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Saturday, May 31, 2008

Mainstream docs join anti-aging bandwagon

But with M.D. endorsements, is the field more credible — or risky?
By Brian Alexander
MSNBC contributor
updated 9:56 a.m. ET
April 21, 2008

For thousands of years, magicians, alchemists, even a few fringe medical practitioners have fueled an unbounded optimism that we can blunt the ravages of time, stay younger for longer, maybe even defeat death itself. Their pitches have usually hinged on some drug, food or device — everything from electricity to yogurt to surgically installing the gonads of animals into our own bodies — that will slow or reverse the aging process. Every decade or so, “anti-aging” promoters grasp onto news coming out of research labs and trumpet those developments as the answer we have all been awaiting.

Lately, the buzzwords are “nano,” which refers to the science of the ultra small (a nanometer is one millionth of a millimeter), and stem cells. One “nano” face cream, for example, promises to stave off wrinkles with "nano-encapsulated technology" into which the makers have "packed microscopic bundles of Prodew, a nourishing skin humectant." A dietary supplement advertised as "The World's FIRST Stem Cell Enhancer," promises to "Rebuild, Renew, Rejuvenate" — giving you more stem cells and keeping your organs healthy — if you take the blue-green algae capsules. The claims are based on wispy science and hype.

But while the cycle remains the same, something new is happening in the world of anti-aging. Mainstream doctors who once wanted nothing to do with the naturopaths, osteopaths and others who first populated modern anti-aging, and whom they often considered glorified carnival barkers, are buying in, signing up for “certification” as anti-aging practitioners and offering patients the promise of youth and rejuvenation through such treatments as human growth hormone, testosterone, special diet and exercise regimens, antioxidants and hundreds of other supplements.

“It is mushrooming,” says Dr. Elliot Snyder, an emergency room physician based in Northern California who follows the movement closely by frequently attending anti-aging meetings and talking to friends in the field. He also uses some of its techniques himself. Besides exercising five days a week and following a strict low-fat diet that includes lots of fruits, vegetables and wild salmon but no white flour or red meat, he takes supplements ranging from thiamin and biotin to DHEA, DMAE, colostrum, arginine, carnitine and omega-3 fatty acids — about 50 pills per day. He is 64 but looks a decade younger.

Back in 1994, the annual Las Vegas meeting of the fledgling American Academy of Anti-Aging Medicine (A4M) was held in a small hotel off the Las Vegas strip. Everyone could fit into a temporary tent-like structure on the pool patio. Last December, at the 15th A4M confab, roughly 2,000 attendees, including business owners, anti-aging promoters and hundreds of doctors — among them obstetricians, ER docs, psychiatrists and internists — filled a cavernous meeting space inside the Venetian Hotel and Resort.

Today, claims Dr. Bob Goldman, A4M’s co-founder, there are about 20,000 A4M-certified doctors around the world. A4M’s tax returns confirm the boom. The income from fees charged to those seeking board certification from A4M more than doubled from $544,845 in 2005 to $1.2 million in 2006.

A rival organization, Age Management Medicine Group, is growing rapidly, too, says co-founder Rick Merner. He claims the group had more than 400 doctors at its last meeting, sponsored by the nation’s single largest “age-management” clinic, Cenegenics. The Cenegenics Foundation also certifies practitioners in age-management medicine (it shuns the term “anti-aging”) and claims to have experienced a 100 percent increase in the number of its physician “affiliates” to more than 800.

Mainstream business has recognized the potential. GE Healthcare, for example, sent a team to the recent A4M meeting to market body scanners that cost about $100,000 each and are often used by anti-aging doctors to look at fat deposits inside the body and convince patients of the need to do something about them. (Msnbc.com is a joint venture of Microsoft and NBC Universal, which is a GE company.)

'A life-changing experience'
Patients all over the country are buying in. Rebecca Gooden, a 57-year-old Charleston, S.C., real estate agent, first saw an anti-aging doctor in December when she sought help for joint pain, insomnia and lack of energy. “I had felt something was going on but standard testing did not show any of it," she says. "I had been having symptoms but doctors kept telling me there was nothing wrong and I knew there was."

Frustrated, when she saw an article about Cenegenics in a magazine, she called for an appointment in hopes of solving her problems. Now, she spends about $1,000 a month on hormones and supplements to treat various hormonal deficiencies and has become an anti-aging convert. “I feel like a new person … it has been a life-changing experience for me.”

All this despite the fact that as far as the American Medical Association or the American Board of Medical Specialties is concerned, there is no such thing as an anti-aging specialty.

Therein lies the often bitter tension between the medical establishment and those physicians and organizations who say they can help us slow or even stop the aging process and the debilitation that comes with it. Goldman and his A4M co-founder, Dr. Ronald Klatz, have been accused by respected academics of being snake-oil salesmen. Cenegenics and A4M have both been labeled glorified hormone-pushers.

Anti-aging advocates, on the other hand, argue that they are a persecuted minority of enlightened medical professionals who have the patients’ best interests at heart and that the AMA, the mainstream media and the government, especially the Food and Drug Administration, have conspired to keep the truth from the public.

“Certain vested interests would not like to have anti-aging,” Klatz argues.

To the ears of Northwestern University bioethics professor Laurie Zoloth, this sounds like an old story. “Whenever one hears these things, that there is a conspiracy against patients, if you come to us we will tell you truth, then one has to ask, ‘Why are your statements credible?’”

Has anti-aging 'arrived'?
That is precisely the question many consumers are now being asked to answer for themselves. If their M.D. is signing onto anti-aging, does that mean the message is now credible? Does the certificate on his or her wall mean that real anti-aging has, at last, arrived? Or does it simply mean that every patient now has one more reason to live by the Latin phrase caveat emptor — buyer beware?

Dr. Thomas Perls, a Boston University researcher who studies centenarians (people who live at least 100 years), and a vociferous critic of the anti-aging industry, argues that while some anti-aging practitioners “may have their hearts in the right place … in my mind the whole anti-aging practice has so many problems of ethical and professional misconduct. These practices are selling medicines and substances at great profit with very little in the way of clinical studies to support what they are doing.”

The answers to the science questions can be complicated, but the motivations of some doctors to enter the anti-aging world are not. Dr. Arnold Relman, a former editor of The New England Journal of Medicine who is now a professor emeritus of medicine and social medicine at Harvard Medical School, believes “the interest in anti-aging practice is mainly based on economic considerations” by physicians who are looking to boost income.

“Get your piece of the $50 billion anti-aging marketplace!” trumpets a flyer distributed to doctors at A4M’s Las Vegas meeting. An article by Klatz and Goldman in "Medical Spas," a magazine that’s a member of A4M, encourages doctors to open their own medical spas and to have them certified under the World Council for Clinical Accreditation, another A4M organization, because “a single anti-aging patient is estimated to bring $4,000 to $20,000 in annual gross revenue.”

The business can be very good, indeed. Doctors can count on regular hours because the patients are not sick. Better yet, patients pay cash because visits and procedures are not generally covered by insurance, which also means there is no upper limit to fees. And since there is no need to deal with insurance companies or HMOs, practices do not require extra staff to handle all that paperwork.

Additionally, anti-aging doctors often sell lines of creams and supplements, such as vitamins, antioxidants and plant extracts, which claim to do everything from strengthening the immune system to boosting libido, directly out of their offices, sometimes with an enormous mark-up. They can also use their own in-office technology, like those GE body scanners, to charge for in-house testing.

Patients generally see anti-aging doctors much more often than regular physicians. That's because in addition to checking on measures like weight and body fat and how patients are feeling overall, the docs are constantly monitoring a large range of sometimes esoteric health indicators with a battery of medical tests, including urinalysis and blood work. They look for levels of everything from testosterone and estrogen to follicle stimulating hormone and dehydroepiandrosterone (a natural steroid known as DHEA). Based on all these results, the doctors may then recommend drugs, hormones, supplements and special diets and fitness regimens — and then set an appointment to see the patient again in several weeks or months for another cash-only check-up.

One doctor, two hats
Dr. Andrew Jurow, an ob-gyn in Burlingame, Calif., says he started an anti-aging practice alongside his ongoing traditional practice after becoming a devotee himself. “I am as mainstream as you can get. I am 59 years old, board certified in ob-gyn, as was my father. If you had come to me five, six years ago and talked about anti-aging, I would have said, ‘Hogwash!’”

But then Jurow, long an avid exerciser, attended an A4M meeting and came away impressed with what he heard. Five years ago he began visiting an anti-aging doctor himself. Now he sees his regular ob-gyn HMO patients through one door of his building and anti-aging patients through another.

Jurow says he is not getting rich off his anti-aging patients. Rather, his motivation is his own belief that it works. Still, he says, if he sees an anti-aging patient for an hour, he can charge $350, whereas HMOs might reimburse him as little as $50 for a traditional office visit. Article Source : www.msnbc.msn.com

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