Doctors are selling the fountain of youth

The anti-aging movement attracts patients willing to spendheavily to look and feel younger-- and doctors eager to cater to them.

Each day, Gary Handwerker takes 40 pills and two injections of humangrowth hormone-at an out-of-pocket cost of $2,000 a month. The 61-year-oldChicago business executive isn't sick. He's just, well, 61 years old. Andhe intends to live a long, disease-free life-unlike his father, who hada heart attack at 45, and his brother, who had one at 42.

For the last 18 months, Handwerker has tried to turn back the clock withanti-aging remedies. Feeling "more energetic and sexually aroused,"Handwerker now exercises six times a week instead of three. "I haveno concrete evidence that I'm 50 percent better, but I feel that I'm better,"he says. "I feel good about what I'm doing."

And feeling good is what anti-aging medicine is all about, its promoterssay. Physicians who are converts to the field not only promise to transformolder, enervated bodies into more youthful ones, but they claim they canslow or even reverse diseases like Alzheimer's, osteoporosis, Parkinson's,atherosclerosis, and diabetes. Such medical wonders are wrought throughhormone replacement therapy (DHEA, human growth hormone, estrogen, testosterone,progesterone, thyroid, pregnenolone, melatonin), vitamins, antioxidants,exercise, and diet.

Sixty-five-year-olds whose growth hormone and sex steroid levels areequivalent to those of 35-year-olds don't look or feel like sexagenarians,according to anti-aging practitioners. They sleep better, perform betterin the gym and the bedroom, and have denser bones, more muscle mass, andless body fat. Anti-aging treatments are also said to sharpen memory, elevatemood, boost HDL levels, and fortify the immune system.

Anti-aging physicians insist they're simply practicing preventive medicine."Instead of attacking diseases with surgery and medical hammers, anti-agingmedicine makes the body stronger so you don't get the diseases," saysob/gyn Edward M. Lichten, who treats men and women in his Southfield, MI,practice, and whose Web site includes a photo of him at age 50 in a tanktop.

Patients who opt for anti-aging therapies tend to be well-educated andwilling to spend time and money keeping themselves in robust health. Babyboomers rebelling against the ravages of time are prime candidates. "Thestimulus for antiaging medicine is coming from patients, who are increasinglydisenchanted with adverse drug reactions and invasive medical procedures,"says endocrinologist Marina Johnson, who runs the Texas Institute of Anti-AgingMedicine in Euless, TX. "They want safer alternatives. I think it'shealthy for people to be interested in prevention, instead of waiting untilcatastrophe strikes."

Tricking the body into thinking it's younger can also foil diseases,according to anti-aging physicians. "I've been able to take diabeticsoff insulin," says Lichten. "I can make the heart stronger sothe patient doesn't need a beta-blocker. I once put a patient, who was ona heart transplant list, on growth hormone and testosterone. He lost 50pounds, began lifting weights, and no longer needs the transplant. And I'vetreated 30 couples who now act like teenagers in the bedroom. That's nicewhen you're in your 50s or even 70s."

Another anti-aging physician, Alan Mintz, says he eliminated all thesymptoms of Parkinson's disease in one patient, and gave a completely paralyzedALS patient movement in his toes.

Anti-aging proponents have become a virtual brigade. In 1993, the AmericanAcademy of Anti-Aging Medicine started with 12 members; today it has nearly7,000--70 percent of whom are MDs and DOs. Physicians can become board-certifiedin the discipline, but anti-aging medicine is not a member board of theAmerican Board of Medical Specialties.

Physician interest is both personal and financial

For many physicians, interest in anti-aging came with their own symptomsof aging or when a family member got sick. Lichten started on an anti-agingregimen "when I turned 47 and was tired and exhausted. Also, my wifehas MS and lupus, and conventional therapy would have been the wrong wayto go. We've used anti-aging therapies and done fairly well."

Alan Mintz, a former radiologist and marathoner, began injecting himselfwith human growth hormone at 57. He says his energy increased, his cholesterolfell from 250 to 180, and his heightened performance in the gym allowedhim to capture the Mr. Illinois body-building title (grand master division)at the age of 58.

Indianapolis FP David Decatur, 60, takes every anti-aging therapy heprescribes to his patients. "I feel like I'm 40," he says.

Decatur was frustrated in his efforts to obtain human growth hormonefor his mother after she broke her hip and became debilitated four yearsago. "At that time, it was only being given to short-stature children,"he says. Recently, the FDA approved the use of hGH in the treatment of adultswith growth hormone deficiency, mostly caused by pituitary tumors and subsequentsurgery. Physicians who prescribe hGH as part of an anti-aging regimen,however, are using the drug off-label.

Other doctors, such as emergency physician Yusuf Saleeby of Savannah,GA, practice anti-aging medicine because they prefer taking care of patientsmotivated to stay healthy. "Ninety percent of the patients I see inthe emergency room have horribly unhealthy lifestyles, and it's too lateto re-educate them," he says. "We work to keep them alive, butas soon as they leave the hospital, they'll smoke another cigarette. That'sdemoralizing for me."

Anti-aging medicine can also be profitable. Patients pay out-of-pocketbecause insurance companies generally don't cover the therapies. Alan Mintzsays that Cenegenics, his lavish, $7 million anti-aging center in Las Vegas,broke even after only 18 months. Sixty percent of his 200 patients takegrowth hormone, which runs an average of $1,300 a month. Those on vitaminsand nutritional supplements, which Cenegenics sells, pay about $250 a month.

With patients from 37 states, Mintz is looking for physician partnersto do follow-up exams when the patients return home. Toward this end, hehas distributed promotional literature promising: "You can regain thesatisfaction of being able to count on a long-term relationship with a gratefulpatient, and you can substantially increase the bottom line of your practice!"

Mainstream medicine is wary of anti-aging regimens

Anti-aging therapy is hardly a neutral topic. Adherents can't praiseit enough, but opponents see it as the stuff of charlatans and snake oilsalesmen.

"I go into anaphylactic shock when I hear the word 'anti-aging,'" says geriatrician Thomas Perls, assistant professor of medicine atHarvard Medical School and director of the New England Centenarian Study."The anti-aging people play into fears that aging and old people areto be avoided at all costs. They perpetuate the myth that it's all downhillafter 65. But with good health obtainable without dangerous anti-aging remedies,those years can be wonderful and filled with opportunities not availableto younger people."

Perls, the author of Living to 100, believes that "the anti-agingpeople are creating a lot of animosity and hard feelings toward old people.I think these guys are just hucksters."

Sports medicine physician Ronald M. Klatz, president and founder of theAmerican Academy of Anti-Aging Medicine, fires back: "The goal of antiagingmedicine is to put an end to old age--and with it, geriatricians. We saypeople don't have to be crippled old fossils after 65. That's a very brightand happy view of aging. What does geriatrics have to point to? Grandmaand Grandpa living in a nursing home with their greatest hope of exercisebeing able to ride a tricycle?"

Anti-aging practitioners have also had to defend against charges thatthe hormone therapies they promote are of unproven effectiveness as anti-agingagents and may have dangerous side effects. The National Institute on Aginglaunched a public service campaign advising consumers not to take growthhormone, DHEA, and melatonin until more research is done. Side effects ofhGH treatment, according to the NIA, can include diabetes and pooling offluid in the skin and other tissues, which can lead to high blood pressureand heart failure. And DHEA may cause liver damage and increase the riskof developing prostate, breast, and endometrial cancers.

To determine the efficacy and long-term safety of giving hGH and othertrophic factors to adults, the NIA appropriated $9.7 million in 1992 tofund several five-year studies. Results are now expected in mid-2000.

Klatz and other anti-aging physicians reason that the decision to extendthe studies amounts to proof that hGH isn't dangerous. "It would becriminal to continue the studies if people were dropping dead," saysKlatz. "We have to conclude that because the studies weren't stopped,the research is almost certainly positive."

Psychiatrist Stanley Slater, NIA's deputy associate director for geriatrics,dismisses such reasoning as "not objective." Difficulty recruitingpatients for the trials accounts for the delays, he says. Although Slatermaintains he doesn't know the results of the double-blind studies yet, hesays: "We know from other studies that the growth hormone producesside effects. It's well known that people suffer carpal tunnel syndrome,joint pain, fluid retention, and worsening of glucose metabolism and diabetes.There is no proven clinical utility of human growth hormone as an anti-agingagent."

He issues a similar warning about testosterone. "It can increasethe hematocrit and cause sludging of the blood in the smaller vessels, whichcan lead to a stroke," says Slater. "It requires careful supervisionand ongoing laboratory testing."

Patients don't necessarily have time to wait for long-term studies todetermine the safety of hormone-replacement therapy, insists FP David Decatur."A 75-year-old who has lost his vitality doesn't want to wait 10 yearsfor study results," he says. "Do you think there were double-blindstudies when physicians started ripping chests open to do the first heartsurgeries?"

Pat Barr, 74, and her 80-year-old husband, Bill, agree. "No oneknows how safe these things are long term," says Pat, "but witholder people it doesn't make a heck of a lot of difference. Why be miserableand live longer? We now have more energy, we look better, and we go to thegym three times a week." She and Bill, who live in Berkley, MI, takeDHEA, pregnenolone, testosterone and estrogen, and B12 shots.

Physicians who prescribe the controversial hGH say they aim to returnpatients' hormone levels to those of a 35-year-old--not a 21-year-old--andthat patients are closely monitored. "People have gotten in troubletaking super doses," says former emergency physician Thomas Newton,a co-founder of the Hilton Head Longevity Center in Bluffton, SC. "Weuse very low doses twice daily, which more closely mimics what happens inthe body naturally."

Endocrinologist Stanley Feld, past president of the American Associationof Clinical Endocrinologists, is more concerned about the danger hGH posesto the wallet. "It can cost more than $10,000 a year, and it has noproven efficacy as an anti-aging agent," says Feld, who was chairmanof the growth hormone initiative task force of AACE. Moreover, he maintainsthat many anti-aging physicians erroneously use IGF-I levels to determinewhether patients need growth hormone.

"A low IGF-I level could be caused by stress, depression, or illness;it doesn't necessarily mean you have a growth-hormone deficiency,"says Feld. "Growth hormone's greatest anti-aging benefit may be itsplacebo effect."

Anti-aging therapies remain outside the mainstream

Impatient with the conservative attitudes of their detractors, anti-agingphysicians maintain that they are futurists practicing at the forefrontof medicine. "Of course you need hormone supplements as you age,"insists the 43-year-old Klatz, whose own anti-aging regimen consists of60 pills a day. "Physicians used to say that postmenopausal women shouldembrace wrinkles, broken bones, and dry skin instead of taking estrogenreplacement. What kind of Dark Ages thinking is that?

"Not giving an insulin-dependent diabetic insulin, or a man sufferingfrom andropause testosterone replacement, or not giving thyroid replacementto a patient with hypothyroidism is considered malpractice today. One day,the same will be true for a doctor not replacing growth hormone or testosteronein a 65-year-old who is losing muscle, organ, bone, and brain mass."

Other physicians steer clear of injected hGH, preferring to use oralsecretagogues. The oral form is safer, says ER physician Yusuf Saleeby,who, at age 34, takes DHEA, antioxidants, vitamin and mineral supplements,and will soon begin taking hGH. "You do get a more predictable responsewith the injectable hGH, but it has the potential to cause certain cancersto grow faster."

Although Ronald Klatz insists that "there's no scientific support"for the claim that injected human growth hormone causes or exacerbates cancer,FP Pam Hiti of Overland Park, KS, says she'd never use injected hGH because"there are too many serious side effects, including cancer."

But the 45-year-old Hiti, who's had a total hysterectomy and has beenon estrogen replacement for nine years, says her patients started askingto take oral hGH after they saw the effects on her. After a few weeks, herinsomnia disappeared, she bruised less easily, and a chronic pain in hermid-thoracic area (from giving osteopathic manipulative therapy for years)vanished. Her need for estrogen replacement has also diminished. "It'sincredible stuff," she says. And oral hGH cost just $1,200 a year--afraction of the cost of injectable growth hormone.

Besides footing the cost for anti-aging medications, patients usuallyalso spend $1,000 to $5,000 for an initial evaluation. Tests can includehormone panels, genetic testing, body-composition analysis, bone-mineraldensity, nerve function, nutritional assessment, and H-scan, a calculationof a patient's "true" age based on 12 parameters.

For $1,200, patients at the Hilton Head Longevity Center undergo suchesoteric tests as a "biological terrain assessment," which measuresthe pH, resistivity, and oxidative reduction capacity of saliva, urine,and blood. "From that we can glean information about a person's diet,mineral absorption problems, and oxidative damage, and it gives us a grossmeasure of biologic age," says Newton. Another test shows damage insideand outside the cells and to DNA. "That helps us target our recommendationsfor nutriceutical products."

The center, which opened in November 1997, has 120 patients. The averagepatient spends $2,000 to $3,000 a year; most are couples in their earlyto mid-50s.

Newton and his partner encourage patients to continue to see their primarycare doctors. "We don't want to be seen as taking patients away fromother physicians," he says. Still, mainstream physicians are slow torefer patients. "Patients hear about us at the gym, the hairdresser's,from some plastic surgeons," says Newton. "We also have to spendtime in the community trying to educate people on what anti-aging is allabout. People aren't standing at the door waiting to come in."

But if there is anything that anti-aging physicians possess, it's a confidencein the future and in their ability to change the face of medicine.

"Things are happening so rapidly in this field," says DavidDecatur. "Not long ago, conventional medicine said cloning was lightyears away, but it's been done. People can definitely live to 120 now. Andin the next decade, we'll be able to stop cancer. Anti-aging medicine givespeople a lot to look forward to. We'll all be able to get wiser and keepour memories."

By Anita J. Slomski, Group Practice Editor

. Doctors are selling the fountain of youth.

Medical Economics

1999;15:94.