Getting Over the Denial of Aging

There's an old vaudeville joke that goes "Denial is not just the name of a river in Egypt." It's no joke to say that books denouncing "magical thinking" will always be timely, and none is more timely that Muriel Gillick's The Denial of Aging: Perpetual Youth, Eternal Life, and Other Dangerous Fantasies. Like Freud, she wants to disabuse us of our magical thinking about old age and put in its place the reality principle. She's got her work cut out for her.

Let's start with a depressing statistic. Each year, sales of antiaging nostrums break new records—more than six billion dollars last year—a strange fact when you realize that, in terms of scientific efficacy, there is no such thing as antiaging medicine. It gets worse. Today there are more doctors in the United States who are members of the American Academy of Anti-Aging Medicine than there are board-certified geriatricians, while training of new geriatricians lags far behind the need. Health care professionals are poorly prepared for the "age boom" soon to be upon us—a precarious situation at a time when more than eight thousand baby boomers are turning sixty each day.

For these reasons, Gillick's book could not appear at a better time. We should send a copy to every member of Congress, as well as to all those doctors peddling bogus antiaging remedies. Readers need her message more than ever, but, alas, they seem unlikely to hear it at all as they rush to pick up prescriptions for human growth hormone, antioxidants, or other "dangerous fantasies" that Gillick decries. Hey, it's a six billion dollar a year business and growing fast! It's enough to make one give up on the idea of autonomy (or the market-place?) in the pursuit of health.

The facts about so-called antiaging medicine are clear enough. No interventions have ever been shown to slow or reverse the biological process of aging. None. Or perhaps there's one exception: caloric restriction—that is, eating less. This drastic approach has long been proven to work with every lower organism on which it has been tried. But it means eating a lot less if you want to live longer: say eighteen hundred calories a day for the average person. Experiments with primates are now underway, but their long lifespan means the jury is still out. Yet even before our current epidemic of obesity, caloric restriction was never popular with Americans. Other "remedies" for aging will hit your pocketbook and perhaps damage your health with side effects (cancer, carpal tunnel syndrome, etc.), but they will fail to do what their promoters promise. Still, the quest goes on, as Ponce de León would have understood. Indeed, even many serious biologists believe that, before long, basic biological research may yield clues to slow the process of aging. Whether such innovations could or should take place is not Muriel Gillick's concern, nor is it the focus of this review.

Gillick writes as an experienced practitioner of geriatric medicine, and she's at her best in chapters focused on that topic. But she also wants to offer advice to her fellow aging baby boomers: ". . . if baby boomers are to have a good old age, we will need to stop squandering resources on tests and treatments that offer little or no benefit" (p. 12).

Her main message appears at the beginning of the book. If we want a good old age, we need to start early—hence preventive medicine and health promotion are the way to go. But it's not easy to travel that road. Gillick believes we're spending our health care resources on all the wrong things—such as attacking uncommon and incurable conditions—while we ignore prosaic problems, like falls and social isolation, that are damaging but within our power to fix. By the time we join the ranks of the "worried well," boomers who believe in autonomy will be demanding more and more screening tests. Those tests are neither cheap nor harmless. And by the time we or our aging parents reach...