recent NYTimes article on anti-aging therapy

Thu, 26 Dec 2002 12:45:49 -0800

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she is 87, and I agree with doing our best to make the years of 55-70 better.  I think it
would be nice to start a second career in those ages.  this may sound silly but I would
like to be a nutionalist and to work in a non-profit agency to teach people how to eat
better for very little,
 Carolyn

Jon Ford wrote:

> Carolyn-- we can't keep old age down forever, but we can at least make the
> years between 55-70 or so very productive and even fun.And some people (more
> and more) are able to live active productive lives into their 80s. It sounds
> like your mother-in-law is really at the end of her natural  (or even
> medicinally enhanced) life-cycle, which is different for different people,
> including reasons like hereditary dispositions to certain ailments like
> cancer or Alzeimer's. Good luck to you and to her.
>
> Jon
>
> >From: Carolyn Garner Siscoe <globe@zipcon.net>
> >To: Jon Ford <jonmfordster@hotmail.com>
> >CC: michaele@ando.pair.com, austin-ghetto-list@pairlist.net
> >Subject: Re: recent NYTimes article on anti-aging therapy
> >Date: Tue, 24 Dec 2002 12:47:57 -0800
> >
> >I use to think that a person could control effects of aging just as you
> >suggest, Jon, but
> >I have done more reading about aging and also having to go through all
> >these  check-ups
> >required by our HMO and being shocked by the questions they ask I have come
> >to realize it
> >isn't so simple.  I definitely wasn't prepared for the reality of what real
> >aging can be
> >and the fact you have very little control over it.  My mother-in-law cannot
> >now open
> >packages,unscrew lids off of jars, or even carry  a half gallon of milk
> >back to her home.
> >And she is healthy; no heart problems or respiratory problems.  I am not
> >sure what one can
> >do to prevent any of the physical problems from happening.
> >Carolyn
> >
> >Jon Ford wrote:
> >
> > > Sounds like a lot of this stuff is based on wishful thinking and
> >laziness.
> > > The best way to ward off the problems of old age (well, it works for my
> >wife
> > > and me) is lots of exercise, yoga, plenty of sex, laughter, projects in
> > > writing, teaching, and lifelong learning, and a balanced diet with
> >plenty of
> > > fish and brocolli.This takes a lot more effort than taking a bunch of
> >shots
> > > and pills, but without making an effort, we'll die. The choice is up to
> >us.
> > >
> > > Jon
> > >
> > > >From: Michael Eisenstadt <michaele@ando.pair.com>
> > > >To: austin-ghetto-list@pairlist.net
> > > >Subject: recent NYTimes article on anti-aging therapy
> > > >Date: Sun, 22 Dec 2002 13:25:10 -0600
> > > >
> > > >This article is SO informative and SO need-to-read that I copied
> > > >it into this email rather than just putting in a link to the Times.
> > > >
> > > >One of our subscribers is/was undergoing this therapy. His comments
> > > >on this will be appreciated.
> > > >
> > > >-------------------------------------------------------------------
> > > >
> > > >Chasing Youth, Many Gamble on Hormones
> > > >By GINA KOLATA
> > > >
> > > >Dr. Ron Livesey was fat, tired and out of shape. At 49, he felt that
> >his
> > > >best years were behind him.
> > > >
> > > >So one day seven years ago, on his way to a medical meeting, he stopped
> > > >at a doctor's office in Palm Springs, Calif., for his first hormone
> > > >injections.
> > > >
> > > >Early the next morning, Dr. Livesey was at the meeting, sitting in a
> > > >darkened auditorium watching slides of technical data. To his surprise,
> > > >he found himself alert, taking everything in. He continued the hormone
> > > >treatments.
> > > >
> > > >"People started commenting that I had so much more bounce and energy,"
> > > >he said. He lost 50 pounds — thanks, he said, to diet changes and
> > > >exercise made possible by the increased vigor.
> > > >
> > > >So Dr. Livesey, then an internist in New Hampshire, decided to go into
> > > >business for himself. With a colleague, Dr. Joseph Raffaele, who went
> >on
> > > >a similar regimen, he founded Anti-Aging Medicine Associates, a clinic
> > > >in Manhattan. They are part of a growing movement among doctors to
> >offer
> > > >a hormone replacement therapy that claims to restore the bodies and
> > > >energy of youth.
> > > >
> > > >Until recently, most scientists considered anti-aging treatments to be
> > > >little more than snake oil, provided by hucksters. Now, few doubt that
> > > >growth hormone and testosterone can reshape aging bodies, potentially
> > > >making them more youthful.
> > > >
> > > >But whether they counteract aging is unknown. And their long-term risks
> > > >are ill defined. So medical experts ask whether it is right to regard
> > > >aging as a disease, as fierce as a malignant cancer, to be fought with
> > > >any and all means, tested or not.
> > > >
> > > >"How much are you willing to pay for a treatment that is not proven?"
> > > >asked Dr. Huber Warner, an associate director at the National Institute
> > > >on Aging. "How much risk are you willing to take?"
> > > >
> > > >But Dr. Ronald Klatz of Chicago, the founder and director of the
> > > >American Academy of Anti-Aging Medicine, says patients cannot wait for
> > > >long-term studies, which are not even in planning stages and would take
> > > >years or decades to complete. "We'd have to wait," he said, "until the
> > > >baby boomers are dead and in the ground and worms' meat."
> > > >
> > > >Clearly, many are not waiting. The academy, which began with 12 doctors
> > > >in 1993, now has 8,000 physician members in the United States, Dr.
> >Klatz
> > > >said.
> > > >
> > > >The treatment is expensive: $1,000 a month for the panoply of drugs and
> > > >dietary supplements, including human growth hormone and testosterone
> >for
> > > >men and women, estrogen and progesterone for women (the doctors say
> > > >their "bioidentical" hormones are safe), melatonin, DHEA, vitamins and
> > > >antioxidants.
> > > >
> > > >The unlikely hero of today's anti-aging movement was Dr. Daniel Rudman,
> > > >an academic researcher at the Medical College of Wisconsin who asked if
> > > >he could reverse the effects of aging by giving growth hormone to
> > > >elderly men.
> > > >
> > > >Aging people, he noted, lose muscle and put on fat, their skin thins
> >and
> > > >their bones weaken. At the same time, growth hormone levels steadily
> > > >decline. He observed that the effects of aging also appeared in young
> > > >people who lacked growth hormone for medical reasons.
> > > >
> > > >So he gave growth hormone to 12 elderly men for six months, reporting
> > > >that they gained muscle and lost fat. Nine men who served as controls
> > > >had no such body changes. In his paper, published on July 5, 1990, in
> > > >The New England Journal of Medicine, Dr. Rudman concluded with this
> > > >sentence: "The effects of six months of growth hormone on lean body
> >mass
> > > >and adipose-tissue mass were equivalent in magnitude to the changes
> > > >incurred during 10 to 20 years of aging."
> > > >
> > > >Dr. Klatz, of the Academy of Anti-Aging Medicine, called the paper "a
> > > >thunderclap in the medical profession."
> > > >
> > > >"It was the first clinical paper in a mainstream U.S. medical journal
> >to
> > > >show that there were available interventions that could have a dramatic
> > > >effect on the physiology of aging," he said.
> > > >
> > > >Human growth hormone has been approved by the Food and Drug
> > > >Administration for use by people with medical deficiencies, and once a
> > > >drug is on the market, doctors can legally prescribe it for any reason.
> > > >
> > > >
> > > >
> > > >"I was thrilled by the concept," said Dr. Maxine Papadakis of the
> > > >University of California in San Francisco. But Dr. Papadakis said she
> > > >worried about the sweeping conclusion about reversing aging. It was a
> > > >small study, she said, and the men who took part knew who was taking
> > > >growth hormone and who was not.
> > > >
> > > >Dr. Papadakis set out to test growth hormone in 52 healthy men from 70
> > > >to 85. She designed the study so that the men did not know if they were
> > > >taking the drug or a dummy medication.
> > > >
> > > >Reporting in 1996, she found that growth hormone slightly increased
> > > >muscle mass and decreased body fat but, paradoxically, did not make the
> > > >men stronger. People had claimed it improved their mental clarity, but
> > > >she found no such effects; if anything, those taking growth hormone did
> > > >slightly worse on memory tests. They also suffered swollen legs and
> >feet
> > > >and achy joints, making them so uncomfortable that a quarter taking
> > > >growth hormone had their doses reduced during the study.
> > > >
> > > >Dr. Papadakis said her results were ignored by growth hormone
> > > >enthusiasts. "They can't let go of the hypothesis because they like
> >it,"
> > > >she said.
> > > >
> > > >Others, like Dr. Warner, worry about animal studies.
> > > >
> > > >"I agree that mice and rats are not people, but mice that don't make
> > > >growth hormone live longer," Dr. Warner said. "Mice that overproduce
> > > >growth hormone live shorter lives. The same principle applies in fruit
> > > >flies and little worms called nematodes. It may be irrelevant, but it
> > > >makes us wonder."
> > > >
> > > >The next major paper was published on Nov. 13 in The Journal of the
> > > >American Medical Association. In it, Dr. S. Mitchell Harman of the
> > > >Kronos Longevity Research Institute in Phoenix and Dr. Marc Blackman of
> > > >the National Center for Complementary and Alternative Medicine, part of
> > > >the National Institutes of Health, reported that older men and women
> > > >taking growth hormone lost fat and gained lean body mass without
> >dieting
> > > >or exercising. They did not formally assess the subjects' appearance.
> > > >But Dr. Harman said, "you could see that some of these guys lost a
> > > >significant amount of pot belly."
> > > >
> > > >On the other hand, many had the same side effects that afflicted Dr.
> > > >Papadakis's subjects. Although they went away when the subjects stopped
> > > >taking growth hormone, they gave the investigators pause.
> > > >
> > > >The American Academy of Anti-Aging Medicine said in a statement that
> >the
> > > >doses used in the study were far too high. Lower doses that reproduce
> > > >the hormone levels of youth are safe and effective, the group said.
> > > >
> > > >But Dr. Papadakis said those were the levels her study reproduced.
> > > >"Maybe we don't know the right dose," she said. "But then how can you
> >be
> > > >giving it to people? Get a grip."
> > > >
> > > >Dr. Livesey and Dr. Raffaele, at the Anti-Aging Medicine clinic in
> > > >Manhattan, had expected most of their patients to be old people trying
> > > >to gain enough strength to rise from a chair unassisted, or middle-aged
> > > >people wanting to look young. Instead, they tend to be baby boomers,
> >the
> > > >doctors said, who are searching for something that other doctors did
> >not
> > > >provide.
> > > >
> > > >"By the time they come here, they've already gone to places to look
> > > >better," Dr. Raffaele said. "They've had the Botox, the plastic
> >surgery.
> > > >The reason they're here is they want to have a good quality of life."
> > > >Most keep their visits a secret, he said, adding: "They don't even want
> > > >to tell their close friends. It's kind of like plastic surgery."
> > > >
> > > >They are like a 50-year-old woman living in New York who arrived at the
> > > >doctors' anti-aging clinic last February. "I was feeling desperate,"
> > > >said the woman, who did not want to give her name because she is
> >keeping
> > > >the treatment secret from her friends.
> > > >
> > > >She was depressed, gaining weight, feeling old and fatigued. But, she
> > > >said, when she began taking growth hormone, estrogen and progesterone,
> > > >she noticed an immediate change in her mood and energy. It gave her the
> > > >stamina and enthusiasm to start dieting and working out at a gym and
> >she
> > > >dropped 10 pounds. She said her libido returned, her hair grew, and
> >even
> > > >her bunions regressed so she could wear high heels again.
> > > >
> > > >Was it the drugs or the power of suggestion, the diet and exercise or
> > > >the growth hormone that made the difference? Will she develop a serious
> > > >disease as a result of taking the drugs or will she enter old age
> > > >healthy and vigorous, younger than her years?
> > > >
> > > >It is impossible to know, researchers said, and that is why good
> >studies
> > > >are needed.
> > > >
> > > >"Our concern is that the evidence is mostly based on personal
> > > >testimonials rather than good data," Dr. Warner said. "It's not hard to
> > > >get people to believe something works, particularly if they are paying
> >a
> > > >lot of money for it."
> > > >
> > > >Dr. Alvin Matsumoto, a geriatrician at the Veterans Affairs Puget Sound
> > > >Health Care System, sounded a similar note of caution.
> > > >
> > > >"For any particular patient, the trick is to determine who is the
> > > >practitioner who has your best interests at heart. It is hard to
> > > >distinguish that sometimes."
> > >
> > > _________________________________________________________________
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she is 87, and I agree with doing our best to make the years of 55-70 better.&nbsp;
I think it would be nice to start a second career in those ages.&nbsp;
this may sound silly but I would like to be a nutionalist and to work in
a non-profit agency to teach people how to eat better for very little,
 &nbsp;Carolyn
Jon Ford wrote:
<blockquote TYPE=CITE>Carolyn-- we can't keep old age down forever, but
we can at least make the
 years between 55-70 or so very productive and even fun.And some people
(more
 and more) are able to live active productive lives into their 80s.
It sounds
 like your mother-in-law is really at the end of her natural&nbsp; (or
even
 medicinally enhanced) life-cycle, which is different for different
people,
 including reasons like hereditary dispositions to certain ailments
like
 cancer or Alzeimer's. Good luck to you and to her.
Jon
>From: Carolyn Garner Siscoe &lt;globe@zipcon.net>
 >To: Jon Ford &lt;jonmfordster@hotmail.com>
 >CC: michaele@ando.pair.com, austin-ghetto-list@pairlist.net
 >Subject: Re: recent NYTimes article on anti-aging therapy
 >Date: Tue, 24 Dec 2002 12:47:57 -0800
 >
 >I use to think that a person could control effects of aging just as
you
 >suggest, Jon, but
 >I have done more reading about aging and also having to go through
all
 >these&nbsp; check-ups
 >required by our HMO and being shocked by the questions they ask I
have come
 >to realize it
 >isn't so simple.&nbsp; I definitely wasn't prepared for the reality
of what real
 >aging can be
 >and the fact you have very little control over it.&nbsp; My mother-in-law
cannot
 >now open
 >packages,unscrew lids off of jars, or even carry&nbsp; a half gallon
of milk
 >back to her home.
 >And she is healthy; no heart problems or respiratory problems.&nbsp;
I am not
 >sure what one can
 >do to prevent any of the physical problems from happening.
 >Carolyn
 >
 >Jon Ford wrote:
 >
 > > Sounds like a lot of this stuff is based on wishful thinking and
 >laziness.
 > > The best way to ward off the problems of old age (well, it works
for my
 >wife
 > > and me) is lots of exercise, yoga, plenty of sex, laughter, projects
in
 > > writing, teaching, and lifelong learning, and a balanced diet with
 >plenty of
 > > fish and brocolli.This takes a lot more effort than taking a bunch
of
 >shots
 > > and pills, but without making an effort, we'll die. The choice
is up to
 >us.
 > >
 > > Jon
 > >
 > > >From: Michael Eisenstadt &lt;michaele@ando.pair.com>
 > > >To: austin-ghetto-list@pairlist.net
 > > >Subject: recent NYTimes article on anti-aging therapy
 > > >Date: Sun, 22 Dec 2002 13:25:10 -0600
 > > >
 > > >This article is SO informative and SO need-to-read that I copied
 > > >it into this email rather than just putting in a link to the Times.
 > > >
 > > >One of our subscribers is/was undergoing this therapy. His comments
 > > >on this will be appreciated.
 > > >
 > > >-------------------------------------------------------------------
 > > >
 > > >Chasing Youth, Many Gamble on Hormones
 > > >By GINA KOLATA
 > > >
 > > >Dr. Ron Livesey was fat, tired and out of shape. At 49, he felt
that
 >his
 > > >best years were behind him.
 > > >
 > > >So one day seven years ago, on his way to a medical meeting, he
stopped
 > > >at a doctor's office in Palm Springs, Calif., for his first hormone
 > > >injections.
 > > >
 > > >Early the next morning, Dr. Livesey was at the meeting, sitting
in a
 > > >darkened auditorium watching slides of technical data. To his
surprise,
 > > >he found himself alert, taking everything in. He continued the
hormone
 > > >treatments.
 > > >
 > > >"People started commenting that I had so much more bounce and
energy,"
 > > >he said. He lost 50 pounds — thanks, he said, to diet changes
and
 > > >exercise made possible by the increased vigor.
 > > >
 > > >So Dr. Livesey, then an internist in New Hampshire, decided to
go into
 > > >business for himself. With a colleague, Dr. Joseph Raffaele, who
went
 >on
 > > >a similar regimen, he founded Anti-Aging Medicine Associates,
a clinic
 > > >in Manhattan. They are part of a growing movement among doctors
to
 >offer
 > > >a hormone replacement therapy that claims to restore the bodies
and
 > > >energy of youth.
 > > >
 > > >Until recently, most scientists considered anti-aging treatments
to be
 > > >little more than snake oil, provided by hucksters. Now, few doubt
that
 > > >growth hormone and testosterone can reshape aging bodies, potentially
 > > >making them more youthful.
 > > >
 > > >But whether they counteract aging is unknown. And their long-term
risks
 > > >are ill defined. So medical experts ask whether it is right to
regard
 > > >aging as a disease, as fierce as a malignant cancer, to be fought
with
 > > >any and all means, tested or not.
 > > >
 > > >"How much are you willing to pay for a treatment that is not proven?"
 > > >asked Dr. Huber Warner, an associate director at the National
Institute
 > > >on Aging. "How much risk are you willing to take?"
 > > >
 > > >But Dr. Ronald Klatz of Chicago, the founder and director of the
 > > >American Academy of Anti-Aging Medicine, says patients cannot
wait for
 > > >long-term studies, which are not even in planning stages and would
take
 > > >years or decades to complete. "We'd have to wait," he said, "until
the
 > > >baby boomers are dead and in the ground and worms' meat."
 > > >
 > > >Clearly, many are not waiting. The academy, which began with 12
doctors
 > > >in 1993, now has 8,000 physician members in the United States,
Dr.
 >Klatz
 > > >said.
 > > >
 > > >The treatment is expensive: $1,000 a month for the panoply of
drugs and
 > > >dietary supplements, including human growth hormone and testosterone
 >for
 > > >men and women, estrogen and progesterone for women (the doctors
say
 > > >their "bioidentical" hormones are safe), melatonin, DHEA, vitamins
and
 > > >antioxidants.
 > > >
 > > >The unlikely hero of today's anti-aging movement was Dr. Daniel
Rudman,
 > > >an academic researcher at the Medical College of Wisconsin who
asked if
 > > >he could reverse the effects of aging by giving growth hormone
to
 > > >elderly men.
 > > >
 > > >Aging people, he noted, lose muscle and put on fat, their skin
thins
 >and
 > > >their bones weaken. At the same time, growth hormone levels steadily
 > > >decline. He observed that the effects of aging also appeared in
young
 > > >people who lacked growth hormone for medical reasons.
 > > >
 > > >So he gave growth hormone to 12 elderly men for six months, reporting
 > > >that they gained muscle and lost fat. Nine men who served as controls
 > > >had no such body changes. In his paper, published on July 5, 1990,
in
 > > >The New England Journal of Medicine, Dr. Rudman concluded with
this
 > > >sentence: "The effects of six months of growth hormone on lean
body
 >mass
 > > >and adipose-tissue mass were equivalent in magnitude to the changes
 > > >incurred during 10 to 20 years of aging."
 > > >
 > > >Dr. Klatz, of the Academy of Anti-Aging Medicine, called the paper
"a
 > > >thunderclap in the medical profession."
 > > >
 > > >"It was the first clinical paper in a mainstream U.S. medical
journal
 >to
 > > >show that there were available interventions that could have a
dramatic
 > > >effect on the physiology of aging," he said.
 > > >
 > > >Human growth hormone has been approved by the Food and Drug
 > > >Administration for use by people with medical deficiencies, and
once a
 > > >drug is on the market, doctors can legally prescribe it for any
reason.
 > > >
 > > >
 > > >
 > > >"I was thrilled by the concept," said Dr. Maxine Papadakis of
the
 > > >University of California in San Francisco. But Dr. Papadakis said
she
 > > >worried about the sweeping conclusion about reversing aging. It
was a
 > > >small study, she said, and the men who took part knew who was
taking
 > > >growth hormone and who was not.
 > > >
 > > >Dr. Papadakis set out to test growth hormone in 52 healthy men
from 70
 > > >to 85. She designed the study so that the men did not know if
they were
 > > >taking the drug or a dummy medication.
 > > >
 > > >Reporting in 1996, she found that growth hormone slightly increased
 > > >muscle mass and decreased body fat but, paradoxically, did not
make the
 > > >men stronger. People had claimed it improved their mental clarity,
but
 > > >she found no such effects; if anything, those taking growth hormone
did
 > > >slightly worse on memory tests. They also suffered swollen legs
and
 >feet
 > > >and achy joints, making them so uncomfortable that a quarter taking
 > > >growth hormone had their doses reduced during the study.
 > > >
 > > >Dr. Papadakis said her results were ignored by growth hormone
 > > >enthusiasts. "They can't let go of the hypothesis because they
like
 >it,"
 > > >she said.
 > > >
 > > >Others, like Dr. Warner, worry about animal studies.
 > > >
 > > >"I agree that mice and rats are not people, but mice that don't
make
 > > >growth hormone live longer," Dr. Warner said. "Mice that overproduce
 > > >growth hormone live shorter lives. The same principle applies
in fruit
 > > >flies and little worms called nematodes. It may be irrelevant,
but it
 > > >makes us wonder."
 > > >
 > > >The next major paper was published on Nov. 13 in The Journal of
the
 > > >American Medical Association. In it, Dr. S. Mitchell Harman of
the
 > > >Kronos Longevity Research Institute in Phoenix and Dr. Marc Blackman
of
 > > >the National Center for Complementary and Alternative Medicine,
part of
 > > >the National Institutes of Health, reported that older men and
women
 > > >taking growth hormone lost fat and gained lean body mass without
 >dieting
 > > >or exercising. They did not formally assess the subjects' appearance.
 > > >But Dr. Harman said, "you could see that some of these guys lost
a
 > > >significant amount of pot belly."
 > > >
 > > >On the other hand, many had the same side effects that afflicted
Dr.
 > > >Papadakis's subjects. Although they went away when the subjects
stopped
 > > >taking growth hormone, they gave the investigators pause.
 > > >
 > > >The American Academy of Anti-Aging Medicine said in a statement
that
 >the
 > > >doses used in the study were far too high. Lower doses that reproduce
 > > >the hormone levels of youth are safe and effective, the group
said.
 > > >
 > > >But Dr. Papadakis said those were the levels her study reproduced.
 > > >"Maybe we don't know the right dose," she said. "But then how
can you
 >be
 > > >giving it to people? Get a grip."
 > > >
 > > >Dr. Livesey and Dr. Raffaele, at the Anti-Aging Medicine clinic
in
 > > >Manhattan, had expected most of their patients to be old people
trying
 > > >to gain enough strength to rise from a chair unassisted, or middle-aged
 > > >people wanting to look young. Instead, they tend to be baby boomers,
 >the
 > > >doctors said, who are searching for something that other doctors
did
 >not
 > > >provide.
 > > >
 > > >"By the time they come here, they've already gone to places to
look
 > > >better," Dr. Raffaele said. "They've had the Botox, the plastic
 >surgery.
 > > >The reason they're here is they want to have a good quality of
life."
 > > >Most keep their visits a secret, he said, adding: "They don't
even want
 > > >to tell their close friends. It's kind of like plastic surgery."
 > > >
 > > >They are like a 50-year-old woman living in New York who arrived
at the
 > > >doctors' anti-aging clinic last February. "I was feeling desperate,"
 > > >said the woman, who did not want to give her name because she
is
 >keeping
 > > >the treatment secret from her friends.
 > > >
 > > >She was depressed, gaining weight, feeling old and fatigued. But,
she
 > > >said, when she began taking growth hormone, estrogen and progesterone,
 > > >she noticed an immediate change in her mood and energy. It gave
her the
 > > >stamina and enthusiasm to start dieting and working out at a gym
and
 >she
 > > >dropped 10 pounds. She said her libido returned, her hair grew,
and
 >even
 > > >her bunions regressed so she could wear high heels again.
 > > >
 > > >Was it the drugs or the power of suggestion, the diet and exercise
or
 > > >the growth hormone that made the difference? Will she develop
a serious
 > > >disease as a result of taking the drugs or will she enter old
age
 > > >healthy and vigorous, younger than her years?
 > > >
 > > >It is impossible to know, researchers said, and that is why good
 >studies
 > > >are needed.
 > > >
 > > >"Our concern is that the evidence is mostly based on personal
 > > >testimonials rather than good data," Dr. Warner said. "It's not
hard to
 > > >get people to believe something works, particularly if they are
paying
 >a
 > > >lot of money for it."
 > > >
 > > >Dr. Alvin Matsumoto, a geriatrician at the Veterans Affairs Puget
Sound
 > > >Health Care System, sounded a similar note of caution.
 > > >
 > > >"For any particular patient, the trick is to determine who is
the
 > > >practitioner who has your best interests at heart. It is hard
to
 > > >distinguish that sometimes."
 > >
 > > _________________________________________________________________
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