"Every man [woman] is a builder of a
temple, called his body, to the god he worships,...
We are all sculptors and painters, and our material is our own flesh and blood
and bones."---Walden, Henry David Thoreau
I would like to introduce to you to one of the most beautiful women whom I
have ever had the pleasure to meet.
She's 91 years old, the only white woman who goes to her all African-American church, mother, grand-mother, great-grand mother (who out-lived two husbands). She's drilled for oil, lived in Mexico, started a school, let her favorite rooster sleep in the kitchen at night, collects beautiful art, makes tea for me, makes me laugh, and I love her.
The FDA thinks I'm trying to make her into a professional wrestler and had made it difficult for me to keep her out of the nursing home. Please let me explain.
This beautiful woman lives very close to me. I won't tell her name in case there might be some parasite that wants to take advantage of an older woman. But, she has given me permission to tell her story and even use her name. I'll call her "Treasure" instead.
A year or two ago, her neighbor asked her, "Who is that long-haired creep who comes your house?"
I usually give the long truthful version (Which is that many of my heroes had long hair: Spiritual: Christ; Physical: Tarzan; Writer, inventor, patriot who risked life for country: Benjamin Franklin; Artist, inventor, thinker-Leonardo da Vinci. My hair helps me identify with my heroes). But, the question was asked of Treasure with some disdain, so off the cuff, she replied, "That is my doctor, he has a friend who is dying with cancer and losing hair from chemotherapy, so he's growing the hair for "Locks of Love" to give to his friend."
I tell you this story just so you will see how quick witted and fun and beautiful she is. Did I tell you that I love her?
Anyway, back to the FDA worrying that I'm turning her into a professional wrestler.
About three years ago, Ms Moses had become so weak and unstable on her feet that she fell and broke her arm. One of her daughters asked me to look in on her. I did blood work that showed she had undetectable levels of testosterone and a very low growth hormone level. So, I started her on both. Within less than a month, she could walk with much more stability and the pain in her back was gone.
I treated her in this way up until a few months ago when she came off of the growth hormone and testosterone. Her daughter called me again to tell me that she was having back pain and trouble walking again. I had quit going for tea and she had quit taking her medication (I had been delivering the testosterone shot and drinking tea every three weeks and her daughter had been giving Treasure the growth hormone injections).
So, I went back to her home, told her how sorry that I was that we lost contact, collected the best hug of the week, gave her a testosterone shot, started her back on the growth hormone and by the end of the week, she was free of pain and out of the bed more.
Here's the catch, growth hormone is the only drug--the only drug-- that a doctor can go to prison for writing the prescription for "off label use." Off label means giving the drug for something other than for which the research has been done to the point that the FDA awards the indication. Hundreds of drugs are used off label. Seizure medication is used for migraines, anti-depressants are used for sleep. The list goes on and on (here's a recent New England Journal article about off label drug use).
It is actually good medicine to write off label. Often the drug companies realize their drug is useful for a second disease (one other than the one for which the drug was initially approved). But, to do the research to get the FDA to give the approval for the second disease can cost many millions and many years, so doctors will do research to prove the usefulness and then start using without the FDA nod of approval-- that is what off label means.
It gets more complicated with growth hormone. It is very plain that growth hormone improves strength and helps healing. If you are wrestler or baseball pitcher making 10 million a year, a week off from work or having to change careers can be expensive. So, they use growth hormone. Who gives a rip (really). No one, not one person died last year from using growth hormone. Many thousands died from bleeding ulcers from aspirin. Many will go on dialysis from Advil and Tylenol. Many will have liver failure from their cholesterol pill. Not one person died from growth hormone. But, thanks to all the hype about the wrestlers, I now risk going to jail for giving Treasure growth hormone (does she really care about long term effects and do we really worry about her committing mass murder?)
But, even if throwing a ball fast is not reason enough to use growth hormone, I think staying out of the nursing home is a good reason. I want Ms Treasure to make me tea and make me laugh so maybe I'm being a little selfish here (I do love her after all). But, if I give her growth hormone without proving that she has growth hormone deficiency, then I risk going to prison or losing my license to practice medicine or both.
Keep in mind, that very good research proves that raising growth hormone levels improves strength, lowers cholesterol, improves the brain, improves mood, works better to improve bone mass than does the leading prescription drug for osteoporosis (and that drug is know to increase the risk of cancer while the best studies on growth hormone show that it decreases cancer risk). But, to complicate matters even more, there is much debate about how to make the diagnosis of growth hormone deficiency. I consider symptoms and a low IGF-1 on an age adjusted level to be sufficient. But, the FDA and the medical board wants a failed stim test (stim for iv medications used to stimulate the pituitary glad to produce growth hormone). Even though, the whole country of Australia no longer requires the stim test, even though it is known to be unreliable, even though there is wide disagreement about how to interpret these tests.
So in short, the FDA and most endocrinologist in my state agree with the local lead endocrinologist at the university near me who told me, "I agree there are people with low growth hormone levels. But I do not know how to diagnosis them and so I do not write prescriptions for growth hormone."
And who can blame him when writing the prescription can land you in jail.
Last month I was at a seminar in Salt Lake city for a literature review of the risks and benefits of growth hormone. The research is overwhelming that the benefits are amazing and the risks are less than most blood pressure pills. This month I will be in Orlando for a seminar by a physician who won his case (after being arrested and having his office and home searched for writing prescriptions for growth hormone).
All that when a certain scientist was excommunicated and dammed to hell by the catholic church for suggesting that moons revolved around Jupiter, when a physician was kicked out of his hospital for suggesting that the obstetricians wash their hands after delivery babies (at that time a bloody lab jacket was sort of a badge of honor), when these people risked all for what they saw as the scientific truth, they were doing no more or less than do I when I write a prescription for Treasure to keep her out of the nursing home.
In December of 2007, the Alabama Board of Medicine published a position paper that said I must do a stim test to prove that my patients who are on growth hormone need it. So, after getting Ms Treasure feeling well, I had to ask her to stop her medication for a month so that we can to the stim test.
The question is, What do I do if she passes?
Today, I spoke with a retired surgeon who is my patient. When he came to me he was treating his depression with an anti-depressant. After I replaced his testosterone and growth hormone, he no longer needed the anti-depressant. But, he said, "when i was treating the depresison with the ant-depressant, i was a zombie. When I treat the depression by replacing growth hormone and testosterone, I feel great, want to sell real estate (his retirement hobby) and want to have a relationship with a woman).
I did a stim test and he failed (thank goodness) so i was able to restart him on growth hormone. But during the time that he took off from the growth hormone, the had to go back on the anti-depressant.
Not sure where all this is going. I have three people over the age of 80 who are now active and off their cane or walker after giving them growth hormone. Why should an 80 year old not have the benefit of strength and energy that the professional ball players have enjoyed. At a time when it is considered acceptable to gastric bypass surgery which kills 1 in 100 of the people (in the hospital when have the surgery--not counting the increase in suicide rate documented a few months ago in the New England Journal). At a time when you will not lose your license for changing a man into a woman and then giving her/him hormones to maintain the sex change--is it really a crime punishable by jail to give a man testosterone to make him more of a man or to give an older woman testosterone to help her stay active (even sexually) if she wants)?
Here's to you, Ms Treasure. I love you. The moons really do go around Jupiter and you will stay out of the nursing home as long as possible.
Peace & Health,
