March 24

Fen-phen revenge

5  comments

Today’s New York Times carries a really heartwarming article about a bunch of people all getting what they deserve.
Apparently a large number of people who were expecting to get large settlements for damage they had sustained as a consequence of taking the fen-phen weight-loss drug regimen were fleeced by a group of less-than-savory lawyers who were in cahoots with a crooked judge. In my view the story is on its way to a happy ending because all the people involved got or are getting shafted.
All the people who thought they were going to get something for nothing got something, but a lot less something than they anticipated because their lawyers shafted them. The lawyers who shafted them are now embroiled in multiple lawsuits that will more then likely eat up all their ill-gotten gains, and they face the possibly criminal proceedings. The judge that helped the sleazy lawyers get their rapacious fees, robbing the folks who expected something for nothing, got hammered by the Judicial Conduct Commission. He was formally reprimanded by the commissioners who said his actions were

disturbing, inexcusable, and shocking to the conscience.

Heh, heh, heh.
For those of you who don’t know what this is all about, here is a summary. Years ago doctors everywhere were prescribing fen-phen for weight-loss to zillions of patients. As with any drug, there were side effects. A small number of people taking phen-fen suffered heart valve disease, sometimes to a degree requiring valve replacement. As reported on the FDA website:

On July 8, 1997, the Mayo Clinic reported 24 patients developed heart valve disease after taking fen-phen. In five patients who underwent valve replacement surgery, the diseased valves were found to have distinctive features similar to those seen in carcinoid syndrome. The cluster of unusual cases of valve disease in fen-phen users suggested that there might be an association between fen-phen use and valve disease.
On July 8, FDA issued a Public Health Advisory that described the Mayo findings. The Mayo findings were reported in the August 28 issue of the New England Journal of Medicine, along with an FDA letter to the editor describing additional cases. FDA has received over 100 reports (including the original 24 Mayo cases) of heart valve disease associated mainly with fen-phen.

When you think about the enormous numbers of people who took fen-phen, these valvular problems, though serious in some cases, represented a tiny, tiny fraction of people who took the drug. Had it stopped at that, there probably wouldn’t have been a big problem. But, it didn’t. What really caused the situation to snowball was the echocardiograph findings of several physicians. From the FDA:

Recently, FDA has received reports from five physicians who had performed heart studies (echocardiograms) on patients who had received fen-phen or dexfen-phen and did not have symptoms of heart disease. Of 291 asymptomatic patients screened, about 30 percent had abnormal valve findings, primarily aortic regurgitation.

What this means is that none of these 291 patients had symptoms of any kind of heart disease, yet 30 percent of them had evidence of abnormal heart valve function. Since these people had no symptoms of heart disease, it’s unlikely that they had ever had a previous echocardiogram. Since there was no previous study done, how did these doctors know that the 30 percent who demonstrated signs of valvular dysfunction didn’t have it all along? All kinds of people have heart murmurs, which are evidence of valvular dysfunction, yet they are entirely without symptoms. In this case, however, since the patients had taken fen-phen, the assumption was made that fen-phen was the cause.
Then the lawyers got involved. They began putting out the call to anyone and everyone who had ever taken fen-phen to come see them. They sent these folks to doctors to get echocardiograms, and it they were found to have any evidence of their valves not working–whether they had symptoms or not–they were taken on as clients. As the group of clients mounted, the legal machine began to move.
MD and I were impacted by all this in an extremely limited way. When all the positive press was going on about fen-phen and doctors everywhere were giving it out like candy, we decided not to join in. We felt that our patients should learn to eat correctly, not just rely on an appetite suppressant to help them lose weight. We lost some patients over our refusal to write prescriptions for the regimen, but most understood and agreed with us. In the time that fen-phen was flying high, we may have written between us a dozen or so prescriptions, but that’s about it. We wrote a few prescriptions for phentermine, a part of the fen-phen regimen, but again, not many. We wrote these on an individual basis for the very few patients we felt had particular situations requiring a little more than simply a change in diet. Even these patients we never let stay on the medication for very long.
When the word got out that there was going to be a settlement, we got a four or five requests for medical records from the maybe 30 or 40 people that we had put on fen-phen or phentermine. Plus, we got letters from people asking if they had been on fen-phen when they were at our clinic; they didn’t know if they had taken the drugs or not, but if they had, they wanted to get part of the payout. I can’t imagine what a nightmare it was for the physicians who had been prescription mills, writing hundreds of fen-phen prescriptions every week. They must have had to send out thousands and thousands of copies of medical records.
All the people having these medical records sent to their lawyers then got their echocardiograms, and if there were any abnormalities in valvular function found, they had hit the jackpot. They were going to get paid. We had one patient who had gotten her echocardiogram before she contacted us to send her medical records. At the time, we were one place and our medical records were somewhere else, so we were unable to send them off the day we got her request. She waited a bit, then wrote us again, telling us that she was in line for hundreds of thousands of dollars and the only thing standing in her way was our delay in sending her medical records. We dug out her records and sent them as soon as we could, but I fear she lost out, because when we reviewed them, she had been on only one part of the fen-phen, and that for only a short period of time. (I’m not familiar with the terms of the settlement, but I think in order to qualify, you have to have been on the drug for a certain length of time.) Since she was on it for just a couple of weeks, I’m fairly certain that whatever valvular dysfunction she had probably wasn’t caused by the phentermine. (She was lucky we even had her records. By the time some of these requests came in we had already shredded our records since they were beyond the age we were required to keep them.)
As you can probably tell, I think that most of the ‘problems’ caused by fen-phen are hogwash. There are no doubt some serious problems, but nothing of a magnitude anywhere near the number of people making claims. It’s been over ten years since fen-phen was prescribed in any large amounts, and if there were truly problems as a consequence, we would be hearing about them. But we aren’t.
Don’t get me wrong. If I think that a patient is harmed by a drug or a procedure I’ll bend over backwards to help out. In fact, I’m loving it that the makers of several NSAIDS are getting pounded because they didn’t disclose the problems they were fully aware of caused by the drugs they so heavily promoted. I would be the first to testify against any of the makers of statins. But in this case, I was in the middle of the whole fen-phen shebang and I know what went on. It wasn’t really the drug company’s fault, and there weren’t all that many people harmed. And most of those harmed were probably warned that there could be side effects, but insisted that they wanted the prescriptions anyway.
The company that made the fen-phen regimen, American Home Products (now Wyeth), crumbled under the onslaught of so many lawsuits and negotiated a multi billion dollar settlement with all the lawyers suing them. The money was paid out on a pro rata basis, and here’s where our story from the New York Times starts.
It is typical when lawyers represent clients on a contingency basis for the lawyers to withhold their percentage from any settlement and send the rest on to their clients. The usual contingency fee is about a third of whatever is collected.
The lawyers in this case received about $200 million for their 440 clients. Had the lawyers taken their third, the clients would be left with about $135 million.

But the clients received only $74 million. An additional $20 million went to a questionable “charitable fund.” The rest — $106 million — went to lawyers. Though amounts of the individual settlements remain sealed, court papers suggest they were from $100,000 to $5 million. On average, plaintiffs received less than 40 percent of what the settlement agreement specified, instead of the roughly 70 percent to which they were entitled.

How come the lawyers got so much? They applied to the court to give them a larger percentage of the fees since they had spent so much time and effort on the case, which the court did. The judge in this court was one Joseph Bamberger, who then left the bench and took a job for $5000 per month administering a $20 million ‘charitable trust’ set up with a portion of the extra money he, as the judge, awarded these lawyers. Very nice.
The 440 clients who were in store to get anywhere from $100,000 to $5 million, ended up getting less. When they tried to find out why they weren’t getting all the money they ‘deserved,’ they were threatened by the lawyers.
I would suspect that based on the statistics involved the vast majority of these people didn’t deserve a dime, yet they perceive themselves as horrendously wronged. Nowhere in this Times article does it mention any sort of disability or medical problems any of these people have–only their anger at not getting the money they ‘deserved.’ Their anguish isn’t over not being able to pay for their huge medical expenses incurred because they took fen-phen, but over not getting the money for other things.
Says one:

I was hoping to get enough money to pay the farm off, a farm that’s been in the family since 1857. I’ve asked the Lord to help me see and try to understand why they [the lawyers] did it. The greed got the best of them. They thought they needed it more than I did. [My bold]

So, we’ve got a situation where several things happened:
Greedy people got screwed. Not totally, but to a limited extent.
The lawyers doing the screwing got screwed themselves.
And the judge who facilitated the lawyers screwing the greedy people got screwed.
As I say, it was a heartwarming story.


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  1. Sir thanks.
    I looked online, at shops(x3), emailed P et G and of course could only come to the prev mentioned 10 gms simply as its the replacement for the 10 gram of non-shite-inducing fat ordinaire.
    Rightly or wrongly i’ll yr concs as corroboration
    Thanks much yr sleuthing.
    Hi Simon–
    …”non-shite-inducing fat ordinaire.”  Sounds so much better than saturated fat.  May I use it in the next book?
    Cheers–
    MRE 

  2. Certainly so long as its not the title and i’ll be wanting the obligatory few free copies if please and actually come to think of it a BMW 1200 Adventure would be a nice little thankyou too.
    Pray how did you manage to find out how much Olestra is in the stuff ?
    We wait with bated breath
    Hi Simon–
    I found the most recent paper on olestra I could find and started tracking back through the references listed, pulling those papers, checking those citations on back until I finally found a 1998 JAMA paper with the information I wanted. Here is the relevant excerpt:

    Overall preference for olestra potato chips was slightly lower, and this is probably reflected in the 22% lower chip consumption in the olestra group. Despite lower consumption, the olestra group reported being no less satiated than the TG chip group. This suggests a previously reported7 possibility that olestra use will reduce energy and fat intake, aiding weight control in those who consume potato chips. While the median consumption of olestra chips was less than TG chips, it was more than 57 g (2 oz), which is more than a typical single-serving snack-sized bag of chips, and there were 155 subjects who consumed more than 113 g (4 oz) of olestra chips (>33 g of olestra). Thus, the consumption levels were adequate to ensure that enough olestra was consumed to evaluate potential GI effects. However, even in the participants consuming more than 113 g (4 oz), there were no differences observed in the frequency or severity of reported GI symptoms between groups, nor was there any indication of a dose-response relationship of increasing symptoms with higher consumption levels in either test group. The 2 statistically significant findings (increased upset stomach in the 0- to 57-g [0- to 2-oz] olestra group and increased incidence of any symptom in the 57- to 113-g [2- to 4-oz] TG group) appear likely to be due to random variation.
    The information label on olestra products states that “olestra may cause loose stools and abdominal cramping.” The current study findings do not support this statement. The label primarily reflects the results from 2 clinical studies in which subjects were required to consume olestra at every meal for 56 consecutive days. In those studies there were statistically significant increases (19%-42%) in mild to moderate GI symptoms in persons eating 20 or 32 g of olestra per day in foods (equivalent to 68-111 g [2.4-3.9 oz] of chips relative to the current study) compared with placebo subjects. [My italics]

    Based on these figures, it calculates out that there is about 8.3 grams of olestra in an ounce of chips.
    Cheers–
    MRE

  3. The Bamberger name is taking a hit these days. I wonder if this guy is related to one Michael Bamberger, the (talented) writer who agonized long enough about Michelle Wie’s rule infraction in her first tournament playing as a professional to get her disqualified. (Had he acted in a reasonable amount of time she would have only suffered the two-stroke penalty that she deserved.) Like your chuckling about Joesph Bamberger, I’m getting a laugh about Michael Bamberger’s name finding it’s way into golf jargon. Just as hitting a weak, effeminate shot is now known as a “Brokeback”, taking a questionable drop (usually due to ignorance rather than dishonesty) and then having someone disqualify you for it well after the fact is now called a “Bamberger”. I love that one — goof up a penalty drop and risk getting “Bambergered” while sipping on a cold one in the clubhouse after the round.
    Thank God none of those in the group I play with would do such a thing.  Our only inviolable rule is ABSOLUTE silence when someone is getting ready to putt.  Break that rule and…
    Cheers–
    MRE 

  4. Ah, touche. But yes, that rule is inviolable. I guess my name is up there with the Brokebacks and the Bambergers but hopefully the easily distracted among us will someday honor me with a bronze monument beside the number 8 green at Rancho.
    I was at Rancho a couple of weeks ago, and the monument is already there.
    Cheers–

  5. Michael,
    did you see this? My goodness! Have they no souls?!
    “Heart Association Backs Statin Use for At-Risk Kids ”
    AHA Scientific Statement: Drug Therapy of High-Risk Lipid Abnormalities and Adolescents A Scientific Statement From the American Heart
    Atherosclerosis, Hypertension, and Obesity in Youth
    of Cardiovascular Disease in the Young, With
    Cardiovascular Nursing
    Circulation. 2007;115:000-000.)
    Hi Robert–
    Yeah, I saw it and read about it.  Disgusting.  As soon as I get the chance, I’m going to put them up for the Reckless Award.
    Cheers
    MRE 

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