Wednesday, January 20, 2010

Vigor Quest

Articles on the use of Human Growth Hormone (HGH) have been fairly popular lately, brought on (I believe) by the misdeeds of Tiger Woods. A couple days after Woods' affair(s) were splashed across the tabloids and blogosphere, The New York Times took a different tack with Woods' culpability. This time, Woods was not the story; he simply served as its hook.

I remember this story standing out to me because it was featured on the front page; at that time, I wondered if this would really be front page news if it weren't for the Tiger Woods mention. The story is about the F.B.I. investigation of Dr. Anthony Galea, who is suspected of providing performance-enhancing drugs to the athletes he treats, one of which is HGH. NYT did a good job following up on the story here and here.

For a while, because of the way HGH is presented in the media, I believed that anyone who injects himself with a hormone is probably a cheating top-tier athlete. For Tom Dunkel, the author of "Vigor Quest," this top-tier athlete is not even worth a mention in his article. His article focuses on older, well-to-do men who wish to curb the aging process using "age-management medicine."

The anchor of the story is John Bellizzi, a 51-year-old who plays soccer every week. To keep himself in the best possible shape, Bellizzi has approached Dr. Florence Comite, whose relationship with Bellizzi is like that of an ace mechanic to a classice car:

Her job is to keep him finely tuned despite worn parts. "I consider what I do aggressive prevention, the basis of which is metabolism modulation," Comite says. "Twenty years from now, this will be the standard of care."

Overall, Dunkel does a really good job balancing the skepticism that "mainstream medicine" has towards anti-aging medicine with the visible results from injections of testosterone and human chorionic gondatropin (H.C.G.), a hormone that is distilled from the urine of pregnant women. He is also careful to state that some of the patients who take these anti-aging treatments are instructed to revamp their lifestyle, so it is sometimes difficult to see whether if the physical and mental change comes from the good eating and exercise, or from the injections of H.C.G.

If the subject of an article is controversial and not generally agreed upon by the public, it is important to show both sides without making it seem like you are writing, "A is good. B is good. A is bad. B is bad." That was a rather pidgin way to illustrate it, but I do believe melding two opposing opinions can take skill, and Dunkel is a pro at putting his two ideas in opposition without seeming too "list-y."

An example would be his initial description of Dr. Florence Comite. He begins the paragraph by showing off her impressive medical credentials and her commitment to medicine; then Dunkel ends the paragraph by listing that a search of her name would get you to her entry on

The merits of this article is that Dunkel is willing to show you more about each person he mentions. He could have easily dismissed Bellizzi as a youth-hungry, vanity-stroking dolt – but he takes us through Bellizzi's life before he met Comite and makes us believe that Bellizzi is doing this for empowerment over his own body and fate. And why shouldn't he? If we, as human beings, are able to fight for something we want, like our job or our apartment or our spouse, why should we not be able to exert some control over our aging process?

Dunkel also refuses to leave Comite as a question mark; he did his homework for this aritcle, and it shows. Dunkel goes through Comite's childhood, tells us her favorite book as a child ("Stranger in a Strange Land," by Robert Heinlein), and shows us how this tiny, miniscule fact connects to the way she works as a doctor. Dunkel wants to show that though Comite's current area of expertise is considered troublesome by mainstream media, she is, in fact, no hack. In 1985, after a tenure at N.I.H. does research in gynecology and precocious puberty (what?), Comite founded Women's Health at Yale University, "arguably the first clinic in the country to treat women's health issues as a special discipline." By listing her achievements and the obstacles she has faced, Comite is presented as a purveyor of independent thinking. 20 years ago, it would be impossible for a male-dominated profession to treat female health problems as conditions of the female body. Today, it would be appalling if a health insurance plan did not cover gynecology visits. What if – and Dunkel sets up his entire scene just so we can wonder – today's perspective on anti-aging medicine makes a 180 in 20 years?

With all that good aside, I do have two little quibbles with this article. The first is that Dunkel is quite a scathing writer. There are some things that seem like almost a dig to the anti-aging movements, and I personally enjoy it. However, my second read-through had me wondering if some of it was necessary. An example is when Dunkel is describing the two founders of the American Academy of Anti-Aging Medicine, both of whom are doctors and amateur body-builders: (emphasis mine)

[Alan Mintz] and her exercise partner, John Adams, owned a radiology-diagnostics company. They sold the business in 1994, pocketing millions. Rather than retire and work full-time on their pecs, they started Cenegenics Medical Institute...

Here's another about Alan Mintz:

That June, Alan Mintz invited [Comite] to Las Vegas, and she ultimately joined Cenegenics' medical advisory board. (Two years later, Mintz, while doing an overhead press in the gym, lost control of the weighted bar, which struck him in the back of his head. He died while undergoing brain biopsy.)

Now was that necessary? It's certainly quite the visual and there is an irony to it, but it does nothing to further the focus on anti-aging medicine. Poor Dr. Mintz - reduced to a punchline.

My second quibble is barely a quibble. It's just a nitpick, and it might not even bother you when you read the article (Please read the article) but it jumped out at me.

About 80 percent of Comite's patients are men. It's a good match. She finds male menopause an area ripe for exploration, and men are generally more receptive to the notion of age management than women, who have been bombarded for years with conflicting information about hormone therapy.

Bob Fitzmaurice, a 48-year-old ...

No, Dunkel, please go back and explain that previous sentence. I believe, as evidenced by face lifts and boob jobs and the rise of the popularity of "Cougar Town" (sorry, it's an awful show, no matter what you say), that women are very receptive to age-management. It is incredibly careless of Dunkel to write that (because it's not true) and not back it up with some quote from Comite. How does being bombarded by information of hormone therapy make women less receptive to age management? Personally, I have never been talked to death about hormone therapy - it's simply not mentioned. And Comite, being the person who set up the first Women's Health clinic (arguably) in America, would definitely have an answer if Dunkel had posed a follow-up question.

All in all, this article was really fantastic. I would never expect myself to go nuts over a health piece, but Dunkel did a great job fine-tuning all the medical jargon into something that is accessible and effective.