practitioner movement to redefine aging

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Social Science & Medicine 62 (2006) 643–653 www.elsevier.com/locate/socscimed

Anti-aging medicine: A patient/practitioner movement to redefine aging Courtney Everts Mykytyn Department of Anthropology, University of Southern California, c/o 5657 Fallston Street, Highland Park, CA 90042, USA Available online 22 July 2005

Abstract Having enjoyed tremendous growth for the past 5 years, the anti-aging medicine movement is redefining aging so that it becomes a target for biomedical intervention. Targeting aging for intervention dislodges popular understandings of aging: for anti-aging practitioners it no longer matters if aging is natural since it can be itself the target of therapy. Socalled ‘‘age-associated’’ diseases like cancer are, in this framework, conceived of as symptoms of aging. Anti-aging medicine is a broad term that may comprise groups selling remedies over the Internet, companies touting the ‘‘antiaging’’ness of their products, practitioners who work outside of scientific medicine, and practitioners of anti-aging medicine in clinics who believe that their work is strictly scientific. This article, drawing from more than 3 years of ethnographic interviews, participant observation in clinics and conferences, and a review of the literature, considers the last group. It examines the involvement stories of anti-aging medicine practitioners in two Western United States metropolitan cities. These stories reflect the practices of anti-aging medicine practitioners and the accompanying rationale for involvement. Often originally patients themselves, practitioners frame their involvement with the antiaging movement in three ways. First, they describe aging as it is currently experienced as a time of decline, suffering, and weakness. This anguish is not inevitable, they argue, and their work toward treating aging biomedically is situated as clearly moral. Secondly, intense frustration with the current biomedical environment has motivated practitioners to look for other ways in which to practice: anti-aging medicine is their chosen alternative. Finally, with dramatic expectations of future biotechnologies and disdain for current medical treatments of old age, anti-aging practitioners embrace a scientific revolutionary identity. These stories of migrations from patient to practitioner reveal the values upon which this movement is grounded and how coming to be a part of it is as much about the movement’s mission as it is the origins of the migrations. r 2005 Elsevier Ltd. All rights reserved. Keywords: Aging; Anti-aging medicine; Social movements; USA

What movement? Anti-aging!1

Introduction And then the police [arrived and we asked them] ‘What’s going on?’ Well, we were told to be here just to watch the movement.

The past decade has seen phenomenal growth in antiaging medicine. Not an organized pummeling of old folks, rather, this movement challenges the ways in which mainstream biomedicine understands and treats

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E-mail address: [email protected]. 0277-9536/$ - see front matter r 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2005.06.021

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Interview: Dr. O 02/07/2002.

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aging; anti-aging practitioners assert that there is much more that technoscience can do to retard, halt, and even reverse aging. Addressing aging as a target for biomedical intervention drastically shifts concepts of nature, life, patienthood, and the responsibilities of medical practitioners. The work of anti-aging is a mutiny among gerontological perspectives, positing a different interpretation and practice of biomedical therapies and advice. This movement bypasses the construct of aging as natural or a disease, for the goal of optimizing health and bodily experience. More significant to these practitioners is that biotechnology will soon—and can now to some degree—offer the ability to both add years to life and life to years. This paper regards anti-aging medicine as a social movement, in as much as movements involve groupings of people bound together under a particular mission in opposition to a ‘‘mainstream’’ calling for the creation of a new cultural order. While difficult to define comprehensively (Crossley, 2002), social movements are credited with being ‘‘processes bearing new ideas’’ that ‘‘have often been the sources of scientific theories and of whole scientific fields, as well as new political and social identities’’ (Eyerman & Jamison, 1991, p. 3). Based in shared belief (della Porta & Diani, 1999), social movements reframe cultural interpretations of the world. Most of this work is conducted within the context of the mission of the movement. Attending to stories of an individual’s involvement in the movement may complicate not only analysis of the mission but also the context of the movement’s development. Anti-aging’s core mission—to herald and operationalize aging itself as treatable—constructs a world wherein the optimal is the goal (and the natural is, if not irrelevant, a mere beginning point). The stories of practitioners’ migration to anti-aging expose not only a sense of optimizing the experience of aging but also the practice of biomedicine and the interpretation and politicization of science. I argue that the anti-aging medicine movement redirects the biomedical and scientific approaches to aging on the backs of concomitant motivations. Addressing in particular the involvement stories of practitioners who came to anti-aging medicine, three patterns emerge. The first is of biological framing; for practitioners, aging is seen as a physiological demise. Any wisdom, creativity, or retirement-freedom that one might associate with old age is marred by joint pain or other ‘‘symptoms’’ of aging. The great majority of practitioners sought anti-aging first as patients and, based upon their own therapeutic success, have redirected their biomedical careers to anti-aging. These patient-practitioners opt into this mutinous medicine by way of patienthood; as both practitioner and patient, they occupy a tricky space that maneuvers legitimacy, rebellion, power, and subjugation.

The second theme surfacing in these migration stories is a intense frustration with the current environment of biomedicine and a sense of salvation in anti-aging practice. As migration stories tell as much about what is being left behind as what is being sought, this critique of biomedicine values a sense of practice that includes greater practitioner autonomy and patient interaction. From practical, material concerns in which anti-aging clearly offers financial advantages to a waning faith in the environment of biomedicine, practitioners embrace the principles of anti-aging with a sense of reneed mission. Thirdly, this troubled relationship with biomedicine is complicated by an equally problematic relationship to science. While practitioners generally hold scientific principles and positivistic mechanisms of scientific understanding in high regard, they also are troubled by its political machinery. Expensive band-aids for diseases have usurped much of the research monies that practitioners would rather have put to aging itself, since they believe that aging is the root cause. I argue that practitioners maneuver these tensions by forging a group identity of scientific revolutionaries. More than a reframing of aging, migration stories reveal how the notion of the optimal has so perfused the anti-aging movement. I argue that this migration reveals more than a shift in the understanding of aging; ‘‘doing better’’ or optimizing the practice of biomedicine and the interpretation of scientific inquiry are as integral to the movement as the overarching goal of explicitly targeting aging for biomedical intervention. These stories show a growing distaste for the current practice of biomedicine and the prevailing approach to aging and a sense of salvation in science well-done. Anti-aging practitioners imagine and work toward a different world of aging within a biomedical complex that values a pursuit of perfection and enhancement (Elliot, 2003) over suppression and palliation of pain. While the paths of migration to anti-aging may be varied, the underlying value of perfectibility complicates the movement’s mission. This new categorization of aging along with the penetration of this pursuit of optimization makes possible a new understanding of the life course, a new interpretation of scientific work and a new practice of biomedicine. Drawing from 3 years of interviews, a review of antiaging (and anti-anti-aging) websites, pamphlets, listserves, books, and articles together with participant observation at conferences and clinics, this article examines the migration stories of anti-aging practitioners. It tenders a critical focus on the ‘‘rationalities and hegemonies through which aging is experienced and represented’’ by the anti-aging medicine movement (Cohen, 1994, p. 152). Examining the bases upon which the practitioners levy their involvement with anti-aging highlights the many fronts on which a reframing of

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cultural goals is taking place: it follows a palpable distaste for aging itself, an intense dissatisfaction with biomedicine, high expectations for the future of technology and an embrace of a ‘‘revolutionary’’ identity. Personal experiences with aging, with the environment of being a doctor, and with beliefs about the possibilities of science drive the stories of involvement and power the conviction that aging should undergo a conceptual overhaul. This movement asserts a new ‘‘order of life’’ via a shift in the understanding of aging and patienthood.

Introduction to anti-aging medicine The most ubiquitous website for anti-aging medicine2 proclaims anti-aging to be ‘‘evidence based, clinically sound health care’’ that is the ‘‘extension of preventive health care [and] the next great model of health in the new millennium’’.3 Composed of a panoply of treatment modalities including nutritional supplements, exercise, hormonal manipulation (most contentiously human growth hormone [hGH]), biomarker analysis, and chelation therapy along with predictions for cloning, regeneration, and genetics, anti-aging proponents expect significant shifts in the future of health, biomedicine and society alongside dramatic promises for individual results. This research concentrates on the growing number of practitioners who identify as anti-aging and who consider their practice an evidence-based one that draws from ‘‘legitimate’’ scientific research. The individuals interviewed for this research were located via the A4M directory of anti-aging practitioners. The practitioners are medical doctors, chiropractors, nutritionists, and even therapists. The MDs come from backgrounds in obstetrics, internal medicine, sports medicine, rehabilitation, anesthesia, and an AIDS/HIV specialty. Notably, none of the practitioners have a background in geriatrics nor is anti-aging their first or only medical focus. Of the interviews with practitioners, 15 of the 20 were men. Attending the annual conferences in Las Vegas, Nevada, white and Asian attendees appeared to be the majority. My interviews reflected these demographics, though I did interview two African–American practitioners. The practitioners ranged in age from mid-thirties to early seventies. Those interviewed reside in Los Angeles and 2 The American Academy of Anti-Aging Medicine (A4M) website, www.worldhealth.net , was the most referenced site in a sample study I conducted in 2000. This study examined the Internet presence of anti-aging medicine by sampling search engines results. Over 33% of all search results referenced or linked to the A4M. No other anti-aging site commanded such presence. 3 www/worldhealth.net/aboutantiagingmedicine/ (12/09/2000).

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Las Vegas; the A4M and Life Extension Foundation websites show that almost every state in the US has at least one anti-aging practitioner, with a concentration in the Southwest, Florida, and the New York areas. Moreover, anti-aging boasts a worldwide presence with practitioners in Singapore, Japan, Europe, and Mexico. The open-ended interviews focused on questions of what anti-aging, aging, and health mean to the practitioners, about how and why practitioners became involved and how they see this movement affecting themselves, their patients, and biomedicine within the US. The practitioners were remarkably receptive to being interviewed with only two declining due to ‘‘impacted schedules’’. The high interview rate suggests that practitioners welcome greater attention. Anti-aging has, within the past decade and more dramatically within the past 5 years, cultivated a significant audience of health care practitioners, scientists, patients, and potential patients. In the US, the A4M is an important piloting force. The A4M has organized 17 conferences (12 national, five international), provides credentials for health care practitioners in the specialty of anti-aging, publishes articles, and lobbies against the ‘‘gerontological bias’’. Much of the education, lobbying, and recruitment work of the A4M is conducted on their voluminous website. According to their website, academy membership (practitioners, researchers, general public) has grown from 6000 to 11500 in the past 5 years; currently, one can search through 495 entries in the practitioner database to ‘‘find a practitioner near you’’. Another organization, the Life Extension Foundation, functions similarly and also grants research monies for scientific anti-aging projects.4 By strategically adopting such mainstream forms of professionalization (providing credentials, conference hosting), the activities of the organizations present attempts at legitimizing anti-aging as a medical specialty. Popular media are particularly interested in anti-aging medicine. Articles about longevity and healthy aging abound in ‘‘mainstream’’ press. Partially motivated by the heavily broadcast fears surrounding the ‘‘greying of America’’ (Blanchette & Valcour, 1998; Lock, 1998; Morgan, 1998; Roszak, 1998, among many others), these pieces have begun specifically acknowledging antiaging. Articles have also surfaced in gerontology journals (Binstock, 2003; Cole & Thompson, 2002; de Grey, 2000; Le Bourg, 2000a, b; Martin, LaMarco, Strauss, & Kelner, 2003;Wick, 2002, among others) and popular science books (Austad, 1997; Fossel, 1996; Guarante, 2002; Hall, 2003; Kirkwood, 1999; Olshansky & Carnes, 2001; Scientific American, 2000; West, 2003). These gerontology ‘‘insider’’ pieces reveal a nascent picture of anti-aging that is largely predatory. In 2002, 4

http://www/lef.org (06/10/2003).

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three prominent gerontologists, along with 48 endorsers, authored a scathingly anti-anti-aging Scientific American statement describing it as ‘‘entrepreneurial’’, ‘‘victimizing’’, and ‘‘pseudoscientific’’ (Olshansky, Hayflick, & Carnes, 2002a–c). Linking the ‘‘concept of ‘anti-aging medicine’’’ to ‘‘tales that recur throughout ancient histories and mythologies’’ launches a three-part Geriatrics roundtable (Butler, 2000; Butler, Fossel, Pan, Rothman, & Rothman, 2000a, b; Raffaele, Livesey, & Luddington, 2000). Anti-aging is contextualized within a history of ‘‘tonic’’, ‘‘nostrum’’, and ‘‘potion’’ peddling. Thus, anti-aging practitioners are reduced to charlatans whose main goal is making money, whose context is a fear of old-age-related suffering, whose ancestors are storytellers, and whose work threatens the legitimacy of gerontology. Anti-aging medicine and the A4M in particular are not currently recognized by the American Medical Association, nor are their therapies covered by insurance reimbursements. This rogue status in biomedicine is advantageous to many proponents who consider their ideas a challenge to current practice. However, antiaging practitioners see themselves squarely ‘‘within science’’ as they incorporate ‘‘mainstream’’ research. Anti-aging medicine’s peripherality is waning with the increasing attention it is receiving in the popular media and mainstream press. Additionally, the President’s Council on Bioethics (PCBE) held hearings on the topic in 2002 and published a report in 2003 stating that ‘‘it is only recently that biotechnology has begun to show real progressybringing us face to face with the possibility of extended youth and substantially prolonged lives’’ (PCBE, 2003). Anti-aging proponents believe that they are launching a revolution. Practitioners use a new interpretation of science to redefine aging. Take the following quotation from a clinic website: Anti-aging medicine is a paradigm shift in how we think about health, disease and preventive medicine. Traditional medicine seeks to treat the complications of aging such as cardiovascular disease, type II diabetes, cancer and dementiay Anti-aging medicine seeks to change the process of aging in the first placey This is the ultimate preventive medicine.5 Here anti-aging takes biomedicine to task for its incorrect focus. Diseases commonly associated with old age become symptoms of aging; aging itself becomes the target for intervention. In this way, the paradigm shift that anti-aging espouses dares biomedicine to move beyond its current limitations and to classify aging as a target for intervention.

Aging as enemy Aging is an enemy. It saps our strength and ability to enjoy life, cripples us and eventually kills us. Tens of millions die of age-related conditions each and every year. The lack of information, advocacy and awareness of anti-aging and healthy life extension research is a terrible thing. Much of the general public thinks of aging as inevitable and natural, rather than as a medical condition that may one day be curable.6 Anti-aging practitioners have absorbed and operationalized the idea that aging is a decline. They do not, however, see it as a necessary decline. As currently experienced, aging is linked with illness, unhappiness, and decrepitude. Practitioners question the worthiness of a life wracked with physical and mental anguish. Many of these practitioners witnessed their parents, their patients, and themselves suffer as they age. Experiences with aging emerge as significant motivation for becoming involved with anti-aging medicine: Dr. S: The anti-aging name was enticing. We all want to stay youngy CEM: What does it mean to get old? Dr. S: You lose your teeth, your sight, your mobility slows down, and this is a natural process. As when you begin to get into adulthood, somewhere in the teenage years, or maybe in your early twenties, that’s when the anabolic process begins to degrade. So when the degrading process starts, that means you die and you’re going backwards. That’s getting old. I still want to be probably in my forties and fifties that’s a good age range. I grew up just about then.7 For Dr. S, the decline of physiology begins in the teenage years while the forties or fifties are identified as a ‘‘good age’’ range at which to remain. Because it was in these two decades that he ‘‘grew up’’, this serves as a good balance between physiological decline and psychological maturity. Dr. S counters a move in gerontology that attempts to infuse the image of older ages with concepts of wisdom and creativity because, for Dr. S, the maturity that came with the ‘‘good age range’’ peaks only to decline afterwards. The degradation of the mind begins alongside the impact of aging on the body sending everything ‘‘backwards’’. For Dr. S, mature mental life loses its form with biological aging. For Dr. N, the acceptance of being old is equated with being a victim. The system in which aging is asserted as natural or reified as graceful only perpetuates 6

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http://www.CaliforniaAntiAging.com/home.asp (12/09/2000).

http://www.longevitymeme.com. Interview: Dr. S. 09/20/2001.

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victimhood. Speaking of the current biomedical approach to aging, he states: It’s a victim model. You grow older, you get sick, you smell bady, you lose your teeth, bone density, vitality, sex drive, and so on. And not that everything should be young forevery But on the other side, the victim mentality of growing older—and don’t really do so much about it because you just accept you have joint pain and all the other symptoms and that’s just part of aging—is not a good model.8 Dr. Z, a highly visible lobbyist for anti-aging medicine, takes the critique further by accusing gerontology of being a ‘‘death cult’’. Dr. Z recounted his frustration while attending a Gerontological Society of America conference a few years ago. There he was sickened that so many people wore buttons proclaiming ‘‘Celebrate Aging!’’ He likens this to a declaration of ‘‘Celebrate Polio!’’9 and imagines attending a polio conference at which the personnel at iron lung exhibition booths wore such a badge. Honoring the need for iron lungs—and the suffering seen as necessitating them—is opportunistically hideous. Likening aging to polio clearly condemns those promoting any reverence for aging. Aging is not to be exulted but, rather, biomedically remedied. When pressed as to the construction of aging as disease, Dr. Z echoed many of the practitioners by skirting of the question and reasserting that the most fundamental point is that aging can be repaired. The contestability of aging’s construction has deep historical roots (Achenbaum, 1995; Friedan, 1993; Gruman, 1966 [2003]; Haber, 2002). More recently, US gerontology has fought diligently against categorizing aging as disease while simultaneously perpetuating a trend toward the medicalization of aging (Arluke & Peterson, 1981; Cohen, 1998; Lock, 1993). This has resulted in the rise a rhetoric of age-associated disease. The anti-aging practitioners interviewed were loathe to categorize aging as a disease or to say that it was not natural. For them, that aging could be a target for intervention nullified the highly political categories that they believe have overwhelmed the study and treatment of aging. Dr. D’s experience with old age is found in the images of convalescent care homes. Though less than 5% of individuals over 65 are actually institutionalized in the US (Saldo & Freeman, 1994), the convalescent home is the symbol of aging’s biological decline:

want to kill these people and certainly everyone has a chance to make their own choice—that is really very important. But I don’t think that we should work toward that end.10 For someone no longer able to care for themselves nor be cared for by others in the home, the convalescent home is the last station. To Dr. D, life is too precious to be spent in such a place. While Dr. D does not advocate mass slaughter of the aged, the moral focus of her work as a physician (and, the use of ‘‘we’’ suggests that she includes the work of medicine as a whole) should not be to prolong or enable a low quality of life. In his cardiology practice, Dr. X dealt with deterioration of the body on a daily basis. Pretty soon we were doing all the big cardiology practice with several other cardiologists, we were doing all the technology of the day, but I don’t think we were doing any good. This was my opinion, everybody else said, ‘Abner11 you are crazy you are doing good.’ ‘How come if I am doing good the same people keep coming back to see me?’ ‘See, your office is filled isn’t that great?!’ I said ‘great business’ but I didn’t become a doctor just to watch people deteriorate and then they end up in the ICU and then we take a piece here and there and their surgeons get their pieces and then they die and I sign their death certificates. Everyday I am signing at least one death certificatey I’m never going back to that kind of practice again.12 Powerlessness over death and illness is a common thread in these stories. Many practitioners speak of frustration both with the inability to cure disease once it has begun damaging the body, and with the lack of prevention in biomedical practice. Dr. O notes that medicine made her ‘‘depressed. Being a doctor I felt so helplessy I was longing to find something else’’.13 Antiaging medicine offers a sense of hope that suffering might be mitigated. Moreover, it tenders a validation that one’s work is beneficial and valuable. In speaking of his own aging, one practitioner recalls seeing a wrinkle in the mirror and thinking ‘‘physician, heal thyself’’.14 To help others, one must help oneself first. Dr. S begins his migration story by stating that he is a ‘‘senior citizen’’, implying that he became interested in anti-aging medicine because he himself is old.15 Dr. Z sees his wrinkle symbolizing the lurking decline. The 10

When I would see older patients in convalescent homes and care centers and that kind of a life, is simply not worth living. And the Bible says ‘‘do unto others’’ and I don’t want that done to me. I don’t 8 9

Interview: Dr. N. 10/16/2002. Interview: Dr. Z 08/08/2002.

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Interview: Dr. D 10/18/2001. All practitioner names are pseudonyms. Only the A4M and LEF, widely published, Internet-available organizations remain without pseudonym. 12 Interview: Dr. X 01/21/2002. 13 Interview: Dr. O 02/07/2002. 14 Interview: Dr. Z 08/08/2002. 15 Interview: Dr. S 09/20/2001. 11

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embodiment of a perceived old age motivated many of these practitioners to seek a way to avoid the prowling decay. The ability to stand symbolically for health by ‘‘healing thyself’’ presents as a critical step toward helping others. Another physician began her own anti-aging regimen in her early thirties: Dr. O: I was 32, my brother had a stroke when he was 30. So I tested myself. I was speechless. I was an energetic woman, I was full of energy to work, I had no wrinkles, I had no gray hair, I was still young, but my biological age was 70. I called Dr. B—he’s the owner of [the laboratory who tested the blood]. I saidy ‘Dr. B., can you review my test? It’s terrible!’ And then he looked, ‘is this your personal test?’ I said, ‘Yeah, what do I do, I’m 70 years old!’ And he said, ‘You have to do something quick. Are you on amino acids?’ I said, I’ve been taking, but maybe not enough.’ ‘It’s not working, how long were you on amino acids?’ ‘Maybe 6 months.’ ‘You need to change. Maybe you should just do hGH.’ And I said, ‘I’m scared.’ And he said, ‘Then try peptide.’ And I had no knowledge of that, but I read a lot. So I started myself. So I buy this, buy that, from here, from there do it myself, repack my blood. You know what, it’s like a miracle! It’s what I was looking for, apparently. This kind of mystic thing that I didn’t know before, I never learned in schooly And then in one or two years I knew I was rejuvenatedy You cannot stop aging. But I think what I did was, I reversed my process of aging to a normal one, because I was aging too fast biologically. And I didn’t even see it yet.16

biologically while she was chronologically 32. When Dr. O found that her biological age had skyrocketed according to the tests, she treated herself and her results impressed her; she was able to ‘‘repack’’ or rejuvenate her blood thus restoring what was taken by aging ‘‘too fast’’. While it is unclear here what the specific restorative ingredients or mechanisms might be, the notion of the rejuvenation of the blood and by extension the body is articulated. Believing that this was something positive she could contribute to the lives of others, she turned her focus as a physician to anti-aging. The importance of distinguishing chronology from physiology is critical; with an expansion in anti-aging it will become increasingly problematic. The idea that a ‘‘way to feel’’ at any given age can be standardized is fascinating but as we theoretically get young or stay younger longer physiologically, these norms will become less informative. Nonetheless, Dr. O credits her antiaging program with her subsequent, physiologically low biomarker score. Many of the practitioners noted that they became anti-aging clinicians because the treatments worked for them. They were patients first, lending credibility to antiaging medicine. Dr. R conducts an FDA-approved study of hGH and notes that many of the research participants are themselves doctors. The participants must pay for the experimental injections amounting to over $10,000US/year. Dr. R indicates that many of these patient-practitioners are trying anti-aging on themselves and, should it prove effective, will migrate to an antiaging practice. Aging is something that happens to everyone—a sort of guaranteed disease whose possible treatments may be self-tested.

Though Dr. O hesitates to say that she ‘‘stopped aging’’, her experience with anti-aging did reverse her laboratory-defined chronological age. An analysis of her biomarkers17 revealed that she was 70 years old ‘‘Regular medicine’’ and physicianhood 16

Interview: Dr. O 02/07/2002. 17 Scientifically constructed biomarkers are diagnostic tools that determine a biological age separate from chronological age; this is done via blood analysis and physical tests (reaction time, lung volume, etc.) and questionnaires (pertaining to psychosocial supports, etc.). They are important tools in antiaging medicine (though inadequately studied according to many gerontologists). Dr. M: The age scanner compares your chronology to physiology. This device was developed by Dr. Richard Hofschild in 1959 for his Ph.D. in biophysiology, electronics and measuring levels. And it’s been validated again and again. It looks at 12 of the most common physiological factors that change in our body relative to age. Vision, hearing, reaction time, memory, respiratory functions. We know that for every year there’s a millimeter decrease loss in the lungs. What we do on this device is the computer system has a mammograph and compares your results to what age it corresponds toy

In speaking about involvement with anti-aging, most practitioners express disdain for current medical practice in the US. They mention frustrations with Health Maintenance Organizations, bureaucratized medicine, difficulties in maintaining a viable private practice, the physical rigors of clinical work and the lack of patient–practitioner relationships. Many practitioners speak of their interest growing ‘‘naturally’’ from other specialties revealing a biomedical lineage that does not begin with geriatrics. Explaining why he left his medical practice, Dr. F situates his frustrations within a broader context of the (footnote continued) So if you’re 30 and you do the test and you come out at 26, then physiologically, you’re ahead of your age. (Interview: Dr. M 01/07/2002)

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changing dynamics of clinical work: Dr. F: [We are at] the age where doctors acknowledge that power had been supplanted by more than 50% by accountants who think the cheapest is the best. [This is] the superstructure of non-physicians making a lot of decisions and individual physicians still [threatened by] malpractice.18 Frustrated at the lack of autonomy in his practice, Dr. F finds in anti-aging a way to practice a medicine in which he could believe. Bureaucratized medicine in which choices are made on the basis of cost and in which threats of lawsuits loom undercut the authority and the dignity of the individual physician. Dr. E was an internist in a large medical group; this company filed for bankruptcy and closed all of its clinics leaving Dr. E to build a practice from scratch. Antiaging offered him a way to survive financially in an otherwise competitive practice environment. Anti-aging proponents solicited his participation via the Internet and mailed pamphlets: Physicians [are] interested in the anti-aging practices right now since the medical health care system in this country is really, really bad for private practice because of HMO reimbursement. It’s very, very tough for a physician to survive. Maybe there is another way you can survive in case you can have a group of patients that trust and believe in the antiaging treatment. You can get much, much better reimbursement from those kinds of practices.19 Anti-aging provides a way to survive in a hostile biomedical field. The reimbursement is ‘‘better’’ in antiaging medicine practice because it circumvents insurance companies; anti-aging treatments are not currently covered by insurance and therefore must be paid directly by the patient. The ability to pay is an important aspect of being an anti-aging patient as the therapies can be quite expensive. A prominent anti-aging practitioner told me that he does not believe that insurance companies should become involved.20 Not only does Dr. A not wish to deal with insurance, but also those clinics that have found a way to do so are ‘‘fraudulent’’. Anti-aging, he notes, ‘‘is not an insurance product’’. Just as one does not have insurance to purchase a car, one does not have insurance for health. Insurance is for disasters and accidents. Health, so the logic goes, is no accident. He further expresses little sympathy for people who claim that anti-aging therapies are expensive; financial ex18

Interview: Dr. F 04/19/2002. Interview: Dr. E 09/12/2001. 20 Interview: Dr. A 12/17/2000 at the Eighth International Congress on Anti-Aging and Biomedical Technologies, Las Vegas. 19

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penditures are choices and some people choose to smoke and eat ‘‘junk’’ food while others choose anti-aging. These statements are self-serving since direct payment is more lucrative than third-party payment. But they also speak of a unique approach to health. Incorporating the insurance companies into the anti-aging field can be both legitimizing and undermining. Constructing anti-aging as not-an-insurance product is a way of separating it from mainstream biomedical practice which may not only be financially advantageous to practitioners but also reinforces the revolutionary nature of anti-aging medicine. Eclipsing insurance companies also makes space for the increasing rhetoric of choice. For Dr. A, anti-aging/ health is about choice since it is, to some extent, within individual control. The ideas of health morality and personal health responsibility are becoming more salient in current biomedical practice (Becker, 1997; Conrad, 1994; Ford, 1998; Goldstein, 2000; Frankenburg, 1993; Lock, 1993) and are clearly pervasive in anti-aging. Obscuring any societal responsibility for the health of people blames sufferers for their own suffering and for the pain of their own aging. The idea of a health morality on the part of the patient also emerges in a discussion of a patient–practitioner partnership. Treating many patients per day in a ‘‘regular’’ practice means long hours and minimal relationships with patients; anti-aging offers more manageable hours and the ability to have longer patient appointments. Many practitioners boasted that their initial visit with a patient averages 2–3 h. The ability to interact with patients on a cooperative level is an important facet of the practice. Dr. M sees his work as a ‘‘partnership’’ in which he works with the patient to accomplish the medical goals—unlike working in ‘‘regular medicine’’ in which the patients ‘‘want to take a pill and that’s it’’.21 Since major components of health are nutrition and exercise, the patient is an integral participant; good health is more than just a pill or surgery away. It requires practitioner and patient dedication. The opportunity to spend time educating and motivating patients is as important to the health of the individual as it is to the job satisfaction of the practitioner. Conjuring up images of the rigors in practicing medicine, Dr. S notes: I had to deliver [babies for] thirty-five patients a day and see about fifty patients in the office. Eventually I got used to it. That’s what they want you to do. So you figure you’re too old, too tired. Then you went out to find something else, but there’s the fact that your lifestyle has a certain quality and you don’t want to drop down which you’re being forced to do 21

Interview: Dr. M 09/07/2001.

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because you don’t have the income anymore. There will be no rich, millionaire doctors riding around in Porsches—that’s old.22 Being a doctor is arduous and intense. We hear in Dr. S’s words a sense of ‘‘getting used to’’ treating upwards of 85 patients per day. This heavy-load practice is exhausting and expected. It also established a certain financial lifestyle difficult to replicate in another job. Anti-aging gave Dr. S a way to continue practicing at a pace he can control. Furthermore, it affords him the income he is ‘‘too accustomed to’’ to surrender. Using his detailed understanding of hormones from his obstetrics–gynecology practice, Dr. S was able to build on his skills in order to improve his work life. Dr. K perceives anti-aging as a development of his practice with people diagnosed with HIV and AIDS. Aging patients and patients with AIDS experience a similar predicament in that there are often multiple medical problems and overlapping treatments: In the field of HIV medicine, these people tend to have lots of problems, and one of these has to do with human growth hormone. They have a hormone deficiency and Chronic Wasting Syndrome. And they waste away, The treatment for those conditions were human growth hormone, steroid treatment, testosterone hormone, and supplementation, replenishment. Because of that I saw the other usage of human growth hormone and hormone treatments in a new field called anti-aging. That’s how I stumbled onto it.23 The extension of an HIV/AIDS practice to anti-aging makes clear a perception of aging as strongly associated with decline. Treating Chronic Wasting Syndrome and aging with similar hormone strategies highlights the analogous deficiencies. Noting parallels between HIV practice and anti-aging, Dr. K embraced this ‘‘new field’’ and abandoned his HIV work altogether. Like Dr. S, Dr. K migrated to anti-aging by adapting his knowledge to new uses. Anti-aging practitioners consistently cite bureaucratized medicine in which cost is privileged over care in their migration to anti-aging. Frustrations with a perceived disregard for prevention, constraints of practice, and financial limitations prove important launching points to ‘‘rejuvenate’’ one’s clinical practice. Migrating to anti-aging from a range of specialties, and applying skills in new ways, these practitioners reject the limitations and rigors of the current biomedical environment.

‘‘Stranger in a strange land’’ Much of the involvement links with cutting-edge science. The image of a journeyman is pervasive. It is a lonely job to break with the mainstream—a job the legacy of which will be great (see also Crigger, 1995; Fox & Swazey, 1992; Terrall, 1998). The anti-aging practitioner is, in the words of Dr. F, ‘‘almost like a stranger in a strange land’’.24 Anti-aging is about exploring unknown terrain—a terrain that certainly exists—without the support of colleagues. Gerontology’s disdain for anti-aging helps paint the picture of the persecuted revolutionary. At the same time, anti-aging is based on the same scientific research as gerontology, and either employs science as validation or condemns science for being ill-equipped to explain aging. These practitioners believe that anti-aging—a new biomedical application of science—is revolutionary. Dr. M regularly reads over 200 scientific articles per week, weighing the data according to the reputation of the journal/institution. For him, anti-aging is a scientific endeavor and those who promote crystal therapy, magnet therapy, and other such unfounded treatments do anti-aging a disservice. For his practice, Dr. M has compiled an anti-aging tutorial that relentlessly documents its scientific roots: Some of the tools that we’re working on are selfrunning CD programs which have information about the benefits, the scientifically studied, published articles from major institutes throughout the world on every area of medicine, from pulmonary medicine to cardiology, nutrition, diabetic problems, rheumatology, orthopedics, every area. And I do collect articles that have been written talking about the negative aspects of hGH, DHEA, and everything else. But they’re anecdotal at best without any hard sciencey And as I’ve said there are over 40,000 published articles I’ve reviewed.25 While Dr. M would prefer anti-aging become mainstream more quickly, he estimates that it will follow a trajectory similar to estrogen. In the past three decades, estrogen replacement therapy has seen a tremendous growth in usage among women in Western countries. The debate about it persists, however, with much continuing longitudinal research on long-term effects. Estrogen replacement and anti-aging therapies are geared toward individuals who attempt to stave off the effects of aging (such as bone density loss) through the replacement of hormones. In this sense, they are not treating the sick but rather the potentially sick. It is Dr. M’s belief that doctors resisted using estrogen just as they are to anti-aging because ‘‘they will have a lot of

22

24

23

25

Interview: Dr. S 09/20/2001. Interview: Dr. K. 12/18/2002.

Interview: Dr. F 02/19/2002. Interview: Dr. M 07/01/2002.

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learning to do, to get to the point where they can understand preventive care when they are so used to doing illness care’’.26 Dr. M asserts that the resistance to anti-aging impedes its entry into everyday medical practice, but because of the scientific support, its acceptance is inevitable. For anti-aging, the differentiation between biomedicine and science is critical. Biomedicine is constructed as a practice. Its job is an interpretation of science filtered though the politics of insurance, of lobbying groups, of patient expectations and individual treatment preferences, and the cultures of the medical training institutions. For anti-aging, science remains largely external to this synthetic and corrupted job of biomedicine. The idea that science is separate from culture has long been studied in science and technology studies and it is interesting not only that science is ‘‘pure’’ but also that biomedicine is ‘‘tainted’’. This sort of hierarchical framework in which biomedicine is bad and science is good (Franklin, 1995) provides anti-aging with its legitimization; they aim to infuse biomedical practice with science thereby mitigating some/all of the corruption. By using science to challenge biomedicine, many practitioners see themselves as pioneers and part of a dynamic, cutting-edge science. Neither is science always revered; some practitioners challenge science itself for being fallible. Dr. D notes that ‘‘scientific experiments aren’t pure science’’ because of the contexts in which they are conducted. ‘‘To that extent, scientific medicine, maybe isn’t quite as scientific as it purports to be.’’27 Dr. N asserts that current scientific practice is flawed because it relies on an overly reductionist model that regrettably ignores the ‘‘synergistic effects’’ of disease causation: Dr. N: It’s a different paradigm. Mainstream medicine is one-cause, one-effect science. Alcohol causes birth defects, smoking causes lung cancery This is kind of accepted. But if you go into—and that can to some extent be experimentally proven—this other concept it gets extremely complex. How do you want to test what a little bit of mercury and a little bit of chemicals and a little bit of this and a little bit of nutrition deficiencies do to you over 10, 20, 30, 40, 50 years? It’s the scientific model, we have no idea how we should compute thaty28 Dr. N further contextualizes anti-aging historically so that major shifts come painfully: Look at the history of medicine. Look at the history of science. When something new comes, a new paradigm comes, which doesn’t make sense initially, 26

Interview: Dr. M 09/07/2001. Interview: Dr. D 10/18/2001. 28 Interview: Dr. N 10/16/2002. 27

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and it’s poo-pooed, the people are persecuted who follow it, and it’s proven and suddenly it’s mainstream. Who’s the guy [who coined the term] ‘paradigm shift’? The image of the persecuted revolutionary echoes here beside the inability of current science to address adequately the complexities of aging. Science itself is flawed and those who attempt to correct it are held in contempt. Anti-aging practitioners see themselves as seekers of a scientific remedy. They use published, mainstream science to substantiate aging as a target for biomedical intervention. They simultaneously condemn current scientific models for being inadequate to understand aging completely. Working at the cutting edge toward a new model of health care, the anti-aging movement reframes aging scientifically in order to treat it biomedically.

Conclusion The mission statement—the stated goal or focal rallying point—is the foundation of a social movement. However, there are often other points at which movements act, rebel, and connect. Examining these bases of solidarity by way of stories of involvement exposes potentially obscured logics and rationale for involvement. Anti-aging medicine is a social movement organized largely by practitioners who are themselves patients. They seek to redefine aging as a target for biomedicoscientific intervention, challenging the way aging has been understood. This attempt to transform knowledge (Eyerman & Jamison, 1991) makes possible a new understanding of the life course, a new interpretation of scientific work and a new practice of biomedicine. Antiaging practitioners are united by the belief that aging is not inevitable. For these practitioners, aging is reduced to a biological experience marked by decline. Aging is done by and against the body. Mitigating aging is constructed as a venture for the patient and his/her practitioner, since aging is an individual process eased both by personal choices and biomedicoscientific intervention. Practitioners, asserting their expertise with the confidence of those who see themselves as revolutionaries, clearly benefit from this understanding of aging. Since the individual does much of the anti-aging work (exercise, nutrition), the practitioner is freed from total responsibility for health. Moreover, out-of-pocket payment protects the practitioners from the world of health insurance. But the practitioners are not simply money-grubbers preying on cultural fears of aging. Their feelings of helplessness as practitioners in other fields, together with

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personal desires to mitigate aging, are also salient aspects of their involvement. Indeed, they want to do good work and help people who are not, in their perception, being otherwise helped. At the minimum, they are seeking a solution for the helplessness experienced in their other fields of practice. Often patients themselves, the practitioners combine their interpretation of the scientific knowledge of the day with optimism for the future of technology. On another level, the practitioners are suggesting something even more remarkable: framing aging as a target for biomedical intervention problematizes the concept of a natural life course, of patienthood, and challenges the goal of biomedical work so that ‘‘optimal’’ health regardless of any age-appropriate constructions is the primary goal. It no longer matters if aging is natural since there is something that can be done about it. The goals of biomedical care shifts to address the patient body through defining health not in relation to a chronological age set but to what is possible at any age. Since we all age chronologically, everyone alive becomes a patient. While defined in opposition to mainstream gerontology, anti-aging employs much of the same ‘‘accepted’’ research to support its claims. It works within the space created by both gerontology’s inadequacies in defining/ treating aging and our cultural understanding of aging as a decline. Anti-aging’s focus on scientific solutions to their understanding of biological aging has fostered growth in participant number as well as in media attention. While the mission of anti-aging medicine involves treating aging biomedicoscientifically, involvement stories reveal that the anti-aging movement is based on more than abolishing or retarding aging. Anti-aging medicine is grounded in a desire to use one’s skills as a health care practitioner toward curtailing suffering seen in aging, a distaste for current biomedical practice, and an identity in which the revolutionary is hero. The growing antiaging medicine movement, populated largely by patientpractitioners, challenges cultural perceptions of aging and expects broad changes in the very near future of biomedicine: Dr. X: Every good doctor does anti-aging medicine. They don’t call it anti-aging medicine, but everything we do to keep people alive and in good health and living longer and more importantly than living longer, living healthier, robust, vital, that’s antiaging. And every single good doctor in the world is practicing anti-aging medicine. That’s what I’ve said and I’ll continue to say that.29

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Interview: Dr. X 01/21/2002.

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