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Wednesday, June 15, 2016

The fountain of youth, where no one drinks

I was greatly privileged this past weekend to deliver a keynote address at the American Academy of Anti-Aging Medicine (A4M) World Congress in Hollywood, Florida. I have spoken before at the Academy's conference in Las Vegas, and will have the opportunity to do so at their sister organization's meeting in Melbourne, Australia this summer (their winter). The conferences are a big draw to health professionals and scientists interested in exploring the latest advances in anti-aging, from basic science to clinical application.

But I didn't really address any advances, latest or otherwise. Rather, I pointed out how late we all already were to our own party.

I began by telling the thousand or so health professionals in the audience about a National Institutes of Health trial, just profiled in the New York Times, examining the anti-aging potential of the drug, rapamycin, in dogs. Effects have already been shown in rodent models, and dogs are next in line.

Given the nature of the conference, and audience, many assembled likely knew more about this particular trial than I do. But that was fine, and rather by design. For me, the dogs in the trial were really just a segue to the neglected elephants in the room.

We already know the anti-aging secret.

After all, what would “anti-aging” mean in practical terms, if not more years in life, and more life in years? We surely don't mean actually stopping the clock, fixing the sun in the heavens and halting the calendar, as Joshua allegedly did. Leaving aside the rather dire, cosmic ramifications of heavenly bodies that stop dancing, I simply note no reference to any such methods in the otherwise quite comprehensive A4M subject matter.

So anti-aging has to mean preserving the good qualities of relative youth, even as the clock hands turn, the planets revolve, and the calendar turns. We must mean, simply: longevity, plus vitality. More years in life, more life in years. And if that is what we mean, we know how. We have long known how.

So I told my audience, delivering a version of a tale I have told innumerable times over the course of my career, from podiums around the world, and in print again, and again, and again. The repetition, alas, seems both necessary and insufficient, as the world is disinclined to heed.

We have known for decades the modifiable, root causes of premature death and chronic disease. These factors are not just modifiable now, with knowledge born of latest advances; they have been modifiable for as long as we've known about them, with knowledge accessible then. Knowledge in this case has been nothing like power, since we have so consistently failed to use what we know.

We have known for years not just the root causes of premature death and chronic disease around the globe, but what happens when we do modify them. Chronic diseases that would have occurred, don't, at least 8 times in 10. People live longer, and better.

We know, too, what happens in cultures where entire populations are beneficiaries of lifestyle as medicine, where they eat well, exercise routinely, avoid toxins like tobacco, sleep soundly, limit the toll of stress, and cultivate their strong connections to one another. In those places we call Blue Zones, people routinely live to a vital 100, and then some time after that, die peacefully in their sleep. If there is a greater prize to which mortals might aspire in this sphere than longevity, vitality, and a gentle exit into that good night at the timely end, I've not found it. If this is not the very quintessence of “anti-aging,” I haven't a clue what would be.

And we know, as well, that these very blessings may be imparted to an entire population in the span of one generation by translating what we have long known about healthful living into a concerted, collective action. In North Karelia, Finland, a dedication to lifestyle as medicine for all has slashed heart disease rates by over 80%, and added fully ten years to life expectancy. An additional ten years of living is an anti-aging achievement worthy of a Nobel Prize if ever there was one, but there are no Nobel Prizes in science for using what we have long known.

Perhaps that's the problem. The unknown always beckons. The new and exotic tantalizes. We are all eager to hear about Nobel Prizes attached to the promise of great, potential advances, even as we fail to keep the promises of the tried and true. We are drawn to the sources of power in distant shadow, even as the amazing might of elephants in the room is put to no good use for the simple fact that they are already in the room, and thus, mundane.

So I told my audience, assuring them I meant no disrespect to the last batch of Nobel laureates, nor to the next. I like Nobel Prizes as much as the next guy. I just wonder why we can't award them to those who learn the things we never knew we never knew, even as we use the things we long have.

We focus on dogs in trials, I contended, while missing elephants in the rooms with us. We chase birds in the bushes, and overlook the bird in hand. We strive to slow the aging of adults, but look on passively as we willfully accelerating the senescence of our children for profit. What lesser charge is deserved by a society that laments the unnecessary propagation of type 2 diabetes among children, even as it peddles sugar-sweetened beverages for every thirst, and the likes of multi-colored marshmallows for every breakfast?

We know what to eat to foster longevity and vitality for people and planet alike, but hardly anyone is willing to swallow it.

Scientists are irresistibly drawn to the glamour, glories, and allure of the unknown. You'll get no objection to that from me; we are all the beneficiaries of that endless quest. But it does seem to invite periodic exhortations on elephants in rooms, reality checks about knowledge and power. Such was my mission in Hollywood.

As for the population at large, and our culture in general, the problem runs rather deeper. We have been preoccupied with anti-aging perhaps since the very dawn of self-awareness, and the implications of mortality it unveiled. We have, ever since, tethered our fears to faith and fantasy, tangled our aspirations up in fable, about fountains of youth in particular.

The reality is, we have long since found just such a fountain, but hardly anyone drinks from it.

Why? Presumably because the fountain dispenses only water, and the line forms elsewhere. There is a concession stand nearby where, inevitably, they are selling Coca Cola.

David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.

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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Auscultation
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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