HEALTH CARE/Joan Retsinas

Low T: Disease, the Gold Mine

You want to get rich. Most of us do. Here is a surefire way. Create a malady – not a disease or an illness, more a condition. Try a deficiency of a vitamin, a hormone, a chemical. Something that sounds natural. Describe the symptoms – nothing life-shattering enough to propel people to emergency rooms, more of an ineffable malaise. Convince people that they may have it. Then invent the cure. Make it simple – like a gel, patch, or tablet. Flood the web with offerings. Then wait for the anecdotal raves. Or create some raves. Voila – a stake on a pharmaceutical goldmine.

You think: this is a hoax. The Food and Drug Administration long ago outlawed snake oil. Making millions in pharmaceuticals must be harder than this. Indeed, the trek from disease to drug is reportedly long and arduous. We have an abundance of diseases: cancer (all kinds), Parkinson’s, asthma, diabetes, multiple sclerosis, arthritis, the list goes on and on. Our bodies often don’t work as they should. And the older we get, the more crotchety those bodies.

Yet we rarely have sure-fire cures, just possible ones, the ones that undergo multi-stage clinical trials. And while we have treatments that postpone, assuage, or “manage” lots of symptoms, those too go through clinical trials. Many drugs fail the trials; others exacerbate the disease, or spur sometimes horrendous side-effects. That potential pharmaceutical minefield is expensive to develop. Not a surefire route to wealth.

But think again: Low T. Surf the web. You’ll find hundreds of offerings - all promising to boost the testosterone level of men, usually aging men, who feel tired, depressed, impotent, achy, discouraged. One-time college athletes can once again ace a serve, kick a ball, shoot hoops. One-time Lotharios can once again woo young women. One-time dynamos can once again dominate board rooms. Maybe the root of their malaise is not their general health, their lives, their families, their jobs – but their T level. Maybe it has dipped low – not life-threateningly low, but low enough to depress their joie de vivre.

Admittedly, some men do suffer from low testosterone – generally men who have undergone chemotherapy or have endocrine tumors. And testosterone does decline as men age (estrogen declines in aging women). Yet physicians have not linked that normal decline to major health problems. For most men, their problems do not lie in their hormones.

Yet entrepreneurs have tapped into this lucrative market. Elizabeth Rosenthal, in “A Push to Sell Testosterone Gels Troubles Doctors,” New York Times, Oct. 16, 2013, describes this business marvel. American men spent more than $2 billion for gels last year; analysts expect them to spend $4 billion in 2017.

The key: advertisements. Just as savvy marketers have convinced consumers that they must have technological gizmos, savvy marketers have convinced men that they must boost their T levels, in spite of a lack of medical data justifying the advertising push.

But the lure of Ponce de Leon is strong. From a patient’s perspective, why not try it? What is the risk? The gels do not appear to have side effects. And insurers will pick up most of the tab, as they do for most prescribed drugs. The patient will pay only the co-payment.

Yet there are downsides. The easy diagnosis of low T might detour men from seeing a physician, to probe what truly might be amiss – or detour men from looking into the social/psychological circumstances of their malaise.

The costs too are real. The nature of insurance is that the costs are spread throughout the pool of enrollees – in short, we all pick up much of this billion-dollar tab.

Crucially, though, we as a society are wasting precious resources. We still have diseases that need treatment, if not cures. Yet the pharmaceutical industry diverts its talent to fabricating ways to raise a hormone that does not need raising, to treat an illness that does not exist. A sad outrage.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, December 1, 2013