Anti-ageing Medicine: Myths & Chances

Evolution of the ageing concept: from irreversible decline to anti-ageing

Until last century, the medical perspective on ageing has been predominated by the strict view that human physical and mental abilities decline with age and defined as such: “Ageing is an aggregate of biological change beyond the point of optimal maturity. It is the point at which development has ceased and any subsequent change is usually seen as decline or deterioration.” (Buhler, 1968).

Since the 80s, a new trend began to modulate this concept with the life-span developmental perspective which defends first, that development occurs at all points across the life-span and is not limited to prematurational processes, but extended to postmaturational processes as well; secondly, that development and ageing is influenced by the past (what has gone on before) and the future (what is expected or perceived to come) of the individual (Baltes et al., 1980; Baltes et al., 1977). Following those pioneering work from social sciences, the concept of ‘successful ageing’ was also demonstrated in medical sciences through large longitudinal and cohort studies that revealed that ageing with a high quality of life is possible through the maintenance of an active and healthy life free of disabilities and with minimum ailments (Rowe and Kahn, 1998).

Recently, with the galloping progresses of medical (bio)technology, the ageing concept has seen a radical shift with a “new health care paradigm” with the emergence of anti-ageing medicine: pathological ageing and decline is the expression of an avoidable and reversible “system failure”. Anti-ageing medicine finds its niche in many biological theories on ageing. Currently, the 19th Century Reliability Theory applied to ageing and death is one of the most relevant and used for anti-ageing. Gavrilov and Gavrilova (2001, 2006) describe ageing and death as a phenomenon of increasing risk of failure for a system with the passage of time (age): “Reliability theory predicts that even those systems that are entirely composed of non-ageing elements (with a constant failure rate) will nevertheless deteriorate (fail more often) with age, if these systems are redundant in irreplaceable elements. Aging, therefore, is a direct consequence of systems redundancy.” (2001).

Anti-ageing medicine is precisely addressing interventions aiming at avoiding or reversing the risk of system failure.

What is Anti-ageing medicine?

The term “Anti-ageing medicine” was created in 1993, with new scientific advances recognizing that the age-related mechanisms of frailties and physical and mental failures associated with normal ageing are caused by physiological dysfunctions and system failure, in many cases, can be ‘repaired’ and anticipated by appropriate medical interventions: “Anti-ageing medicine is 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 and Goldman, 2003, founder of the anti-ageing movement).

Anti-ageing medicine bases its approach on biotechnological progress aiming at countering the effects of disease, but furthermore preventing and intervening on micro-components of the ageing process, from the cellular level on to the global functional and mechanical level. It covers a vast array of domains from therapeutic cloning, stem cells, genomics, to dietary supplements, brain enhancement, bionic devices, bio- and aesthetic surgery, smart environment and robotics (see graphic 1).

Graphic 1: Areas covered by Anti-Ageing Medicine

According to their protagonists, anti-ageing medicine is an extension of preventive health care: “If you have had your cholesterol tested, taken a lipid-lowering drug, had a mammogram, or taken hormone replacement therapy with thyroid, testosterone, oestrogen, melatonin, or DHEA, you have experienced anti-ageing medicine.” (Klatz and Goldmann, 2003).

It aims not only to prevent and reduce the severity of age-related diseases – arthritis, dementia, cataracts rheumatisms, parkinson – but also to prevent and reduce the severity of ailments which are due to the natural process of ageing, such as skin ageing, and the loss of muscle tissue and bone density, and so maintain some of the characteristics of youth. Through the appropriate transfer of the newest medical technology, not only is the early detection process improving but also the interventions measures in ‘fine tuning’ of body imbalances. For example, functional decline is countered by either supplementing the organism with depleted metabolic substances or by surgical interventions to replace defectuous body parts. Anti-ageing medicine uses the classical preventive measures such as alternative regimes in an integrated approach, nutrition, physical and mental training, but moreso it aims at preventing future age-related health problems at the earliest stage possible or reversing metabolic inbalances causing physical and mental diorders. Therefore anti-ageing medicine is not merely geriatric medicine which treats and takes care of old people who are ill, but aims at all ages by preventing any age-related problems throughout life and to maintain health into old age. It includes advances in diverse disciplines such as biochemistry, biology and physiology, but also in bioengineering, biosurgery, molecular genetics, and emerging medical technologies. For this reason, anti-ageing medicine integrates all specialities and often a transversal approach of medicine, while promoting a different outlook on ageing.

The founders have clearly marked a change with the classical model of ageing and health care for healthy ageing people and assert anti-ageing as a new true revolution: “Anti-ageing medicine is the newest clinical medical specialty, the "optimum" of wellness and longevity, and employs extensive therapies and treatment in the preventative health care field far beyond just cholesterol testing and mammograms. A profound paradigm shift is now underway on how the medical establishment views ageing and age-related disease” (Klatz and Goldmann, 2003). The fact that anti-ageing medicine claims to be a branch of medical science and applied medicine, aiming at treating the underlying causes of ageing and at alleviating any age-related ailment and signs, with the ultimate goal of extending the healthy lifespan of humans is creating a surge among geriatric establishment. The term ‘anti-ageing medicine’ itself has been subject to controversial opinions and other terms are today used such as “interventive biogerontology”, “preventative interventions” or even “ strategies for engineered negligible senescence (SENSe)”. The latter term basically means to artificially slow down ageing to almost zero (Aubrey de Grey).

Anti-ageing medicine while still not officially recognized by most national medical boards and academies in the world is a fast growing field in subspecialties such as gynaecology, dermatology, surgery and cosmetology. One of the interests lies in the advances made in differentiating biological age from chronological age through the development of different types of “biomarkers” which up to date have only found consensus in “functional biomarkers”.

The TA-Swiss Study on Anti-Ageing Medicine^[1]

TA-SWISS Centre for Technology Assessment has just completed a study on anti-ageing medicine which aimed at studying the future perspectives of better ageing and anti-ageing medicine. It strived to identify and classify the interventions, treatments and products as well as assess their evidence-based risk or security for the medical practice and for the patient and consumer (Stuckelberger, 2008; Stuckelberger, Wanne and So-Barazetti, 2008).

Extracts of the analysis and results are presented here.

The analysis shows that while the traditional view of ageing sees an irreversible decline, “Better Ageing” as a medical concept offers different prevention tools than Anti-ageing medicine. Going beyond “classic prevention”, anti-ageing medicine considers itself as an extension of preventive health care, pushing prevention to the limits of detection and intervention (graphic 2 and graphic 3). On one hand, the metabolic age-related changes, usually identified by medical doctors in classic prevention (i.e. hypertension, cholesterolemia), are taken a step further by anti-ageing medicine through more refined indicators for doctors, but going further technology is transferred to the home through self-measurement devices (i.e. hypertension device, cholesterol home testing devices)^[2]. On the other hand, biomarkers for specific modifications are being developed and advocated by the anti-ageing medicine movement (i.e. levels of homocysteine^[3]), which allows practitioners and the anti-ageing medicine market to propose, beside nutritional changes, a list of dietary and speciality supplements to compensate for the age-related decline in metabolic measures. For example, for each age-related decrease in specific hormones, a targeted speciality supplement is proposed. The interventions can take place at many levels: internal (i.e. biomolecular or pharmacological interventions) or external (i.e. surgery, resurfacing skin techniques, wellness, etc.).

Graphic 2: Ageing Patterns According to 3 Prevention Models

Source: Stuckelberger (2008)

Results shows a variety of level of evidence: while some interventions have been thoroughly studied in animals (i.e. caloric restriction positive effect on longevity and a disease-free life), others have not been demonstrated at the population level but successful cases are reported in private practices. All so-called anti-ageing medicine interventions studied have some level of proof in humans, but with specific targeted groups (i.e. retina replacement with stem cells, statins, growth hormone, dietary supplements) or in case of deficit of a metabolic compound. It can be noted that, in contrast to geriatric medicine, anti-ageing medicine is not primarily targeting the oldest old or centenarians, but rather a wide range of ages among the healthy population starting at an ever earlier age. While the users are demanding anti-ageing medicine and visiting numerous clinics and internet site to buy promising anti-ageing medicine, substantive research and technologically development are still required to generalize the efficiency and safety its application.

The book on Anti-Ageing Medicine develops the results for a number of interventions and technological solutions while analysing the level of evidence and subsequent risk for the population. Each section starts with a background explanation of the technological intervention and ends with a risk assessment, ethical considerations and recommendations. The last chapter offers a set of 7 detailed recommendations which can be applied to each nations in the word through informing informed analysis for policy-makers, legal departments, researchers, medical and paramedical professionals, private sector and last but not least for the consumer.. This book hopes to provide information and tools to advance in a safer and healthier world while contributing to quality of living throughout the time of our life.

Graphic 3: Differences between “Better Ageing” and “Anti-Ageing” Perspective

Dr. Stuckelberger is interested in hearing your responses to her work. In particular, Dr. Stuckelberger would like to hear your answers to a few "anti-ageing medicine" questions. Yor responses will help her in her continuing work on in this area.

[1] See: http://www.ta-swiss.ch

[2] Cholesterol, Home Testing Devices: Several devices are on the market. Some measure only total cholesterol. Others measure total cholesterol and high-density lipoprotein (HDL) or "good" cholesterol. One measures low-density lipoprotein (LDL) or "bad" cholesterol, HDL cholesterol and triglycerides (blood fats). The American Heart Association is discussing this new trend but has not yet taken a position on cholesterol home testing devices.

[3] Homocysteine is an amino acid, elevated levels of homocysteine (Hcy) has been shown to increase the risk for several disease states. Homocysteine levels can be accurately determined from a small sample of blood which can be done in medical practice. S

references

1. Buhler, C. (1968). Old Age as a Phase of Human Life. Human Development. 11, 53-63.
2. Gavrilov L.A. and Gavrilova N.S. (2001). The reliability theory of ageing and longevity, Journal of Theoretical Biology, 213: 527-545.
3. Gavrilov, L. and Gavrilova, N. (2006). Reliability theory of ageing and longevity. In: Handbook of the Biology of Aging. Academic Press, 6th edition (pp.3-42).
4. Baltes P. B. (1997). On the incomplete architecture of human ontogeny, American Psychologist, 52(4):366-380.
5. Baltes P. B. and Baltes M.M. (1990), Successful Aging: Perspectives from the Behavioral Sciences, Cambridge, UK: Cambridge University Press.
6. Rowe J.W. and Kahn R.L. (1998), Successful Aging. New York: Random House.
7. Klatz R. and Goldman R. (2003), The new anti-ageing revolution. Basic Health Publications.
8. Stuckelberger A. (2008). Anti-Ageing Medicine : Myths and Chances, results of an global and national study for the Swiss confederation innovation and technology Department, the Swiss Medical Academy of Science and the Center for Technological Assessement (TA-Swiss). Verlag, ETHZ, Zurich, Switzerland
9. Stuckelberger A., Wanner Ph. And So-Barazetti B. (2008). Mettons notre vieillesse de côté pour plus tard/Das Altern sparen wir uns für später auf/Lets save old age for later, Synthetic publication of the « Anti-Ageing Study » conducted for TA-Swiss, Technological Assessment Switzerland, TA52A/2008. Bern

Did you know what anti-ageing medicine is? Do you buy anti-ageing products or use anti-ageing interventions? Would you use anti-ageing medicine? What type would you choose? Do you feel you can buy safely anti-ageing labelled products? Do you think you need to be better informed? Do you think you will age as your grand-parents? - Dr. Astrid Stuckelberger