Page 1, 2, 3, 4, Appendix/Notes
Contributing Physicians and Scientists
Martin Dayton, DO; Medical Director, Dayton Medical Center (Florida, US)
Robert M. Goldman, MD, PhD, DO; Cofounder and Chairman, American Academy of Anti- Aging Medicine; Cofounder and Chairman, World Anti-Aging Academy of Medicine
Brad Grant, DO; past President, Osteopathic Physicians and Surgeons of California
James Forsythe, MD, HMD; private practice (Nevada, US)
Steven F. Hotze, MD; Director, Texas for Physicians’ and Patients’ Rights; Chief Executive Officer, Hotze Health & Wellness Center (Texas, US)
Ronald M. Klatz, MD, DO; Cofounder and President, American Academy of Anti-Aging Medicine
Hans Kugler, PhD; President and Founder, International Academy of Anti-Aging Medicine
A. Tina Miranda, MD, MBA; private practice (Florida, US)
Iris Breuer Mueller, MD; Psychiatrist, the Cantonal Hospital of Lucerne, Switzerland; University of Zurich, Switzerland
Emil K Schandl, MS, PhD, MD, (MA), FNACB, SC(ASCP), CC(NRCC), LNC, CLD (FL, NY, CA); Director, American Metabolic Laboratories, Clinical Laboratory
C. Norman Shealy, MD, PhD; President, Holos Institutes of Health Inc. (Missouri, US)
Astrid Stuckelberger, MSc, PhD, Docent; Faculty of Medicine, University of Geneva, Switzerland; Secretary-General, International Association of Gerontology and Geriatrics – European Region; President, Geneva International Network on Aging; Expert on Aging at the United Nations and European Commission
Appendix A: Literature Review
This section presents a selection of published peer-reviewed studies that document the life-enhancing and/or life-extending benefits of HRT in aging adults. For further references, see the A4M's White Paper "Guidance for Physicians on Hormone Replacement Therapy"; May 2007; available at http://www.worldhealth.net/white-papers-official-statements.
HGH
Aberg ND. Growth hormone increases connexin-43 expression in the cerebral cortex and hypothalamus. Endocrinology. 2000 Oct;141(10):3879–3886.
Abs R. Update on the diagnosis of GH deficiency in adults. Eur J Endocrinol. 2003 Apr;148 Suppl 2:S3–S8.
Adamopoulos S et al. Growth hormone administration reduces circulating proinflammatory cytokines and soluble Fas/soluble Fas ligand system in patients with chronic heart failure secondary to idiopathic dilated cardiomyopathy. Am Heart J. 2002 Aug;144(2):359–364
Aimaretti G et al. Diagnostic reliability of a single IGF-I measurement in 237 adults with total anterior hypopituitarism and severe GH deficiency. Clin Endocrinol (Oxf). 2003 Jul;59(1):56–61.
Albert SG et al. Low-dose recombinant human growth hormone as adjuvant therapy to lifestyle modifications in the management of obesity. Clin Endocrinol Metab. 2004 Feb;89(2):695–701.
Aleman et al. Insulin-like growth factor-I and Cognitive Function in Healthy Older Men. J Clin Endocrinol Metab. 1999;84:471–475.
Andreassen et al. Concentrations of the acute phase reactants high-sensitive C-reactive protein and YKL-40 and of interleukin-6 before and after treatment in patients with acromegaly and growth hormone deficiency. Clin Endocrinol (Oxf). 2007 Aug 28.
Baffa R et al. Low serum insulin-like growth factor 1 (IGF-1): a significant association with prostate cancer. Tech Urol. 2000 Sep;6(3):236–239.
Bartke A et al. Consequences of growth hormone (GH) overexpression and GH resistance. Neuropeptides. 2002 Apr;36(2–3):201.
Baum HB et al. Effects of physiologic growth hormone therapy on bone density and body composition in patients with adult-onset growth hormone deficiency. A randomized, placebo-controlled trial. Ann Intern Med. 1996 Dec 1;125(11):883–890.
Bengtsson BA, Edén S, Lönn L, et al. Treatment of adults with growth hormone (GH) deficiency with recombinant human GH. J Clin Endocrinol Metab. 1993;76:309–317.
Bennett R Growth hormone in musculoskeletal pain states. Curr Rheumatol Rep. 2004 Aug;6(4):266–273.
Bennett RM et al. A randomized, double-blind, placebo-controlled study of growth hormone in the treatment of fibromyalgia. Am J Med. 1998 Mar;104(3):227–231.
Besson A et al. Reduced longevity in untreated patients with isolated growth hormone deficiency. J Clin Endocrinol Metab. 2003 Aug;88(8):3664–3667.
Biller BM et al. Sensitivity and specificity of six tests for the diagnosis of adult GH deficiency. J Clin Endocrinol Metab. 2002 May;87(5):2067–2079.
Blackman M et al. Growth hormone and sex steroid administration in healthy aged women and men. JAMA. November 13, 2002;288(18).
Bocchi EA et al. Growth hormone for optimization of refractory heart failure treatment. Arq Bras Cardiol. 1999 Oct;73(4):391–398.
Bogarin R et al. Growth hormone treatment and risk of recurrence or progression of brain tumors in children: a review. Childs Nerv Syst. 2009 Jan 14.
Boguszewski CL, Meister LH, Zaninelli DC, Radominski RB. One year of GH replacement therapy with a fixed low-dose regimen improves body composition, bone mineral density and lipid profile of GH-deficient adults. Eur J Endocrinol. 2005;152:67–75.
Bohdanowicz-Pawlak A et al. Risk factors of cardiovascular disease in GH-deficient adults with hypopituitarism: a preliminary report. Med Sci Monit. 2006 Feb;12(2):CR75–CR80.
Borson-Chazot F et al. Decrease in carotid intima-media thickness after one year growth hormone (GH) treatment in adults with GH deficiency J Clin Endocrinol Metab. 84:1329–1333, 1999.
Branski LK et al. randomized controlled trial to determine the efficacy of long-term growth hormone treatment in severely burned children. Ann Surg. 2009 Sep 2.
Burgess W et al. The immune-endocrine loop during aging: role of growth hormone and insulin-like growth factor-I. Neuroimmunomodulation. 1999 Jan–Apr;6(1–2):56–68.
Caidahl K, Edén S, Bengtsson BA. Cardiovascular and renal effects of growth hormone. Clin Endocrinol (Oxf). 1994;40:393–400.
Cappola AR et al. Association of IGF-I levels with muscle strength and mobility in older women. J Clin Endocrinol Metab. 2001 Sep;86(9):4139–4146.
Cappola et al. Insulin-like growth factor I and interleukin-6 contribute synergistically to disability and mortality in older women. JCEM. 2003 May;88(5):2019–2025.
Cenci MC, Soares DV, Spina LD, et al. Comparison of two dose regimens of growth hormone (GH) with different target IGF-1 levels on glucose metabolism, lipid profile, cardiovascular function and anthropometric parameters in gh-deficient adults. Growth Horm IGF Res. 2012;22:116–121.
Chan et al. Plasma insulin-like growth factor-I and prostate cancer risk: a prospective study. Science. January 1998;279.
Cherbonnier C et al. Potentiation of tumour apoptosis by human growth hormone via glutathione production and decreased NF-kappaB activity. Br J Cancer. 2003 Sep 15;89(6):1108–1115.
Christiansen J. Influence of growth hormone and androgens on body composition in adults. Horm Res. 1996;45(1–2):94–98.
Colao A et al. Beginning to end: Cardiovascular implications of growth hormone (GH) deficiency and GH therapy. Growth Horm IGF Res. 2006 May 9.
Colao A et al. Effect of growth hormone (GH) and insulin-like growth factor I on prostate diseases: an ultrasonographic and endocrine study in acromegaly. J Clin Endocrinol Metab. 1999 Jun;84(6):1986–1991.
Colao A et al. Impaired cardiac performance in elderly patients with growth hormone deficiency. J Clin Endocrinol Metab. 1999 Nov;84(11):3950–3955.
Colao A, di Somma C, Cuocolo A, et al. Improved cardiovascular risk factors and cardiac performance after 12 months of growth hormone (GH) replacement in young adult patients with GH deficiency. J Clin Endocrinol Metab. 2001;86:1874–1881.
Colao A.Bone loss is correlated to the severity of growth hormone deficiency in adult patients with hypopituitarism. J Clin Endocrinol Metab. 1999 Jun;84(6):1919–1924.
Collier SR et al. Growth hormone responses to varying doses of oral arginine. Growth Horm IGF Res. 2005 Apr;15(2):136–139.
Cook DM. Shouldn't adults with growth hormone deficiency be offered growth hormone replacement therapy?Ann Intern Med. 2002 Aug 6;137(3):197–201.
Cook D et al. Route of estrogen administration helps to determine growth hormone (GH) replacement dose in GH-deficient adults. J Clin Endocrinol Metab. 1999Nov;84:(11):3956–3960.
Corpas E et al. Oral arginine-lysine does not increase growth hormone or insulin-like growth factor-I in old men. J Gerontol. 1993 Jul;48(4):M128–M133.
Cuatrecasas G et al. Growth hormone as concomitant treatment in severe fibromyalgia associated with low IGF-1 serum levels. BMC Musculoskelet Disord. 2007 Nov 30:
Cuatrecasas G, Alegre C, Fernandez-Solà J, et al. Growth hormone treatment for sustained pain reduction and improvement in quality of life in severe fibromyalgia. Pain. 2012 Jul;153(7):1382–1389.
Drake W et al Optimizing growth hormone replacement therapy by dose titration in hypopituitary adults. J Clin Endocrinol Metab. 1998 Nov;83(11):3913–3919.
Fazio et al. A preliminary study of GH in the treatment of dilated cardiomyopathy. N Eng J Med. 1996:334:809–814.
Elbornsson M, Götherström G, Franco C, Bengtsson BÅ, Johannsson G, Svensson J. Effects of 3-year GH replacement therapy on bone mineral density in younger and elderly adults with adult-onset GH deficiency. Eur J Endocrinol. 2012 Feb;166(2):181–189.
Fiebig HH et al. No evidence of tumor growth stimulation in human tumors in vitro following treatment with recombinant human growth hormone. Anticancer Drugs. 2000 Sep;11(8):659–664.
Follin C, Thilén U, Ahrén B, Erfurth EM. Improvement in cardiac systolic function and reduced prevalence of metabolic syndrome after two years of growth hormone (GH) treatment in GH-deficient adult survivors of childhood-onset acute lymphoblastic leukemia. J Clin Endocrinol Metab. 2006 May;91(5):1872–1875.
Franco C et al. Growth hormone treatment reduces abdominal visceral fat in postmenopausal women with abdominal obesity: a 12-month placebo-controlled trial. J Clin Endocrinol Metab. 2005 Mar;90(3):1466–1474.
Franco C, Andersson B, Lönn L, Bengtsson BA, Svensson J, Johannsson G. Growth hormone reduces inflammation in postmenopausal women with abdominal obesity: a 12- month, randomized, placebo-controlled trial. J Clin Endocrinol Metab. 2007 Jul;92(7):2644–2647.
French RA et al. Age-associated loss of bone marrow hematopoietic cells is reversed by GH and accompanies thymic reconstitution. Endocrinology, Jan 2002;143(2)690–699.
Frohman LA. Controversy about treatment of growth hormone-deficient adults: a commentary. Ann Intern Med. 2002 Aug 6;137(3):202–204.
Garten A, Schuster S, Kiess W. The insulin-like growth factors in adipogenesis and obesity. Endocrinol Metab Clin North Am. 2012 Jun;41(2):283–295.
Genth-Zotz S et al. Recombinant growth hormone therapy in patients with ischemic cardiomyopathy: effects on hemodynamics, left ventricular function, and cardiopulmonary exercise capacity. Circulation. 1999 Jan 5–12;99(1):18–21.
Ghigo E et al. Diagnosis of adult GH deficiency. Growth Horm IGF Res. 2008 Feb;18(1):1–16.
Gibney et al. The effects of 10 years of GH in adult GH deficient patients J Endocrin Metab. 1999 August.
Gilchrist FJ et al. The effect of long-term untreated growth hormone deficiency (GHD) and 9 years of GH replacement on the quality of life (QoL) of GH-deficient adults. Clin Endocrinol (Oxf). 2002 Sep;57(3):363–370.
Gillberg P et al. Two years of treatment with recombinant human growth hormone increases bone mineral density in men with idiopathic osteoporosis. J Clin Endocrinol Metab. 2002 87: 4900–4906.
Gotherstrom G et al. A prospective study of 5 years of GH replacement therapy in GH- deficient adults: sustained effects on body composition, bone mass and metabolic indices. J Clin Endocrinol Metab. 2001 Oct;86(10):4657–4665.
Giustina A, Barkan A, Chanson P, et al. Pituitary Society; European Neuroendocrine Association. Guidelines for the treatment of growth hormone excess and growth hormone deficiency in adults. J Endocrinol Invest. 2008 Sep;31(9):820–838. Review.
Harris TB et al. Cytokines, insulin-like growth factor 1, sarcopenia, and mortality in very old community-dwelling men and women: the Framingham Heart Study. Am J Med. 2003 Oct 15;115(6):429–435.
Hedstrom M. Hip fracture patients, a group of frail elderly people with low bone mineral density, muscle mass and IGF-I levels. Acta Physiol Scand. 1999 Dec;167(4):347–350.
Higashi Y, Sukhanov S, Anwar A, Shai S-Y, Delafontaine P. Aging, atherosclerosis, and IGF-1. J Gerontol A Biol Sci Med Sci. 2012;67A (6):626–639.
Ho KK et al. Regulating of growth hormone sensitivity by sex steroids: implications for therapy. Front Horm Res. 2006;35:115–28.
Hong J et al. IGFBP-3 mutants that do not bind IGF-I or IGF-II stimulate apoptosis in human prostate cancer cells. J Biol Chem. 2002 Jan 9, 2002.
Ingermann AR, Yang YF, Han J, Mikami A, Garza AE, Mohanraj L, Fan L, Idowu M, Ware JL, Kim HS, Lee DY, Oh Y. Identification of a novel cell death receptor mediating IGFBP-3-induced anti-tumor effects in breast and prostate cancer. J Biol Chem. 2010 Sep 24;285(39):30233–30246.
Isgaard J et al. GH improves cardiac function in rats with experimental MI. Eur J Clin Invest. 1997;27:517–525.
Isley WL. Growth hormone therapy for adults: not ready for prime time? Ann Intern Med. 2002 Aug 6;137(3):190–196.
Janssen Y et al. A switch from oral (2 mg/day) to transdermal (50 mg/day) 17b-estradiol therapy increases serum insulin-like growth factor-I levels in recombinant human growth hormone (GH)-substituted women with GH deficiency. J Clin Endo Metab. January 2000;85.
Jenkins PJ, Mukherjee A, Shalet SM. Does growth hormone cause cancer? Clin Endocrinol (Oxf). 2006 Feb;64(2):115–121.
Johannsson G et al. GH treatment of abdominally obese men reduces abdominal fat mass, improves glusoce and lipoprotein metabolism and reduces diastolic BP. J Clin Endocinol Metab. 1997;82:727–734.
Johansen PB et al. Ipamorelin, a new growth hormone releasing peptide, induces longitudinal bone growth in rats. Growth Horm IGF Res. 1999;9:106–113.
Johnsen P et al. Insulin-like growth factor (IGF) I, -II, and IGF binding protein-3 and risk of ischemic stroke. J Clin Endocrinol Metab. 2005;90:5937–5941.
Kelley KW, Brief S, Westly HJ, et al. GH3 pituitary adenoma cells can reverse thymic aging in rats. Proc Natl Acad Sci U S A. 1986;83:5663–5667.
Khansari DN et al. Effects of long-term, low-dose growth hormone therapy on immune function and life expectancy of mice. Mech Ageing Dev. 1991 Jan;57(1):87–100.
Kishimoto I, Tokudome T, Hosoda H, Miyazato M, Kangawa K. Ghrelin and cardiovascular diseases. J Cardiol. 2012 Jan;59(1):8–13.
Kurek R et al. The significance of serum levels of insulin-like growth factor-1 in patients with prostate cancer. BJU Int. 2000 Jan;85(1):125–129.
Lang CH et al. Cytokine inhibition of JAK-STAT signaling: a new mechanism of growth hormone resistance. Pediatr Nephrol. 2004 Nov 10.
Laughlin GA et al. The prospective association of serum insulin-like growth factor I (IGF-I) and IGF-binding protein-1 levels with all cause and cardiovascular disease mortality in older adults: the Rancho Bernardo Study. J Clin Endocrinol Metab. 2004 Jan;89(1):114–120.
Laughlin GA, Barrett-Connor E, Criqui MH, Kritz-Silverstein D. The prospective association of serum insulin-like growth factor I (IGF-I) and IGF-binding protein-1 levels with all cause and cardiovascular disease mortality in older adults: the Rancho Bernardo Study. J Clin Endocrinol Metab. 2004 Jan;89(1):114–120.
Leal-Cerro A The growth hormone (GH)-releasing hormone-GH-insulin-like growth factor-1 axis in patients with fibromyalgia syndrome. J Clin Endocrinol Metab. 1999 Sep;84(9):3378–3381.
Liu H, Bravata DM, Olkin I, Nayak S, Roberts B, Garber AM, Hoffman AR. Systematic review: the safety and efficacy of growth hormone in the healthy elderly. Ann Intern Med. 2007;146:104–115.
Liu QL, Wang YS, Wang JX. Effect of growth hormone on the immune function of dendritic cells. Chin Med J (Engl). 2010;123:1078–1083.
Longobardi S et al Effects of two years of growth hormone (GH) replacement therapy on bone metabolism and mineral density in childhood and adulthood onset GH deficient patients. J Endocinol Invest. May 1999.
Major J et al. Insulin-like growth factor-I and cancer mortality in older men. J Clin Endocrinol Metab. March 2010;95(3):1054–1059.
Marcell TJ et al. Oral arginine does not stimulate basal or augment exercise-induced GH secretion in either young or old adults. Gerontol A Biol Sci Med Sci. 1999 Aug;54(8):M395–M399.
Mitsi AC et al. Early, intracoronary growth hormone administration attenuates ventricular remodeling in a porcine model of myocardial infarction. Growth Horm IGF Res. 2006 Apr;16(2):93–100.
Mitsi AC et al. Early, selective growth hormone administration may ameliorate left ventricular remodeling after myocardial infarction. Med Hypotheses. 2005;64(3):582–585.
Molitch ME. Diagnosis of GH deficiency in adults–-how good do the criteria need to be? J Clin Endocrinol Metab. 2002 Feb;87(2):473–476.
Moyle GJ, Daar ES, Gertner JM, et al; Serono 9037 Study Team. Growth hormone improves lean body mass, physical performance, and quality of life in subjects with HIV-associated weight loss or wasting on highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2004 Apr 1;35(4):367–375.
Muniyappa R et al. Long-term testosterone supplementation augments overnight growth hormone secretion in healthy older men. Am J Physiol Endocrinol Metab. 2007.
Munzer T et al. Effects of GH and/or sex steroid administration on abdominal subcutaneous and visceral fat in healthy aged women and men. J Clin Endocrinol Metab. 2001 Aug;86(8):3604–3610.
Nam SY et al. Growth hormone and adipocyte function in obesity. Horm Res. 2000 Jul;53 Suppl S1:87–97.
Nam SY et al. Low-dose growth hormone treatment combined with diet restriction decreases insulin resistance by reducing visceral fat and increasing muscle mass in obese type 2 diabetic patients. Int J Obes Relat Metab Disord. 2001 Aug;25(8):1101–1107.
Nam SY, Kim KR, Cha BS, et al. Low-dose growth hormone treatment combined with diet restriction decreases insulin resistance by reducing visceral fat and increasing muscle mass in obese type 2 diabetic patients. Int J Obes Relat Metab Disord. 2001 Aug;25(8):1101–1107.
Napolitano LA, Schmidt D, Gotway MB, et al. Growth hormone enhances thymic function in HIV-1-infected adults. J Clin Invest. 2008;118:1085–1098.
Nguyen CT, Aaronson A, Morrissey RP, Agarwal M, Willix RD, Schwarz ER. Myths and truths of growth hormone and testosterone therapy in heart failure. Expert Rev Cardiovasc Ther. 2011;9:711–720.
Niikura, T et al. Insulin-like growth factor I (IGF-I) protects cells from apoptosis by Alzheimer's V642I mutant amyloid precursor protein through IGF-I receptor in an IGF- binding protein-sensitive manner. J Neurosci. March 15, 2001;21(6):1902–1910.
Nyberg F. Growth hormone in the brain: characteristics of specific brain targets for the hormone and their functional significance. Front Neuroendocrinol. 2000 Oct;21(4):330–348.
Perrot A et al. Growth hormone treatment in dilated cardiomyopathy. J Card Surg. 2001;16:127–131.
Pfeifer M et al. Growth hormone (GH) treatment reverses early atherosclerotic changes in GH-deficient adults. J Clin Endocrinol Metab. 1999;84:453–457.
Popovic V et al. Hypopituitarism following traumatic brain injury. Growth Horm IGF Res. 2005 Jun;15(3):177–184. Epub Mar 21, 2005.
Popovic V et al. The effectiveness of arginine + GHRH test compared with GHRH + GHRP-6 test in diagnosing growth hormone deficiency in adults. Clin Endocrinol (Oxf). 2003 Aug;59(2):251–257.
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Rosén T, Bengtsson BA. Premature mortality due to cardiovascular disease in hypopituitarism. Lancet. 1990;336:285–288.
Rousseau N et al. Effect of aging on growth hormone-induced insulin-like growth factor-I secretion from cultured rat chondrocytes. Growth Regul. 1997;7(1).
Rudman D, Feller AG, Nagraj HS, et al. Effects of human growth hormone in men over 60 years old. N Engl J Med. 1990;323:1–6.
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Ruiz-Torres A, Soares de Melo Kirzner M. Ageing and longevity are related to growth hormone/insulun-like growth factor-1 secretion. Gerontology. 2002;48:401–507.
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Schneider HJ, Klotsche J, Wittchen HU, et al. Effects of growth hormone replacement within the KIMS survey on estimated cardiovascular risk and predictors of risk reduction in patients with growth hormone deficiency. Clin Endocrinol (Oxf). 2011;75:825–830.
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Takala J et al. Increased mortality associated with GH treatment in critically ill adults. N Engl J Med. 1999;341:785–792.
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Notes
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Endorsing Organizations
American Academy of Anti-Aging Medicine (A4M)
Academy of Anti-Aging Medicine – China
Asia-Oceania Federation of Anti-Aging Medicine (AOFAAM)
AustralAsian Academy of Anti-Aging Medicine (A5M)
European Society of Anti-Aging Medicine (ESAAM)
German Society of Anti-Aging Medicine (GSAAM)
German Society of Hemotoxicology
Hellenic Academy of Antiaging Medicine
Indonesian Society of Anti-Aging Medicine
International Academy of Anti-Aging Medicine
Japan Anti-Aging Medical Spa Association (JAMSA)
Japanese Society of Clinical Anti-Aging Medicine (JSCAM)
Korea Anti-Aging Academy of Medicine (KA3M)
LatinoAmerican Federation of Anti-aging Societies
Romanian Association of Anti Aging Medicine
Sociedad de Medicine Antievejenimiento y Longevidad de Gran Canaria
Society for Anti-Aging & Aesthetic Medicine Malaysia (SAAAMM)
South African Academy of Anti-Aging & Aesthetic Medicine (SA5M)
Spanish Society of Anti-Aging
Thai Academy of Anti-Aging Medicine
Anti-Aging Research and Education Society, Turkey
Center for Study of Anti-Aging Medicine, UDAYANA University, Indonesia
Ukrainian Association of Preventive & Anti-Aging Medicine
World Anti-Aging Academy of Medicine (WAAAM)
Disclaimer
This position paper is intended to articulate the general policy positions of certain officers and directors of the American Academy of Anti-Aging Medicine (A4M), its numerous worldwide affiliated scientific and medical societies, and befriended organizations, and also to provide general information to practitioners and the public. This position paper is not intended to necessarily reflect the views of A4M's members or the members of A4M''s affiliated organizations. This position paper is also not intended to provide specific regulatory or legal advice at either the state or federal level. As state laws vary widely and individual circumstances may vary, readers are advised to consult their own legal counsel for guidance in meeting both state and federal requirements in their specific medical practice. In no event shall A4M, its parents, subsidiaries, affiliates and their respective members, directors, officers, employees, stockholders and agents be liable to you or any other entity for any and all damages including but not limited to direct, compensatory, indirect, incidental, consequential, special, exemplary or punitive damages (including, without limitation, damages for loss of profits, business interruption, loss of information and loss of business opportunities) arising out of or relating to (1) the use of or inability to use the above information, or (2) reliance on the content of this position paper; or (3) errors, inaccuracies, omissions, contained within the above materials; or (4) the satisfaction of any government regulation requiring disclosure of information on prescription or off-label drug products with regard to the information contained within this position paper. Because some jurisdictions may not permit each of these disclaimers and limitations, the above limitation may not apply to you. A4M and its parents, subsidiaries, affiliates and their respective members, directors, officers, employees, stockholders, and agents further do not warrant the accuracy or completeness of the information, text, links, or other items contained within this position paper. A4M may make changes to this position paper at any time without notice; however, A4M makes no commitment to update this position paper.
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