August 11, 2010
Joe Biden and Other Obstacles to Preventive Sick CareBy Michael Applebaum, MD
In the sick care domain, there are several dirty words. Two are "anabolic" and "steroid."
The Ur anabolic steroid (AS) is testosterone (T). Erroneously characterized as a male hormone, it is produced by both sexes, where it exerts anabolic effects -- i.e., it builds tissue. Another term for AS is "androgens" since AS also have androgenic (masculinizing) effects.
The relationship between sick care and these dirty words is multifarious, complex, broad, and deep.
The relationship between government and these dirty words is sickening. Literally.
For now, all that will be covered is the matter of chronic illness prevention and anabolic steroids. (The values of AS in treatment are left for another essay.)
Before continuing, let's address three sensational aspects to anabolic steroid use:
1. In sport, for performance enhancement, AS are used in doses reported to be over one hundred times those used therapeutically. To put this into perspective, one hundred times the recommended dose of Tylenol is downing a 325-mg tablet about every minute of every hour of every day. By the way, a "severe overdose" of Tylenol is said to occur from taking 7 grams in a day. The daily therapeutic maximum is considered to be 4 grams. This makes taking a mere 1.75 times the therapeutic dose of Tylenol, a "safe" drug, very dangerous. "There have been no reports of massive androgen overdose."
2. Some claim that AS are part of "anti-aging medicine." Personally, I am clear that so-called "anti-aging medicine" is a scam. I do not believe that we know enough about aging to do anti-aging. Aging is not normal. Our experience living past the thirties has been around only for the last two hundred years. Our experience living past the fifties has been around only over the last hundred years. And for all we know, some aspects of aging may be accelerated by the substances we take to anti-age. For the here and now, the only way of which I am aware to anti-age is to die. That is a high price.
3. So-called "'roid rage," an uncertain entity, is claimed to occur when amounts of AS far in excess of those used clinically are taken. This phenomenon is not germane to the topic at hand.
When addressing preventive care, what's properly meant is decreasing the risk of certain common and bad diseases that are costly in terms of suffering and money (though not true in Fedspeak).
A recent study cited by Richard H. Carmona, M.D., the seventeenth U.S. Surgeon General, identified seven conditions that incur the greatest human and monetary costs.
The similarity between the two is striking.
Combining them results in the following (asterisks denote ailments common to CDC and Carmona):
* Heart disease
Accidents (unintentional injuries) (CDC)
*Pulmonary conditions (chronic lower respiratory diseases)
Alzheimer's disease (CDC)
Mental illness (Carmona)
This merged list enumerates those conditions where prevention can yield the most bang for the buck.
These illnesses are the conditions that come good and hard with living past the mid-forties, as shown in the following table derived from the CDC's Health Data Interactive site:
Likewise, osteoporosis and sarcopenia, conditions leading to debility, injury, loss of independence, elder abuse, frailty, and death manifest at a similar time.
There are some interesting relationships between the illnesses in the combined list and AS -- virtually every one of them is associated with low levels of androgens in the body.
Though this does not prove cause and effect, it is of note that virtually all of the conditions in the combined list have been shown to improve following the administration of AS.
Further evidence for a role low AS might play in these illnesses comes from data where AS are congenitally diminished. In this situation, the incidence of the illnesses noted above is increased.
The bottom line is that with substantial certainty, something is going on that in any of a number of studies AS have been shown to be related to occurrence (when low) and fix (when replaced).
Oddly, this is not news. As examples, positive effects of T on cardiovascular disease have been known since 1942, and AS were used to treat osteoporosis decades ago with FDA approval.
What happened? When and why did AS become outcasts?
The medical profession can trace its role in this debacle back to the 1970s and 1980s. During that period, organized medicine had a relationship with AS that has been, and continues to be, described as dishonest.
The pharmaceutical industry can trace its role back to the 1980s, where, under government edict, its patents for various AS formulations ran out, and incentives for promoting anabolics shriveled.
Arguably, the most disturbing, enduring, and overriding reason is the posture adopted by the number-two man in the administration -- Joe Biden.
As senator, he, more than just about anyone else, saw to it that anabolic steroids were treated as badly as possible. It was his pursuit of classifying these medications as controlled substances over the objections of the AMA, FDA, and DEA that promoted the mythology of their dangers in the minds of sick care workers and patients.
A reading of the proceedings resulting in the Steroid Control Act of 1990 indicates that the intent was to hurt athletes for allegedly abusing these medications.
In so doing, the public was punished.
Adios bath water, and baby, too.
The resulting nationwide penalization would not be unfairly characterized as similar to implementing a substantial form of prohibition across the land because of a few who allegedly drink to excess.
In practice, the medical profession, which for decades had a dishonest relationship with anabolic substances, essentially joined in lockstep with the government, uncritically and contrary to the best interests of patients.
Times have changed. Testing athletes for AS has improved. Those who "cheat" are not getting away with "cheating" as they used to by taking the formulations of T available clinically (barring corrupt labs, docs, techs, officials, etc.). They get "better stuff."
To be sure, not every person will benefit from every medication. In fact, some medications make their market from the alleged failures of other drugs:
Still, the policy question arises, "Given the potential benefits of AS in many expensive and debilitating conditions, their relative low cost, and their generous safety margin, is it not worth rehabilitating them in the minds of the public and sick care practitioners for their proper roles in sick care?"
It should be obvious that this approach, which may prevent and/or reverse the conditions, most often causing suffering and expense, is preferable to condemning people to lives of dependence, possible abuse, fear, and substantially diminished participation in life -- even if perpetuating suffering and expense, arguably, help pay back political favors, e.g., the CLASS Act (see page 710 of PPACA) and SEIU.
However, obvious may not be adequate for DC.