Diet pill still ails Mass. patients

Many defy warning vs. Brazil export

Nearly three years after federal regulators sounded an alarm about dangerous diet pills imported from Brazil, doctors in Massachusetts continue to treat patients stricken with heart problems, headaches, and insomnia linked to the powerful drugs.

Just yesterday, a Cambridge Health Alliance internist saw two patients who told him they are taking the medications, typically a brew of speed, tranquilizers, and other chemicals mixed into a capsule.

One of the patients, who gets the pills from a doctor in Brazil, has heart palpitations and high blood pressure, well-recognized side effects of the weight-loss regimen. Another, hooked on the pills for four years, plunges into bouts of depression when she tries to stop using them, said Dr. Pieter Cohen.

And a police bust in May suggests there remains a robust market for the drugs: Detectives in Marlborough confiscated nearly 46,000 illegal diet pills, which, they said, were peddled in plastic bags from a convenience store catering to Brazilian emigres in neighboring Hudson.

The term "Brazilian diet pill" refers to multiple formulations that cannot be sold in the United States but are legal in Brazil, where they are touted as an all-natural method for shedding unwanted pounds rapidly.

Because the pills exist in a black market, it is impossible to know precisely how many people in the state's burgeoning Brazilian community - and outside of it - use them.

But a survey of more than 300 immigrants published last year found that nearly 1 in 5 Brazilian women interviewed at a Somerville clinic acknowledged taking the pills since arriving in the United States.

And 1 in 10 women questioned at churches in Massachusetts with Brazilian congregations reported they had tried the medications.

"When people were originally bringing me these prescriptions, I was just staring at them - I was just shocked that these would be provided to people for their benefit," Cohen said.

The temptation to use the pills, which usually cost $100 to $200 a month, proves irresistible for some Brazilians who find themselves in a land where they toil hours on end, consume calorie-laden fast food, and don't find opportunities to exercise similar to those in their homeland, said Elisa Garibaldi, who was a surgeon in Brazil before emigrating.

They are also lured by the weight-loss success stories of friends: Some people say they lost up to 30 pounds in a month.

"They want to have the same body they used to have in Brazil," said Garibaldi, a board member of the Brazilian Immigrant Center, an advocacy and education coalition in Boston. "But it's hard. The reality here is different."

The desire for a slim figure can lead to tragedy. In 2006, a woman died from a botched liposuction procedure performed by a Brazilian emigre who portrayed himself as a skilled surgeon, exposing a culture of underground operations.

"So, the pills seem innocent enough," said Dr. Helena Santos-Martins, medical director of the East Cambridge Health Center. "Patients think, 'Nobody's cutting me. I'm not under anesthesia. It gets me results immediately.'

"We have to get rid of that myth that these pills are safe."

In January 2006, the US Food and Drug Administration warned consumers about the pills, cautioning that they contain key ingredients from Prozac and antianxiety medications as well as Fenproporex, a stimulant not approved for sale in the United States.

Michael Levy, director of the FDA's Division of New Drugs and Labeling Compliance, said in an interview yesterday that his agency, in tandem with customs inspectors, watches for commercial shipments of the pills and has stopped at least one such shipment in the past five years.

"However, a lot of these products are likely purchased over the Internet by individual consumers," Levy said. "When that occurs, we are far less likely to actually capture the imported product."

Cohen details the dangers of the pills in today's Journal of General Internal Medicine, and reports that the medication threatens not only patients' health - it can also endanger their livelihood.

That's what happened to a Brazilian woman living in Massachusetts.

She packed on unwanted pounds while working and attending school to become a licensed practical nurse. On a trip back home to Brazil last year, a doctor prescribed pills that he assured her were safe, containing natural Brazilian herbs.

The woman experienced heart palpitations and dehydration on the pills, and when she took a urine test for a new job, she flunked, unaware that the pills contained a chemical cousin of amphetamine.

Ultimately, with a note from Cohen as well as the prescription from the doctor in Brazil, she was allowed to practice as a nurse.

The woman, whose account was verified by Cohen, requested anonymity, fearing recrimination if colleagues learned she had taken the pills.

Other women should not take the medication, the 32-year-old said, "all in the name of beauty. It is really not worth it. Besides, you don't lose weight in a healthy way."

Stephen Smith can be reached at stsmith@globe.com.