From: ct (tilley314@attbi.com)
Date: Thu Dec 12 2002 - 05:52:12 MST
The "Bogus medical claims" thread (from November) offered a great deal of
information about growth hormone(GH) treatment for adults. Appropriateness,
dosage, monitoring and contraindications were examined at length.
Still, the issue remains unresolved.
An article in the New York Times on December 1st provides an excellent
summation of the debate.
==============================================
To Stop Aging, First Stop Fighting
By FRED BROCK
http://www.nytimes.com/2002/12/01/business/yourmoney/01SENI.html?ex=1040642897&ei=1&en=d1355fe951c1fd10
<snip>
Results of a clinical study published last month in the
Journal of the American Medical Association showed that
human growth hormone did increase lean muscle mass and fat
loss in test subjects, but that the gains were accompanied
by adverse side effects in nearly half the cases. The side
effects included pre-diabetes, diabetes, aching joints and
swollen tissues.
Dr. S. Mitchell Harman, director of the Kronos Longevity
Research Institute in Phoenix and an author of the study,
says he believes that medical science may someday be able
to take 20 years off your age. "But we sure as hell can't
now," Dr. Harman said. "Anyone who says they can is of the
P. T. Barnum school."
Dr. Tom Perls, an associate professor at Boston University
Medical School and director of the New England Centenarian
Study, hopes the human growth hormone study will be the
"death knell" for the hormone's use as an anti-aging agent.
"Before this, we didn't have that much armor to attack
these guys," he said.
But Dr. Ronald Klatz, president of the American Academy of
Anti-Aging Medicine in Chicago and a leading proponent of
human growth hormone, contends that the side effects of Dr.
Harman's study were hyped. He said they were a result of
doses of the hormone that were too big.
"They used inappropriately high doses that were two to
three times higher than they need to be for anti-aging or
rejuvenation purposes," he said. "With our lower doses, we
see almost none of these side effects; when we do, we
adjust the doses down and the side effects go away."
Dr. Harman responded: "You know, it is possible they are
right. Reduced doses and more frequent dosing could dilute
out the adverse effects and still produce some beneficial
effects. But the problem is, no one has studied this. There
are no data. There are just the anecdotal reports of these
clinics and the people they serve, or disserve, as the case
may be."
He added that he planned to propose that some of these
clinics allow him to study their patients to find out if
what they're doing really works. But he said he doubted
that the anti-aging doctors would cooperate. "They never
get back to me," he said. "They don't want to know."
Dr. Klatz responded with an unprintable expletive.
I'm
not sure how keen these dueling doctors may be on taking
advice from someone who flunked college biology, but here
goes: If there's any hope that this stuff can work at lower
doses, then stop fighting and get together and test it.
History is rich with stories of new ideas and treatments
that had a tough time getting past establishment
resistance. It wasn't so long ago that surgeons scoffed at
washing their hands before operating on people. The doctor
who linked blood levels of homocysteine to heart disease in
1969 was virtually booted out of Harvard Medical School
only to be proved right years later. The Atkins diet,
nearly universally condemned 25 years ago, now has a degree
of mainstream medical acceptance.
RAY OLSHANSKY, an epidemiology professor at the University
of Illinois at Chicago and a critic of anti-aging medicine,
said many doctors confuse the manifestations of aging with
aging itself. "Even if we cured heart disease, cancer and
stroke, we wouldn't have altered aging," he said. "The
cellular process of aging will continue and people will get
old and die. But research scientists are on track to alter
the biological rate of aging. We think it's going to happen
in our lifetime."
Professor Olshansky agreed that the dosage controversy over
the hormone should be tested using standard scientific
methods. "But the anti-aging proponents will be critical of
anything that comes up with conclusions that are not
consistent with what they're doing," he added.
I warned you that this was a nasty battle.
===============================================
Some additional links:
The JAMA article(abstract only)
Growth Hormone and Sex Steroid Administration in Healthy Aged Women and Men
A Randomized Controlled Trial
http://216.239.33.100/search?q=cache:yTAhWBpVoqkC:jama.ama-assn.org/issues/v288n18/abs/joc21207.html+jama+harman+human+growth+hormone&hl=en&ie=UTF-8
Conclusions In this study, GH with or without sex steroids in healthy,
aged women and men increased LBM and decreased fat mass. Sex steroid + GH
increased muscle strength marginally and O2max in men, but women had no
significant change in strength or cardiovascular endurance. Because adverse
effects were frequent (importantly, diabetes and glucose intolerance), GH
interventions in the elderly should be confined to controlled studies.
===============================================
Eureka review of JAMA article:
http://www.eurekalert.org/pub_releases/2001-11/aps-oao113001.php
Growth hormone, sex steroid combination 'not ready for prime time'
"This study makes the important point that because adverse effects were
common in response to growth hormone administration, individuals,
particularly those who are elderly, should not use hGH outside of
controlled investigational studies. Growth hormone has not yet been
demonstrated to be of clinical utility as an anti-aging intervention," said
Stanley Slater, M.D., deputy director of the NIA's Geriatrics and Clinical
Gerontology Program. "Nonetheless, there were significant changes in body
composition and cardiovascular endurance, which were augmented by the
addition of testosterone in men. This remains an interesting area for
further research."
===============================================
AACE Clinical Practice Guidelines For Growth Hormone Use In Adults and Children
AACE(American Asso of Clinical Endocrinologists)
http://www.aace.com/clin/guidelines/hgh.pdf
Side effects of GH treatment:
In the initial clinical trials composed primarily of adults with AO-GHD,
when starting doses of GH were higher than those now recommended, the most
common side effects were...
Of note, these symptoms most commonly occurred at the outset of therapy,
and most resolved within 1-2 months while therapy was continued...
GH induces transient resistance to the actions of insulin...
These Clinical Guidelines from 1998(9pages) are thorough and objective, but
would be even more valuable once they are updated.
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