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From:  "John Messmer, M.D." <jjm23@p...>
"John Messmer, M.D." <jjm23@p...>
Date:  Mon Jan 1, 2001  11:58 pm
Subject:  Recalled medication - phenylpropanolamine


This is another case of how government (of the US anyway) is not capable of
managing health care.

Phenylpropanolamine (which I will abbreviate as PPA since it saves time
typing) has been on the market for decades. It has been non-prescription as
long as I have been a doctor (almost 24 yrs). Doctors have known for as
long as that (and longer) that it has the potential to cause cerebral
hemorrhage; it can also provoke heart attacks and rhythm disorders. In the
entire time I have been a physician I have not had one patient, nor have I
been aware of any patients of my colleagues, who have had a hemorrhage or
heart problem from PPA.

OTOH, aspirin which has been freely available since it's invention over 100
years ago is extremely dangerous. I have personally treated about 10 people
who have had gastrointestinal hemorrhages from aspirin and one person who
had a perforation of her intestine from aspirin and almost died. I have had
about 5 patients who have had a GI bleed from ibuprofen.

It's all a matter of relative risk. Driving is dangerous; driving without a
seatbelt is more dangerous; driving drunk without a seatbelt is even more
dangerous; driving drunk without a seatbelt at 100 mph on an icy road at
night with the lights off is even more dangerous. How many of you never
drive because of the danger? How many of you have used aspirin (maybe not a
fair question to a group of singers). The point is PPA is NOT that
dangerous. Yet in the US, since the FDA banned it for EVERYONE, I can not
even prescribe it to a person I judge to be one who could benefit from it
because the risk is so low to that person.

The reason this came out is that many people use it as an appetite
suppressant, particularly young women who are overweight and may have high
blood pressure already. They were able to use it without supervision and
consequently some had hemorrhages. IMO it is too dangerous for weight
control but is useful for nasal decongestion or control of stress
incontinence, if the benefit vs the risk is considered by a physician.

It should be available by prescription. I will predict that the FDA will
reverse its stand next year and allow it to be by prescription.

BTW, MaHuang is similar in its effects but is still readily available to
anyone in health food stores.

John

John J. Messmer, M.D.
Assistant Professor, Family & Community Medicine
Penn State College of Medicine


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