Forever Young: A Cultural History of Longevity

Figure 1.

Lucian Boia

Reaktion Books, £16.95, pp 224 ISBN 1 86189 154 7 www.reaktionbooks.co.uk

Rating: ★★

The Romanian historian Lucian Boia sees the pursuit of longevity, even to the eventual status of immortality, as a natural strategy for humankind. He cites the decline in religious belief and the afterlife, as well as the failure of secular “religions” such as Progress and Science, as key factors in the present interest in the subject.

However, it seems a little odd to cite science's failure to provide solutions for humanity as one of the drivers of the quest for salvation through the prolongation of life—especially given medical science's record in providing many of the epidemiological explanations and treatments that have helped increase life expectancy dramatically in the 20th century. Additionally, the study of genetics has contributed greatly to our understanding of the ageing process.

On the other hand, the list of treatments that scientists throughout history have proposed to counter ageing allows us today to have a good chuckle. For example, the 19th century British physiologist and neurologist Brown-Séquard injected himself with extract of rams' testes, while Russian transplant pioneer Serge Voronoff (1866-1951) believed that the same products from chimpanzees were far superior. The consumption of viper meat and the close proximity of healthy young people were part of the holistic approach of medieval experts.

Occasionally, however, the anti-ageist specialists were, probably by chance, correct. The 13th century English philosopher and scientist Roger Bacon advocated red wine, while the 14th century Venetian Cornaro, whose books were in print for several hundred years, extolled temperance and dietary restriction, which he believed were good for both spiritual and physical wellbeing.

The patients that geriatricians see have already tasted old age and its effects. Therefore, discussions tend to focus on their specific diseases and disabilities rather than on any extension of life for its own sake. The children of these patients also tend to focus on when their mother or father will die, rather than on for how long life will be prolonged. Indeed, the news that someone will live to be over 100 may be a cause for alarm rather than for celebration.

However, geriatricians cannot escape from issues that surround longevity. Clinical trials have shown that a number of interventions will extend life, and audits of national service frameworks and clinical guidelines will tell us how good we are at prescribing life prolonging medicines. The problem is that for very few conditions do we have robust evidence for the effectiveness of pharmacological interventions in the over 80s, or for those whose life expectancy is to be measured in months rather than years. Such patients have been excluded from clinical trials and extrapolation from studies in younger people is problematic.

While we must resist a nihilistic and ageist approach, a 10% or 20% prolongation of life may be statistically significant with a large number of zeros after the p < sign but result in only a small quantum of benefit. Perhaps the solution lies in the burgeoning concept of concordance that allows patients to decline interventions legitimately if they assess any benefits to be of no or minimal importance.

However, we still have not resolved the issue of how to respond to requests for treatments that doctors consider to be of unproven value. Boia tells us that he has not sought to separate what is true from what is not. Should we be allowed such liberty?