You’re Looking Very Well
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Nevertheless, there is extensive advertising of anti-ageing products and the public is spending vast sums of money on them, even though in most cases there is little or no scientific basis for their promises and some may have harmful side effects. Some scientists are unwittingly contributing to the proliferation of these pseudoscientific anti-ageing products by failing to participate in the public dialogue about the reliable science of ageing research. There are, for example, advertisements for a treatment which prevents shortening of telomeres and so promotes longevity. Although telomere shortening may play a role in limiting cellular lifespan, there is no evidence that telomere shortening plays a major role in the determination of human longevity.
There are a variety of reports of substances that can extend life. A study of over a thousand men in Holland over 40 years found that those who drank half a glass of wine a day lived about five years longer than those who drank no alcohol at all, and two and a half years longer than those who drank beer and spirits. Herbs such as ginseng, rhodiola and maca have active ingredients that are claimed to suppress ageing. Studies show that a plant compound, resveratrol, can extend the lifespan of yeast, worms, flies and fish but there is as yet no evidence that it helps with humans. Resveratrol appears to mediate ageing effects partly by activating sirtuins. Resveratrol is found in the grape plant and in berries, and it is also a vital component of red wine.
A new star has appeared in the field of drugs that delay ageing in laboratory animals, and are therefore candidates for doing the same in people. The drug is rapamycin, already discussed in relation to TOR, its target, and which is in use for suppressing the immune system in transplant patients and for treating certain cancers. It can increase the lifespan of nematodes and fruit flies, and recently increased the lifespan of mice significantly. Given to the mice when they were 600 days old, it increased their lifespan by about 30 per cent. It has not been tested on humans and this should be done with great care because of its effects on the immune system. Studies in mouse models indicate that weakening the pathway on which rapamycin acts leads to widespread protection from an array of age-related diseases.
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Aubrey de Grey is a scientist who, contrary to the standard scientific view, believes it will be possible to significantly prevent ageing. He calculates that two thirds of the people who die each day worldwide die of ageing, based on a definition of ‘death from ageing’ as death from causes that afflict the elderly more than young adults. He claims it will be possible to reduce the effects of ageing so greatly that humans will have a 50/50 chance over the next thirty years of being effectively immortal. He believes regenerative medicine may be able to thwart the ageing process altogether within that time. He works on the development of what he has termed ‘Strategies for Engineered Negligible Senescence’, a tissue-repair strategy intended to rejuvenate the human body. One basis for his claim is that mitochondria are damaged due to free radicals damaging their DNA, and they cause their host cells to secrete more damaging free radicals and so damage other cells. He believes that it will be possible to obviate the damage in the mitochondria’s DNA. He also claims that many age-related degenerative diseases are linked to inadequate lysosomal function. Lysosomes are small vesicles in cells whose contents can destroy almost any unwanted cellular material—but not quite all, and this shortfall is known to underlie various age-related problems, including cardiovascular disease and macular degeneration. Alzheimer’s disease involves the failure of unwanted proteins to be destroyed by other waste disposers both inside and outside the cell. Amyloid protein aggregates, a possible cause of Alzheimer’s, are made from a normal protein that has been altered. An anti-amyloid vaccine could be helpful as the immune system would destroy the aggregates. A clinical trial along these lines was stopped when one individual became very ill, but a new trial has now reached phase 3.
In order to prevent ageing in this way, it will be necessary to repair, or else render harmless, numerous types of accumulating molecular and cellular damage so that the age-related pathologies caused by excessive amounts of that damage are prevented. In various cases, this requires manipulating genes, which at present would need to be done in the fertilised egg. And then the researcher would have to wait more than a hundred years to see if that individual survives that long, and suffers no problems from the manipulation to the genes. This is a most unlikely scenario; it is far too risky, and few if any researchers would live to see if their treatment worked. Thus, as de Grey accepts, the comprehensive application of regenerative therapies to ageing within a few decades relies on the development of safe and highly effective somatic gene therapy, which currently remains a daunting prospect. Additionally, an effective panel of therapies must address cancer, extracellular damage causing pathologies such as heart disease, and viral and bacterial infections. Finally, it is also far from clear that preventing cellular ageing would prevent cognitive abnormalities such as dementia and depression occurring, and de Grey acknowledges our ignorance of such matters.
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In the UK the life expectancy for men and women is now 77 and 82, and a young man in his 20s today is expected to live five years longer than a man in his 50s. There are estimates that one in eight UK citizens now aged 35 will live to over 100. Half of the children alive today in countries with high life expectancies may celebrate their 100th birthday. In the UK, with a population of 61 million, 400,000 are over 90 and there are more pensioners than children under 16. The small village of Montacute in Somerset has the highest life expectancy for men in Britain, possibly because many of them grow their own food and work hard at it. In the USA, male life expectancy is 75 and female is 81. There is expected to be an increase from 4 million to 20 million over-85s by 2050 in the USA, at which time there may be nearly one million centenarians. At present about 10 per cent of the world’s population is over 60 but by 2050 it will be 20 per cent, and the elderly will outnumber children worldwide. Women outnumber men at age 100 by 5 to 1. Japan has the current highest life expectancy for females, estimated at 85, and Iceland for males, at 80 years.
There are currently about 40,000 centenarians in the United States, and they are the fastest growing segment of the population. Traditionally scientists believed that most people who live to 100 experience a ‘compression of morbidity’—that is, they do not develop common age-related chronic illnesses like diabetes or coronary disease until very late in life, if at all. However, more recently, investigators have found that nearly one-third have in fact suffered from long-standing chronic illness, in many cases for 15 years or more, before turning 100. What they experience is a compression of disability: they avoid major disability and require little or no assistance in performing the activities of daily life, at least until extreme old age.
The increase in the numbers of elderly people throughout the developed world is already having serious consequences, which will only increase in the future. Leon Kass, who has been chairman of the US President’s Council on Bioethics, has questioned whether the resulting overpopulation problems would make life extension unethical. ‘Simply to covet a prolonged lifespan for ourselves is both a sign and a cause of our failure to open ourselves to procreation and to any higher purpose… Desire to prolong youthfulness is not only a childish desire to eat one’s life and keep it; it is also an expression of a childish and narcissistic wish incompatible with devotion to posterity.’ He highlighted the importance of lifespan limits in making room for new generations who deserve to take their rightful place in the world.
Francis Fukuyama, who predicted the eventual global triumph of political and economic liberalism, argues that efforts to increase human longevity risk undermining social security schemes, damaging family structures, and rendering the United States vulnerable to assault by countries with more youthful populations. He suggests that it could lead to a ‘posthuman future’, where human existence would be radically different from what we currently experience. This may be an alarmist view, but the problems associated wi
th increasing human lifespans are still severe.
What impacts might a much further increase in age in the population have? Would immortality be a benefit or a disaster? In Kurt Vonnegut’s 1998 story ‘Tomorrow and tomorrow and tomorrow’ a grandfather aged 172 takes an anti-ageing potion; he drives his descendants mad by taking the best food and space. Many fear that extending lifespan without reducing illnesses would increase the time living with limited physical and mental abilities, but it could nevertheless offer new opportunities. Superlongevity, radical life extension, would require every citizen to learn new skills. There would probably be a craving for novel experiences. Even now, many of those who have retired feel much younger and wish to have an active life that can include new work and learning. Living longer would enable people to find out what the future is like, but they would need to be healthy and cared for—and not be bored. And note again that in spite of all the research, no way of preventing ageing other than by a healthy lifestyle has yet been discovered.
Nevertheless there are several organisations devoted to extending lifespan and even superlongevity. Leon Kass apparently believes that if our bodies don’t grow old we will become even more fearful of death. He also thinks we will feel unhinged and lack the sense of purpose that supposedly comes with growing old. Superlongevity would make time of no consequence and this could have bad consequences due to the increase in population size. The emerging picture of perhaps many hundreds, or even thousands, of small effects and tissue-specific damage provides a sobering challenge for those aiming to engineer reduced senescence. Controlling behavioural and environmental exposures to reduce cell damage may be a more realistic priority, as the great majority of people are likely to have large numbers of genetic vulnerabilities for one or another disease not related to ageing. A £5 million programme of bioengineering has been proposed to do research to find solutions to the problems associated with ageing of the body. Research will focus on joints, spine, teeth, heart and circulation. This seems more sensible than trying to develop safe and effective genetic engineering to alter the thousands of small damaged functions in our cells.
In Shakespeare’s All’s Well that Ends Well the king is suffering from physical disability related to old age. When Helena offers to cure him, which she later does with a potion from her doctor father, the king responds with cautionary words:
We thank you, maiden;
But may not be so credulous of cure,
When our most learned doctors leave us and
The congregated college have concluded
That labouring art can never ransom nature
From her inaidible estate.
9. Preventing
‘To get back my youth I would do anything in the world, except take exercise, get up early, or be respectable’
— Oscar Wilde
If we cannot be immortal, can at least our youthful looks be maintained? Almost everyone wants to look reasonably young while still living to a respectable old age without serious disabilities. Youth’s attraction is no mystery: evolution wants us to reproduce and so has selected us to find young people attractive, since they are the best reproducers. The same principle has resulted in us finding old faces unattractive. What could we do to avoid changes in our appearance with age? Having the right genes is a good beginning, as is keeping fit and active, and eating the right foods—staying slim is one of the key factors to looking young, but it does not hide wrinkles.
Efforts to hide and prevent ageing are far from being a modern obsession. In Ancient Egypt cosmetics were applied to the face and eyes, and cosmetic implements, particularly eye-makeup palettes, have been discovered in the earliest graves. Honey as well as various herbs and plants were used in an attempt to devise anti-ageing treatments. The aloe plant was commonly used as an anti-wrinkle treatment and is still with us today. Cleopatra is known to have used lactic acid in order to peel her skin, believing it made her appear more beautiful. The arid desert climate of Egypt led to the widespread use of body oils as moisturisers. It is believed that all classes of Egyptian society were concerned with their appearance, both men and women.
This pattern is repeated throughout the ancient world. As now, the focus was on the youthful beauty of women rather than men. The Roman poet Ovid despaired of time’s encroachments: ‘The years will wear these charming features; this forehead, time withered, will be crossed with wrinkles; this beauty will become the prey of the pitiless old age which is creeping up silently step by step.’ Other writers saw the comedy as well as the pathos of the situation. ‘The Man and His Two Mistresses’ is one of Aesop’s Fables, written around 600 BC:
A man of middle age, whose hair was turning grey, had two mistresses, an old woman and a young one. The elder of the two didn’t like having a lover who looked so much younger than herself; so, whenever he came to see her, she used to pull the dark hairs out of his head to make him look old. The younger, on the other hand, didn’t like him to look so much older than herself, and took every opportunity of pulling out the grey hairs, to make him look young. Between them, they left not a hair in his head, and he became perfectly bald.
In a recent survey many men and women said that they are, will be, or were, at their physical peak not during their youth but during their early middle years around the age of 40. Those aged 65 and over said 46 was their personal best age. But in terms of appearance, youth remains the golden age. Marie Helvin, at 54 still a supermodel, said: ‘Please shoot me if I’m doing this in my 80s. Anyway, one day I won’t be able to. My mother always said that Japanese women look youthful for years and then one morning they wake up and they’ve aged like 100 years. And she’s right. It happened to her when she was 79.’
Celebrities and many others have fallen prey to the cloned-youth look. The American anti-ageing magazine New Beauty offers articles on how to get flawless feet, and lists the top ten wrinkle reducers. However, the treatment needed to achieve this youth has, it is claimed, made many women look like waxwork escapees from Madame Tussaud’s. Many have had their faces injected with a filler to remove the creases while others have plastic surgery. In a survey 20 per cent of men said they thought that cosmetic surgery for their wives could save their marriage; it seems no one asked the women whether they would like the pot bellies of their husbands reduced.
Currently the global anti-ageing market for cosmetic products and treatment is estimated to be worth approximately $57 billion, a figure that is expected to grow at breakneck speed in coming years. In the UK cosmetic surgery has tripled in the last five years. Britons are spending nearly £500 million a year on cosmetic procedures, said Which? magazine, more than any other European country. A total of some £673 million a year is spent on skin care, and these figures are dwarfed by figures from the US. Of course not all this money is spent by the old, but anti-ageing products are the largest growing sector. An article in Time magazine in early 2009 introduced the concept of ‘amortality’ when referring to the current attempts to avoid ageing and achieve a leap in life expectancy. Age-appropriate behaviour, it claimed, will be relegated to the past, like black-and-white television. Amortals do not dread extinction—they deny it.
Surveys exploring attitudes towards ageing, beauty and cosmetic surgery can yield varying results. In one survey of some 2,000 Americans aged over 18, as well as 500 who have had cosmetic surgery, almost all of those interviewed were satisfied with the way they look for their age, and over half felt that inner beauty is more important than physical appearance—this was particularly true for the old. Just one in three said physical beauty counts most. More than half believed that men and women age gracefully, and only a quarter of women felt that maintaining an attractive physical appearance was important for them. Most of the women were satisfied with their appearance. After 45, women were more interested in looking good for their age than in trying to look a different age. Agony Aunt Virginia Ironside has commented, ‘I want to look good at my age, but I also want to look old enough for people to open heavy door
s for me.’ She also very much appreciates being offered a seat on a crowded bus.
But in another survey, almost three quarters of women cited body shape as a ‘major concern’. Meanwhile, men are also taking more time over their appearance. About 20 per cent said they would consider getting cosmetic surgery in the future, while about 22 per cent were unsure if they would. Those under the age of 40 were nearly twice as likely to consider having a procedure in the future. A study by Which? magazine found that Botox treatments are seen as a desirable Christmas present by 50 per cent of people aged between 16 and 24, and 45 per cent of those aged 55 to 64. A survey of schoolchildren found that 18 per cent of all boys and 25 per cent of all girls declined to imagine any form of enhancement because they saw it as unnatural or simply unnecessary. One girl commented, ‘I wouldn’t want an upgrade because I wouldn’t want to be different. I like being who I am.’
Despite people’s professed opinions, however, cosmetic surgery in general has been growing in popularity in Britain, with a threefold increase in the first decade of the twenty-first century. According to figures released by the British Association of Aesthetic Plastic Surgeons, only 10,700 procedures were performed in 2003, but by 2009, this figure had risen to 36,482. One of the biggest growth areas was in people in middle or late middle age. These figures do not include non-surgical interventions like the use of Botox, which has been increasing even more rapidly. The most common procedures were breast enlargement, liposuction, and eyelid and facial surgery.
In the US, over 10 million surgical and non-surgical procedures were performed in 2008, costing over $11.8 billion. Men had over 800,000 cosmetic procedures. Strikingly, people aged between 54 and 61 had about a quarter of these procedures, and people over 65 much fewer. Over half were for breast augmentation and fat reduction. Plastic surgery of the face can help you feel better, but does not affect what is going on inside the body. Anti-ageing surgery procedures are widely advertised on the internet with the injunction to ‘Get expert free advice’. These include Eye Bag Removal, which can restore a youthful look through the removal of fat and excess skin from both sets of eyelids, and the Brow Lift is a procedure that concentrates on restoration in the upper part of the face, correcting drooping eyebrows and loose skin in that area. Facelift surgery challenges the most visible signs of the ageing process: loose facial and neck skin is removed to produce a smoother, fresher appearance. The operation can take between two and three hours and it is recommended that patients spend at least one night in the cosmetic surgery clinic after the procedure. Liposuction entails the removal of fatty deposits from any part of the body, a process usually taking no more than one and a half hours to complete. The recovery time involved is minimal, with most patients getting on with their lives again within a few days.