Harvard Study Examines the Import of Illicit Compounded Diet Pills From Brazil

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NEWS FROM CAMBRIDGE HEALTH ALLIANCE

December 11, 2007

Use of Dangerous, FDA-Banned Diet Pills From Brazil Tracked for First Time in U.S.

Approximately 15 percent of women born in Brazil and surveyed in a Massachusetts community have used dangerous diet pills while living in the United States

Two-thirds of the female Brazilian immigrants who used the FDA-banned pills experienced adverse effects including palpitations, anxiety, and vomiting

Cambridge, Chelsea, Everett, Malden, Medford, Revere, Somerville, Winthrop, MA…A new Harvard study is the first to examine the prevalence of illicit compounded diet pills imported from Brazil. Led by Cambridge Health Alliance community-based clinicians who are also Harvard Medical School researchers, the study has just been published by the Journal of Immigrant and Minority Health.

The authors found that two-thirds of the female Brazilian immigrants who used the pills experienced adverse effects including palpitations, anxiety, and vomiting. The study determined that being unmarried, college-educated, and dissatisfied with current weight increased the odds of imported diet pill use. Additionally, women advised by a physician in the United States to lose weight were eight times as likely to have used compounded diet pills prescribed by a Brazilian physician.

Compounded diet pills, in which multiple prescription medications are combined by a pharmacist under a physician’s direction, are commonly prescribed in Brazil. These compounded appetite suppressants contain on average three to six prescription medications and can include amphetamines, benzodiazepines, antidepressants, diuretics, and laxatives. In 2006, the Food and Drug Administration banned their sale in the United States, citing substantial safety concerns. Despite their common use in Brazil, none of the prescription medications included in these compounded diet pills is recommended for the treatment of obesity or overweight according to generally accepted practice guidelines.

Pill use was assessed by an anonymous survey of over three hundred women in Massachusetts, split amongst one clinic and two churches. Eighteen percent of clinic respondents and nine percent of church respondents (15 percent overall) reported using compounded diet pills from Brazil. None of the respondents purchased diet pills via the Internet. In fact, more than half obtained pills in the United States, either from Brazilian acquaintances or at a convenience store, indicating evidence of an underground distribution network. While the majority of pill users reported the pills helped them lose weight, 64 percent admitted having had at least one side effect. The most commonly reported side effects were difficulty sleeping, anxiety, palpitations, fatigue, and nausea/vomiting.

Lead author Pieter A. Cohen, MD, a primary care physician with Cambridge Health Alliance, chose to investigate this trend after seeing an alarming number of his Brazilian immigrant patients employ dangerous weight loss techniques. “We found that women were using the compounded diet pills at particularly high rates, often resulting in visits to ambulatory clinics and emergency rooms for medical treatment that, ultimately, is unnecessary,” said Dr. Cohen. “Some of our patients who were using the pills lost their jobs after testing positive for illicit substances on employment toxicology screenings.”

The study highlights the need to better understand Brazilian immigrants’ use of hazardous dieting techniques. The authors recommend that physicians not only screen for compounded diet pill use when caring for Brazilian immigrants but also be aware of the impact their advice to lose weight has on patients. Physicians, nutritionists, and health counselors should combine recommendations to lose weight with culturally relevant counseling on safe dieting methods.

Pieter A. Cohen, MD, is a physician at Cambridge Health Alliance and an Instructor of Medicine at Harvard Medical School. In addition to serving as an internist caring for a predominantly Brazilian immigrant patient population, Dr. Cohen acts as Associate Program Director for the Cambridge Health Alliance's Internal Medicine Residency Program. Since 2003, he has worked extensively on developing and implementing Harvard Medical School’s Cambridge Integrated Clerkship, for which he currently serves as the Tutorial Course Director. He has served as a Cross-Cultural Care core faculty member at Harvard Medical School since 2005. Dr. Cohen received his medical degree at Yale School of Medicine and completed residency training in internal medicine at Cambridge Health Alliance.

The study, titled “Imported Compounded Diet Pill Use Among Brazilian Women Immigrants in the United States,” was published online by the Journal of Immigrant and Minority Health (http://www.springerlink.com/content/119982) and is scheduled to appear in an upcoming print issue. In addition to Dr. Cohen, authors of the study are Danny McCormick, MD (Cambridge Health Alliance), Carolyn Casey (Harvard Medical School), Glen F. Dawson (Institute for Community Health at Cambridge Health Alliance), and Karen A. Hacker, MD, MPH (Institute for Community Health at Cambridge Health Alliance). Drs. Cohen, McCormick, and Hacker hold faculty appointments at Harvard Medical School.

Cambridge Health Alliance (CHA) is an innovative, award-winning health system that provides high quality care in Cambridge, Somerville, Everett, Malden, Revere, and the surrounding Metro-North communities in Massachusetts. It is a teaching affiliate of Harvard Medical School and includes three hospitals, more than 20 primary care practices, the Cambridge Public Health Department, and the Network Health plan. With this unique model, CHA is able to offer the finest health services, a diverse working environment, and a premier training experience for those interested in community-based medicine. For more information: http://www.challiance.org/