In Our Prime (29 page)

Middle age medicine is a biological four corners, an intersection of traditional Western practice, alternative therapies, the beauty and fitness industries, and quackery. Science has never been so frequently invoked and so frequently abused. In Las Vegas, the Anti-Aging Academy takes up residence at the Venetian Hotel, where the conference rooms are a short stroll from the hotel's faux St. Mark's Square. There, under a perpetually blue sky, cheerful baritones in red-and-white-striped shirts navigate their gondolas down a mini-canal near sidewalk cafés that occupy faux sidewalks. The
resort's exhibit hall serves as a village square and town market. On display are examples of the “new,” “revolutionary,” “pioneering,” “miraculous,” “scientifically tested,” “science-based,” “doctor-approved” wonders and wares that fill today's antiaging department store. I strolled through the aisles of the cavernous hall at the 2008 meeting to sample Cleopatra's 24K gold skin cream ($55 for five ounces), Brain Longevity capsules ($40 for a month's supply), and a miniaturized paint roller with 192 tiny needles that prick the skin for better absorption of skin-care products ($120). I lay in an oxygenating home hyperbaric chamber, a blue cylindrical pod that looked as if it could hold an astronaut in suspended animation ($20,000 for the canvas home unit; $72,000 for metal), and exposed my cheeks to a chilly “facial workout” with a cryotherapy set that resembled a pair of lightbulbs filled with blue curaçao—in reality, antifreeze ($30 a pair, or $9.49 a gallon at your local gas station, bulbs not included).

Technical jargon and unproved claims are common. And since most of these products are not advertised as diagnosing or treating anything, they do not need approval from the Food and Drug Administration. The brochure for the Ondamed, a biofeedback system, includes a brief history of “great innovations in non-invasive medicine.” On its pages are portraits of Gabriel Fahrenheit, the inventor of the first mercury thermometer in 1714; René Laennec, who introduced the first stethoscope in 1816; Wilhelm Conrad Roentgen, who discovered the X-ray in 1895; and Rolf Binder, unshaved and wearing a scruffy T-shirt, the man who introduced the Ondamed.
The makers of Ion Magnum
muscle builder and Perfector electronic face-lift suggest their products can reverse aging by making time go backward, Einstein be damned. A thick, shiny booklet in robot-silver declares that “microscopic laws of physics allow for time reversal,” referencing a study that “found a single substitution in the amino acid sequence of an enzyme seemed to turn the clock 2.5 million years back.” Taking ten years off a face should therefore be a snap.

One can discern a path from the conference back to the period when plastic surgery expanded medicine's portfolio from treating diseases of the body to supplying happiness. Indeed, the atmosphere at these gatherings is similar to that of a nineteenth-century Age of Science exhibition, when the astonishing leap forward in knowledge was accompanied by gross
misinformation and false promises.
Although the medical establishment rejects
the belief that aging is a disease, the notion has nonetheless been revived by leaders of today's antiaging and beauty industries, from Ronald Klatz to the beauty and health guru Nicholas Perricone. “
Wrinkled, sagging skin is not
the inevitable result of growing older,” Perricone advises. “It's a disease, and you can fight it.” To capitalize on the faith in science, companies have invented a new vocabulary to suggest a scientific pedigree. They sell “cosmeceuticals” and “nutriceuticals.” “We're trying to connote the fact that there's serious scientific research here, even though it's a cosmetic or a vitamin,” Perricone said when asked about his own line of antiaging products. “Buzzwords like these give people a way to identify products that are moving in the direction of science-based rather than marketing-based.”

According to a 2006 Harris poll, nearly six out of ten people surveyed incorrectly believed the FDA regulates antiaging products. It does not. As Goldman and Klatz themselves advise in collections of antiaging articles they edit: “
Under no circumstances is the reader
to construe endorsements by the academy of any specific companies or products. Quite to the contrary,
Caveat Emptor.
”

If there is a single item that embodies the contentiousness of the antiaging movement, it is human growth hormone, or HGH. The pituitary gland, the pea-sized CEO of the endocrine system that is located at the base of the skull, is its natural producer. In 1971, biochemists figured out how to isolate and synthesize growth hormone in the laboratory, and doctors can now legally prescribe it for children and adults with severe deficiencies or muscle-wasting diseases. The hormone has also been popular among athletes, who use it to bulk up and speed their recovery from injuries, and antiaging enthusiasts, who believe it restores youthful vigor—although it is illegal to use the substance in the United States for these purposes and it is banned worldwide in most athletic competitions. Assessing the assertions of both the disciples and the scarred evokes the 1985 dystopian fantasy
Brazil
. In the film, one woman goes to a brilliant new plastic surgeon and becomes miraculously younger with each treatment, a
glamour-puss swirling around the dance floor in a red dress, until she eventually looks younger than her son. The same treatment, meanwhile, leaves her friend progressively more crippled and mutilated, a wheelchair-bound biddy insisting that the doctor will manage to successfully adjust her treatment any day now. “There's been a little complication with my complication,” she explains, until she finally wastes away, not even leaving a body for her coffin.

Growth hormones gained notice
in the 1990s after a
New England Journal of Medicine
article reported that twelve men between the ages of 61 and 81 had more lean body mass and less fat after six months of taking the substance. Since then, claims for its fountain-of-youth-like effects—increasing bone density, smoothing skin, improving one's outlook and mental acuity—have tumbled from the mouths of enthusiastic supporters. Yet our understanding of what HGH will do to the body in the long term is sketchy, and the government as well as various medical societies have issued warnings about its use. Dr. L. Stephen Coles, a gerontology researcher and lecturer at the University of California–Los Angeles, was one of the dozen doctors who was in Mexico with Klatz and Goldman but is no longer associated with the movement. “I remember saying [HGH] is really important; this is what medicine will be in the next five years.” He has since revised his opinion, stating, “Growth hormone is risky, and I'd like to see long-term studies.”

A 2007 review of thirty-one randomized, controlled studies published in the
Annals of Internal Medicine
concluded, “risks far outweigh benefits when it is used as an anti-aging treatment in healthy older adults.” Side effects include diabetes, high blood pressure, hardening of the arteries, abnormal growth of bones or internal organs, and carpal tunnel syndrome.

To many antiaging practitioners, HGH is part of the solution to aging itself. In their view, aging is by definition a hormone deficiency condition, since the body produces less growth hormone as the years go by. But human biochemistry is in constant flux.
Cells start dying off while we are
in the womb, programmed to “commit suicide” so that their healthy brethren can mature and develop. The only human cells known to reproduce indefinitely are cancer cells. No direct link between HGH and cancer has been established, but some scientists think there is evidence of
a troubling connection. They hypothesize that the body cranks down the production of growth hormone in adults to curb the abnormally rapid growth of malignant cells; dosing on growth hormone may eviscerate that protection.

Advocates contend such dangers are exaggerated, and either dismiss the research or argue that low doses of hormones are safe and effective. For many Gen Xers and boomers over 40, the promise of strength and energy is too seductive to worry about the risks. Many of the doctors who push HGH are true believers, and they inject themselves and their spouses, arguing that it makes as much sense as restoring insulin to diabetics. The academy is a heavy promoter of growth hormones—something that has not gone unnoticed by the FDA. Half of the twenty people indicted in 2007 for Internet trafficking in human growth hormone and anabolic steroids belonged to the Anti-Aging Academy or promoted products at its conferences. (The law requires a doctor to examine a patient before prescribing the hormone.)
The academy was not charged
, but Klatz, who co-authored a book on human growth hormones,
Grow Young with HGH: The Amazing Medically Proven Plan to Reverse Aging
(1997), disdains the restrictions: “By the time the F.D.A. researches and approves these drugs, we'll all be dead.”

In rare instances, the FDA has gone after a physician, as it did in 2004, when Dr. James Forsythe, the owner of a Las Vegas clinic, was indicted for prescribing HGH as an antiaging treatment. Prosecutors charged that he gave an unfounded diagnosis of adult hormone deficiency to a patient in order to administer the steroid. He was acquitted. At 70, Forsythe is an avuncular man, with a round head and gray hair. He has been injecting himself with hormones six days a week since 2002 and tells me he has never felt better. An entire day of panels at the academy's 2008 conference was devoted to Dr. Forsythe's battle with the FDA, and he was cheered as a hero in battle with a villainous bureaucracy.

The academy has aggressively attacked critics in the medical establishment. “
Simply put, the death cult of
gerontology desperately labors to sustain an arcane, outmoded stance that aging is natural and inevitable,” Klatz declared. “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 depend on an uninterrupted status quo in the concept of aging in order to maintain its unilateral control over the funding of today's research in aging.” Fears about debilitating side effects from other hormone treatments like testosterone and estrogen were similarly dismissed by promoters at the conference.

No one knows precisely why the human body ages, whether it is the result of natural wear and tear, a genetically determined life cycle, environmental pressures, or an evolutionary adaptation. People live longer than they used to because sewage is not dumped on the streets, meat, fruit, and vegetables are plentiful, houses are heated, and doctors can prescribe antibiotics and chemotherapy. But whether human beings can extend the life span a couple of additional decades, let alone the eighty years Klatz imagines, without attendant deterioration is unknown.

The name that Klatz and his colleagues have chosen to represent their efforts to prolong life has an ironic edge. Think of the term itself: antiaging. Literally, against aging. It is labeled “the enemy,” a scourge to be eliminated rather than life's natural progression, and women and men are depicted as being at perpetual war with it. “
Antiaging” today is like “antiwar” in the 1960s
, a term that encapsulates opposition to everything we hate and fear, said Nina Jablonski, the head of the anthropology department at Pennsylvania State University. “‘Anti-aging' is one of the words that have slipped into the language in this decade, because everything connected to natural aging is anathema.”

Antiaging entrepreneurs often make incomplete and inaccurate claims, but it is not simply a matter of a shrewd puppet master pulling the strings of a gullible public. Middle age medicine has a strong grassroots element. Many doctors at the Las Vegas conference said they were motivated to explore antiaging strategies by requests from their patients. Companies, of course, have been quick to capitalize on these desires, reinforcing and expanding them. The movement is a by-product of an empowered patient who refuses to meekly accept the pronouncements of a man in a white coat. That is both its virtue and its vice. It has prompted patients to demand more information and better service. Consumers like
its emphasis on prevention and wellness, and its attention to the entire patient, which runs counter to the increasing specialization of modern medicine.

Joseph Maroon, like James Forsythe, has the perspective of both a physician and patient. The vice chairman of the Department of Neurological Surgery at the University of Pittsburgh Medical Center, Maroon is one of the academy's two senior vice presidents.
At 68, he arrived
at the conference after finishing an Iron Man triathlon in Hawaii. Maroon is well known in the sports world for helping to develop a computerized system to determine the severity of concussions and the recuperation time an athlete needs before returning to play. It has become the standard of care for concussion management in the NFL, NHL, Major League Baseball, and NASCAR, and it is used in more than twenty-five hundred American colleges and high schools. During the Las Vegas meeting, Maroon described his first academy conference as “an Archimedes-like Eureka experience, a mind-blowing event.”

Like many other proponents, Maroon was inspired by personal experience. With dozens of Iron Man competitions under his belt, Maroon was feeling the pain by his seventh decade. The Advil he had taken regularly over the years had given him an ulcer. He recalled that at his first conference some of the speakers were talking about fish oil as a natural anti-inflammatory with its beneficial effects on heart function. He tried it and was amazed by how much better he felt.

“There are things presented at this meeting that are clearly controversial, that you don't agree with,” he acknowledged to the early-morning Vegas crowd. Maroon later told me he understands that the academy, in the wake of negative press, had recently created the vice presidential posts to bolster its credibility by associating with respected doctors. But he maintains it is “the only scientific organization” that is devoted to the healthy extension of life. If he had his way, he would replace the term “antiaging” with “preventive medicine.” “We're so busy treating diseases, very little is spent on prevention unless you're in the highest socioeconomic class,” he said.