Arlene Weintraub, who spent 10 years as a science reporter at Business Week, first wrote about antiaging in 2006. Her new book, Selling the Fountain of Youth: How the Anti-Aging Industry Made a Disease Out of Getting Old — And Made Billions, takes readers behind the scenes at the aging clinics, compounding pharmacies and for-profit businesses that are working to legitimize antiaging medicine. (Read an excerpt from Selling the Fountain of Youth.) Prepare to be scared — and challenged — by what she discovered.
Q. What started the modern antiaging movement?
A. In 1990, scientist Daniel Rudman published a sensational study. He gave human growth hormone (HGH) to about a dozen healthy men over 60. They significantly increased their lean body mass, including muscle, and they lost about 14 percent of their fat.
Q. How did we get from a single splashy study to an entirely new industry?
A. A small group of doctors latched on to the idea that if you replace your hormone levels to where they were in your 30s, you'll feel as great as you did back then. Rudman's study inspired the formation of the American Academy of Anti-Aging Medicine and has been cited on the Web something like 50,000 times.
Q. What are the cornerstones of the antiaging industry?
A. It started with HGH and expanded into alternative estrogen and progesterone products for menopause, as well as testosterone, which has recently become quite a sensation in this industry. It's being prescribed not just to men, but also to help improve women's libido.
Q. What are proponents claiming about these products?
A. They say if you replace those hormones, you can prevent osteoporosis, shield yourself from Alzheimer's, improve your sleep, lose weight, gain muscle mass and boost your sex drive.
Q. Does any good science support those claims?
A. Antiaging doctors often say HGH is one of the most studied hormones. Well, that's true, but many of those studies were in children with growth hormone deficiencies, and you can't extrapolate from those children to healthy adults. The original Rudman study of HGH in adults was very small, and some scientists have been disturbed by the popularity of it. Some antiaging doctors twist the research to fit their viewpoints.
Q. Why aren't there any better, more long-term studies?
A. They're expensive. Also, it's hard to recruit patients without knowing the risks and benefits. And you can't expose patients to something that might be a cancer-causing agent. For example, one study looked at a patient who took HGH for longevity and ended up developing cancer. You can't make a direct link, but there's enough suspicion that it would be unethical to do a longevity study.
Q. What are mainstream doctors' biggest concerns about the safety of antiaging medicine?
A. One of the biggest safety issues is with the bioidentical hormones, which are supposed to be chemically identical to those your body produces. They're estrogen and progesterone products derived from yams and soybeans. Many neighborhood pharmacists are able to compound their own creams, gels and injectable pellets.
The pharmaceutical industry also offers hormones derived from plant sources, but many antiaging doctors say those versions are synthetic while compounded versions are not. Antiaging doctors say things like, "We've invented these great bioidentical products, they're from nature, they're perfectly safe for you to take the rest of your life."
However, mainstream doctors believe all estrogen is dangerous, regardless of its source, and has the same risks as the standard menopause hormones like Premarin and Prempro, which the Women's Health Initiative showed to raise the risk of breast cancer and stroke.
Q. Why are patients so eagerly embracing unproven treatments that could actually harm them?
A. They're very popular among the baby boomer generation. They want to keep working or have an active retirement, and don't want to get frail. So they're very eager to try substances even if they might be risky.
Q. It's hard to argue that someone wouldn't want more sex or sleep.
Q. Would you consider wrinkle creams and Botox as risky as bioidentical hormones?
A. Botox is one of the only FDA-approved antiaging products. Its label contains a lot of warnings, so patients know what they're getting into. The compounded hormones being prescribed for antiaging generally don't offer as much cautionary information.
Q. Why don't they have to carry warning labels?
A. There's a web of regulations and rulings in this country, including the Dietary Supplement Health and Education Act of 1994, that dictate what compounding pharmacists can and cannot do. But the bottom line is that compounding pharmacists have a lot of freedom. For example, they don't have to include warning labels on their products. That's tragic. They should have to include the same warning labels as pharmaceutical companies when they're using the same chemicals.
Q. So drug companies and compounding pharmacies are offering essentially the same products?
A. Exactly. They're all hormones, just derived from different sources. So women are really confused. They don't know they can get bioidentical hormones that are approved by the FDA and maybe paid for by insurance, because the antiaging industry does such a good job telling them only their compounding pharmacy can make these products.
Q. Are there any real differences?
A. Well, the other controversy is that the antiaging industry says you have to have a form of estrogen called estriol, because that's what your body makes naturally. Estriol is not actually in any FDA-approved drugs, so technically, under FDA guidelines, compounding pharmacies are not supposed to be using it in any products. There are some studies showing it to be dangerous. The FDA told me they've had adverse reports of people taking estriol.
Q. If both mainstream medicine and antiaging practitioners are offering virtually the same products, why is there more concern about the antiaging industry's programs?
A. Antiaging doctors will often tell people it's safe to be on these regimens indefinitely. But the mainstream medical world believes the safest route is to take the smallest dose possible for the shortest amount of time possible. Also, many critics believe antiaging products should carry labels saying things like, "This product contains estrogen and progesterone, which have been tied to breast cancer," or "This product also contains estriol, which is not contained in any FDA-approved product."
Q. Why aren't antiaging doctors telling their patients there are FDA-approved alternatives?
A. I did meet some ethical doctors who give their patients a choice. But they say, "You can get such-and-such product made by a pharmaceutical company, or you can go to our compounding pharmacy and get something that's tailored just for you."
Q. It sounds like the Starbucks cure for aging. Why would you get plain old drip coffee when you can order a nonfat, low-sugar vanilla, extra-foam, extra-hot latte.
A. Plus, I talked to ob-gyns who say you can't tailor products that way. Your hormone levels vary throughout the day, so a single blood or saliva test doesn't tell you much. What they're promising may not be exactly accurate.
Q. Do antiaging patients understand what they're taking?
A. Some of the women I talked to didn't seem to understand they were taking estrogen. They thought they were taking something that isn't a drug, and it didn't occur to them these products might have any risks.
Q. What surprised you the most while you were reporting this story?
A. I was shocked by how many doctors are taking these substances themselves. For their patients, it's like, "If my doctor is taking these hormones, how can they be dangerous?"
Q. What types of medicine were most antiaging doctors practicing before specializing in antiaging?
A. You'll find doctors from all different specialties — from internists to emergency room doctors — but you won't find many endocrinologists in antiaging. Which is ironic, because antiaging focuses on hormone treatment.
Q. Suzanne Somers says her antiaging program is the best thing she's ever done in her life. And she looks as young, beautiful and healthy as she did in her 20s!
A. She does estrogen, testosterone and HGH, and on Oprah last year she showed a line of 60 supplement pills. She's created this perception that compounded bioidentical compounds are not synthetic drugs. I truly think she believes that. But no mainstream doctor would tell patients that hormones are not drugs. So she's created a lot of confusion.
Q. What did you think of that Oprah show?
A. It was the biggest boost the antiaging industry has ever gotten. Suzanne Somers was on the stage, while the actual medical doctors were sidelined in the audience. I interviewed one of those doctors, Lauren Streicher. She keeps running into situations where Suzanne Somers is shown as the expert, and she — the Northwestern ob-gyn [who teaches at the Feinburg School of Medicine] — is shown as some crazy lady trying to discredit Suzanne Somers!
Q. What do you say to critics who claim you've been compensated by pharmaceutical companies?
A. I laugh. I'm not sure where they're getting that idea. Some say Business Week took pharmaceutical advertising, and therefore I was getting paid by drug companies. But we had a Chinese wall between advertising and editorial, so reporters were never affected by ad sales. What's especially funny is that during my 10 years at Business Week I could count our pharmaceutical ads on one hand.
Q. Others say you must have cozy industry ties after covering the health beat for so long.
A. I actually have a record of not being very kind to the pharmaceutical industry — you can read those stories on my website. I did a series of stories on conflicts of interest in the pharmaceutical industry [read one of those stories here]. And my book takes a harsh look at pharmaceutical companies' marketing of human growth hormone. I also criticize Wyeth for not being entirely honest about selling estriol overseas while fighting its distribution in the U.S.; it looked like Wyeth was just trying to protect its Premarin franchise.
Q. This antiaging obsession makes growing old seem like something to be avoided at all cost. But it's just another part of the human experience.
A. And there's a school of thought among some doctors that the decline of hormones is protective. Because we see hormones linked to cancer, maybe it's by design that we lose hormones as we age. I personally see aging as a privilege, not something to be avoided.
Christie Findlay lives in Virginia.