- Danny Robbins The Atlanta Journal-Constitution
For more than two decades, Dr. Jan McBarron has been one of the country’s most outspoken physicians in calling out traditional medicine for its reliance on prescription drugs.
Across multiple platforms, including a series of books and a nationally syndicated radio program, the Columbus weight-loss specialist has regularly expounded on how vitamins, herbs and other natural products can be just as effective in dealing with disease.
That advocacy has brought the 66-year-old physician, comfortable in front of cameras and microphones, special recognition from the nation’s largest dietary supplement lobbying group and made her a virtual rock star in the worlds of holistic and alternative medicine.
Yet what McBarron has long preached hasn’t always guided her practice.
The doctor famous for railing against the dangers of prescription drugs has built a source of income by prescribing and dispensing a potentially dangerous diet drug, an investigation by The Atlanta Journal-Constitution found. And, the AJC found, she has done it by prescribing the drug in at least some instances for people she never met.
Earlier this year, an informant contacted the AJC alleging that McBarron was prescribing and dispensing the appetite suppressant phentermine for people based solely on their answers to an online questionnaire.
To investigate the allegation, the AJC asked two people who had never been McBarron’s patients — one in Georgia and the other in a state more than 500 miles away — to fill out the patient signup form on the website for the doctor’s practice, Georgia Bariatrics. The form required that they list their height and weight and note their understanding that they would be taking medication for the sole purpose of losing weight.
Both quickly were informed by an email that they were registered as patients and could obtain the drug online as well as in the doctor’s office. They then were asked to complete a one-page questionaire seeking information about their medical histories. Within days of submitting the questionnaires, they received the medication via Federal Express.
Phentermine is a controlled substance similar to amphetamines. It can be harmful to some people such as those with high blood pressure or heart problems. By law, it can’t be prescribed without a thorough examination, and federal authorities around the country have successfully prosecuted physicians for prescribing it improperly.
Moreover, a physician who prescribes a controlled substance for a patient “solely on a consultation via electronic means” can be disciplined by the Georgia Composite Medical Board for unprofessional conduct, board rules state. McBarron was in fact investigated by the board 17 years ago and ordered not to solicit patients by offering to dispense controlled substances without exams.
The newspaper’s findings highlight how some physicians avoid scrutiny of their prescriptions by dispensing the drugs themselves. Some states have enacted laws severely limiting the practice, but neither Georgia nor Alabama, where McBarron also is licensed, has taken that step. In Georgia, the only requirement for becoming a dispensing physician is to notify the medical board.
By dispensing, doctors also can charge whatever they want. Most pharmacies charge less than $30 for a 30-day supply of phentermine, which generally isn’t covered by insurance. The two people who purchased the drug online from McBarron at the AJC’s request paid more than three times that price.
“If a physician wants to have a practice where he or she doesn’t have to worry about oversight, they can do it by dispensing products,” said Carmen Catizone, executive director of the National Association of Boards of Pharmacy.
When contacted by the AJC last month and asked whether she had prescribed phentermine for people she never examined, McBarron immediately replied, “That’s not true.” She then said there would be no way to order the drugs on her website.
Checking the doctor’s assertion, the AJC found that the links that had allowed the two people to buy phentermine for the newspaper had been eliminated.
McBarron declined to meet with the AJC to discuss her practice more fully. Responding to an email in which the newspaper sought a meeting and again described what its reporting found, the doctor wrote, “I have no comment.”
Not for everybody
Phentermine, approved nearly 60 years ago for short-term weight loss, has remained popular even as newer drugs have come on the market. It was part of fen-phen, the 1990s weight-loss sensation later found to have caused heart-valve damage in some patients, but phentrmine wasn’t pulled from the market because the other drugs in the treatment, fenfluramine and dexfenfluramine, were linked to the heart issues.
Physicians like phentermine because of its record for safety as well as its affordability. However, like any stimulant, it’s not recommended for some people, including pregnant women or those with hypertension and a history of heart disease. It also can cause troubling side effects such as insomnia and mood changes.
Deaths from phentermine overdoses, while not common, have occurred. The best-known case is that of actor and former NFL defensive lineman Bubba Smith, who died in 2011. An autopsy determined that Smith, 66, suffered from “acute phentermine intoxication” as well as heart disease and hypertension.
Weight-loss physicians contacted for this story said they will only prescribe phentermine for patients who meet certain obesity standards and who have been closely examined to make sure they will not be adversely affected by the drug.
“At the very least, you should be checking the patient’s blood pressure and asking if they have a cardiac history,” said Dr. Lawrence Cheskin, director of the Weight Management Center at Johns Hopkins University.
Dr. W. Timothy Garvey, a professor of medicine at the University of Alabama at Birmingham who chairs the school’s Department of Nutrition Sciences, noted that prescribing the drug based solely on an online questionnaire allows patients to say anything they want about their medical histories, whether true or not.
“This is just so far from best practices it can’t be sanctioned in any way, in my opinion,” he said.
The AJC found at least eight cases in which physicians have been ensnared in criminal prosecutions for prescribing the drug without examining patients.
In one particularly notable case, a Miami pharmacist received a nine-year prison sentence after orchestrating a scheme in which doctors wrote prescriptions for phentermine based on the answers to brief questionnaires submitted online. One of those who obtained the drug, a 46-year-old Texas woman, died of an overdose.
In recent years, an increasing number of weight-loss physicians have become dispensers of phentermine as well as prescribers.
Those who support the practice say it makes things more convenient for patients. However, critics believe it injects profit into decisions that should be based strictly on medical guidelines and also eliminates an important safety net provided by pharmacists.
“It’s a matter of separation of powers, so to speak,” said Ned Milenkovich, an attorney and pharmacist who serves on Illinois’ State Board of Pharmacy. “When a doctor is both prescribing and dispensing, there’s a certain inherent conflict.”
Dr. Scott Isaacs, an Atlanta endocrinologist who serves as an adjunct instructor at the Emory School of Medicine, said he has never considered dispensing phentermine even though he prescribes the drug and gets regular mailings from wholesalers offering to sell him thousands of pills for just pennies a pill.
“Phentermine shouldn’t change your salary,” he said. “When it does, it’s a total loss of objectivity.”
`Duke and The Doctor’
McBarron has been practicing in Columbus since completing her medical training at Hahnemann University in her home town of Philadelphia more than 30 years ago. She sees patients in a modest suite of offices on Columbus’ Macon Road as well as another location in nearby Opelika, Ala.
Her interest in the weight-loss field grew out of her own weight problem, which led to her losing 70 pounds, according to biographical information on her website. She began studying the efficacy of natural products when she saw the side effects of prescription drugs on her patients, the website says.
With her husband, Duke Liberatore, McBarron hosted a daily radio program that regularly touted vitamins and supplements as alternatives to prescription drugs. “Duke and The Doctor” ran for 15 years before the couple ended it in 2014.
In her books, McBarron has covered the same ground. Her most recent offering, published in 2012, dealt with curcumin, a chemical compound found in the spice turmeric, and her belief that it can prevent and reverse cancer, dementia and other serious illnesses and conditions.
“Curcumin literally scrubs the oxidative ‘rust’ from your cells, preventing serious disease and reversing diseases you may already have ” she wrote.
She also has sold supplements on her website, including a so-called “fat-burning injection” advertised as seven vitamins in a B-12 “base.”
In 2010, a lobbying group for supplement retailers and manufacturers, the Natural Products Association, named McBarron its “Clinician of the Year.” The organization cited her advocacy of vitamins and herbs as “healthier and less expensive alternatives to prescription drugs.”
But along with the praise of those who share her opinions, she has also found herself on the radar of the Georgia medical board.
In the late 1990s, the board alleged that McBarron appeared in television broadcasts in which she recommended that people use “unproven” natural remedies in place of medications prescribed by their doctors.
The board also contended that she improperly dispensed a thyroid hormone for weight loss to a patient who ultimately suffered hyperthyroidism and had to have her thyroid removed. According to the board, the patient’s records showed no evidence that the doctor had conducted a physical examination or reviewed the patient’s medical history.
McBarron denied wrongdoing but agreed to a 1999 order that placed her on six months’ probation. She also agreed that she would not solicit patients “by offering to dispense controlled substances without (a) medical examination.”
The probation was lifted in 2001, and McBarron has not been subject to public board sanction since, records show.
McBarron’s online sales of phentermine began about a decade ago, a former employee told the AJC.
The former employee said many of the online orders were from U.S. military personnel in Afghanistan and elsewhere who needed to “make weight.” It was unclear whether any of those who ordered the drugs were ever examined by McBarron, although it’s possible they were at some point, the ex-employee said.
McBarron’s website includes testimonials from three soldiers, one of whom, a woman identified only as Stephanie, is quoted as saying she was facing expulsion from the military until Georgia Bariatrics helped her lose weight.
When the two people obtained phentermine through McBarron’s website at the AJC’s request, each provided accurate information, although no one contacted them to verify it.
One ordered a month’s supply and was charged $101.95, which included the cost of the pills plus shipping and handling. The other ordered a two months’ supply, for which the charge was $190.95.
In both cases, the pills arrived in bottles with McBarron’s name and DEA number on the labels. The labels indicated that the pills were manufactured by a generic drug company in Pennsylvania and distributed by a wholesaler in New Mexico that specializes in providing medication to dispensing physicians in the weight-loss industry.
The pills also came with flyers touting the benefits of McBarron’s fat-burning injections, suggesting that using them along with phentermine makes the drug “more effective.”
“When you purchase a package, you receive the fact-burning injections and appetite suppressants,” the flyers said. “There are packages for various budgets!”
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