Are “Anti-Aging Medicine” And “Successful Aging” Two Sides Of The Same Coin? Part 1

Please contact oscar.xiao@wecistanche.com for more information

Key Words: Anti-aging—Hormone replacement—Prevention—Quality of life—Qualitative research.

The notion that the human aging process can to some degree be managed or controlled underlies one of the most vibrant intellectual traditions in gerontology: successful aging. "Successful aging" first appeared as the title of Havighurst's(1961) article in the inaugural issue of The Gerontologist, which he defined as "the conditions of individual and social life under which the individual person gets a maximum of satisfaction and happiness"(p.8). What constitutes and contributes to successful aging has been sharply debated in the decades since, and the concept itself has been critiqued from within gerontology. However, the idea that one can"succeed" at aging, and that some strategies and interventions might increase that success, has reached a position of near-ubiquity within gerontology today—despite the distinctly varied interpretations of the meanings and applications of "successful aging.

Please click here to know more

As"successful aging" models were advanced and broadened within gerontology, the"anti-aging medicine" movement was gaining traction with both commercial and public interests. On one hand, images and prescriptions for"successful aging" from gerontology challenged ageist beliefs and stereotypes by claiming that there were positivist meth-ods that could be employed to create a"new" kind of aging, whereby the fruits of middle age could be enjoyed well into old age(Moody,2005). flavonoid extraction method pdf Anti-aging medicine, on the other, argues that the aging process is something that can be targeted with biomedical interventions in order to delay or even reverse aging (Mykytyn,2006). Although mainstream gerontology and anti-aging medicine have a long history of alienation and antagonism and are considered by many to be antithetical, others have posited that anti-aging medicine simply may offer"a new option to [achieve] successful aging"(Stuckelberger,2008, p.86).

Both the success of the successful aging paradigm and the anti-aging movement can be situated within the context of socio-cultural changes associated with the"postmodern life course" of the late twentieth and early twenty-first century, changes that diminished the salience of age and generation in social life and organization(Katz,2001-2). flavonoids Both paradigms appeal to longstanding American cultural ideals of personal autonomy and responsibility that suggest that the course of old age is not predestined, but rather a condition that can be modified and controlled by individual choices(Moody,2005; Vincent,2013). The routes to modifying or controlling aging, however, are somewhat bifurcated. Proponents of the successful aging claim that these models are buttressed by strong scientific and empirical legitimacy, while the legitimacy of anti-aging medicine has long been questioned and has been coupled with accusations that its practitioners exploit cultural fears of aging for commercial gain (Vincent,2013; Vincent, Tulle, & Bond, 2008).

Cistanche can anti-aging

This article examines the connections between prominent models of successful aging and the anti-aging movement as represented by physicians who are practicing under the auspices of anti-aging medicine. Our analyses reveal how the goals and approaches of anti-aging practitioners, often viewed as unconventional within the field of medicine, are largely consonant with much of the rhetoric of successful aging that has dominated gerontology for the last three decades, even though the two approaches diverge significantly in their motives, means, and promotional strategies.

Although the anti-aging medicine movement has not to date been explicitly tied to successful aging, we argue that the anti-aging movement and the industry associated with it have capitalized on gerontology's success in popularizing successful aging. The success of the empirical models of successful aging has aided in the cultural construction of images of positive aging, which have not only countered ageist beliefs but also created a space in which the anti-aging industry has been able to flourish. Through an analysis of interview data with anti-aging practitioners, we identify how the practices and ideas about aging espoused by these practitioners reflect the rhetoric and underlying tenets of the successful aging paradigm. We conclude by discussing the ideological convergence and divergence between these two seemingly polar approaches to aging and the possible origins of this overlap. To provide context, we begin with a necessarily brief history of both anti-aging medicine and successful aging.

American Academy of Anti-Aging Medicine and the Critique of Anti-Aging Medicine

While attempts to control human aging have existed from early human civilizations(Gruman, 2003; Olshansky & Carnes, 2001), the exponential growth of an anti-aging social movement in the United States in the last two decades has coalesced around the notion that aging can be altered or controlled through biomedical intervention (Mykytyn, 2006). Propelling the movement's prominence has been the creation of organizations that certify and promote the endeavors of anti-aging medical practitioners (Binstock, 2003; Fishman, Binstock,& Lambrix,2008; Mykytyn, 2006; Vincent, Tulle,& Bond,2008). The most visible of these organizations is the American Academy of Anti-Aging Medicine(A4M,2013a), which claims more than 26,000 members. Despite the fact that neither the American Medical Association nor the American Board of Medical Specialties recognizes A4M, it has established certification and fellowship programs in "anti-aging medicine" for medical professionals(A4M, 2013b).A4M takes on many roles in promoting anti-aging medicine: professional organization, lobbying group, and direct-to-consumer marketing firm via their website(Fishman, Binstock,& Lambrix, 2008; Spindler & Streubel, 2009). The relationship between A4M and gerontology is contentious at best. Previous research has revealed how gerontology and the anti-aging movement have actively engaged in "boundary work"meant to create and reinforce their respective power and status (Binstock, 2003; Settersten, Flatt,& Ponsaran,2008). Gerontologists have vehemently distanced themselves from A4M, which has, since its inception, been embroiled in lawsuits with one another over the founders' medical credentials, legitimacy of its claims, use of controversial treatments, and slander (Weintraub, 2010; Zs-nagy, 2009).

Anti-aging medicine is big business, worth a purported $50 billion(Japsen,2009). When over-the-counter anti-aging products are included, the broader anti-aging industry balloons to an estimated $88 billion in sales each year (Weintraub,2010). Gerontologists contend that anti-aging medicine promotes fear of aging—as something to oppose and conquer with unconventional and unproven therapies, all in the name of widening their market share. Perhaps the most widely publicized criticism of anti-aging medicine from gerontology was a Scientific American article, "No Truth to the Fountain of Youth."It summarized a lengthier position statement signed by a group of 51 distinguished gerontologists in order to"inform the public of the distinction between the pseudoscientific anti-aging industry, and the genuine science of aging"(Olshansky, Hayflick,& Carnes, 2002, p. B292).In 2002, a judging panel of these scientists(Jay Olshansky, Leonard Hayflick, and Bruce Carnes)even" presented"the cofounders of A4M with the"Silver Fleece" Award (the University of Illinois at Chicago Office of Public Affairs, 2002). This award, modeled after the "Golden Fleece Awards" that former US Senator William Proxmire gave to public officials for wasteful spending, was an effort to make the public aware of anti-aging quackery.

In response, the A4M (2002) retorted...the death cult of gerontology desperately labors to sustain an arcane, outmoded stance that aging is natural and inevitable... Ultimately, the truth on aging intervention will prevail, but this truth will be scarred from the well-funded propaganda campaign of the power elite who de-pendon an uninterrupted status quo in the concept of aging in order to maintain its unilateral control over the funding of today's research on aging.

Another way A4M has responded to criticism has been to promote its members as the"go-to" experts on treatments that lie outside of traditional medical practices, particularly hormone treatments. For example, their White Paper Guidance for Physicians on Hormone Replacement Therapy argues that "most traditional endocrinologists have had no intense training in treatment" and"lack...interest and expertise in how to treat testosterone and adult growth hormone deficiencies and some other hormone deficiencies that may accelerate aging"(A4M,2007,p.3). hesperidin uses Further, they"point to the right of every patient who is suffering from these deficiencies to get relief..by the adequate hormone treatment"(p.4).

Views in whole fields are rarely monolithic. But it is within this backdrop of "boundary work" that anti-aging medicine is practiced. It is not our intention to evaluate the scientific or medical legitimacy of their treatments, which, as we have noted, have been raised elsewhere. Instead, we aim to examine how anti-aging practitioners explain their purposes and clinical practices in light of the public debate and portrayal of anti-aging medicine as opposed to mainstream gerontology. We caution the reader, however, against reading individual anti-aging practitioners' motives as being purely profit-driven. One of the consistent findings from research on anti-aging practitioners is that they partake in the same therapies they prescribe to others and are often drawn to the field based on their personal experiences with aging relatives(Mykytyn,2006), the latter of which may also be true of gerontologists. In fact, renowned anthropologist of aging Gutmann (1997)once observed that two kinds of people are drawn into gerontology: "gerontophiles" who have had positive experiences with aging relatives and want to do good for old people and "germophobes" who, consciously or not, fear aging. These selection biases affect what "mainstream" gerontologists see and do as well.

Successful Aging

The last century saw marked increases in the human life span that were met with increased research interests in uncovering factors for a higher quality of life in old age. These interests were also actively promoted by gerontologists to offer a counterpoint to earlier views of aging as an "inevitably bleak and unrelieved landscape characterized by irretrievable loss"(Maddox,1994,p.767). Negative views of aging and associations with"unproductivity, inflexibility, and senility," said pioneering gerontologist Butler(1974, p.529), "must be changed if the elderly are to have more opportunities for successful aging."

Discussions about what constitutes successful aging have been ongoing in gerontology since the 1950s and 1960s (Havighurst,1961; Havighurst & Albrecht,1953; Williams & Wirths, 1965), yet there are no universally shared definitions or measures (see Depp & Jeste,2006). One of the earliest explications was Havighust's(1961)comparison of activity theory, which envisioned successful aging as the "maintenance as far and as long as possible of the activities and attitudes of middle age"; with disengagement theory, which envisioned successful aging as "the acceptance and the desire for a process of disengagement from active life"(p.8). During the 1960s and 1970s, activity and disengagement theories received considerable attention and critique (see Maddox & Wiley,1976). lost empire cistanche This era also saw attempts to establish empirical measures of successful aging (e.g., Neugarten's [1974] subjective measure of life satisfaction to account for individual and cultural differences, or Palmore's[1979]objective criteria of surviving to age 75 in good health, as well as a subjective judgment of happiness).

The late 1980s brought the influential framework offered by Rowe and Kahn(1987)who argued that the practice of dichotomizing aging into pathological versus normal (or nonpathological)states did not fully capture the range of aging experiences. They instead differentiated"normal" aging into usual aging, in which individuals experience typical, nonpathological age-related changes but are at high risk for disease, and successful aging, in which nondiseased individuals experience high functioning and are at low risk for disease. As a result, this conceptualization was nonetheless rather one-dimensional in its focus on objective physical functioning.

A decade later, Rowe and Kahn's(1997,1998)model, developed in conjunction with the MacArthur Research Network on Successful Aging, emphasized three components:(a) low probability of disease and disease-related disability,(b) high cognitive and physical functional capacity, and (c)active engagement with life. Each of these three components has been operationalized in a variety of ways, often into"high," medium," and"impaired" ranges of functioning (Berkman et al,1993), and the model has been applied in national (McLaughlin, Connell, Heeringa, Li,&Roberts,2010) and cross-national (Hank,2011) studies.

Rowe and Kahn's formulation, however dominant, has not been the only model of successful aging (see Depp &Jeste,2006). Indeed, since the 1990s, the study of successful aging has been refined or expanded, often in response to criticism of Rowe and Kahn's model(Bond, Cutler,&Grams, 1995; Garfein & Herzog,1995; Glass, Seeman, Herzog, Kahn,& Berkman,1995; Kahana & Kahana, 1996). These perspectives turned attention to components such as self-efficacy(Strawbridge, Wallhagen,& Cohen, 2002), ability to conduct everyday activities(Menec,2003), productivity (Glass et al., 1995), and spirituality(Crowther, Parker, Achenbaum, Larimore,& Koenig,2002), among others.

Despite the growing variability in measures of successful aging, most frameworks have nonetheless continued to contain variants of the first two components proposed by Rowe and Kahn: low probability of disease and disease-related disability and high cognitive and physical functional capacity. Much of the literature on successful aging also suggests that these outcomes can be influenced by individual effort and specific actions(Angus & Reeve,2006; Holstein &Minkler,2003; Laliberte Rudman,2006).

Although most models have defined success as an outcome, some have emphasized processes. Perhaps the most influential model in this regard is the goal-based tradition conceived by Baltes and Baltes (1990; see also Baltes & Carstensen,1996; Baltes & Smith,2003), the"SOC" model, which grounded successful aging in the interaction of three processes: Selection involves redirecting efforts and resources to certain goals and tasks while disengaging from other goals. This in turn allows individuals to optimize and strengthen the resources necessary for achieving selected goals. Aging individuals can also compensate for declining abilities and skills by establishing new resources and strategies for maintaining desired outcomes. In these models, the assumption is that these self-regulatory processes grow crucial with age and have become more salient in the face of greater longevity (Freund, Nikitin,&Ritter,2009; Rohr&Lang,2009).

These models have been and continue to be criticized for being most applicable to the relatively healthy "third age" of life or "young old" populations rather than in the "fourth age” or for the “oldest old,” which comes with significant constraints in functional capacity, frailty and psychological losses, and limited effectiveness of interventions. Others point out that they place too much emphasis on the passive reaction or adaptation of individuals to losses rather than pro-active coping strategies that might prevent potential threats, to begin with (Oewehand, de Ridder, & Bensing,2007). micronized purified flavonoid fraction 1000 mg uses Indeed, related research has countered these limitations by emphasizing "assimilative" (intention-based) efforts alongside “accommodative”（adjustment-based） efforts （Brandtstädter & Rothermund,2002) or, similarly, "primary" control strategies alongside more "secondary" strategies (Heckhausen, Wrosch, & Schulz,2010; Schulz & Heckhausen,1996). Any attempt to define "success" is fraught with competing interests and evaluations. The literature on successful aging has been further critiqued by critical gerontologists and others for being too anchored in the experiences of privileged groups, minimizing or neglecting significant variability and inequality in aging experiences (e.g., by gender, ethnicity, socioeconomic position, education, and other aspects of social location and cultural life; Calasanti, 1996,2004; Estes, Biggs,&Phillipson,2003). It has also been critiqued for imposing onto populations and individuals a set of standards or expectations that may not be desirable or attainable (Marshall, 2012; Martinson & Minkler, 2006; Minkler & Fadem, 2002). These critiques often focus on the neoliberal tendencies of the successful aging model, whereby it becomes the responsibility and even moral imperative of individuals to do everything they can to achieve "success" in aging at the risk of being blamed or held responsible for "failure"(Katz & Marshall,2004).

Despite the contested meaning of "successful" aging, the popularity of the concept has had profound effects on the cultural, social, and economic constructions of aging. One might even argue that anti-aging practices have flourished precisely because the popularity of successful aging has created a space for them to do so. To what extent do the practice goals of anti-aging providers mirror the components of dominant models of successful aging? Our analyses of interviews with anti-aging practitioners reveal rhetorical overlap which, intentional or not, highlights some of the problematic consequences of efforts to reconceptualize old age.

This article is extracted from © The Author 2013. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.