In Depth

Legal loopholes fuel growth of steroid clinics in South Florida

Anthony Bosch’s clinic, now the focus of a widening steroid investigation, was hidden in plain sight, next to a bank in an office complex on South Dixie Highway across from the University of Miami. Yet it was beyond the reach of state health regulators.

The clinic, BioGenesis of America, fell into a gray area of Florida healthcare law that has allowed many “anti-aging” or “rejuvenation” clinics to proliferate across the state with little government oversight.

Exploiting the same legal loopholes that made South Florida the top source of black-market prescription painkillers, these clinics have helped make the region one of the top markets in the United States for illegal steroids and growth hormones — feeding potentially dangerous medications not just to athletes and bodybuilders, but also to aging men hoping to fend off Father Time.

“How these anti-aging clinics are getting by the law is beyond me,” said Dr. Gary Wadler, a New York physician who works with the World Anti-Doping Agency.

Bosch is now under criminal investigation from the U.S. Drug Enforcement Administration over allegations that he supplied steroids and human growth hormones to several Major League Baseball players, including New York Yankees slugger Alex Rodriguez. Bosch’s ties to the ballplayers were first reported by the Miami New Times, which received copies of what the newspaper says are Bosch’s handwritten ledgers from his Coral Gables clinic, which opened last March but now sits vacant.

In 2009, the DEA also investigated whether Bosch supplied banned substances to All-Star Manny Ramirez of the Los Angeles Dodgers. No charges were filed. Bosch, 49, could not be reached for comment, and his lawyer did not return messages.

While Bosch’s name may be familiar to the DEA or baseball’s doping investigators, he’s an unknown to Florida health regulators.

Bosch is suspected of prescribing and administering medications, yet he is not a doctor or licensed healthcare professional regulated by the state’s Department of Health. The Health Department does investigate people suspected of prescribing drugs without a license, but the department would not say whether Bosch was the target of an investigation.

Bosch is described as “Dr.” in papers filed in 2009 for a now-defunct corporation, state records show. He is listed as having a Ph.D. on the BioGenesis Facebook page.

Bosch’s clinic — advertised as a “spa” on its Facebook page — was also unregulated, state health officials said. Most medical clinics in Florida are monitored by the state Agency for Health Care Administration; however, AHCA only inspects clinics that accept insurance — and many “anti-aging” clinics do not take insurance.

Avoiding spotlight

The Department of Health monitors clinics owned by doctors. But many anti-aging clinics are owned by non-doctors who then hire physicians to work for them — avoiding the scrutiny of regulators.

This is the same gap in the law that allowed scores of pain clinics to sell powerful painkillers across South Florida with almost no oversight, once making Broward County the national pipeline of black-market oxycodone and other dangerous pills. The Legislature finally forced pain clinics to register with the state and increased monitoring in 2009.

“Anti-aging” has become a popular marketing slogan for medical practices specializing in cosmetic procedures. But it has also become something of a code word for steroids and growth hormones, particularly among bodybuilders and pro athletes.

The Mitchell Report, a 2007 examination of steroid use in Major League Baseball by former U.S. Sen. George Mitchell, highlighted the popularity of Florida “anti-aging” clinics as a source of illicit steroids and performance-enhancing drugs for ballplayers.

“Some businesses that describe themselves as anti-aging or rejuvenation centers sell steroids or human growth hormone and arrange for buyers to obtain prescriptions for those substances from corrupt or suspended physicians, or even, in some cases, a dentist,” the report said.

Among the clinics cited in the Mitchell Report was South Beach Rejuvenation, a West Palm Beach clinic that marketed steroids through Internet ads and in fitness and bodybuilding magazines. The clinic was founded by Jeffrey George, who, along with his brother, headed a $40 million pill-mill empire built on illegal steroids and prescription painkillers.

George, who is not a doctor, pleaded guilty to trafficking charges in 2011, and he was sentenced to 15½ years in prison. George also pleaded guilty to murder for the overdose death of a patient at one of his pain clinics.

Federal law prohibits the use of steroids for muscle-building, and human growth hormone (hGH) has been approved by the Food and Drug Administration for use by adults only in rare circumstances. “The law is very specific in what you can use it for,” Wadler said.

Nevertheless, an increasing number of South Florida clinics offer treatment with human growth hormone to combat the effects of aging.

For example, the Anti-Aging Group of Miami, an Aventura clinic, offers human growth hormone therapy to treat patients suffering from low energy, increased fat or a slowing sex drive.

“No Energy? Lost Your Libido? Low Hormone Levels May Be the Reason Why,” the company’s website says.

The clinic’s medical director, Dr. Fikri Victor Shabanah, was identified by Sports Illustrated as having supplied steroids to a hurdler on Jamaica’s 2008 Olympic team. Shabanah did not respond to a request for comment.

The ‘silver bullet’

Another local clinic, BioFit Miami off Brickell Avenue, describes human growth hormone as the “Silver Bullet of Life Extension” on its website.

But hGH has never been approved by the FDA as an “anti-aging” treatment. The DEA has described the use of hGH for anti-aging therapy as “illicit.”

“There’s no evidence that growth hormone extends life at all,” said Jay Olshansky, an epidemiology professor at the University of Illinois in Chicago, and an expert on aging. “It’s kind of amazing what you can put out there without the FDA coming after you.”

Growth hormones may be prescribed only for people suffering from unusual hormone losses — usually as a result of brain trauma — not to prevent the natural decline of these hormones from aging, said Dr. Alejandro Ayala, an endocrinologist at the University of Miami’s Miller School of Medicine.

“They actually pitch it to the consumer, so the consumer will ask for the hormone. Then it becomes a legalized business,” Ayala said. “This is unethical, and I would say it’s unsafe until science proves otherwise.”

“Miami is particularly known for this type of thing,” he added.

Ayala said many doctors wrongly diagnose patients as having “hGH deficiency” by simply comparing a patient’s current hormone levels with those of a younger person — a method that would not indicate a specific condition requiring hormone treatment. “Most patients they treat are not hormone deficient,” he said.

Steroids and hormones could also be dangerous for patients, increasing the risk of tumors, diabetes or other illnesses, Ayala said.

“They’re basically conducting a biological experiment on their own patients,” Olshansky said.

Another danger: synthetic or counterfeit steroids and hormones from other countries. Because the manufacture of hGH in particular is tightly controlled, black-market sellers have sought out the drugs from overseas, which may be adulterated.

In 2007, for example, the owners of a Colorado pharmacy were indicted for smuggling in hGH from China and shipping it to physicians around the U.S. — including a doctor at a Fort Lauderdale clinic, court records show.

Though doctors can be disciplined for improperly prescribing steroids, punishment in Florida is rare. Of the 81 doctors disciplined by the state for violating prescription rules since 2010, only four were punished for steroid or growth-hormone violations, records show.

But federal investigators have taken notice of the problem.

In 2010, four men were indicted for trafficking human growth hormone through Powermedica, a Deerfield Beach pharmacy. A year later, the DEA arrested 13 people in a steroid trafficking ring centered on a rogue pharmacy in Jensen Beach, in Martin County, which shipped 10,000 steroid prescriptions to patients around the country in a six-month period, records show.

Three doctors were among those arrested as part of the Jensen Beach probe, including two from Broward County. State health officials said the doctors filled out prescriptions for steroids and human growth hormone without ever examining the patients receiving the drugs.

Dr. Steven Pearlstein of Coral Springs and Dr. Alan Lefkin of Parkland both pleaded guilty to conspiracy charges last fall, and both are now awaiting sentencing in federal court.