; please remove it if you think it isn't needed any more.

Thank you for all the work you put into this article! Feel free to contact me if you need more information or help. Cheers, ἀνυπόδητος (talk) 14:40, 1 July 2011 (UTC)

minor edit and additional material[edit]

I made some minor changes, improved, IMHO, the content levels and added reference re pulmonary hypertension. I used the citation bot but it didn't work. Help! PietrH (talk) 16:00, 2 July 2011 (UTC)

Hm. It worked for me. Did you save Fenfluramine/phentermine before starting the citation bot (ie. the saved page was displayed in your browser alright)? Did you type "Fenfluramine/phentermine" in the top box of the bot (no typos)? If yes, what did the bot tell you?
Regarding the rating: here is a typical C class article. I think it is considerably more developed than Fenfluramine/phentermine, but I'm still not sure what makes a combination drug article class C. If you are keen on a better rating, I'd really suggest asking at WT:PHARM; there are bound to be some people with more rating experience at that place. --ἀνυπόδητος (talk) 16:42, 2 July 2011 (UTC)

Reverting back to June 2011 version[edit]

This article was significantly transformed by Pietr (talk · contribs) (see above Talk:Fenfluramine/phentermine#Conflict_of_Interest_Statement). It was changed from an article which focused precisely on what made fen-phen famous and told the story which the vast majority of users will come to this article to understand into a very short and highly misleading scientific monograph which suggests that the treatment combination is still in use (despite no evidence presented to this effect). In support of Pietr's niche 1994 addiction finding, he has even gone so far as to reference his own Google Sites link (https://sites.google.com/site/pietrhitzig/Home/reference-manager/reference-manager/NIDA_DIR_266.pdf?attredirects=0) in the article even though the link is already dead. While is an interesting finding, there's clearly no attention paid to it, and given that there's already naltrexone, I doubt anyone's going to be using it even with fenfluramine removed.

The article also suggests that fen-phen is effective "in maintaining a significant weight loss" (quote from Pietr's version of the article). While I don't have access to the source, this statement is actually debatable - the article used to note, with a reference, that the patients, on average, lost 5 pounds. The weight loss is certainly statistically significant (assuming a large enough sample - of course, any amount becomes statistically significant with a large enough sample) but that doesn't mean contemporary scientists believe it a "significant amount". Modern medicine has become more attuned to the difference between clinical significance and statistical significance. Witness the rise of attention to effect size and the recent scrutiny the FDA has placed on the spate of recently proposed diet drugs. I request a direct quote from the article, PMID 1587079, supporting the statement that fen-phen causes significant weight loss.

Now, this is not to say that we can't talk about contemporary research about fen-phen. The addiction finding is unlikely to deserve a header, but certainly a sentence or two. Further information can go into the phentermine article if it ever gets used, because the most recent study doesn't even use fenfluramine.II | (t - c) 21:42, 31 December 2011 (UTC)

I should add that if we're going to have discussions on the science behind fen-phen, these should be relatively recent references and review articles if at all possible. In the early years after the issues with fen-phen became clear, there was some debates in the literature, particularly from consulting doctors hired by the defendant - but my quick review of the literature tells me fen-phen's effect on the heart is not seriously debated today (see e.g. Hopkins & Polukoff 2003). Also, a Google search reveals that Wilsker 1997's article says that fen-phen did not cause significant weight loss. In any case, again, this article lies as much in the spheres of government, public policy, and law as it does in medicine. If I recall correctly, fen-phen when adjusted for inflation is the most expensive product liability case in U.S. history. II | (t - c) 21:57, 31 December 2011 (UTC)

While I agree that the parts of the history that are probably most interesting to our readers are missing in Pietr's version, it was actually longer than the present one. Also, it did not suggest that fen-phen is still in use (quote from the lead: "Fenfluramine, its S-enantiomer dexfenfluramine, and a few other serotonin agonists were shown to cause potentially fatal pulmonary hypertension and heart valve problems, which eventually led to their withdrawal and expensive legal settlements.")
The link from Pietr's Google site works perfectly well for me; the question is whether it's a reliable source, ie. published in a reputable journal, which it probably isn't.
The "significant weight loss" problem could be amended by changing it to something like "statistically significant, but only slight effect", but that would depend on what the article says. I don't have access to it either.
Your request for recent literature is fair enough; thanks for your sources. Hopkins & Polukoff basically says that fen-phen does pose a risk for developing aortic and mitral valvular heart disease – the article does and did not say anything else, but the newer source should be included in my opinion. I don't have access to Wilsker so I can't say what they mean by "significant weight loss" (statistically, or clinically relevant?). Anyway, this is probably not a good source for a medical article, seeing that it was written by a Law School B.A. and published in a non-medical journal (Journal of Law and Policy).
Overall, I'd like to see the History and Aftermath sections as they currently are, along with those parts of Pietr's additions that can be adequately sourced. Being the more technical part, the latter should go after the history sections in my opinion. --ἀνυπόδητος (talk) 10:11, 18 February 2012 (UTC)
I appreciate you reading my comments carefully and I agree that there is salvageable information from Pietr's version. There are some people who are real sticklers about WP:MEDRS but I guess I'd be willing to leave the primary sources cited by Pietr in. The original source for my comment that fen-phen did not cause significant weight loss was Avorn's book Powerful Medicines, who is/was a professor at Harvard Med School and Chief of Brigham and Women's_Hospital. On page 78, Avorn says "on the front lines, clinical experience was making it clear that the weight loss these drugs produced was small and transient". I'm not necessarily opposed to some of Pietr's other information such as the the original addiction research, the statement that he coined the term "fen-phen", and perhaps the evolution into a phentermine/5-HTP combination. I don't have access to the article and the statement that Pietr coined fen-phen is not the type of thing I would expect to see in the sources cited (Pietr Hitzig 1994 and Rothman et al 1994). II | (t - c) 19:36, 18 February 2012 (UTC)
I have to thank you for your constructive comments. I've asked PietrH to address your concerns. The originator of the term fen-phen is probably unsourceable. What third-party source would publish such a fact? --ἀνυπόδητος (talk) 20:27, 18 February 2012 (UTC)
I replaced/supported vague terms ("significant, only a few pounds, small and transient") with the actual data from the 1984 study. The fact that weight loss was transient (as with all weight-loss drugs I'm aware of) should probably be mentioned, but I'm a bit worried about adding another reference to Avorn, which isn't a reliable source.
I still need to do some reading before I re-add (or don't re-add) any information on addiction and anxiety/depression. Please feel free to edit after me, or raise any concerns with my additions here. --ἀνυπόδητος (talk) 20:12, 21 February 2012 (UTC)
Nice work!! By the way, phentermine is back in the news today [1] with Qnexa, a combination of phentermine and topirimate. II | (t - c) 03:31, 22 February 2012 (UTC)

(outdent) Thanks, I'd just put the Qnexa page on my watchlist two days ago :-)

I have added the addiction section despite your original post. The most recent study, which doesn't refer to fen-phen, is only mentioned in a single sentence, and it adds some context in my opinion. However, I'll have to do some reading before I re-add the depression finding. --ἀνυπόδητος (talk) 18:37, 23 February 2012 (UTC)