Nearly three years after federal regulators sounded an alarm
about
dangerous diet pills imported from Brazil, doctors in Massachusetts
continue to treat patients stricken with heart problems, headaches,
and
insomnia linked to the powerful drugs.
Just Monday, a Cambridge Health Alliance internist saw two
patients who
told him they're taking the medications, typically a brew of speed,
tranquilizers, and other chemicals mixed into a capsule.
One of the patients, who gets the pills from a doctor in Brazil,
has
heart
palpitations and high blood pressure, well-recognized side effects
of the
weight-loss regimen. Another, hooked on the pills for four years,
plunges
into bouts of depression when she tries to stop using them, said
Dr.
Pieter
Cohen.
And a police bust in May suggests there remains a robust market
for the
drugs: Detectives in Marlborough confiscated nearly 46,000 illegal
diet
pills, which, they said, were peddled in plastic bags from a
convenience
store catering to Brazilian emigres in neighboring Hudson.
The term "Brazilian diet pill" refers to multiple formulations
that
cannot be sold in the United States but are legal in Brazil, where
they
are
touted as an all-natural method for shedding unwanted pounds
rapidly.
Because the pills exist in a black market, it is impossible to
know
precisely how many people in the state's burgeoning Brazilian
community -
and outside of it - use them.
But a survey of more than 300 immigrants published last year
found that
nearly 1 in 5 Brazilian women interviewed at a Somerville clinic
acknowledged taking the pills since arriving in the United States.
And 1 in 10 women questioned at churches in Massachusetts with
Brazilian
congregations reported they had tried the medications.
"When people were originally bringing me these prescriptions, I
was just
staring at them - I was just shocked that these would be provided
to
people
for their benefit," Cohen said.
The temptation to use the pills, which usually cost $100 to $200
a month,
proves irresistible for some Brazilians who find themselves in a
land
where
they toil hours on end, consume calorie-laden fast food, and don't
find
opportunities to exercise similar to those in their homeland, said
Elisa
Garibaldi, who was a surgeon in Brazil before emigrating.
They are also lured by the weight-loss success stories of
friends: Some
people say they lost up to 30 pounds in a month.
"They want to have the same body they used to have in Brazil,"
said
Garibaldi, a board member of the Brazilian Immigrant Center, an
advocacy
and education coalition in Boston. "But it's hard. The reality
here is
different."
The desire for a slim figure can lead to tragedy. In 2006, a
woman died
from a botched liposuction procedure performed by a Brazilian
emigre who
portrayed himself as a skilled surgeon, exposing a culture of
underground
operations.
"So, the pills seem innocent enough," said Dr. Helena
Santos-Martins,
medical director of the East Cambridge Health Center. "Patients
think,
'Nobody's cutting me. I'm not under anesthesia. It gets me results
immediately.'
"We have to get rid of that myth that these pills are safe."
In January 2006, the US Food and Drug Administration warned
consumers
about
the pills, cautioning that they contain key ingredients from Prozac
and
antianxiety medications as well as Fenproporex, a stimulant not
approved
for sale in the United States.
Michael Levy, director of the FDA's Division of New Drugs and
Labeling
Compliance, said in an interview Monday that his agency, in tandem
with
customs inspectors, watches for commercial shipments of the pills
and has
stopped at least one such shipment in the past five years.
"However, a lot of these products are likely purchased over the
Internet
by individual consumers," Levy said. "When that occurs, we are
far less
likely to actually capture the imported product."
Cohen details the dangers of the pills in Tuesday's Journal of
General
Internal Medicine, and reports that the medication threatens not
only
patients' health - it can also endanger their livelihood.
That's what happened to a Brazilian woman living in
Massachusetts.
She packed on unwanted pounds while working and attending school
to
become
a licensed practical nurse. On a trip back home to Brazil last
year, a
doctor prescribed pills that, he assured her, were safe, containing
natural
Brazilian herbs.
The woman experienced heart palpitations and dehydration on the
pills,
and
when she took a urine test for a new job, she flunked, unaware that
the
pills contained a chemical cousin of amphetamine.
Ultimately, with a note from Cohen as well as the prescription
from the
doctor in Brazil, she was allowed to practice as a nurse.
The woman, whose account was verified by Cohen, requested
anonymity,
fearing recrimination if colleagues learned she had taken the
pills.
Other women should not take the medication, the 32-year-old
said, "all
in
the name of beauty. It is really not worth it. Besides, you don't
lose
weight in a healthy way."
Stephen Smith can be reached at stsmith@globe.com.
c.2008 The Boston Globe