Longform

The Internet Internist

Page 4 of 9

". . . Resolution of depression usually occurs in 60 to 90 minutes. In a study of severely depressed alcoholics, 16 of 19 had normal psychological tests after two weeks of Fen/Phen treatment."

An internist by training, the doctor told the chat room he'd practiced general medicine for 20 years "before devoting himself to the exclusive treatment of patients" by prescribing fen/phen.

He said his regimen was "an exciting new treatment for many illnesses comparable in its potential to heal with the claims of 'snake oil' cures of the past. That idea that one treatment could help everyone has been a part of our society for thousands of years. Fen/Phen is THE medical treatment able to help society, and back its claims with research and testing . . ."

In August 1997--a month before Alvin Chernov died--Hitzig's Web site page said the cost for the first six months of his fen-phen program "is only $1,154," including a $350 down payment.

"Since July of 1996, we have been able to monitor patients by phone," Hitzig noted, "allowing continued treatment of patients outside of the Washington, D.C., area. Although we greatly prefer to see everybody in the office when the program is started, we can make exceptions if there are strong reasons that you can't make it to the office."

Alvin Chernov was one of those "exceptions." From the time he started taking fen-phen treatments in March 1997 until he killed himself six months later, he and Hitzig communicated only by e-mail or phone.

"A doctor makes decisions by listening, looking, by assessing the total picture presented by a patient," says Dr. George Lundberg, editor of the Journal of the American Medical Association. "If you don't even know what the patient looks like, then you don't know if the patient is conjuring, lying, misrepresenting or anything else. The Internet strips away much of that ability to communicate."

One clue to the amount of fen-phen Alvin Chernov ingested comes from receipts his father found after the suicide. Gary Chernov says the receipts for fen-phen and the other drugs totaled more than $3,500--more than three times what Hitzig's Web site says it would cost for six months.

The drugs phentermine and fenfluramine long had been available through prescription: The FDA approved phentermine for short-term use with a low-calorie diet in 1959, and okayed fenfluramine as an appetite depressant in 1972. But neither drug had grabbed a foothold because, individually, they were only mildly effective. Like most drugs, they have side effects--among them, depression with fenfluramine and, in rare cases, psychotic episodes with phentermine.

In 1992, the nation's pharmacists filled only about 60,000 prescriptions for fenfluramine.

Then, in July 1992, a researcher issued findings that caused the popularity of what became known as fen-phen to soar. Dr. Michael Weintraub claimed the drugs, taken in tandem, melted away pounds while negating each other's side effects.

Weight-loss clinics based almost solely on fen-phen--including at least five in the Valley--popped up after Weintraub's findings were publicized. In 1996, druggists filled more than six million prescriptions for fen-phen.

Pietr Hitzig was one of the first to jump on the bandwagon. In late 1992, he coined the term fen-phen. And he was savvy enough in the early 1990s to recognize the burgeoning communication device called the Internet.

Alvin Chernov's life was difficult long before he heard of Pietr Hitzig, fen-phen or the Internet. He was the third of four children in the tumultuous Phoenix household of Gary and Martha Jean Chernov.

Severely asthmatic, Alvin spent most of his time as a child indoors, honing a bent for mathematics and science. His sister Debbie says Alvin never had many friends, but the few to whom he warmed knew an intelligent, serious and sensitive young man.

Gary Chernov scraped by in a variety of small business ventures, some of which made money. His wife ran the household, which Debbie Knight--now 27--describes as volatile.

In the early 1980s, Martha Jean Chernov disappeared for about a month. She later told Debbie Knight she'd planned to starve herself to death--haunted by what she said was sexual abuse by her own father as a child.

"I don't know how our mother was so good to us with all of her own problems and a lousy marriage, but she was," Knight says. "I didn't know until after Alvin died how much she really meant to him."

Chernov attended Phoenix Central High, an honor student who kept to himself and seemed destined for a career in computer science. He never had a girlfriend, either in high school or at college, though not because he didn't want one. He wasn't bad-looking, but his family members agree he lacked basic socialization skills.

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Paul Rubin
Contact: Paul Rubin