Hilariously while reading the first few paragraphs I excitedly thought: "Holy s*!t. That's exactly how I feel! I'm about to get an explanation for this syndrome that my PCP has never been able to put his finger on".
My hopes dashed against the rocks of reality once again :)
I'm not a health care professional, but I do have a scientific background, and per my Substack profile I'm "a grumpy old mansplainer" (age 81+). So I have a question:
What happens if/when medical science (perhaps inspired by those pesky "longevity folks") actually finds ways to significantly retard the aging process? Those that know the science better than I might claim that that is not likely to happen, at least in the foreseeable future, because the aging process is so hardwired into our genetics that altering our "natural" lifespan would basically require transforming humans into a different species with a substantially different genotype and phenotype, like turning an ordinary rat into its longer-living relative the naked mole-rat.
But from what I can glean from my (admittedly amateur) sleuthing, extending the lifespans of people already living might not be such a far-fetched idea after all. If that's true, then successfully treating some illnesses associated with aging (cancer, heart disease, Alzheimer's, etc.) would often by necessity involve tackling the aging process itself, as would preventing those illnesses from developing in the first place.
My guess is that if/when those anti-aging treatments are developed and refined into procedures or medications that don't involve nasty side effects, people who learn of their existence will clamor for them to become generally available. Of course that won't include everybody. Some people, young or old, will be content to "go gentle into that good night" (apologies to Dylan Thomas).
The prospect of such anti-aging treatments raises a whole host of technical, financial, psychological, social, political, religious, and philosophical issues. Some so-called "bioethicists" may object on the grounds that the value of human life depends on it being limited in duration; otherwise it loses its dignity and poignancy. Of course it's easier to feel that way about other anonymous people's lives; not so easy when it's your own or those of your family and friends. Religious scholars may object that extending the human lifespan beyond its usual limits (three score ten and change, plus a bit more for some lucky folks) involves the forbidden act of "playing God". Some psychologists may claim that people with extended healthspans will become bored with their existence, doomed to wander aimlessly around our already overpopulated planet. Personally I don't think that would happen to me, since I'm constantly thinking of interesting things to do with my time, especially if I can remain healthy and active.
Civil rights activists may demand that anti-aging treatments be banned until everyone has access to them without regard to how wealthy they are. Unfortunately, I fear that such a "fair, just, and equitable" policy would deny such treatments to ordinary people, while the rich and powerful will, as usual, find ways around such restrictions.
To answer the objections of environmentalists who worry about the overpopulation problem that greater lifespans would likely produce, perhaps we can turn to Elon Musk for help (okay, I'm getting a bit nerdy and speculative here, having read a lot of science fiction in my youth). If Musk can bring the cost of space travel down far enough, we could send lots of the excess population off in ships to go colonize and mess up and pollute other planets.
I imagine that someday people who take anti-aging therapies for granted may wonder how anyone could have lived back in primitive times like ours when lives were "Nasty, Brutish, and Short" (apologies to Thomas Hobbes).
I love this comment. Thank you so much. I have thought about this as it applies to many parts of Medicine. Alzheimer’s disease in particular. Eventually I will get my head around enough to write something.
the absolute best therapies currently available for "anti-aging" are healthy diet and exercise. Though even that won't guarantee a long life. Genetics a big factor, environmental exposures, and finally - luck. There is nothing currently available that will come close to changing the aging process to the extent of anything you are raising.
Any of us as physicians are quite happy to have people live as long and healthy as possible. Unfortunately, mid-80s' (85+) is generally the time of frailty starting to set in. There are many outliers but eventually time/age does become an equalizer.
As a society, we cannot focus a majority of resources in the very elderly on treatments that won't change things much. To the detriment and limitation in truly preventive or curative treatments for younger people (and I say this as someone nearer 80 than to 30). That is the ethical discussion we all need to be having.
Completely agree with your entire piece! Well done! Elder care is best done by very experienced clinicians. It is best done by someone who has some time to pay attention and listen carefully. The elderly are not served by more tests and aggressive treatment options. As a society, we need to put some focus on this fact. Throwing the elderly into the current system that values "productivity" and through-put is not serving them well. Busy clinicians keep up with the pace by ordering tests and having patients "follow up". As our current medical system continues to churn elders through, we'll get to a point where the system just breaks. I very firmly believe that we need an "elder care" system that is separate from the rest. The extreme elders (> 85 y/o) need a separate care track - probably best manned by experienced docs near the end of their career. This would allow the appropriate things to be done and off-load the rest of the system. We need to increase social supports. Tests and treatments are not the answer.
Nice post! I find that the cataloguing of symptoms and their severity are not as important as understanding how the symptoms are limiting their achieving goals. If we understand that, then we are better able to meet the patient's needs. Maybe it's not the pain so much as it prevents a patient from going on walks with friends. Most patients as they age are less interested in longevity than they are in having and achieving goals.
All so true and so wonderfully written. Patients are always teaching me lessons. I had an 82 yo patient who I knew well, start complaining to me that he could not lift weights like he used over the last few years. He was an amateur boxer in his younger years. I tried to explain that this was to be expected with aging, but he was convinced something was wrong. So we did some tests, and I saw him back a couple of times with the same complaint and concern. Then on his fourth visit for the same problem, he reported, "Doc, I figured out what was wrong." "What is that? " I asked. His response was a wonderful lesson for us all. "I am not Superman!" he replied.
In retirement and with aging, I realize I too, have lost my "superpowers". Grieving that loss is one of my biggest challenges and one I am fairly certain one that I share with many of my retired colleagues.
Great advice. Having just celebrated my 80th birthday, I can relate to the problems with memory and sleep patterns. Struggling to come up with certain words or names was a problem for many of my elderly patients. I finally figured out that most of their anxiety was due to a fear that they were experiencing the early onset of dementia. It helped when I could reassure them that forgetting names and words that describe abstract thought were normal in aging because they don't correspond with specific material objects. If they couldn't identify a chair as a chair, then we had something to discuss.
"The doctor must avoid excessive evaluations while not missing the occasional needle in the haystack." That is so much of the challenge of medicine . . .
"Although longevity folks try to convince us otherwise, human bodies age, and as we get older, more things hurt, we sleep less well, and our cognitive abilities decline" - Amen thank you for reminding all of us that aging is not a disease/diagnosis. Embrace the moments you have and be grateful for every year around the globe
Alas, aging is inevitably accompanied by a steady decline in cardiofitness. A decline in cardiofitness can also be a marker for significant cardiac problems like aortic stenosis and heart failure. Sorting this out requires all the wisdom and skill of the experienced physician.
I marvel at my own adventuresome aging process at 77. It is a gift and a privilege to be alive and upright. Humility, patience and stay in the moment! Ultreia
Fun read and my favorite population to care for. Usually the most calibrated people with the least angst about the unknown. When less time is spent investigating and more time is spent discussing how to make it to a graduation or wedding, all that matters seems to come into focus.
I believe many times these sort of symptoms are just manifestations of a patient mourning the loss of their youth. Or as you said, struggling to face their own mortality.
Perhaps there is a market for an “anti-longevity” clinic where the focus is not on extending life but enriching the present. Books would be read and art appreciated….
Hilariously while reading the first few paragraphs I excitedly thought: "Holy s*!t. That's exactly how I feel! I'm about to get an explanation for this syndrome that my PCP has never been able to put his finger on".
My hopes dashed against the rocks of reality once again :)
So sorry to let you down.
This spring, I am teaching a nursing course that focuses on wellness in aging. I am excited to include your article in the course.
I'm not a health care professional, but I do have a scientific background, and per my Substack profile I'm "a grumpy old mansplainer" (age 81+). So I have a question:
What happens if/when medical science (perhaps inspired by those pesky "longevity folks") actually finds ways to significantly retard the aging process? Those that know the science better than I might claim that that is not likely to happen, at least in the foreseeable future, because the aging process is so hardwired into our genetics that altering our "natural" lifespan would basically require transforming humans into a different species with a substantially different genotype and phenotype, like turning an ordinary rat into its longer-living relative the naked mole-rat.
But from what I can glean from my (admittedly amateur) sleuthing, extending the lifespans of people already living might not be such a far-fetched idea after all. If that's true, then successfully treating some illnesses associated with aging (cancer, heart disease, Alzheimer's, etc.) would often by necessity involve tackling the aging process itself, as would preventing those illnesses from developing in the first place.
My guess is that if/when those anti-aging treatments are developed and refined into procedures or medications that don't involve nasty side effects, people who learn of their existence will clamor for them to become generally available. Of course that won't include everybody. Some people, young or old, will be content to "go gentle into that good night" (apologies to Dylan Thomas).
The prospect of such anti-aging treatments raises a whole host of technical, financial, psychological, social, political, religious, and philosophical issues. Some so-called "bioethicists" may object on the grounds that the value of human life depends on it being limited in duration; otherwise it loses its dignity and poignancy. Of course it's easier to feel that way about other anonymous people's lives; not so easy when it's your own or those of your family and friends. Religious scholars may object that extending the human lifespan beyond its usual limits (three score ten and change, plus a bit more for some lucky folks) involves the forbidden act of "playing God". Some psychologists may claim that people with extended healthspans will become bored with their existence, doomed to wander aimlessly around our already overpopulated planet. Personally I don't think that would happen to me, since I'm constantly thinking of interesting things to do with my time, especially if I can remain healthy and active.
Civil rights activists may demand that anti-aging treatments be banned until everyone has access to them without regard to how wealthy they are. Unfortunately, I fear that such a "fair, just, and equitable" policy would deny such treatments to ordinary people, while the rich and powerful will, as usual, find ways around such restrictions.
To answer the objections of environmentalists who worry about the overpopulation problem that greater lifespans would likely produce, perhaps we can turn to Elon Musk for help (okay, I'm getting a bit nerdy and speculative here, having read a lot of science fiction in my youth). If Musk can bring the cost of space travel down far enough, we could send lots of the excess population off in ships to go colonize and mess up and pollute other planets.
I imagine that someday people who take anti-aging therapies for granted may wonder how anyone could have lived back in primitive times like ours when lives were "Nasty, Brutish, and Short" (apologies to Thomas Hobbes).
I love this comment. Thank you so much. I have thought about this as it applies to many parts of Medicine. Alzheimer’s disease in particular. Eventually I will get my head around enough to write something.
Thanks, I'm glad you liked it.
the absolute best therapies currently available for "anti-aging" are healthy diet and exercise. Though even that won't guarantee a long life. Genetics a big factor, environmental exposures, and finally - luck. There is nothing currently available that will come close to changing the aging process to the extent of anything you are raising.
Any of us as physicians are quite happy to have people live as long and healthy as possible. Unfortunately, mid-80s' (85+) is generally the time of frailty starting to set in. There are many outliers but eventually time/age does become an equalizer.
As a society, we cannot focus a majority of resources in the very elderly on treatments that won't change things much. To the detriment and limitation in truly preventive or curative treatments for younger people (and I say this as someone nearer 80 than to 30). That is the ethical discussion we all need to be having.
Completely agree with your entire piece! Well done! Elder care is best done by very experienced clinicians. It is best done by someone who has some time to pay attention and listen carefully. The elderly are not served by more tests and aggressive treatment options. As a society, we need to put some focus on this fact. Throwing the elderly into the current system that values "productivity" and through-put is not serving them well. Busy clinicians keep up with the pace by ordering tests and having patients "follow up". As our current medical system continues to churn elders through, we'll get to a point where the system just breaks. I very firmly believe that we need an "elder care" system that is separate from the rest. The extreme elders (> 85 y/o) need a separate care track - probably best manned by experienced docs near the end of their career. This would allow the appropriate things to be done and off-load the rest of the system. We need to increase social supports. Tests and treatments are not the answer.
Nice post! I find that the cataloguing of symptoms and their severity are not as important as understanding how the symptoms are limiting their achieving goals. If we understand that, then we are better able to meet the patient's needs. Maybe it's not the pain so much as it prevents a patient from going on walks with friends. Most patients as they age are less interested in longevity than they are in having and achieving goals.
Excellent point.
All so true and so wonderfully written. Patients are always teaching me lessons. I had an 82 yo patient who I knew well, start complaining to me that he could not lift weights like he used over the last few years. He was an amateur boxer in his younger years. I tried to explain that this was to be expected with aging, but he was convinced something was wrong. So we did some tests, and I saw him back a couple of times with the same complaint and concern. Then on his fourth visit for the same problem, he reported, "Doc, I figured out what was wrong." "What is that? " I asked. His response was a wonderful lesson for us all. "I am not Superman!" he replied.
In retirement and with aging, I realize I too, have lost my "superpowers". Grieving that loss is one of my biggest challenges and one I am fairly certain one that I share with many of my retired colleagues.
Great advice. Having just celebrated my 80th birthday, I can relate to the problems with memory and sleep patterns. Struggling to come up with certain words or names was a problem for many of my elderly patients. I finally figured out that most of their anxiety was due to a fear that they were experiencing the early onset of dementia. It helped when I could reassure them that forgetting names and words that describe abstract thought were normal in aging because they don't correspond with specific material objects. If they couldn't identify a chair as a chair, then we had something to discuss.
Here to say two things:
1. Fantastic piece.
2. The Costco episode of acquired is incredible.
Costco episode is one of my favorites. The most recent one on the NFL is also excellent - so interesting!!
Of course you are a fan of Acquired...
Another gem from Dr. Cifu.
"The doctor must avoid excessive evaluations while not missing the occasional needle in the haystack." That is so much of the challenge of medicine . . .
"Although longevity folks try to convince us otherwise, human bodies age, and as we get older, more things hurt, we sleep less well, and our cognitive abilities decline" - Amen thank you for reminding all of us that aging is not a disease/diagnosis. Embrace the moments you have and be grateful for every year around the globe
Alas, aging is inevitably accompanied by a steady decline in cardiofitness. A decline in cardiofitness can also be a marker for significant cardiac problems like aortic stenosis and heart failure. Sorting this out requires all the wisdom and skill of the experienced physician.
I marvel at my own adventuresome aging process at 77. It is a gift and a privilege to be alive and upright. Humility, patience and stay in the moment! Ultreia
Fun read and my favorite population to care for. Usually the most calibrated people with the least angst about the unknown. When less time is spent investigating and more time is spent discussing how to make it to a graduation or wedding, all that matters seems to come into focus.
I wish more Dr's had your acumen and patience while dealing with their patients.
I believe many times these sort of symptoms are just manifestations of a patient mourning the loss of their youth. Or as you said, struggling to face their own mortality.
Perhaps there is a market for an “anti-longevity” clinic where the focus is not on extending life but enriching the present. Books would be read and art appreciated….