COMMENT BOOKS & ARTS involved in longevity pathways, or destroy Lifespan: Why We Age — and Why We Don’t only the vicissitudes of elderhood is like harmful senescent cells that accumulate Have To saying that youth is defined by acne. In fact, as we age and help to fuel disease. Sinclair DAVID A. SINCLAIR AND MATTHEW D. LAPLANTE in old age we might know ourselves better Atria (2019) and LaPlante claim that some of these drugs than ever and obtain more overall life satis- might already be here. The effects of the Elderhood: Redefining Ageing, Transforming faction. Aronson conceives of anti-ageing not widely prescribed diabetes drug metformin Medicine, Reimagining Life as Sinclair and LaPlante see it — as a bid to and the immune modulator rapamycin, for LOUISE ARONSON medically ‘cure’ the condition — but as bat- Bloomsbury (2019) instance, seem to mimic beneficial strategies tling the many “discriminatory beliefs and — the equivalent of (respectively) exercising policies” affecting the elderly. In her view, the more and eating less, in pill form. from her own experience of ageing. very idea of ‘curing’ ageing is ageist; such a Defining ageing as a disease is central to Many of her stories reveal cracks in the US concept is not invoked for any other life stage. their approach. If we treat age medically, as health-care system. We learn, for instance, Indeed, in Aronson’s eyes, the worst we do heart disease or cancer, they argue, about Neeta, a frail patient with mild demen- offender might be the medical system innovative therapies will emerge more rap- tia who breaks her hip. After surgery, Neeta itself. She sees it as failing both patient and idly. That mirrors the increasingly popular is transferred to a less-than-stellar care home physician. It lacks nuance on subtle but ‘geroscience hypothesis’, which posits that where she becomes agitated, is sedated, devel- important differences in life phases, and therapies targeting the fundamental biology ops bedsores and spirals into hospice care. We focuses on “diseases and organs rather than of ageing will help to slow or prevent chronic also learn of Aronson’s personal frustrations. people and lives”. For instance, she notes diseases that plague older people, such as In one instance, when physicians in a busy that many over-the-counter medicines are type 2 diabetes and dementia. Sinclair’s accident and emergency department were too not tested on older people, adding risk to argument, based on decades in the lab, is distracted, she had to perform a rectal exami- prescribing them. She advocates a new para- that there is no immutable biological tenet nation on her own father to demonstrate that digm: a re-balancing act in which technol- that limits how long, or how well, we can live. he was bleeding internally. ogy has a role but the focus returns to care. Sinclair and LaPlante examine the Unlike the high-tech, algorithmic march of economics of extending lives on a crowded, ESSENTIAL STAGE modern medicine, her idea of truly ‘person- resource-limited planet, and the ethics of Meshed with these very human tales are a alized medicine’ incorporates the patient’s tinkering with the supposed natural order. wealth of social, cultural and historical per- past experiences and current expecta- But they also speculate on some inadvert- spectives. At the start of the book, Aronson tions. This integrative, humanistic model ent, potentially positive effects. Knowing tells of an encounter with Guy Micco, a physi- of geriatrics is rare. One can only hope its you were going to meet your great-great- cian teaching at the University of California, practices are adopted swiftly. grandchildren, for instance, might make you Berkeley. Micco asked a class to write down What are we to conclude? Is ageing a a more accountable steward of the present. If associations with the word ‘old’: concepts such disease that can be eradicated by science, many generations lived and worked together, as weak and frail predominated. The word or the natural third act of life, threatened we might all become more empathetic — as ‘elder’, by contrast, elicited terms including by over-medicalization? Viewpoints will Sinclair puts it, “more human”. At a time of respect, experience and knowledge. To Aron- undoubtedly be as variable as experience and political, economic and environmental uncer- son, part of the problem is that we adhere to a temperament. There might be some wisdom tainty, that could be ever more important. utilitarian, late-nineteenth-century concept in simply following an adage attributed to sev- If Lifespan is a lively sprint into the future of the body as a machine. Viewed through enteeth-century philosopher Francis Bacon: of ageing, Elderhood is a contemplative walk that industrial lens, being ‘old’ is no longer the “old age is always 15 years older than I am”. ■ in its here and now. Since the early 1990s, apex of life experience. It is a loss of function Aronson has worked as a geriatrician at the and, by extension, of intrinsic worth. Toren Finkel holds the Beckwith Chair University of California, San Francisco. Her Aronson sees life as a three-act drama: in Translational Medicine and is director exquisitely written book mixes vignettes childhood, adulthood and elderhood, the of the Aging Institute at the University of about her patients (remarkably, she still latter subdivided into senior, old, elderly and Pittsburgh and the University of Pittsburgh makes house calls) with lessons learnt from aged. Each act builds on the one before, and Medical Center in Pennsylvania. caring for her elderly parents and insights is essential. Aronson notes that emphasizing e-mail: [email protected] SPACE SCIENCE India on Mars: the film Subhra Priyadarshini lauds a movie on the country’s first interplanetary mission. n 2013, India reached for Mars. Its Mission Mangal MOM off the ground. Research Organisation (ISRO) and the first interplanetary mission, dubbed DIRECTOR: JAGAN R e l e a s e d o n country’s technological prowess, and as such Mangalyaan (officially the Mars Orbiter SHAKTI 15 August — India’s stirs up national pride. But the film is also Cape of Good Films/ IMission, or MOM), launched a probe carry- independence day successful scientific storytelling, performed Hope/Fox Star Studios ing five instruments to study aspects of the (2019) — Mission Mangal by a glittering cast. red planet, from its mineral composition to fictionalizes the tense Science communication can be notori- potential signs of past life. Now, a fictional months from approval to launch, a race to ously tricky, treading a line between over- treatment on film by first-time director lift off when Mars would be closest to Earth. simplification of concepts and overuse of Jagan Shakti celebrates the scientists who got It is very much a homage to the Indian Space jargon. Mission Mangal avoids the latter, 194 | NATURE | VOL 573 | 12 SEPTEMBER 2019©2019 Spri nger Nature Li mited. All ri ghts reserved. ©2019 Spri nger Nature Li mited. All ri ghts reserved. Vidya Balan plays Tara Shinde, project director for India’s Mars Orbiter Mission, in Mission Mangal. but some sections have been accused of Dhawan in the 1960s and 1970s, Indian common among space-faring nations is dumbing down highly technical ideas. One scientists paving the way to a national space also captured. Mission Mangal alludes to a scene drew widespread criticism at the programme have practised ‘frugal efficiency’. cartoon published in The New York Times trailer’s launch in July. MOM project direc- Mission Mangal is framed by an apparent in 2014, of a turbaned man leading a cow STERLING MEDIA STERLING tor Tara Shinde (played by the supremely setback. This is the moment in 2010 when knocking at the door of a building marked talented Vidya Balan) is shown making a test of ISRO’s Geosynchronous Satellite ‘Elite Space Club’. It was widely criticized puris, deep-fried rounds of Indian bread. Launch Vehicle was aborted just over a as racist, and the paper apologized. Three After she turns the stove off to save gas, the minute after lift-off, after scientists detected years later, after India launched a record oil remains on the boil for some time. She snapped communication connectors. The 104 satellites on one craft, The Times of then realizes that a similar technique would film recounts how lead scientists Shinde India published a cartoon showing India allow ‘smart’ space vehicles to stay in orbit: and Rakesh Dhawan (Akshay Kumar) plan inside the club as other countries seek the fuel could be switched off to make use a relaunch, but are politely shunted to ISRO’s entry. of Earth’s gravitational pull. As I watched unglamorous, underfunded Mars section. The coming decade is set to see some this supposedly divisive scene, a woman Here, they begin of India’s major space ambitions take sitting beside me nodded approvingly. The “The coming to work their wing. The Department of Space got an principle of economy in space had hit home. decade is set magic as they pull 11% budget hike for 2019–20, and ISRO It’s a key point: judicious use of resources to see some of together and train is set to launch its first crewed mission, is an ISRO speciality. The organization their team. NASA, Gaganyaan, before the 75th anniversary boasts the world’s cheapest solutions for India’s major inevitably, is a of India’s independence, in 2022. And, space missions. They range from the com- space ambitions recurrent theme. in a fitting 50th-anniversary tribute to pact Small Satellite Launch Vehicle to space- take wing.” The Indian-born, Apollo 11, India’s second mission to the saving satellites such as the Microsat, which NASA-trained Moon, Chandrayaan-2, set a course for weighs about 100 kilograms and can latch scientist Rupert Desai (Dalip Tahil) the uncharted lunar south pole in July.