Biogenesis Just Hints at Florida's Anti-Aging Catastrophe

Outside a $600,000 Coconut Grove condo, the pool glittered blue in the afternoon sunlight and tennis balls popped off a green asphalt court. Inside, a tornado hit. Sharon Cohen watched her heavily tattooed Spanish husband, Alvaro, slam his head over and over against a TV set.

She'd recently filed for divorce, and when she refused Alvaro's demands to sign paperwork to help him stay in the country, he'd flipped, yelling and attacking the TV. Then, suddenly, he grabbed a kitchen knife from the counter. He rounded on Sharon, who screamed and sprinted into the laundry room. Alvaro followed, bellowing. As he backed her into a corner, he held the knife to her throat and punched her again and again in the stomach. "I'm going to kill you if you don't do what I say!" he hollered.

Sharon Cohen, a short, beautiful 44-year-old, couldn't believe it had come to this. But she knew exactly where it had started: three years earlier, with the couple's visit to a charismatic anti-aging doctor in South Miami. Alvaro had bought steroids, abused them, and become impotent. Now she barely recognized him.


Biogenesis Just Hints at Florida's Anti-Aging Catastrophe

See also: "Tony Bosch and Biogenesis: MLB Steroid Scandal"

"My husband became isolated, hostile, and violent," Sharon told state investigators two years later. "He lost his sex drive and blamed me for it."

See also: "Tony Bosch and Biogenesis: MLB Steroid Scandal"

Today, the doctor Sharon blames is internationally famous. Sham physician Tony Bosch's face has been plastered across newspapers and ESPN updates ever since a January Miami New Times investigation revealed that his Coral Gables clinic, Biogenesis, was selling performance-enhancing drugs to professional athletes, including superstar Yankee third baseman Alex Rodriguez. This summer, Major League Baseball suspended 14 players — including A-Rod for a record 211 games — over their ties to Bosch. It was the single biggest round of drug suspensions in American professional sports.

Sharon Cohen's story of love turned violent shows that millionaire ballplayers weren't the only ones whose lives Bosch destroyed. Hundreds of ordinary clients were also his victims.

Her tale also illustrates the dangers of lax regulation in Florida, where the underfunded, dysfunctional state Department of Health has for years allowed clinics such as Biogenesis to sell restricted, potentially dangerous drugs to just about anyone willing to pay cash.

Though the DOH investigated Bosch's clinic in 2009 and again in 2011, the agency took no action. And that's par for the course. A three-month New Times investigation has found the department's enforcement bureau — the only state agency chartered to go after both charlatans like Bosch and real doctors and pharmacies who abuse their power — is systemically flawed and has been castrated under Gov. Rick Scott.

Among the specific findings:

• In the past four years, the DOH has referred 206 cases of unlicensed practitioners like Bosch to law enforcement agencies. Those cases have resulted in only four convictions.

• Less than half of the $610,175 in penalties levied by the bureau in that time has been paid.

• In just the past three months, more than a half-dozen experienced agents and supervisors in the Bureau of Enforcement's unlicensed activity program have quit or transferred out. At one point, there were five investigators for the entire state, including one for Miami-Dade, Broward, and Palm Beach counties.

• Budget cuts and mismanagement have left agents without readily available unmarked cars and access to vital prescription databases, poisoning a work environment in which supervisors discourage pursuit of criminal charges.

• Multiple clinics and pharmacies are owned by or closely tied to felons arrested for everything from burglaries to DUIs to the illegal sales of anabolic steroids.

• Perhaps most significant, clinics busted in the past for selling drugs to athletes have quickly and quietly reopened.

As a result, Florida now has 549 anti-aging clinics, the most in the nation. "We need to apply the same kind of rules and regulations that we're currently applying to pain clinics to these operations," says Sen. Eleanor Sobel, a Hollywood Democrat. "Felons should not be allowed to operate these clinics and they should be open to inspection by the state... This needs to become a priority in Tallahassee."

When Alisa Jaffe first met Brian Yusem, he told her everything she wanted to hear. Jaffe had recently turned 45, worked a high-stress job as a financial adviser, and was feeling worn down.

Yusem, a buff man in his late 50s with dark, wavy hair, promised to fix all of that with science. His Boca Raton clinic, Maxim Life, claimed to work miracles. "We don't treat symptoms," Yusem wrote on his website. "We go to the underlying problem that is the cause of the symptoms and eliminate it."

After a round of blood tests, Yusem concluded Jaffe's hormones and nutrition were out of whack. She needed a two-year program of body cleanses and drugs, including thyroid medication. "It sounded like an interesting program," she later told Health News Florida. "It certainly was a good sales job."

As weeks went by, Jaffe felt worse than ever and eventually visited another doctor. He gave her a thorough exam and quickly discovered the truth: She had a large and dangerous tumor on her thyroid. Surgery, not body cleanses, was required.

Jaffe had surgery and then sought help from a holistic physician in Boca Raton named Dr. Kenneth Woliner, who quickly learned the misdiagnosis was only the beginning. In fact, Yusem, who advertised himself as a "naturopathic doctor," wasn't a physician at all. He was actually a self-described former escort service owner who had stumbled into the anti-aging game while running a business called Sneaker Madness.

He was also an admitted steroid dealer who was outed in 2007 by Yahoo! News as the source for former NFL quarterback Tim Couch. (Couch later admitted to buying HGH from Yusem but denied taking steroids; he was suspended six games by the NFL in 2007 for violating league drug policy.) "I think we can create a race of super-athletes," Yusem had told Yahoo!, bragging that an unnamed NBA veteran, a retired MLB player, and a top golf pro were working with him to develop drugs for young athletes.

Woliner was shocked to find that despite such obvious public admissions, neither Yusem nor his drug supplier — a hair-replacement specialist with a blinding smile named Dr. Glenn Charles — had ever been touched by authorities.

Woliner vowed to see justice done. But even he didn't know how hard that would prove. "Not only did I file a complaint with the DOH; I also filed one with the Palm Beach Sheriff's Office," Woliner says. "Neither aggressively pursued this."

Woliner is an unlikely champion for reform. An excitable, fast-talking doc who earned his medical degree at Tampa's University of South Florida before moving back to his hometown, he'd never been a snitch. But then, in 2006, the DOH cited him for misdiagnosing a patient's thyroid condition, fined him $5,000, and required him to take a course on medical regulations. Instead of viewing the class as an annoyance, Woliner jumped into the state's rules like a biblical convert consuming the New Testament.

He learned the DOH was the brainchild of Dr. William G. "Doc" Myers, a wheelchair-bound Republican state representative from Hobe Sound and a medical doctor. In 1996, the Legislature named a bill after Myers that split the behemoth Department of Health and Rehabilitative Services into two pieces that handled public health and social services.

For years, the DOH seemed to be improving a reputation sullied by years of news reports about missing children and forgotten elderly. A new enforcement wing recruited ex-cops and state investigators to craft criminal charges against unlicensed practitioners, while regulators ensured bad doctors faced discipline from state boards.

Then, in 2011, Rick Scott ran for governor, making no secret of his disdain for health-care regulators. Before turning his sights to politics, Scott had founded Columbia Hospital Corp. — a firm that later ended up paying a record $600 million fine after pleading guilty to 14 felony counts of defrauding Medicare.

In his first budget, Scott helped the Legislature strip $55.6 million from the DOH, a move that led to 229 layoffs, mostly in county health departments. The governor also began appointing apparatchiks who favored small government and less regulation.

"The people coming in were all political folks, and their direction was all coming straight from the governor's office," says Daniel Parker, who spent 14 years working in the DOH before quitting over his concerns with Scott's management. "What was driving all this was an ideology that wants to get rid of government altogether."

In the seven months before Parker departed in June 2012, nearly a dozen other top-level administrators had quit or transferred. Among them was Scott's first choice to run the DOH, Frank Farmer, who resigned after less than a year on the job.

That turmoil has had wide-ranging ramifications, from the closure in July 2012 of A.G. Holley Hospital — the only tuberculosis facility in a state that has seen the disease spike — to rock-bottom morale.

But no problem concerns Parker as much as the ongoing effects of the cutbacks on the DOH's Bureau of Enforcement. "I understand when people say they want less government," he says. "But... do you really believe your doctor will do a good job with no oversight at all?"

In 2007, federal agents with battering rams beat down the door of a third-floor office in a quiet corner of Palm Beach Gardens. Inside a clinic called the Palm Beach Rejuvenation Center, they found packages stuffed full of stanozolol, an anabolic steroid; and dozens of cartridges of Genotropin, the most popular human growth hormone on the market.

The raid was the culmination of the largest sting organized on Florida's booming anti-aging industry. A three-year investigation, cheekily titled "Operation Which Doctor," had involved federal and state agents as well as prosecutors from New York state who sparked the probe by looking into internet pharmacies selling steroids online.

The trail had led to the small clinic and to an Orlando-area compounding lab called Signature Pharmacy that provided most of the meds. Among the clients were a host of professional ballplayers, including Cardinals outfielder Rick Ankiel, Orioles outfielder Jay Gibbons, and all-pro NFL safety Rodney Harrison.

A year later in an Albany courtroom, the clinic's owners — a former nightclub impresario named George Stephanos and his brother Glenn — pleaded guilty to, respectively, a misdemeanor and a felony count of attempted sale of a controlled substance. Their ex-partners, including noted Palm Beach youth sports supporter Joseph Raich and a physician, Dr. Robert Carlson, had already pleaded to their own felonies.

The Albany prosecutors were elated. "This should put them out of business," Assistant District Attorney Christopher Baynes gloated to the media.

But five years later, many principals in the case are right back in the Florida anti-aging game. Despite his felony conviction in New York, Glenn Stephanos has a new clinic three miles south of the former offices of the Palm Beach Rejuvenation Center, according to state records. His business is called Palm Beach Preventative. Its website offers "testosterone therapy" and "bio-identical hormone replacement."

"We only do hormone therapy," a woman at the clinic tells a reporter and directs calls to a "counselor" who can do blood tests. Stephanos did not respond to a message left with his assistant.

Stephanos isn't the only criminal tied to a Florida anti-aging facility. In 2001, Javier Fernando Murcia founded a Hollywood clinic called Modern Therapy. Six years earlier, the Colombian-born businessman had been caught at 1:30 a.m. in the parking lot of a Fort Lauderdale business that had been repeatedly robbed; an officer found a flashlight, a crowbar, and a hammer in Murcia's car. He was arrested and charged with felony prowling and possession of burglary tools (adjudication on both charges was later withheld by a judge). In 1997, he and an accomplice were arrested for trying to steal nitrous oxide from Columbia Medical Center (those charges were dropped.) In 2000, he was sentenced to a year in jail for a series of DUIs and was even arrested while in custody at a work-release house for stealing juice from a fridge.

Six years after Murcia opened Modern Therapy, Sports Illustrated reported the clinic had sold performance-enhancing drugs to Orioles outfielder Jay Gibbons. Modern Therapy closed in 2011 but reopened last year registered to Maria Murcia. State business records show it's currently based in a Hollywood home owned by "Fernando Murcia." Reached by phone, Maria Murcia confirmed the business had once been owned by Javier but declined to put a reporter in touch with him. Asked about his relationship to the current clinic, she said, "That's private information" and hung up.

Others nabbed in Operation Which Doctor were allowed to keep their Florida licenses despite felony pleas in New York. Take Signature Pharmacy's owners, Naomi and Robert "Stan" Loomis. This past February, their business pleaded guilty to a felony count of criminal sale of a controlled substance and agreed to pay $100,000 in fines; adjudication was withheld on the couple's own felony charges.

Florida allowed the Loomises to keep practicing, and Signature Pharmacy is again registered as an active business in Winter Park. Naomi Loomis is now a pharmacist for Olympia Pharmacy, a compounding facility based in Orlando with a website that advertises "hormone consultations" and sells HCG and "testosterone therapy." Stan Loomis did not respond to multiple messages left at Olympia. In 2008, the couple sued David Soares, Albany's district attorney, alleging he violated their civil rights with his mass prosecution; they dropped that case in February.

Palm Beach Rejuvenation's Dr. Robert Carlson is also back in business. The Sarasota-based heart surgeon who signed off on prescriptions for $5,000 per week was charged with seven felonies. He pleaded guilty to one count of insurance fraud and agreed to pay a $300,000 fine. He later appealed that plea deal, and his case remains open in New York.

Florida's Board of Medicine fined Carlson $10,000 and ordered him to take a rules course and perform 50 hours of community service but allowed him to keep his license. He recently opened a new clinic, the Ändlös Institute, which offers hormone replacement therapy and HCG weight loss. He did not respond to an email or a message at his office.

Other clinics are run by physicians with questionable records. Take Broward County's Royal Men's Medical Center, which offers testosterone and hormone therapy. The head of the Deerfield Beach business, Dr. Dagoberto Rodriguez, pleaded guilty to battery in Hillsborough County back in 1986. When he applied for his medical license in 1990, he lied about the case, answering "no" to a question about whether he'd ever pleaded guilty to a crime. He did the same in 1999 when renewing his license. Two years later, the DOH charged him with falsifying his application, eventually only fining him $1,000 and requiring him to take an education course. (Monica Rodriguez, an attorney representing the doctor, says that the Hillsborough County charge was related to a fight that happened at a college rugby game and that the problems with his license applications were a misunderstanding. "This is not, in the scheme of things, a big deal," she says.)

In Florida, those caught selling anti-aging drugs without proper documentation rarely face charges. Take the case of Pharmacy RX Solutions, a Tampa facility with a website that notes it specializes in "hormone replacement therapy" and custom mixes of testosterone and HCG.

In June, a DOH inspector found the facility was open with no licensed pharmacist on hand, a violation of state rules. Then he discovered shipments without proper paperwork. Drugs were being compounded without sterilization and testing for dangerous impurities. The department issued an emergency order last month shuttering the business, but the order was lifted after 20 days and pharmacist Adria Jackson has kept her license. A DOH complaint against the pharmacy is pending. (Ed Bayó, an attorney for the pharmacy, says DOH's emergency order was inappropriate. Jackson was attending to a "family emergency" the morning she wasn't in the pharmacy and the other issues were quickly dealt with, he says. "I'm reasonably confident the pending cases against the pharmacy will be dismissed," he says.)

With steady profits, rare enforcement, and a large population of retirees, it's no surprise that anti-aging has exploded here. Across the state, clinics openly advertise on I-95 billboards and in newspapers.

But federal law seems clear about testosterone and steroids. The Anabolic Steroids Control Act of 1990 classifies them as Schedule III drugs that are legal only if a patient has a diagnosed medical condition. Human growth hormone, meanwhile, is one of a handful of drugs the FDA has allowed for a small set of diseases mostly related to growth deficiencies. In all, fewer than 45,000 people nationwide have such conditions, according to a 2012 Associated Press investigation.

Florida has its own specific prohibitions on all three drugs. State Statute 458.331 outlaws "prescribing, ordering, dispensing, administering, supplying, selling, or giving growth hormones, testosterone or its analogs, human chorionic gonadotropin (HCG), or other hormones for the purpose of muscle building or to enhance athletic performance."

Yet unlike the offices of dentists, chiropractors, nutritionists, or even massage parlors, anti-aging clinics aren't required to register with a state medical board or to list a licensed medical director. That means anyone can open and own one, and if the owner — like Yusem or Bosch — isn't a doctor, he or she doesn't even have to list the physician who's providing controlled substances.

Most trace the beginning of the industry's growth to 1992, when the American Academy of Anti-Aging Medicine (A4M) was founded by Dr. Ronald Klatz, a Belize-educated osteopath who claims he coined the term "anti-aging," and Dr. Robert Goldman, a former anti-steroid advocate who became a vocal force for chemical enhancement.

According to his website, Goldman is a "black belt in karate, Chinese weapons expert and world champion athlete with over 20 world strength records." The site includes an animated GIF of him doing one-handed pushups. A4M stages annual conventions in Orlando and elsewhere that draw tens of thousands. Under their stewardship, clinics like Tony Bosch's Biogenesis have exploded. There are more than 26,000 worldwide, and the lobby's headquarters are located in a plush Boca Raton office.

The industry has found a legal gray area in which to thrive. Many anti-aging doctors simply check patients' testosterone or growth-hormone levels, pronounce them "deficient," and then prescribe the drugs as a remedy. They point out that HGH is approved for "Adult Hormone Growth Deficiency" and say that's what they're treating.

"Poor presentations of the science... [have] erroneously suggested that the replacement of HGH in aging adults is illegal, and has led to sensationalized headlines," A4M says in a statement. "Patients are not given HGH for a diagnosis or treatment of 'anti-aging' ... The A4M does not endorse or condone the use of any illicit substances for sports cheating. However, the A4M does support the continued availability of such substances to adult patients with objectively assessed hormone deficiencies."

But many mainstream doctors say lower hormone levels are just a natural part of aging and question the benefit of HGH and synthetic testosterone. A 2010 New England Journal of Medicine study estimates that only 2 percent of men aged 40 to 80 actually suffer from real hormone deficiencies.

Other studies have suggested HGH can increase cancer risk and cause other adverse health effects (a claim A4M disputes). "The marketing and sale of growth hormone for... anti-aging or age management is a pure scam," says Dr. Thomas Perls, an age researcher at Boston University. "The anti-aging industry markets and sells this drug because it has a great name and they can make huge profits with it [by] charging clients about $12,000 a year."

Indeed, the clinics aren't the only ones making beaucoup profit. Drug makers pulled in $1.4 billion selling HGH in 2011, according to the Associated Press. The top profiteer, AP found, was Roche subsidiary Genentech, which banked almost $400 million in HGH sales in the United States in 2011, a two-thirds increase from 2005; Pfizer and Eli Lilly sold $300 million and $220 million, and Pfizer's HGH medicine, Genotropin, actually outsold its famous antidepressant Zoloft.

In all, the industry's HGH sales were up 69 percent between 2005 and 2011, while the average drug saw only a 12 percent increase, the AP found. A separate study by research firm IMS Health determined that sales of hormone and androgen drugs nearly doubled between 2007 and 2011, from 2.9 million to 5.3 million, according to figures shared earlier this year with the New York Times.

South Florida clinics are packed into strip malls, tucked into tanning salons, and operating out of gyms. Side businesses have even popped up to connect unlicensed clinics looking for drugs with licensed physicians. Consider AA Life, a Northlake, Illinois-based company with a satellite office in Fort Lauderdale. The firm faxes ads to doctors' offices: "We are in need of a physician with a valid M.D. or D.O. license," they write. "Doctor can work at own location."

After receiving this note, Boca anti-steroid activist Dr. Woliner sent an email to AA Life asking for more details. A woman named Olga replied that AA Life would provide patients' bloodwork and exams plus a recommendation for how much testosterone and HGH was needed. All Woliner had to do was sign for the drugs. His compensation: "$100 for each prescription." If he got up to ten per week, he'd get $1,000 extra. "We have a database with the patients who need Hormone Replacement Therapy!" Olga wrote.

Critics like Woliner say such offers amount to "renting" doctor's licenses, an illegal but common practice in Florida. "That's aiding an unlicensed practice of medicine," he says. "But this is widespread. This happens with a lot of these cash clinics."

Florida in particular has had trouble enforcing drug laws thanks to the DOH's decimation under Rick Scott. Four current and former investigators interviewed by New Times, three of whom declined to be named for fear of reprisal, detailed the breakdown in the bureau over the past two years.

First, in early 2012, an edict came down from Tallahassee: Investigators, who on average had more than 60 pending complaints on their desks, were ordered to "purge" cases. Those more than a year old were automatically closed; most newer cases were sent to Tallahassee, where DOH lawyers gave them a cursory look and declared them "legally insufficient."

The next blow came in June 2012. That's when investigators learned they'd no longer be able to pick up unmarked cars at will, which had been the previous policy. They'd have to fill out onerous paperwork and red tape to schedule the cars ahead of time.

"The problem is this isn't an 8-to-5 desk job where you can plan everything out," one current investigator says. "You never know when a tip comes in and you need to run out to stake out an illegal pharmacy or doctor's office. The result was, it became much, much harder to mount investigations."

In March, the DOH closed its Hollywood office, where all the unlicensed activity investigators for the area had been based. They were scattered to auxiliary offices. Finally, in June, the investigators were told they'd no longer have access to the statewide database that tracks prescriptions. Supervisors in Tallahassee cited unspecified "misuse" by an investigator, sources say.

"That was a key tool for us because we could see immediately if someone was prescribing 10,000 oxy pills in one month," one current investigator says. "Suddenly, we're frozen out."

Even worse was the active interference. Christopher Knox, a retired cop who joined the department as an investigator in 2010, ran into similar resistance. He found evidence a Miami pharmacy was illegally selling painkillers and then was ordered by his superiors not to take that evidence to the DOH's prosecutors.

"They actually ordered me not to assist the police in going after someone who was breaking the law," says Knox, who was fired this past March and has filed a whistleblower complaint. "That's when I realized that I couldn't work in this organization any longer."

In a statement sent to New Times, DOH defended its policies and says it's serious about going after unlicensed doctors. Investigators can still get unlicensed cars when they need them, DOH says, and protecting their safety while working cases is "of utmost importance."

"The Department has dedicated more resources to combating the unlicensed practice of a health care profession and, for the first time, has established a statewide coordinator in Tallahassee," the statement reads.

But the problems described by Knox certainly aided Tony Bosch and his father, Dr. Pedro Bosch. They were first investigated by the department in 2009, when ESPN reported they were suspected as the source of PEDs that led Dodgers slugger Manny Ramirez to fail a test, says a DOH source with intimate knowledge of the case. But no action was taken. Asked about that case, Ashley Carr, a department spokeswoman, says that "due to confidentiality constraints... we can neither confirm nor deny the existence of a complaint." (Complaints against actual doctors like Pedro Bosch are public only if sustained.)

In 2011, the DOH opened a probe into Tony Bosch based on an anonymous complaint that he was practicing medicine without a license at his Gables clinic, then called BioKem. An investigator staked out the place and briefly interviewed Bosch's partner, Carlos Acevedo, who assured them Bosch was a "marketing" expert working on "referrals," according to state records. The investigator closed the case without interviewing Bosch or talking to any clients.

Worst of all, though, is what happened after New Times' January investigation into Bosch's clinic was published. DOH investigator Jerome Hill took up the case, hoping to charge Bosch with practicing medicine without a license — a felony that carries a minimum one-year prison term in Florida. Hill interviewed three patients, including Sharon Cohen, the domestic violence victim. All signed sworn affidavits that Bosch had presented himself as a licensed doctor.

Two weeks after interviewing Cohen, though, Hill got a call from Tallahassee: Tony Bosch would be sent a cease-and-desist letter and fined $5,000 (which was later reduced to $3,000). The case would be closed. Hill was flabbergasted. In an email sent to his boss, he warned that without more investigation, "the report will be sent up without the quality it requires." Even worse, DOH administrators then gave Miami-Dade prosecutors just a one-page letter with only a copy of Bosch's citation rather than Hill's full report.

Miami-Dade State Attorney Katherine Fernandez Rundle replied that there wasn't enough evidence to press charges. When WSVN-TV's Carmel Cafiero later showed Rundle's spokesman, Ed Griffith, Hill's full report, Griffith admitted he found it "very surprising" that the DOH had never provided it to prosecutors.

Yusem and Charles, the pair who missed Alisa Jaffe's thyroid tumor at Boca Raton's Maxim Life, also benefited from the DOH's lax enforcement. After Palm Beach Sheriff's deputies raided the office and confiscated vials of steroids and HGH, Yusem was charged with two felony counts of practicing medicine without a license. Charles was hit with two misdemeanors for enabling him.

But in January, Yusem pleaded guilty in exchange for his felony adjudication's being withheld; he'll serve two years' probation, sell his stake in Maxim Life, and promise to stop playing doctor. In exchange, his record will be clean.

Dr. Charles got off even easier. His adjudication was also withheld, and he kept his license. Last month, Woliner traveled to Tampa to plead with the Osteopathic Board of Medicine to strip Charles of his license. But each time Woliner tried to explain the DOH's failings, he was cut off by board members. "You can only address what's in the administrative complaint," board chair Ronald Burns scolded Woliner.

In the end, the board forced Charles to pay an additional $11,800. But he'll keep his license.

In a state where felons can own clinics that are rarely if ever inspected, patients go to anti-aging clinics at their own risk. And sometimes they get burned.

A sampling of complaints against clinics like Biogenesis finds a heart patient allegedly killed by an experimental procedure, a fraudulent doc who injured a minor by taking him off his medication, a steroid user whose failed suicide attempt cost him internal organs, and an international criminal enterprise that crumbled over a 'roid rage incident.

Among the most interesting cases is that of Bishop Peter Bukawyn, a longtime immigration advocate and pastor at the Apostolic Mission of Christ in downtown Miami. He died in 2010 after a treatment at Lauderhill's Institute of Advanced Medicine.

Its proprietor, the Mexico-educated Dr. Herbert Slavin, boasts of nabbing a mention in Suzanne Somer's latest health book and offers bio-identical hormone replacement and HGH therapy on his website.

According to a pending appeal with the DOH, Bukawyn went in for "chelation therapy," a chemical IV drip that Slavin claims can reverse heart disease without invasive surgery. The pastor went through the therapy for a month in June 2010. Then, on July 4, he was rushed to the hospital with a Stage 4 heart attack and died. In the complaint, Slavin is accused of breaking state regulations by refusing to refer the pastor to a cardiologist, failing to get his consent for an experimental procedure, and dispensing heart medication without a license.

Slavin was also reprimanded by the state in 1993, according to the Sun Sentinel, for overprescribing dilaudid, a powerful and addictive narcotic, to six patients. He was eventually put on probation and fined $3,000. In 2008, state records show a patient complained she'd been injured when Slavin prescribed meds for hyperthyroidism even though her thyroid was fine; the state pressed charges, and despite testimony from an expert witness, an administrative judge sided with Slavin last January. The case was dismissed. Slavin didn't respond to four messages left at his clinic.

Just north in Stuart, the Back to Eden Wellness Center had a less dramatic but much stranger case. The place was run by Lynette Blake, who called herself a "naturopathic doctor" despite having no state license. Blake convinced one underaged patient's parents to take him off his meds and, when his condition quickly worsened, told them "with 100 percent certainty their son was possessed by an evil spirit," according to a police report.

Blake drew ten vials of blood from another patient and then refused that person's demand to be taken to the hospital when the patient became dizzy. Blake was arrested in August and charged with practicing medicine without a license. She is out on bond and awaiting a hearing.

Others are indirect victims of easy access to steroids in Florida. Stephen Bailey, who was 25, got a job in early 2010 as a trainer at the Sebring YMCA. Thrown into a macho weight-room culture, he soon started buying Winstrol, an anabolic steroid, from a fellow trainer. "I'm not going to say Stephen never struggled with depression before," says his mother, Tina Haley. "But everything changed once he started taking steroids."

One night a few months after starting Winstrol, Bailey choked down more than 200 Tylenol PM pills. He was rushed to the hospital, and doctors kept him in a medical coma at 92 degrees for two weeks. Amazingly, he regained consciousness, but doctors had to remove portions of his liver, intestines, and lungs. "I don't know where the steroids first came from, but somewhere out there, a doctor was willing to sign his name to a prescription he knew was bogus," Haley says.

Last, there is the case of Sharon Cohen, whose impotent husband threatened her with a knife and pounded his head on a TV set. Her testimony actually helped bring down a violent criminal gang. In April, Cohen told Hill, the DOH inspector, in harrowing detail how Bosch's medications led her husband to become increasingly violent until the terrifying attack.

"He held me against my will in the laundry room and beat me with his closed fist on my stomach," she said. She survived only because she "called 911 through a panic button that I installed."

Alvaro Lopez Tardon was arrested on domestic violence charges March 1, 2011, but much worse would soon follow. On July 14, federal agents swarmed another apartment he owned in the luxury Continuum building in South Beach.

Four thousand miles away across the Atlantic, Spanish police burst into a Madrid mansion and hauled out Alvaro's brother, Artemio. Inside, they found 19 million euros hidden beneath the floorboards near a hot tub.

Alvaro Lopez Tardon had been running one of Europe's largest, bloodiest drug rings, police say, and was tied to at least five murders back in Spain. His brother had moved millions in drugs before sending at least $26 million back to Miami for Alvaro to launder by snapping up condos and luxury cars, they allege. He was charged in July 2011 with five felony counts of conspiracy to commit money laundering. (He has pleaded not guilty, and his attorney claims he was in fact in the luxury car business.)

What Sharon wanted, though, was simple: To see Tony Bosch punished for the role he played in sparking her near-death experience. Like so many other clients burned by clinics like Biogenesis, the deception that threw her life into disarray was simple. "I thought Tony Bosch was a medical doctor," she told Hill. "[I] believed that he was."

How to clean up the mess of Florida's anti-aging industry? One answer might come from a look at Florida's once-booming pill-mill industry. For nearly a decade, unregulated "pain clinics" boomed in the Sunshine State, thanks to regulations that let them operate freely so long as they didn't take insurance money.

The results would have been hilarious if they weren't so deadly. In Broward alone, more than 100 clinics had opened by 2009, selling more than 9 million pills a year in a county with just 1.8 million people. ­Nationwide, nearly 90 percent of all oxycodone sales were rung up in Florida. One chain was owned by the Bonanno Mob. Another handed out gas coupons so drug dealers from across the Northeast could drive down to stock up. And then there was the "Oxy Express," the weekly Fort Lauderdale charter that jetted down from West Virginia's rural Tri-State Airport just so pill pushers could buy up meds that cost $4.50 in Florida and resold for $80 to addicts in the hill counties.

Fast-forward four years and pill mills are on the decline across Florida. The biggest reason? Embarrassed by repeated reports of rampant abuse, the state Legislature finally closed loopholes and tightened regulations.

Would that same approach work with anti-aging clinics? "If we were allowed to inspect anti-aging clinics, you'd see an immediate reduction in illegal business," says Knox, the former DOH investigator. "Owners who shouldn't be in the health-care business wouldn't be around for long."

Florida's pill-mill fix has been far from perfect, but it did make it harder for the most obvious crooks to stay in the game. A 2009 bill signed by then-Gov. Charlie Crist banned felons from owning clinics and barred clinics from selling pills onsite. Legislators also changed the rules so that even pain businesses that took cash only could still be inspected by the DOH.

As a result, drug deaths from oxy and other narcotics have been falling since 2010, and many of the shadiest clinics have left for more permissive states. The same might happen if rules were changed on anti-aging clinics. "You can do a few things right away that would help," says Mike Fasano, a former Florida state senator and representative who championed the pill-mill legislation until he left Tallahassee in 2012. "You can bar felons from owning clinics. You can inspect them and license them, and you can stop cash payments. You do those four things, and you'll close a lot of the unethical facilities right away."

But Fasano admits that it took years of fighting to get even modest reform on pill mills. And Scott and his allies have since retreated on those reforms by cutting funding for the prescription drug database and rolling back regulations. "Money talks in Tallahassee, just as it does in Washington and any other state capital," Fasano says.

New laws governing the anti-aging industry also wouldn't fix the Department of Health's internal problems. Current and former investigators say that as long as Scott's appointees actively discourage criminal charges against bad doctors and fakes like Bosch, not much is likely to change.

As long as Florida clinics continue pumping millions into local economies and physicians' and drug companies' pockets, there may be little taste in Tally for upending the status quo — even in the face of scandals like Biogenesis.

"There are huge profits being made off these drugs by the pharmaceutical companies," Dr. Perls says. "And the guys making money hand over fist on these products are turning a blind eye to the abuse."

Writers Gus Garcia-Roberts, Steve Miller, and Jared Leone contributed to this article.

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