Cenegenics 2006 Las Vegas Review-Journal Article

IN DEPTH: Hormone therapy: CENEGENICS: Pioneering treatment or expensive quest for fountain of youth?

Anti-aging movement captures imagination; some say treatment unproven, not necessarily safe

Dr. Alan P. Mintz gets plenty of publicity, but his best advertising is his own body. At 67 years old, Mintz charges around with the energy of a man decades younger. At an age when most people have retired, the Las Vegas physician is leading an anti-aging medical movement that has captured the imagination of many of his and even younger generations, as well as a growing number of medical peers.

Some physicians, however, say the hormone therapy driving the trend is unproven, expensive and not necessarily safe.

Mintz's Cenegenics Medical Institute in Summerlin is popping up in magazine articles every few days. Mintz said an article on hormone therapy in the January issue of GQ, which prominently mentioned the institute, produced more than 1,000 phone calls and 100 patients in four business days. The institute has been featured on several national television shows. A Google search of the Internet produces 33,000 documents mentioning the trademarked term.

The man behind it still hits the gym regularly and, without a shirt on, shows off arms like Popeye's, corded with bulging veins. Like others in his operation, he has been a successful competitive bodybuilder.

On a business day, however, he sits in an office that resembles a starship bridge, surrounded by large video screens on which he can call up, at a moment's notice, visual displays to answer any question about Cenegenics. He plays the consoles as competently as an adolescent video game freak, but instead of car chases and virtual explosions, the screens burst with statistics and graphs.

The key chart is one of the simplest: A line graph with the horizontal axis representing age and the vertical one representing physical well-being, descending from "fun" through "function" and "frailty" to "failure." A line on this graph, representing a typical person's life, makes a gradually increasing curve, almost level for two or three decades then starting downhill about the 40s, coasting down the long slope to oblivion by the age of 100.

Many years of that downhill curve are spent in the no-fun lower reaches of the chart, characterized by heart ailments and loss of bone density, walkers, wheelchairs, and adult diapers. Another line on the chart represents the potential of life for the age-managed patient. It ends the same place as the other line -- dead by 100 -- but is a more square-cornered curve; it doesn't drop from the "fun" zone to mere functionality until about the 80th year.

"We're about squaring that curve," Mintz said. "We're all gonna die, we need to make room for the next generation.

"But how about quality of life? Right now life expectancy for women is around 80, men are around 77 or 78, and increasing. Our patients are proving to us that we're going to make it maybe into our 90s in very good shape," he said.

"Next year does not have to be worse than this year. If we call it squaring the curve, instead of sliding downhill, what if we maintain a high level of functionality, our brain working, our body working, good sexual activity -- not like 25-year-old guys having sex four times a day, but how about good sexual activity with your loved one once a week, twice a week, feeling good about it?"

However, asked how what is actually measured to plot the course and slope of those lines, Mintz admits that nothing was measured. "It's not a scientific graph."

In other words, it's an aspiration presented in the format normally reserved for measured results.

That said, who would argue with the aspiration?

Mainstream medicine, Mintz said, still focuses primarily on treating the sick. Cenegenics, and most of the anti-aging movement of which it is part, focus on preventing illness. "We'd rather have you come in still healthy and maybe spot some warning sign that lets us fix something before it's really broken."

For instance, he said, "We can look at people and predict a tendency to have a heart attack with a high degree of accuracy. Chronic inflammation, which is easily measurable, is generally ignored. In the literature is substantiation that early inflammation is a root cause of both cancer and heart disease. Whether it's mild liver inflammation, bowel inflammation, arthritic inflammation," he said.

"And with simple things like fish oils, we can correct that inflammation before that heart attack develops. Most kinds of inflammation can be alleviated if not eliminated." Such remedies are also well known, he said, but they're never applied in the lives of most people.

This is as much the patient's fault as traditional medicine's, he suggested. "If you take your car to a gas station and it's a quart low on oil, you put that quart in it, and you don't even question it. But if it's their body we're talking about, most people wait till the red light comes on."

Much of the program is teaching people to figuratively check the oil and be careful what kind of fuel they're putting through the engine, something even the most traditional physician would endorse. Another aspect of the program is providing the client, for a healthy price, an extremely sophisticated initial evaluation and unlimited access to his physician's time and attention.

A third aspect, and the most controversial, is a regimen of hormone therapy, which Mintz says is prescribed for a substantial minority of the clients.

An initial appointment at Cenegenics Medical Institute is a six-hour affair, and, according to Mintz, each doctor sees only one new patient a day. The customer's blood tests have been done before he arrives, sometimes using samples that were drawn by a technician sent to the customer's office or home. Patients show up at a Rampart Boulevard building that looks like an antebellum Sou thern mansion and access the second-floor consultation rooms via a wide marble staircase resembling those descended by sorority girls at cotillion balls.

In the offices clients undergo a variety of tests using specifically designed equipment. They lie in a specialized X-ray machine that measures muscle-to-fat ratio and bone density. On equipment resembling a Dance Dance Revolution arcade game, they hop from one colored circle to another testing agility and how fast their bodies can stabilize once they've moved. They lift weights to determine general muscle strength and tone.

When it is necessary to wait between stages, they don't do it on an examination table covered with uncomfortable waterproof paper, but each in a comfortable private sitting room that resembles the breakfast nook at a high-end hotel. They're served lunch there -- a tasty but utterly healthy meal of the kind Cenegenics wants them to eat routinely. There is a consultation with a physician, which lasts until neither party can think of anything else to say or ask, usually about two hours.

Somebody typically pays about $2,000 for this first visit, and the somebody is very, very rarely an insurance company.

"We don't bill insurance but many times (clients) get some coverage after the fact. Insurance companies usually aren't interested in any three-hour doctor visits," Mintz said. "Some corporations are beginning to recognize that it is in their interest to maintain their executives' health."

Additional diagnostic procedures include the disease risk profile at $495; the neurological chronometric assessment to determine risk of Alzheimer's disease and suggest risk-reduction therapies, at $495; an oxidative stress/anti-oxidant profile which gathers the information a physician will need to recommend appropriate doses of specific vitamins and minerals, at $995.

"There was a lot of upselling, but I didn't get involved with that," said one patient of several years ago, who asked not to be identified. "I got probably the cheapest package you could get at the time, about $1,700. They tested my whole body, much more detailed than you would get at a regular doctor, and they gave me prescriptions for hormones that other doctors, not connected with them, have said were right on the mark." She doesn't go to Cenegenics anymore, but still uses the same hormones.

After the initial visit, cost of ongoing treatment varies considerably with the patient. "I would guess our average patient spends less than $500 a month with us," Mintz said.

"We look at it and obviously most patients look at it as an investment in productivity, because nothing is more counterproductive than being sick." A good lawyer who avoids only three or four hours of unbillable sick time, Mintz figures, is money ahead for the month.

"We give doctors a discount, but with 25 percent of our patient population being doctors, we couldn't discount it too much," Mintz said.

Everybody gets dietary training, which varies from conventional wisdom not only in subtle detail, but perhaps more important, in the amount of time spent teaching the patient how to decide what to order in a restaurant.

The recommended diet minimizes artificial fats, such as margarine; excess sugars; and foods that are converted to sugars. "Fasting insulin levels and hemoglobin A1C, a long-term measure of blood sugar, are better predictors of heart disease than cholesterol, but most doctors don't look at that," Mintz said.

Vitamin and mineral supplements are recommended for every client. "The soil has become so depleted that it's no longer practical to depend on getting all the necessary nutrients in food alone," Mintz explained. The institute recommends using only its own line of supplements.

Everybody is put on an exercise program, if not already in a suitable one. Many patients are treated by lifestyle adjustments alone, Mintz said, but some hormone therapy is recommended for perhaps 30 to 35 percent. Most of the men in that group receive testosterone, DHEA, thyroid, and human growth hormone (HGH). "For women, it's usually the same four plus estrogen and progesterone, which serves to balance the estrogen that regulates a woman's cycle."

Mintz's writings say 15 years of widespread research into HGH was touched off by the late Dr. Daniel Rudman in 1990 when he published a pioneering study in The New England Journal of Medicine. For six months Rudman injected HGH into 20 men over the age of 60, and found four reversals of the symptoms of aging: a 14 percent average decrease in body fat, an 8.8 percent increase in muscle mass, and increases in skin thickness, and lumbar spine bone density.

Further studies, Mintz claims, have suggested that HGH can decrease skin wrinkling, decrease LDL (the "bad" cholesterol); improve immune function, increase aerobic activity, decrease diastolic blood pressure, increase blood flow to the kidneys and improve the patient's mood.

Both men and women report benefits in his own practice. At least one study suggests that a hormone called IGF-1, which the body makes from HGH, is associated with greater risk of prostate cancer, but Mintz said at least three studies indicate no such connection. He deems the risk unproven, and if real at all, small and acceptable.

HGH is injected six mornings a week with a 3/8-inch, 30-gauge needle, a size so small the business end resembles a stiff human hair, and sometimes isn't even felt by the user. However, it must be injected, Mintz said, because HGH taken orally or otherwise will be broken down before the body gets to use it. The forms typically sold on the Internet are therefore worthless, he warned.

Because of manufacturing costs and patent protection, effective HGH therapy costs about $500 a month.

Testosterone and DHEA, though considered male sex hormones, have other functions and are found in women as well. Mintz admits DHEA is tricky to use, particularly in women who have not yet undergone menopause, and should only be administered by physicians specifically trained in hormone modulation.

Properly used, Mintz said, DHEA increases lean muscle mass, decreases fat mass at least in males, and increases the patient's sense of well-being.

A study published in 2003 in the Journal of the American Medical Association showed testosterone to increase lean body mass and muscle strength in men, and to reduce body fat, though it did not do the last as well as HGH. Other research, Mintz claims, indicates testosterone therapy helps maintain bone mass in aging men and women.

Most males who take testosterone supplements experience increased sex drive. Some verbally report better erectile function, though clinical studies have not confirmed it. Testosterone therapy can have negative side effects including acne, crabbiness, and increasing a related hormone associated with enlarged prostates and male pattern baldness, but those symptoms are controlled by dose reduction; however, the patient must be monitored closely.

Estrogen therapy is well-known and popular with women following menopause but received a black eye in 2002 when a study was publicized associating orally administered estrogen with increased risk of breast cancer. However, Mintz said that the Cenegenics program has avoided that pitfall by using only natural estrogens, which can be taken as a cream, gel or patch instead of orally.

Others question the validity of anti-aging hormone therapy, and particularly using HGH for that purpose. One is Dr. Andrew Weil, director of the program in integrative medicine at the University of Arizona and author of several popular books on health, including "Healthy Aging," published in 2005. Weil was critical of the anti-aging movement in that book and specifically critical of HGH therapy in an interview for this story.

"The recommendations made by anti-aging enthusiasts are based on a very small clinical trial. There is no evidence that (HGH therapy) extends life. It has some beneficial effects on body composition. And we do not know the long-term safety profile. In general there is a lack of scientific evidence for the claims they make for it."

If it's ever to be accepted by mainstream medicine, Weil said, "It needs to be tested in a larger population."

Simply using HGH in anti-aging practice, Weil said, doesn't meet the standard that other modern medical treatments normally do. "The way they are using it does not constitute clinical trial," he said. "There's no placebo control, no randomization, no double blinding."

Drug therapies are normally tested, he explained, by randomly assigning subjects to receive therapy with the real drug or a placebo -- an inactive substance represented to be the real drug. And the studies are supposed to be double-blind, meaning that neither experimenter nor subjects knows whether a given subject is receiving a placebo or the real McCoy.

"I think there are far more intelligent ways to preserve one's health that have to do with diet, stress reduction, use of dietary supplements, physical activity," Weil said.

Mintz said more than 1,000 Cenegenics patients are themselves physicians. "A subset of those, perhaps 400, have gone through our training, and most of those go through the AMA accreditation procedures and become certified in age management medicine."

Most of the latter subgroup, Mintz said, become Cenegenics affiliates. "It doesn't cost them anything but they work with us to make sure their patients are getting the right kind of therapies; they can tap into our database of experience, and they can use our physicians as references. About 100 physicians are now active this way; these are the people we're in contact with every week."

Cenegenics Institutes are also located in Tokyo, Seoul and Hong Kong, and one is planned in Charleston, S.C.

The Institute's sales pitch to physicians, who are considering taking training there, emphasizes high profits along with the benefits to patients.

Mintz and the institute's medical director, Dr. David Leonardi, co-authored a paper called "Combating the Symptoms of Aging, From the Inside Out; An Introduction to Anti-Aging Medicine for Practitioners of Aesthetic Plastic Surgery." One of its main points: "Repeated visits to the office for evaluation and adjustment of anti-aging therapies creates a sense of comprehensive care related to keeping the patients healthier and gives the doctor access to the patients, allowing them to be introduced to additional services and products."

Doctors studying family medicine at the University of Nevada School of Medicine residency program all visit the Cenegenics Institute. "I have my residents spend half a day there seeing their business model," said Dr. Thomas Hunt, chairman of the three-year residency program.

"Part of their training is in management; they get about a month of that training altogether. More and more doctors are going to a boutique practice or a unique practice. ... I am not training them to be Cenegenics doctors, but I want them to know that there is a model out there of a practice that serves people who don't mind spending money and will really work to take care of themselves," Hunt said.

The institute has generously supported the school with contributions to the resident education fund, which allows residents to attend meetings and conferences, Hunt added. One of the Cenegenics doctors, Alvin Lin, is on the faculty part time. "He's a board-certified family physician with a good reputation, who speaks on a national level, and he teaches family medicine here," Hunt said.

"He excels with using hand-held technology to improve patient care. For instance, a PDA (personal digital assistant) has many uses in patient care. A lot of people are still using paper charts, and could be doing something better."

The program's high cost to patients, incidentally, may be partly responsible for its anecdotal success, theorizes Dr. Jeffry F. Life, a physician at the institute. "It's true that if you just do the hormones and don't do the rest of it, you're not going to reap the full benefit," he said.

"But most of my clients really do watch their diets, and we monitor them pretty close for blood sugar and so forth, and really stay on them about it. Most of my clients do go to the gym -- I would say two-thirds of them.

"Most of them are very highly motivated to do it all," Life continued. "They're paying a lot of money for the opportunity."