The weight of evidence seems to establish the fact that old is never physiological, but pathological, at least its visible and appreciable evidences are pathological ones. WH Curtis, 1906.
The Fountain of Youth
From the beginning of time man has been in search of the fountain of youth. The reasons for this quest are many, and the reasons themselves are probably less important than the journey man has traveled in his attempt to fulfill this desire. That journey has led to a better understanding of why we age, and from that knowledge developments have emerged leading to treatments that would not have been possible had man just accepted his infirmity, his afflictions, his pain, and his ultimate fate, his own mortality.
From that exploration of eternal youth quality of life has improved and to some degree the lifespan itself. Yet, despite the words of WH Curtis aging is not considered a disease – it is not considered pathological by the medical establishment and those who now control the delivery and access of healthcare. Yet, the desire to understand aging and to live longer younger is more than quite natural. That desire should be expected. It’s as innate as man’s desire to be free and to control his own destiny.
The trek towards the fountain of youth has included nutritional therapies, and in the past century and half hormonal treatments have emerged. In more recent years the development of stem cell treatments capable of growing entire organs and tissues, and compounds to prevent telomere shortening (perhaps the fundamental reason we age) provide real hope for meaningful life extension and vitality.
Over the years scientists have been more than eager to experiment on themselves demonstrating the pull the fountain of youth possesses. Edourd Brown-Sequard, best known for his contributions in neurology, injected himself (circa 1889) with extracts made from crushed testicles of dogs and guinea pigs. Following a series of such injections Brown-Sequard reported improved mental capacities, better sexual potency, and claimed the injections took 30 years off his 72-year-old life.
The first human to human testicle transplant was performed 1911 (hate to have been the donor) by Victor Lespinasse. The benefits of such transplants went beyond restoring male vigor and were found helpful for dementia, hypertension, and skin disorders – providing early evidence that testosterone has wide-range health benefits. Yet, skepticism for hormonal replacement therapy perhaps has never been stronger than it is today.
Stem cells treatments are finding new applications in humans including in the management of stroke, diabetes, and heart failure. TA-65, a telomerase activator, has been shown in clinical trials to improve biological markers of aging, and to lengthen telomeres.
If the past is any indication these treatments will be slow to catch on and a generation of patients will miss out on the benefits of these treatments. Why is that? Why will these and other treatments be slow in gaining acceptance? Below I offer two possible explanations.
Maintaining the Status Quo
There are populations and cultures on this planet whose members rarely suffer from heart disease, cancer, obesity, and diabetes (to name a few). And, they don’t have access to the latest medical technology (HINT: they don’t eat the American Diet).
Though, it may not have been intended, we’ve created a health care system that keeps patients alive as long as possible but in a poor state health generating money for hospitals, pharmaceutical companies, insurance companies, laboratories and diagnostic companies, and of course, health care providers. We are probably the “sickest” richest country in history on this planet. There is little disease that we actually cure. We simply “manage it” while making patients feel that they’re getting the best care possible.
Suffice it to say it’s probably not possible to live longer without being healthier. And, suffice it to say that prevention is a major key to longevity and youthful living. Only 10% to 15% of cancer is strongly genetically based meaning that most cancer is preventable, as is heart disease, type 2 diabetes, and most chronic diseases. Prevention of disease threatens oncologists, cardiologists, and other providers, not to mention all the other entities mentioned above.
It’s one reason why prevention has not been embraced in this country like it has in others. Any treatment that actually might cure a disease (stem cells) is sure to be resisted by those it threatens.
Evidence-Based Medicine and the Fountain of Youth
Completion of the journey towards the fountain of youth and the practice of medicine in general has been stymied in part by evidence-based medicine, or more appropriately, the misinterpretation of evidence-base medicine. Evidence-based medicine is the new rage in the practice of medicine. Certainly the concept of evidence-base medicine seems worthy, appropriate, and well-intended But, what is it really?
Many physicians have taken the position that evidence-based medicine means that no treatment should be considered until there is overwhelming evidence that its benefits outweigh a treatment’s risks, usually determined by a large randomized controlled trial. Depending on the disease and treatment in question such studies can take 10 to 20 years to complete and years to analyze the results.
Plus, not all diseases and treatments can be studied in a randomize controlled trial for a variety of reasons. So while we wait for “conclusive” evidence many will suffer unnecessarily.
But, what does David Sackett, MD, considered the father of evidence-based medicine say? On more than one occasion Dr. Sackett has found himself needing to clarify the intent, goal, and scope of evidence-based medicine. From his paper “Evidence-Based Medicine: What it Is and What it Isn’t” Dr. Sackett says that evidence based medicine ” integrates the best external evidence with individual clinical expertise and patients’ choice”.
Notice the patient has a choice in the decision-making process, and that the physician can and should use his clinical experience to determine if the best available medical evidence applies to a particular patient. Dr. Sackett emphasizes the use of the best available medical evidence.
He further says “Evidence based medicine is not restricted to randomised trials and meta-analyses. It involves tracking down the best external evidence with which to answer our clinical questions……However, some questions about therapy do not require randomised trials (successful interventions for otherwise fatal conditions) or cannot wait for the trials to be conducted. And if no randomised trial has been carried out for our patient’s predicament, we must follow the trail to the next best external evidence and work from there.”
What does this have to do with the fountain of youth? The bulk of the available medical evidence favors the use of hormone replacement therapy and many “anti-aging” treatments. Not all individuals will be interested in these treatments, but those who show an interest should have the opportunity to discuss with their physician how such treatments might benefit them and what risks are involved.
Though we are far from full discovery of the fountain of youth, the journey thus far has been rewarding and fruitful, and should be viewed and embraced as one worthy of continued pursuit.
Towards the end of his paper Dr. Sackett says, “External clinical evidence can inform, but can never replace, individual clinical expertise, and it is this expertise that decides whether the external evidence applies to the individual patient at all and, if so, how it should be integrated into a clinical decision.”
Here’s the irony. If the three tenants of evidence-based medicine (best available medical evidence, individual clinical expertise, and patient choice) were actually put into practice, progress towards the fountain of youth would occur more rapidly.
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