A foul-smelling, amber-colored drug, syrup of ipecac has been sold in drugstores for years to induce vomiting in poison victims. General practitioners have long recommended having a bottle in the medicine chest as a cheap antidote; a one-ounce bottle costs only about $2. But the fact is that ipecac, in large doses, may cause irreversible damage to the heart, and if taken repeatedly, is a lethal poison. One month after Carpenter's death, Deborah Mae Mellon, 32, a mother of two, died of emetine poisoning. Two Philadelphia lawyers, Thomas E. Mellon Jr., Mrs. Mellon's brother-in-law, and Michael B.L. Hepps, have filed a lawsuit charging the numerous manufacturers of ipecac with failure to warn the public about the drug's toxic dangers. The suit, initiated on behalf of Mrs. Mellon's estate, seeks $5 million in compensatory damages and $10 million in punitive damages. "No one can know from looking at this poison antidote that it is a poison itself," says Mellon. "Like Karen Carpenter, Debbie thought ipecac was harmless. She was a happy, healthy woman who simply was desperate to lose weight." Mellon says if the cause of Karen's death had been revealed immediately, it might have saved Debbie's life. "And it would have stopped other women from taking ipecac, too. They would have said to themselves, 'This is what killed Karen Carpenter. I'm not going to take it.' "
Now some doctors fear an epidemic of ipecac misuse among an estimated 150,000 anorectics and two million patients who suffer from bulimia, binge eating and purging. A group of psychotherapists who specialize in treating the two illnesses has decided to publicize the true cause of Karen's death. Chief among them is Steven Levenkron, a psychotherapist and author. It was Levenkron who treated Carpenter for anorexia—successfully, he thought—for almost a year before her death. "Just as Karen slipped through our fingers, so are many other women," he says now. At a hearing later this spring in Washington, D.C., Levenkron and his colleagues will ask the FDA to declare ipecac a prescription drug. "Ipecac should not be readily available," he says. "It should be controlled immediately."
When she died, Karen had been suffering from anorexia for eight years—apparently since reading a passing reference to her chubbiness in a review. After seeing several therapists in California, she moved to Manhattan to begin working with Levenkron. He eventually put her in the hospital, where she raised her weight from a skeletal 83 to 108 and overcame her addiction to laxatives. In November 1982 Karen decided that she was able to go home. Soon after, according to Levenkron's reconstruction of her final months, she must have begun swallowing several teaspoonfuls of ipecac every night after dinner and eventually increased her intake to a bottle or two. The drug, which causes sharp cramps followed by violent vomiting, gradually weakened her and led, on Febuary 4, to her sudden death.
Levenkron says he was shocked to learn that his patient had died from ipecac poisoning. "I thought I knew everything about her." During phone conversations, he recalls, he had asked her, "Are you losing weight? Are you taking laxatives?" and she had always answered, "No." "Ipecac was something that never occurred to me to ask her about," he says. "I assume Karen thought this was a harmless thing to do," to eat regularly yet maintain her weight at 108.
In a press release for his autopsy report on Karen, the L.A. coroner failed to mention ipecac. The release in fact stated that "laboratory tests had ruled out drug or medication overdose as a cause of death." Says Dr. Kornblum now, "It never occurred to me to mention ipecac. In my mind, emetine and ipecac are the same thing."
Since Karen died, Deborah Mellon's has been the only reported death from ipecac poisoning. But some observers suspect that many diet-obsessed girls may have died from overusing the drug. "We think that many anorectics and bulimics who've died of mysterious heart failure may have actually died of ipecac abuse," says Levenkron. Dr. Alan Adler, a Philadelphia physician who in 1980 treated the first reported victim of ipecac death, a 26-year-old woman, explains, "People don't admit to taking ipecac, most physicians aren't aware that it's cardiotoxic, and to my knowledge only one lab in the country tests for emetine poisoning."
Ipecac comes from the root of the ipecacuanha plant, a shrub that grows in South America. It is the only nonprescription drug known to contain emetine. Until the late '70s, when studies of ipecac poisoning started showing up in medical journals, many doctors never considered that ipecac might be misused. "None of us had taken the trouble to investigate this drug," says Levenkron, "because who would abuse a drug that produces horrible pains, nausea and vomiting?" Dr. John Adams Atchley, a Manhattan psychiatrist who is president of American Anorexia/Bulimia Association Inc., answers the question: "If you heard [bulimics] talk about the great joy they get in cleaning themselves out, you'd understand why they're willing to take ipecac. They'll put up with all kinds of things to get that almost spiritual high."
Anorexia is self-starvation resulting from a disturbed sense of one's own body image. Bulimia is recurrent binge eating, followed by self-induced vomiting or purging by laxatives and diuretics. Bulimics are perfectionists and obsessive-compulsives, with high standards and low self-esteem; they are fleshier than anorectics, whose wasted look marks them as victims of a bizarre disease, and their number is growing. "In eight years I saw our meetings in New Jersey change from groups of emaciated young women to groups of field hockey types who were bingeing their heads off, taking laxatives and throwing it up," says Dr. Atchley. But on closer look there are telltale signs: puffiness around the eyes and a swelling of the glands on the sides of the jaws. Chronic vomiters sometimes have facial rashes, damaged teeth and premature cheek wrinkles—like rows of parentheses on the sides of their faces.
Although bulimics seem sturdier than anorectics, they are often actually less robust. Bingeing itself can be fatal. Recently a 23-year-old model, who had starved herself down to 84 pounds, died in London after gaining 19 pounds during one binge. According to a letter in the British medical journal, Lancet, the woman's fatal intake consisted of liver, kidneys, steaks, eggs, cheese, bread, mushrooms, carrots, a whole cauliflower, 10 peaches, four pears, two apples, four bananas, two pounds of plums, two pounds of grapes and two glasses of milk.
Some vomiters end their binges with several bottles of diet soda. This makes the food float to the top of their stomachs and sparks the gag reflex. Some simply will themselves to throw up. Others—300,000 by some estimates—take ipecac.
Despite the tragedy of Karen Carpenter, not everyone agrees that ipecac should be made a prescription drug. Dr. John Schlegel, president of the American Pharmaceutical Association, suggests that instead, "We endorse labeling changes on the product that will more adequately warn consumers about the potential dangers of using ipecac incorrectly." Says Ron Williams, APhA's director of professional affairs, "Every year ipecac saves 150,000 lives. Everyone should have a bottle in the medicine chest in case of accidental poisonings." To counteract certain poisons, ipecac must be taken within a half hour.
Dr. Atchley argues that requiring a prescription won't jeopardize poison victims. "A mother could ask her pediatrician for a prescription and keep a bottle in the medicine chest," he says. His position is seconded by former users of the drug. One of Levenkron's patients, a 14-year-old girl, said she bought ipecac at a drugstore after reading about it in a book about bulimia. She took it several times even though it made her vomit blood and bile. "Would you have used it even if it had a skull and crossbones on the label?" Levenkron asked the girl. "Yes," she said, she would have.
When Karen Carpenter collapsed at 32 from heart failure in a wardrobe closet of her parents' Downey, Calif, home two years ago, the acting Los Angeles coroner, Dr. Ronald N. Kornblum, said she died of complications from anorexia nervosa, specifically "cardiotoxicity" brought on by the chemical emetine. What he did not specify was how the emetine got there. Experts now agree there was only one way possible: She had misused a common, over-the-counter drug called ipecac.