Selling the Promise of Youth
COVER STORY
By ARLENE WEINTRAUB
The anti-aging industry is offering a dizzying array of hormones and supplements. Business is booming. But some remedies are risky, and the benefits are unproven.
As Dr. Ron Rothenberg bursts through the door of his anti-aging institute in Southern California, a cell phone pressed to his ear, his nurse warns him of the busy day ahead. There will be four-hour consultations with each of three prospective patients, she says. They're all coming to hear the 60-year-old Rothenberg's pitch about how his tailored regimens of diet, exercise, and hormones will make them feel younger and live longer.
In between the meet-and-greets, Rothenberg catches up with patient Dr. Howard Benedict, a retired dentist. The two men met in 1999 and became friends while surfing at Cabo San Lucas, Mexico. Rothenberg put Benedict on a $10,000-a-year regimen of 30 vitamins and supplements, plus testosterone gel and injections of human growth hormone. Benedict says his arthritis pain has eased so much that he rides his bike and surfs for hours at a stretch, after sucking down a huge protein smoothie he learned to make from Rothenberg's in-house nutritionist. "Those other guys my age, they're only out there surfing for a half-hour," says Benedict, 61. As a sly smile creeps across his face, he adds: "I feel like I'm 20 years old with my wife. It's just amazing."
For Rothenberg, this is a typical day at the California Healthspan Institute in Encinitas, which caters to patients eager to slow down the inevitable march toward Metamucil mornings and Viagra nights. As 77 million baby boomers approach retirement, the relatively new field of anti-aging is racing to keep up with them. Anti-aging medicine goes way beyond Botox, Retin-A face creams, and medical spas that offer plastic surgery and laser-based cosmetic procedures. In fact, only a small portion of what these new medicine men and women do is aimed at making patients look younger. Instead, anti-aging doctors seek to turn back the internal hands of time by prescribing megadoses of supplements that they believe prevent the body's organs from deteriorating and dying. In addition to hotly disputed biologic drugs such as human growth hormone (HGH), there's an alphabet soup of supplements that includes DHEA, antioxidant vitamins C and E, glucosamine, Omega-3, and more. Women have been consumers of hormone replacement therapies for decades. Now men are also being primed to view middle age in terms of male menopause, sometimes called andropause. That's one reason more patients than ever are starting to gobble up the anti-aging promise.
Controversies
The movement even has its own professional group: the American Academy of Anti-Aging Medicine (A4M), which issues a certification to doctors who want to hang out a shingle in this field. A4M sponsors conferences, sells books and DVDs about anti-aging, and serves as a general clearinghouse of information for patients looking for the nearest clinic. It also waves around research showing that the industry pulls in $56 billion a year now -- and that number could swell to $79 billion by 2009. The promise A4M and its members dangle before patients is summed up perfectly in the title of Rothenberg's self-published book: Forever Ageless. According to A4M, 1,500 doctors have sought board certification in anti-aging medicine since 1996. Rothenberg, who has about 300 patients, was No. 10 on the list, and he's proud of his status as a pioneer. "We're reversing the aging process and improving quality of life," he says. "I see it every day."
Rothenberg and other practitioners in the field have precious little scientific data to back up their claims that the potions extend life. But they insist the regimens will guarantee what Rothenberg calls "rectangularization" -- years of healthy living followed by a short, acute decline, as opposed to a slower, triangle-like descent toward the grave. As Rothenberg puts it: "Rather than spending a few years in a nursing home, why not fall apart fast and die?"
The anti-aging movement is barely one step ahead of the controversies it has spawned. Many of the dietary supplements these physicians recommend are not regulated as medications by the Food & Drug Administration. That means the products don't go through the rigorous safety and efficacy testing that most prescription drugs face. Furthermore, some hormone products prescribed by anti-aging physicians are made by specialized pharmacists who, detractors say, may not be adhering to the same FDA standards of consistency and purity as mass-market drug manufacturers. The anti-aging arsenal could swell substantially in coming years as a whole complement of experimental biotech drugs comes on stream.
Rothenberg points to himself as proof that anti-aging medicine works. A former hippie, he earned an M.D. at Columbia University. He practiced tropical emergency medicine in the Amazon, then returned to the U.S. and taught seminars on the subject at the University of California at San Diego, where he is still on the faculty. (He was also the local rattlesnake expert.) He first started injecting himself with HGH about a decade ago. Having just passed his 50th birthday, he felt off his game -- tired, disengaged with his patients at his San Diego practice, and less lively on his surfboard. "I was losing my edge," says Rothenberg, who, with his rapid-fire speech and easy laugh, bears more than a passing resemblance to the comic actor Gene Wilder. "I was losing my memory. Libido-wise, it was take it or leave it." Today, with a regimen that includes supplements and testosterone, he has enough energy to run his practice, train other anti-aging physicians, and even work once a week as an emergency room doctor.
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Anti-aging doctors often prescribe vast quantities of alternative treatments to halt the cruel march of time. But critics are concerned about many of the things these physicians promote. 
