Forever Young

With the burgeoning of the `anti-aging' industry, many people are convinced they are on the way to discovering the fountain of youth. Is this a legitimate medical option, or a fraudulent means of deluding people, which may even be hazardous to their health?

Dr. Rani Weissbort sits among plastic bags scattered on the desk and floor in a clinic overlooking the upscale Kikar Hamedina square in Tel Aviv. The bags contain boxes of vitamins and medicines that are purported to aid man in realizing one of his oldest dreams: to slow down or stop the aging process. The boxes bear stickers of the Multidiscipline Medical Center in Tel Aviv, an institute that offers anti-aging treatment, where Weissbort was employed until a few months ago.

Weissbort is one of the Israeli physicians who has been certified by the American Academy of Anti-Aging, which deals in treatments to delay aging or restore youth. About five years ago, he relates, when he returned from the United States, the critics called him a "specialist in total charlatanism, who promises things that have no foundation." However, he now says proudly: "They had to eat their hats."

According to Weissbort, the treatments bring about "a slowdown in the aging processes, like seeing a goal in playback and turning back the biological clock. It is possible to be younger and improve the immune system and enhance sexual ability, frequency and desire."

Weissbort specialized in pathology. In 1994, the Health Ministry looked into complaints about prescriptions he allegedly issued contrary to the Drugs Ordinance, but the investigation did not turn up any grounds for taking disciplinary action against him. He went to the United States and returned as a specialist in the restoration of youth. In his temporary clinic, he offers his patients a homeopathic spray of growth hormone and injections of Gerovital, a product that includes Novocain, which is used in dental procedures to reduce discomfort.

The growth hormone, which is produced naturally in the pituitary gland, regulates height in children. Its rate of production decreases gradually from the end of puberty. In 1998, Israel's Ministry of Health barred the use of the growth hormone for the purpose of restoring youth, on the grounds that no authoritative scientific proof existed for its effectiveness or safety. This does not deter Weissbort from recommending to his patients that they purchase a growth hormone abroad and inject it into themselves.

`Prestigious' treatment

Before the interview, an elderly Alzheimer's patient and his daughter emerged from Weissbort's office. The daughter said that her father has been treated "successfully" by the doctor for some years. However, she also explained (at her initiative) that the effects of the treatment were not apparent because her father had stopped seeing Weissbort in order to take part in experimental treatment elsewhere. At the same time, she also found it difficult to remember the name of the medicines or preparations her father received; nor could her father himself say anything about the treatment being administered by Weissbort.

In this case, obviously, anti-aging treatment did not sharpen the memory. Patients pay between NIS 20,000 and NIS 40,000 for a half-year series of treatments. The physicians, for their part, do not always remember to tell the patients that the health authorities in both Israel and the U.S. have not authorized or recommended some of the treatments they offer. Many patients receive medicines without a "consumer's guide" - mandated by law - that describes the drugs involved and explains possible side effects. Nor do they receive information to the effect that there is insufficient scientific proof of the effectiveness of the treatments, and worse: that there is no proof that the medicines are not dangerous.

Hundreds of Israelis have received anti-aging treatments at private medical centers in recent years. Few of them are willing to talk on the record about the treatments, even though they are considered "prestigious." Among the few who do not hide the fact that they are getting such treatments are broadcaster Eli Yisraeli, fashion designer Tova Hassin, best known as "Tovaleh," and entertainer Nancy Brandes. Hassin and Brandes also advertise one of the institutes in a barter deal: treatments for commercials.

Brandes, 53, was placed on a regimen of vitamin pills and hormones for a year and a half by Weissbort, and today is a patient of Dr. Jacob (Jackie) Sarov at the Multidiscipline Medical Center. He admits that the bottles of vitamins he was given did not come with an explanatory leaflet for consumers. He also receives hormonal injections.

"The treatment did not make me any younger," he says, "but I feel fit and everyone I meet compliments me on how wonderful I look." Brandes says that in addition to the drugs and vitamins, he changed his lifestyle and now works out and tries to avoid sweets.

Tovaleh, 56, is also an advocate of anti-aging treatment. She has been receiving treatment for the past six months from Sarov, who she had known beforehand as a family doctor. Sarov is of the internal medicine emergency department at Ichilov Hospital, and their acquaintance deepened when she did community service work in his department - the punishment meted out to her after she was convicted of a serious tax-evasion offense.

She, too, is receiving Gerovital injections, a growth hormone and vitamins. The treatments, she says, have not restored her youthful appearance, but have given her "a new feeling of tranquillity and vitality. I feel better physically, my walk is younger and I get up better in the morning." Tovaleh "doesn't know exactly what" she is taking, but does know that she is getting drops of a homeopathic growth hormone (even though she does not believe in homeopathic medicine, she says), and a monthly injection "to improve the memory." In addition, she says, for years, she has been walking eight kilometers a day and swimming.

Banned by the Health Ministry

It would be natural for physicians who are experts in hormones and old age (specialists in endocrinology and geriatrics) to offer treatments aimed at restoring youth. However, most of them keep their distance from this field. Indeed, some are highly disparaging of it and very critical of the treatments that are offered. That does not stop a few physicians who are employed in the established health system from giving extracurricular anti-aging treatments to private patients. One of these is Sarov. Another is Dr. Alexander Arditi from the nuclear cardiology unit at Kaplan Hospital in Rehovot. Dr. Michael Golan, a heart surgeon who also works at private hospitals, offers anti-aging treatment, too. The most famous of this group is Dr. Rafi Carasso, the director (currently on leave) of the neurology department at Hillel Yaffe Medical Center in Hadera. Carasso is also a professor of psychology and a senior associate lecturer in the faculty of medicine at the Technion - Israel Institute of Technology in Haifa.

In his book "Anti-Aging," Rafi Carasso notes that many famous people were treated for years using various means that were purported to prolong their lives - among them were Charlie Chaplin, Winston Churchill, Charles de Gaulle, Dwight D. Eisenhower and Nicolae Ceaucescu. "Rumor has it," he adds, "that David Ben-Gurion and Golda Meir received life-prolonging treatment from Prof. Paul Niehans, a Swiss physician who injected his patients with fetal cells of sheep." In the 1970s Niehans opened a clinic in Herzliya where Carasso also worked. According to Carasso, the clinic was closed "for economic reasons."

The growth hormone is the great hope of rejuvenation treatment. Products that contain the hormone, via injection or spray, claim to fulfill the age-old desire to stop the aging process, but are not given within the framework of public medicine. These products, along with Gerovital injections and other hormones (such as the melatonin hormone) are at the heart of the medical and ethical dispute over anti-aging treatments. The other treatments and tests that make up the anti-aging basket - such as periodic medical check-ups, guidance in maintaining physical health and a proper diet, and use of vitamins and preventive medicine - are accepted by physicians as measures that can be useful in blocking or diminishing illnesses and in generating a good overall feeling. Those treatments, however, are available at the health maintenance organizations (HMOs) and cost a fraction of the treatments that claim to rejuvenate people.

Weissbort says he recommends that "everyone" be injected with growth hormone, but adds, "because Israel is the only stupid country that still prohibits the injection of growth hormone for anti-aging," he is forced to make do with supplying the homeopathic spray. Health authorities in Europe and North America may not have prohibited the use of growth hormone to prevent aging, but they have certainly not permitted it. That loophole is being exploited by physicians in a number of Western countries, notably the U.S., in order to use growth hormones in the treatment of wealthy seekers of eternal youth, who pay tens of thousands of dollars to make the dream come true.

In Israel, the Health Ministry permits and underwrites the injection of the growth hormone in the treatment of children who are suffering from growth disorders of various types. Beginning last summer, the ministry also sanctioned such injections for adults (usually up to age 30) who have been diagnosed with a severe growth hormone deficiency, such as may occur after an operation in which the pituitary gland is removed.

An initial discussion of the subject was held in Israel in 1998 following a report in the weekly women's magazine La'isha to the effect that a clinic in the Sheba Medical Center at Tel Hashomer, a government-owned hospital, was planning to offer anti-aging treatments, which would include use of growth hormone. The treatments were to be administered by senior physicians, such as Dr. Shlomo Segev (who joined the program, he said, because he knew "rich people"), and Prof. Avi Karasik, head of the endocrinology department at Sheba. At the same time, Dr. Ze'ev Rothstein asked the Health Ministry, on behalf of Sheba, to approve the use of a medical preparation that contains growth hormone and is intended for "adults who have deficient hormone secretion."

The Health Ministry learned about the true purpose of the hormone's use only from the article in the magazine. In the wake of this, Prof. Gabi Barabash, who at the time was director-general of the ministry, set up a committee to examine the matter headed by an endocrinologist, Prof. Shlomo Glick, who is today the ministry's ombudsman.

Karasik explained to the committee "his program for the controlled use of growth hormone to treat the elderly." According to Karasik, scientific data existed showing "a strong correlation between growth hormone deficiency and aging." He added that a demand for the hormone had developed among the aged, first in the U.S. and later in Israel. Karasik urged the committee to authorize the use of growth hormone for older people who were healthy "following a series of tests and accompanied by monitoring" of those who would receive the hormone. "If a responsible academic institution does not provide growth hormone," he said, "centers are liable to be established that will provide it without control and supervision." The cost of the treatment would be borne by the patients, Karasik proposed.

The committee was not convinced. "The treatment has not been proved to be effective," the panel's report stated, adding, "it is not desirable to give treatments with a medicine that has yet to prove itself in reliable studies and regarding which the relationship between usefulness and harm is unknown. That would be an undesirable educational message." The Health Ministry's final decision was "to prohibit the use of growth hormone as an anti-aging preparation." That ban still stands.

Still, a number of physicians in Israel offer healthy patients growth hormones, albeit in minuscule amounts, in the form of a mouth spray rather than as an injection, as is the practice in the U.S. A Health Ministry spokesman states that medicines for anti-aging treatment "have not been approved as such by the Health Ministry" and that "growth hormone was not approved for this use even in the U.S."

What about the homeopathic spray form of growth hormone treatment? Physicians maintain that the spray "ostensibly stimulates growth hormone secretion," the Health Ministry notes, "but to the best of the knowledge of Glick, the ombudsman, that statement is unsupported."

Dr. Michael David, deputy director of the medical administration department in the Health Ministry, says that the effectiveness of the anti-aging treatment has not been proven, and that the professional literature on the subject is meager and not serious. The preparations currently in use for this form of medical treatment have not been submitted to the ministry for professional examination, he says, nor does the ministry supervise the clinics that offer such treatment.

Bottled gold

V., a 70-year-old lawyer from Jerusalem, was treated, beginning in August 2000, by Dr. Michael Golan at the Multidiscipline Medical Center. "Old age is frightening," he says. "You get up in the morning and your whole body hurts. The appetite declines, sexual prowess decreases, there are black spots on your face and your memory plays tricks."

V. paid NIS 22,000 (after a reduction of 10 percent, on the basis of an agreement between the medical center and the Israel Bar Association). For his money, the lawyer met with Golan every month for brief sessions and was given injections of Gerovital (which, V. was told, are meant "to improve the state of mind and slow down aging") every six months. He also received six bottles of diluted growth hormone spray and a few types of vitamins.

In his first meeting with V., Golan checked the patient's blood pressure and examined the results of the blood and urine tests he had done at his HMO. V. says that he was told the following: "We will bring about an increase in your growth hormone. We cannot only delay aging processes, we can also turn you back five years; you will feel that you are 65." V. says it was also suggested that his sexual performance would improve and he was told, he says, that his penis might be enlarged.

Golan denies that he spoke to V. about enlargement of the penis.

In the course of the treatments, V. lost weight and began an intensive program of physical activity - which in themselves made him feel better, he says. Following half a year of treatment, however, V. says that he felt he had been duped and that the treatments did not help. "It was a case of self-delusion," he says. "My doctor at the HMO told me that my skin looks better, but for that I use ointments every night." V. maintains also that at one of their sessions, Golan suggested, as part of the program to preserve his health, that he do a cardiological catheterization, "because sometimes we find out what's happening by means of that procedure."

V. was taken aback when he lost his bottle of growth hormone spray and was asked to pay NIS 1,200 for a new bottle. He then discovered that via the Internet, he could purchase the same spray from the U.S. for $84, about a third of what he was being asked to pay in Tel Aviv. At the last meeting, he says, Golan urged him to continue the treatments for another half-year cycle. After he complained to the center's financial director about the high cost, V. was offered a price of NIS 13,000 for the treatments - about half the regular amount - but he decided not to continue.

The director of the center, Yaakov Azariya, said that V.'s case was "puzzling," as the relationship that had developed between him and Golan had gone beyond that of doctor and patient, and reached a level of personal friendship. According to the center, V. had reported "improvement in sleep, in sexuality, sexual functioning and general functioning. The claim about a promise to enlarge the penis is silly."

Golan recommends that treatment be started from age 30 till 120. It includes, he says, prevention of illness, body maintenance and "sending the body back in time."

The Multidiscipline Medical Center asked seven of its patients to speak to Ha'aretz in praise of the treatment they received. Some of them were far more restrained and hesitant than the physicians in expressing their feelings about the treatment. A few reported that parallel to the anti-aging treatments, they changed their nutrition and physical activity habits, so that it was impossible to know what had brought about the improvement in their feeling.

Z., 58, a senior figure in the economic field, has been treated since last August by Sarov at the Multidiscipline Medical Center. He was initially treated by Rafi Carasso, but says he had the feeling that Carasso did not have enough time to devote to him. He says that he paid Carasso $4,000 for a year's worth of treatments that included examinations and vitamins. Z.'s treatments include injections of Gerovital, growth hormone spray and dietetic advice, and costs NIS 20,000.

Z. says that even before he started the treatments he was aware of proper nutrition and that his blood tests were reasonable, but since then, he has felt less ill. In addition, his hormone level has improved, he says: "I am 58 and I don't have time to wait until the research proves [the benefits of] the treatment. It's true that there is a problem here with the safety of the materials. I consider it a low-risk, controlled experiment."