The following was originally posted on my personal blog.
So my name appears in an article in Monday’s Wall Street Journal. Here’s the beginning of the article:
|
Cracking Down On Illicit Use Of AIDS Drug By Christopher Windham LAW-ENFORCEMENT crackdowns across the country are starting to stem the tide of an unusual type of contraband: an AIDS medication that has found an underground recreational use as a bodybuilding drug. The drug is Serostim, a growth hormone prescribed to fight the wasting syndrome that can affect AIDS patients. Some bodybuilders inject it to pump up their muscles. At weight-lifting havens, illicitly acquired Serostim is referred to as “stim” or “GH.” A Hollywood bodybuilder, Tim Fogarty, who says he doesn’t use it himself, nevertheless declares, “You cannot compete at the national level without taking massive amounts of growth hormone.” Unlike anabolic steroids, Serostim is undetectable by sports groups’ blood tests. |
If you subscribe to the WSJ, the complete article can be found here.
I’ve never been called a Hollywood bodybuilder before. Should I get an agent?
The author had contacted me back in July and visited Los Angeles in August. I showed him around town, took him to Gold’s Venice, and passed on some information from some HIV doctors who wouldn’t talk on the record.
The problem with the article is the same thing that I discussed over and over again with the author: Serostim is not the issue. Bodybuilders have been using massive amounts of growth hormone for over 15 years. Serostim is only one brand. Bodybuilders don’t care about the brand name as growth hormone is growth hormone. However, Serostim is the only brand approved to treat HIV wasting, so therefore its the only brand that can be prescribed for patients who receive their medications through a government program such as state ADAPs and Medicare.
Athletes were using growth hormone long before Serostim was approved for HIV wasting. Most of it was brought in via Mexico. When Serostim started showing up on the black market, the number of users didn’t increase. The manufacturers of Serostim simply increased their (black) market share at the expense of overseas manufacturers.
The real story, which I tried to convince Chris of the Wall Street Journal to write about, is the problem with the way drugs get approval. There are lots of brands of growth hormone out there. Only the manufacturer of Serostim spend the hundreds of thousands, if not millions, of dollars to get it approved for AIDS wasting, so Serostim is the only thing that doctors can prescribe when they’re restricted to drugs that are “on-label”.
Serostim is not even a good choice for the treatment of HIV wasting. The package insert suggests that 4-6 mg injected subcutaneously daily should result in an increase of lean body mass of 3-5 kg in 8-12 weeks. But 200 mg of testosterone cypionate and/or nandrolone, both anabolic steroids that have been around for decades, will achieve similar gains at a fraction of the cost. At this dose, a one month’s supply of generic nandrolone cost under $80. Serostim can cost $3-6 thousand per month.
There is another problem with Serostim. The doses recommended to treat HIV wasting are huge, even by bodybuilder standards. Bodybuilders usually talk about GH in terms of IUs. One mg of growth hormone is three IUs, (the size of a an IU differs from drug to drug), so the recommended doses for GH are 12 to 18 IUs per day. Even the most hardcore bodybuilder would be wary of taking 18 IUs of growth hormone for any length of time. And an athlete would never take GH without also taking anabolic steroids, unless perhaps he was being tested for anabolic steroids.
Side effect of growth hormone include joint pain and water retention. Long term use causes acromegaly, the growth of cartilage such as your ears, nose, jaw, and brow, as well as the growth of your internal organs. Unfortunately, long term use of GH does not cause your rib cage to grow, so the only place for your enlarged internal organs to go is out your abdomen. If you look at old bodybuilding magazines, you can see a dramatic increase in this protruding gut in the top bodybuilders begining in the late 1980s. Even though anabolic steroids have been used by the top bodybuilders since the late 1940s, and they were pretty much mandatory by the 1960s, the symmetrical bodybuilder with the wide shoulders and narrow waist disappeared in the late 1980s with the advent of human growth hormone.
So why are doctors prescribing expensive Serostim when there is a much cheaper alternative? Because prescribing anabolic steroids to treat HIV wasting is considered off-label. No drug company has ever spent the money necessary to get them approved for that purpose. Why? Because the drug companies would never recoup their investment. There are plenty of cheap generic brands of anabolic steroids available. There is no money to be made by getting anabolic steroids approved for the treatment of HIV wasting.
The people most likely to be receiving Serostim are those on government assistance. If they had a job, they’d likely have decent insurance and their doctor would have the freedom to prescribe medicines for off-label use. People with HIV without jobs and insurance usually get their meds through an ADAP program which don’t allow off-label use of medications. So doctors must prescribe expensive growth hormone instead of much cheaper anabolic steroids.
Daily injections of an expensive drug for little gain with lots of side effect by patients who are probably on disability and having trouble making the rent. Athletes already paying top dollar for a drug that has been coming in from overseas for close to a generation. Its no wonder that all of a sudden lots of Serostim from US pharmacies was making it onto the black market.
But the Wall Street Journal article doesn’t make any of these points. Instead, its “athletes discover new drug used to treat AIDS.”