A high-profile Sydney doctor who specialises in "anti-ageing" medicine has been found guilty of professional misconduct and could be struck off after an investigation found she inappropriately prescribed steroids, hormones and other drugs.
Dr Julie Epstein, a consultant physician who set up one of the state's first "anti-ageing clinics", was prosecuted by the Health Care Complaints Commission over her treatment of 40 patients at her Moore Park rooms between August 2007 and August 2009.
On Monday the NSW Civil and Administrative Tribunal found Dr Epstein repeatedly prescribed anabolic steroids and human growth hormones "off-label" where there was no proper indication for the prescribing and "without exercising responsible medical judgement".
Some of these patients had a known history of abusing steroids and testosterone, including body builders, bouncers, boxers, a former Mr Universe and a former SAS member who had been injured during service. However Dr Epstein ignored or "turned a blind eye".
The patients also included a hedge fund manager, a 49-year-old man who wanted to "turn back the clock" and an older woman with a history of depression and anorexia. Others were HIV positive or had warning signs for prostate cancer.
The tribunal also found Dr Epstein generally failed to conduct clinical examinations, such as measuring weight or body mass index, of patients before prescribing and dispensing drugs. She accepted her patients' account of their symptoms, without seeking verification via scans or other tests.
Further, she failed to keep proper records or communicate with patients' referring doctors.
The barrister for the HCCC, Kate Eastman SC, said the case was not about determining the validity or otherwise of the practice of anti-ageing medicine.
But Dr Epstein's barrister, Philip Greenwood SC, said the tribunal should not judge her practice of anti-ageing medicine by reference to conventional or mainstream medicine. He said a number of studies supported her prescribing practices and said innovation has lead to substantial changes in the practice of medicine.
Dr Epstein prescribed five drugs – anastrozole (Arimidex), human chorionic gonadotrophin, human growth hormone, nandrolone deconoate and testosterone.
Prescribing drugs "off-label" – for a use other than approved by the Therapeutic Goods Administration – is not illegal.
However the tribunal found in conjunction with her failure to conduct physical examinations, the sometimes excessive doses and prescribing two or more hormone therapies simultaneously "make it difficult to find the practitioner's off-label prescribing as conforming to acceptable medical practice."
HGH prescribed off-label is particularly expensive, costing about $12,000 a year for an adult patient and there is a significant black market use by body builders and athletes.
Dr Epstein had been warned by authorities in 2007 about needing to exercise caution in prescribing anabolic steroids and human growth hormone off-label.
She again came to their attention when one of her patients had a significant quantity of anabolic steroids seized when he travelled to Switzerland.
In 2009 a number of conditions were placed on her medical registration.
During a 21-day hearing in November and December last year, Dr Epstein said she now conducts physical examinations of her patients and has changed her record keeping.
She said in her almost 40-year history as a doctor she had held positions including general physician treating patients with respiratory problems at Royal North Shore Hospital.
She told the tribunal in the late 1990s she developed an interest in "preventative medicine" and says she is "the only practitioner in Australia engaged in the particular type of anti-ageing medicine" she practices.
"I treat my patients with a view to preventing health decline, lost function and loss of mobility and cognition that is common in the last decades of life today," she said.
But the tribunal found she was at times "naïve" and "emotionally swayed" and "acquiesced to patients' demands".
It said it agreed with the HCCC's submission that: "Choosing to practice outside the mainstream does not absolve the practitioner from practising in accordance with the standards relevant to the field of speciality."
In some cases her treatment was "improper and unethical" and "placed her patients at risk".
Dr Epstein currently practises in Artarmon, on the lower north shore.
A hearing will be held in mid April to determine what protective orders will be imposed, which could include the cancellation of her registration as a doctor.
