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What's up, Doc?

National | Physicians soft-pedal bad news; a jury sends the father of fen-phen to prison; and studies clash over the benefits of fruits and vegetables

Issue: "Schundler's bliss," July 7, 2001

Doctor, Doctor, give me the news
All man's days are numbered and known only to God, but physicians in some cases know a lot more than they let on. A dying patient's question, "How long do I have?" usually prompts an overly optimistic answer or none at all, according to a new study. Telephone interviews with 258 Chicago-area doctors found that 37 percent said they would give their best guess to a patient. The rest said they would give either no estimate or something different from their own estimation, says the study published in the Annals of Internal Medicine. "The physician's primary obligation to their patients is to do no harm, but the very well-intentioned protection of patients can be damaging when a patient wants information, and not giving a frank disclosure can hinder that," said Dr. Elizabeth B. Lamont, who led the study. The researchers did not ask why the doctors answered as they did. They guess that the doctors were trying to spare patients some grief or keep the bad news from making them sicker. Each of the doctors in the survey had referred cancer patients to hospice care. But sometimes patients can pressure physicians into giving estimates when prognoses are unknown. When doctors avoid a specific time frame, they may be trying to avoid engaging in hypotheticals rather than simply withholding information. Fen-phen finís
Pietr Hitzig calls himself the father of fen-phen, the diet drug that was a 1990s fad before it was pulled from the market. Now he faces up to 104 years in prison after a jury convicted him of illegally prescribing the drug over the Internet to patients he never saw. Prosecutors accused him of treating his patients like "human guinea pigs," prescribing fen-phen "for every illness known to mankind"-including Gulf War syndrome, chronic fatigue, drug addiction, AIDS, and cancer. They said hundreds of patients around the world obtained medication from Dr. Hitzig after visiting his website. The Maryland doctor started promoting fen-phen as early as 1993 as an addiction controller. The first part of the combination of fenfluramine and phentermin was yanked in 1997 amid concerns that it scarred heart valves irreversibly and sometimes caused death. Two years later, Dr. Hitzig turned in his medical license after admitting he had sex with some of his patients. Yet he still defended his medical concoction. "It's built into our genetic code to resist new ideas," he claimed in 1999. U.S. Attorney Christine Manuelian told jurors that Dr. Hitzig cared more about his own fame than his patients' safety. She said some patients became addicted, suffered psychotic episodes, or became openly hostile toward family members and bosses. One patient died under Dr. Hitzig's care from "drug intoxication" and another, who was being treated for cocaine addiction, committed suicide, according to a report by the Maryland Board of Physician Quality Assurance, which called his case one of the worst ever in the state. Meanwhile, fenfluramine manufacturer American Home Products is still buried under 9,000 lawsuits related to the drug. Last year executives agreed the company would pay up to $3.75 billion in a proposed settlement that could cover all 6 million users. Fruit and veggie tale
Eat your fruits and vegetables. A major European study has revived the theory that fiber helps fight colon cancer, concluding that high-fiber diets reduce risk by as much as 40 percent. The massive research project involved 406,323 people from nine European countries. Scientists separated people into categories defined by how much food they ate. The group that ate the least fiber had 176 colon cancer cases, while the group that ate the most had 124 cases-hence the 40 percent figure. The link between fiber and cancer prevention is under heavy scrutiny in the medical community. Colon cancer is the second most deadly form of cancer worldwide. Last year, two studies found no effect from a diet rich in fruits, vegetables, and grains. If fiber does prevent cancer, how does it work? Researchers theorize that bacteria in the colon ferment fiber into a substance called butyrate that helps kill off bad cells before they become cancerous. Researchers presented the findings at the European Conference on Nutrition and Cancer in Lyon, which also discussed possible links between red meat and cancer. Lab tests have shown that the combination of red meat and colon bacteria produces chemicals called N-Nitroso compounds, some of which are carcinogenic, according to Dr. Sheila Bingham, deputy director of the Human Nutrition Unit at Cambridge University, who led both studies. But experts say the evidence so far is circumstantial and does not prove a connection. Still others say the problem is worse with preserved meat like bacon, cured ham, and salami than with fresh beef. Martin Wiseman, a professor at the Institute of Human Nutrition in Southampton, England, who was not involved with the research, said that more must be known before drawing authoritative conclusions. "What about hamburgers?" he asked. "Are they processed or fresh meat? And meatballs? Where do they fit in? We are just starting to disentangle all this."

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