The 'Medicalization' of Aging

Rebranding aging

The ‘medicalization’ of aging: what it is, how it harms, and what to do about it

As an industry, we need to help overturn the spreading notion that aging is a disease, and put forth a positive, wellness model that supports people in living as fully as possible at any age, regardless of health conditions

by Marilynn Larkin, MA

This article is the first in a series on “re- own blog: “It [the Washington Post story] branding” aging in the Journal on Active didn’t feel like sound health journalism Aging®. Watch for articles throughout 2011 to me … There was not one word about by authors tackling different aspects of this many experts’ concerns about the disease- topic. mongering of osteopenia—another pre- disease state that lowers the threshold for On November 17, 2010, the headline what we call disease, opening new mar- of a Washington Post health blog read: kets for people to be treated with drugs or “Gwyneth dances great on ‘Glee,’ despite vitamins or whatever.”2 osteopenia.” The posting about actress Gwyneth Paltrow’s television appearance Schwitzer also linked to related com- went on to explain that the 38-year-old ments. An article published in the British star is “quite young for such a diagnosis” Medical Journal in 2008 noted that “we and imply that her dancing ability is need to ask whether the coming wave of somehow influenced by the condition, marketing targeting these women with which normally affects older adults.1 pre-osteoporosis will result in the sound effective prevention of fractures or the In response, Gary Schwitzer, publisher of unnecessary and wasteful treatment of HealthNewsReviews.org, a website dedi- millions more healthy women.”3 cated to improving the accuracy of news stories about medical treatments, tests, products and procedures, wrote in his Continued on page 30

28 The Journal on Active Aging January/February 2011 www.icaa.cc The Journal on Active Aging January/February 2011 www.icaa.cc 29 The ‘medicalization’ of aging: what it is, how it harms, and what to do about it Continued from page 28

Another comment came from the blog 80% reduction in the risk of developing Hooked: Ethics, Medicine and Pharma, the most common and deadly chronic by Howard Brody, MD, PhD, director of This focus on diseases.8 These same behaviors can make the Institute for Medical Humanities at a powerful impact on how we age,” Mil- the University of Texas Medical Branch, medicalization and ner stresses. “We need to promote a well- Galveston. “When the term (osteopenia) ness model and empower our constituents was formalized at a 1992 scientific meet- to embrace a more positive approach to ing in Rome,” Brody posted in 2009, “it anti-aging contributes aging—one that includes opportuni- was seen simply as a name for the statisti- ties to live as fully as possible at any cal condition of not-quite-osteoporosis, to the idea that aging age and encourages a more balanced and not as a diagnosis, certainly not a dis- view of the ‘burdens’ seen in negative ease that needed drug treatment.”4 is something wrong … stereotypes.” Brody also alluded to a story that ran Many in the active-aging industry already in December 2009 on NPR (National to be feared … and to recognize the impact of society’s nega- Public Radio) in the United States, en- tive views and expectations of aging on titled “How a bone disease grew to fit the people’s experiences in later life, Milner description.” According to NPR’s Alix be treated with pills continues. Last year, a strategy to counter Spiegel, “This is the story of how pills aging stereotypes and challenge ageism for osteopenia ended up in [54-year-old and potions was recommended as part of ICAA 2020, Katie] Benghauser’s medicine cabinet, and an initiative established with support in the medicine cabinets of millions of from Morrison Senior Living to create a women like her all over the United States. Olshansky, PhD, professor in the School vision for the future of the industry. And But more broadly, it’s the story of how the of Public Health, University of Illinois in late 2010, a “Rebrand Aging” work definition of what constitutes a disease at Chicago. “Loss of bone mass, loss of group presented an action plan to ICAA, evolves, and the role that drug companies testosterone, loss of growth hormone, loss Milner says. The organization and its al- can play in that evolution.”5 of visual acuity, hearing loss—every single lies are now exploring how to move ahead one of these is going to be called a disease, with projects that promote a fuller, more The osteopenia story is but one example if it isn’t already,” Olshansky tells the Jour- realistic picture of aging. of how conditions associated with aging nal on Active Aging® (JAA). “Because we are becoming increasingly medicalized. tend to think of diseases in terms of how What is ‘normal’ aging? According to sociologists Renée Beard we could cure them, if the consequences To understand the impact of medicaliza- and Carroll Estes,6 “[m]edicalization de- of aging—or aging itself—are positioned tion, it is useful to define which age-asso- scribes a process through which largely as diseases, people can sell products that ciated changes in the body are considered social issues may be redefined as medical purport to cure them. A classic example,” “normal.” Surprisingly, that is easier said problems, thus increasing the jurisdic- he says, “is growth hormone7 being sold than done. “The debate about whether or tion of medicine … [It] has assisted in to healthy adults for medically inappro- not aging is a disease has been going on the transformation of health and other priate uses at ‘anti-aging’ and ‘age man- for many years, and there is quite a litera- human needs into commodities for spe- agement’ clinics.” ture in the topic,” Olshansky observes. cific economic markets in ways that have An example is a debate in the Journal of promoted a gargantuan and highly profit- The medicalization of aging has impor- Gerontology: Biological Sciences9 between able (but not necessarily most efficacious) tant implications for the active-aging two luminaries in the field of gerontol- trillion-dollar-medical-industrial complex industry and its clients and customers, ogy—molecular biologist Robin Holliday, … [t]he desire for a ‘silver bullet’ to cure states Colin Milner, CEO of the Interna- PhD, who investigates the cellular basis health problems reflects the tendency of tional Council on Active Aging® (ICAA), of aging, and microbiologist Leonard doctors to medicate and of health care which publishes JAA. “What’s missing in Hayflick, PhD, a past president of the consumers to prefer to be medicated … the picture are all the benefits of lifestyle Gerontological Society of America and a The result may be an over-medicated changes. Recent research found that four founding member of the council of the population.” healthy lifestyle factors—never smoking, US National Institute on Aging. maintaining a healthy weight, exercising “Aspects of aging are being transformed regularly and following a healthy diet— into individual diseases,” affirms S. Jay together are associated with as much as an Continued on page 32

30 The Journal on Active Aging January/February 2011 www.icaa.cc The ‘medicalization’ of aging: what it is, how it harms, and what to do about it Continued from page 30

Both concede that graying hair, wrinkled to Hayflick: “(a) occur in every animal How medicalization hurts skin, and presbyopia (a condition in that reaches a fixed size in adulthood, Fueling much of the medicalization ap- which the lens of the eye loses the ability (b) cross virtually all species barriers, (c) proach is the anti-aging industry, made to focus) are natural consequences of ag- occur in all members of a species only up mainly of large pharmaceutical coming. But then they diverge. Simply put, after the age of reproductive maturation, panies, supplement manufacturers, and Holliday contends that changes such as [and] (d) occur in all animals removed major beauty products companies. In loss of muscle mass and bone mass are from the wild and protected by humans 2002, Olshansky and more than 50 other inexorably linked to pathology—that is, even when that species probably has not researchers in the field of aging collabo- there is “considerable overlap” between the experienced aging for thousands or even rated on a position paper decrying the aging process and age-associated diseases. millions of years ….” industry. They wrote: “A large number of products are currently being sold by Not so, according to Hayflick. He argues It is beyond the scope of this article to anti-aging entrepreneurs who claim that that the aging process confers only explore all the facets and implications of it is now possible to slow, stop, or reverse vulnerability to age-associated diseases. this debate; however, one thing is clear: human aging. The business of what has Hayflick writes that the “distinction People are increasingly being urged to become known as anti-aging medicine has between aging and age-associated diseases take medicine for conditions that hereto- grown in recent years in the United States is based, not on a dictionary definition, fore were not labeled diseases. Examples, and abroad into a multimillion-dollar but on several practical observations.” In in addition to osteopenia, include over- industry. The products being sold have his view, aging is a multifaceted, universal active bladder, sarcopenia (low muscle no scientifically demonstrated efficacy, process. Among other factors, and “[u]n- mass), pre-hypertension, pre-diabetes, and in some cases they may be harmful, and like any disease,” age changes according “borderline-high risk” cholesterol. Continued on page 34

Resources

How a Bone Disease Grew to Fit the Publisher: Journals of Gerontology, Series * Available at http://biomedgerontology. Prescription A: Biological Sciences and Medical Sciences, oxfordjournals.org/content/59/6/B551. Author: Alix Spiegel 59(6), B543–546, 2004 full Publisher: NPR (National Public * Available at http://biomedgerontology. Radio), December 21, 2009 oxfordjournals.org/content/59/6/B543. Position Statement on Human Aging * Available at http://www.npr.org/ full Authors: S. Jay Olshansky, PhD, Leonard templates/story/story.php?storyId= Hayflick, PhD, and Bruce A. Carnes, 121609815&sc=emaf Debates: The Not-So-Close Relationship PhD Between Biological Aging and Age-Asso- Publisher: Journals of Gerontology, Series Multiple Medicines. The Shopper’s ciated Pathologies in Humans A: Biological Sciences and Medical Sciences, Guide to Prescription Drugs Series, Author: Leonard Hayflick, PhD 57(8), B292–297, 2002 Number 4 Publisher: Journals of Gerontology, Series * Available at http://biomedgerontology. Publisher: Consumers Union and Con- A: Biological Sciences and Medical Sciences, oxfordjournals.org/content/57/8/B292. sumer Reports Best Buy Drugs, 2007 59(6), B547–B550, 2004 full * Available at www.consumerreports. * Available at http://biomedgerontology. org/health/resources/pdf/best-buy- oxfordjournals.org/content/59/6/B547. Medicalization of Aging drugs/money-saving-guides/english/ full Authors: Renée L. Beard, PhD, and MultipleMedicines-FINAL.pdf Carroll L. Estes, PhD Debates: Response to Dr. Hayflick Publisher: MacMillan Encyclopedia of Debates: The Close Relationship Be- Author: Robin Holliday, PhD Aging, MacMillan Press, 2002 tween Biological Aging and Age-Asso- Publisher: Journals of Gerontology, Series * Available at http://medicine.jrank. ciated Pathologies in Humans A: Biological Sciences and Medical Sciences, org/pages/1106/Medicalization-Aging. Author: Robin Holliday, PhD 59(6), B551, 2004 html

32 The Journal on Active Aging January/February 2011 www.icaa.cc The ‘medicalization’ of aging: what it is, how it harms, and what to do about it Continued from page 32

of this feeds into fear, insecurity and self- doubt,” he says.

Countering the trend So how do we counter a multibillion-dollar industry and a mindset that reinforces stereotypes about aging? How do we encourage a more positive, realistic view of aging and reposition aging as a time of opportunity? Here are some ideas:

Adopt a wellness model if you haven’t done so already. “It’s much more cost effective to maintain and sustain health than it is to regain it once we’ve lost it,” says Healthy lifestyle choices can have a big impact on how we age ICAA’s Milner. “Wellness programs for older adults are growing, and research those selling them often misrepresent the medicines on a regular basis. One in 10 is increasingly showing that whereas the 11 science upon which they are based. [We] takes seven or more drugs. While in medical, or sickness model, may have have collaborated to inform the public of many cases these medicines are necessary, helped us live longer, the wellness model the distinction between the pseudoscien- research has shown that the more drugs will keep us healthier longer.” tific anti-aging industry, and the genuine someone takes, the more likely that per- science of aging that has progressed rap- son is to experience dangerous side effects Encourage lifestyle changes. Physical inac- 10 idly in recent years.” from drug interactions. Medicalizing ag- tivity and poor diet are among the lead- ing means it’s probable that individuals ing causes of illness and death and play a Kevin O’Neil, MD, FACP, CMD, medi- will take more drugs, supplements and role in the development of a wide range cal director of Brookdale Senior Living, other products, many of which are of of chronic diseases, according to the US a national provider headquartered in questionable value and increase the risks Preventive Services Task Force.13 A large Brentwood, Tennessee, and medical advi- of polypharmacy. body of research has shown that people sor to the Brookdale-funded Institute for with only moderately elevated blood pres- Optimal Aging, is “shocked that more Wasted money. The market for anti-aging sure or cholesterol levels who start exercis- physicians now are involved in the anti- products has grown exponentially, mostly ing, lose weight, and improve their diet aging industry than in the American Ge- in the United States and Europe. The may be able to reduce or even eliminate riatrics Society. Beyond the profit motive, most recent data suggests the global their need for drugs. And a recent study I’m concerned that much of what they market for anti-aging products will reach showed that a dietary pattern consistent 12 do is not based on good science,” states US$291.9 billion by 2015. Yet the end with current guidelines—plenty of veg- O’Neil, who is also an ICAA Advisory result of the use of many such products— etables, fruit, whole grains, poultry, fish Board Member. “We, as medical profes- when they’re not overtly harmful—is “ex- and low-fat dairy products—seems to sionals and active-aging providers, have a pensive urine,” Olshansky believes. be associated with “superior nutritional fiduciary responsibility to the people we status, quality of life and survival in older care for to base our practice on the best Self-blame. The problem with medical- adults.”14 evidence—on what we know from re- ization is “more insidious than just the search is beneficial and not going to cause profit motive,” according to Olshansky. Promote engagement and socialization. harm. The pushing of vitamins and herbal “The tendency now is to blame people “Wellness embraces not just the physical supplements, colon cleansings and the for the things that go wrong with them as dimension, but also the emotional, social, like—most of it is just quackery.” they grow older, so the industry can guilt spiritual, intellectual and purposeful di- them into buying products. If you have mensions of wellness,” states Brookdale’s Potential downsides for older adults who sarcopenia, you haven’t exercised enough; O’Neil. [Ed. The Optimum Life® initia- buy into these products include: if you get heart disease, it’s your fault tive at Brookdale includes a “purposeful” because you’ve been eating the wrong Polypharmacy. Half of people ages 60 foods—and by the way, we have a miracle and over take three or more prescription food or supplement that can fix you. All Continued on page 36

34 The Journal on Active Aging January/February 2011 www.icaa.cc The ‘medicalization’ of aging: what it is, how it harms, and what to do about it Continued from page 34 wellness dimension, which the organiza- nary disease. And while it’s health status, trieved from http://brodyhooked.blogspot. tion defines as “providing a sense of value not age, that determines the recommen- com/2009/12/npr-how-osteopenia-became- treatable.html. and focus.”] “Many people don’t realize dations, the fact remains that most older that social engagement is a more potent adults have one or more chronic diseases 5. Spiegel, A. (2009, December 21). How a predictor of longevity then one’s age or and may need medication even while Bone Disease Grew to Fit the Prescription. NPR (National Public Radio). Retrieved from medical conditions,” O’Neil continues. making lifestyle changes.” http://www.npr.org/templates/story/story. “Being involved with something that gives php?storyId=121609815&sc=emaf. us a sense of meaning and purpose can “What’s not needed,” ICAA’s Milner have a significant impact not only on lon- adds, “and can be harmful, are supple- 6. Beard, R. L., & Estes, C. L. (2002). Medical- ization of Aging. MacMillan Encyclopedia of gevity, but also health and quality of life.” ments, elixirs and other interventions Aging. MacMillan Press. Retrieved from http:// purported to reverse the aging process. medicine.jrank.org/pages/1106/Medicalization- Tara Cortes, PhD, RN, FAAN, execu- And we most certainly do not need more Aging.html. tive director of the Hartford Institute for so-called ‘diseases’ attributed to aging.” 7. Olshansky, J. S., & Perls, T. T. (2008). New De- Geriatric Nursing, New York University This focus on medicalization and anti- velopments in the Illegal Provision of Growth College of Nursing, observes: “I look at aging “contributes to the idea that aging is Hormone for “Anti-Aging”and Bodybuilding. people who are 95 who sit in a chair all something wrong … to be feared … and Journal of the American Medical Association, (23), 2792. day and wait to die; and I look at people to be treated with pills and potions,” Mil- 299 who are 95 and active, giving lectures, ner continues. “In fact, we’re all getting 8. Ford, E. S., et al. (2009). Healthy Living Is the going out to dinner every night, vital older from the day we’re born. That’s real- Best Revenge: Findings From the European people—and a big part of the difference ity. Our goal is to support people in living Prospective Investigation Into Cancer and Nutrition–Potsdam Study. Archives of Internal is socialization. The more you do, the as well and fully as possible, regardless of Medicine, 169(15), 1355–1362. more you can get yourself to do,” Cortes their age or individual challenges.” says. “But it’s a mindset that ideally starts 9. Holliday, R., & Hayflick, L. (2004). Journals in your 50s and 60s. That way, by the of Gerontology, Series A: Biological Sciences and Marilynn Larkin, MA, is an award- Medical Sciences, 59(6), B551, B543–546 (Hol- time you’re 80 or 90 years old, you don’t winning medical writer and editor, as well liday) and B547–B550 (Hayflick). sit there and say, ‘Everyone’s gone; there’s as an ACE-certified personal trainer and nothing I can do.’” group fitness instructor. She is also ICAA’s 10. Olshansky, J. S., Hayflick, L., & Carnes, B. A. (2002). Position Statement on Human Aging. Northeastern Regional Manager and a Journals of Gerontology, Series A: Biological Sci- Educate. O’Neil cautions that many regular contributor to the Journal on Active ences and Medical Sciences, 57(8), B292–B297. interventions that appear under the um- Aging®. brella of “wellness” are not based on good 11. Consumers Union and Consumer Reports Best Buy Drugs. (2007). Multiple Medicines. evidence. “There’s a lot of garbage out References The Shopper’s Guide to Prescription Drugs Se- there,” he stresses. “We have to be care- ries, Number 4. Retrieved from http://www. ful that what we advocate in the name of 1. Huget, J. L. (2010, November 17). Gwyneth consumerreports.org/health/resources/pdf/ dances great on “Glee,” despite osteopenia. best-buy-drugs/money-saving-guides/english/ wellness is based on sound science.” One The Checkup blog. Washington Post. Retrieved MultipleMedicines-FINAL.pdf. way we can help our constituents is to from http://voices.washingtonpost.com/ inform them about reliable information checkup/2010/11/gwyneth_dances_great_on_ 12. Global Industry Analysts, Inc. (2009, Febru- sources, particularly when searching for glee_d.html. ary 19). Press release: Global Anti-Aging Prod- ucts Market to Reach $291.9 Billion by 2015, health information on the Internet. Those 2. Schwitzer, G. (2010, November 18).Why did According to New Report by Global Industry could include government and university the Washington Post have such a “Glee”-ful Analysts. Retrieved from http://www.world sites, and the organizational sites they link story of a rich actress with osteopenia dancing? health.net/news/global_anti-aging_products_ to. Gary Schwitzer’s HealthNewsReview Blog. Re- market_to_rea/. trieved from http://www.healthnewsreview.org/ blog/2010/11/why-did-the-washington-post- 13. Lin, J. S., et al. (2010). Behavioral Counseling Avoid a cookbook approach. “Although I’m have-such-a-glee-ful-story-of-a-rich-actress- to Promote Physical Activity and a Health- an advocate for wellness and preventive with-osteopenia-dancing.html. ful Diet to Prevent Cardiovascular Disease in Adults: A Systematic Review for the US Pre- gerontology, I know that ‘one size does 3. Alonso-Coello, P., et al. (2008). Drugs for preventive Services Task Force. Annals of Internal not fit all,’” O’Neil comments. “What osteoporosis: prevention or disease mongering? Medicine, 153(11), 736–775. Retrieved from I suggest to a vibrant, physically active BMJ, 336, 126. Retrieved from http://www. http://www.uspreventiveservicestaskforce.org/ and cognitively intact 82-year-old will bmj.com/content/336/7636/126.full. uspstf11/physactivity/physart.htm. be totally different from what I say to a 4. Brody, H. (2009, December 23). NPR: How 14. Anderson, A. L., et al. (2011). Dietary Patterns 65-year-old with congestive heart failure, Osteopenia Became a Treatable Disease. and Survival of Older Adults. Journal of the diabetes and chronic obstructive pulmo- Hooked: Ethics, Medicine, and Pharma. Re- American Dietetic Association, 111(1), 84–91.

36 The Journal on Active Aging January/February 2011 www.icaa.cc