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Executing aging: an ethnography of process and event in anti-aging medicine

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EXECUTING AGING: AN ETHNOGRAPHY OF PROCESS AND EVENT IN
ANTI-AGING MEDICINE

by

Courtney Everts Mykytyn

A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(ANTHROPOLOGY)

May 2007

Copyright 2007 Courtney Everts Mykytyn

ii
ACKNOWLEDGEMENTS

This research would not have been possible without the critical
guidance and support of my Committee Members, Dr.’s Cheryl Mattingly,
Lanita Jacobs-Huey, and Vern Bengtson. I am indebted also to Dr. Nancy
Lutkehaus, Dr. Peter Mancall, Dr. Marianne de Laet, Dr. Andre Simic,
Sadie Moore, Jay Hasbrouck, Niki RoussoSchindler and Shaye
RoussoSchindler for their thoughtful insights and challenging critiques. I
have been fortunate for the loving support of Lili Rossi, Dave Rossi, Ian
Everts, Elisabeth Everts, and Paulette Westphal. Funding from the Wenner
Gren Foundation (Grant #6982) was critical for the pursuit of the research.
The Institute for Advanced Studies of Science, Technology and Society in
Graz, Austria provided me with two months of focused writing and analysis
with a most accommodating and thoughtful group of scholars. I wish to
thank my beautiful children for encouraging me with their daily smiles and
going to sleep that I may write at night. Finally, I wish to thank my
generous, loving and witty husband Roman, without whom none of this
would be possible.

iii
TABLE OF CONTENTS

Acknowledgements ii

Abstract v

1. Executing Aging: Introduction 1
1.1 The Anti-Aging Field 10
1.1.1 Defining the Field 10
1.1.2 Debates and Controversies 19
1.2 The Trope of Execution 25
1.3 Methodology 28
1.4 Chapter Profile 38

2. Anti-Aging Medicine in the Context of Nature, Perfectibility,
Process, and Event 43
2.1 Aging – What Is There To Be “Anti” About? 45
2.1.1 Age-Related Disease 47
2.2 The Medicalization of Aging and the Construction of Disease 51
2.3 Nature in Science And Aging 57
2.3.1 Predictability of Nature 63
2.4 Enhancement Technologies: The Quest for the Optimal 65
2.5 The Process/Event Distinction 68
2.5.1 Process, Event and Execution 75
2.6 Conclusion 76

3. A History of Anti-Aging Medicine From 1990-2003 79
3.1 1990-1995 84
3.2 1996-1999 91
3.3 2000-2003 103
3.4 Conclusion 119

4. Migration to Anti-Aging Medical Practice: Practitioners
and Their Stories 125
4.1 Aging As Enemy 128
4.2 “Regular Medicine” And Physicianhood 139
4.3 “Stranger In A Strange Land“ 145
4.4 Conclusion 152

5. The President’s Council on Bioethics and Anti-Aging Medicine 157
5.1 The Testimonies 161
5.2 Beyond Therapy 178
5.3 Conclusion 185

iv
6. Executing Aging: Conclusion 191
6.1 Research Implications 205
6.2 Directions for Future Research 210
6.3 Summary 217 205

Bibliography 22
v

ABSTRACT

Anti-aging medicine has emerged over the past twenty five years with the
explicit goal of biomedicoscientifically intervening into aging. Anti-aging
practitioners treat patients in their clinics with a wide array of anti-aging
strategies: nutrition, exercise, supplements and hormone therapies (human
growth hormone being the most contentious). Anti-aging researchers search for
ways to intervene into the aging process, having to first grapple with the
unsettledness of what that process might entail. Interventions into aging have
been dubbed by many detractors as a linkage between aging and disease. This
dissertation, drawing from more than six years of ethnographic interviews,
participant observation in clinics and conferences, and a review of pertinent
literature, argues that practitioners do not conceptualize their work in this way.
Instead, anti-aging proponents generally eschew this linkage arguing that aging
is not a disease but that it is not inevitable and thus subject to scientific scrutiny
and biomedical intervention. The meaning of aging, nature, and the role that
biomedicoscience plays in shaping and responding to these conceptions is
explicitly at stake. Anti-aging medicine raises a number of critical issues: access
to care, the mandate of biomedical treatment, how we think of ourselves in
relation to our life-cycles and time, how we construct nature and its categorical
power. I argue that the notions of process and event underlie these issues. By
thinking of aging as a process, its naturalness becomes less significant. By
avoiding the construction of disease, anti-aging practitioners bypass the inherent
vi

politics that herald fears of medicalization. Nature is not completely irrelevant
here, however. Instead of relating to nature as a kind of sanctuary in which
biomedical intervention is constructed as hubristic at best, anti-aging proponents
argue that nature is more significant in the human drive to overcome biological
constraints. Thus, it is more natural to pursue anti-aging medicine than to regard
aging as natural and do little beyond attend to it’s “associated” diseases such as
Alzheimer’s Disease. This dissertation attends to anti-aging proponents’ attempts
to make sense of these seeming contradictions and ultimately argues that the
ever-expanding catalog of scientific possibilities render inadequate our current
vocabularies.
1

1. EXECUTING AGING: INTRODUCTION

Methuselah. Gilgamesh. Brown-Sequard and the dessicated goat testicles.
The breath of virgins. Gulliver’s Struldbruggs. Ponce de Leon. Soylent Green.
These stories of humanity’s wrestling with time, aging and mortality – some
cautionary, some ecstatic – tell of the consequences of immortality and/or its pursuit.
They tell of the desire not to age and the pervasiveness of this yearning. Indeed,
some anthropologists argue that this drive to live longer is a hallmark of human
cultural activity (Roughley 2000). Whether or not it is universal, the current
emergence of anti-aging medicine draws from this desire not to age and does so
within a particularly scientific framework. While immortality still colors the
landscape of anti-aging medicine, its overarching goals tend toward living longer and
healthier as opposed to the shelving of death. The extension of healthy life in anti-
aging medicine is largely predicated upon the notion that biomedicine can and
should intervene into the process of aging itself. This is a dramatic repositioning of
biomedicoscientific work that has heretofore largely focused upon the events of
disease and pathology. Locating process rather than event as a point of biological
entry into the conceptualization and treatment of aging opens biomedicoscience to a
changing approach to its work that will have striking consequences for biomedicine
and beyond.
This is a story about aging, about what aging means and how that meaning
can shift. This is also a story about science, biomedicine, perfectibility and nature.
This is a story about what we can and should do with our aging grandparents,
2

parents, and selves. What we envision as our therapeutic options is precisely at stake
in defining where biomedicine should intervene. Moreover, the rationale for
biomedically “treating” aging impacts our everyday lives in terms of how we
approach old age and aging – whether we are increasingly framed as physiological
beings, how we see those who are not aging “healthily,” and even how we fund
programs like Medicare and Social Security. This is a story of a biomedicine
struggling to deal with shifting concepts of nature and disease in light of its
tremendous technological progress that presents significant philosophical challenges.
This story of potential scientific success in treating aging rests on fundamental
questions of whether aging is “too natural” to intervene upon or if the nature of
humanity is marked more importantly by the quest to supercede our biological
constraints. And this is a story of a lexical vacuum such that we wrestle with even
knowing how to talk about such issues. This ethnography of anti-aging medicine
explores the meaning of aging and nature and science as they relate to, depend on,
and challenge one another.
Anti-aging medicine has grown tremendously since the early 1990s. Anti-
aging medical practices have opened all over the United States and abroad
1
, many
organizations are devoted to anti-aging medicine, biotechnology firms are interested
in its potential, researchers are debating its pursuit, bioethicists are discussing its
consequences, historians its origins. Thus far, it has not garnered much
anthropological attention though social gerontologists have been interested in what it
might mean for gerontology and society at large. Dr. John Vincent of Exeter
3

University has recently begun looking at practitioners of anti-aging medicine in
Europe and the Bioethics group at Case Western Reserve has begun a large scale
research project with a component of it aimed at anti-aging practitioners
2
. Since
1999 I have studied anti-aging medicine and have witnessed first-hand the
development and growth of the field during some of its most explosive times.
This research intersects with literature on the construction of the natural life
course and the natural body as well as to constructions of disease and aging, the
goals and mandates of biomedicoscience, and recent work with enhancement
therapies. While anti-aging medicine proponents target aging for biomedical
intervention, they do so without the framework of disease. In other words, for anti-
aging medicine, aging need not be constructed as a disease in order to facilitate
intervention. This marks an interesting departure from many other biomedical
projects in which the construction of a disease is an intrinsic part of medicalization.
Many social gerontologists and anthropologists of aging have discussed the
medicalization of aging but have largely done so within a disease framework (Arluke
and Peterson 1981, Cohen 1998, Kaufert 1988, Lock 1993, among others); however,
the route anti-aging medicine has fashioned for itself bypasses disease
categorization. This sidestepping of disease categories to intervene in what has
generally been thought of as a “natural part of life” bears significance in that it
orients biomedical intervention toward process of aging rather than its events of
disease.
4

For the purposes of this work, I work with the term “process” as an
explanatory concept in a biological sense. In biology, aging has long been considered
a process, a series of physiological happenings that can be roughly correlated to
chronology. This process involves many organ systems and molecular changes
within the body that predispose bodies to disease events. The process of aging has
also been constructed as an intrinsically natural process. In other words, it is
universal and predictable in that everyone ages (barring unforeseen accident or
“early” disease) and is likely to bear one or more associated diseases and losses of
function. While the tendency to correlate aging with disease has always plagued
gerontology and biomedicine, aging was often spared this association because of its
naturalness and because of its processualness. It neither had the etiological certainty
of a beginning point for disease nor a single pathway of progression. Aging, and
natural processes in general are not conceived of as caused by anything save the
existence of life and survival. Thus, a natural process refers to a series of universal
occurrences that happen over time with relatively predictable steps and no moment
of commencement. Processes are less rigidly constructed, messier, and less
momentous than disease events.
Events, on the other hand, refer to instances that have a fairly pin-pointed
beginning. An event may be something as momentous as a myocardial infarction
(heart attack) or a diagnosis of a disease with which a patient will have to contend.
The event of a disease may have processes embedded in its meaning; just as there are
processes that lead up to a laboratory finding of, for example, atherosclerosis.
5

However, there is a perceived point at which atherosclerosis is confirmed. Thus we
have a moment of diagnosis that may not necessarily be exact (if a patient is
diagnosed with atherosclerosis that is suspected to have preceded the diagnosis) but
that there is a kind of etiological moment. Now the clinical finding for
atherosclerosis exists. This moment may also be embryonic in cases of genetic
diseases/”abnormalities” such that a baby is born with disease X whose “event” of
molecular mal-formation happened in utero. An event is a kind of beginning of
disease that may have both processes that lead up to the diagnosis such as the case
with atherosclerosis as well as processes of the disease as it manifests post-diagnosis.
For those diseases whose etiology is unknown, the scientific belief in knowability
asserts that an etiology exists but is simply awaiting discovery.
Biomedicoscience is largely event-centered (Kaufert 1988, Marcus 1995: 7;
Young 1982: 272); it focuses on the instances of pathology by marking their
particular etiologies against a norm from which they deviate. Once a disease or
pathology is excised from “the normal” it then presents as a bioscientific problem to
be solved and a biomedical problem to treat. Such norms, often couched as “natural”
are themselves constructed as (human) biological universals. The diseases that occur
more frequently in older age are indeed related to aging but are marked as
pathologies. This differentiation between “normal aging” and pathology has been
critical to the discipline of gerontology as it distinguishes particular sites for
medicalization without labeling aging a disease.
6

“Nature” and the “natural body” have furnished the backbone of biomedicine.
They provide a framework from which normality and disease can be identified and
understood; disease marks an abnormal state of the body’s being, an aberration.
Abnormalities are identified as experiences that are not universal (everyone does not
get prostate cancer) and bear causes and symptoms and provoke cures and therapies
under their given disease-name. They are understood as events of disease. They are
incidences of pain or bodily malfunction or viral/bacterial menaces. Anti-aging
medicine offers a different mode of investigation and understanding by positing the
aging process itself as the locus of intervention. Anti-aging medicine proponents
argue that precisely because of the universality (or predictability) of “troubles” in the
aging body, aging itself is the mitigating factor. Just as a flu can manifest different
symptoms in different people, so can aging and, just like a flu, aging is the root of
the symptoms. However, for anti-aging proponents, aging is largely not identified as
a disease (because everyone does age, thus it is a universal ‘norm’). However,
because it comes packed with expected pain and physiological debilities, aging can
be identified as a universal process that can and should be biomedicoscientifically
targeted. Indeed, some practitioners argue that the “age-associated diseases” are
universal but we just die of one before we suffer from the others.
Thus, the making of disease has traditionally located the point of entry for
biomedicine while natural processes have largely experienced sanctuary from
intervention. However, with the amplification of reproductive technologies and
genetics, this sanctuary is increasingly becoming problematic as the definition of
7

nature is being profoundly destabilized. For biomedicoscience, nature has
principally been taken as the reality we can come to understand through science. It
is perceived as extra-cultural, as existing separate from the doings of people.
However, the work of many philosophers, historians, anthropologists and
sociologists of science have shown repeatedly that nature itself is a cultural
construction and carries with it certain moralities (Escobar 1999, Gordon 1988a/b,
Haraway 1989, Knorr-Cetina 1992, Latour 1993[1991], Latour & Woolgar 1986
[1979], Rabinow 1996, Strathern 1980; Williams 1980, among many others).
The category of nature is of great importance as it confers not only ethical
and behavioral judgments, but also structures the mandate of biomedicoscience.
Science, based on the description of and particular relationship to nature is a kind of
“ethical plateau” where multiple technologies interact in a “terrain of consequential
decision making” (Fischer 2003: 36). Choices, interpretations, determinations, and
judgments made regarding everyday and momentous experiences are made within a
framework of nature and “natural” humanity. Anti-aging medicine shifts that
relationship not by asserting that aging is not natural, nor that aging is a disease, but
rather that nature and disease no longer prove relevant to the question of biomedical
intervention.
In the wake of the biotechnological progress that has allowed scientists to
“intervene into nature,” the notion of enhancement therapies has emerged. Such
technologies that aim to make us “better than well” (Elliot 2003) generally
characterize “interventions designed to improve human form or functioning beyond
8

what it necessary to sustain or restore good health” (Juengst 1998: 29). This
bifurcates biomedical work into the camps of improvement versus therapy wherein
therapies are designed for well-defined biomedical ailments. Of course, the
definition of good health is dependent upon what can be expected, upon what it is
that we agree is normal or natural, and upon what unhealthy means. Thus, the
predicament for scholars interested in enhancement therapies is precisely the
meaning and consequences of nature. This problem lies at the forefront of these
discussions. While we can point to an treatment and call it enhancement as opposed
to therapy, the fuzziness of these distinctions are increasingly cumbersome (Parens
1998, President’s Council on Bioethics 2003).
Even as nature is being destabilized, it remains an important force for
understanding the “progress” of biomedicoscience and technology. With the
destabilization and conceptual politicization of nature, notions of process have
emerged as a new kind of vocabulary. This work with anti-aging medicine reveals
just such a shift from a focus on nature and abnormality to the framework of process
and event.
This shift reveals a growing kind of biomedical holism – an responsiveness to
the limitations of reductionist biomedicoscience. Wherein disease-focused work
aimed to understand and manipulate the etiology of an abnormality, many anti-aging
researchers and clinicians are trying to look at biological systems and their
interactions rather than what they see as a kind of myopic examination of their
essences. In other words, processes come to matter more than events. In Emily
9

Martin’s work that relates late capitalism and the central theme of flexibility and
complex systems to the discourse around immune systems (Martin 1994), she
foregrounds the importance of flux and relation. Everything is constantly changing
and is also related to something else. This anti-aging work reveals the same kinds of
things but in different ways. That anti-aging advocates speak of and wish to do
something about the process of aging, they invoke the systemic complexity, the
interrelatedness, the non-momentous, non-eventness of aging. Aging is biologically
multi-connected and without a single foundational site, with the exception, perhaps
of chronological time that relates very imprecisely to the aging process. Thus, in
order to do anything about aging, this processual web must be addressed as a web
rather than single strands.
By throwing open to debate the constructions of process/event in relation to
biomedicine, I underscore the stickiness of “nature” while focusing the analysis in
different terms – process and event – that may offer a relevance grounded in
contemporary discussions. This major rhetorical shift in the science and medicine of
aging takes place in both macro- and microscopic ways: through national bioethical
deliberations, major debates within the gerontological field as well as with
practitioners who treat patients. This analysis provides another theoretical vantage
point for analyzing the ways in which biomedicoscience relates to the body,
constructions of what it means to be human, and aging in particular.
The focus on process and event that I pose here is only one of many ways in
which anti-aging medicine can be interrogated. I could have concentrated my
10

analyses more explicitly around doctor-patient relationships, ageisms, bioethical
concerns of inequality and access to care, constructions of time, paradigm shifts and
scientific controversies. However, I believe that the rhetorical implications that
emerge within the framework of process and event lie at the heart of these topics.
These categories have tremendous power to structure our understanding of the body,
its biologies, and how we relate these to and through biomedicine. Thus, process and
event highlight most vividly the stakes in anti-aging medicine, aging, and
biomedicine. However, the categories themselves are often so tacit, so taken-for-
granted, that the power they issue seems to emanate from elsewhere.
Many factors have brought forth anti-aging medicine, including a sense that
aging is both socially and personally painful, a dissatisfaction with the current
practice of biomedicine, a belief in the “good” of science, the ricketyness of the
category of nature, financial incentives, and a growing acceptance of alternative
medicines (and alternative viewpoints about medicine). While the efficacies of anti-
aging medicine is uncertain, the orientation toward this goal is of utmost importance
to the practice of biomedicine and the science of aging today.

1.1 THE ANTI-AGING FIELD
1.1.1 Defining the Field
The field of anti-aging medicine has grown in the past decade or so, and most
sharply in the past five years. Its emergence has occurred in a number of realms.
Scientific journals been dispatched with an anti-aging focus, numerous conferences
11

have been held specifically on anti-aging and much academic and popular ink has
been spilled on the topic. Additionally, webcasts have been held on anti-aging
medicine and a special interest group in the Gerontological Society of America was
inaugurated in 2003. Biotech companies have formed both explicitly and subtly
attending to anti-aging interventions. Furthermore, many health care practitioners
have established anti-aging medicine practices and clinics. Scores of websites sell
anti-aging remedies and major corporations have co-opted the term to advertise
everything from skin care products (e.g., Oil of Olay) to pet food (e.g., Iams).
Many individuals and groups are linked to anti-aging: practitioners working
in anti-aging practices, gerontologists, organizations devoted to the study and well
being of the aged, and companies selling anti-aging products (See also Mykytyn In
Press). Their identities are still nascent and the political distinctions are contentious,
but the idea that aging should become a target for biomedical intervention provides
the common thread. Some anti-aging proponents seek a dramatically protracted life
span while others focus on the goal of increasing “health span” that could mitigate
instances of frailty and decrepitude. Some people currently practice anti-aging for
their patients and themselves while others believe that no legitimate anti-aging
practice currently exists (Austad 1997, de Grey 2004a, Fossel 1996, Hayflick 2001,
Johnson 2004, Kirkwood 1999, Olshansky and Carnes 2001, Olshansky, Hayflick
Carnes 2002). And of those who argue the latter, some believe that the future looks
optimistic for an effective anti-aging medicine [Austad 1997, de Grey 2003, Fossel
2002, Johnson 2004]).
12

Currently, there are hundreds, perhaps thousands of practitioners of anti-
aging medicine in the U.S.
3
. They are medical doctors, chiropractors, doctors of
osteopathy, nutritionists and even psychotherapists; the vast majority do not come
from geriatrics but rather the fields of sports medicine, endocrinology, cardiology,
obstetrics/gynecology, rehabilitation, anesthesia and even AIDS/HIV specialty.
These practitioners, many of whom are affiliated with the American Academy of
Anti-Aging Medicine (A4M) in some way, aim to help their patients (and themselves
since many practitioners use anti-aging treatment protocols) be as healthy as possible
through the use of “proper” nutrition/exercise, supplements, and hormone
replacement therapies (including the prescription of the contentious human growth
hormone). Practitioners generally focus their energies on increasing their patients’
overall sense of health – a flexible and nebulous notion that resembles a sense of not
declining or suffering any “age-associated” weaknesses or impairments. These
practitioners enter anti-aging for a complex set of reasons including a growing
dissatisfaction with the current practice of biomedicine, a belief that aging is a
painful physical decline, and the invigorating sense of being at the cutting-edge of
biomedicoscience (Mykytyn 2006).
For many anti-aging practitioners, anti-aging medicine refers to the
prevention of age-related diseases as well as the goal of optimal health. At some
level this might appear to be what most physicians aim to do. Yet, the notion of
optimal health takes on a different meaning here. Many anti-aging practitioners
rebel against the age norms accepted by more mainstream medicine. For these
13

practitioners, there is no ‘normal’ that should be accepted for a man of 72 years
when, instead, they aim to target his care toward the ‘norms’ of a 30 year old man.
The chronological numbers are tricky as there is no consensus over biomarkers for
aging; however, the rejection of any acceptance of pain/debility due to one’s age is,
according to many practitioners, a break from more mainstream care. Many
practitioners interviewed in my research (along with futurist Ray Kurzweil
[Kurzweil and Grossman 2004]) acknowledge that they are oriented around optimal
health so that when “real” anti-aging therapies are developed, their patients will be
better able to take advantage of them. Thus, many anti-aging practitioners
understand the limits of current science but nevertheless work toward anti-aging
goals of optimal health and the amelioration of pain they see in aging.
Practitioners come to anti-aging medicine for a variety of reasons and while
they are derided by others who claim that their work raises false hopes at best and is
profiteering at worst, the practitioners are the interface between anti-aging patients
and biomedicoscience. As such, theirs is a complicated space that must manage
patient expectations, scientific and clinical efficacy along with practitioners own
lives and lifestyles.
Practitioners often reveal a dissatisfaction with current biomedicine wherein
patients are prescribed pills but may take “too little” of a role in their own healthcare.
Anti-aging medicine offers a way to form more of a “partnership” with patients.
Their patients often pay more money “out of pocket” (not reimbursed by health
insurance) for lengthy sessions with their doctors more also is expected from them in
14

terms of nutrition and exercise. While practitioners often embrace and are well
versed with the relevant scientific literature, they do not diminish the impact that
“lifestyle factors” have on their patients’ health. Practitioners often tell of the great
lengths they go to in order to educate and encourage their patients to make healthy
choices. Often, those patients motivated to seek out an anti-aging practitioner are
somewhat self-selecting in that they are willing and committed to make such choices.
Practitioners also see themselves at the forefront of biomedicoscience and
have varying levels of contempt for the “victim mentality” they see fostered in
current modalities. Thus, they see their work as a kind of paradigm shift. This shift
involves not only the science of age-associated issues but also the way in which
science is applied to patients’ bodies. Practitioners often see their work as this
application process and as such shape not only the landscape of anti-aging medicine
in practice but also research agendas.
The strategies for achieving an anti-aging intervention are currently unclear
though great hopes are raised for stem-cell work, nanobiology, and gene therapy.
The American Academy of Anti-Aging Medicine forwards a “future equation” that
argues that work in the areas of cloning, artificial organs, and digital cerebral
interfacing are integral to an anti-aging future. Perhaps most notably, Cambridge
researcher and indefatigable anti-aging promoter Aubrey de Grey has controversially
outlined the “Strategies for Engineered Negligible Senescence” (de Grey et. al.
2002a); these strategies aim to address the seven primary categories of metabolic
side-effect accumulation in an effort to explicitly “cure” aging.
4
The predictions
15

made for these therapies and avenues of research are integral in securing funding,
establishing and preserving field legitimization, and generating greater discussion of
anti-aging medicine within and beyond the academy (Mykytyn 2006b)
Among the most well-known (and most controversial) organizations is the
American Academy of Anti-Aging Medicine (A4M). This U.S.-based organization
began in 1993 and has worked steadily to put anti-aging medicine on a national
agenda through sponsoring numerous conferences and credentialing physicians and
other health care practitioners in the “medical specialty” of anti-aging medicine.
Much of their public education work has been done in their enormous penetration of
the internet wherein many introductions to anti-aging medicine are made. In a 2000
survey of five major internet search engines, I found that a substantial 33% of 2150
search results referenced the A4M with no other single site featured so heavily. The
A4M site is geared toward educating physicians and lay public as much as it is
recruiting members and proponents. On the site
5
, one can search for articles on anti-
aging topics, find a practitioner “near you”, take a longevity test, purchase books
written by founders Ronald Klatz and Ron Goldman, register for membership, read
about A4M activities, and access position statements. By 1999, the site boasted
upwards of two million hits per month. This organization has been at a forefront of
anti-aging in so far as it has actively and publicly promoted anti-aging medicine in
both the public and practitioner arenas. Adopting mainstream biomedical forms of
professionalization (such as credentialing and conference hosting), the organizations’
16

activities attempt to legitimize anti-aging as a medical specialty and to situate the
A4M as the fields’ repository of expertise.
Academic researchers of aging have begun, mostly within the past five years,
to show explicit interest in anti-aging. The launching of the Journal of Anti-Aging
Medicine in 1999 (JAAM renamed Rejuventation Research in January of 2004)
marked a purposeful claim to professionalization for anti-aging. JAAM’s explicit
mission is to “provide both a multidisciplinary forum for anti-aging science and
ultimately to make a difference in the exploration of the anti-aging frontier… to
separate truth from fiction” (Wolf 1998). This journal is situated admittedly at the
fringe of gerontology by taking a controversial stance while demanding to be taken
as serious science. Their marginality was clear to the editorial staff and contributors.
Then-Editor-in-Chief Michael Fossel writes:
JAAM has, since its inception, been in a curious gray zone between science-
with-little-clinical-application and applications-with-little-supporting-science.
Over time this has changed slightly and, we believe, will change a great deal
more – and quite soon (Fossel 2002).

This “curious gray zone” has also been inhabited by a multitude of academic
publications in mainstream journals (Butler, et al. 2000a, Cole and Thompson 2001,
de Grey 2003a, de Grey et al., 2002a, Fossel 2002, Le Bourg 2000a/b, Olshansky,
Hayflick and Carnes 2002a, Wick 2002) and books (Austad 1997, Fossel 1996,
Hayflick 1994, Kirkwood 1999, Olshansky and Carnes 2001, Post and Binstock
2004). In 2003, a focus group was established at the annual Gerontological Society
of America conference focusing on the challenges and dilemmas anti-aging poses.
Additionally, Science Magazine established the internet site SAGE-KE (The Science
17

of Aging Knowledge Environment) in 2001 and in 2003 began monthly webcasts of
debates on aging topics (SAGE Crossroads launched in March 2003 by the Alliance
for Aging Research and the American Association for the Advancement of Science –
publishers of Science Magazine). The year 2003 also saw the invention of the
Methuselah Mouse Prize which awards researchers who successfully pursue certain
anti-aging goals.
6

A number of scientific conferences focusing specifically on anti-aging have
been convened. The UCLA Roundtable, held in 1999 (UCLA Roundtable 2003) led
to the SENS I conference in 2000 (de Grey et al. 2002a) and SENS II in 2001 (de
Grey, et al. 2002b). SENS– or Strategies for Engineered Negligible Senescence –
explicitly champions the plausibility of the indefinite postponement and even
reversal of aging by discussing tactics for its achievement. Other conferences such
as the International Association of Biomedical Gerontology series, the Integrative
Medical Therapeutics for Anti-Aging Conference, and perhaps even the somewhat
more peripheral Immortality Institute’s Life Extension Conference 2005 continue to
vie for a serious scientific look at anti-aging possibilities. These places of academic
discussion seek a scientific basis for understanding and most promote a form of anti-
aging optimism.
In the scientific world, perhaps a useful barometer of anti-aging’s increasing
foray into mainstream scientific thinking may be the use of the keyword ‘anti-aging’
in the online article search engine Medscape. ‘Anti-aging’ was used in 116 journal
articles from 2000 through 2003 compared to 41 published before 1990, 41 from
18

1990 through 1995, and 55 times between 1996 and 1999 (See also Gavrilov 2002).
While many anti-aging practitioners and researchers draw significantly from other
bodies of research that do not explicitly apply their work toward anti-aging, these
numbers represent only a fraction of data used to support anti-aging claims.
Therefore, the body of work informing anti-aging medicine is actually much larger
than only the work bearing “anti-aging medicine” as a keyword. Nonetheless, the
willingness for authors to reference anti-aging reflects some movement toward its
validation as a scientific idiom.
Predictions around anti-aging medicine are numerous, ranging from the
assertion that we are likely to have successful interventions in the next few decades
to predictions that the first person likely to live to 150 has already been born. Anti-
aging practitioners and proponents – and gerontologists as well – hope to prolong a
healthy life. These hopes curb questions of quality versus quantity of life as anti-
aging proponents shun the notion of a lengthened, painful life. Predictions about
how long and how soon technoscience may indeed increase our longevity range from
a few additional years to complete immortality. Aside these conservative and liberal
outliers, most discussions invoke 120-150 years as the likely life span average that
could be achieved within the next fifty years.
The financial stakes of anti-aging are great: an estimated twenty billion
dollars of patient/consumer expenditure in the anti-aging marketplace (more than the
$15.2 billion U.S. weight control products/services industry but less than the $22.8
billion world power tool industry) (Freedonia 2005), funding monies, research
19

reputations, pharma/nutraceutical development, insurance actuarial tables and
payouts, field leadership, and so on. The creation of an anti-aging field is a critical
step toward professionalization and the spoils associated with such an identity:
funding, publicity, entering scientists and practitioners, and a paying consumer base.

1.1.2 Debates and Controversies
For the growing and diverse field of anti-aging medicine, the quest for a
cohesive and coherent set of principles and practices remains unsettled. With so
many individuals, institutions, organizations, conferences, publications, and
companies claiming rights to “anti-aging medicine,” the term has taken on a wide
array of meanings and political identities. Clearly anti-aging medicine does not
mean the same to everyone (de Grey, et al. 2002a), and certainly, the battles over
language are not merely a trifle: with the politics of funding, of career reputations, of
anti-aging clinic viability and such, these labels have great consequence. The
conversations about the term “anti-aging medicine” reflect this complexity by
cleaving along a number of lines. Do we have any anti-aging medicine yet? Will we
ever have an anti-aging medicine? Should we? What is the goal (e.g., immortality,
rejuvenation, retardation, the amelioration of suffering) and how does this relate to
the mission of biomedicine? How can we scientifically achieve it? Who is doing
anti-aging medicine? And finally, is it any different from what we are already doing?
These questions cover the primary lines of dissent though this analysis argues that
perhaps the most critical cleavage is found between those who critique the existing
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scientific practice and those who work within it toward anti-aging ends. In other
words, it is the orientation toward an anti-aging goal that bespeaks the primary
commonality.
Perhaps one of the first problems in defining anti-aging medicine is the
difficulties faced in clearly defining aging. Long and deep debates have raged over
what we mean by, and what contexts we invoke when we speak about aging; aging
itself is a complicated term. And the precarious and contested definitions provide a
medium in which anti-aging medicine may ferment. Moreover, it could be argued
that it is precisely this precariousness that has made room for anti-aging medicine to
emerge as it has. With the definition of aging so contentious, with its meaning
subject to much interpretation, anti-aging medicine has the rhetorical and material
space to cull its own understanding of aging suited for its own particular purpose.
Moreover, anti-aging medicine provides a way of thinking about aging and
biomedicine in ways that “fit” one another. Said again, the contentiousness of our
definitions of “aging” and our placement of aging within a natural process of life are
ill-equipped to deal with the tremendous new powers of biomedical-scientific
inquiry; anti-aging medicine has stepped into this vacuum.
However, anti-aging practitioners, the A4M and its principle players (Klatz
and Goldman) have sparked a great deal of controversy and criticism. The recipients
of the first “Silver Fleece Award” in 2002, the A4M was “honored” by
biodemographer S. Jay Olshansky with a bottle of vegetable oil labeled “Snake Oil.”
By tagging the A4M as fraudulent and its principals as profiteers, this award aims to
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protect “real” science from the taint of swindle. It is this desire to protect the good
name of gerontology (Binstock 2003) that also led to the publication of a position
paper signed by 51 gerontologists entitled “No Truth to the Fountain of Youth” in
Scientific American (Olshansky, Hayflick and Carnes 2002). While not specifically
referencing the A4M, this article sought to curb the “resurgence and proliferation of
health care providers and entrepreneurs who are promoting antiaging products and
lifestyle changes that they claim will slow, stop, or reverse the processes of aging.”
This paper, along with other similarly refrained works (such as Austad 1997), aims
to publicly mark a line-in-the-sand between legitimate scientific work and those
who, the article insinuates, are about profiteering.
While drawing data from “legitimate” scientific journals, the A4M harbors its
own disdain for their outspoken gerontological opponents. Not present to receive the
Silver Fleece Award, the A4M responded in kind with a paper on their website: “The
Fleecing of Academic Integrity by the Gerontological Establishment” (A4M 2002).
Noting the accomplishments of the A4M, the article asserts that “to deny these facts
offered by the new clinical medical specialty of anti-aging medicine defies basic
logic.” This claim to truth rests on a notion that while anti-aging is not “ science as
usual” it is cutting-edge and revolutionary and not bound by entrenched ideologies
(Mykytyn 2006).
This image of the pioneer saturates much of the anti-aging practitioners
narrative. Going against the grain of contemporary biomedicine that they see as
“finger-in-the-dyke” at best provides an important aspect of the anti-aging identity.
22

Practitioners have repeatedly cited stories of medical ideas that took time to gain
recognition and the sometimes heroic battles for “accepted” knowledge.
Biomedicine is an always evolving practice and these practitioners see themselves on
its cusp whereas their detractors are deemed conservative and foot-dragging.
The claim of the name “anti-aging” by these practitioners has unnerved many
physicians and gerontologists. As such, in a move to distinguish between the “real”
and the suspect, other terms have emerged – albeit with limited purchase. A major
clinic in Las Vegas, Cenegenics, refers to their work as “age-management
medicine.” “Evolutionary medicine” has also been forwarded as an alternative
(Raffaele et al 2000:37) along with “longevity medicine” (Butler 2001: 64) and
“preventive medicine” (Perls in Arking et .al 2003). Even the Journal of Anti-Aging
Medicine was renamed Rejuvenation Research in part to distance itself from any
contamination that “anti-aging” might confer. Efforts by researchers have also been
made to differentiate the “anti-aging industry/medicine” from anti-aging research
(Arking et al. 2003) thereby claiming some space for legitimacy while
acknowledging the problematic work of others. The A4M’s response to these labels
is unambiguous: “Longevity medicine, successful aging, health aging, optimal
aging, and aging gracefully, among other synonyms, are being substituted by
conventional gerontologists for the term anti-aging. Simply put, the gerontological
establishment seeks to silence the most visible independent source of innovations in
aging research and education” (A4m 2002a). Clearly, the rubric under which anti-
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aging-geared science or the biomedical practice of anti-aging operates is contentious,
political, and consequential.
The “boundary wars” between gerontology and anti-aging practitioners
expose issues of funding and legitimacy (Binstock 2003) and are consequential to
leadership in the emerging anti-aging field. The stakes of anti-aging are enormous
and as a result, great efforts are made to assert each groups own ideas of anti-aging
as the only real or scientific stance. The research harnessed, histories employed, and
predictions mobilized by these groups often coincide but also often discount claims
made by competing groups. The battles over boundaries, identities, and leadership
are fierce (Binstock, 2003).
As researchers of aging argue that there is no effective anti-aging therapy yet,
the work of anti-aging practitioners is suspect because such a medical practice does
not target the process of aging but rather the effects of aging. Thus, for many
scientist-advocates, anti-aging refers to the retardation and/or reversal of the aging
process: a truly effective anti-aging medicine therapy would intervene into aging
itself. Some practitioners whose relationship to aging is distilled through a
conviction that aging is inherently about so-called “age-related diseases,” believe
that their work can affect aging but that they are being silenced by a conservative
mainstream. Many practitioners claim that while they understand that their work
does not affect the process of aging, they nevertheless aim for their patients to be in
the best shape possible when an efficacious anti-aging treatment inevitably becomes
available. Certainly, the idea of affecting the process is debatable since processes
24

and events are themselves constructions. In this line of thinking, anti-aging
practitioners might be indeed affecting aging as they see it where their opponents
argue that they are only intervening in the events of age-associated disease.
Nonetheless, the crux of this issue is that the practitioners see their work as targeting
aging. In other words, the orientation of their work IS toward the aging process –
whether they have the tools to do so in the eyes of the researchers is secondary.
Thus, as many anti-aging practitioners have argued, organizing their practice around
anti-aging goals is a break from mainstream biomedicine that woefully neglects
preventive care.
The question of what an anti-aging future would look like has drawn
significant attention (Post and Binstock 2004, Stock and Callahan 2004a/b) and there
are many who are anti-anti-aging. Great fear, disdain for, and worry over an anti-
aging future looms large in many of these texts. The President’s Council on
Bioethics asserts that humanity is inextricable from mortality, and therefore the
medical endeavor of anti-aging that undermines aging also undermines humanity
(President’s Council on Bioethics 2003). Eminent gerontologist Leonard Hayflick
speaks of the “population bomb” that anti-aging would engender; he paints this
future as “bizarre, even terrifying” (Hayflick 1994: 6). Others harness fears of
inequity in a world where anti-aging is only for the wealthy.

Concerns of many of
the prominent opponents and skeptics have as long a history as do optimists for
varying anti-aging remedies (Gruman 1966 [2003], Haber 2004)/2005; the question
of our humanity is most always at stake.
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As anti-aging medicine is taken more seriously by many in the scientific and
biomedical arenas, it poses some great challenges. Reorienting the
biomedicoscientific work on the process of aging rather than the to events of aging
(namely disease and pathology) is a dramatic reinterpretation of the biomedical
mandate. Should anti-aging continue to garner serious attention (and I believe that it
will), the relationships between nature, disease, aging, biomedicine will require
adjustment.

1.2 THE TROPE OF EXECUTION
The emergence of anti-aging medicine over the past fifteen years has directly
challenged our notions of aging and the biomedical relationship to aging. By
positing that aging itself ought to be a target for intervention, anti-aging medicine
practitioners and proponents are executing aging along three primary planes. First,
anti-aging medicine seeks to execute/destabilize our long-held notion of aging as
inevitable. Second, anti-aging medicine argues for a new understanding of aging as
that which can be scientifically understood and biomedically “cured” and thus are
executing/administrating the new framework following the desired collapse of the
previous construction of aging. Third, anti-aging medicine proponents offer
glimpses, sometimes vague and at other times quite material, of a future for anti-
aging medicine that executes a kind of scientific imaginary future performance that
is important to anti-aging medicine today. I rely on this triad of execution
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(destabilization/adminstration/performance) to illuminate and frame the complexities
of anti-aging medicine.
The execution/destabilization of aging refers to the work of eliminating,
shifting, changing, subverting our understanding of aging as referent to nature.
Drawing from a long history of regarding aging as unsavory and biotechnoscience as
magnificent, one would think this an easy job – and to some degree it is. But aging
is in many ways a marker of what it means to be human, and thus aging has been
constructed as natural even if there is much we can hate about it. For anti-aging
medicine proponents, aging is criminally painful and should no longer be accepted
and biomedicoscience must exact some sentence in the name of “justice” couched as
biomedical obligation. The figure of a guillotiner comes to mind as one who
executes the tried convict on a public stage to draw attention to the execution that is
taking place. With the power of mandate behind him, the brawny figure drops the
blade and publicly completes the act of execution.
The second figure in this trope, that of execution/administration is less
theatrical and less violent, perhaps, but no less dramatic. Anti-aging medicine
proponents are administering, supervising, practicing a new biomedical relationship
to aging. Through the use of human growth hormone among other things, they are
orienting their biomedical work toward intervening in the aging process. Different
anti-aging medicine conglomerations also are looking for ways to be the leaders in
this new administration and herein we see huge political battles between and among
practitioners and researchers. Anti-aging medicine argues for a new understanding
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of aging as that which can be scientifically understood and biomedically “cured” and
thus are executing/administrating the new framework following the hoped-for
collapse of the previous construction of aging. Who will be the trusted executor of
the “will” of the “old”/executed approach to aging? Who will interpret and enforce
its last testament?
Anti-aging medicine proponents offer visions of a future for anti-aging
medicine that executes a kind of scientific imaginary future performance that is
important to anti-aging medicine today. The essence of this subtle performance, is to
give shape to ideas – like a mime who draws on things we understand (like a wall or
a flower) and puts them in places we had not seen them before (like suspended in
mid air, unseen, then imaginable, and finally seeable). The execution here is
provocative and alluring, a bit out of reach but nonetheless attempts to make sense of
where the destabilization of aging might lead.
Thus, the triumvirate of “executions” that anti-aging medicine practitioners
and proponents are undertaking (with various degrees of success and with stark
divisions within this “field” [or, really, under the “anti-aging” moniker] is ultimately
challenging biomedicine not to reassess its relationship to nature (see also Haraway
1997, Rabinow 1996, Rheinsberger 2000, Franklin 1995b among many others) but
rather to evict nature from the equation. Moreover, these executions call for a
reorientation of the biomedical project from events of disease to processes of life.

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1.3 METHODOLOGY
This dissertation stems from research undertaken between 1999 and 2006. In
late 1999, while wandering around the internet one afternoon, I happened across a
website offering anti-aging therapies. As someone long interested in issues of aging
and medicine, and as someone taking a course in the gerontology department at that
time, I was intrigued enough to stop surfing for a few moments. I found it amusing
that people would offer such a thing. Anti-aging? Aging is, after all, something that
just happens. Not-aging happens in science fiction stories. To not-age is counter to
my understanding of life, to the expected course I expect my life to take. Could they
be serious or, rather, egregiously profit-mongering? I thought that certainly this
would be fodder for some mockery the next day in my gerontology seminar. And it
also seemed to underscore, I assumed, the “ridiculous” and futile desire to remain
young and beautiful and thin (and, hopefully also rich). Like the magazines aimed at
the new market of “tween” girls that highlight make-up tips and jeans to “fit and
flatter YOUR body type,” I expected to read about how wretched are the skin
wrinkles of time and how just a little of this cream twice a day will have your friends
begging to be let in on your marvelous secret. After a few searches, I realized that
anti-aging medicine was remarkably well-entrenched online (how was I so slow to
know of this, so out-of-the-loop?). I read testimonials and scientifically-worded
tracts about the “amazing” treatments, the clinics specializing in anti-aging medicine,
and the treatises written by individuals and groups proclaiming anti-aging as “new
paradigm” for the biomedicine of aging.
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The two questions I am asked most about my research are, first, “is it true
that we will have an effective anti-aging medicine (and where can I get some)?”, and
second, “why did you choose this topic?”. The answer to the first question is easy if
not a bit evasive: I don’t know. That many fine and earnest researchers are
interested and believe in anti-aging medicine may say something about its potential.
It may not. However, the efficacy issue is not what drew me to the topic.
What initially caught my attention was the seeming absurdity of anti-aging
medicine – so much money, time, effort, and concern being directed toward an
ostensibly futile cause. It is not unusual for anthropologists to seek out the “exotic,”
the odd, the foreign. While many anthropologists do study what at first glance
appears mundane and everyday, we often do so in a way that makes this ordinary
quite extraordinary. We are fascinated with the margins of cultures and cultural
practices and find margins even in the middle. And this is, I believe, one of the more
glorious aspects of anthropology. In keeping with my anthropologist tendencies, I
stumbled upon anti-aging medicine and was captivated. To live forever (which, I
later found was not really what anti-aging medicine was about for most people) is an
almost cliché story in science fiction and fantasy literature, to say nothing about the
morality tales that encompass immortality. But to see that people were actually
serious about it seemed preposterous. And it amused me.
In retrospect, this amusement is a troubling aspect of my research. Why was
my first reaction to scoff? And how do I know that in my presentations I am sure to
get a at least a chuckle when talking about the Iams® cat food commercial in which
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an older, fatter feline jumps from a fence to eat this scientifically formulated kibble
only to then leap miraculously backwards onto the fence getting more slender and
agile all the way? How do I know that the smirking laughter will ensue when I
discuss the LEX Award for anti-aging medicine offered by the American Academy
of Anti-Aging Medicine was motivated by the search for an anti-aging therapy for
the beloved dog of one of the organizations’ co-founders? Why do these folks seem,
at first glance, so… goofy? Moreover, why is this a shared sentiment that I can so
easily tap into when discussing my research with others?
Secondly, that I was compelled by this amusement and that I did not continue
searching for other more “serious” topics like end-of-life hospital practices or the
global inequalities of health perhaps says something about me. And if I am at all
representative of Americans, middle-class Americans, middle-class white American
women in their 20s and 30s with a great deal of formal education, or any such
demarcation, does this kind of interest say anything at all? This question of what I
am calling the “amusement factor” offers an entirely other set of research questions
that have much less to do with anti-aging medicine and much more to do with a kind
of popular culture. I do not expect to do this “amusement factor” any theoretical
justice here though offer it as an attempt toward being mindful of my own reactions
in this analysis. Nonetheless, I present a short story to illustrate, perhaps, the spirit
of this kind of amusement.
During my undergraduate work in biology, I was taking a biochemistry
course that helped to make the excruciating chemistry I was supposed to be learning
31

a bit more accessible to me. I saw how chemistry mattered in the real sense, in the
sense beyond sulfuric reactions that I was only able to memorize in that short-term,
avisceral way that amounts, actually, to very little real understanding. I found the
biochemistry class difficult and exciting. The professor was engaging and
enthusiastic which inspired me to care that little bit extra that I was sure would pay
off for my grade as well as my ability to converse with other budding scientists and
doctors. The exam was an essay – unheard of in my other science courses – and we
were to describe the Kreb’s Cycle in words rather than diagram. Thinking that the
professor and the teaching assistants would be reading upwards of one hundred dry
versions of the Kreb’s Cycle, I attempted to give it a different kind of worded life. I
anthropomorphized chemicals and documented the excited journey of this metabolic
process as one might describe a band trip through Europe. I thought it funny and I
walked out of the exam feeling unusually confident.
For the first time in a long while, I was not wracked with the rolling nausea
that had characterized my experience of going to find out my organic chemistry
grades. Before the exams were retuned, Professor did a kind of exam post-mortem.
He discussed the pie chart of grades and where people tended to make mistakes or
perform brilliantly. Then he began to get angry. He spoke of the person who
mocked the Kreb’s Cycle. At length he railed against the disrespect shown to this
intricate biological process by “this persons’” juvenile silliness. Livid, he announced
that if he ever, EVER were to see something like this on any other exam, a failing
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grade would be issued without further perusal of the answers. The Kreb’s Cycle was
serious. Serious. Serious.
Sweating, my eyes began to mist and I felt my life slipping into the “want-
fries-with-that?” trajectory. And then, after mourning my the loss of my first “good”
grade in anything chemistry, I found it funny. It was not the hilarious kind of funny
that offers a kind of physiological release, but the pompous, cynical funny that points
and giggles at those who “take themselves so damned seriously.” I learned two
things that day. Needless to say, the first lesson was that I should not repeat such a
performance if I valued my GPA and secondly, that perhaps I was in the wrong
place.
Since then, I have learned and come to understand more from this and other
like experiences. Firstly, attributing humor to otherwise serious circumstances has a
way of easing some burdens. This practice of not taking too much seriously or,
perhaps, making the serious just a little bit funny in order to tolerate it has certainly a
truism for my life and I suspect that I am not alone in this. Perhaps it is an issue of
laughing in the face of hopelessness – that serious things are seen as just too big and
systemic to be ameliorated. Perhaps laughing provides the only coping mechanism
perceived to be available.
Secondly I have come to realize that absurdity is proportional to the
seriousness in which it is proposed. If “it” appears absurd it might or might not be
absurd. Yet the ante is upped when “it” appears absurd and the participants take
themselves seriously. The absurdity is not the only aspect here; it is the attribution
33

of funny-ness to an otherwise “serious” issue – a kind of kitsch. Certainly the Kreb’s
Cycle is serious. Metabolism is not really a funny joke at all. But so are many
things in which humor can be found. And so, really, are many of the foundations of
humor. Moreover, is it really disrespect that my band-trip version of the Kreb’s
Cycle tendered?
Thirdly, and perhaps obviously, I have realized that those on the “periphery”
of the “norm” are far more subject to mockery. It is easy to laugh at people who
believe “odd” things or participate in “strange” cultural practices. Of course, as
anthropologists, we find that those on the periphery are no stranger than those who
are not. And, depending on the particular vantage point, the periphery is the center
and the center, periphery. Therefore, those people who are practicing the oddities
are not necessarily odd or peripheral at all.
Examining the “odd” alongside this kind of amusement – and thinking
through what allows the amusement – offers a different kind of understanding.
Being attentive to the absurdity that engages us allows for a distinctive look at its
underlying premise. By examining anti-aging medicine, an absurdity at first glance,
I became more aware of the consequences of how a different view of the world or
aging could take shape. It caught my attention because it was amusing. It kept my
attention because under that funny was a quite serious issue with long-ranging
implications.
Having ostensibly “landed on the beach” of my soon-to-be fieldsite, I was
somewhat unprepared. I had been exposed to some anthropology of aging and
34

medical anthropology literature, but I was completely ignorant of the anthropology
of science work, much less of the existence of anti-aging medicine. Unlike many
anthropologists who have some prior knowledge of the group they intend to visit and
research and who are wise to equip themselves with great academic preparation, I
had only a lingua franca. Having earned an undergraduate biology degree and taken
a few graduate seminars in gerontology as well as having worked in the health care
field as a research assistant on a epidemiological cancer study, a research assistant on
an anthropological study of occupational therapy, a medical secretary for an
orthopedist, a health educator for birth control and STD prevention program, and a
HIV testing counselor, I had become familiar with medical and scientific discourse.
Since my “tribe” was to be scientists and physicians, my introductions to these
people and ideas could come more slowly and did not require the arrangement of
housing and GPS equipment that a more traditional anthropological fieldsite might
necessitate.
Over the course of the six years of study, my “fieldsite” has generated many
types of data. I have collected more than forty hours of interview data and
conducted countless hours of ethnographic observation in anti-aging clinics. I
attended three national anti-aging conferences and a local seminar on anti-aging
medicine and traveled to a Midwestern metropolis to interview certain “key” players
in the field. I have examined thousands of pages of written materials (pamphlets,
academic articles, news articles, newsletters, and books) and analyzed over thirty
hours of media coverage of anti-aging topics (National Public Radio segments, other
35

radio segments including infomercials, news and “tv-magazine” segments, television
shows). I have also “observed” over twelve hours of internet debates and
discussions and many thousands of listserve entries. Additionally, I have analyzed
many hours worth of proceedings of the President’s Council on Bioethics
deliberations on anti-aging medicine.
One of the major hurdles I faced in this diverse, scattered, “multi-sited”
fieldwork (Marcus 1995b) has been keeping track of all the various players,
organizations, and publications, etc. In order to wrangle this data, I devised a
database that works as a kind of geneaological catalog. This database records not
only individuals, but also their “links” to other people. Moreover, the database
registers publications, institutions, companies, conferences, scientific advisory
boards, “mentions” of other individuals within publications. All of these ways in
which people, organizations, etc., are linked to one another serve as a kind of “family
tree” of the anti-aging field. This database has been particularly important in
tracking the movement of ideas about anti-aging medicine as the field has grown.
I began my introduction to this group online and quickly compiled lists of
anti-aging physicians in practice. I contacted many such folks in writing requesting
interviews and was surprised to find great willingness. My own doctor could barely
spend five minutes with me in an exam room, but these practitioners and researchers
generously gave me hours of their time to discuss anti-aging medicine. Perhaps I was
seen as a potential source of legitimization. I realized rather quickly that many of
these people were interested in how I was going to publish and publicize my data and
36

one practitioner even encouraged me to publish an exposé on his clinic in a national
health-and-fitness magazine. This kind of eagerness to be heard did not seem as
desperate as it seemed hopeful. That my work may somehow contribute to the
national discussion on anti-aging medicine and that this research had been based on
actually talking with practitioners (as opposed to some discussion on anti-aging
medicine that was not based in any kind of ethnographic enquiry) appeared to
reassure many of the practitioners that a new and more “genuine” story might be told
herein. These practitioners believed strongly in their work and were eager for others
to acknowledge and embrace it.
In these relationships, I often was assigned and accepted the role of the nice,
nascent graduate student, a kind of puppy-like devotee who would listen
meticulously and ask questions conscientiously. During many interviews I tape-
recorded the discussions in addition to taking notes. This kind of focused attention
seemed to frame the relationships as one of teacher and student rather than research
subject and researcher. Interviewing and trailing mostly medical doctors and/or well-
entrenched academic researchers, my student status contributed to an almost implicit
kind of hierarchy that was further buttressed by our respective ages (I was always
younger than the practitioners). I cannot say for certain whether my gender played a
part in this teacher/student role though I am inclined to think that I appeared less
threatening and confrontational. Some researchers have experienced difficulty in
establishing relationships with doctors due to a perception of social science
research’s tendency to “doctor bash” (Mathews 1987). While I asked pointed and
37

sometimes directly challenging questions – and sometimes even got into heated
debates -- the sometimes patronized role I inhabited facilitated a rapport that
circumvented this problem of physician reticence to speak with social scientists to a
certain degree.
Studying anti-aging medicine has presented some challenges in the defining
of the field. Anti-aging means different things to different people and some people
are perceived as being “involved” even though they do not identify themselves in
such a way. For example, a biogerontologist I spoke with who had been referenced
often by anti-aging proponents refused to discuss anti-aging medicine with me.
Instead, this researcher only wanted to direct me to texts on the biology of aging.
This researcher was willing to be a reference source but specifically unwilling to be
interviewed as a research subject. In other words, this researcher wanted to assist in
my research study but not be a subject in it.
Moreover, I have been confronted with questions around the “treatment” of
information generated from gerontology. Is the gerontological work on anti-aging
medicine part of the scholarly literature from which I theoretically draw or another
data set? I have found that the answer is both. Some gerontological scholarship
have greatly informed my analyses while simultaneously serving as a set of data that
I analyze as part of this research on anti-aging medicine. Clearly, there is much
traffic between these two “uses” of the field that I must carefully negotiate.

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1.4 CHAPTER PROFILE
Excavating the trope of execution (destabilization, administration, and
performance) alongside the shifting relationship between biomedicine and
event/process will entail a few forays into anti-aging medicine. From its history to
its the involvement of anti-aging practitioners to federal deliberations on its
bioethical significance, anti-aging medicine poses both clear and subtle challenges to
biomedicine and the science of aging. Examining anti-aging medicine along these
two axes (the “executions” and process/event) explicates these challenges in
complementary ways.
Chapter 2, “Anti-Aging Medicine in the Context of Nature, Perfectibility,
Process and Event,” contextualizes anti-aging medicine within the pertinent literature
on the relationship between biomedicine, nature, aging, perfection, and the
constructions of process and event. Detailing the literature on the cultural
construction of aging, and most specifically how it is that aging is something to be
“anti-“ about, the emergence of age-related diseases becomes particularly salient.
The construction of diseases is inherently intertwined with the medicalization of
aging such that old age becomes a special moment in which certain pathologies can
be identified and the whole of old-age becomes regularly linked with frailty and an
insult to health. The relevant literature on disease construction leads into writings
about the constructions of nature and nature’s increasingly destabilized relationship
to science and particularly aging science. In the wake of the sense of shifting
“nature,” the notion of a process has gained a foothold in that certain things happen
39

to a body as it ages and those things can be predicted as they are nearly universal –
though only some of these things become excised from the process to become
events. As predictable events become fodder for a burgeoning biotechnological
prowess, the belief in the optimization or perfectibility of the human body becomes
more salient. While such “enhancement technologies” are often considered
improvements on “nature,” the rhetoric of anti-aging medicine relocates the
discussion from natural aging to the “natural” drive to progress. These related
bodies of literature contextualize this research by revealing the ways in which
process and event have emerged at the same time in which nature has become less
culturally anchored.
In Chapter 3, “A History of Anti-Aging Medicine,” the historical research
attends to the rising materialization of anti-aging medicine and the various debates
regarding the ethics of anti-aging medicine, whether an effective therapy currently
exists, whether one will be found, hucksterism and revolutionary/cutting-edge
science. This chapter trisects the history of the recent materialization of anti-aging
medicine into (a) the earlier years [1990 - 1995] during which the anti-aging
medicine field emerged; (b) the middle years of tremendous growth of anti-aging
medicine [1996-1999]; and (c) the years leading up to the publication of the
President’s Council on Bioethics report [2000-2003] when anti-aging medicine was
firmly planted on the public agenda. By outlining the field of anti-aging medicine
via its history, this chapter will address the ways in which proponents, opponents,
and observers have approached and discussed anti-aging medicine as well as aging
40

itself. In parsing out the metaphor of “execution,” this history chapter will discuss
the struggle to execute/purge previously held notions of aging within the context of
how anti-aging medicine came about. This historical account reveals the strong
purchase anti-aging medicine has had despite and perhaps because of its surrounding
controversy. As debates flare up, the crux of these arguments center around
biomedicine’s relationship to process and event.
Chapter 4, “Practitioner Involvement,” analyzes the work of some anti-aging
practitioners and how they came to practice this “medical specialty.” I discuss the
struggle to execute/administer anti-aging in the context of its redefinition. This
chapter outlines the various motivations for practitioner migrations to the field of
anti-aging medicine which include: a sense that aging is a horrifying decline, a belief
that biomedicine has the ability to “fix” aging, practitioners identifications with
revolutionaries, and their dissatisfaction with the current practice of medicine. With
the perspective that the process of aging is ameliorable and that biomedicoscience
has the ability (if not the current wherewithal) to intervene, contemporary biomedical
practice appears archaic and reactionary while anti-aging practitioners emerge as
pioneers.
Chapter 5, “Bioethical Considerations,” investigates the President’s Council
on Bioethics deliberations on anti-aging medicine. This analysis examines how the
ethical stakes of anti-aging medicine are addressed and contextualized in this very
public, federal body in comparison to its construction by its practitioners. Much of
the work of the Council deals with anti-aging medicine’s potentialities and
41

possibilities via scientific testimonies regarding the history and research-to-date in
biogerontology. These deliberations and the Council’s subsequent report illustrate
that the obligations of biomedicine (especially in relation to aging) are contentious
and dependent upon not only a relationship to “the natural” but also to suffering.
This chapter will discuss the struggle to execute/purge aging as we come to
understand it and that the discussion of how to think about aging has, to a certain
extent, been forced by anti-aging medicine. In particular, I will analyze how and
upon what grounds anti-aging medicine is coming into the mainstream discussion
and aging is being reframed and/or resisting reframing.
This ethnography chronicles the history of anti-aging medicine alongside its
current practice and the debates and discussions it engenders. Using the trope of
executions to excavate the work of anti-aging medicine, I argue that anti-aging
medicine explicitly shifts the orientation of relevant biomedicine not only away from
nature and but also away from event toward process. This shift happens in the wake
of a nebulous but important notion of nature and its relationship to biomedicoscience
with a particular construction of aging as something fraught with pain and suffering.
The targeting of aging for intervention brings a provocative set of ideas and
orientations to the biomedicoscientific table.

1
From Mexico to Germany, from Monaco to Indonesia, from Japan to Australia, anti-
aging medicine is in many ways a global emergence. This work focuses
primarily on the emergence of anti-aging medicine in the United States of
America.

2
Those involved in the project include Eric Juengst, Robert Binstock, Stephen Post,
and Jennifer Fishman.
42

3
The American Academy of Anti-Aging Medicine lists 721 physicians practicing
anti-aging medicine (as of April 2006). However, this number does not take
into account the many practitioners who are not registered in this listing.

4
see also www.gen.cam.ac.uk/sens/index.html 2005.

5
www.worldhealth.net.

6
Interview: Dr. de Grey 03/30/2001.

43

2. ANTI-AGING MEDICINE IN THE CONTEXT OF
NATURE, PERFECTIBILITY, PROCESS, AND EVENT

The anthropological literature on the constructions of disease and nature, as
well as the developing research on enhancement technologies, have largely skirted
the concepts of process and event in biomedicoscience. The scholarly literatures
detail and analyze the creation of events such as disease, but have undertheorized the
categories of events and processes themselves. Analyzing anti-aging medicine has
revealed the critical importance of process and event as categorical foundations in
this emerging medical trend. While anti-aging medicine proponents focus on aging
as a target for biomedical intervention, their efforts effectively reconceptualize
biomedicine as a force to deal with processes of life as opposed to events of disease.
This analysis operates at the intersections of the scholarly literature on nature,
the construction of disease, enhancement technologies, and aging drawing from
anthropology (primarily), science and technology studies, and social gerontology.
My argument incorporates these literatures as follows:
1. The social construction of aging – This literature reveals how constructions
of aging in the U.S. reflect a decline both in biological and cultural terms. This
decline has been supported by biomedical attempts at understanding aging and
identifying/treating diseases associated with aging.
2. The construction of disease and medicalization – The relevant literature
illustrates ways in which diseases are not simply discovered scientifically but rather
are culturally “made.” This construction applies to aging and its medicalization as
44

well in that diseases of aging are understood within a framework of aging as a
natural decline with pathological effects.
3. Nature in Science and Aging – Diseases are generally thought against
ideas of “the norm” or the “natural” bodily state; thus, discussing disease is, in effect,
invoking nature. That nature itself is a kind of cultural construction is a provocative
topic in recent scholarship. This literature focuses on what it means to be “natural.”
A component of “nature” especially salient for discussions of anti-aging medicine is
that of predictability because of the critical link between aging’s predictability and
nature.
4. Enhancement Therapies – The “natural” also plays a role in enhancement
therapies since it provides the norm that such therapies aim to improve.
Enhancement therapies represent a kind of antithesis to disease-oriented biomedical
work; while targeting disease restores health, enhancement therapies aim to improve
health. Thus, the standard of “health” itself, like aging, is very much at stake.
This chapter then moves to discuss the notions of process and event and their
intersections with these literatures. Unraveling the meanings and stakes of anti-
aging medicine requires explication of these literatures not only in and of themselves
but in their relation to one another. This review will center ideas of process and
event as they crystallize the work of anti-aging medicine.

45

2.1 AGING – WHAT IS THERE TO BE “ANTI” ABOUT?
In many regards, aging is a cultural endeavor. Accumulating chronology,
measuring one’s life through time and birthday-cake candles bestows different rights,
responsibilities, expectations on individuals, their families, and their "tribes" cross-
culturally. The cultural label of “old” generally requires a chronological point and
that powerful moment varies (McPherson, 1995:): at 40-50 years of age among the
Igbo (Shelton 1972) and at 60 in Thailand (Cowgill 1972). While such a term can be
tricky and shifting, some form of “old” occurs across space and time. But “aged” and
“aging” are not interchangeable terms (Bengtson, Rice and Johnson, 1999). “Old” is
a state of being. Arriving at that state and moving temporally within it – “aging” – is
a process. An act. A doing of something. While the two are inextricably linked, this
act of aging bears a set of complexities and contexts.
In the U.S. and Western/Northern societies, and certainly within biomedical
science, chronology organizes the process of aging (Cole 1991, Fry 1999). Greater
chronology implies ideas about what this process means; and here, the rhetoric of
aging-as-decline has been pervasive (Adolph 1993, Cohen 1998, Cohler and
Altergott 1994, de Beauvior 1972, Friedan 1993, Scheper-Hughes 1983, Sontag 1972
among many others). Old age is rife with negative images: doddering, infirm,
drooling, pathetically dependent, forgetful, unattractive. Researchers have suggested
that youth-worship or youth culture have played significantly in the production of
such images (Blaikie 1999, Cole and Thompson 2002, Friedan 1993, Gullette 1997,
Lock 1993, Minois 1987, Spencer 1990). Modernization and industrialization,
46

which displace the social importance of older people, have also been cited as a factor
(Blaikie 1999, Cowgill 1986, Fischer 1977, Fry 1980, Holy 1990, Simic 1978, 1982).
A lingering Victorian inability to “infuse decay, dependency and death with moral
and spiritual significance” may also contribute to the cultural distaste for old age
(Cole 1991: 33). Foucault argues also that the relationship between life and death
greatly impact the understanding of aging. He states:
“The aged body became reduced to a state of degeneration where the
meanings of old age and the body’s deterioration seemed condemned to
signify each other in perpetuity. By recreating death as a phenomenon in life,
rather than of life, medical research on aging became separate from the
earlier treatises that focus on the promise of longevity” (Foucault, 1973:41).

With this, he argues that the appreciation of death as something that happens
in one’s life as opposed to a function of life itself affects how aging is conceived –
here as a functional, physiological decline. Thus, the decline construct of aging then
impacted the ways in which science has approached aging.
I argue, along with Foucault and others, that a major force in culturally
constructing aging in the West has been science (Vincent 2006). The scientific
production of knowledge, with biomedicine implied herein, has absorbed and
perpetuated the construction of aging as biological decline. As I will elaborate upon
shortly, the attempts to reduce aging to its component molecular parts in order to
understand aging has fostered a sense of aging’s uniqueness within the life course as
well as its ultimate characterization of deterioration.
A function of the scientific endeavor to understand aging has been the
biomedical attempts at dealing with aging. The medicalization of old age and the
47

separation of the old as a particular (and problematic) patient group is forwarded as
another reason for the negative images of aging (Arluke and Peterson 1991, Blaikie
1999, Cohen 1998, Haber 2000, Lock 1993, Manheimer 2000). I shall discuss in
greater detail shortly the notion of medicalization, ways in which aging is
medicalized, and its larger contextual impact.
Significantly, aging is perceived and often experienced as a negative, a time
of social and physical suffering. Though the desire to souse the reputation of old age
with concepts of wisdom, creativity, and freedom from the constraints of career, etc,
abound, (Fisher and Specht 1999, Friedan 1993) these negative images persist.

2.1.1 Age-Related Disease
Gerontology has historically had a difficult time defining aging. Looking
back to the seminal textbook Geriatrics by Dr. Nascher in 1914, we see that the
originating assumption of the biomedical approach to aging was that aging was
natural and special. Old age in this text was marked as a patently distinct yet normal
part of the lifespan; that peculiarity has established the problematic and lingering
contradiction between aging as natural or aging as pathology (Cohen 1998). While
the current gerontological consensus is that aging is not itself a disease, aging is
treated as a natural biological decline often partnered with age-associated diseases
(see Achenbaum 1995 for excellent review of the history of gerontology, see also
Birren 1999). Thus, old age has become a marked time in the life course; it carries
with it greater risk for disease and is subsumed within a sense that aging is a natural
48

expected potentiality. Due to the trend toward biological reductionism and the
medicalization of old age (Abel and Browner 1998, Blaikie 1999, Cohen 1998, Cole
1991, Fabrega 1982, Friedan 1993, Latimer 1999, Lock 1993, Lock and Kaufert
1998, Loustanau and Sobo 1997, Kaufman and Becker 1996, Scheper-Hughes 1992,
among many others), this distinction between decline and disease is becoming
increasingly awkward.
In dealing with the difficulty in talking about aging and the decline associated
with aging, a rhetoric of “age-associated” or “age-related” disease has emerged.
Problems such as cancer and cardiovascular disease that occur more frequently in old
age bear this moniker. Aging itself is not the cause, per se, but rather a precursor or,
at least, a mitigating factor for these diseases. The distinction between aging and
age-related disease is of utmost importance for gerontology as it carves out space for
biomedical intervention as well as for embracing old age for its naturalness (thus,
attempting to undermine ageism). The rationale for this distinction balances upon
the idea that since not every individual will experience the same age-related disease,
aging itself may be a factor but is not the cause. Thus, the idea of a universal
experience locates nature. All humans age but not all humans suffer from diabetes or
Alzheimer’s and therefore aging is located as natural while the diseases that are
associated with aging are marked as pathological. Whether a disease is or is not “of
nature” is inconsequential since the disease category instead invoke sanctioned
biomedicoscientific intervention.
49

Age-related diseases are prime targets for intervention. The moral imperative
of biomedicoscience is to seek a cure or treatment for these ailments. A particular
problem earns its age-relatedness through statistical frequencies and epidemiological
risks. As chronological age rises, one is more at risk for certain health problems. It
is at this juncture that anti-aging medicine seeks to shift thinking. Precisely because
of these statistical risks in increasing chronological age, anti-aging advocates assert
that the biological component is not cancer but aging itself. Alzheimer’s, arthritis,
congestive heart failure become symptoms of aging. The president of the A4M,
Ronald Klatz, M.D. noted that it is likely that everyone will get all of these so-called
age-associated diseases; we just die before we do
1
. In other words, they are
universal symptoms that have been obscured by death.
Klatz defines aging biologically in an effort to locate aging as a universal.
Take the following quote:
There is a biologically controlled aging process, and it is designed to
get Madame Calmet
2
and all of us in the end. If there were not such a
thing as biologically controlled aging, then people who live on pure
organic food, or reside on serene mountaintops, or chant mantras with
the sunrise would be immortal. With their low-stress, high level of
physical movement, and good diet, they shouldn’t die of anything.
But, of course, that is not the case. They all age, because aging is
biologically based. (Klatz 1998: 50)

Not only is age biologically based but it is also separated from purity in food,
from serenity and natural beauty, and from spirituality. Clearly, one might counter
many assertions in this quote: how do we know that chanting mantras is not a high
stress activity, for instance. Nonetheless, the important point here is that for anti-
50

aging medicine, aging does not happen solely because of social forces or so-called
lifestyle choices. Aging is a universal, biological experience that leads to death.
A great deal is at stake in this classification. Just as disease naming has
marshaled resources in particular ways (Rosenberg 1992), so, too, will shifting
medical intervention toward what had been previously thought of as a natural
process that cannot be biomedically affected. Health care policymakers and
practitioners may be forced to more coherently address issues of optimizing health,
the body and life. “Norms” set for particular age sects may require renovation. The
careers of many scientists in the field of aging may be threatened by any dramatic
shift and funding agencies will likely need to reconsider their missions (funding
symptom-studies, like cardiovascular disease research, etc., may be abandoned for
cure-work focusing specifically on aging, for example). The concept of a decline in
aging may be associated with a biological process that can be treated (provided one
can financially access such services). Insurance companies may have to decide
about reimbursement for the treatment of universal diseases and for guaranteed
patient status for everyone. The U.S. Food and Drug Administration (FDA) may
likely confront issues of monitoring and governing products that are now over-the-
counter but must undergo regulatory procedures if the products are linked with the
treatment of disease.
If a successful anti-aging intervention is developed, lives may be drastically
changed. Not only in expectations of the life course (will I marry at 25 if I can
expect to live another 150 years?) but in the experience of life itself. To an even
51

larger degree, old age may become something done well or done poorly. Nature may
become an even more irrelevant category in biomedicine and may lose the ability to
protect a particular process (like aging) from intervention. From the funneling of
scientific dollars to individual biomedical careers, from lived experience to
expectations of life, aging is a powerful cultural category.

2.2 THE MEDICALIZATION OF AGING AND THE
CONSTRUCTION OF DISEASE

As aging is constructed as a natural, processual, biological decline, its
associated diseases are the subject of intense concern. The construction of disease is
of particular import for medical anthropology and science and technology studies.
How and when and why and where and by whom a culturally-defined set of
symptoms and etiology becomes labeled a specific disease – is medicalized – carries
great consequence. Medicalization is the "process by which problems and behaviors
become reinterpreted as illnesses, such that a mandate is given the medical
profession to provide some type of treatment for them" (Arluke & Peterson, 1981:
271). It is a process through which some thing that has been articulated as natural is
transformed into some biomedical thing. A medical name is given to that thing and
the thing gets to be disordered or syndromed or diseased or even branded (de Vries,
Berg & Lipkin 1982; Browner 1999; de Vries, Fabrega 1982; Frankenburg 1993;
Franklin 1995, 2003a; Gaines & Hahn 1985; Good & Good 1993; Gordon 1988;
Haraway 1997a; Kleinman 1982; Maretzki 1985, Ohnuki-Tierney 1997).
Menopause (Lock 1993a, 1993b), maternity and childbearing (Davis-Floyd 1992; di
52

Leonardo & Lancaster 1997; de Vries et al. 2000; Franklin 1995a; Ginsburg & Rapp
1995; Martin 1997; Nelson 2000; Squier 1999; Strathern 1992a, 1992b, 1995; Teman
2003), death (Kaufman 2000; Lock 1997, 2000; Ohnuki-Tierney 1997), genetics
(Franklin 2003a; Goodman, Heath & Lindee 2003; Rabinow 1992; Taussig, Rapp &
Heath 2003), Post Traumatic Stress Disorder (Dumit 2000), Alzheimer’s disease and
dementias (Cohen 1998), “small” breasts (Nader 1997), and atherosclerosis (Mol
2000) are among some of the poignant examples of the medicalizations of otherwise
“natural” or “normal” conditions.
Disease constructions are based upon an event construction. Something in
the body goes awry. This takes place in definable moments with concomitant
laboratory signs and/or patient-experienced symptoms. These moments may be as
dramatic as a myocardial infarction (heart attack) or as subtle and stealthy as chronic
fatigue syndrome that may have a yet-unknown etiology and slow symptom
progression. Nonetheless, the physiological trouble must be measured against the
standard generally regarded as “normal” or “natural” and as a result can be isolated
as an event that sanctions biomedical intervention.
Menopause presents an excellent case study in this regard. In North
America, menopause is constructed as a particular event that invokes certain bone
density and other tests and may warrant the prescription of hormone replacement
therapies. Menopause happens over time but is “clearly” marked by the cessation of
menstruation and is treated as an event in women’s lives. Alternatively, the
“cessation of menstruation” was conceived of as a process in Japan (at least prior to
53

the 1990s) (Lock 1993). Lock’s ethnographic interviewing reveals that there was, at
the time of her field research, no Japanese concept that translates to the North
American construction of menopause. Instead, Japanese cultural beliefs had not
marked this cessation with a culturally significant label. By cultural standards,
menopause did not exist. Lock found that menopause is quite different for North
American women and their physicians in part due to the belief in the “inherent
unnaturalness and inevitable decline in the female body once past reproductive age”
(Lock 1993b: 147). The understanding of menopause as an event mandated a certain
relationship for North American women and their physicians than its construction as
a process for Japanese women and their physicians. In North America menopause is
not explicitly called a disease. However, it does come packed with treatable medical
conditions such as low estrogen production, and it is located temporally as an event
of dwindlingly irregular or completely absent monthly menstrual cycles.
While the mainstream biomedical consensus is that aging is not explicitly a
disease (Austad 1997, Butler 2000a, 2000b, 2002; Butler et al 2000, Crews 1993;
Jasmin 2000; Jean-Nesmy 1991; Kouchner 2000 among many others) old age is
increasingly being medicalized (Abel & Browner 1998; Arluke & Peterson 1981;
Blaikie 1999; Cohen 1994, 1998; Cole 1991; Fabrega 1982; Friedan 1993; Gullette
1997; Kaufman & Becker 1996; Latimer 1999; Lock 1993a; Lock & Kaufert 1998;
Loustanau & Sobo 1997; Scheper-Hughes 1992 among many others). The
generalized aches and pains of old age are falling more into the realm of medicine in
that the events of their etiology are becoming scientifically “known,” and their
54

treatment protocols outlined (and prescriptions patented). Our grandmother’s aches
and pains have become our diabetes and osteoporosis, glaucoma and Alzheimer’s.
The medicalization of aging has garnered attention from the social sciences,
medical anthropology and the anthropology of aging in particular, because of the
threats medicalization may pose to ageism. Ageism, or the discrimination of
individuals and groups based on age, can manifest such that old age is regrettably
linked with the sick role encumbered with all the loss of status therein (Arluke and
Peterson 1981). That older folks are increasingly seen as “at risk” which can result
in greater institutionalization, loss of autonomy, and other outcomes stems from this
notion that older adults have special, discrete biomedical needs (Kaufman and
Becker 1996). Then, issues of personal health responsibility and so-called “lifestyle
choices” are presented such that moral judgments can be made of individuals whose
health is perceived as compromised as a direct result of their own behaviors (Conrad
1994, Rowe and Khan 1998, Singer 1990).
The medicalization of old age has been associated with a lingering Victorian
refusal of death (Cole, 1991: 33), with the changing family structure such that there
are fewer children to care for aging parents (Arluke & Peterson 1981), with a quest
for eternal youthfulness and “the puritanical heritage of North America with its
insistence on individual responsibility for a disciplined body” (Lock 1993a: 367).
Medicalization has been regarded as a form of social control (Abel and Browner
1998, Conrad 1992, Singer 1990) that has incredible power that implicates individual
bodies, experiences, health practitioners, pharmaceutical enterprises, and so forth.
55

As a result of this medicalization and the difficulties in defining aging, the
distinction between decline and disease is, as argued earlier, becoming increasingly
awkward. Aging-as-decline becomes aging-with-disease-X. But the “aging-as”
element is still important and problematic. Anti-aging medicine fills this
problematic and contradictory space by asserting that it is no longer useful to think
of aging in terms of a natural decline; whether aging is or is not natural is bemoaned
as an unproductive exercise. Moreover, the disease-focused work of biomedicine
and science becomes linked with a kind of (often) well-intentioned but pathetic
ineptitude in dealing with the “real” problem of the process of aging itself.
Social science scholarship presents the trend toward the medicalization of
aging as worrisome. It invokes issues of social control and the diminished social
roles of older individuals, whether set in motion by the cultural refusal of death or
the consequence of individual health responsibility. The social aspects of aging –
not all of them unfortunate or uncomfortable – become eclipsed by the
medicalization of aging often with dire consequences (Friedan 1993, Vincent 2006).
However, if we examine and critique the medicalization of aging as the ways in
which biomedicoscience carves aches and pains out of aging and labels them as
pathologies thereby dominating discourse on aging, the essence of biological aging
becomes reduced to a function of time. In other words, once biological aging is
excised from the whole experience of aging and the various problems become
extracted from aging, aging itself is left to become a mere chronological back-drop.
The critique of the medicalization of aging argues that aging is more than these
56

associated diseases: the experiential aspect of aging socially as well as material
aspects of aging such as retirement and social security. While I take no issue with
the critique that the dominant discourse of aging is biological, I argue that perhaps
there is more to the construction of biological aging as well.
Analyzing anti-aging ideologies reveals the belief that aging causes these
associated diseases more than being merely the predisposition of time. The more an
individual ages, the more they are likely to have accumulated more time and more
aging-process. Aging happens not just at the moment of old-ness but long before.
Aging, then, is a matter of degree. The elderly person who is not sick is more of a
biomedical commodity than someone twenty years junior because of the his or her
relative risk of becoming sick. However, the junior individual still embodies risk of
eventual illness as well. When examining the process of aging – with all of its
lamentable aspects – then the individual is always a patient with varying degrees of
problems.
If medicalization is a mechanism defining the individual as his or her disease,
then much of the aging process that happens before the diagnosis of disease is
eclipsed from this evaluation. Thus, anti-aging medicine is the ultimate form of
medicalization in that everyone is effectively a patient. This is a more inclusive
medicalization, one that is focused as much on health preservation as it is on health
restoration. Everyone becomes a patient in this model because a diagnosis need not
precede intervention.
57

The images of aging as largely negative, wrought with pain and characterized
by concomitant illness is supported by a biomedicine that aims to treat such
associated diseases while maintaining that aging is a natural – expected, predictable
– process (Lock, 1993c: 356, Loustaunau and Sobo, 1997: 67). The biological
decline image of aging presupposes that aging is something we don’t want –
something we can be explicitly “anti” about.

2.3 NATURE IN SCIENCE AND AGING

The category of nature has been integral to the evolution of science and
modernity. It has served as the field of that-which-is-to-be-understood as well as
that-which-can-be-explained. Nature is both the unknown and yet the knowable,
provided we have the technology sophisticated enough to “discover its secrets”.
Though social scientists have revealed the many ways in which the concept of nature
is not universal historically or culturally (Escobar 1999: 4, Strathern 1980; Williams
1980), the power of the category is based precisely in its construction as universal.
As much of the science studies literature critiques, nature is culturally constructed as
independent from the parameters of space and time; it exists and has existed forever
and everywhere. It is subject to experiment and reducible to laboratorily configured
and scientifically digestible components (Knorr-Cetina 1992; Latour & Woolgar
1986 [1979]). Nature is considered material in that it exists in the world, for certain
and materially. We have made nature autonomous, separate from culture, from
society (Gordon 1988a; Latour 1993[1991]). In nature’s separateness, it remains
58

external to morality; nature initially appears neither ethical nor fraudulent, neither
well-intentioned nor deceitful but rather as an objective fact of life..
However, and as much writing on the subject reveals, nature is neither
autonomous, amoral, pure, or unsullied. Indeed, nature is precisely where values are
hidden (Escobar 1999, Gordon 1988a; Haraway 1992, 2003; Koenig 1988; Lock
2000; Lock & Kaufert 1998; Martin 1992, Merchant 1990; Nelkin 1992; Toumey
1996). Nature has become “the basis for truth itself" (Kleinman 1982: 8) such that
that-which-is-natural equates to that-which-is-real. With this power of reality, nature
has been addressed by STS scholars as neither distinct nor distant from culture and,
in fact, this nature/culture dichotomy is so faulty that neither can be used as context
for the other (Barad 2000; Callon & Latour 1981; Cambrosio, Young & Lock 2000;
Franklin 2003a; Haraway 1997b; Jensen 2003; Rabinow 1996; 2000; Rheinberger
2000; Ridley 2003; Strathern 1992a). We cannot speak of nature without implying
culture nor can we speak of culture without invoking nature. In what is taken for
granted as nature, or natural, lay ideas about our place in the world, our rights to the
world, our expectations and obligations, our frames of life and of living. Thus,
nature has been critical for the production of meaning (Robertson, et al. 1996: 2).
However, nature’s categorical structure and relevance is increasingly
threatened by new biotechnologies that allow us to “see” nature in new ways – from
reading genomes to imaging the brain. This ability to see begets attempts to change
what it is we see. What we “see” “will be “known in such a way that it can be
changed” (Rabinow 1996:93) and those changes will become recursively natural.
59

Seeing the brain allows a different relationship to it – perhaps less mysterious,
perhaps more reverent – but this relationship is based on a particular kind of
understanding. This nature seen on a PET scan is a technological product (Dumit
2000) made of laboratories and mechanics and interpreted by individuals and
standardized by consensus (often, indeed, a shaky or hard-won consensus, or even a
consensus that barely masks heated disagreements). Scientists, here neurosurgeons,
can project interventions into what they see. Thus, the interventions “fix” produce a
new nature “remodeled on culture” (Rabinow 1996); the interventions may restore or
yield a normal that is a culturally constructed normal. Thus nature will become
“overtly artificial just as culture becomes natural” (Lindee, Goodman and Heath:
2003: 5).
Strathern writes that we are “after nature” because nature’s “grounding
function” is gone (Strathern 1992:195). Nature, in this light, is naked, unstable and
vulnerable. Revealed as a construct, it no longer retains its right to reality and
thereby relinquishes its power to categorize the world. Not surprisingly, this invokes
a new relationship with ourselves and our thinking about the world. Thus, nature has
lost its ability to speak for life creation and kinship. Drawing from her research on
reproductive technologies, Strathern stresses that once biology is “under control” it is
no longer nature. Once we have disciplined and
domesticated/processed/tamed/commanded biology in our very peculiar scientific
ways, then it no longer resembles that nature which we had endeavored to affect. It
is synthetic, made by cultural and cultured beings.
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The fate of nature has also been described within the framework of collapse
(Rheinberger 2000). Ontologically, Rheinberger notes, there is no further use for the
category under the weight of emerging genetic technologies and life discourses;
nature is an increasingly antiquated concept that clots our thinking of what it means
to exist in these times. Nature, for Rheinberger, no longer posseses adequate
descriptive power for our bodies, our diseases, our world.
Haraway posits that nature has not collapsed but rather has “reanimated” such
that nature is activated through technoscientific corporate “brands” (Haraway 1997).
Here nature is constructed and then affected but its affectation is not a
destabilization. Instead, we intervene into what we see as natural, to produce another
natural (harkening back to Rabinow) that serves as important tools for the biotech
power players. For example, corporate science giant Dupont bred a mouse with a
particular cancer gene. The “oncomouse” was patented and branded (Oncomouse™)
and sold for laboratory experiments. But still, this is a breathing being, a “natural”
kind of breathing being with questionable parentage (Dupont? Mommy/Daddy
mouse?) and a good bit of profitability. Thus, nature still matters and matters a great
deal. This notion of “branding” signifies a biotechnological trope, an important
storyline that buttresses many scientific projects (Franklin 2003).
For biomedicine, nature is the backdrop against which pathologies are
identified and treated. Pathologies and diseases mark the abnormal as that which
demands intervention. On the other hand, the natural has the power of sanctuary
from intervention. To be natural is to be protected from biomedical intercession.
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According to Nelson, physicians have “lost any sense of the natural or the contingent
as a moral category. Rather, the natural serves to mark the domain that resists the
physician’s intervention… The natural become that which cannot be technically
overcome rather than that which should not be overcome” (Nelson 2000: 214).
While the decision of intervention may indeed entail a “moral” evaluation that
implies nature, the relationship between the category of nature and biomedical
obligation seems clear: biomedicine intervenes where nature goes awry and, thus, is
no longer nature. A problem must be excised from nature and labeled disease before
the commencement of biomedical intervention.
In the context of anti-aging medicine, it does not appear that nature is
imploding or collapsing per se, but rather that its relationship to biomedicine is
dramatically shifting. Nature’s categorical influence over biomedical practice in this
anti-aging realm is diminishing. Anti-aging practitioners generally agree that aging
is natural and that aging is not a disease. Nonetheless, practitioners argue that
because aging is objectionable and because we have the magnificent machinery of
science to understand and manipulate it, that we also are mandated to do “good” by
ameliorating its pain. As bioethicist Stephen Post notes, “anti-aging research is much
less driven by the desire to carelessly modify human nature than by the salutary wish
to eradicate the age-related diseases that plague our already established demographic
transition to an aged society. The essence of human nature has always been freedom
over human nature” (Post 2004: 88). For Post, then, anti-aging medicine is not
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simply a flippant or hubristic exercise but rather another manifestation of the
“natural” human drive.
Science writer and advocate for “liberation biology,” Ronald Bailey, notes
that
human history has always been all about liberating more and more people
from their biological constraints. It’s not as though most of us still live in our
species’ ‘natural state’ as Pleistocene hunter-gatherers. Human liberation
from our biological constraints began when the first human sharpened a stick
and used it to kill an animal for food. Further liberation from biological
constraints followed with fire, the wheel, domesticating animals, agriculture,
metallurgy, city building, textiles, information storage by means of writing,
the internal combustion engine, electric power generation, antibiotics,
vaccines, transplants, and contraception. In a sense, the goal toward which
humanity has been striving for millennia has been to liberate ourselves, by
extending our capacities, form more and more of our ancestors’ biological
constraints. (Bailey 2005: 19, emphasis original)

Bailey locates the human drive for progress – or liberation – as being
ultimately more human that the biological apparatus around which humans try to
operate. The history Bailey sees as, at least in part, defining humanity is precisely
the drive to “overcome.” The perception of a problem that generates advancement,
like the wheel, air travel, and the printing press, is an integral component in such
progress; as discussed earlier, aging is constructed as a problem both for the
individual and society. Thus, aging is only another hurdle for this humanity rather
than a natural state to revere. Anti-aging medicine and research, in this view, is
more human than is aging.
Many anti-aging proponents argue, it is more “natural” for humans to
“progress” in this anti-aging way (a kind of scientific manifest destiny) than it is
natural to age in that traditional geriatrics painful way. Thus, this endeavor is not
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about shepherding nature to oblivion, but rather it is about a deeper nature to
eliminate perceived and experienced pain and suffering. Anti-aging medicine
proponents make this point about progress and aging not by linking aging to the
more familiar notion of the disease, but rather through a more direct route involving
intervention into the process of aging. This approach us beguilingly simple in a
conceptual sense and yet it is one for which we have no vocabulary: how do we
speak of aging and intervention without invoking nature or disease?
This lack of vocabulary is predicated on event and process. Nature and
process are synonymous with aging. Nature “gone wrong” – an event of pathology
and disease – requires treatment. The anti-aging work of intervening in nature
(process) is not framed as an “improve[ment] on nature’s poor design” (Lock 1993a:
367) per se but rather a service to a “higher” nature: the drive toward perfection or
optimization.

2.3.1 Predictability of Nature
Predictability plays a critical role in the construction and understanding of
nature. The ability to foretell, with enough “knowledge,” what nature will do rests
upon the association of nature with universality. Natural occurrences and existences
are natural because they happen universally and designate any breach as unnatural or
pathological. Predictability is fundamentally intertwined with a particular and
historicized imagination for the future (Fujimura 2003) that draws from scientific
perceptions of the universal.
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In many societies, aging carries with it an expectation that we will live a
predictable number of years and as such there is a sort of “chronological
standardization” (Cole 1991: 29). This implies a sense of knowing the future, of age
meaning similar things to everyone. The predictability of the life course presents a
cultural construction, one that dates back to the nineteenth century and is rooted in
life being continuous and knowable (Becker 1997). This predictability lends itself to
reflecting on preventability; having an expectation of what is to come alongside
deeply held beliefs in the imminent progress of science tenders a sense of being able
to alter that which we do not fancy. In the rhetoric of age-associated diseases such
maladies become anticipated; they are conditions that biomedicine has indicated that
we are likely to experience at least partially. Therefore, predictability is linked to
universality (or near-universality) and, by extension, to the natural. While all
“natural” things are not predictable because not all things are yet “known,” perhaps
all predictable things are seen as natural.
A4M founder Ronald Klatz’s assertions that we all would experience the
same symptoms of aging but we “die before we do” foregrounds issues of
predictability. The construction of aging as a process is linked to its universality even
including the variability of the experienced age-associated diseases. Everyone does
age in similar ways though we succumb to its torments in different moments;
sometimes the event of cancer kills us before the inevitable heart disease, for
example.
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Predictability is intertwined with universality and it is universality that is a
hallmark of nature. However, anti-aging medicine advocates call upon the
predictability of aging not with an acceptance of it as natural but rather with a sense
of a scientific knowability that can be subject to intervention.

2.4 ENHANCEMENT TECHNOLOGIES: THE QUEST FOR
OPTIMAL

Anti-aging medicine has been characterized as being a kind of enhancement
therapy (Post 2005, President’s Council on Bioethics 2003, Rothman and Rothman
2003). The growing trend for biomedicoscience to try and improve upon the
“natural” state of the human body has been of great interest in the past decade
(Caplan 1992, 2004; Elliot and Chambers 2004, Juengst 2004, Kramer 1993, Parens
1998, Post 2004, Rothman and Rothman 2003); the notion of being “better than
well” (Elliot 2003) has been framed under the auspices of “enhancement
technologies.” These enhancements have been of particular concern for bioethicists
who query the ethics of biological self-improvement (Parens 1998) by questioning
the rights and responsibilities that are implied, and the social equalities threatened (or
social inequalities exacerbated) when we gear our health services along the lines of
enhancement, for example. The difficulty with thinking through enhancement,
however, is that it demands a definition of nature and “good health” against which
any enhancement can be determined.
To enhance is to make better and the idea that the human body can be
improved is a particularly cultural belief: that it is a human right or ability or even
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obligation (and not a Godly/godly one) to conceptually surpass the “mere” treatment
of an insult to “health.” Indeed, the belief in the perfectibility of humanity and the
goal of improving the human body is not recent. This conviction of improvement is a
cultural assertion that has long been attributed to an American middle class, among
other cultural groups (du Bois 1955; Taussig, Rapp & Heath 2003). “Notions of
mastery and perfectibililty …have been … brought into the realm of science and
technology within the rubric loosely identified as modernity, in which individual
embodied choices reveal an attachment to the pursuit of progress and perfectibility
(Berman 1982).” (Taussig, Rapp and Heath, 2003: 65). Thus, the desire on the part
of individuals to seek perfection, either in their own bodies or in the scientific work
they do, links the ever-important notion of progress-as-good with the belief in human
perfection.
The American right to the pursuit of happiness (di Leonaro & Lancaster
1997; Elliot 2003) has grounded not only the belief in improvement but also imbued
this pursuit with moral overtones. This pursuit is not only considered possible but
also good; it is embedded in an ethical aesthetic that deems it a natural, human
pursuit. Happiness and health represent the pinnacles of human perfection – a happy
mind and healthy body are not only wonderful but they are also the responsibilities
of individuals and biomedicoscience. This notion of individual health responsibility
has been deeply ingrained in U.S. biomedicine (Baer 2003, Becker 1997, Goldstein
2000) as it reflects a culture of intense individualism (Gordon 1988) and the
“puritanical heritage of North America[‘s] insistence on individual responsibility for
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a disciplined body and continued good health” (Lock 1993a). Individual health
responsibility has seen an even more dramatic ideological entrenchment within the
holistic health movement (Baer 2003) that emerged in the 1970’s when the baby-
boomers. who are now approaching older age, were in their twenties and thirties.
Whether an improvement is achieved and whether that achievement can be thought
of as perfect is not as significant here as the endeavor.
Foucault’s “Technologies of the Self” addresses a similar idea. Speaking
about what might now be considered “enhancement technologies,” Foucault argues
that they “permit individuals to effect by their own means, or with the help of others,
a certain number of operations on their own bodies and souls, thoughts, conduct, and
way of being, so as to transform themselves in order to attain a state of happiness,
purity, wisdom, perfection, or immortality” (Foucault, 1994[1982]: 225). Invoking
the long history of the desire to combat death (not necessarily aging) through
immortality, Foucault highlights the possibility of transformations. The ability to
alter the body and/or soul, to cause changes that are not restorative, such as getting
oneself “back to health,” but rather to orient toward some notion of perfection
implies a particular course of work.
Locating this idea of perfectibility further, we can cite the critical importance
of individualism and free-choice which obligate us to consider the “array of
technically mediated choices [within] varied discourses of perfectibility” (Taussig,
Rapp & Heath 2003: 59). The tension here between biotechnologies and choice
results in what these authors refer to as “flexible eugenics,” a notion which draws
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from Martin’s notion of late capitalism’s “flexible bodies” (Martin 1994). Martin is
concerned with the emerging sensibility of the "complex systems model" that puts
everything in flux, including the biomedico-scientific imagery of the "innovative
agile body." For the flexible body, health and illness are becoming less and less
definable. As such, the “technologies of the self” permits people to transform,
materially and predictively, what is seen as natural (Taussig, Rapp & Heath, 2003:
65). In a similar vein, Blaikie argues that the construction of aging a is shifting from
a sense of a “natural” life cycle to a more flexible model dependent upon individual
ways aging (Blaikie 1999). This flexibility therefore compromises the importance of
nature in aging while at the same time suggests a kind of individually possessed
power for guiding the aging process along.
I have linked optimization and perfectibility to nature and the role that the
category of the natural plays in these notions of optimization and perfectibility. What
happens to nature now that we can scientifically envision, or in some cases engage,
therapies that are about perfectibility? The literature on enhancement therapies relate
specifically to that of nature because the former rejuvenates the latter. Nature still
matters, to be sure; it is, as Franklin notes, an important trope (Franklin 2003a). In
this package of perfectibility, nature is a powerful notion that has the pretense of a
common-sensical stability but is actually quite rickety.

2.5 THE PROCESS/EVENT DISTINCTION

Events are the things that happen to us in a moment or are perceived as
concretized in moments. They are incidences, episodes, or occasions. They may be
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watershed occurrences – from which there is no going back – or they may be
disruptions from which recovery can be established with modest or monumental
effort. In contrast, processes are naturalized elements of humanity. Growth, decline,
death are progressions and developments regarded largely as a function of nature.
However, an event can also be natural (acne perhaps, cancer, are natural in that they
may emerge without human doings) but its naturalness has become irrelevant to its
biomedical treatment imperative. Instead an event earns a scientific name and
becomes a thing, a moment, or a pathology that biomedicine is mandated to fix. An
event can be extracted from a process for direct attention but it generally resists
being synonymous or symbolic of that process.
A biological process, on the other hand, is natural in that it is universal.
Everyone (every “normal” one) grows a neural tube, goes through puberty, and ages.
These are largely the “givens” of human life; the backdrop against which events of
abnormality are understood. These processes are inherently and importantly
natural/universal. Using scientific means to do something with and about them is
often met with protests of “interfering with nature.” Thus, I argue, “natural”
processes have not generally been easily subjected to biomedical intervention.
Processes are also appreciated as somewhat linear and temporal. In other words,
processes have a timeframe and a timeline and may be composed of certain events
(often in a particular configuration) that are strung together to mean something
larger. This “something larger” is key; events can occur and even be culturally
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marked but they are marked as part of a process which, in a holistic way, is more
than the sum of its events.
Science and biomedicine are structured around events (Marcus 1995: 7;
Young 1982: 272). Research on menopause, as discussed previously, articulates this
idea; even while many women conceived of menopause as a gradual process,
defining a beginning point of menopause (e.g. a woman’s last menstrual cycle)
allowed a shift from its conceptualization from a time of life to an event with a label
for biomedicine (Kaufert 1988). Menopause came into meaning alongside
biomedical ideas that had shaped understanding of this “time of life” in North
America into a specific moment that often required treatment (such as hormone
replacement therapy) (Lock 1993).
Death, too, illustrates the eventness of biomedicine as death is constructed in
particular ways (Lock 2001, Ohnuki-Tierney 1997) that do not always correspond to
beliefs, for example, about the souls’ “gradual detach[ment] from the body” in Japan
(Ohnuki-Tierney 1997: 226). In the U.S., the process of dying became the event of
death with the construction of brain death as a “clearly” definable marker (Lock
1997: 217). The “gray areas” of death evaporated in light of the biomedical
pronouncement of its moment.
Illness and disease are themselves events (Romanucci-Ross, 1982: 173).
They involve particular sets of symptoms and pathologies that isolate them from “the
norm.” Illness and disease are extracted from nature and as such the construction of
disease marks criteria that relates to a defined event offering “points of entry for
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therapeutic interventions” (Landecker 2003: 53). In other words, through marking
disease events, biomedicine can determine a course of action through which to affect
some change.
Broadening the scope of analysis beyond biomedicoscience reveals that the
stories with which we make sense of our illnesses, our experiences, our lives not
only constitute an event but are the stuff of events (Mattingly, 1998: 8). Narratives
are “event-centered;” they speak of disruptions or interruptions of the natural or
normal course (Mattingly, 1998: 13). Events are the stuff of stories (especially in
much television news coverage) and biomedicine is the stuff of events.
Biological aging is understood not as a single event but as a process
(Bengtson, Rice and Johnson 1999, Markson 1991, Meyerhoff and Simic 1978) thus
it is not analogous to arthritis or Alzheimer’s. Aging, and specifically old-aging
presupposes that individuals will “get” something be it arthritis or Alzheimer’s
thereby creating a kind of universal patienthood. However, it is this ability to “get”
that is at stake here, not what one “gets.” Just as aging is characterized by pain and
increasing debilitation, the specific maladies are less critical than aging itself. While
attempts to quantify moments of aging – via biomarkers that aim to measure aging
distinct from chronology – are of great concern and deliberation
3
and would provide
indicators through which interventions could be staged, the orientation of anti-aging
medicine work is toward the process of aging entirely and specifically.
I move toward process and event as explanatory terms that have emerged
time and again in interviews with proponents and opponents of anti-aging medicine.
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Explicitly theorizing these concepts offers other vantage points for social scientific
interrogation. Firstly, this distinction moves slightly away from the problematic of
nature as it dislodges nature from the center of analysis. While nature is an
undeniable and powerful construct, scientific interpretation and creation of fact often
rests upon the process/event distinction moreso than it does upon constructions of
nature.
Secondly, the process/event distinction reorients discussion away from the
construction of disease to take into account larger movements in biomedicine. This
research suggests that biomedicine not only constructs disease so that disease may
fall under its purview, but it is also trying to grapple with its abilities to affect and
create things beyond what we have heretofore accepted as disease.
Thirdly, the process/event distinction foregrounds the importance of
predictability since the construction of a process is linked to its universality:
everyone ages a certain way, thus it is predictable – a process. By examining anti-
aging medicine through the lens of process/event, the notion of the predictable or
expectable life course and bioscientific course is subject to interrogation.
Finally, this distinction creates a space in which to analyze enhancement
technologies that do not rely upon nature for its backdrop. Optimization of the
body’s “natural” processes often calls on a different nature – the nature of going
beyond, of doing God’s will with the gifts bestowed. Thus, nature is employed by
both opponents and proponents of enhancement technologies either by marking the
process too “natural” to affect or by asserting that it is precisely human nature to
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surpass our given bodies. These characterizations of what-is-natural are important
but ultimately replay philosophical arguments of the Enlightenment and Industrial
eras which grappled with the stakes of “interfering” with nature. The process/event
distinction skirts some of this debate by removing nature from the relevant lexicon.
Process/event and nature/disease categories share many conceptual
similarities: nature and process are both more sheltered from biomedical intervention
than event and disease which are both more demanding of intercession. But all are
categorical constructions with enormous cultural consequence. All of these
constructions carry implicit beliefs about the world and relationships. Both process
and nature bank on their predictability and universality. Both event and disease can
be identified and excised from process and nature respectively in order to mandate
biomedical intervention.
Despite these significant resemblances, process and event are not simply
replacement terms for nature and disease. While process and event are just as
constructed as nature and disease, they entail different political contingencies than
those which are linked to nature and disease. In practice, there might be less cultural
resistance to initiating intervention when the target is considered a process rather
than considered as natural. Under the increasing pressure of the cultural critiques of
constructs of disease and nature, process and event have emerged as powerful
alternatives that have been employed by biomedicoscience. Thus, the process and
event designations jettison some of the baggage conferred by nature and disease.
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I am using the themes of process and event as both a theoretical tool for
understanding the complexities of nature with respect to aging and as a means of
acknowledging and analyzing them as important rhetorical devices in biomedicine.
By viewing aging as both a process and event, we can see constructions that might
otherwise have been normalized in rhetoric that privileges aging as natural.
Additionally, recognizing process as increasingly significant in the challenges that
anti-aging medicine poses for biomedicine makes room for analyses of how process
and event can come to matter.
Exploring an example from some Science and Technology Studies work on
reproduction in reference to nature reveals a way in which a process and event
analysis may unfold. In many places, surrogates are not viewed as “natural” mothers
because of the genetic location of natural motherness (Strathern 1993, Teman 2003).
Surrogates are vehicles for motherhood to happen but they are not its locus.
Examining this in term of process and event might contribute another kind of
analysis that may play to the process of pregnancy that is defined more on the event
of chromosomal diploidization than on the event of blastocelic implantation. Or
perhaps it may reveal that the process of motherhood is less about the pregnancy
than it is about the growth of the fetus – that natural motherhood is linked in this
particular way that makes self-pregnancy a fortunate convenience for those able to
conceive and carry all in their own body but that is irrelevantly womb-linked. This
potentially complicates analysis by teasing apart in a different kind of way how
certain events are more natural than others, how the construction of events and
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processes reveal meanings and relationships to nature, or, conversely, do not. So the
process/event distinction may helpfully complicate the notion of pregnancy.

2.5.1 Process, Event and Execution
The three nodes of anti-aging medicine’s execution (destabilization,
administration, performance) help illustrate the process and event distinction.
Firstly, anti-aging medicine attempts to reorient biomedicoscientific work on aging
away from the events of disease. By purging the importance of linking nature to
aging (not that nature becomes dislodged as an idea, rather that the notion of nature
no longer confers great significance in light of the biomedical project) and by
condemning the current practice of aging-medicine as unsatisfactory at best, anti-
aging medicine destabilizes long held relationships between aging and biomedicine.
Further anti-aging medicine offers a new practice of aging-medicine that
deals directly with the goal of treating aging specifically. In other words, it executes
a new administration of aging-medicine that focuses less on the events within aging
and more on its process. This execution of aging via the practice of anti-aging
medicine involves not merely the prescription of, for example, human growth
hormone, but also the rhetoric around aging and biomedicine.
Finally, anti-aging medicine offers a vision through which we can understand
its goals and perhaps will enjoy or suffer its consequences. By making explicit the
implications of what a successful anti-aging medicine might bring, anti-aging
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medicine shapes current biomedical practice through a kind of performance of
envisioning tomorrow’s success.
These three executions are not linear models of progression. The assertion
that our current understanding of aging should be redefined is a function of an
imagination of a future with anti-aging medicine. Moreover, the imagination for that
future is a product of dissatisfaction with the current definition of aging. And both
of these depend upon the administration of some practice of anti-aging medicine.
Thus, these three nodes of execution are in concert and dependent on one another.
Nonetheless, each of these nodes speaks to the categories of process and event as
they shepherd the relationship of biomedicine and nature/aging away from the event
of disease and toward the process of aging.

Execution  Event  Process

Destabilization Attempts to reorient work
 of aging-medicine away from event
Administration Practice of moving aging-medicine
 from event-centered to process-centered
Performance Imagines/practices a new
aging-medicine (anti-
aging medicine)

2.6 CONCLUSION
This chapter presents an analysis of the pertinent literatures on aging, nature,
disease, and perfectibility that reveals a sense of shifts and instability. The category
of nature as it has been understood is increasingly unstable in the face of
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biotechnologies and the efforts to “improve” oneself have manifested into
biomedical goals and orientations epitomized in anti-aging medicine. However,
beliefs about the “naturally human” pursuit of perfection remain entrenched in
biomedicine, if not intensified. Anti-aging medicine is occurring precisely at these
intersections.
With a cultural construction of aging as an unfortunate biological decline and
biomedical technologies as often triumphant, the category of nature loses the power
to “protect” aging from intervention. Bypassing the construction of disease while
drawing on the history of the medicalization of age-associated diseases, anti-aging
medicine situates the process aging as a target for biomedical intervention. Herein,
the process of aging, rather than an event of abnormality, should employ
biomedicoscientific attention. This is not about making an event out of aging but
rather about changing the work of aging-biomedicoscience from event-centered to
process-focused.
By excavating the constructions of processes and events this analysis of anti-
aging medicine moves away from deconstructing “nature” and aging-as-natural and
foreground issues presented by emerging biotechnologies that challenge deeply held
beliefs about aging and nature. Moreover, issues of predictability and universality
emerge as central tenets in biomedicoscientific constructions of nature and aging that
shape how events and processes are constructed. Enhancement technologies may be
considered from a process/event analysis differently than when “nature” serves as the
excavating tool. In the next chapters, I explore these issues further. In Chapter
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three, I pay particular attention to the history of anti-aging medicine in the U.S. and
the ways in which aging and nature are constructed in relationship to
biomedicoscience. Chapters four and five examine the perspectives of anti-aging
medicine practitioners, researchers and bioethicists toward aging and nature; the
process and event distinction proves particularly important in how the endeavor of
anti-aging medicine is considered.

1
Interview: Dr. Z 08/08/2002.

2
Madame Jeanne Calmet was a French woman who enjoyed?/suffered? a great deal
of international notoriety for her longevity. She died in 2000 at the age of
122 (Scientific American Special Edition: The Quest to Beat Aging, vol 11,
no. 2, Summer 2000: 9).

3
The NIA launched a twenty million dollar initiative in 1988 toward finding
biomarkers in rats. However, after ten years the initiative had produced
dismal results and was ultimately abandoned as unsuccessful (Warner 2004).
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3. A HISTORY OF ANTI-AGING MEDICINE FROM
1990-2003

In July of 1990, the New England Journal of Medicine published an article by
Daniel Rudman stating that “the effects of six months of human growth hormone on
lean body mass and adipose tissue were equivalent in magnitude to the changes
incurred during 10 to 20 years of aging” (Rudman, et al. 1990). Four years earlier,
pharmaceutical giant Eli Lilly beat out Genentech in synthesizing the 191-amino-
acid-length chain for human growth hormone; the difficult process of drawing hGH
from human cadavers was circumvented and Humatrope® was born. Funded in part
by Eli Lilly, the Rudman study declared that science can intervene upon aging.
Arousing researchers and health care practitioners, this seemingly successful
intervention and the study’s publicity marked a beginning for anti-aging medicine.
The Rudman study was certainly not the first effort to ameliorate aging in any
of its variant forms nor the first to think of aging as ameliorable. In a 1966 study of
“prolongevity” (re-published in 2003 in the wake of the growing attention to anti-
aging medicine), historian Gerald Gruman documents historical quests to cure aging.
This study details quests from antiquity to the Enlightenment and focuses
specifically on those anti-aging quests founded on “nonsupernatural means.” Anti-
aging pursuits were observed in Taoist and alchemic traditions which led up to the
hygenist movement that advocated the longevity benefits of a moderate lifestyle in
the seventeenth and eighteenth centuries. These are interesting not only for their
failures but also for the systematicity with which they approached a cure for aging.
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Gruman notes that the scientific revolution of the Enlightenment served as a major
turning point in thinking about aging and the notion of progress. The Enlightenment
“heralded the ending of proto-science and the beginning of a scientific foundation for
prolongevitism.” (Gruman 1966[2003]:157).
Following the Fountain of Youth theme and the many stories of vitality-
embuing waters, Enlightenment scientists sought a cure for aging through
replenishing the body with what was missing in old age. Aging was scientifically
marked by loss and biomedicine was charged with the duty of replacement. By
reducing the body to the ebb and flow of its component parts, various practitioners at
various times claimed to have isolated the missing substrates. For example, these
attempts at replacement included Brown-Sequard’s testicular implants in the late
1800s and Ana Aslan’s “Gerovital H3” prescription in the 1960s (Haber 2004).
However, as modern science expanded, curing aging became the business of
individuals and not the primary goal of science. These more recent anti-aging quests
appear to be short-lived, effectively unsuccessful, and spearheaded by a small
number of individuals who seek (and invariably find) substantial financial gain
(Coles, 1995, Haber 2002). On the other hand, most of the researcher-progeny of
Enlightenment science seemed to largely abandon the anti-aging quest in favor of
more reductionist, disease-based research. In the twentieth century, with the
emergence of the discipline of gerontology, research priorities have largely been set
by government, big business, univerisites and senior citizen interest groups – in other
words, Big Science (Achenbaum 1995: 124). Gerontology has taken great pains to
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legitimize itself within Big Science and so has abandoned anti-aging pursuits as they
are perceived to reek of quackery (Binstock 2003).
The “apologist” tradition – invoking the desire to not not-age – boasts an
equally long history. Apologists assert that aging is a moral obligation, that dying is
a fundamental aspect of humanity and as such, the quest to cure aging is
characterized as folly, hubris, and blasphemy. Today’s apologists are criticized as
stodgy and wasteful and even immoral by anti-aging activists. Nonetheless, these
naysayers have dramatically impacted the kinds of science and talk permitted in
scientific circles. The legs of this tradition are vociferously in motion today as will
be shown in the statements of many gerontologists and the Presidents Council on
Bioethics.
Historical and cross-cultural anti-aging quests abound and a majority of
gerontological and historical writing locates contemporary anti-aging as an extension
of these pursuits. Ponce de Leon’s search for the Fountain of Youth is, by far, the
ubiquitous icon (de Leon instead “found” Florida). Similarities between
contemporary anti-aging medicine and historical quests are easily pinpointed:
scientific rhetoric, the sense of being close to success, a systematic approach, the
attempts toward professionalization, and mostly, the idea that aging is something we
should be anti about. Some groups link anti-aging medicine and past quests in order
to undermine today’s attempts because historical quests not only failed but also bear
the stink of charlatanry. Some anti-aging proponents, on the other hand, trace the
roots of anti-aging medicine through the lens of revolutionary thinking thereby
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linking anti-aging medicine to a new frontier – even, explicitly a new paradigm – and
gerontology to reactionary conservativity. In other words, those who link
contemporary anti-aging medicine to historical anti-aging medicine are participating
– wittingly or not – in the game of contested histories.
This story of anti-aging medicine begins along three somewhat porous tracks:
(1) the American Academy of Anti-Aging Medicine (A4M) and other groups and
individuals seeking to legitimize anti-aging in practice and who actively lobby the
public, the academy, and the government to consider aging a target for biomedical
intervention, (2) the disparate scientific research specifically studying aging and
harnessing other research to apply to aging as something that targetable, and (3) the
growing willingness of popular writing to reconsider the idea that aging is too
“natural” to affect. Increasingly, anti-aging medicine has experienced a shift from
the active promoting of anti-aging by practitioners to an increasing acceptance in the
“hard” sciences. Popular discussions have varied but have generally responded
positively to anti-aging hopes and even moreso to the growing scientific optimism.
The 1990 Rudman article fertilized scientific ground for anti-aging medicine.
The A4M notes that this study is “one of the most important milestones in the history
of clinical anti-aging medicine” (A4M 2002a). The Life Extension Foundation
(LEF) celebrates the “explosion of clinical research on the effects of replenishing
depleted growth hormone levels in persons of middle and old age” following the
Rudman study (LE Magazine 1996). According to the NEJM website, the “1990
article by Rudman et al. receives as many ‘hits’ in a week as other 1990 articles do in
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a year” (Drazen 2003). However, in light of this inordinate “hit” frequency and the
controversy surrounding hGH administration, the journal editor accompanies all
downloads of the Rudman article with two additional but far more cautionary articles
(NEJM 2003).
However, Daniel Rudman and his group were not the first nor the only
researchers interested in anti-aging kinds of interventions. Indeed, Geron was
established in 1990 to address issues of the chromosomal telomeres that are found to
be significantly shorter in older individuals. Geron corporation was officially
founded in 1992 when Michael West, Geron’s founder, assembled a group of
interested researchers and found financial backing for the company (West 2003).
Seizing upon the Rudman publication as kind of a birth date that marks an
anti-aging interest within and beyond the academy and industry, I trace the history of
anti-aging medicine through 2003 when the President’s Council on Bioethics
(PCBE) produced a statement against the anti-aging medicine framing of aging as a
target for intervention. Because anti-aging medicine often claims much cachet from
its scientific grounding (though the stability of this grounding itself is controversial),
the detection of a hormone that might mitigate aging serves as an important launch
pad. The PCBE presents as an interesting cutoff in that it reveals the success of
anti-aging not only in capturing the attention of the public and the federal
government, but also because it reveals a coalescing of the many strands of anti-
aging medicine. No longer are the practitioners so easily dismissed as quacks, nor
the researchers so quick to reject the idea that aging can be scientifically modified.
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The crossover between these factions is deep-seated but, by 2003, the two groups
become less discrete. The fight over whose expertise reigns over the interpretation
of data and whose voice will register with the greatest significance will surely
continue. While it looks as though the researchers who come to the anti-aging table
with the entrenched respect of science will dominate, the importance of the
practicing physicians and their advocacy groups cannot be minimized.
In this time period, aging underwent a dramatic reinterpretation. The
prospect of growing old continued to be linked with images of decrepitude and
decline and aging remained a natural part of the biological life. The notion aging
could be ameliorated soon began to flower and overshadow its naturalness as the
process of aging fell under scientific, biomedical, and popular scrutiny.

3.1 1990-1995
As the Rudman hGH study is published, aging is becoming an important
national topic; baby-boomers (the large cohort of people born in the U.S. between
1946 and 1964) are beginning to approach later life. Additionally, by 2002, the
average life expectancy for a person born in the United States jumped from 47 years
in 1900 to 79 years for females and 73 years for males [NIA 2002]. This meant that
not only were more people alive but those people were also living longer. In Britain,
researchers report, life expectancy “has been increasing at a rate of five hours every
day” (Highfield 2006); every day we live grants us five hours of life later on – a day,
thus, only “takes” 19 hours of our lives. Social implications of expected longer
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lifespans spurred a flurry of worried interest both academically and publicly. While
much research explores the social implications of the “longevity boom,” academic
interest also addressed potential biotech successes. From a book culminating from
an Italian conference and British colloquium in 1988, the first chapter notes that “a
significant postponement of senescence… is likely to be feasible in humans”
(Ludwig 1991: 2). The issues of concern here are not only those of scientific
feasibility but also the implications of this endeavor. The idea that aging can and
will be addressed as something that can be mitigated by science is emerging within
the academy.
Robert Butler, the first director for the National Institutes on Aging
(established 1974), founded the International Longevity Center (ILC) in 1990.
Butler has spent much of his career combating “ageism.” Ageism, defined as the
“systematic stereotyping of and discrimination against people because they are old,”
characterizes older people as “senile, rigid in thought and manner, old fashioned in
morality and skills” (Butler 1969 in Butler 1994). The ILC’s mission, as extension
of Butler’s personal mission, is to “help societies address the issues of population
aging and longevity in positive and constructive ways and to highlight older people's
productivity and contributions to their families and to society as a whole” (ILC N.d.).
The ILC’s emphasis on aging‘s beauties in hopes of undermining the growing
sentiments of reticently aging boomers propels the ILC to join and at times head the
fight against anti-aging medicine.
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Stephen Coles co-founded the Gerontology Research Group in New York in
1960, in Los Angeles (currently the most active chapter) in 1990 and in Washington
D.C. in 1993. Most of the members are MD’s and Ph.D’s. The founding charter
reads:
The Gerontology Research Groups … are dedicated to the proposition death
is not an inevitable consequence of the human condition, as various apologist
spokesman have sought to make us believe. Instead, we hold that aging is
simply a biological phenomenon, and therefore susceptible to clinical
intervention like any other pathological process, such as heart disease,
cancer, or stroke.

In our view, the human lifespan is a side effect of an historical adaptation to
our role as mammalian hunter-gatherers... But now we are approaching a
time in which we will routinely intervene in the aging process at the
molecular level. We therefore dedicate ourselves to removing the constraint
of a sharply limited human lifespan. Furthermore, we are prepared to
accomplish this challenge within our own lifetimes. (Editors Note: The First
Draft of this statement was prepared in the Fall of 1991. It has not been
substantially revised over the last ten years. --- May 2002) (GRG 2002,
emphasis mine)

The mission of the GRG is a determinedly scientific one. The GRG meetings
and listserve debates depend upon science published in “legitimate” publications. In
“Journal clubs,” books and articles are discussed and position papers produced. The
GRG – the “Physicians, Scientists, and Engineers dedicated to the quest to slow and
ultimately reverse human aging within the next 50 years” – proposes that aging
should be a target for biomedical intervention and to this end has organized to
educate one another. Moreover, addressing aging in this way demands a different
kind of talk than mainstream gerontology embraces. Bolstered by their recitation of
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evolution and the success of molecular science, the GRG hopes not only for
mitigating the effects of aging, but for its reversal.
The hopeful discussion of life extension is particularly sexy for the popular
media. Interested in part because of the growing baby-boomer readership and a
sense of the older folks as a wealthy and relatively unexploited market, journalists
are beginning in the early nineties to write about the science of aging. Four months
before the release of Rudman’s study, a Newsweek article, reviewed then-current
theories of aging and the scientific attempts to prolong the life span. “The Search for
the Fountain of Youth” focused primarily on the ways in which diet, exercise, stress
reduction and intellectual challenge can slow the effects of aging (Begley 1990).
But of course, there is much more to aging than individual health “choices.”
The early nineties witnessed a titanic rise in biotech start-ups (Geron, MRX
Biosciences, Genox) aiming to capitalize on the aging market and mitigate the
suffering of old age (see Hall 2003 and Solomon 2005 for a review of Geron and
other biotech-firms-on-aging). Biotech and pharmaceutical companies became
interested and an influx of companies selling hGH and secretagogues (therapies
reported to stimulate the body’s production of hGH) and other supplements aimed at
stalling aging emerged in great numbers.
In 1993, the A4M, a key and highly controversial player in the anti-aging
medicine movement, was launched. This organization, founded by Ronald Klatz and
Robert Goldman
1
, dedicates itself to increasing awareness of anti-aging, to
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professionalizing it as a medical specialty and perhaps, as their adversaries critique,
to making money. Their mission states:
The A4M promotes the development of technologies, pharmaceuticals, and
processes that retard, reverse of suspend the deterioration of the human body
resulting from the physiology of aging and provides continuing medical
education for physicians.
(A4M
N.d.a
)

That aging is an ameliorable decline is a founding principle for this
organization. Aging is primary cause of physiological deterioration and thus is the
crux of the problem and, by extension, the target of the solution. The fundamental
basis for the organization is the “principle that aging [is] a disease … amenable to
treatment.” (Klatz 2000: 6). This designation of aging as a disease was explicitly
based on the desire to treat aging; it can and should be treated, diseases require
treatment, thus, aging becomes a disease. In this vein, the A4M defines anti-aging
medicine (a term the organization controversially claims coinage of) as:
a medical specialty founded on the application of advanced scientific and
medical technologies for the early detection, prevention, treatment, and
reversal of age related dysfunction, disorders, and diseases. It is a healthcare
model promoting innovative science and research to prolong the healthy
lifespan in humans. As such, anti-aging medicine is based on principles of
sound and responsible medical care that are consistent with those applied in
other preventive health specialties (Klatz 2001 quoting original definition
from 1993).

Targeting physicians and their education has been a mainstay of A4M
practice. Setting up anti-aging as a “medical specialty” based on the “application”
of “science and medical technologies” is a strategic move that explicitly positions
aging not only as a biomedical target but an adversary worthy of the full arsenal of a
dedicated medical specialty. For physicians, it offers a way to expand their medical
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practices with the legitimizing cachet of science. Meanwhile the A4M assumed the
critical job of doing the applying. The movement of science-at-bench to practice-at-
bedside is contentious and weighty. And applying scientific work to people’s bodies
demands particular interpretations of the data – a structure for the knowledge, a way
to understand what data matters when and where. It demands a sense to practice, a
means to put data into bodies. Here, aging as not-inevitable is the structure for piles
of data to be shelved and the library from which physicians schooled and practices
shaped. By staking claim to this transitioning, the A4M maneuvers between the
bench and the bedside and positions the organization such that, if ultimately
successful, it has a great deal to gain.
In 1994, the Food and Drug Administration (FDA) issued a consumer
warning against anti-aging (Napier 1994). The warning discusses some “anti-aging
remedies” that consumers have spent over two billion dollars annually to acquire.
Coenzyme Q-10, DHEA, and SOD
2
as anti-aging remedies are listed as “direct
health hazards that cause serious injury or as indirect health hazards that cause
people to delay or reject proven therapies.” The NIA website advises people to
“check with your doctor before buying pills or anything else that promises to slow
aging…” (NIA 1994). The same warnings echo in both publications: advertising
claims are exaggerated and nothing currently is known to extend life or slow aging.
These warnings illustrate not only the marketplace impact of anti-aging but also the
growing concern of the federal government.
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Anti-aging optimism was not so widespread within the gerontological
community. Eminent gerontologist Leonard Hayflick’s How and Why We Age
(1994) was a particularly popular pop-science book on aging; his words of caution
about the feasibility of life extension are clear. Not only does Hayflick note without
caveat that there is no “medical intervention, lifestyle change, nutritional factor, or
other substance [shown to] slow, stop, or reverse the fundamental aging process or
the determinants of life span” (313), he also strongly doubts that any intervention
will be developed in our lifetimes (335). Moreover, he questions the morality and
benefit of such a goal. His is a morally pessimistic, scientifically wet-blanketing
book – one whose predictions are passionately countered by other gerontological
popular science books.
Pursuing the moral significance of the quest to cure aging, bioethicist Daniel
Callahan begins his warnings against anti-aging in 1994. He argues that
prolongation of life for its own sake is problematic in part because of its focus on the
individual rather than the greater good. Citing Leon Kass, who would, eight years
later, head the President’s Council on Bioethics, Callahan speaks of cultural
boundaries and the importance of skepticism (Callahan 1994). In similar caution,
Peter Singer, the author of Animal Liberation (1977), argues against anti-aging
because we not only lack the resources to slow aging, but likewise do not have the
right to do so (1991). The apologist voice, that which does not engage in discussions
over whether or not science can do something about aging but rather whether or not
it should, has begun to voice their dissent.
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By 1995, the onslaught wrought in part by the Rudman article was well
underway; anti-aging medicine experienced a snowballing momentum. The drudgery
of aging became infused with the hope of scientific triumph. The relationship
between aging and biomedicoscience was beginning to be distilled through the
notion of ameliorableness rather than nature. Aging-as-natural was not completely
executed, the utility of its framework has indeed been placed on trial. Within
gerontology, debates were beginning to address not only the feasibility of this
scientific goal but also its morality. Popular media were fascinated by anti-aging;
biotech firms and pharma/nutraceutical companies were lured by its potential for
profits. The government was becoming involved. The A4M’s membership reached
820 and their conference attendance had buoyed to 903 with 76 vendor companies
staged at the exhibition hall. A4M growth was steady during these early years; it
would soon explode.

3.2 1996-1999
In 1996 membership in the A4M jumped to 2,600 – a 217% increase over the
previous year. By 1999, the organization would have over 8,600 members.
Conference attendance in 1999 would reach 4,500 with 489 companies exhibiting in
the massive vendor hall. The first medical textbook, Advances in Anti-Aging
Medicine: Volume 1, was published by the A4M in 1996 and the authorship of Klatz
and Goldman would soon include six pop books on anti-aging.
3

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With effectual foresight, the A4M quickly recognized the potential of the
internet. One of the most potent tools for disseminating their mission and name has
been the massive A4M website (www.worldhealth.net). Perhaps the titanic jump in
membership in 1996 can be attributed to the website’s construction in the same year
(Personal communication with Ronald Klatz, February 27, 2004). In a sampling
study conducted in 2000, over 33% of internet search results referenced the A4M
(Mykytyn 2001). By analyzing the “blurbs” or results in Google and other search
engines when searching for “anti-aging,” it was evident how the deeply A4M had
penetrated this topic on the internet. The site worldhealth.net is geared toward
educating physicians and lay public as much as it is recruitment of members and
proponents. By 1999, the site boasted upwards of 2 million hits per month.
In an effort to professionalize anti-aging as a medical specialty and to
standardize anti-aging practice, the A4M held the first medical licensure exam in
December 1997 at their Fourth Annual conference in Las Vegas. The American
Board of Anti-Aging Medicine was established as a professional physician
“certification and review board” (A4M N.d.b). A counterpart, the American Board of
Anti-Aging Health Practitioners geared toward licensed health care practitioners
(nurses, physical therapists, etc) was established two years later. These boards are
expensive
4
and require a written and oral exam, an active medical license, and a
minimum of five years clinical experience.

ABAAM certification represents on of the most important goals of the
[A4M]: to establish professional guidelines for anti-aging techniques,
protocols, diagnostics, and therapeutics… It is the belief of the [ABAAM]
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and the [A4M] that this certification and examination process will ultimately
lead to sub-specialty recognition and create a new status for anti-aging
medicine and for those practicing it as qualified practitioners in a new,
valuable area of clinical medicine. (A4M N.d.c)

Standardization is a hallmark of science. For some thing to be available to
science and biomedicine this thing must operate by some rules. Though the rules
may change the more that is discovered about the thing, the standards by which it has
come to be understood provide a handle to hold onto that thing. The thing – here
aging – must behave in generally universal ways that standards may measure and
measure against. These A4M boards aim to ensure that practitioners have the same
handle.
Accordingly, forging a common identity based in shared practice is a critical
step toward professionalization and the A4M’s board exams go far toward
standardizing anti-aging medical practice. Successfully designating anti-aging
medicine as a specialty requires more than a rhetorical strategy and the A4M aims to
buttress it by packing the “anti-aging medicine specialty” with a set of practices,
guidelines, laboratory tests, diagnoses and scientific references.
Two other A4M efforts at professionalizing and legitimizing aging for
biomedical intervention came in 1999: the establishment of the Consumer Education
and Research Council (CERC) and the Life Extension Core of Information research
study (LEXCORE). On the heels of increasing press on quackery, the A4M
responded strategically. By establishing CERC, the “A4M supports the efforts of
those who seek to expose fraudulent commercial activities but also believes that
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there are many legitimate and beneficial anti-aging products.” Choosing not to
counter the accusations that scam exists, the A4M admitted marketplace problems
while underscoring the legitimate goals of the good guys. Attempting the shrug off
the accusation of quackery by setting the organization apart from the less admirable
activities often linked with anti-aging medicine, the A4M asserted that “the best way
to protect the public from fraudulent claims is by educating consumers. A4M also
believes that the anti-aging marketplace should begin to regulate itself” (A4M
N.d.e). Thus, CERC, an arm of the A4M, became a self-appointed industry
clearinghouse for the separation of the good and the bad. A powerful position,
indeed.
If ABAAM’s duty was monitoring and authorizing practitioners and
standards of practice and CERC’s job was educating and protecting the lay public,
LEXCORE sought custody of the other parent of legitimization: science. An
“unprecedented longitudinal... study of how and why we age,” LEXCORE’s primary
objective is to differentiate biological age from chronological age. This
measurement problem has been a troublesome one in gerontology. Measuring the
biological “age” of a body is tricky and, distinguishing biological age from
chronological age – the number of years they have lived – is even trickier. The
NIA’s Biology of Aging branch conducted a similar hunt for the measurement of
physiological aging in individuals as well. The NIA launched a twenty million
dollar initiative in 1988 toward finding biomarkers in rats. However, after ten years
the initiative had produced dismal results and ultimately ended without any solid
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findings (Warner 2004). LEXCORE’s biomarker discovery goal was significant not
only because it highlights the reigning uncertainty regarding the issue but also
because any success will be a ground-breaking move toward scientific
standardization of the process of aging and its discovery will be highly touted.
Interestingly, the A4M began to abandon its indictment of aging as a disease.
The rhetoric begins to quietly shift toward talk of intervention without reference to
aging as disease. For example, in their website recitation of the A4M history, the
organization cites that it is a “a society of forward-looking physicians, scientists and
researchers dedicated to the belief that physical aging in humans an be slowed,
stopped or even reversed through existing medical and scientific interventions”
(A4M N.d.g.). Thus, disease is excised from the rhetoric through vocabulary
situating aging as ameliorable by way of scientific intervention.
Whether LEXCORE discovers a valid measurement tool, the ABAAM
become the gold standard for practitioner education, or CERC has any public impact,
the A4M displays a tactical awareness for situating anti-aging medicine on “the”
scientific map. A4M’s mission of operating and galvanizing anti-aging medicine
was wide-reaching, strategic and optimistic for its own success and the promotion of
aging as scientifically fixable.
The sanguine exuberance paraded by the A4M was not unique. The first
page of Michael Fossel’s Reversing Human Aging predicts that “we will be able to
prevent, even reverse aging within two decades” (Fossel 1996:1). Fossel – a
Clinical Professor of Medicine at Michigan State University – excitedly reviews
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theories of aging with respect to the potential of science in his optimistic pop-science
book. In Why We Age (1997) Steven Austad, a respected zoologist, soberly asserts
that currently no interventions have been demonstrated to slow aging in humans.
However, he is not without hope as he suggests that some likely candidates exist for
“real” anti-aging treatments in the near future. Tom Kirkwood’s Time of Our Lives
(1999) asserts that aging is neither inevitable nor necessary thus forming the basis
for his disagreement with the fatalism of many contemporary theories of aging.
In these books aging is not represented as a disease. Fossel writes that “aging
is an intrinsic, cumulative, and inevitable loss of function causing a progressive
increase in the potential for disease and death” (Fossel 1996, 54). Aging here is a
physiological decline, measured by function; it is not simply a macro-functional
decaying of the ability for an individual to do certain things, but also the decline of
cellular function. When science comes to understand the “underlying cause of
aging,” it will “likely allow us to alter the process.” However, the cause of aging,
Fossel argues, must be differentiated from its effects (Fossel 1996, 55). In other
words, we must keep a keen eye trained on the separation of cause and effect and be
diligent in conceptualizing this distinction. Thus, the process of aging is being
separated from the events it may spawn. This division will be of great value for
scientific researchers as anti-aging ideas continue to make headway; it will serve as a
marker between whether anti-aging medicine currently exists or not, thereby
delineating who is and who is not really doing anti-aging medicine.
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Interestingly, the back cover of Fossel’s book carries praise from A4M’s
Ronald Klatz: “Dr. Fossel’s book clearly outlines important discoveries in the new
science of anti-aging medicine.” The A4M is a highly controversial player in this
movement. The organization is generally regarded contemptuously by
gerontologists – both by those who advocate for and those who do not believe in
anti-aging medicine. While the A4M frequently appropriates the work of some
gerontologists to their cause, it is highly unusual for a gerontologist (wishing to
maintain a good reputation within the academy) to reference the A4M – much less to
amass A4M praise. The explosion between the gerontological circles and the A4M is
only a few years away and yet, the promotion of Fossel’s book by Klatz reveals that
the two groups are anything but distinct.
The influx of pop-science books mirrors the increase in public attention. For
example, a local television news show in New Haven aired a segment entitled
“Forever Young” in which Fossel was interviewed along with three ‘on the street’
elderly folks, an adult day care worker and a job market analyst (News Channel 8,10
February 1997). This brief “expose” talks about the promise of telomeres as well as
the implications of an extended lifespan. Many other articles are more cautionary
and echo the government warnings about the dodginess of anti-aging claims (Boyes
1999, Frankel 1996, King 1996). However, between 1996 and 1999, over 139 books
on anti-aging medicine and longevity are published
5
with such titles as Heinerman’s
Encyclopedia of Anti-Aging Remedies (Heinerman 1996), Age-Proof Your Body:
Your Complete Guide to Lifelong Vitality (Somer 1998), and Anti-Aging for Dogs
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(Simon and Duno 1999). The abundance how-to manuals with such motivating titles
as Outlive Your Enemies (Sanford 1996), invoke the growth of complementary and
alternative medicine as well as the trend toward personal responsibility. Moreover, it
reflects a growing dissatisfaction with mainstream biomedicine’s unwillingness to
focus on this important task.
Alongside pop-science interest, a few biogerontologists began mobilizing
anti-aging with the hope of legitimizing the endeavor. A UCLA conference in 1999
engaged eleven researchers for a roundtable on “Critical Future Milestones in Aging
Research.” Among those attending the conference were Austad, Caleb Finch,
George Martin and Cynthia Kenyon; no representative from the A4M was present.
A Science article covering the conference wrote that “they were a small group of
eminent academic scientists who had their reputations to think of” (Kolata 1999).
The taint of hucksterism clearly threatens the academic name these scientists have
built for themselves yet the risk the attendees incurred belied the belie that
postponing senescence should be tabled for discussion.
Financial sponsorship for this conference included the American Federation
for Aging Research and Kronos (a major anti-aging player in years to come as well
as a “unique integrated healthcare delivery system” founded in 1998

[Kronos N.d]).
The dovetailing of these individuals and supporters raises issues surrounding the
practice of science – the interest and stake in scientific endeavors is as much for a
clinic as it is for researchers’ careers, as it is for an arguably conservative,
mainstream funding organization. The abstract for the conference noted that research
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on aging had only recently emerged from being a “backwater.” To combat this exile,
the goal of devising a list of research milestones toward postponing aging was
explicitly marked as a way to strategically attract more research monies (SENS
N.d.). The financial component to this quest is instrumental to its success; for
continued funding of scientific activities, the goals and means must be unassailable
and this roundtable was a step toward scientific legitimacy.
Government agencies, universities and foundations are not the only funding
mechanisms: another realm is start-up/Big Pharma. As the anti-aging field gains in
prominence and magnitude, Pharma is attentive and biogerontologists proactive.
Kenyon, a molecular geneticist at UCSF is well known for her research on daf-2
genes and her lab’s six-times life extension of worms and in 1999 she and Leonard
Guarante of MIT founded Elixir Pharmaceuticals. A “genomics based company,”
Elixir hopes to “discover drugs that will slow down aging” (Elixir N.d).

The startup
would be named “among top 15 emerging biotech companies of 2003” and would,
that year, be the beneficiary of a $17 million dollar financing venture
6
. Many other
biotech companies were formed with the hopes of discovery an anti-aging treatment
and other companies included such goals in their lines of investigation: Helicon,
Advanced Cell Technology, Inc., Eukarion, Genentech, and Centagenix among them
(Solomon 2005).
Geron, the company started by researchers aiming to hunt down an anti-aging
therapy via manipulation of telomeres, went public in 1996. As part of its platform,
it poised telomerase (an enzyme involved with preventing the shortening of
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telomeres) for therapeutic intervention on “age-related diseases.” By 1997 Geron
was quietly moving away from anti-aging research in part to dissociate itself from
any taint of pseudo-science that anti-aging bestowed so that it could attract more
investment monies (Solomon 2005: 35). Nonetheless, Franklin notes that the
language of promise mobilized by Geron is significant. This promise overshadows
“a great deal of uncertainty, among the public at large and also within science itself,
about the risks of these much-celebrated potential advances. And these risks are not
just biological or medical” (Franklin 2003b). It is likely, too, that this uncertainty
played a role in the ways in which Geron speaks about its work and mission. The
language of intervention and aging and age-related disease, as well as the stains of
failed and mythical anti-aging pursuits are consequential on a level that implies not
only “pure” research, but also investors and the public at large.
The anti-aging focus within biotech firms illustrates the anti-aging’s growth
in the private sector. Moreover, it reveals the interest by gerontologists and the
sculpting of the stakes in this endeavor. Success is integral to the careers and
reputations of researchers, to the wallets of company founders, investors, and
shareholders. The winner in this game of biotech predicting and field-shaping stands
to be the beneficiary of the fountain of all that is good, not old, and wealthy.
An important aspect of legitimacy in science is peer-reviewed journals and
1998 saw the first issue of the Journal of Anti-Aging Medicine. Published by Mary
Ann Leibert, Inc. and with Fossel serving as Editor-In-Chief, the naming of JAAM
was a subject of some controversy even before the first issue. The A4M leadership
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maintained that they had already claimed that name and threatened to sue to keep it.
This matter was ultimately resolved out of court in favor of Leibert; the A4M went
on to publish the International Journal of Anti-Aging Medicine. As discussed in
Chapter One, this journal self-consciously placed itself in the gray no-man’s-land of
science. JAAM tendered its somewhat bastard subject of anti-aging medicine by
asserting itself as explicitly Science in the professionalizing way of peer-reviewed
publications. Later, in 2004, to preserve its legitimacy, JAAM was renamed
Rejuvenation Research under the editorship of Aubrey de Grey.
Edging its way out of the proverbial closet during these middle years, anti-
aging medicine made sweeping gains of prominence in both the public, private, and
academic sectors. The public profile of the A4M increased and the organization
went to great lengths to professionalize itself with the credentialing boards, the
consumer education initiative, and the LEXCORE attempts at coordinating scientific
work. Popular science books were published, a professional journal was launched,
conferences were held and popular media interested mounted. These developments
and the ways in which aging and anti-aging was invoked within them reflects
conceptual disparities regarding the relationship between aging and biomedicine.
Aging has been increasingly considered scientifically ameliorable but the conceptual
ways of intervening are still unclear. Gerontologists largely reject the notion that
aging is a disease and rail against this aging-disease link they see emanating from
much of anti-aging medicine. However, anti-aging medicine proponents do not
really say that – or, rather, they are not saying that in the same way. I argue that the
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disease link is used by some practitioners and some anti-aging groups because it
speaks most directly to the relationship between aging and biomedicine they
advocate. The aging-disease association rests on a very simple ‘read’ on disease –
that it necessitates treatment. Therein, the disease rhetoric emerged for lack of an
adequate vocabulary in which to think about aging and intervention.
However, the aging-disease rhetoric has indeed waned but is certainly not
gone. We can see this in the A4M’s move from presenting anti-aging medicine in
terms of disease and then a refinement to presenting anti-aging medicine in terms of
intervention. In part, the disease rhetoric has ebbed because the entrenched belief
that aging is nature contradicts too drastically with the notion that aging (and
therefore nature?) is a disease. But the potential for therapeutics for aging begs the
question of intervention: what does intervention mean if not at the site of disease?
Where does the process of aging end and the manifestations of aging begin? Fossel
posits, for example, that there is something that is aging that predisposes us toward
disease and that comprehending that something will likely make it possible to
intervene. Thus the process of aging becomes a target for intervention though the
entrenched notion that it is the duty of biomedicine to operate on the events of
disease leave us with a feeble vocabulary with which to deal with these anti-aging
developments. Compounding this, as Hayflick notes (2002), there is great confusion
over what aging means leading to a confusingly wide array of constructions and
relationships to aging. The discourse of distinguishing between the “manifestations
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of aging” versus the process of aging have emerged in the vacuity of consensus and
would continue to proliferate.

3.3 2000-2003
While important groundwork toward mobilizing physician and public support
was laid during the first phase of anti-aging medicine (1990-1995), the second phase
(1996-1999) gave rise to increasing gerontological interest alongside an entrenched
anti-aging activism. The turn of the millennium would usher in a new phase.
Scientific and public conversations would expand beyond the feasibility issue to the
direction that science ought to take – from whether or not we should pursue this goal
to what means would best suit it. Differentiating between prevention of disease and
cure would be a particularly thorny issue. No longer would the gerontological
community be so apt to dismiss the goals of anti-aging; the wrangling for authority
would be fiery.
From 2000 to 2003, the popular media became even more enamored of the
subject of anti-aging medicine. As the prospect of success became a topic for
increased deliberation, the excitement became palpable and the concerns ominous.
National Public Radio, Science Magazine, Scientific American, and Newsweek were
some of the major national media outlets addressing this movement. Scientific
American published a special journal edition focusing on aging and longevity in the
summer of 2000. “The Quest to Beat Aging” (Scientific American 2000) offered
both hope and caution. Austad was quoted as saying “the first 150 year old person is
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probably alive right now” (9). Finch asked “who’s to say we couldn’t go 10 or 20
years longer [than the oldest recorded lifespan of 122 years by Frenchwoman Jeanne
Calment]?” Tom Johnson, Professor at University of Colorado and founder of
GenoPlex was also clear in his prediction: “I’m confident we’ll find drugs that
stimulate resistance to environmental stresses and so increase longevity” (11).
While this edition also spoke of overpopulation and desires not to live longer, the
overarching tone was one of optimism and scientific glory.
Coinciding with the publication of Olshansky and Carnes’ optimistic but
cautionary pop-science book The Quest for Immortality (2001), Olshansky and
Austad publicized their wager involving the possibilities of life-length with intact
cognition. By 2150, Olshansky bet that the upper limit of human longevity would be
130 years whereas Austad more optimistically wagered 150 years. The potentially
$500 million dollar stakes are to be determined by three scientists appointed by the
American Association for the Advancement of Science and the winnings donated to
the winner’s school of choice (McCaan 2001). This wager between two recognized
gerontology researchers reflected both an optimism about the potential for
efficacious anti-aging interventions as well as the uncertainty this potential produces
amongst researchers.
Journal articles deliberating on anti-aging goals during this time were
numerous. In the summer of 2000, Geriatrics, edited by the International Longevity
Center’s Robert Butler, published a series addressing issues of efficacy and safety
(Butler, et al. 2000b), defining aging as a pathology (Butler, et al. 2000a), and an
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interview with anti-aging doctors (Raffaele, Livesey, and Luddington 2000). The
first of the three “roundtables,” addresses the question of what makes anti-aging
medicine different from geriatrics. Roundtable participant Michael Fossel notes that
while we cannot currently “affect fundamental aging… we can affect health.” (Butler
et al 2000a: 39). David Rothman, Professor of Social Medicine at the Columbia
College of Physicians and Surgeons, notes that the “appeal of anti-aging medicine,
even absent data, is returning to a systems approach” (Butler et al 2000a: 40). The
systems approach that Rothman refers to opposes the organ-focused approach to
medicine wherein disease is located and treated in a kind of bodily-geographic way.
And this focus on systems is a intriguing analog to health. While perhaps science is
unable at this moment to intervene into aging in a precise, bodily-geographic way, it
is able to operate on the larger notion of health – itself a kind of meta-systemic
evaluation. Fossel goes on to suggest that “all of us who treat older patients are
‘anti-aging medicine’ doctors” (Butler et al 2000a: 41) and this is in part because
there is a great deal of preventative care that both anti-aging and geriatric
practitioners undertake but also because the patients increasingly demand anti-aging
medicines. People – particularly babyboomers – are now more proactive regarding
their health and health care: the doctor “is up against a demanding, questioning, and
often very knowledgeable patient, who has probably read about these new anti-aging
compounds” (Butler et. al. 2000a: 43). Thus, engagement with anti-aging
interventions, whether their discouragement or their prescription, are bubbling “up”
from the lay arena into the biomedical practice. The systems approach to
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biomedicine that may be an important focus of anti-aging medicine, the drive to
improving “health,” and the effect of patient demands situates anti-aging medicine’s
philosophy of aging as ameliorable at the center of aging and biomedicine.
The second and third of the Geriatrics’ roundtables discuss the practice of
anti-aging medicine. Panel two addresses anti-aging therapies such as hormones and
nutrition. Butler opens this discussion by asserting that “our nation is engaged in an
enormous, unsanctioned clinical trial in which consumers are taking all sorts of
nonprescription remedies… without having any information about the efficacy or
safety of these substances” (Butler et a. 2000b). Opening the panel in this way
explicitly frames anti-aging medicine as an unproven and potentially dangerous
enterprise. As the panel members discuss the scientific “proof” of various
supplements and hormones, issues of scientific uncertainty
7
, the need for an
individualized approach to care, and overwhelming patient request surface.
Nonetheless, the older patient is situated as different from the younger patient. Dr.
Pan, Assistant Professor in Geriatrics and Adult Development, notes that it is
“important to realize that the primary care approach to the older patient may be
different from taking care of younger adults. When the younger adult comes in with
an illness, you usually want to find one single disease process that’s causing the
manifestations. But in older patients, the problem is often multi-factorial” (Butler et
al. 2000b: 51). This delineation between the two “types” of adult patient underscores
not only the uniqueness of older age but also harkens to the need for a systemic
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approach rather than a disease-focused one. In other words, the process of aging is
more than its associated diseases and patient care requires more than disease focus.
In the third panel, two anti-aging practitioners discuss their work and their
patients (Raffaele, Rivesey and Luddington 2000). Many of their patient’s are
themselves physicians (the A4M claims that over 70% of anti-aging practitioners are
also patients

[A4M N.d.d]) and the primary patient population is comprised of
babyboomers The panelists echo the claims that patients are requesting anti-aging
therapies and locate this trend within a disappointment in current biomedical care.
These practitioners’ patients express “dissatisfaction with internal medicine’s
approach to the diseases of aging” (37) thus further recognizing a distinction
between treating the process of aging itself and reacting to the disease-effects of
aging. As I discuss further in Chapter Four (and in Mykytyn 2006), this
dissatisfaction is indeed a widespread, compelling rationale for practitioner and
patient migration toward anti-aging medicine.
Biogerontology published a debate between Aubrey de Grey, a major
proponent of anti-aging, and Eric Le Bourg who cautions gerontologists to limit their
publicized optimism (Le Bourg 2000a, de Grey 2000, Le Bourg 2000b). The role of
responsible researchers responsibility to the public is in question; how vocal and how
soon should gerontologists discuss anti-aging research beyond the academy? This
discussion also leads to Wick’s (2002) warning against anti-aging in Experimental
Gerontology. He links anti-aging medicine to the host of products offered under that
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banner thereby lumping all anti-aging endeavors into the same bucket as predatory
quackery.
An entire edition of Generations, a social gerontology journal, was devoted
to the polarizing question “Anti-aging: are you for it or against it?” (2001). This
issue overwhelmingly asserts that anti-aging practitioners and proponents view aging
as a disease; the Generations authors rail against such a categorization. Butler
argues that anti-aging medicine “promotes and reinforces ageism because it is based
on the misconception that normal aging is a disease. It puts a profoundly negative
connotation on the natural and inevitable occurrence of growing old, emphasizing its
negative and depleting aspects” (Butler 2001: 64). Carole Haber locates anti-aging
medicine within the long line of pursuits pre-dating it. She asserts that “old age is a
disease to be eliminated by science is hardly a novel idea; it has a recognizable
history” (Haber 2001: 9). Hayflick, too, argues that aging is not to be considered a
disease: “[t]here are thousands of manifestations of the aging process that few would
consider to be pathologies or disease in need of a cure. Emergency room personnel
would not look kindly on patients who sought admission because of complaints that
their hair is turning grey” (Hayflick 2001: 21). Thus, many of these authors seek to
temper the current they see as anti-aging medicine and to dissociate aging from
disease. Moreover, the critique implicates notions of humanity and how anti-aging
medicine is threatening. Issue editors Thomas Cole and Barbara Thompson argue
that “whenever “anti-aging” enourages [sic] evasion, denial, or avoidance of painful
constraints, it points in anti-human or dehumanizing directions” (Cole and
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Thompson 2001: 7). Anti-aging medicine here is constructed as misguided at best
and dangerous at worst
Of all these publications, the Generations piece was the only one to include
the A4M in its discussion. While Raffaele, Livesey, and Luddington (2000) mention
the A4M, Generations included a chapter authored by A4M founder and President
Ronald Klatz (Klatz 2001). Sounding like a clip from the A4M website, his article
trumpets the benefits of this new paradigm. The other thirteen Generations articles
are more cautious and while they do not mention Klatz or the A4M by name, they
accuse the “non-scientists” of “exploiting the ignorance and gullibility of the public”
(Hayflick 2001: 25). Klatz counters this by asserting that anti-aging medicine is
scientific, evidence-based, and well documented in peer-reviewed journals. He offers
the “original, official definition of anti-aging medicine” as “a medical specialty
founded on the application of advanced scientific and medical technologies for the
early detection, prevention, treatment and reversal of age-related dysfunction,
disorders, and diseases” (Klatz 2001: 59). Klatz’s article does not link aging to
disease and is careful in outlining the goals of anti-aging medicine in relation to age-
associated diseases.
While staging a sort of silent protest of not-publicly-naming their opposition,
the gerontological academy was, indeed, paying close attention to the A4M. Perhaps
the most significant document in this debate was the Scientific American position
statement published in the early summer of 2002 (Olshansky, Carnes and Hayflick
2002a, 2002b). Scientific American is not generally in the business of publishing this
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kind of position paper and thus, the “Truth About Human Aging Position Statement”
article and on-line position paper was a rare move on the part of the respected
magazine. The fifty-one gerontologist-signatories stated emphatically that there are
“no lifestyle changes, surgical procedures, vitamins, antioxidants, hormones or
techniques of genetic engineering available today that have been demonstrated to
influence the processes of aging.” The paper was sparked by worries over the
relative gerontological silence on anti-aging and a fear of unwittingly contributing to
the its growth by not voicing dissent.
Although there is every reason to be optimistic that continuing progress in
public health and the biomedical sciences will contribute to even longer and
healthier lives in the future, a disturbing and potentially dangerous trend has
also emerged in recent years. There has been a resurgence and proliferation
of health care providers and entrepreneurs who are promoting antiaging
products and lifestyle changes that they claim will slow, stop, or reverse the
processes of aging.

This article aims to distinguish the “real” science of aging from the
pseudoscientific anti-aging proponents. It accomplishes this not within the realm of
whether or not science will have future breakthroughs but rather about the
interpretation of current work: the “real” science may succeed in the future, however,
the current anti-aging work rests merely on claims and therefore is suspect.
Their clarity is hard won. That “fifty-one researchers agree” is presented to
underscore that their statements are, indeed, the truth. Olshansky described the
collaborative process as intensive, time-consuming, and remarkable

(Personal
communication with Dr. Olshansky August 20, 2002). This inadvertently spotlights
the fact that the science of aging is contentious and that it is, truly, made of people.
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The significance of agreement calls attention to the interpretive practice of science.
If science spoke so clearly for itself, there would not be so much enthusiasm about
the concord. Austad, however, did not sign this “exclusive;” though he received a
great deal of pressure to do so, he took issue with the portion on genetics and refused
to add his name (Personal communication with Dr. Austad November 24, 2003).
Many gerontological notaries did sign, however: Kirkwood, Johnson, Coles, de
Grey, Martin, Perls, Butler, among others, and the authors Olshansky, Carnes and
Hayflick.
The enormous publicity over the Scientific American piece was not always in
favor of the gerontologist-signatories. On the American Association of Retired
Persons (AARP) discussion board, the comments were overwhelmingly annoyed.
One writer states: “I will not heed the [Scientific American] warnings” (AARP
2002a). Another person located the gerontologists as pharmaceutical yes-boys
noting that “there are MOUNTAINS of evidence that show many of the therapies
and products derided in this article help people like me live more active lives. Stop
selling fear to support the drug companies’ bottom lines” (AARP 2002b). Another
contributor writes in response to the excitement over the successful collaboration:
“There are more scientists alive today and working than ever lived on this planet
before. Just because you got 51 of them to make some claim does not make it
significant” (AARP 2002c). Olshansky responded to the comments online by
reiterating the distinction between intervening on the manifestations of aging (like
cancer) and the biology of aging. Mindful of his audience, he also stressed his
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optimism that we will one day be able to “modify the rate at which we age” (AARP
2002d).
Swiftly, the A4M responded to the Scientific American position statement
with their own “Official Position Statement” (A4M 2002b). Their rhetoric is
definitive: “the death cult of gerontology desperately labors to sustain an arcane,
outmoded stance that aging is natural and inevitable.” Fighting the death cult on a
point-by-point “Gerontological Bias/A4M Factual Response” basis, the A4M
rebuttal was strategic, citing mainstream journals (including the Rudman study) and
locating gerontology as the entrenched bullies of conservatism. Recognizing that the
battle for funding is one of the most significant, the A4M notes that “discoveries
made in human aging interventions threaten the powers-that-be who exert a
stranglehold control of the pursestrings that fund aging research.” Here, the
establishment falls vulnerable to the revolutionaries of science.
The Scientific American article ratcheted up the discourse on the
manifestations of aging. That talk had, as we have seen, been lingering but this
article foregrounded it forcefully and explicitly. The YET factor, whether science is
ready yet to declare a “true” anti-aging remedy, highlights optimism and potential for
future therapies while at the same time delineating between the “real” and the
“sham” science of aging. This distinguishing marker also revolves around whether
or not current anti-aging therapies address aging itself or, rather, the effects of aging.
Partially because there is no accord in defining the mechanisms of aging,
distinguishing between intervening into the process of aging or the manifestations of
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aging becomes hazy. And this haze provides the cover for those who believe in
current anti-aging interventions and those who believe these interventions to be
merely attempts at dealing with aging’s manifestations. This also speaks to notions
of consensus – is the interpretation of current scientific evidence “enough” to
establish health and treatment claims? In the face of such tensions, the responsibility
of science and biomedicine in regards to aging and aging patients is unsettled.
In the wake of the Scientific American article the Silver Fleece award was
established as another arm of the public education campaign to distinguish between
the “legitimate” research and “entrepreneurial” anti-aging practice. “Honored” in the
first round of the Silver Fleece Awards was the A4M (2002); the third annual Award
was given to a suite of anti-aging substances created by the A4M’s Klatz and
Goldman and sold on the Internet by Market America, Inc. and to the International
Journal of Anti-Aging Medicine published by the A4M (2003). Working in the
public arena, these awards aim to highlight the preposterousness of much of the anti-
aging world thereby claiming legitimacy for the benefactors of the awards and
undermining the voice and purchase of the beneficiaries.
Science established The Science of Aging Knowledge Environment (SAGE-
KE) in 2001 as the “premier online forum for emerging issues of human aging”
(Sagecrossroads N.d.).

Funded through a major gift from the Ellison Medical
Foundation this “subscription-based Website… publish[es] original Perspectives,
Reviews, and Essays/Editorials” and in 2003 began monthly webcasts of debates on
aging topics. With links to the Scientific American position statement and other
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articles, this site fostered a scientific discussion of anti-aging. The webcast debates
have brought in researchers such as de Grey, Olshansky, Callahan, the chairman of
the President’s Council on Bioethics, and notably, has not invited an A4M
representative.
To publicize the site, Science published a special edition on aging in February
2003 (Martin, et al., 2003). Gerontologist and site editor George Martin introduced
this edition stating that “scientific research on biological mechanisms of aging may
be at the end of the beginning, but the larger discussions of why we study aging and
the proper use for this knowledge are yet in their infancy” (Martin, et al. 2003:
1341). This “end of the beginning,” reveals a shift away from the dismissal of anti-
aging goals and toward a potent discussion of means and ethics. The editors of this
special issue of Science argue that focusing on the “one disorder at a time” approach
is too limiting whereas “it is through deciphering the biological underpinnings of
processes of aging that scientists will likely discover ways to extend the human life-
span” (Martin, et al. 2003). Here again the focus on disease comes to mean a
restrictive and ultimately futile endeavor. Thus, asserting that the processes – not a
single process but rather plural processes – of aging should be the focus of those
interested in extending life.
In one of the many extensions of Rudman’s hGH research, Marc Blackman
detailed in JAMA the effects of hGH on “composition, strength, endurance, and
adverse outcomes in aged persons” (Blackman, et al, 2002). Study subjects who
took hGH gained lean body mass and lost fat; adverse effects included diabetes and
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tissue aches. The study was hopeful but Blackman urged that hGH is not “ready for
prime time yet” because of the uncertainty of long term effects and the relatively
small size of the study group (Kolata 2002). The A4M’s response issued the same
month read the results more optimistically and countered the severity of these side
effects. “It is the position of the A4M that the side effect profile of GH therapy is
nominal when the dosage is properly determined and monitored by a qualified
endocrinologist or anti-aging physician.” The statement goes on to note an
“overwhelming number of peer reviewed, scientific studies published in the past 24
months that clearly support the benefits of adult GH therapy” followed by a listing of
some of those studies (A4M 2002c). Again asserting expertise – or, rather, the
expertise of anti-aging physicians – the A4M cites science against science aware that
interpretation is political.
The hGH research controversy invokes the dramatic history of hormone
replacement therapy (HRT). The rise of menopause as a socially important time
marking a woman’s end of reproductive capabilities came with a flurry of interest in
the replacement of estrogen and then progesterone (see Greer 1992, Gonyea 1998,
Kaufert 1988, Lock 1993 among many others). The subject of continuing
controversy, menopause and HRT remains a prominent debate and women and their
doctors are left to decide for themselves whether HRT is indicated. Andropause, or
the male equivalent to menopause, is now making its way into national discourse
carrying with it discussions of testosterone replacement for older men. The hGH
battle falls in with these histories as practitioners claim the HRT work to have been a
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revolution that took years to catch on just as they expect for hGH. Moreover, it
seems, benefit and risk interpretations are not clear-cut and subject to deliberation
but the construction of the problems of the pauses demands a search for their
solution.
The efforts to distance gerontology and the “real research” from the
“entrepreneurs who hawk anti-aging remedies to the senior set” (Sommerfeld 2002),
is a topic taken up by social scientist Robert Binstock. He locates the gerontological
“war on anti-aging medicine” as an attempt to “preserve their hard-won scientific
and political legitimacy, as well as to maintain and enhance funding for research on
the basic biological mechanisms of aging” (Binstock 2003). The link between
gerontology and science is historically rickety and as anti-aging claims threaten to
destabilize it, gerontology defends its borders. Highlighting the debate prompted by
the Scientific American statement and the A4M response, Binstock argues that this
“war” may have inadvertently “blurr[ed] public understanding of the difference
between the anti-aging medicine movement and the anti-aging aspirations of some
biogerontological researchers.” The boundaries of which Binstock speaks assume a
fairly rigid distinction between these two groups. The blurriness that I argue exists is
rather a feature of contentious scientific interpretation and competing claims more
than a silly and stars-in-the-eyes public.
In October of 2000, the SENS – or Strategies for Engineered Negligible
Senescence – conference took place as a follow up to the UCLA Roundtable.
Bringing together eight researchers who believe that something that can and should
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be done about aging, this conference led to the an article in the Annals of the New
York Academy of Science (de Grey, et al. 2002). Their notion of SENS draws on
Finch’s idea negligible senescence (Finch 1990) while explicitly championing the
plausibility of the indefinite postponement of aging and discussing tactics for its
achievement. The article counters the “pessimism” of gerontologists and argues that
“reversing mammalian aging is not necessarily harder than dramatically postponing
it.” Anticipating public concern, the authors advise that apprehension “must not
divert us from pursuing a goal that, after millennia of frustration, may now be within
sight.” The authors vie for adequate funding and strategize research efforts toward
this lofty goal.
The second SENS conference in August of 2001 was funded by the
Maximum Life Foundation. The MLF with Coles, de Grey, and Guarante among
others serving on the scientific advisory board, was founded in 1999 upon the
mission to “accelerate the pace of research on the human aging process” (MLF N.d.).
The SENS conference resulted in an article in Bioessays (de Grey, et al., 2002) that
is highly optimistic about reversing aging and chastises biogerontologists rather than
“their interlocutors” (read: A4M). The biogerontological “focus on making aging
less debilitating has given rise to phrases such as ‘successful aging’ and
‘compression of morbidity’ as goals… However, diverse statistics show consistently
that the period of late-life frailty is not being shortened by medical advances.”
Admonishing the academy for their complicity in not pursuing anti-aging rather than
scolding the A4M and anti-aging practitioners reframes the debate as a one of
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scientific strategy and plausibility rather than defense of science in the name of
public protection.
Another effort to reframe the discussion of anti-aging, and yet another led by
Aubrey de Grey (lead author in both SENS publications), was the invention of the
Methuselah Mouse Prize. This prize awards researchers documenting the oldest lived
mouse (postponement prize) and the best late-onset intervention (reversal prize).
Developed with help from creators of the Space Tourism Xprize
8
, Methuselah was
launched in June of 2003. De Grey believes that scientific prizes attract people and
increase the visibility of the goals (Personal communication March 30, 2001). By
applying for research funding toward these goals, the prize motivates interest and
cannibalizes research monies as well. The “fatalism” that serious anti-aging is a
pipe dream can be most effectively combated by success

(Methuselah Mouse Prize
N.d.a). By March of 2004, donations for the prize had reached an astounding
$51,534.28 with most contributions coming from individuals donating under $100
each (Methuselah Mouse Prize N.d.b). Recently, in September of 2005, the founder
of the internet credit card payment site PayPal pledges $3.5 million dollars to the
Methuselah Foundation further underscoring its increasing attractiveness to
individuals outside of the research establishment.
In January of 2002, President George W. Bush appointed a panel of medical
doctors and ethicists to the President’s Council on Bioethics (PCBE). The PCBE
dealt principally with stem cell research though anti-aging became a particular focus
in 2002 and 2003 with both Austad and Olshansky testifying (I address this Council,
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its meetings and its findings in greater detail in Chapter Five). By October of 2003,
the PCBE had issued a lengthy report entitled Beyond Therapy: Biotechnology and
the Pursuit of Happiness; the chapter on “Ageless Bodies” spoke directly to anti-
aging issues. Accepting as imminent the goal of life extension, the chapter examines
the “ethical considerations.” The report asserts that the fear of decline motivates the
hunt for “ageless bodies” while at the same time it is death and the final summation
of aging’s decline that is
central to what makes us human rather than divine… The scientific quest to
slow the aging process is not explicitly aimed at conquering death. But in
taking aging of the body as itself a kind of disorder to be corrected, it treats
man’s moral condition as a target for medicine, as if death were indeed rather
like one of the specific (fatal diseases)… It seeks to overcome the ephemeral
nature of the human body, and to replace it with permanent facility and
endless youth. (PCBE 2003)

Anti-aging raises profound questions of the meaning of humanity and the
proper job of science. The PCBE asserts that humanity is inextricable from death;
life’s meaning is wound with its end. Thus, a medical endeavor that undermines
death undermines humanity. The Council’s conservative approach to stem cell work
created a public outcry; the publication of “Ageless Bodies” provoked a squall
around which anti-aging proponents and researchers would respond.

3.4 CONCLUSION
Since the 1990’s and with the support of patient/practitioner advocates, the
anti-aging movement has captured the attention of the media, the government, and
increasing numbers of clinicians and gerontologists. The emergence of anti-aging
medicine not only highlights differences between and among the various players in
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this complex field, it also defines stakes for expertise. Claiming leadership in the
emerging field, the A4M positions itself between the science and the patient,
investing in both. JAAM (renamed Rejuvenation Research in 2004 under the
editorship of Aubrey de Grey) stands out as an important site of recruitment for the
notion of anti-aging; the journal is a rallying point of anti-aging research asserting
expertise through the biogerontological “bench.” While the A4M gladly adopts
research published in JAAM and other journals, the organization is not seen as an ally
for the aging researchers. Vying for increased funding on the biological processes of
aging and for a revolution in our understanding of aging, all of these groups share an
imagined future of biotechnological victory.
In the early years of 1990-1995, the idea of targeting aging for intervention
became tenable. Though the mainstream, traditional categorizations of aging as too
natural to affect looms as a huge hurdle for anti-aging medicine, these notions of
aging are being tried. The middle years of 1996-1999 saw a dramatic increase in
anti-aging attention both scientifically and publicly and the various groups were
jockeying to administrate-execute this reframing of aging as ameliorable. By 2003
the dream of scientifically targeting aging for intervention had become plausible
enough for scrutiny. No longer was it relegated to the fantastic. The morality of the
quest continues to be contentious while the scientific debates are shifting toward
strategies and timelines. Some timelines involve lifespan limits while others deal
with the when of the imminent scientific progress. The optimism has become
torrential.
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The debates around anti-aging medicine circulate around issues of funding,
feasibility, prevention of versus reversal age-associated decline, morality, expertise
and the legitimacy of the field. While increased scientific funding is desired by all,
many gerontologists feel that the A4M threatens funding with its claims, the A4M
advocates see gerontology as inappropriately targeting funding toward keeping
people old. As talk of anti-aging increasingly embraces its feasibility, debates over
goals of reversing aging and mitigating age-associated decline become furious.
Whether we should pursue such a goal looms as a powerful ethical question. As
apologists caution against the potential harmful effects to society and claiming the
quest undermines our humanity and advocates asserting that alleviating human
suffering is precisely the goal of biomedicine. The quest for expertise, for who has
the final word in the interpretation of anti-aging medicine science, lies at the heart of
this potent debate. The A4M, the apologists, the optimistic biogerontologists all
make a bid for an anti-aging identity. A battleground of expertise lies in the
recognition of anti-aging as a scientific field and identifying as a field has been a
debatably successful outcome of this movement. While some claim it as an
extension of gerontology and others claim it as a unique domain, and while many
replacement monikers have been floated (such as “longevity medicine” and “life
extension medicine”) anti-aging medicine surely has a place now in popular
discourse.
The protagonist in this unfolding story of anti-aging medicine is aging, and
more specifically, the relationship between aging and biomedicoscience. In the
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thirteen year span surveyed here, anti-aging medicine rhetoric has largely moved
away from specifically categorizing aging as a disease and instead moved toward the
intervention into the aging process. While discussions regarding the manifestations
of aging and whether or not any anti-aging therapy currently exists pose serious
questions around the practice of anti-aging medicine, the idea of intervening into the
aging process has gained tremendous purchase.
Anti-aging medicine merges histories of the development of hGH and other
companies attempting to find anti-aging interventions, the aging baby-boomer
generation, a scientific quagmire in defining aging, the arguably human universal
desire to halt aging, scientific controversies, a reductionist biomedical complex, the
internet, a trend toward “better-than-well” medical practices, hucksters and personal
health responsibility. A complex arrangement of midwives has birthed this
movement and many fortunes and fates are at stake in it. Nonetheless, the
comparisons with previous, failed anti-aging quests are falling away as a scientific
promise increasingly frames aging as a target for biomedical intervention. A
growing group of biogerontologists and anti-aging practitioners and the A4M declare
scientific potential; the bioethicists on the PCBE and elsewhere in the gerontological
community tarnish this promise with claims of infeasibility, immorality and
inhumanity. Seeking to shift ideas of nature and biomedical objectives, the anti-
aging movement has, at the minimum, succeeded in placing the question on the
national scientific table. With the controversy over anti-aging medicine rising, its
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promise is palpable for many medical practitioners. In the following chapter, I will
examine the complexities of their interest in this field.

1
In 2000, the State of Illinois Department of Professional Regulation ruled that Klatz
and Goldman may not claim the “MD” degree since the MD received in 1998
by the Central America Health Sciences University School of Medicine (an
institution approved by the World Health Organization) was “never properly
licensed through this department” (www.quackwatch.org/111nd/klatz.html).

2
CoQ-10, a dietary supplement, is thought to have antioxidant properties. DHEA, or
Dehydroepiandrosterone, is a steroid hormone whose production declines
with age and is often billed as a kind of “wonder hormone.” SOD, or
superoxide dismutase, is thought to disarm free radicals thereby reducing the
oxidative stress that may increase with age.

3
Stopping the clock: why many of us will live past 100--and enjoy every minute!
(1996), Anti-Aging Secrets for Optimal Digestion and Scientific Weight Loss
(1996), Grow Young with HGH: The Amazing Medically Proven Plan to
Reverse Aging (1998), Ten Weeks to a Younger You (1999a), and Anti-
Aging Secrets for Maximum Lifespan (1999b).

4
The boards cost U.S.$4035 for physicians and $1190 for health practitioners
including preparation materials (prices current as of 03/2004). For
comparison, the cost of sitting for a board exam at the American Board of
Internal Medicine was $950 in 2004 per telephone call to Board March 22,
2004.

5
This number was determined via a sampling study I conducted in 2004. An online
search of book seller Barnes and Noble for publications on “aging and
longevity” as well as “anti-aging” revealed that before 1990 25 books were
published; from 1990 to 1995, 52 books; 1996-1999, 139; 2000-2003, 92.

6
This is the first closing of a second round of financing. MPM Capital, Oxford
Biosceince Partners, and ARCH Venture Partners. (www.elixirpharm.com
accessed March 24, 2004).

7
Scientific uncertainty is presented regarding the prescription of estrogen, the
paucity of evidence regarding the use of progesterone and testosterone and
beta-carotene and vitamin E (though evidence is growing).

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8
The X Prize is a $10,000,000 award to the first privately-funded person or team to
travel to and from the edge of space (www.xprize.org).
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4. MIGRATION TO ANTI-AGING MEDICAL
PRACTICE: PRACTITIONERS AND THEIR STORIES

With all of the raging debates and relative volatility of anti-aging medicine,
why are practitioners immigrating to this kind of medical practice? Opponents of
anti-aging medicine argue that it is the financial incentives and profit potential that
lures practitioners; those who practice anti-aging medicine are often labeled
“charlatans” and “profiteers.” Nonetheless, I argue that while the reasons that
practitioners migrate to anti-aging medicine include money, they are more varied
and complex than a profit-potential connotes (See also Mykytyn 2006b).
I argue that the anti-aging medicine 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
upon their own therapeutic success have redirected their biomedical careers to anti-
aging. These patient-practitioners opt in to 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
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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 renewed mission.
Thirdly, this troubled relationship with biomedicine is further complicated by
a 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 mitigate. 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 anti-aging medicine. 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
anti-aging as the overarching goal of explicitly targeting aging for biomedical
intervention. These stories show a growing distaste with 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
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enhancement (Elliot 2003) over suppression and palliation of pain. Practitioners do
not assert that aging is a disease and accept that it is a natural process; however,
they further argue that aging is not healthy. Thus, this pursuit is balanced upon the
notion that it is the process of aging itself that must be addressed. 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.
The individuals interviewed for this research were located via the American
Academy of Anti-Aging Medicine (A4M) directory of anti-aging practitioners. The
practitioners are medical doctors, chiropractors, nutritionists, and even
psychotherapists. 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, fifteen of twenty were
men ranging in age from their mid-thirties to early-seventies. Those interviewed
reside in Los Angeles, Chicago and Las Vegas; the A4M and Life Extension
Foundation websites show that most every state in the U.S. has at least one anti-
aging practitioner with a concentration in the Southwest, Florida, and the New York
areas.
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 anti-aging medicine affecting themselves, their patients,
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and biomedicine within the U.S.
1
. As mentioned in Chapter 1, the practitioners were
remarkably receptive to being interviewed with only two declining to speak with me
due to “impacted schedules.” The high interview rate suggests that practitioners
welcome greater attention and are eager to engage in discussions of their practice.

4.1 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.
3

Anti-aging practitioners largely believe that aging is a decline: painful and
costly both individually and societally. Practitioners question the worthiness of a life
wracked with physical and mental anguish and also question their complicity in
perpetuating this model of aging. Many of these practitioners witnessed their
parents, their patients, and themselves suffer as they age. Experiences with aging
emerge as significant motivation for involvement with anti-aging medicine.
Dr. S: The anti-aging name was enticing. We all want to stay young…
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.
4

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For Dr. S, the decline of physiology begins in the teenage years while the ages
of forty or fifty are identified as a “good age” range at which to remain. Because it
was in these two decades that he “grew up,” this age 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 afterward. 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 in the terrible about-face of biological aging.
Dr. S listed these bodily developments as processes – “natural processes.”
They happen over a relatively long period of time and are predictable enough to be
generalizable. Dr. S presented two peaks in this process: (1) the physiological apex
of late-teen/early-twenties after which degradation ensues, and (2) his personal
maturity in his forties and fifties when he “grew up.” These two moments of
physical, mental/emotional glory reveal not only a belief that a certain separation
between mind and body occurs (though are linked again with the loss of mind that
often comes with older old age), but also and perhaps more importantly, that anti-
aging medicine is not about being young but rather physiologically feeling young.
The youth of body and the maturity of “middle” age are bound together as the kind
of pinnacle desire.
Dr. D’s experience with old age is found in the images of convalescent care
homes. Though less than five percent of individuals over sixty five are actually
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institutionalized in the U.S. (Saldo & Freeman, 1994), the convalescent home is the
pinnacle symbol of aging’s biological decline.
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 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.
5

For someone no longer able to care for oneself 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 quantity of life but raise
quality of life – preferable both at the same time.
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, ‘Abner
6

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
certificate… I’m never going back to that kind of practice again.
7

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.
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Dr. X’s filled waiting room and loyal patients only served to fortify his sense that
such biomedical work was hopeless. Serving as a witness to deterioration did not
seem to be “doing any good” with “all the technology of the day” for the patient or
Dr. X. Dr. O notes that medicine made her “depressed. Being a doctor I felt so
helpless… I was longing to find something else.”
8
Anti-aging 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 glibly recalls seeing a wrinkle
in the mirror and thinking “physician, heal thyself.”
9
To help others, one must help
oneself first, so the adage implies. And anti-aging medicine, unlike pediatrics
oncology for example, is well-suited for self-treatment since patienthood status is
generated simply by virtue of being human. Dr. S begins his migration story by
stating that he is a “senior citizen,” and became interested in anti-aging medicine
because he himself is old.
10
Dr. Z, who is not a “senior citizen,” sees his wrinkle
symbolizing the lurking decline. The embodiment of a perceived old age motivated
many of these practitioners to seek a way to avoid the prowling decay. The ability to
symbolically stand for health by “healing thyself” presents as a critical step toward
helping others.
The “self-help movement” that has emerged in the past decades, exemplified
by the proliferation of relationship books, diet books, spiritual growth books and
seminars and motivational lectures on such topics, may be applicable in part to anti-
aging medicine. Scholars who have examined self-help and the “makeover culture”
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argue that this movement is principled in the belief that individuals can create their
own realities and even “re-make” themselves (McGee 2005, Salerno 2005).
Furthermore, the notion of self-help can be critical to the creation of illness identities
by increasing visibility for the illness and coalescing suffering under a specific label
(Barker 2002). Certainly, anti-aging practitioners are vying for a their work’s
legitimacy. But, perhaps more interestingly, is the notion of transformation here.
The belief that one can improve one’s relationship to the universe, to food, to one’s
mate and so forth may indeed set the stage for a belief in improving one’s process of
physiological life. While the self-help movement and anti-aging medicine are not
explicitly linked, this belief in transformation lies at the center of the anti-aging
pursuit.
Another physician began her own anti-aging regimen in her early thirties,
prompted by the fact that her brother had suffered a stroke when he was only thirty
years old:
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. L— he’s the owner of [the laboratory
who tested the blood]. I said… ‘Dr. L., 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 school... And then in one or two years I
knew I was rejuvenated… You cannot stop aging. But I think what I did
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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.
11

Though Dr. O hesitates to say that she “stopped aging,” her anti-aging
regimens did reverse her laboratory-defined chronological age. An analysis of her
biomarkers
12
revealed initially that she was seventy years old biologically while she
was chronologically thirty-two – a frightening fifty-eight year difference. Aging and
“aging too fast” here are distinguished by laboratory testing and the former becomes
the baseline while the latter a target for intervention. These tests that are said to
determine biological age, then, are very powerful in defining normal aging against
which abnormal is cast and treated. Dr. M describes the use of one of the more
standard sets of tests:

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 twelve 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 to… So if you’re 30 and you do the test and you come out at
26, then physiologically, you’re ahead of your age.
13

Dr. M’s discussion of the biomarker tests reveals not only some of the ways
in which these physiological determinations are made, but also the importance of a
biological baseline. A mammogram of a “normally aging” or perhaps “average”
thirty year old woman will look like “X”, and it is against this image that a testing
patients’ mammogram is compared. According to Dr. M, Dr. Hofschild, and others,
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aging involves functional loss that can be measured so that an individuals’ body can
be measured and scored against the statistics.
Returning to Dr. O’s narrative of her very personal introduction to anti-aging,
we see that for Dr. O, aging is a lurking, unstoppable force. But “aging too fast,”
also a shadowy thing only seen via laboratory tests, could be stopped. Here aging is
divided into the normal and the problematic. Disease is not invoked by Dr. O,
though a mandate for treatment certainly is indicated by the “too fast-“ness of her
personal aging. Laboratory tests allowed her to “see” her “aging too fast”
physiology in ways that she did not otherwise acknowledge. Frightened by the
results and her relative ignorance of anti-aging medicine, she set about investigating
and incorporating various treatments and eventually felt successful in “repacking her
blood.” The notion of repacking conjures up images of replacements correlating
aging to decline, loss, subtraction of health. Anti-aging medicine becomes a plug in
the dike, a kind of years-bequeathing fountain of replacements.
Many of the practitioners noted that they became anti-aging clinicians because
the treatments worked for them. They were patients first, able to stand as breathing
testimonials to their patients and colleagues. These patient-practitioners quite
literally embodied their work. Anti-aging practitioner 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
running upwards of $10,000U.S. per year. Dr. R indicates that many of these
patient-practitioners are trying anti-aging on themselves and should it prove
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effective, will migrate to an anti-aging practice. Aging is something that happens to
everyone – a sort of guaranteed demise indicating a nearly universal patienthood
whose possible treatments may be self-tested.
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
victimhood. Speaking of the current biomedical approach to aging, he states:
It’s a victim model. You grow older, you get sick, you smell bad…, you lose
your teeth, bone density, vitality, sex drive, and so on. And not that
everything should be young forever… 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.
14

The pain of sickness and the offensiveness of malodor are presented as
obstacles rather than acceptables. This mode of understanding quite explicitly
mandates intervention and castigates those who are “accepting” and those who
sponsor such a model of aging (read: gerontology and geriatrics).
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!”
15
and
snidely imagines attending a polio conference at which iron lung exhibition booth
personnel wore such a badge. Honoring the need for iron lungs – and the suffering
seen as necessitating them – is opportunistically hideous. Likening aging to polio
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clearly condemns those advancing 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’s response
echoed many other practitioners’ with a skirting of the question and a reassertion
that the most fundamental point is that aging is fixable. Many of 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.
CEM: One of the interesting things about anti-aging to me is this idea that
aging is a disease. And I’ve talked with a number of physicians who don’t
necessarily agree with that. I’m getting that from—
Dr. B: Right but that’s why it’s
CEM: —the A4M stuff (Dr. B: yeah) But it’s a really interesting concept to
think of aging as a disease, that sort of causes things like cancer or heart
disease, diabetes…
Dr. B: It’s a process, at least I would call it a process. And, um, it is kind of
this part, that um… that…kind of, the progression in a person’s life, is aging.
CEM: But you don’t see the aging in itself as a disease.
Dr. B: [pause] I’m not sure. Maybe as a syndrome I would call it maybe
probably just a syndrome, that, uh, our interest is in trying to slow it down,
by preserving certain substances in the body, or certain levels in the body to
the optimal level by replenishing the levels, so that process, that aging
process gets slowed down.
CEM: Now how would you, how would you figure out, what is optimal and
what is normal, I mean how are things kind of…?
Dr. B: I think it’s still, we go by whatever we know at this point.
CEM: Sure. And it’s always evolving.
Dr. B: Yeah, it’s always evolving…
16

Dr. B expresses a reticence in categorizing aging as a disease and yet
simultaneously is unsure of an adequate replacement framework in which treatment
is acceptable. Dr. B categorizes aging as a process and, when pressed as to the
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question of whether aging is a disease, frames aging first as a syndrome and then
reverts back to his initial assessment of aging as a process. Nonetheless, this process
is amenable to intervention, to “trying to slow it down” via a range of therapies. Dr.
B acknowledges that the distinction between normal and optimal is temporal –
dependent upon what we currently know with room for shifts as we come to know
more. Dr. B collapses knowing and categorizing into the same act; science produces
fact that may only “fit” into other facts in very precise ways. However, not only is
the act of knowing a particular cultural enterprise, but so is interpretation and sense-
making of that knowledge. Dr. B’s statement underscores his belief in a rationalist,
consensus Science even though what he is currently practicing in his medical offices
is in the midst of a great debate about “what we” actually “know now.”
Dr. N similarly has difficulty talking about aging and disease and where his
work fits into the equation:
CEM: So do you believe that, a lot of what I have heard also is that aging is
explicitly a disease. And there’s a lot that goes into it in terms of what the
FDA can do if it is or is not a disease, and those kinds of things, more than
just semantically, but, would you venture to say that aging should be
classified as a disease in that sort of sense?
Dr. N: No, I don’t think so. I think ahh- no, I think the diseases of aging, are
diseases which you shouldn’t accept. You know, I mean, but aging in itself,
is I still think a natural process. We might push down the clock 10, 20, 30
years…, who knows, somewhere in that range. And then there’s some other
possibilities, more scientific possibilities, but in a natural lifestyle level we
have a certain…, but,I-I, you know the whole concept of the, the… I would
say, I wouldn’t accept the disease of aging necessarily, some of it’s
necessary. Uh, but aging in itself, it depends how you age, I mean there are
some people who age healthy. I mean just the fact that they’re wrinkly at 85,
I wouldn’t necessarily consider a disease. You see what I’m saying?
CEM: So the disease aspect would be things like joint pain (N: joint pain)
and loss of bone density and those sorts of things.
Dr. N: Correct. Depression, low vitality, cardiovascular disease…
17

138

Dr. N, a particularly busy practitioner in a busy anti-aging medical office that
even holds monthly seminars to the public, categorizes aging as natural and not as
disease. However, this framework did not seem to capture what Dr. N was doing.
He struggled to answer my question and it struck me during the interview that this
question and those kinds of categories I wanted to explore are clumsy. As precise
and eloquent a speaker as Dr. N otherwise was during this interview, he had trouble
trying to make his work fit seamlessly into the disease and nature models.
Dr. N believes that we should not so simply accept the “diseases of aging.”
The word “of” presents a problem. Is he referring to gerontology’s age-associated
diseases or does he see such diseases as inherent moments within aging such that
aging is the principal factor? He lists depression and cardiovascular disease, two
pathologies with a somewhat (though arguable) standardized diagnosis and treatment
protocol, alongside “low vitality.” “Low vitality” is inherently unquantifiable and
subjective and an oft-heard complaint related to aging. That Dr. N collapses the
three together suggests that he is not referring only to the set of age-associated
diseases but rather places aging as the hub around which problems flutter. In other
words, the process of aging provides the focus for his work.
So while aging is all these hideous things – convalescent homes, dependency,
illness, and decline – it is not a disease. For these anti-aging medicine practitioners,
aging is natural but that characterization is not as significant as the pain inherent in
aging. These practitioners see themselves as physicians whose goals are to reduce
suffering and anti-aging medicine provides a way for them to do just that.
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4.2 “REGULAR MEDICINE” AND PHYSICIANHOOD
In speaking about involvement with anti-aging, most practitioners express
disdain for the current medical practice in the U.S.. Referenced are 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 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

Discouraged by the lack of autonomy in his practice, Dr. F finds in anti-aging
a way to practice a medicine in which he could believe and be more autonomous.
Here, 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 had been an internist in a large medical group; this company filed for
bankruptcy and closed all of its clinics leaving Dr. E, along with the many other
physicians in the group, the grueling work of building a practice from scratch. Anti-
aging offered him a way to financially survive in an otherwise competitive practice
140

environment. Anti-aging proponents solicited his participation via the internet and
mailed pamphlets and as he learned more about anti-aging medicine, he decided to
incorporate it into his medical repertoire in an effort to build a viable practice.
Dr. E: 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 anti-aging
treatment. You can get much, much better reimbursement from those kinds
of practices.
19

Anti-aging also provides a way to survive in a hostile biomedical field. The
reimbursement – the money – is “better” in anti-aging 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, 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. Thus, aging is not
situated as a disease but rather an expectable process that is not commensurate with
the work of insurance companies.
141

These statements are propitious 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 reinscribes the revolutionary
aspect of anti-aging medicine.
Some anti-aging practitioners have found a way to bill insurance companies
on behalf of their patients. Dr. O reports that insurance companies will sometimes
pay – under the right conditions. She is aware that “if you don’t call it a disease, you
have no right to treat” and so goes about finding an appropriate disease code under
which she can bill.
Dr. O: If you can prove that [the patients] are undergoing an adult-onset
growth hormone deficiency problem, okay, you cannot find a bacteria or
other diseases, and but then you prove in that hormone panel that they are
very deficient in their growth hormone, and the signs and symptoms of
growth hormone deficiency is blah blah blah. So you can prove this, they
pay for the treatment which is the growth hormone and the supplement and
everything.
CEM: The insurance company will pay?
Dr. O: Yes, yes, because you have that much is there already. So it’s just
have, you have to learn how to prove it. That’s actually, uh, established.
Now, the people who are not going to get coverage is those who want to not
wait until they have the problem. So like you, maybe, how young are you?
CEM: Uh, 29.
Dr. O: 29. We check your hormones, probably everything is okay, okay.
You take a few supplements, then you will be okay. I mean, insurance will
not pay. Because, you know, [the complaints] are subjective: “oh I’m
moody” and you cannot be showing them your mood. Just like, I have a
headache. Where? Where, you cannot tell them where, so they have to
believe you, right? So the doctors, the anti-aging medicine doctors, that is
what they have to learn. How to create, not to create, to prevent the problem
142

so that it makes sense scientifically so that they can get an approval. I get an
approval from the insurance, the worker’s comp, because many people who
are injured, and they have to take a heavy pain medicine. They have a lot of
side effects, you know, and they, uh, they come to me, and I personalize it for
them, they feel better. The insurance pays. Because I say this is a medical
necessity. Or do you want to give them more drugs? Because this is all of
the drugs that gives them side effects, so I’m giving them something to offset
it and hopefully so they can take less drugs. So you’re saving money. So
during the process I explain the whole thing, and they understand, they pay.
21

Dr. O has found a way to make the insurance system cover her patients’ care.
She translates the subjective complaints of her patients into “scientific sense” such
that not only is the patient’s care covered, but the insurance company may even save
money on the deal. Explaining her method via a hypothetical injured-on-the-job
patient scenario, Dr. O frames her work as offsetting the additional problems caused
by the biomedical treatment for the injury.
While Dr. O is not unique, the majority of anti-aging practitioners I spoke
with do not bill insurance companies for their work. Eclipsing these third party
payors 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. He
expresses little sympathy for people who charge that anti-aging therapies are to
expensive; financial expenditures are choices and some people choose to smoke and
eat McDonalds while others choose anti-aging. Drawing the line between personal
responsibility and health is a major theme in anti-aging medicine (and beyond) as it
places “lifestyle factors” and their moral contingencies at the center of health
evaluation. This kind of thinking is intrinsic not only to U.S. health care at large
(Becker 1997, Conrad 1994, Frankenburg 1993, Goldstein 2000, Lock 1993, Singer
143

1990), but also the growing trend of alternative and complementary medicine (Baer
2003). Obscuring societal responsibility for the health of people blames sufferers for
their own suffering and for the pain of their own aging but also offers the hope for
individual control over the body (see McGee 2005, Salerno 2005).
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 bragged that their initial visit with a patient
averages two to three hours. 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”
wherein 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.”
22

Since a major component of health is nutrition and exercise, the patient is an integral
participant; good health is more than just a tablet 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.
The theme of heavy patient-loads that lead to minimal time for individual
patients is a commonly heard refrain – not just in anti-aging medicine. 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
144

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 because
you don’t have the income anymore. There will be no rich, millionaire
doctors riding around in Porsches—that’s old.
23

Being a doctor is arduous and intense. We hear in Dr. S’s words a sense of
“getting used to” treating upwards of eighty-five patients per day. This heavy-load
practice is exhausting and expected. It also established a certain financial lifestyle
difficult to replicate in another job – difficult to replicate now at all. 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 endocrinology and hormones from his obstetrics-gynecology
practice, Dr. S was able to build on his skills in order to improve his work life.
Frustrations in their previous practices are often presented as instigators for
change. Yet most of the practitioners interviewed saw anti-aging medicine as a kin
of “natural” extension of their previous work. Dr. K perceives anti-aging as an
outgrowth of his practice with people diagnosed with HIV and AIDS. Aging
patients and patients with AIDS experience a similar sort of predicament in that
there are often multiple medical problems and overlapping treatments.
Dr. K; 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.
24

145

The extension of an HIV/AIDS practice to anti-aging makes clear an
appreciation of aging as steeped with decline. Treating Chronic Wasting Syndrome
and aging with similar hormone strategies highlights the analogous deficiencies and
also underscores not only that aging is not taken as disease but rather as multifaceted
and chronic. 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 for 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.

4.3 “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
whose legacy 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.”
25
Anti-aging is about exploring unknown terrain – a terrain that
they believe, in spite of all the circling controversy, surely exists – without the
support of colleagues. Gerontology’s disdain for anti-aging helps paint the picture
146

of the Gallileic revolutionary. At the same time, anti-aging is based on much of the
same scientific research as gerontology though some of the interpretations differ
(such as with the work on human growth hormone), 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.
Anti-aging medicine represents another approach to aging and health in
terms of both philosophy and practice.
Dr. M: Once the deficiencies are detected, treatment is geared toward
returning levels to a more youthful state. But physicians who practice
longevity medicine, we interpret the results much differently than traditional
physicians. And traditional physicians in general ignore the progressive
decreases in hormone, discounting it as being a part of the normal aging
process. And anti-aging physicians do not contest the fact that there is a
normal progressive decrease in all our hormones. But what we ask is, are
these decreases healthy?
26

Accepting that aging is normal and degenerative, Dr. M reframes the
question from issues of normality to issues of health. Dr. M asserts that the
disparities between traditional physicians” and anti-aging – or longevity medicine –
physicians lie in their interpretation of data. When one reads the results of a blood
test in terms of “normal aging” then certain levels may appear normal. However,
when read in terms of functional health or optimal health, those same levels appear
problematic. This declares a clear schism with the scientifically, demographically,
statistically devised age-graded, accepted norms.
147

Placing anti-aging medicine within science is important and also sometimes
difficult in light of the training many of these physicians have received. Recalling
Dr. O’s story:
Dr. O: 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 school... And then in one or two years I knew I was
rejuvenated…
27

Dr. O locates the miraculousness, mysticness of anti-aging medicine
precisely where the medical school teaching ends. The kind of extra-scientific terms
Dr. O employs to describe anti-aging medicine seem to suggest that her anti-aging
medicine is one born not “of science” but rather of something supernatural.
However, she invokes the miracle and mysticism of anti-aging medicine to connote
the arenas of care revealed to her that she had not been exposed to during her
training as a more “mainstream” physician. She has also been involved in the
creation of a fellowship to “teach the doctors, because it takes 4 years to learn all of
this nutritional science again, and they – we – never learned this at school!” The
deficiencies of medical schools in teaching anti-aging data and principles,
specifically nutritional information, reveal a major Achilles heel in Western
biomedicine, according to Dr. O and it was in this anti-aging search of her own that
she found her place as patient, educator, and practitioner. Believing that this was
something positive she could contribute to the lives of others, she refocused her
physician work to anti-aging.
148

Dr. O: Anti-aging is very unique and very mystic, and uh I don’t want to stay
like that, I don’t want people to think this is mystic because the science is so
deep. You combine several, uh departments. And that’s why you know-
CEM: Where do you see it combining?
Dr. O: Endocrinology for the hormones, pharmacology for the medicine
part, uh nutrition, not so much uh in the doctor’s knowledge but they have to
know this, and they have to know toxicology, how to detox people, because
this will make them more alert when they are old. And internal medicine.
Which, you know, if you are too late then they go to gerontology, then
geriatric medicine will take care of them. Geriatric medicine doesn’t mean
anti-aging. No, it’s the opposite. I tell you a little too late, but I never tell
this to my customer or patient because once they realize that they want to be
healthy and they want to stay from, uh, anything that cause side effects, I
usually help them…
28

That anti-aging medicine is seen as scientific is important to Dr. O and she
makes a point to correct her previous descriptors of miracle and mysticism. She sees
anti-aging medicine as springing form a “deep” “science.” The depth comes from its
multi-layeredness, that it draws from and bridging many of the biomedical and
scientific specialties such as endocrinology, nutrition, and toxicology. Geriatric
medicine is the antithesis of her work, she argues, in that geriatrics does not aim to
stop people from aging and her work incorporates such a broad realm of biomedical
practice and research.
Dr. M’s approach to anti-aging medicine illustrates another example of the
“depth” of the science. Dr. M regularly reads over two hundred 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 by
associating the science of anti-aging medicine with the wackiness of
149

“psuedoscience.” For his practice, Dr. M has compiled an anti-aging tutorial that
relentlessly documents anti-aging medicine’s scientific roots.

Dr. M: Some of the tools that we’re working on are self-running 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
science… And as I’ve said there are over 40,000 published articles I’ve
reviewed.
29

While Dr. M would prefer anti-aging become mainstream more quickly, he
estimates that it will follow a trajectory similar to estrogen prescription. In the past
three decades, estrogen replacement therapy has seen a tremendous usage growth
among women in Western countries. The debate about its usage persists, however,
with much continuing longitudinal research detailing its long-term effects. It is Dr.
M’s belief that doctors resisted using estrogen just as they are resistant to anti-aging
because “they will have a lot of learning to do, to get to the point where they can
understand preventive care when they are so used to doing illness care.“
30
Thus,
“mainstream” doctors react to pathologies whereas Dr. M and the “scientific” anti-
aging practitioners preemptively address the process of aging itself thereby
potentially staving off the pathologies that others are so focused upon. Nonetheless,
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.
150

Within anti-aging medicine, the differentiation between biomedicine and
science is significant. Biomedicine is constructed as a practice, a clinical concert
playing out scientific work. 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 is long studied in science
and technology studies and interesting in this case is not only that science is “pure”
but also that biomedicine is “tainted.” This sort of hierarchical framework wherein
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 frontierspeople 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.”
31
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 cancer...
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
151

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? In the scientific model, we have no idea how we
should compute that…
32

Dr. N locates biomedicine as inadequate, a one-disease, one-organ enterprise.
But this is also a problem of science, scientific validation, and scientific research.
How, Dr. N asks, can we measure the systemic, multi-factorial “nature” of the body
and its reactions? Dr. N implies that the aging process should be targeted for
intervention but that it is a particularly difficult enterprise. Nonetheless, anti-aging
medicine offers a “different paradigm” in which to begin thinking about all of these
interactions and consequences that comprise and affect aging and health.
Dr. N further contextualizes anti-aging historically such that major shifts
come painfully.
Dr. N: 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, 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’?
33

The image of the persecuted revolutionary echoes here along with the
inability of current science to adequately address 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 scientific Ponce de Leons, conquering aging in
science rather than Florida. Instead of a magical fountain of youth, these
practitioners use published, mainstream science to substantiate aging as a target for
biomedical intervention. They simultaneously condemn current scientific models
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for being inadequate to understand aging completely. Working at the cutting-edge
toward a new model of health care, promoters of anti-aging medicine reframe aging
scientifically in order to treat it biomedically.

4.4 CONCLUSION
Practitioners, asserting their expertise with the persecuted confidence of
those who see themselves as revolutionaries, clearly benefit from this understanding
of aging. That the individual does much of the anti-aging work (exercise, nutrition),
liberates the practitioner from the total responsibility of health. Moreover, out-of-
pocket payment can protect practitioners from the limitations and constraints of
health insurance – an advantageous position, indeed.
But the practitioners are not simply money-grubbers preying on cultural fears
of aging. Their feelings of helplessness as practitioners in other fields along with
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 very minimum, they are seeking a solution for the
helplessness experienced in their other practices of biomedicine. Often patients
themselves, the practitioners combine their interpretation of the scientific knowledge
of the day with optimism for the future of technology into a framework that pursues
aging such that the suffering they no longer feel they must accept is not perpetuated.
On another level, the practitioners are vying for something even more
remarkable: framing aging as a target for biomedical intervention problematizes the
153

concept of a natural life course, of biomedical work, of disease, and of patienthood.
The practitioners who contributed to this work do not claim that aging is a disease
and accept that aging is a natural process. However, these notions are irrelevant to
the work these practitioners have undertaken. 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. And since aging, they assert, is the
common thread to so many later-life problems, aging itself – not its associated
diseases – ought to be addressed biomedically and scientifically.
Anti-aging practitioners are bound by the belief that, with science, 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; aging is the enemy. It
follows then, that accepting the decline of aging is a defeated, victim mentality. And
it is just this kind of mentality that many anti-aging medicine practitioners see in
gerontology and geriatrics. Since aging is by and large seen as “natural,” everyone
is bound to patienthood and the practitioners are no exception. Many practitioners
found their way to anti-aging medicine because of their own experience with aging
and a deep resistance to its pain and potential pain.
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. Anti-aging practitioners are not as restricted by the
biomedical practice environment with its insurance and time constraints and are able
to spend more time with patients, creating a kind of health partnership that
154

practitioners often maintain are personally and professionally rewarding. They do
not feel relegated to the position wherein they “just watch patients die.” Instead, by
moving away from previous disease-focused, or body-part-focused specialties,
practitioners embrace a certain hopefulness for themselves and their patients.
The role of the scientific revolutionary factors into practitioner migration
stories largely in response to the controversy around their work. They have made a
break from the mainstream and often see themselves as more than just cutting-edge
practitioners, but rather, paradigm shifters. The science of anti-aging medicine, they
argue, is rooted so deeply in many specialties that it pieces back together the science
to foster a more synergistic biomedical practice. And while science struggles with
the multi-layeredness of bodily interactions, it will ultimately prevail in finding more
and more efficacious anti-aging therapies to deal directly with aging – providing it
does not delay in shifting from the inherently limiting disease-focused research.
While the mission of anti-aging medicine involves treating aging
biomedicoscientifically, migration stories reveal that the anti-aging medicine is
levied 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 the
suffering seen in and because of the aging process alongside a comptemtp for current
biomedical practice that neither allows doctors authority nor time with their patients
nor the ability to live a desired lifestyle, and an identity in which the revolutionary
is hero.
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
155

and living longer and more importantly than living longer, living healthier,
robust, vital, that’s anti-aging. 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.
34

1
I also interviewed gerontologists who are opposed to anti-aging medicine as well as
researcher proponents of anti-aging medicine. For the purposes of this
chapter, I focus on the practitioner data.

2
http://www/lef.org (06/10/2003).

3
http://www.longevitymeme.com.

4
Interview: Dr. S 09/20/2001.

5
Interview: Dr. D 10/18/2001.

6
All practitioner names are pseudonyms. Only the A4M and LEF, widely published,
internet-available organizations remain without pseudonym.

7
Interview: Dr. X 01/21/2002.

8
Interview: Dr. O 02/07/2002.

9
Interview: Dr. Z 08/08/2002.

10
Interview: Dr. S 09/20/2001.

11
Interview: Dr. O 02/07/2002.

12
Scientifically constructed biomarkers are diagnostic tools that determine a
biological age separate from chronological age; this is done via blood
analysis alongside a multitude of physical tests (reaction time, lung volume,
etc.) and questionnaires (pertaining to psychosocial supports, etc.). They are
important tools in anti-aging medicine, though inadequately studied
according to many gerontologists.
13
Interview: Dr. M 01/07/2002.

14
Interview: Dr. N 10/16/2002.

15
Interview: Dr. Z 08/08/2002.
156

16
Interview: Dr. B 12/18/2001.

17
Interview: Dr. N 10/16/2001.

18
Interview: Dr. F 04/19/2002.

19
Interview: Dr. E 09/12/2001.

20
Interview: Dr. A 12/17/2000 at the 8
th
International Congress on Anti-Aging and
Biomedical Technologies, Las Vegas.

21
Interview: Dr. O 02/07/2002.

22
Interview: Dr. M 09/07/2001.

23
Interview: Dr. S 09/20/2001.

24
Interview: Dr. K. 12/18/2002.

25
Interview: Dr. F 02/19/2002.

26
Interview: Dr. M 09/07/2001.

27
Interview: D. O 02/07/2002.

28
Interview: Dr. O 02/07/2002.

29
Interview: Dr. M 07/01/2002.

30
Interview: Dr. M 09/07/2001.

31
Interview: Dr. D 10/18/2001.

32
Interview: Dr. N 10/16/2002.

33
Interview: Dr. N 10/16/2002.

34
Interview: Dr. X 01/21/2002.
157

5. THE PRESIDENT’S COUNCIL ON BIOETHICS AND
ANTI-AGING MEDICINE

“The inevitability of aging, and with it the specter of dying, has always
haunted human life; and the desire to overcome age, and even to defy death,
has long been a human dream…. But it is only recently that biotechnology
has begun to show real progress toward meeting these goals, and bringing us
face to face with the possibility of extended youth and substantially
prolonged lives“ (President’s Council on Bioethics 2003: 179-180).

The stories practitioners tell of their migrations to anti-aging medicine
highlight the good that they see in this emerging anti-aging field. However, the fact
of this “good” is far from settled. The ethical questions surrounding the impacts of
anti-aging medicine are complex and profound. These issues include the
consequences of an efficacious anti-aging therapy in which more people would live
much longer in good health as well as the constructed relationships between
biomedicine, science, nature and aging. In this chapter, I explore these issues as they
are considered in a formalized national venue.
In 2001, George W. Bush created the President’s Council on Bioethics
(PCBE) to prompt conversation on biotechnologies; amongst deliberations on such
matters as stem cells and designer babies, the Council also trained its intellectual
energy on anti-aging. In staging these deliberations, the Council envisioned that
anti-aging therapies will come to scientific fruition – a marked turn from the
accusations of charlatanry and passionate skepticisms that have encircled the anti-
aging field. Sidelining many of the feasibility debates in gerontology, the Council
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focused specifically on whether we should or should not pursue anti-aging goals
even while noting that their continued pursuit and achievement is likely.
The examination of the PCBE testimonies and its final report illustrates that
the obligations of biomedicine (especially in relation to aging) are contentious and
dependent not only upon a relationship to “the natural” but also to suffering.
Whereas the Council largely employs the expected “natural life course” to structure
biomedicine’s obligations, anti-aging practitioners regularly employ pain. Placing
the process of aging within the framework of nature, the Council argues that any
intervention into aging threatens our “nature,” our humanity. Conversely,
practitioners assert that because aging is painful, biomedicine ought to be concerned
with alleviating its suffering; herein, whether or not aging is natural is irrelevant to
biomedicine’s duty.
The questions posed in the Council’s deliberation pits the anti-aging
endeavor against a “nature” constructed as a domain bequeathed with certain moral
sanctity that ought to shelter aging from biomedical intervention. This chapter
analyzes the testimonies and sessions dealing with aging alongside the final report of
the Council. I pay particular attention to the ways in which aging is framed in
relation to biotechnology and nature.
In trying to understand the intent and implications of anti-aging medicine, the
Council struggles with a vocabulary in which to discuss it. The primary challenge is
to imagine and provide an ethical arbitration upon an idea that has not had much
place in contemporary biomedicine. Intervening upon the process of aging demands
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a different understanding and analysis outside of the framework of disease as a
guide. As a result, the discourse around this process intervention, the similarities and
dissimilarities between aging and disease, and the meaning of enhancement versus
medical therapy become particularly problematic.
President Bush established the PCBE in November of 2001 by appointing
seventeen “leading researchers and scientists” (White House 2002). The White
House presented this group as “diverse,” thus attempting to legitimize it as isolated
from political maneuverings. However, many critics cried foul because of a
“stacking” of the bioethics deck (Orecklin 2001, Brainard 2004, UCS 2004). The
critiques charge that the Council was too closely ideologically tied to Bush’s
conservative positions. This judgment came especially on the heels of the
appointment of Chairman Kass, an eminent bioethicist well known for his vocal and
vigorous opposition to human cloning. And when Dr.’s Blackburn and May, two of
the more “liberal” council-members, were eventually dismissed from the Council,
another round of public discussion ensued regarding the “narrow” composition of the
panel (UCS 2004). Thus, the panels’ work began in a foreshadowing tumult of
controversy.
The shaping of the anti-aging/biomedical obligation discussion within a
framework of the “natural” ignores the perspectives of anti-aging practitioners. The
Council drew a particular portrait of anti-aging based on testimonies presented by
academic researchers. Thus, researchers – not practitioners – were consulted
regarding issues of biomedical obligation. This marginalized the array of
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contemporary forms of anti-aging and contributed to a limited understanding of anti-
aging in practice. Most specifically, by asking about the future of anti-aging, the
Council sidelined its history: why have practitioners come to this field? What does
this tell us about what anti-aging means? It is this contextualization that complicates
the issue of biomedical obligation since the goals of practitioners and their patients
as well as the critiques they levy against the biomedical environment help to shape
the dialogue about anti-aging medicine.
Social science scholars are beginning to address ethical questions of anti-
aging around the issues of accessibility to treatments (Holstein 2001), the potential
for ageism (Butler 2001), physiological side effects, the raising of public
expectations (Butler 2000, Le Bourg 2000, Olshansky et al. 2002a/b), and the
”threat” to gerontological legitimacy (Binstock 2003). The PCBE came into anti-
aging medicine within a larger discussion of enhancement and framed its
deliberations along the lines of the value of anti-aging to humanity and its
implications for human nature.
The importance of the consular articulations reaches beyond a simple
“weighing in” on the subject of anti-aging. The Council’s mission was to “advise the
President on bioethical issues, [and] provide a forum for a national discussion of
bioethical issues” based on a “deep and comprehensive understanding of the issues”
(White House 2002). This forum, at the federal level, is significant precisely
because of its national stage. Theirs was a highly visible discussion that set anti-
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aging on an agenda alongside other ethically weighty issues of stem cells and
cloning.
The PCBE report is an important document shaping the discourse around
anti-aging medicine; analyzing the transcripts of the testimonies and the non-
testimonial deliberations complicate the analysis of the report by providing the
context for its content. The ways in which topics and lines of reasoning emerged in
the deliberations reveal the contentiousness and ambiguity of the issue of anti-aging
medicine.
By taking anti-aging seriously, and indeed, by envisioning its realization, the
Council moved anti-aging from the wings to the spotlight. Though debates about
charlatanry in this field rage, the Council’s attention makes it difficult to simply
dismiss anti-aging as fantasy or quackery. While gerontology has been attentive to
anti-aging for some time, the Council provided a highly-visible, national forum in
which to shape the discussion of anti-aging medicine and to discuss its
consequences.

5.1 THE TESTIMONIES
Over the course of twenty-two, ninety-minute meetings, the Council’s inquest
included deliberations human cloning, stem cells, genetic enhancements,
pharmacological elevation of mood, and sex-selection of children (“designer
babies”). All of these, to certain degrees, invoked some form of enhancement.
However, the Council quickly pegged the enhancement/therapy distinction as
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instituting too rigid a dichotomy.
Chairman Kass: “I’m not sure that the language of enhancement versus therapy
is the optimum way to do this. It might be better to leave that language alone
and to ask ourselves, really, the question of, what, if any, are the boundaries
between the admirable and less admirable uses of these powers without having
to tie it into some definitional thing of what you mean by enhancement or
not… of what it would mean actually to conduce to human flourishing and our
fulfillment, which is not a simple matter and it’s not for governmental
commissions to settle” (PCBE 2002a)

Kass‘ reservations about this distinction provided for his redirection toward
the language of value, of what we should be cautious about or celebrate. The
question then became one of “flourishing and … fulfillment.” (PCBE 2002a). The
alternative offering of “admirable/less admirable” redirects the work from
categorizing biotechnomedical projects as enhancement or therapy to the work of
ethical valuing that would extend to articulate the role of biomedicine. Kass
reasserts here that the mission of the Council is not to adjudicate “flourishing”
though bioethical value discussions clearly depend on such images. The support of
particular projects depends upon the value it is given both in terms of prioritization
of desires as well as worth and cost to society.
The idea of a thriving humanity casts questions regarding the relationships
between humanness, biomedicine, and nature. How can we think of flourishing
without having some baseline – what is “normal” that a flourish is measured against?
Moreover, this line of inquiry yields questions around the purpose of biomedicine
and how it relates to such norms. Council-member Hurlbut addressed the
challenges of biotechnology when stressing that
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“[w]e have to figure out how we relate to nature, what is good within the
order of nature, and it’s going to take not just scientific knowledge but a kind
of self-knowledge of what’s driving the force that would produce the
gradients along which we would move toward our enhancements” (PCBE
2002a).

Not only does council-member Hurlbut assert that there is a nature to which we
relate as humans but that this relationship is shifting. Claiming that there does exist
a nature external to humans but to which humans necessarily relate alongside a belief
that there is “good within the order of nature” (implying that there is perhaps “bad”
in this order as well) supports the notion that humanity can indeed place and operate
upon a valuing of this nature. Moreover, that our relationship with nature may
change as we consciously and deliberately “move toward our enhancements”
suggests that this relationship is shiftable. In Hurlbut’s statement, this humanity-
nature relationship is fluid and subject to our decisions and scientific knowledge.
This relationship must not only be understood in terms of scientific knowledge but in
introspective consideration of ourselves in relation to that knowledge. This directly
links scientific knowledge to a relationship to nature – scientific knowledge forms
the backbone of our relationship to nature. As such, along with the expansion of
scientific knowledge, the relationship with nature needs reassessment.
By the time the “age-retardation
1
” testimonies are offered, the Council has
engaged with discussions of enhancements, nature, biotechnologies and their shifting
connections. First to testify in the “Adding Years to Life: Current Knowledge and
Future Prospects” (December 12, 2002: PCBE 2002b) session was Steven Austad,
Biological Sciences Professor at the University of Idaho. In addition to his laboratory
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work, Austad also authored a pop-science book, Why We Age (1997), and attended
some of the prominent anti-aging research meetings (UCLA Roundtable: Critical
Future Milestones in Aging Research [February 1999], International Association of
Biomedical Gerontology Tenth Congress [September 2003]). Additionally, he
serves as a scientific advisor to the Methuselah Mouse Prize. He is optimistic about
anti-aging; while he stated that “there are currently no diets, vitamin, mineral, or
hormone supplements, attitudes, behaviors, or lifestyle choices that have been
demonstrated to slow aging in humans,” he suggests that some candidates do exist
for real anti-aging treatments in the near future (Austad 1997).
Like other sessions, Austad’s presentation was designed around Council
questions (PCBE 2002b). These involved defining aging, delineating current
research on aging/age-retardation as well as questions of potential lifespan increases
and the existence of a maximum life span. Austad begins by noting that the anti-
aging research goal is “not really the prevention of death, but the preservation of
health…slowing aging is really a much more effective approach to preserving health,
than is the treatment of individual disease.” Here Austad derails the conception that
anti-aging is about immortality and affirms that “most” of the researchers “in this
field” are motivated toward health as opposed to thwarting death. That “health” is
something that ought to be “preserved” reveals a baseline of expectation; in other
words, safeguarding a state of the body or experience of the body as “healthy” is
forwarded as a given. Austad implies that aging takes away from “health” and
moreover, doubts the utility of a disease-focused approach. In orienting this
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position, Austad disengages anti-aging from intervening in nature but extends it to a
kind of dramatic preventive medicine.
Defining aging has long been problematic for gerontology. Debate surrounds
whether aging is a singular process or many simultaneous ones; only recently has
there been any consensus that aging exists (Miller 2002, Holliday 1999, Rattan 2005,
among others, see also PCBE 2003: 194). The coupling of aging and health-decline
becomes explicit in Austad’s definition of aging as “the gradual and progressive loss
of function over time, beginning in early adulthood. It leads to decreased health and
well-being, and an increasing incidence of death, disability I might say, as well as
disease.” Again, “health” is offered as an experience that exists as an absence of
disease and disability. That aging is “gradual and progressive” suggests that it is a
process that is determined in part by its association with health-destabilizing events.
Austad goes on to categorize aging research into those lines of inquiry “associated
with specific diseases” and those which are “process-based investigations.” Thus,
there exist, he argues, two primary models of aging research, one focused on events
of disease and the other on the process of aging itself. His position, stated clearly at
the beginning of his presentation marks this latter line of inquiry with the greatest
potential for staving off the ill-effects of aging.
Fellow testifier Jay Olshansky is a biodemographer at the University of
Illinois at Chicago’s School of Public Health. His interest in anti-aging compelled
him to pen a number of public warnings regarding the current existence of any
effective therapy (most famously the Scientific American position paper [Olshansky
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et al. 2002a/b]). His vita also includes a pop-science book on the pursuit of
immortality (Olshansky and Carnes 2001) and other articles in the same vein
(Olshansky and Carnes 2004, Olshansky, et al. 2004). To promote the discrediting
of anti-aging “frauds,” he launched the Silver Fleece Award whose 2002 inaugural
"honor" was presented to the A4M
2
.
Olshansky’s presentation differentiated aging (“the passage of chronological
time”) from senescence (the term used by gerontologists to “describe what’s really
happening”) (PCBE 2002c). This differentiation allows for a slightly less cluttered
examination of aging in respect to its scientifically defined markers that can be
separated from analyses based on time. Nonetheless, the number of years people in
the United States can expect to live on average has increased dramatically in the past
century. This life expectancy rise led many to predict continuing spectacular
trajectories; Olshansky countered such claims by asserting that
“if there’s going to be another quantum leap in life expectancy, we’re going
to have to extend the duration of life… it’s going to have to happen by
altering the basic biological rate of aging itself, which is something we
cannot currently do, but … are trying to do” (PCBE 2002c).

Thus, for Olshansky, the work ahead is different from the work past. To
date, we have an elimination (or rather, reduction) of factors such as infant mortality
and infectious disease. The impending work must now intervene into the processes
of senescence itself. He argues that any increase in life expectancy now must be
thought of not in terms of aging, or years, but rather in terms of biological
developments. This notion of a new path conveys a sense of a journey into uncharted
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territory with all of the accompanying anxieties. Most poignantly, it frames the work
of anti-aging as intervening explicitly in biology.
Moving toward a biological intervention into the processes of aging begets a
shift in the scientific approach. Olshansky wants to “go after … aging itself.” These
kinds of statements, coupled with a critique of the disease-focused model of
research, provoke interesting questions around the prioritization of scientific and
clinical work as exemplified in the following exchange between Dr.’s Krauthammer
and Olshansky.
Dr. Krauthammer: “If you were then retroactively reordering history, would
you have preferred that we had not engaged in the medical efforts that reduce
heart disease and others that have created the epidemic of Alzheimer’s?”

Dr. Olshansky: “No, I would not ask that we stop our effort to go after the
major fatal diseases. All I’m saying is we need to be aware of the
consequences of our success. And if we continue to succeed in enabling
people with heart disease, cancer and stroke to survive longer with their
disease, we may not necessarily like what we see. I’m not saying we should
be truncating that effort, we just need to be aware of the consequences of our
effort. … Actually, I think what I am suggesting is that not only should we
go after the major fatal diseases, and the non-fatal disabling conditions, but
also in a way, perhaps more importantly, aging itself. I mean, the entire
medical model is very much taking – it’s a product of our effort to go after
infectious diseases. It’s whatever disease is in our face a the moment, and I
refer to it as the hurdle approach to diseases. You know, whatever is in front
of us, we jump over it, only to face another one later on. And the hurdles get
more frequent and higher the older we get, and I’m suggesting we push the
hurdles back, and that’s the effort to go after the aging process itself.” (PCBE
2002c)

Olshansky does not advocate the abandonment of disease-focused research
but offers two critiques of this model. First, he argues that the current “medical
model” is built around the “hurdle approach” that has its roots in the history of
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American medicine’s push to handle infectious disease. As one disease is “jumped,”
another appears and in aging this happens with greater frequency. Secondly,
Olshansky reasons that this approach may eventually backfire by producing other
diseases that we do not currently know about or deal with regularly. He illustrates
by asserting that “the modern rise of Alzhiemer’s Disease might be in part a classic
example of a product of our success” and the “more successful we are at ending
duration of life, the more we are going to see the diseases that are most common
among the elderly occurring”
3
. Thus, by dealing only with diseases and ignoring the
process of aging itself, we may “enable” other diseases to flourish. Ultimately, he
argues that perhaps a readjustment in our research priorities are in order.
Both Austad and Olshansky believe that a biological maximum life span limit
likely does not exist. This long held belief in a biological maximum – that humans,
even in the best of biosocial circumstances, can only live to a certain age – is
beginning to crumble and Austad and Olshansky represent the challenge to a fixed
maximum. Austad hedges that while this is not yet proven, animal data suggests that
there may be no limit. Olshansky maintains that evolution “could not have given rise
to genes designed for the purpose of killing us.” Evolution here becomes a force
that is not interested in designed death. The absence of the controversial biological
ceiling opens the door to feasible intervention by asserting that we are not limited by
nature. The absence of a maximum life span can also indicate that there is nothing
“natural” that limits our longevity – but yet, cultural expectations of our life span
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may be more crucial to our relationship to it than the biological evidence of its
existence.
This life span expectation issue becomes a rather significant one for the
Council in the deliberations as well as the final report. Olshansky argues that the
“approach that [medicine is] taking in a way is the one that’s going to permit many
of these age-associated problems to be expressed; which is precisely the reason why
aging should be the enemy, not death.” A few minutes later, Dr. Meilaender takes up
this question and poses:
“I think that, in fact, something probably the contrary of that. I think that
death is an enemy, which doesn’t mean that it should always be resisted.
There are enemies to which one must submit on occasion, but I’m a lot less
sure about aging. I love baseball. Would it really be so good if I were
playing at age 80, or would that suggest some sort of fundamental immaturity
in me? I’m not sure”(PCBE 2002c).

And Dr. Hurlbut continues in the same vein:
“I agree with Gil [Meilaender] that I don’t exactly think aging is the enemy.
In fact, I’d like to go a little bit on Michael’s [Sandel] side, and say that
there’s something about the givenness of aging that might have some good
things about it, but how do we sort out what those are, and in which to
intervene, if we can? I want to be used up in life. I don’t want to be on
reserve, or alter myself in such a way that I’m preserved but not engaged as
deeply as I can, meaningfully as I can in my life” (PCBE 2002c).

The notion here is that aging, with all its pains and loss, can be, in fact is,
important to our life experience. This theme emerges within discussions of
innovativeness and creativity that anti-aging success might produce a kind of
aimlessness that limitless time might bestow This reveals a belief that an end-point to
life, and a decline in health, is intrinsic to our human character. This perspective on
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the “good” of aging’s decline undermines the anti-aging medical desire to intervene
directly into aging. By engaging with anti-aging medicine in this way, the Council
avoids the quagmire of disease construction. They address the anti-aging medicine
endeavor of intervening into the process of aging head on and take issue with the
assumption that the decline of aging is dreadful and to be avoided.
In January of the following year (2003), the Council discussed a paper
prepared by Chairman Kass entitled “Beyond Therapy: Biotechnology and the
Pursuit of Human Improvement.” In this discussion, the notion of the life course
was broached and Kass queried the good of adding
“increments to it as if it had no form of its own; that it was either going to be
more of it or less of it or a lot more of it, or something like that. What I was in
a way arguing for here, … [is] to perceive one’s life as time, the extension of
which is to be regarded homogenously, as if were just a variable in physics,
rather than to see it as a part of something that has a shape and a trajectory and
a form. I think is a kind of distortion of what the truth about things is“ (PCBE
2003b)

In other words, Kass has serious reservations about the notion of simply
“adding” bits of life as if the life course had no innate integrity. He speaks about this
issue elsewhere and posits the concern that changing the expected life course could
birth a detrimental shift in human aspiration; if one expects to live much longer,
then perhaps he is not as likely to act/be innovative now.
In the afternoon session, on the same day of Austad’s and Olshansky’s
testimony, discussion turned explicitly to enhancement. In this discussion of a paper
by council-member Sandel entitled “What’s Wrong with Enhancement?”
enhancement was complicated by the rather unsteady relationship between science
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and nature. If enhancement comes as a way of scientifically creating “superhumans”
(Krauthammer in PCBE 2002d), then the notion of a “natural human” must be
articulated; we must know what human is so that we might make it super. This
articulation is highly problematic as “part of our nature is our freedom to reshape life
as well… And so to be human is to be two-sided in this way; to be finite and limited
by certain givens, but also to be free to reshape them.” (Mileander in PCBE 2002d).
In conversation with the morning session on age-retardation, these questions of
humanity and scientific research/goals highlight the problems not only in the
categorization schema of enhancement/therapy but also in the challenges issued by
biotechnologies regarding aging.
Three months following the Olshansky/Austad testimonies, the Council
discussed staff working papers entitled “Age Retardation: Scientific Possibilities and
Moral Challenges” and “Stronger, Longer-Lasting Skeletal Muscles through
Biotech?” (March 6, 2003: PCBE 2002e). Kass begins the session with an opening
question about disease and aging. He asks:
“does it strike us as reasonable to regard biological aging on the model of a
disease which would be at least addressed, if not remedied or alleviated, at
least to some extent by medical intervention?…” (PCBE 2002e)

Considering aging as a kind of disease impacts not only the ways in which
we think about aging but also the ways in which we are scientifically and clinically
obligated to aging. But this notion of disease is problematic and ultimately loses
traction in these proceedings. Professor George:
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“I'm wondering about the distinction between the biological processes of
aging and disease in order to evaluate whether we can conceive the biological
processes of aging on a par with disease. What I have in mind is a sort of --
can be expressed in a kind of simple flat-footed way. We go to grandma's
house for Thanksgiving. She greets us at the door. How are you, grandma?
Oh, I'm okay. What do you mean you're okay? Something is wrong? Oh,
nothing. It's just old age. Right. Now when she's saying that, she's referring
to some biological processes, but she probably has various things, various
symptoms that are diseases, aren't they? Or things are breaking down, things
aren't going right. It could be anything. It could be Gout, it could be -- well,
all the things that happen to us as we get older. Now is there some distinction
between the biological processes of aging and just that collection of things
that grandma has in mind?” (PCBE 2002e).

George here tries to clarify what aging might mean not only to academicians
and clinicians, but also to those “experiencing” aging. Grandma is not feeling
splendid but that which is making her merely “okay” are accepted here as “just old
age.” Feeling only “okay” is presented as something less than feeling great – the
baseline that one should feel. She is accepting her hypothetical aches and pains and
loss-of-functions as part of the natural course of things and thus does not herald them
to her hypothetical grandson as remarkable events. George asks whether it is these
things that the question of disease circulates around or the process of aging itself that
may be something altogether separate. In other words, he asks, what is the
difference, if any, between aging and the collection of “all the things that happen to
us as we get older.”
In an effort to clarify the point, Professor Sandel asks “does anybody ever
really die of old age?”. In other words, can aging itself, without any noted disease
events (such as heart attack or stroke) be the cause of our biological demise? Sandel
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is effectively looking for the event of aging, the event of aging’s ultimate success
marked irrefutably by our physiological capitulation.
Death then becomes a kind of biological failure. However, death is itself
tricky in its categorization (Lock 1997/2000). As Lock discusses in her analysis of
organ transplantation in the United States, “one of the problems the Commission [on
defining death] faced was to transform the process of dying into a clearly definable
event -- to establish death as a point in time” (Lock 1997: 217, emphasis original).
Salient here is the attempt to find an event by which biomedicoscience can collar
what may also be seen as a process. Process is slippery and event more definable,
stable and graspable. This is a problem the Council is facing regarding aging: how
ought we make sense – scientific, cultural sense – of aging and interventions into
aging when, as a process, it is so nebulous and complex? The disease label does not
fit quite well, as Chairman Kass offers:
“ Let's take the -- here's the example from the muscle would be a useful
particular in which you could see it. In those muscle experiments that Dr.
Sweeney reported on, the injection of the gene for the insulin-like growth
factor in the early life of these mice and rates prevented -- when they got to
be two years of age or whatever, there was none of the normal decline of
function that one ordinarily sees as a result simply of what, of these
biological processes of use, whatever the mechanism is, so that the muscle
remain vigorous, healthier, repaired themselves better, and showed no sign of
decline of the sort that one normally saw in the life cycle. And the point of
this question was not to introduce a kind of new set of language where you
had to decide whether something was a disease or not. That might only make
the thing more complicated. Here there is an underlying biological process of
decline which makes us more susceptible to specific known diseases, and in
fact, is increasingly vulnerable also to death. And the question is, should we
regard this as the kind of thing, as the kind of badness in human life which,
with the same kind of medical means that we attack disease, we should set
about attacking this, and the attempt to slow it down, arrest it, postpone its
onset” (PCBE 2002d).
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Kass moves away from talk of disease as it “might only make the thing more
complicated” and instead grants that the larger question is one of intervention.
Appreciating aging as primarily painful and horrific allows for an attempt for its
amelioration. However, this value – is aging too bad or relatively good – is
precisely, Kass argues, where discussion needs to concentrate. Dr. Krauthammer
excavates the understanding of disease as follows:
“Well, I would just offer, to be as provocative as I can in answer and to
provoke discussion from that, would be that disease implies some defect in
biology, some error, some deviation from the normal trajectory. It was hard
to see how philosophically you could call aging a disease if it is the 100
percent norm for all organisms, so from that perspective, a biological
perspective, I would say that I find it hard to call it a disease, it being such an
intrinsically natural, if you like, process. From the human psychological
perspective, it's a disease in the sense that it creates problems which we want
to fix, and that -- and we regard -- it sort of ranks psychologically as a disease
in that sense, but I'm not so sure how much applying the word helps us in
deciding what to do about it, but that's what I would offer as an answer to is it
a disease? Biologically, philosophically, no. Psychologically, it feels like it;
therefore, we treat it as one” (PCBE 2002d).

Herein lies a special kind of problem, the one that, I argue, anti-aging
medicine is effectively posing. Disease categorization mechanisms are caught
between “the biological” and “the philosophical” and “the psychological” though
arguably all of these are ultimately cultural constructions and categorizations as they
all represent various ways of making sense. Our understanding of our biology, our
psychology, and our philosophies do not “naturally” coincide nor reconcile neatly. Is
biology more true than the other two approaches – or philosophy or psychology?
What classificatory schema is most important? Krauthammer’s triad varies on
nature, predictability, and abnormality as well as on any effort to deal with aging.
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Anti-aging medicine challenges that we do not need to label something disease in
order to treat it; the process of aging is menacing enough to bypass these
distinguishers.
The solicitation of testimony from Austad and Olshansky bespeaks a
particular perspective on anti-aging medicine and research. Gathering testimony
from every “expert” “in the field” is as prohibitively time-consuming as it is
unwieldy to define the field. While the Council’s witness-identification process was
not transparent, examining the selection of Olshansky and Austad against the
omission (or refusal?) of others is telling. Olshansky and Austad both hold posts at
major American research universities. Both have established a public face, though
neither as prominent as Aubrey de Grey. Not only have they engaged in their highly
publicized wager, they also have each authored pop-science books. But theirs are
not the only books broaching the topic (Fossel 1996, Guarente 2002, Kirkwood
1999, Miller 2002, among others). Both embrace some optimism for the future of
anti-aging and both argue that none currently exists and therefore not aligned with
the American Academy of Anti-Aging Medicine (A4M). While Austad did not sign
the Scientific American paper because he did not agree with the language in the
genetics section
4
, the sound-bite of the paper – that no anti-aging currently exists–
echoes statements from his 1997 book. These two men are both “legitimate”
scientists whose work is not sequestered within the “ivory tower.” They actively
engage with anti-aging both in their research and in their public-professional lives
and are not medical doctors and therefore do not see patients.
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Significantly, the Council did not solicit testimony from anti-aging
practitioners nor anyone clearly affiliated with an anti-aging clinic. Neither the A4M

nor any other anti-aging related organization (such as Life Extension Foundation,
Maximum Life Foundation, or Immortality Institute) were represented. This
omission may have been quite deliberate and was likely based on the belief that:
“there is at present no medical intervention that slows, stops, or reverses
human aging, and for none of the currently marketed agents said to increase
human longevity is there any hard scientific evidence to support the hyped-up
claims“ (PCBE 2003: 179-180 emphasis original, citing Olshansky, Hayflick
and Carnes 2002a).

By citing the Scientific American position statement on anti-aging medicine
and accepting the assertion that no efficacious anti-aging therapy currently exists, the
Council drew a portrait of the anti-aging field that aligned with much of the
gerontological position.
In addition to the omission of practitioners and some more “popular”
organizations, no one with any apparent interest in one of the biotech firms in search
of anti-aging therapies like UCSF researcher Cynthia Kenyon were heard. The
Council did not confer with any social gerontologists (such as Binstock, Cole, Haber,
Juengst, Post), sociologists, historians, or anthropologists involved with anti-aging
medicine. No one involved with the journal Rejuvenation Research testified.
Perhaps the Council deemed explicit entanglements (such as with biotech firms or
anti-aging clinic) conflicts of interest that undermine expert status. The targeting of
researchers who engage with quantitative science took priority over those social
scientists who have engaged with anti-aging in other ways. The standing in of
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Olshansky and Austad for the field suggests that quantitative, academy-related
science confers legitimate expertise, that their work offers a more “pure” well from
which to drink.
The organization of these testimonies revealed the Council’s intent to
understand the relationship between aging and its academic study – not its practice.
To a certain extent, its practice on the body and its scientific theory were seen as
distinct. While many differences and perspectives divide the clinical and research
aspects of anti-aging medicine, they are but two arms of the belief that aging’s
decline can be ameliorated.
The Council geared these testimonies to sketch a sense of what a “real” anti-
aging medicine might look like – whether it be simply a longer life, a shorter
“decline,” freedom from disease, or some combination thereof. On numerous
occasions, the Council explicitly set aside issues of accessibility and side effects and
took as feasible many of the claims (or at least goals) of anti-aging research while
taking as fact that aging does exist and can involve suffering. But in the silence of
the practitioners lies a significant axis for consideration; by thinking of anti-aging
medicine as means to reduce suffering – or to preserve health as heard from Austad –
practitioners challenge the biomedical pursuits that aim to do this job poorly or
inefficiently (as with the disease-focused research). Practitioners wield a critique of
American culture and its preoccupation with disease events, and a biomedical system
woefully and perhaps unnecessarily inadequate. Moreover, this critique extends to
the construction of nature that is at once beautiful and mysterious and to-be-
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protected that often undermines a “nature in ourselves” that demands progress and
has found potential outlet in anti-aging.

5.2 BEYOND THERAPY
In October of 2003, the Council published its final report, Beyond Therapy:
Biotechnology and the Pursuit of Happiness - A Report of the President’s Council on
Bioethics. Beyond Therapy posits that “biotechnology is bigger than its processes
and products; it is a form of human empowerment” (PCBE 2003: 2). In this sense,
biotechnology offers energy and muscle to human desires. In the forward to the
report, Kass writes:
“The unique American commitment to the pursuit of happiness -- made for
our nation by its fathers at the moment of its birth -- takes on new meaning as
we enter the age of biotechnology. In the years to come, we may gain vast
new powers to satisfy our desires and to seek our fulfillment” (Kass, in
PCBE 2003: vii)

This statement locates biotechnology at the center of the potential for the
“pursuit of happiness.” It suggests that biotechnology will have the wherewithal to
succeed in new ways in this “unique American” pursuit. It also seems to locate
biotechnology as responsive, as heeding and trying to make good on “our desires.”
Perhaps, also, biotechnology is a powerful force in shaping such desires and
fulfillments, that our desires take shape in what biotechnology is imagined to be able
to accomplish (Mykytyn 2006). That a longer and healthier life is often constructed
as a human universal suggests that biotechnology may indeed simply be responding
or capitalizing on a human desire. However, the growing confidence in the potential
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for biotechnological success in anti-aging medicine reveals a shift in the clamoring
hopes for anti-aging medicine from pie-in-the-sky, romantic notions of immortality
and real, hard, ardent pleas. This shift comes from a complex interaction between
desire and biotechnology since biotechnology is just as filled with people as people
are filled with biotechnology. Nonetheless, biotechnology is indeed expanding and
may soon, as Kass posits, give us “vast new powers” to both respond to and help
shape these desires.
This report constructs the expectability of life as crucially related to how we
live now as it foreshadows the size and shape of our future. The consequences of a
“successful” anti-aging largely call upon this expectability in terms of the life course.
The report posits the predictability of the life as an intrinsic and potent factor for an
individual’s life; a successful age-retardation would dramatically impact
expectations of the life course. Beyond Therapy asserts that while having greater
freedom to explore “new things and enjoy familiar ones” (PCBE 2003: 211) is a
positive consequence, concerns about perceiving a limitless future-time in terms of
levels of engagement and urgency may seriously undermine the value of that time.
The report states that “age-retardation technologies make aging both more
manipulable and more controllable as explicitly a human project, and partially sever
age from the moorings of nature, time, and maturity” (PCBE 2003: 217). In other
words, by making room for a longer and healthier life, the expectations of our future
would not be related, as they are now, to “nature, time, and maturity.”
“… [I]n the end, these techniques could also leave the individual somewhat
unhinged from the life cycle. Without the guidance of our biological life
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cycle, we would be hard-pressed to give form to our experiential life cycle,
and to make sense of what time, age, and change should mean to us.” (PCBE
2003: 217)

The report asserts that a successful anti-aging medicine would be
dramatically disorienting. This “unhinging” of our life experience to our
relationships with the world is equated with a loss of “biological guidance,” a kind of
life-course unruliness that ruffles a natural, expected order. Not only are “[f]amily
life and the relationship between the generations … built around the shape of the life
cycle” (PCBE 2003: 219), but so are notions of innovation, change, and renewal.
Thus the overarching reshaping of society would reveal a “very different place to
live than any we had known before” (PCBE 2003: 223). Life’s meaning, in other
words, is wound with its end, and with predictability of its end. This unknown future
so thoroughly changed is unclear; Beyond Therapy asserts that an altered topography
is as certain as the uncertainty of its contours.
Not simply in regard to living longer, Beyond Therapy reasons that even the
decline of aging serves an important function.
“The very experience of spending a life, and of becoming spent in doing so –
that is, the very experience of aging – contributes to our sense of
accomplishment and commitment, and to our sense of the meaningfulness of
time’s passage, and our passage through it. Being ‘used up’ by our activities
reinforces our sense of fully living in the world.” (PCBE 2003: 212,
emphasis original)

Here spending and the limitations in how much there is to spend define the
practice of aging. To be “spent” is to be exhausted of everything – of health, of time,
of energy, of curiosity, of desire. Thus, the physiological decline of aging is
important. Time and health are some of the costs of “fully living” and to have fewer
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limitations of either of these will, the report asserts, undermine the very fullness of
life.
Beyond Therapy asserts that the “anti-aging medicine of the not-so-distant
future would treat what we have usually thought of as the whole, the healthy, human
life as a condition to be healed. It therefore presents us with a questionable notion
both of full humanity and of the proper ends of medicine” (PCBE 2003: 227). This
proposes an unsettled existence of a “full” humanity, thought against a diluted and
fractional humanity, based on expectations of that life. The linking of aging
(senescence) with the “the whole, the healthy, human life” marks aging as a process
that is inextricable from its humanity and denotes the “whole” life as one that is
expected. Thus, constructing the expected as disease disturbs not only the life course
but the very experience of our own humanity as well.
The Council struggles with whether “aging is a disease” (PCBE 2003: 227).
“In addressing aging as a disease to be cured, we are, in principle, and at least tacitly,
expressing a desire to never grow old and die, or, in a word, a desire to live forever”
(PCBE 2003: 210). While aging is not framed specifically as disease here, the
efforts to “address” aging seem to mark it as a “disease to be cured.” Thus, the
problem of treating aging in these anti-aging medicine kinds of ways presents some
lexical issues. Discussing a scientific and biomedical process in which intervention
is possible and perhaps even inevitable lacks a precise vocabulary precisely because
of a tradition of disease-focused work.
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This quote also proposes that anti-aging endeavors are efforts at immortality.
Neither Austad nor Olshansky spoke in terms of immortality but rather in terms of
some life-extension (not life ad infinitum) with a focus on quality of life and health.
This construction of anti-aging medicine as immortality-seeking proved problematic,
also, to some of the council-members.
Two council-member-bioscientists took issue with the report’s implication
that “immortality is the goal of this research, despite all reliable scientific evidence
to the contrary” and that it is “predominantly to serve vanity” (Blackburn and
Rowley 2004, see also Blackburn 2004). In their Beyond Therapy commentary, with
fellow council-member Gazzinga, they argue that “the best, more scientifically-
rooted researchers have a different goal: not eternal life, but to improve health while
alive” (Gazzinga et al. 2003: xii). They requested a more “balanced treatment” to
include the “potential positive aspects of slowing biological aging, such as prolonged
good health” along with the inclusion of “quotes from researchers more
representative of the biomedical research community.” (Blackburn and Rowley
2004). Thus, they criticize the “incomplete presentation of science’” that resulted in
the reports’ stress on immortality as it strays from the primary goals they see as
characterizing this research.
Beyond Therapy attempts to transcend distinctions between enhancement and
therapy. The report defines “beyond therapy” as the
“strictly voluntary uses of biomedical technology through which the user is
seeking some improvement or augmentation of his or her own capacities, or,
from similar benevolent motives, of those of his or her children. Such use of
biotechnical powers to pursue “improvements” or “perfections,” whether of
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body, mind, performance, or sense of well-being, is at once both the most
seductive and the most disquieting temptation. It reflects humankind’s deep
dissatisfaction with natural limits and its ardent desire to overcome them…
What’s at issue is not the crude old power to kill the creature made in God’s
image but the attractive science-based power to remake ourselves after
images of our own devising” (PCBE 2003: 12).

Striking in this description is the notion of the voluntary. That this is posited
as a choice speaks not only to a freedom of biotechnological relations but also a
sense that it can be rejected without impunity. It proposes that these biotechnologies
will be “used” (not imposed) and places the individual “seek[er] of improvement or
augmentation” at the center of the discussion while eclipsing context of these
choices. This statement locates such technologies as options provided to individuals
in efforts to re-make themselves not spiritually or emotionally, but biologically.
This definition of “beyond therapy” calls to mind Foucault’s Technologies of
the Self “which permit individuals to effect by their own means, or with the help of
others, a certain number of operations on their own bodies and souls, thoughts,
conduct, and way of being, so as to transform themselves in order to attain a state of
happiness, purity, wisdom, perfection, or immortality.” (Foucault, 1994[1982]: 225).
For the Council, science is imbued with the power that has the ability to transform
the given, to, in effect, trump God. Individuals burdened/privileged with this
“biotechnical power” have authorship for their own “perfection” that is not moored
to God’s sanction. Herein, the human activity of science can supercede “natural”
(God-imagined) “limits” which suggests that nature itself is malleable. Not only does
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a natural life course exist in fact for the Council, it is also something that can be
altered (Rabinow 1996).
In this definition, it is natural, biological limits that generate our “deep
dissatisfactions.” But why are limits constructed as natural? Do the limits serve some
sort of design purpose or are they merely accidents of evolution? In other words, are
these limits natural because they have been outlined for us, or are they natural
because we have evolved to these limits? Beyond Therapy contends that biological
limits are more natural than the “nature” of the “ardent desire” to “overcome them.”
The desire and its efforts are constructed as a kind of meddling with nature rather
than natural in and of themselves – even when both have deep histories. Humanity
has long attempted to control “nature,” from the adaptation of fire to the
domestication of animals. And yet, these natural biological limits seem to trump the
other natures that might have guided the analysis.
This seemingly contradictory character of nature – that it exists externally but
also subjectively to human experience and control – suggests that even while the
Council struggles with understanding aging in reference to nature, nature’s
“grounding function” is problematic (Strathern 1992: 195). Nonetheless, it appears
that nature’s foundation solidifies around expectations. The expected life course
becomes the natural life course. Intervening in the natural life course is to transform
what is expected. But this is an intervention that produces something other than the
natural life course only because we had an expectation that preceded it.
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While the Council situates the ambition to live longer as common, the
consequences of such an endeavor are seen as undermining the humanity that birthed
it. Beyond Therapy cautions that, though advances in biotechnologies may indeed
make anti-aging medicine a real possibility, the effects of going beyond “natural,
biological limits” may be far-reaching and tremendously problematic for the
individual as well as for society at large.

5.3 CONCLUSION
In the Council’s deliberations and final report, anti-aging medicine is
constructed as a biomedicoscientific targeting of the process of aging. Austad
separates two lines of aging research into that which focuses on diseases often
associated with aging and that which targets the process aging itself. Olshansky
argues that any leaps in life expectancy will have to happen by “altering the basic
biological rate of aging itself” and goes on to argue that disease-focused work
backfire in terms of additional diseases and functional problems people may come to
experience. In the Council’s sessions, both Austad and Olshansky maintained that
the goal of anti-aging research is not immortality but rather, in Austad’s words, the
“preservation of health.” And both argued that anti-aging research provides a
necessary foundation to preserve health whereas disease-focused work may not
ultimately be as effective.
The Council, largely on the back of discussions of the life course, is more
cautious about such an endeavor. The Council’s predominantly worrisome portrait
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drawn of an anti-aging future is grounded in the assertion that this endeavor
intervenes in the natural life course – in what can be expected. Arguing that not only
would a greatly extended life span negatively affect human aspiration and drive, the
physiological decline of aging is similarly important to a sense of meaningfulness in
life. While some have argued that the pursuit of anti-aging interventions do not
reflect a siege on the natural order because that order has little moral or spiritual
significance (Cole, 1991: 33), the Council’s deliberations and reification of the life
course suggest otherwise. The Council cautions against anti-aging’s pursuit
precisely because of this seeming intervention into the expected, natural life; this life
roots our humanity. Thus, the life course becomes a kind of explication of nature;
like nature, this life course is largely expectable and predictable and has shaped the
very meaning of life and therefore should be approached with a kind of
preservationist respect.
Much of the social science literature attending to constructions of nature
assert that nature is so inextricable from culture that its grounding function is gone
(Strathern 1992: see also Haraway 1997, Lindee et al. 2003, Rabinow 1996, Soper
1996). The “natural,” in other words, is so moored to the “cultural” that it has no
separate dominion. Nature is culture is nature. However, the idea of a natural life
course is powerful in outlining our relation to ourselves. Some have argued that
even the life course as predictable and knowable enough to frame this self-image is a
particularly Western concept (Becker 1997) and thus a cultural construction rather
than a force of an autonomous nature. Beyond Therapy, constructs the “natural” life
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course as a kind of expectation that should confer a sanctuary from intervention.
This is, perhaps, the greatest point of contention for the practitioners.
The issue of speaking about treating the process of aging– whether or not the
process of aging can be targeted in the same manner as disease – consumed a great
deal of deliberation time. The nebulous line between pathology and nature proved
particularly problematic. Attempting to embolden this line, discussions of old age
causing death emerged. Could aging (or old agedness) itself, without any other
noted disease events (such as heart attack) trigger our biological demise? This line
of reasoning aims to find the event of aging, an event that could signal its more
disease-like machinery and dispose of the bioethically challenging problem of
treating the process.
Without a clear answer to this question, Kass retreats from talk of disease as,
he argues, it complicates rather than illuminates the issue. Instead, the larger
question is one of intervention. While the life course has shifted significantly in the
past 100 years as we can expect to live longer now than ever before, the critical issue
now is that to extend this trajectory requires an intervention into the biology of aging
itself. Thus, biomedicine’s duty is called into question. Is it the job of biomedicine
to attend to Alzheimer’s or, rather, to the processes of aging which may have
predisposed bodies toward Alzheimer’s? Aging can be awful and painful but, Kass
whether it is too awful and painful. Again, the importance of the life course, with all
of its beauty and gruesomeness, claims a major stake in the discussion. Thus, the
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work of treating disease is posed as different from the work of anti-aging medicine
and the aging-as-disease rhetoric loses traction in the deliberations and final report.
The question then becomes one of enhancements – itself an indefinite notion.
Enhancements are marked against the “natural” they endeavor to transcend; and so
“nature” looms as significant but also unclear. The difficulty in talking about issues
of enhancements on the rickety frame of nature is obvious in the Council’s
deliberations though that difficulty figures less prominently in its final report. This
haziness, well acknowledged by the Council, provides for the title of the final report:
Beyond Therapy. Going “beyond therapy” means to seek “some improvement or
augmentation of [one’s] own capacities,” or, in other words, to surpass the nature of
oneself. And of course it is this very nature that anti-aging medicine challenge.
While the Council argues for a life course kind of nature, anti-aging proponents
argue that the nature of trying to transcend is more natural. In this latter view anti-
aging medicine is, thus, more human.
In biomedicine, pain and suffering are largely addressed via therapeutic
means (Kleinman et al. 1992: 14). Whereas the Council posits pain as an important
facet of the human experience, practitioners foreground the duty of biomedicine in
response to the witness of suffering. As these two perspectives converge in the
realm of anti-aging, the bioethical constructions of the natural life course register
against the obligation of biomedicine. But how should we acknowledge pain
(Kleinman et al. 1997)? The work of the PCBE argues that suffering itself is an
important, morally acceptable if not even laudable, part of life. The suffering of
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aging is therefore valuable. On the other hand, practitioners vie for the mitigation of
aging as a function of a biomedical obligation to reduce suffering.
The Council forwards a particular portrait of anti-aging medicine: this
depiction portrays a likely biotechnological success as well as an image of its “real”
players. Excluding anti-aging practitioners from the deliberations, and accepting the
assertion that no anti-aging therapy currently exists, the Council frames the field of
anti-aging medicine within the future of science as opposed to the contemporary
practice. Thus, the ability to execute the administration of aging is confined to some
groups and not others. By arguing that this endeavor undermines our humanity and
may bring about terrible consequences for the individual and society, the Council’s
work resists the execution, or purging, of contemporary beliefs about aging that anti-
aging medicine ultimately challenges.

That amongst the high-profile issues of designer babies and cloning, the topic
of anti-aging medicine received the Council’s time and a full chapter in Beyond
Therapy, at once places anti-aging on the national table and in part validates its
perceived likelihood. The Council’s struggles with trying to understand the meaning
of scientifically targeting the process of aging for biomedical intervention reveal a
fissure in our lexicon in which biotechnologies, specifically anti-aging medicine,
operate. Constructions of nature and biomedical prospects and obligations converge
and collide around the process of aging. Now a formalized and publicized topic,
anti-aging medicine is sure to cultivate greater attention.

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1
“Age-retardation” is defined by the Council as the “slowing down of the biological
processes involved in aging, resulting in delayed decline and degeneration
and perhaps also a longer life. It is one possible route to life extension”
(PCBE 2003, p. 185).

2
“Awarded” at the International Longevity Center’s conference February 2002.

3
Austad also discussed this idea in his presentation.

4
Interview: Dr. Austad, 11/22/2003.

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6. EXECUTING AGING: CONCLUSION

Over the past two decades, anti-aging medicine has emerged onto the field of
biomedicine with significant challenges to our understanding of aging, nature, and
the role that biomedicoscience plays in shaping and responding to these conceptions.
The anti-aging move toward intervening in the process of aging stems in part from a
construction of aging as physiologically painful, biomedicine as myopically focused
on disease, and Science as being the repository of promise. The notion of
perfectibility becomes significant in this story when the “norm” of aging is linked
with nature and the universality/predictibility of aging; yet perfectibility becomes
less salient when anti-aging proponents argue that it is “more natural” for humans to
strive to surpass their apparent bodily constraints than it is natural for us to age.
Anti-aging medicine is a story of the competing claims to nature and the relationship
between biomedicine and the construction of aging. The categorical power of
process and event provide the fulcrum for this story by leveraging the moral claims
and constructions of nature of the varying proponents and opponents of anti-aging
medicine.
Constructions of aging in the United States have been predominantly
assembled around the belief that aging is a natural decline. Many researchers
bemoan the reduction of aging to its biological features and argue that aging is much
more than simply its biology. While researchers attempt to infuse our understanding
of aging with its broader sociocultural contexts (Blaikie 1999, Cohen 1998, Cole
1991, Friedan 1993, Vincent 2006), discussion of aging’s natural, physiological
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decline dominate the cultural discourse. Indeed, the decline of aging is treated as
immutable fact. However, the biological research that endeavors to help older
patients focuses not on aging itself as much as it does the “age-associated” diseases
such as late-life cancers and Alzheimer’s Disease.
Practitioners of anti-aging medicine readily accept the belief that aging is a
physiological decline. For the practitioners, aging is a process during which “you get
sick, you smell bad…, you lose your teeth, bone density, vitality, sex drive, and so
on.”
1
For these practitioners, aging is biologically agonizing and they embrace anti-
aging medicine as a way to mitigate its pain.
The belief in the undesirable physiological decline of aging has perfused the
history of the contemporary emergence of anti-aging medicine. However, the
history of anti-aging medicine has not been a litany of scientific advances concerned
with age-associated diseases but rather a history of the idea that aging can be
affected directly. There is a deep human history concerned with the extension of life
and the elimination of aging (Gruman 2003[1966], Haber 2001/2004/2005), and this
desire emerged again in what I have labeled the “early years” of anti-aging medicine
between 1990-1995. While mainstream categorizations of aging deemed aging as
too natural to affect, the assertion that the process of aging ought to be the focus of
scientific and clinical discussion materializes during the early nineties. The late
nineties experienced a dramatic upswell of interest in anti-aging attention both
scientifically and publicly. By 2003, with the scrutiny of the President’s Council on
Bioethics, the dream of scientifically targeting aging for intervention had become
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plausible enough for national, federal debate. No longer was it relegated to the
fantastic fringe and many practitioners and researchers were actively asserting their
anti-aging expertise. With the prevailing belief that aging is an objectionable decline
alongside the development of new biotechnologies that allow researchers to “see”
aging in new ways, the decline of aging is being made increasingly available to
scientific inquiry.
The President’s Council on Bioethics likewise accepted that the process of
aging is, at least in part, a physiological decline. However, through its deliberations
and publications, the Council offered a way to embrace the decline – not just with,
but even because of its aches and anguish. The notion of being “used up in life”
(PCBE 2002c), or “becoming spent” in aging provides, the Council argues, a “sense
of accomplishment and commitment, and to our sense of the meaningfulness of
time’s passage, and our passage through it.” (PCBE 2003: 212). Aging further
imparts a kind of “biological guidance” (PCBE 2003: 219) in the shape of a life
cycle that has, as an anchor, the decline of aging. Thus, for the Council, the
physiological decline of aging, however harrowing, is a critical aspect of being
human and living fully in the world. Any successful anti-aging therapy, the
Council’s report asserts, may well undermine the very fullness of life and therefore,
our humanity.
Social science theorists have linked the decline discourse on aging to
increasing medicalization of aging (Arluke and Peterson 1991, Blaikie 1999, Cohen
1998, Haber 2000, Lock 1993, Manheimer 2000). The medicalization – or the
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“making [of] something medical by annexing what is not illness into illness” (de
Vries, Berg and Lipkin 1982: 269) – largely involves the construction of diseases.
The event of a disease etiology with its concurrent symptoms and articulations of
treatment is a cultural process that involves the recognition of these signs and a
framework for understanding them as separate from nature. The medicalization of
aging in particular has been done on the back of the medicalization of age-associated
diseases – from Alzheimer’s Disease and dementia (Cohen 1998) to menopause
(Lock 1993, Kaufert 1988) and atherosclerosis (Mol 2000). That more and more
diseases are “found” in older adults reinforces the notion that aging is chiefly a
physiological decline, and that aging is constructed as a decline invigorates attention
to the “age-associated” diseases.
The medicalization of aging has been critiqued by social scientists who argue
that it leads to ageism (Arluke and Peterson 1981, Butler 1994, Cole and Thompson
2001b). Medicalizing aging also has been shown to contribute to the sense that older
individuals are perpetually “at risk” for biomedical problems thereby potentially
diminishing the social roles of older individuals (Kaufman and Becker 1996, Latimer
1999). This may also lead to a kind of judgment against those who do not take
“proper” care of themselves (especially in terms of nutrition, smoking, and exercise)
(Conrad 1994, Rowe and Khan 1998, Singer 1990). Old age is situated as a segment
of the life course, distinct from other aspects of the life course such as childhood,
with its peculiar pathologies and bodily expectations and yet is seen as natural and
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universal. Its distinction affords a sense of categorization such that we can even
think of old age and aging as a particular subset of life.
As this unique “time of life” that is old age and this unique process of life
that is aging increasingly becomes a subject of study, distinguishing between the
“normal” and the “pathological” of aging has become increasingly important for the
discipline of gerontology. Anti-aging advocates are operating in the elusiveness of
this division. Instead of separating between the normal and the pathological such
that the latter mandates intervention and the former commands acquiescence, these
practitioners and researchers posit that the “pathological” aspects of aging are merely
symptoms of the aging process. Thus, from this line of reasoning, the symptoms
should not consume all of the limited biomedical resources and attention but rather
their cause.
It should follow then, as the generalized progression of medicalization
suggests, that aging should be constructed as a disease. This is not what has
happened. The mainstream biomedical consensus is that aging is not explicitly a
disease (Austad 1997, Butler 2000a, 2000b, 2002; Butler et al 2000, Crews 1993;
Jasmin 2000; Jean-Nesmy 1991; Kouchner 2000 among many others). Anti-aging
advocates do not typically challenge this assertion; in fact, many practitioners and
researchers have told me specifically that aging is not a disease. Some practitioners
had difficulty with this question of aging as disease, they were able to say what aging
is not (a disease) but unable to say what aging is. Instead, practitioners responded by
reorienting discussions back to what they hope to accomplish with their anti-aging
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medicine practice. Recall Dr. B’s reasoning that aging is a “process” and perhaps a
“syndrome” while ultimately he spoke of his work as a way to slow down the
process.
2
Thus, while not a disease, there is something about aging that is subject to
intervention.
The history of anti-aging medicine is, in part, a story of the categorization of
aging. While anti-aging medicine advocates noted early on that aging is a disease
(Klatz 2000: 6), this kind of talk eventually faded and the notion of disease became
less prominent in anti-aging practitioner discourse. Researchers of aging who have
written popular science books on aging that are optimistic for the future of anti-aging
medicine have also been keen to dissociate aging from disease (Austad 1997, Fossel
1996). The persistent claims from anti-anti-aging advocates that aging is not a
disease seems to be based on the belief that anti-aging advocates claim it is. While I
have not found a great deal of evidence to support the assertion that anti-aging
proponents construct aging as a disease, it is understandable that biomedically
focusing on aging itself seems like a association between aging as disease. The sense
that anti-aging medicine is treating aging as disease, even while most anti-aging
advocates disagree, emerges, I argue, because of a lack of vocabulary for
biomedically intervening into the process of aging.
The President’s Council on Bioethics similarly had difficulty with
understanding the purpose of and foundations for anti-aging medicine. The Council
spent a great deal of intellectual energy trying to ascertain whether or not the process
of aging can be targeted in the same manner as disease. Councilmember
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Krauthammer argued that disease categorization mechanisms are caught between
“the biological” and “the philosophical” and “the psychological” such that in the
biological and philosophical frameworks aging is not disease though aging is a
disease psychologically (PCBE 2002d). In other words, we feel that aging is disease-
like and therefore treat it as such even though it does not follow more strict
definitions of disease. Chairman Kass eventually retreats from the invocation of
disease since he believes it convoluted rather than clarified the issue. The notion of
disease and the act of biomedical intervention could, he argued, be separated.
Both advocates for and opponents of anti-aging medicine share a consensus
that aging is not a really a disease. Theoretically, then, can anti-aging medicine be
labeled a kind of medicalization? I argue that anti-aging medicine is the most
inclusive form of medicalization. Bypassing the construction of disease, anti-aging
therapeutics (whether they currently exist or may in the future) aim to intervene
directly into this process of life.
If we critique the medicalization of aging as the ways in which
biomedicoscience carves aches and pains out of aging and labels them as pathologies
thereby problematically dominating discourse on aging, then biological aging
becomes reduced to a function of time. The critique of the medicalization of aging
argues that aging is more than these associated diseases. While I concur that the
critique that the dominant discourse of aging is biological, I assert that there is more
to the construction of biological aging as well; it is not enough just to say it is
biological. We must be attentive to how it is constructed as biological and what
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aspects of this biology become most meaningful. Thus, anti-aging medicine is the
ultimate form of medicalization in that everyone is effectively a patient. This is a
medicalization that is focused as much on health preservation as it is on health
restoration. Everyone becomes a patient in this model because a diagnosis need not
precede intervention.
Practitioners argue that the traditional biomedical approaches to dealing with
this pain have been insufficient at best; spending time, intellectual energy, and
scarce funding monies on the age-associated diseases, they argue, have offered little
more than stop-gap measures or palliative care.
Social scientists have critiqued biomedicine for being far too reductionist, for
focusing too much on the biological structure of the body and too little on
sociocultural aspects of the body (Atkinson 1988, Gaines and Hahn 1985, Good and
Good 1993, E Martin 1994). Critiques have, as we have seen, also been presented
similarly about aging (Friedan 1993, Cole 1991, Lock 1993a/b, Vincent 2006, among
others) – that the U.S./Western constructions of aging are too myopically biological.
Anti-aging proponents accept the physiological decline of aging construction and
also critique biomedical myopia. However, this anti-aging critique takes a slightly
different approach; by concentrating as it does on events, biomedicine discounts the
larger issues at stake – a “cannot see the forest for the trees” kind of argument. The
aging process, implicating all of the body’s organs and systems, is complex and
intricate. It is also, anti-aging proponents assert, the underlying common
denominator for late-life diseases and losses of function. Therefore, by
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acknowledging that it is the aging process that ought to be the primary focus for
scientific attention and clinical intervention, anti-aging medicine proponents are
perhaps offering a more holistic biomedical approach to aging.
Along similar lines, anti-aging medicine corresponds to social science
critiques regarding the cultural construction of disease. To varying degrees, many
anti-aging advocates see diseases as important topics in biomedicine – though not as
important as aging. Research into disease can contribute to a growing understanding
of the body and the physiological “ravages of time.” However, the age-associated
diseases are constructed against an understanding of a given “norm” for the body.
Many proponents and practitioners assert that the norms we have come to accept for
and with our bodies are norms only because we have not approached them as though
they might be surpassed. Mainstream biomedicine has constructed these norms as
natural and they are therefore relatively well-protected from intervention. However,
anti-aging proponents suggest that this kind of construction is inadequate. I argue
that just as social scientists have examined the production of disease from a cultural
standpoint that details the motivations for, ways in which, and consequences of
disease construction at various moments, many anti-aging proponents have also been
keenly cognizant of the cultural framing of disease. Moreover, that a disease can be
culturally constructed may also mean, to these practitioners, that the framework for
understanding biomedicine and the body is shiftable. Just as Dr. N cited Kuhn (or
rather “that guy who coined the ‘paradigm shift’”
3
), anti-aging practitioners see
themselves on the front lines of this paradigm shift.
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An anti-aging intervention, if we think of it as a way to improve our human
biological condition as anti-aging proponents assert, may be thought of as a kind of
enhancement therapy. However, this label of “enhancement therapy” which denotes
“interventions designed to improve human form or functioning beyond what it
necessary to sustain or restore good health” (Juengst 1998: 29), depends upon a
definition, or at least rough sketch, of health. “Good health” is a murky concept that
itself is balanced upon a sense of what is “natural” or “normal” and thus what can be
expected of the body (Parens 1998).
Practitioners do not identify their work as enhancement because nature is
neither a guiding force nor, they argue, are the physiological experiences we have
come to expect and accept of aging inevitable. One practitioner forcefully stated that
“the victim mentality of growing older – [that] 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.”
4
These practitioners also see much of their
work in terms of prevention and believe anti-aging medicine is as much about
preserving good health as it is improving it. Thus, fully treating one’s patients with
all of the available anti-aging arsenal is viewed as a much more moral and
comprehensive biomedical practice. Enhancement is only another word for good
medicine whereas the alternative, from the viewpoint of many practitioners, is
merely mainstream, disease-oriented medicine.
The anti-aging practitioners with whom I spoke do think of their work,
however, in terms of optimizing aging. They aim to provide their patients with ways
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to be as healthy as possible. This, of course, is no different from what most doctors
may aim for; the difference for anti-aging practitioners lies in the approach and the
ultimate goal. These practitioners focus on nutrition and exercise more than they
believe their mainstream counterparts do. I often heard lamented that medical
schools provide paltry education in this realm – sometimes little more than a week of
formal education on nutrition. Anti-aging practitioners also include controversial
therapies such as human growth hormone to replenish levels that decrease as we age.
Thus, the goal is not to age as prescribed by established “norms” for aging, but to
replace and replenish hormone levels so that the body can function more like, say, a
thirty year old than a seventy year old.
While not generally constructed as a disease by anti-aging advocates or
gerontology, aging is often constructed as natural – an indisputable fact of life.
However, social science theorists have long argued that nature itself is culturally
constructed (Escobar 1999, Haraway 1997a/b, Rabinow 1996, Rheinberger 2000,
Strathern 1980, Williams 1980). Nature exists in our particular understanding of the
world and appears autonomous and separate from culture (Gordon 1988a; Latour
1993[1991]). Nature has become the “the basis for truth itself" (Kleinman 1982: 8),
critical for the production of meaning (Robertson, et al. 1996) about our place in the
world, our rights to the world, our expectations and obligations, our frames of life
and of living.
However, the category of nature within biomedicoscience has become less
stable, especially in light of the development of new biomedical technologies (Lock,
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Young and Cambrosio 2000, Rheinberger 2000). The power of nature to guide
biomedical practice may be waning as researchers are increasingly able to “see”
nature in new ways that may then be biomedically affected (Dumit 2000, Rabinow
1996). Thus, the relationship between nature and biomedicine is questioned.
Strathern argues that nature’s “grounding function” is gone (Strathern 1992:195).
Rabinow suggests that nature will become overtly artificial just as culture becomes
natural (Rabinow 1996a). Haraway posits that nature will “not so much as displaced
as reanimated” (Haraway 1999). This research supports Haraway’s notion of
reanimation in that nature is a shifting concept and not one that is ultimately
irrelevant.
I argue that in the anti-aging field, nature is significant but that there is a kind
of hierarchy of nature. Aging, while not constructed as a disease by many anti-aging
proponents, is not seen as importantly natural. Anti-aging proponents describe aging
as natural when pressed but ultimately do little with such a categorization generally
treated as irrelevant. That does not mean, however, that nature itself is irrelevant.
Nature comes to matter significantly in terms of the construction of the human desire
to free oneself from pain. Thus, scientific progress is a natural, human pursuit.
Aging being natural is trumped by the belief that the “natural” drive to “progress”
and supercede our own biological (natural) constraints.
As articulated in Bailey’s work, liberating ourselves from our biology is
ultimately more human than acquiescing to it (Bailey 2005). Bioethicist Stephen
Post argues that “anti-aging research is much less driven by the desire to carelessly
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modify human nature than by the salutary wish to eradicate the age-related diseases.”
He goes on to note that the “essence of human nature has always been freedom over
human nature” (Post 2004: 88). For Post, then, as with the anti-aging proponents
interviewed in this research, anti-aging medicine is not simply frivolous or
imprudent but rather an extension of the “natural” human drive. Anti-aging
practitioners had difficulty speaking of aging and nature in the same frame as their
work. Surely, aging is natural, but why, many of the practitioners asked me, did it
matter in term of anti-aging medicine? Anti-aging medicine does not endeavor, they
argue, to abandon or discard nature, but rather it attempts to eliminate the perceived
and experienced pain and suffering in aging. The practitioners construct this goal of
pain prevention and elimination as the most imperative objective of biomedicine.
In this analysis of anti-aging medicine, the naturalness of the process of aging
appears to be of the greatest importance for those who disagree with the anti-aging
endeavor. Arguing either that aging is too natural to affect or the pursuit of such a
quest is hubristic at best and folly at worst, these opponents of anti-aging medicine
invoke nature as the primary categorical framework for understanding aging.
The President’s Council on Bioethics took the notion of nature and aging as a
primary consideration in their deliberations. For the Council, aging is such a natural
aspect of life that any anti-aging intervention threatens our humanity. However,
Steven Austad testified to the Council that, in his opinion, aging takes away from
“health.” In orienting this position, Austad disengages anti-aging from intervening
in nature but extends it to a kind of dramatic preventive medicine (PCBE 2002b).
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Nonetheless, the Council’s final report states that anti-aging endeavors “partially
sever age from the moorings of nature, time, and maturity” (PCBE 2003: 217).
Aging, no longer so tightly moored to nature, becomes, in turn, chaotic and
ultimately less human.
A primary component of the Council’s objection to anti-aging medicine is
that aging is natural because it is predictable. Aging is predictable in that
biomedicoscience has articulated many of the biological decline components of older
aging and that individuals expect certain biological things to happen as they age.
The predictability of life helps to guide our sense of being in the world (Becker
1997, Cole 1991, PCBE 2003). However, with anti-aging medicine, it appears that
the notion of predictability is not so much employed as a way to reinforce nature as it
is to mark it off as a site of biology that lends itself to intervention.
Social science scholars have argued that biomedicine is largely event-based in
that it constructs diseases upon events of bodily malfunction (Marcus 1995, Kaufert
1988). That which is not marked as malfunction stays firmly, then, in the categorical
realm of nature. Events become mandated sites of biomedical intervention while
processes may be scientifically explored but not clinically mediated. These two
categories designate these different responses as they come with implied moral
responsibilities.
Anti-aging medicine proponents object to this moral mandate demarcation.
Their work is principled not upon the relationship between nature/process and
biomedicine but upon the belief that pain and suffering (here, in aging) is the
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primary foe of biomedical effort. Thus, focusing on the process of aging with hopes
to find interventions is the primary objective – one grounded in a belief that
mainstream biomedicine geared toward pain palliation or disease treatment is
inefficient at best and ineffective at worst.
Instead of accepting the so-called norms for aging, anti-aging medicine
asserts a different set of criteria from which to operate. The notions of pain and
progress figure most prominently. On one hand, the practitioners and researchers
who are more or less advocating anti-aging medicine do so upon the belief that aging
is painful and it is the job of biomedicine to ameliorate pain. On the other hand are
the arguments about the nature of humanity to transcend what may be conceived of
as constraints. That aging is painful and that it is a biological constraint provide the
moral basis for intervening into the process of aging. That aging is a biological
process and that nature is more relevantly linked with a kind of scientific manifest
destiny for anti-aging proponents changes the equation for mandated biomedical
attention.

6.1 RESEARCH IMPLICATIONS
I have argued throughout this manuscript that anti-aging medicine illustrates
the increasing instability of the categorizations of nature, disease and aging. I offer
the process-event theoretical framework as an alternative to understanding these
instabilities and to make sense of how people are responding. Explicitly theorizing
these concepts with respect to anti-aging medicine offers another vantage point for
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social scientific interrogation. I employ “process” and “event” in two ways: (1) as a
theoretical tool for understanding the complexities of biomedicine’s relationship
nature, especial with respect to aging and, (2) in regards to their importance as
rhetorical devices in biomedicine. Analyzing aging as a process rather than the
events of “age-associated” disease illuminates constructions that might otherwise
have been normalized in discourse that privileges aging as natural. Additionally,
identifying the significance of “process” in biomedicine makes room for analyses of
how biomedical subjects are shaped and operationalized.
The process/event framework is not merely a proxy for nature/disease. While
these two models share conceptual similarities, their implications differ. Both event
and disease entail some degree of biomedical intervention while process and nature
both bank on notions of predictability and universality. Just as osteoporosis is
excised from nature, labeled disease, and treated, the expectedness of the life course
implies a natural, processualness. These two categorical frameworks are both
constructed and they both imply explicit beliefs about the world. However, it is in
the ways that each make sense of the world that they differ.
Process and nature diverge particularly in their political contingencies. In
practice, the cultural resistance to intervention into nature is much more robust than
that of process. Process appears more neutral, less entangled with God and ethics
and the-way-things-are-supposed-to-be. Nature, on the other hand, largely embodies
these ideas. Nature is precisely where values are hidden (Escobar 1999, Gordon
1988a; Haraway 1992, 2003; Koenig 1988; Lock 2000; Lock & Kaufert 1998;
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Martin 1992, Merchant 1990; Nelkin 1992; Toumey 1996). If nature has become
“the basis for truth itself" (Kleinman 1982: 8), then an intervention into nature, here
the nature of aging, has the power to become abominable in principle. Process has
the comparable buoyancy of being less determinedly moored. While a process can
be natural, and indeed these are often coupled – aging as a natural process – its
processualness is foregrounded and in some cases may eclipse nature altogether.
The cultural critique of disease and disease construction has made diseases
more subject to interrogation. The disease status of multiple chemical sensitivity
(Dumit 2000) and many “psychological” diseases (Elliot 2003), for example, are
particularly contentious. Nonetheless, how biomedicoscience frames and
acknowledges diseases is distinguished from the norms of the natural body. As
nature comes into question, then so disease. Thus, an analysis of an event
designation may throw into relief what may otherwise have been taken for granted in
a disease focused discourse.
The trope of “executing aging” employed herein highlights the three modes
of execution: the destabilization of constructions of aging, the administration of an
anti-aging medicine approach, and the performance of anti-aging medicine. This
triad of executions aim to explain and interrogate the work of anti-aging medicine vis
a vis the larger field of biomedicoscience.
Firstly, the destabilization of aging refers to the ways in which the decline
construction of aging is being disengaged from nature. Anti-aging medicine
proponents propose, both implicitly and explicitly, that nature is no longer a
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particularly relevant category for thinking about aging. Nature is relevant, however,
in the endeavor of anti-aging medicine. While aging has long been constructed with
respect to nature – that aging is predictable, universal, biological and therefore
natural – the naturalness of aging loses significance in that it refuses an
interventionist mandate. However, proponents argue, because it is human nature to
alleviate painful constraints, it is only “natural” that the agonizing decline of aging
we have come to expect and accept be purged. This invokes a kind of scientific
manifest destiny that asserts our nature conquer our nature.
Destabilizing the naturalness of aging creates the space in which the process
of aging can rhetorically dominate. This execution of aging embraces the
predictability of aging not to link it with nature but rather to draw aging as knowable.
That the process can be known affirms the possibility of developing interventions.
Thus, the aging process can be subject to biomedicoscience if we deem it important
to do so.
Secondly, the administration of the process of aging is an execution of
authority. This authority, or expertise, is highly contentious and as we have seen,
many groups and individuals are vying for its position. Notwithstanding is the
notion of disease and aging. As thinking in terms of process allows for a
disengagement with natural aging, so it calls into question both the preeminence of
“age-associated” diseases as well as the importance of disease in order to authorize
intervention.
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Examining the process of aging as a site of intervention opens up a much
broader set of bodily forms to biomedically arbitrate. Anti-aging medicine advocates
a profound and sweeping form of medicalization. Rather than the medicalization of
aging occurring incrementally as events of disease are scientifically recognized and
conceptually excised from natural aging, anti-aging medicine posits that the entirety
of the aging process be subject to, for, and by biomedicine. This is a more inclusive
medicalization, one that is focused as much on health preservation as it is on health
restoration, and as such everyone has patient status.
The third execution, that of performance, refers to the ways in which aging is
operationalized as an ameliorable process. Aging has been constructed as a decline
which has, through a disengagement with nature, been targeted for intervention.
This intervention, though, is based on the belief that we can intervene. Regardless of
whether or not a current efficacious anti-aging medicine therapy exists, the hope that
one – or more, better ones – may be developed in the future persists in this
operationalization of aging as a process. This vision of future success has the power
to direct contemporary practice. The histories employed by anti-aging advocates
speak of increasing longevity throughout the twentieth century that provide a
trajectory for continued escalation as well as a sense of continuing biotechnological
breakthroughs (See also Mykytyn 2006b).
Moreover, the execution of aging implies a kind of biomedical holism.
“Performing” aging as a process highlights the interconnectedness of systems. It
entails not only organs and their functions specifically in the decline of aging, but
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more critically the relationships between them. Anti-aging proponents critique the
narrow, reductionist focus that disease-focused research and practice pursues.
Disease-focused work aims to understand and manipulate the etiology and effects of
an abnormality. Anti-aging advocates argue that while this is not in and of itself a
bad thing, it has the tendency to neglect the larger complexities of the process of
aging. By looking more holistically into the process of aging, anti-aging research
endeavors to look at biological systems and their interactions rather than what they
see as a kind of myopic examination of their essences. For anti-aging proponents,
process matters more than events.
The stakes of anti-aging medicine are great economically, socially, and
biomedicoscientifically. Certainly a successful anti-aging intervention will affect
individual lives and the whole of a society whose population may live to or beyond
150 years. Nevertheless the pursuit of an anti-aging medicine intervention presents a
challenge to biogerontology to conceptualize physiological aging as an ameliorable
process.

6.2 DIRECTIONS FOR FUTURE RESEARCH
While the research herein was conducted with anti-aging medicine
practitioners and researchers, no ethnographic work has been conducted to date with
patients of anti-aging medicine. Many of the practitioners with whom I spoke used
some form of anti-aging medicine therapy on themselves, however, practitioners are
only a small sampling of the wide range of anti-aging patients. Some evidence
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suggests that patients are generally Caucasian and in their forties (Raffaele, Livesey,
and Luddington 2000) and I have been told by practitioners that their patients are
generally in their fifties with some in their early sixties and forties. Nonetheless, this
paltry demographic data needs to be ethnographically buttressed. It will be
interesting to see how, over time, patients fare with anti-aging medical attention, how
long patients stay with their practitioners, and how people make sense of their
experience as an anti-aging patient.
On the theme of practitioners as patients, there is a great deal of interesting
work that can be undertaken to flush out the differences between the kinds of
medicines that practitioners use on or for themselves and those that practitioners do
not. Certainly, oncology might not be a specialty in which physicians test out their
treatments on themselves in order to substantiate their belief in specific therapies.
The A4M suggests that 70% of anti-aging practitioners are practicing anti-aging
medicine on themselves (American Academy of Anti-Aging Medicine N.d.b).
Though certainly the 70% figure given by the A4M is subject to discussion, certainly
the fact that practitioners treat themselves has been borne out in this research. When
considered alongside the demographics of anti-aging medicine patients, this statistic
does not appear stunning. Practitioner demographics are fairly consistent the patient
demographic: both groups are generally comprised of Caucasian individuals (both
men and women) in their forties or fifties. However, when thought of in terms of
“what physicians do,” I would be surprised to find that practitioners in other
specialties practiced on themselves in such great numbers. What does this mean for
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and about biomedicine? What kinds of differences between and among
biomedicines lend themselves to self-therapy?
I have found through my research that death does not play a significant role
in the discourse around anti-aging medicine. While many opponents of anti-aging
medicine assume and assert that this endeavor is about not dying, I have not found
this to be the case. Quite the opposite in fact. The anti-aging medicine practitioners
that I spoke with said that their work had little to do with death and much to do with
life. While this sounds like the front page of a slick brochure, it also tells of a sense
that anti-aging medicine is about being healthy as long as possible, but not about
being alive forever. It has not been a fear of death that has compelled the
practitioners I interviewed but rather a fear of the painful decline of aging – and even
more specifically, the fear of “losing one’s mind” and failing to recognize and
cherish loved ones. In future ethnographic work, I shall like to explore this more
fully. In a similar vein, the rhetoric of death and how it influences and is impacted
by anti-aging research is currently being examined by Dr. John Vincent of Exeter
University.
As emerged most prominently in the Chapter 5, the theory/theories of
evolution and its/their relationship to our understanding of aging is another
interesting topic to explore more fully. Much of the belief that aging is natural is
based on the belief that aging is a kind of programmed process. However, there is
great discussion as to whether this process is one programmed by God/Nature or
whether it is “simply” a byproduct of evolution that we decline and die. If aging is
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an evolutionary byproduct, then how do we construct our ethical relationship to it?
Furthermore, it would be productive to think of evolution and aging in relation to
how beliefs about evolution contribute to the importance of process and event in
science.
I have discussed in this analysis the relationship between increasing
understanding of the body via genetics and anti-aging medicine. This deserves a
greater deal of attention especially in terms of process and event. If genetics is
constructed as the “essence of life” then manipulation of “bad” genes poses the same
kinds of problems as anti-aging medicine poses with respect to interventions into
processes of life without, perhaps, the political entanglements of nature. I believe
that the proliferation of genetics in science and the popularization of it as a
bioscientific field have helped to stabilize, legitimize, and make way for the
emergence of anti-aging medicine.
The controversy over the prescription of human growth hormone is a
particularly contentious one. From the synthesis of the 191 amino acid chain of hGH
in the laboratory, to the publication of Daniel Rudman’s much-cited article (Rudman
et al., 1990) to the international market for hGH and its related IGF-1 oral sprays for
sale over the internet, hGH is a cornerstone for much of the anti-aging medicine
therapy today. While many endocrinologists argue that we know too little about
hGH to advocate its usage, there is also a great deal of literature detailing its side
effects. Yet its consumption continues despite FDA prohibitions on its usage outside
of “approved” disease treatments. Currently, anti-aging medicine does not fall under
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this approved category and the FDA may begin enforcing more stringent controls on
hGH prescription as an anti-aging therapy (Weintraub 2006). Some of the
practitioners I interviewed compared hGH and its controversy to the controversies
over estrogen and progesterone (often referred to as HRT or hormone replacement
therapy). In this comparison they stated that hGH will likely follow the same
trajectory and that HRT encountered similar challenges in the beginning of its usage
as well. It remains to be scientifically seen if hGH is really “like” other hormones,
though it will be interesting to examine how it is constructed – or not – alongside
other hormones. Detailing the comparison more fully may be important in
contributing to the scholarship on the production of marketable therapies as well as
the new “underground” internet marketplace. An interesting project may also lay in
an analysis of hGH alongside the emerging discussion of andropause – or “male
menopause.”
The field of anti-aging medicine is diverse. It comprises the practitioners and
researchers in the biology of aging I have interviewed, and, of course, those I did not
interview. However, the term “anti-aging medicine” is often employed by
companies selling anti-aging skin care products and magnet therapies as well as
plastic surgeons who specialize in anti-aging surgeries. While not the focus of this
research, it would be fascinating to look at issues of beauty in relation to anti-aging
medicine. Certainly, at first glance, the notion of looking “younger” seems obvious.
But what does young mean here? Is it merely the absence of sagging skin and
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thinning hair? And what is it about looking younger that compels so many
companies to sell products to so many individuals, both men and women?
Moreover, where, if anywhere, are the boundaries between the “real” and the
“pseudo” science? All but one of the practitioners with whom I spoke scoffed at the
idea of magnet therapies and energy auras. They considered these therapies
unscientific and fringe, very fringe. In terms of excavating notions of pseudoscience,
I believe that the anti-aging medicine field would provide an excellent case study.
I am particularly interested in the relationship between the “Self Help
Movement” and anti-aging medicine. Self-Help is often described as promoting the
“remaking” of oneself (McGee 2005, Salerno 2005). Usually, this “remaking” takes
place on a spiritual or emotional plane whether it involves encouraging individuals to
connect and communicate with their loved ones in different ways or to reinvent the
self in a more “positive” and “healthy” light. Self-Help, especially Self-Help books
and seminars, has enjoyed a dramatic proliferation since the 1970s with books being
published monthly and sometimes reaching bestseller status. I am interested in the
traffic between this idea to remake the self that Self-Help has advocated and the
belief in many anti-aging medicine circles that the self can be biologically remade as
well. I suggest, though it is far too early to say anything definitive, that these notions
of transcendence that have pervaded Self-Help and even the “New Age Movement”
may indeed have some relationship with anti-aging medicine.
Finally, the phenomenon of scientific prizes deserves more academic
attention. The Methuselah Mouse Prize, which aims to award researchers who
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produce and document the longest lived mouse and the best late onset interventions
in longevity, has drawn over a million dollars in personal contributions to date.
While there are a few large donations, a solid amount of this fund comes from
individuals pledging less than $500. Prize creators Aubrey de Grey and Dave Gobel
believe that not only will the prize snowball popular interest in anti-aging research,
but also that interest may have an effect on the agendas of funding organizations.
Furthermore, the work that researchers conduct in order to compete for the prize is at
least partially funded by grants they have ‘won’ from funding agencies. Thus, de
Grey has told me, this is a kind of “cannibalization” of resources
5
. The mobilization
of resources and popular attention surround this prize speaks to a strategic and
perhaps unusual approach to scientific endeavoring. Investigating the creation and
development of the Methuselah Mouse Prize within the context of other historic
scientific prizes such as the Xprize for space tourism may provide an interesting
vantage point for examining a site of scientific democratization – though this is
unclear at this point..
These avenues for future research engagement are but a few examples of the
social science work that could be undertaken. A few researchers have begun study of
anti-aging medicine: John Vincent of Exeter University, Eric Juengst, Robert
Binstock and Jennifer Fishman and their group at Case Western Reserve, and Diana
Watts-Roy, a graduate student at Boston University have all begun ethnographic and
survey research on various aspects of anti-aging medicine. Regardless of whether an
effective therapy is developed, anti-aging medicine poses deep challenges to
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biomedicoscience and bioethics with profound implications for biomedical research,
clinical practice and for society.

6.3 SUMMARY
The meaning of aging, nature, and the role that biomedicoscience plays in
shaping and responding to these conceptions is explicitly at stake in anti-aging
medicine. Anti-aging medicine raises a number of critical issues: from questions of
access to care to the mandate of biomedical treatment, to how we think of ourselves
in relation to our life-cycles and time, to how we construct nature and its categorical
power. I argue that the notions of process and event underlie these issues. By
thinking of aging as a process, its naturalness becomes less significant and by
avoiding the notion of disease, anti-aging practitioners bypass the politics inherent in
these kinds of constructions that herald fears of medicalization. Nonetheless, I argue
that by asserting that a process of life can be intervened upon, anti-aging medicine
poses a greater kind of medicalization.
This medicalization of process raises issues of perfectibility. The notion of
making one “better than well” (Elliot 2003) has spawned a distinction between
enhancement and therapy. Enhancement therapies are seen as choices that
individuals can make to improve upon their physiological conditions. On the other
hand, medical therapies represent a kind of response to a physiological need. For
anti-aging proponents, aging is marked by physiological suffering and thus presents
anti-aging medicine as being a “need” rather than a “want.”
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The emergence of anti-aging medicine over the past twenty-odd years
partially stems from an increase in thinking of the body through the lens of genetics
wherein life, process, nature, and disease are more complicated and entail less
discrete boundaries. Anti-aging medicine has also been grounded in a construction
of aging as a particularly painful time. Biomedicine, similarly critiqued as
inefficient and myopically focused on disease, also grounds anti-aging’s emergence.
That Science is seen as the repository for potential solution not only unites the
varying players in the anti-aging field, but also grants anti-aging medicine a certain
and important kind of legitimacy.
Returning to the question of whether or not I believe in anti-aging medicine, I
must first acknowledge my own evolution of thinking while conducting this
research. Following my initial impression that anti-aging medicine was laughable,
the earlier versions of papers I wrote and presentations I gave highlighted the bizarre
without fully appreciating its grounding. I was naively captivated by the seeming
absurdity and employed this as my primary lens through which to view this practice.
After conducting many more interviews and being quite moved by the sincere
passion with which many practitioners discussed their work and the sorrowful stories
they shared in telling their stories of becoming involved with anti-aging medicine, I
reexamined my early reactions and began to appreciate the real challenges anti-aging
medicine poses and the inherent critiques implied in those challenges. I have grown
to appreciate some of the ways in which anti-aging medicine responds to the
contemporary practice of biomedicine in that the overarching drive is to undercut the
219

pain of aging. Surely, I do not wish to slowly become more frail. I would like to
play with my grandkids, wrestling on the floor and chasing them around the yard just
as I do with my own children. I am uncertain of the charge that life is to be “spent”
such that one feels “used up” and ready to “go” when the time comes. However, I
can identify with a saying that I read on a decorative hand towel in someone’s
bathroom once: “The object of life's journey is not to arrive at the grave safely in a
well preserved body, but rather to skid in sideways, totally worn out, shouting, 'Holy
Shit, What a Ride!!!’”. Perhaps it is a particularly American sentiment to want to
squeeze every ounce of life from every moment. Nonetheless, it is a common
enough sentiment so as to warrant its own message embroidered onto a towel.
Like many social scientists, I am critical of the ways in which nature can be
used to forward certain agendas. That its foundation in morality is often hidden
disturbs me and I strive to make these hidden meanings more explicit not only in my
work but in my life as well. Therefore, divorcing aging from nature then carries with
it some measure of comfort for me. But nature is never out of the equation and, as
the anti-aging proponents have shown me, it is only transformed to mean something
else that forwards another kind of agenda.
The critique that anti-aging medicine presents a kind of ageism seems to be
only one way to think of what ageism means. Certainly, in anti-aging medicine there
is a sense that aging is something to be avoided, but it is not necessarily the older
person herself that should be prosecuted. I can appreciate the sentiment that
220

accepting the pains of aging is tantamount to a greater kind of ageism than anti-aging
medicine may levy in thinking of biological aging as ameliorable.
I am leary about the ways in which anti-aging medicine currently is marketed
as a promise that may lead people to believe it can do more than it actually may do.
It’s hype may indeed lead to its downfall in the popular sphere which may have
deleterious repercussions in the field of biology. Additionally, I am concerned that it
is available only to those who can afford it. I have little sympathy for the comment
made by a very successful anti-aging clinician that anti-aging medicine “is about
making choices, just as eating at McDonalds is a choice.” Do the people who eat
frequently at McDonalds always have as much access to the kinds of information
sources, belief systems, and financial resources that are pre-requisites for anti-aging
therapies?
Whether an effective anti-aging therapy that really lengthens life and “health”
is developed is unclear at this point. However, I have been somewhat beguiled by its
potential. I have changed my personal lifestyle habits as a direct result of this
research; eating more vegetables and less calories overall, exercising with greater
frequency, taking daily vitamins. Were an intervention to happen in my lifetime, I
would like to be in the best possible to shape to receive it. And if not, certainly
living a more healthy life in my body has its own benefits regardless. Most
importantly perhaps, the thought of aging has been at the forefront of my mind and
imagination now for years and I no longer think of myself only at the age I am. I can
221

no longer eclipse from my consciousness the probability that I will one day be sixty,
seventy, eighty.

The story of anti-aging medicine’s emergence and practice tells of an intense
desire to live healthier, longer. It is a story of the suffering of aging and of faith in
biomedicoscience. It is a story rife with controversy and personal battles and is
peopled with disgruntled, hopeful physicians, advocate-organizers who play to the
public through the media and internet, researchers wary of the side-effects both
philosophically and physiologically of anti-aging interventions, and scientists who
are dedicated to making aging less painful. Moreover, it is a story of the increasing
difficulty and, indeed, the growing freedom for biomedicine to deal not only with its
own biotechnological advances, but also with its increasing foray into the human
life.
By removing the relevance of aging as natural and bypassing its construction
as a disease, anti-aging medicine aims to execute aging through a kind of
medicalization of the process of aging itself. This is a compelling prospect, one that
is strategic in its construction and powerful in its promise. Thinking in terms of
process, anti-aging medicine practitioners and researchers powerfully reorient the
relationships between biomedicoscience, aging, nature, and disease.

1
Interview: Dr. N. 10/16/2002.

2
Interview: Dr. B. 12/18/2001.

3
Interview: Dr. N. 10/16/2002.

222

4
Interview: Dr. N. 10/16/2002.

5
Interview: Dr. de Grey 03/30/2001.
223

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Abstract (if available)

Abstract Anti-aging medicine has emerged over the past twenty five years with the explicit goal of biomedicoscientifically intervening into aging. Anti-aging practitioners treat patients in their clinics with a wide array of anti-aging strategies: nutrition, exercise, supplements and hormone therapies (human growth hormone being the most contentious). Anti-aging researchers search for ways to intervene into the aging process, having to first grapple with the unsettledness of what that process might entail. Interventions into aging have been dubbed by many detractors as a linkage between aging and disease. This dissertation, drawing from more than six years of ethnographic interviews, participant observation in clinics and conferences, and a review of pertinent literature, argues that practitioners do not conceptualize their work in this way. Instead, anti-aging proponents generally eschew this linkage arguing that aging is not a disease but that it is not inevitable and thus subject to scientific scrutiny and biomedical intervention. The meaning of aging, nature, and the role that biomedicoscience plays in shaping and responding to these conceptions is explicitly at stake. Anti-aging medicine raises a number of critical issues: access to care, the mandate of biomedical treatment, how we think of ourselves in relation to our life-cycles and time, how we construct nature and its categorical power. I argue that the notions of process and event underlie these issues. By thinking of aging as a process, its naturalness becomes less significant. By avoiding the construction of disease, anti-aging practitioners bypass the inherent politics that herald fears of medicalization. Nature is not completely irrelevant here, however. Instead of relating to nature as a kind of sanctuary in which biomedical intervention is constructed as hubristic at best, anti-aging proponents argue that nature is more significant in the human drive to overcome biological constraints.

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Asset Metadata

Creator Mykytyn, Courtney Everts (author)

Core Title Executing aging: an ethnography of process and event in anti-aging medicine

School College of Letters, Arts and Sciences

Degree Doctor of Philosophy

Degree Program Anthropology

Degree Conferral Date 2007-05

Publication Date 05/04/2007

Defense Date 10/26/2006

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag aging,anti-aging medicine,biomedicine,OAI-PMH Harvest,science

Language English

Advisor Mattingly, Cheryl (committee chair), Bengtson, Vern (committee member), Jacobs-Huey, Lanita (committee member)

Creator Email everts@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-m483

Unique identifier UC1218495

Identifier etd-Mykytyn-20070504 (filename),usctheses-m40 (legacy collection record id),usctheses-c127-497961 (legacy record id),usctheses-m483 (legacy record id)

Legacy Identifier etd-Mykytyn-20070504.pdf

Dmrecord 497961

Document Type Dissertation

Rights Mykytyn, Courtney Everts

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Repository Name Libraries, University of Southern California

Repository Location Los Angeles, California

Repository Email cisadmin@lib.usc.edu