In the vanguard of biomedicine? The curious and contradictory case of anti‐ageing medicine

Abstract

The rise of anti-ageing medicine is emblematic of the current conditions of American biomedicine. Through in-depth interviews with 31 anti-ageing practitioners, we examine how practitioners strive for—and justify—a model of care that runs counter to what they see as the ‘assembly line’ insurance-managed industry of healthcare. Their motivation, however, is not merely a reaction to conventional medicine. It is derived from what they see as a set of core beliefs about the role of the physician, the nature of the physician-patient relationship, and the function of biomedicine. We analyse this ideology to underscore how anti-ageing medicine is built on a ‘technology of the self’, a self in need of constant surveillance, intervention, and maintenance. The ultimate goal is to create an optimal self, not just a self free of illness. A fundamental irony is that, despite their self-presentation and the perception of the public, anti-ageing providers do not use practices that are especially ‘high-tech’ or unconventional. Instead, the management of ageing bodies rests on providers’ perceived knowledge of their patients, tailored treatments, and a collaborative pact between the provider and patient.

Bioidentical hormones, menopausal women, and the lure of the “natural” in U.S. anti-aging medicine

“…The A4M directory was intentionally chosen because clinicians voluntary choose to advertise themselves as providing “anti-aging medicine,” which was the target of our larger research project. It is important to note, however, that while these physicians were members of A4M and had requested to be included in the online directory, they also referred to and marketed themselves using other monikers and via other organizations (e.g., “age management,” “integrative health,” “holistic health,” etc.—see Fishman, Settersten, & Flatt (2010)) and could have been found by patients in ways other than through the A4M directory or the “anti-aging” label.…”

“…The rise of the “anti-aging physician” in the U.S. is in large part a response to the desire and demand for more “holistic” and “integrated” health care (Mykytyn 2006, Fishman, Settersten, & Flatt 2010). Furthermore, the rise of the multi-billion dollar “natural products” market worldwide—including products sold in health food stores and recommended by alternative health specialists— has surely led to the acceptance of BHRT by the practitioners and patients described in this study.…”

Subjective Aging and New Complexities of the Life Course

“…First made visible in cultural essays by Inge Powell Bell (1970) and Susan Sontag (1972), the notion of the "double standard" of aging for men and women is surely a particularly important part of subjective aging: the physical signs of aging affect men and women differently, with wrinkled skin and grey hair making a man look distinguished and the very same characteristics making a woman look over the hill-leading to harsher evaluation of women' s aging, not only by men but also potentially by women, and to a sense of becoming invisible. Indeed, antiaging medical practices are focused on women (e.g., hormone replacement therapies, injections, and plastic surgeries), and the patients who consume these (generally out-of-pocket) services are largely middle-aged women with ample fi nancial resources (Fishman, Settersten, & Flatt, 2010;Mykytyn, 2006). There is also the massive over-the-counter cosmetic market, focused on "regenerative" antiaging products, which caters to women.…”

“…Subjective aging is inherently connected to aging bodies. Indeed, medical and consumer efforts to slow human aging are meant to change both bodies and minds-but often with the assumption that improving physical aging is the key to improving subjective aging (Fishman, Settersten, & Flatt, 2010).…”

Peering into the pharmaceutical “pipeline”: Investigational drugs, clinical trials, and industry priorities

“…This broader area of scholarship has shown how the profession of medicine has encroached on and claimed expertise over routine aspects of life from birth to death (e.g., Howarth, 2007; Starr, 1982; Sullivan & Weitz, 1988). Similarly, scholars have shown how pharmaceuticals have extended medicalization such that aging, sex, and sleep have all become problems requiring chemical intervention (Fishman et al, 2010; Fox & Ward, 2008; Healy, 2012; Marshall, 2002; Williams, Seale, et al, 2008). Williams, Martin, and Gabe (2011) define pharmaceuticalization as “the translation or transformation of human conditions, capabilities and capacities into opportunities for pharmaceutical intervention” (711).…”