The Internet Internist

Dr. Pietr Hitzig of Maryland has prescribed a fen-phen panacea for all manner of ailments to thousands of patients he has never met. One of them, Alvin Chernov, killed himself.

"Isn't that what we're supposed to be doing these days," Hitzig asks New Times, "using advanced technology so we can improve our care and availability? I can give better support from 2,500 miles away than the average Arizona psychiatrist can give from five inches."

Arizona, like most states, has no laws against treating patients over the Internet. The public and politicians have yet to grapple with the issue of regulation of medicine in cyberspace.

That gap allowed Hitzig to mass-market his program over the Internet. "We have successfully treated over 8,000 patients," he claims in one of his Web site's blurbs.

Drug Enforcement Administration agents raided Hitzig's home and offices in Maryland on September 30, seizing his computers, files and other documents. The raid came after an agent posing as an out-of-town businessman contacted the doctor over the Internet and quickly got prescriptions for fen-phen and other drugs.

But Hitzig has yet to be charged with any crimes.
"It's an ongoing investigation, so I can't talk about it," says Baltimore-based DEA agent Cathy Gallagher, who was present at the raid. "I will say this case concerns a new area of concern for us--the Internet. It's complex, time-consuming stuff."

The feds have deemed both phentermine and fenfluramine "controlled substances," and doctors must obtain a license from the DEA to legally prescribe them.

A DEA affidavit filed at a federal court in Baltimore said the agency is investigating whether Hitzig prescribed drugs "outside the ordinary course of accepted medical practice," a crime. Courts have interpreted that phrase variously. (See accompanying story.)

But Arizona medical officials say they hold no sway over Pietr Hitzig. "We can only apply our regulations to doctors licensed in this state," says Donna Nemer, BOMEX's acting deputy director. "We can't do anything to this guy if he's not licensed in Arizona. That would be up to Maryland."

BOMEX could have issued a cease-and-desist order to Hitzig through the Arizona Attorney General's Office. It didn't. In fact, Debbie Knight says she agreed not to file a complaint against Hitzig in Maryland after a BOMEX investigator discouraged her by insisting that the doctor's arrest was imminent.

It wasn't.
Hitzig's license to practice medicine remains intact, says Charles Cichon, chief investigator for Maryland's Board of Physician Quality Assurance, that state's equivalent of BOMEX. Cichon says regulations keep him from revealing even if his board is investigating Hitzig.

However, the DEA affidavit says its interest in Hitzig stems from the Maryland board's December 1996 referral, which indicated it had gotten "numerous complaints" against the doctor.

Hitzig calls himself a victim, says the FDA had no basis to remove fen-phen from the market and considers the DEA raid "a totally political hit by a bunch of goons. They came in to destroy me, to kill my business. I'm still surviving, but I've had to downscale. The fake fen-phen scare and the raid has taken a bite out of me. If they--the medical board or the cops--had a good charge against me, don't you think they would have shut me down?"

Hitzig says he was unaware of Alvin Chernov's death until told of it by New Times:

"He died? Oh, my gosh. I knew those doctors in Arizona did some crazy things to his head. What did he do, commit suicide? That doesn't surprise me in the least. It was totally unnecessary. He was a wonderful guy."

In the wake of the FDA recall, most stories about fen-phen concerned the alleged incidence of heart-valve damage. Recent reports in medical journals and other data, however, indicate that far more fen-phen users have complained about profound mood swings and depression than heart problems.

That jibes with a mid-1980s report in which Swedish doctors questioned the safety of fenfluramine after getting numerous complaints from patients about psychiatric problems. But most of those patients had histories of psychoses, and the Swedes couldn't establish an ironclad connection.

Cause-and-effect also is a dilemma in Alvin Chernov's case. Did fen-phen and the other drugs Hitzig prescribed push an already-troubled young man over the edge? Or was his demise inevitable, with or without fen-phen?

It's impossible to say with certainty why someone chooses suicide.
But mental-health experts and others express shock at how readily Pietr Hitzig tweaked the brains of virtual strangers through cyberspace.

"I don't prescribe anything to people who just call up and ask," says Dr. Deborah Brogan, a psychiatrist at ASU's Student Health Center. "After a thorough, in-person evaluation, I'll recommend a medication to start with, if any. I'm not clear why this doctor was prescribing meds at all, and I don't understand this combination to treat depression. I always advise anyone with a mood disorder to avoid fen-phen because it's mood-altering."

Hitzig counters, "Look. If you use my technique, you'll stop all psychoneuroses. So, why should the doctor have to worry what the psychoneurosis is? You just fix the people. You tell them, 'Go down this list. If you got a stuffy nose, you increase your dopamine. If you're feeling anxious or hostile, you increase your seratonin. And you call me anytime you want.' I believe in taking care of people. I believe in medical care."

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