The Internet Internist

Last September 6, a desperate Debbie Knight mailed a letter to medical authorities in Arizona.

"I write this letter to you today because I need your help," the Marysville, California, woman wrote the Arizona Board of Medical Examiners (BOMEX).

"There is a doctor living in Maryland who practices medicine over the Internet and telephone. His name is Pietr Hitzig [and], according to his own information, is the 'father of the fen/phen protocol,' which he believes to be cure for practically every condition known to man . . . I came to know this man as a result of a visit from my brother [Alvin Chernov], who lives in Arizona . . ."

Knight wrote to BOMEX a month after her 25-year-old sibling abruptly ended his troubling visit to her home. She described how he'd rarely slept during his weeklong stay--sitting at a computer into the wee hours. Inexplicably, Chernov had bundled some of her belongings for disposal. He'd pried apart computer disks, rendering them useless. He'd expressed his unrequited love for popular singer Meredith Brooks, and vowed to win her over.

One day, Chernov had surprised Knight and her husband, Kasen, with an expensive new home computer. He assured them his employer--a Scottsdale computer software firm--would reimburse him out of gratitude for his hard work. Knight learned later that her brother had been fired weeks earlier.

Chernov told her in the spring of 1997 that he was taking the diet drug combination widely known as fen-phen. (The "fen" refers to the appetite depressant fenfluramine, the "phen" to phentermine. Both are amphetamines.

Though he was overweight, Chernov wasn't taking fen-phen to lose weight. He told his sister that his doctor had been treating him for stress-related depression.

Knight also saw pill bottles marked Carbidopa and Levodopa among her brother's belongings. Those drugs normally are used to treat Parkinson's disease, not depression. Prescribing drugs "off-label"--for disorders other than those for which the medication was approved--is commonplace. But the Physicians' Desk Reference warns against prescribing Carbidopa and Levodopa to some patients: ". . . All patients should be observed carefully for the development of depression with concomitant suicidal tendencies. Patients with past or current psychoses should be treated with caution."

Alvin Chernov should have worn that warning on a sandwich board. The 1996 Arizona State University graduate had a history of depression, and his behavior at his sister's home was ominous.

Shortly after Chernov returned home to Tempe, Knight's letter continued, she'd phoned Pietr Hitzig in the Baltimore suburb of Timonium: "He told me . . . that Alvin began treatment with him March 19, 1997, for severe depression, self-hatred and fibromyalgia . . . [He] told me, 'Right now, I am everything to him.'"

Knight wrote that she spoke with Hitzig again a week later.
"I asked Hitzig if he had seen Alvin in person. He said no, that he did not need to--he had given Alvin a very thorough psychological test via the mail. . . . I asked him what he thought Alvin's problem was when he stayed for that week [in California]. Dr. Hitzig said he was simply taking too much of the fen-phen, and was becoming manic. Dr. Hitzig then told me I, too, should be on his protocol because I had the sniffles and the meds would clear it right up."

Knight said the doctor directed her to his Internet Web site, then hung up.
On August 15, Tempe police had delivered Chernov to Maricopa Medical Center for a court-ordered psychiatric evaluation. He was released August 26, after promising to undergo outpatient therapy with ComCare, Maricopa County's mental-health agency.

"I am greatly concerned for the future of my brother," Knight's letter to BOMEX concluded. ". . . I implore you to please do whatever is within your power to stop this type of medical practice. Alvin may never be the same again, and only time will tell if he will survive the physical and mental challenges he now must face."

One week later, on the morning of September 13, Chernov drove to his father's Glendale home. Minutes after arriving, he took a handgun owned by his father, Gary, stepped into a bathroom and shot himself in the head. He died at St. Joseph's Hospital the next day.

On September 15, the federal Food and Drug Administration ordered the recall of fenfluramine and dexfenfluramine--most commonly sold as Pondimin and Redux, respectively. It happened after the Mayo Clinic linked the drugs to a noteworthy incidence of heart-valve disorders. The news forced the lucrative diet industry and its millions of patrons to regroup. (Phentermine--the other half of fen-phen--remains on the market.)

That day, Debbie Knight again wrote to BOMEX, this time about her lost battle to save her brother's life.

"In my first letter, I asked for your help in stopping Dr. Pietr Hitzig . . . I know there is nothing anyone can do to help my brother at this point, but for others like him, I ask you: Please do not let this happen again."

Pietr Hitzig's treatment of Alvin Chernov raises many disturbing questions. Among them: When does a doctor's conduct stray beyond the bounds of professional negligence into the realm of criminal behavior?

The Chernov case also sheds light on the dark side of cyberspace, and on a doctor who has dispensed a potent chemical stew to thousands of patients he never met--and insists he's done nothing wrong.