Doctors’ Lounge
(continued from page 35)
an official Committee Opinion which
essentially refutes any assertion that bioidentical hormone therapy is preferable,
much less comparable, to FDA approved
treatments. “Because of a lack of FDA
oversight, most compounded preparations
have not undergone any rigorous clinical
testing for either safety or efficacy, and the
purity, potency, and quality of compounded
preparations are a concern.” In addition,
the numerous blood, urine, and saliva
tests used by these anti-aging clinics come
under fire. “There is no evidence that
hormonal levels in saliva are biologically
meaningful.” They state, and I agree, that “If
treatment is initiated for symptom control,
subjective improvement in symptoms is the
therapeutic end point, and there is no need
to assess hormone levels. Hormone therapy
should not be titrated to hormone levels
(serum, urinary or salivary).”
My patients are in the main convinced
that all this is safe and though they have
all signed some kind of release, hardly any
can recount a thorough discussion of breast
cancer or endometrial cancer or DVT risk.
Men at testosterone clinics do get PSAs
done, because I have referred to urologists
several who called me with a high PSA level
that was found at the testosterone clinic.
They are just now, with recent research,
beginning to be uneasy about any cardiac
risk. But sex appeal and beauty trump
safety: patients want to feel younger and
prettier and livelier. They glowingly note
the sheer burst of energy they get, and the
comforting reassurance they get, from being
seen frequently and told that they are now
wonderful.
Selling Youth to the aging has made many
people rich over the millennia, and it always
will. Medical hucksterism masquerading as
entrepreneurship is as old as the hills. There
is no shortage of get-rich opportunities in
Louisville for this, although there is a decent
amount of competition, if you look at all
the websites. As for the practitioners, it is
easier to sell someone fancy vitamins and
hormones than to fill out preauthorization
forms, give chemo, operate on someone,
make an exact diagnosis, or save lives in the
emergency room. It’s a cynical but lucrative
use of one’s medical license. People will
pretty much buy anything that promotes
youth and beauty, especially if some
doctor promises them it will work. There’s
a chiropractor who advertises online, who
gives coffee enemas for anti-aging (only
with pesticide-free organic coffee that he
sells you, of course!) using the Dead Sea
Scrolls as his reference. I cannot say that
most anti-aging clinics are promising
results from coffee enemas. But I’d sure
like to see the scientific studies that offer
Level I evidence for these practices – and
since these creams are not subject to FDA
approval, I have a feeling such studies are
very hard to come by. LM
Note: Dr. Barry practices Internal
Medicine with Norton Community
Medical Associates-Barret. She is a clinical
associate professor at the University of
Louisville School of Medicine, Department
of Medicine.
Medical Camouflage
Larry P. Griffin, MD
One of my most valued experiences is based
on my time with the Navy and Marine
Corps, in which, over a 23-year period, I was
given the opportunity to learn and practice
skills which I would never have developed.
In hostile environments, or in areas where
covert operations are conducted, a critical
skill is camouflage to prevent your targets
from either detecting you at all, or at the
very least misdirecting their activities so
that they do not interfere with your agenda
of strategy and tactics to accomplish your
ultimate goal.
I don’t know about you, but I am really sick
and tired of having every new initiative of
the hospital being couched in terms of “best
practices,” “patient safety” or “collaborative
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practice,” or bolstered