Aims and information sources

The research on which this paper is based has had two interacting elements. One has been textual critiques, firstly of the output of the proponents of anti-ageing interventions and of biogerontology in popular science publications and academic journals, with a focus on both the constructs and language that are employed to describe human old age, and secondly of accounts of two controversies about the effectiveness of anti-ageing science and medicine. These are Olshansky and others' disputes with the American Academy of Anti-Aging Medicine (A4M) (Olshansky, Hayflick and Carnes Reference Olshansky, Hayflick and Carnes2002a, Reference Olshansky, Hayflick and Carnes2002b; Olshansky, Hayflick and Perls Reference Olshansky, Hayflick and Perls2004), and the reaction to Aubrey de Grey's ‘Strategies for Engineered Negligible Senescence’ (SENS) research programme (de Grey et al. Reference de Grey, Ames, Andersen, Bartke, Campisi, Heward, McCarter and Stock2002; de Grey Reference Warner, Anderson, Austad, Bergamini, Bredesen, Butler, Carnes, Clark, Cristofalo, Faulkner, Guarente, Harrison, Kirkwood, Lithgow, Martin, Masoro, Melov, Miller, Olshansky, Partridge, Pereira-Smith, Perls, Richardson, Smith, von Zglinicki, Wang, Wei and Williams2003; Nuland Reference Nuland2005; Warner et al. Reference Warner, Anderson, Austad, Bergamini, Bredesen, Butler, Carnes, Clark, Cristofalo, Faulkner, Guarente, Harrison, Kirkwood, Lithgow, Martin, Masoro, Melov, Miller, Olshansky, Partridge, Pereira-Smith, Perls, Richardson, Smith, von Zglinicki, Wang, Wei and Williams2005). The other element has been attendance at biogerontology conferences and events at which interviews with several leading anti-ageing practitioners were arranged, with the same focus on the displayed conception of human old age and ageing. The research has then been an individual investigator's scoping or pilot study. This paper focuses on the language and imagery that is used among anti-ageing practitioners to characterise ‘old age’, particularly to understand why it is viewed so negatively. The paper's starting point is that old age is a cultural category.

Cultural variations in the representation of human ageing

Some aspects of the trajectory of social and biological changes over the lifespan are identified as ‘ageing’. Age is also understood as a sequence of categories differentiated by specific criteria – including not least measures of chronology. Human cultures not only classify individuals and groups by ‘age’ but also develop normative expectations about ‘ageing’. The specific content of these processes and categories are contested and their meanings are not fixed. The lifecourse has different life stages in different eras and cultures. New stages in the 20th century have included ‘teenager’ and ‘third-ager’. There are also stages of the lifecourse with less definite ages and sequential positions, and some that not all experience (e.g. child-raising). Historical gerontology has usefully documented the changing understanding of old age and the rise of the modern dominance of medical definitions (Achenbaum Reference Achenbaum1978; Van Tassel and Stearns Reference Van Tassel and Stearns1986; Cole Reference Cole1992; Katz Reference Katz1996, Reference Katz2005; Lupton Reference Lupton, Albrecht, Fitzpatrick and Scrimshaw2000; Thane Reference Thane2000). Foucault described very well the shift in the understanding of the body in old age:

Building on the Foucauldian approach, Katz (Reference Katz1996) identified a key discursive change that started in France during the late-eighteenth and early-19th centuries, whereby ‘medical research developed what we have called a discourse of senescence: a new organization of associated ideas and practices that captured the aged body through three commanding perceptions’ (1996: 40). He listed these as: (i) ‘the aged body as a system of signification’, by which physicians now examine bodies for indications that they mask ‘inner states of disorder’; (ii) the aged body as having a distinct pathology requiring medical therapy; and (iii) the aged body as a dying body. He argued that in pre-modern society, death was understood as a mysterious external force, while during the early 19th-century, science reconceptualised death as an internal phenomenon of the body. I suggest that contemporary science is also engaged in reconceptualising death and old age. Hayflick observed that it is impossible to die of old age in America today because it has been removed as one of the 130 permitted ‘causes of death’ on a death certificate (Moody and Hayflick Reference Moody and Hayflick2003).

Cultural categories are established through constructing contrasts and boundaries that mark semantic space. Meanings cannot be established in isolation, and categories are part of meaningful systems that interlock. To understand old age, it is necessary to know its boundaries and how to recognise the markers between what is and is not old age. If we examine the language and the communications of those involved in the anti-ageing movement, we can see how the meanings they create are achieved, which distinctions are important, and which key concepts and categories are used to explain and understand old age (cf. Doyle Reference Doyle1997). The debates are about the boundaries of the science of ageing, who counts as a bona fides scientist, and who can claim knowledge about old age, on what basis and with what consequences. Katz has usefully reminded us that such debates have a long history:

Meanings of ‘old’ are communicated in concrete situations using mutually comprehensible linguistic and cultural resources. As the details of much biochemical and physiological research are not comprehensible by lay people, it is understandable that practitioners use metaphors when communicating with non-biologists. Military metaphors are particularly useful because they explicitly or implicitly characterise old age as an unmitigated enemy.

The ‘anti-ageing movement’ and its targets

The characterisation of anti-ageing medicine and the broader movement are contested. Three definitions from the literature are informative. Post and Binstock (Reference Binstock2004: 1) emphasised that the intentions of the practitioners of ‘anti-aging interventions [have] a wide variety of ambitions and measures to slow, arrest, and reverse phenomena associated with aging’. Mykytyn (Reference Mykytyn2006: 644) regarded ‘anti-aging medicine as a social movement. … Anti-aging's core mission [is to] to herald and operationalize aging itself as treatable’. The Longevity Meme website emphasises the diverse practices of different anti-ageing groups:

We can map the field of anti-ageing by exploring the diverse professional groups that present themselves as ‘waging war’ on old age – as challenging the inevitability of ageing. They construct old age as a naturalised, self-evidently negative, biological phenomenon, which must be attacked and defeated (Vincent Reference Vincent2006a). They use different weapons by which to defeat ageing based on their differing claims to technical expertise and ability to control natural phenomena. Four groups can be recognised on the basis of their different approaches to old age:

• • Those who direct their control of the body to the removal of the signs of ageing, whose objectives might be characterised as symptom alleviation.

• • Those who equate old age with ill-health and identify themselves as warriors in a battle against disease and whose objectives are to effect cures.

• • Those whose objective is to control fundamental intra-cellular processes and thus to transform ageing by extending or breaking the limits to the human life span.

• • Those whose explicit aim is to achieve immortality and for whom the enemy is death.

From this starting point, anti-ageing science can be classified variously by the motives of the practitioners, their different disciplinary expertise and practices, the length of lifespan extension they propose, and the different social groups to which they are affiliated (Table 1).Footnote ¹

Table 1. A typology of anti-ageing science

Notes: 1. Life extension aim in years. HRT: hormone-replacement therapy. SENS: Strategies for Engineered Negligible Senescence (see text).

It is important to emphasise that this classification of anti-ageing science does not identify groups with clear boundaries, but rather is a first map of an extensive field in which many activities and academic and professional disciplines overlap. We can take the example of the ageing brain by way of illustration. Anti-ageing commercial entrepreneurs who sell their dubious brain-exercise CDs fall into the cosmetic category, but their sales pitch appeals to well-founded research that has shown that mental stimulation is a factor in reducing the risk of Alzheimer's disease. There is serious biomedical research into drug therapies for Alzheimer's with, for example, an important debate about the administration and effectiveness of Aricept (donepezil). This is clearly medical research. There is associated research into brain-enhancement drugs that appear to have a preventative effect on dementia and which have enhanced the cognitive performance of aircraft pilots (Yesavage et al. Reference Yesavage, Mumenthaler, Taylor, Friedman, O'Hara, Sheikh, Tinklenberg and Whitehouse2002); they are marketed for children taking exams. In terms of cell biology and biochemistry, enhancing cell protection and repair chemistry could sustain the functioning of brain cells. Immortalists, on the other hand, build on stem-cell science to foresee the possibility of brain cell replacement and repair, thus enabling undiminished mental function in extended lifespans. Both mainstream and bogus science are contested across all four categories.

Language and imagery

In both biogerontological and popular discourse about old age, metaphors of the body are employed. A common example represents the body as a machine (Shilling Reference Shilling1993), and efforts to prevent the diseases and disorder of ageing, and ageing itself, are objectified and distanced by imagining these efforts as a battle. The contributions in Kenyon, Birren and Schroots (Reference Kenyon, Birren and Schroots1991) helpfully explored various epistemological approaches to the study of the individual and the collective metaphors of ageing used in many disciplines and contexts. They feature representations of the ageing person as a traveller and naturalistic metaphors of the time and seasons, but given what is now apparent about anti-ageing science, there are surprisingly few references to military metaphors. Mechanical metaphors can be seen as a logical accompaniment of the medical approach to the body, with its roots in the Enlightenment and the development of modern science. The French philosopher Jean-Jacques Rousseau exemplified the reasoning:

Lupton (Reference Lupton1994: 62) located the model in economic and technical change: ‘since the industrial revolution, the mechanical metaphor has been frequently used in discourses on the body’. These mechanical metaphors reflect the technology of the time; for the Victorians, the steam engine was one such metaphor:

Other times and technologies have spawned different metaphors. Familiar metaphors from the era of electricity are ‘recharging our batteries’ and ‘blowing a fuse’, clockwork metaphors include ‘feeling run down’ and ‘ticker’ for the heart, and other body metaphors borrow from hydraulics, transport and computing. Lupton has interpreted the mechanical metaphor for the body as a ‘cultural logic’:

The literature of biogerontology is full of mechanical metaphors of the body and its ageing. The popular science texts of Alex Comfort (Reference Comfort1979) and Tom Kirkwood (Reference Kirkwood1999) are replete with such images, which were also heard frequently at the biogerontological conferences I attended. One leading biologist at the International Conference on the Functional Genomics of Ageing (ICFGA) in 2006 stated that ‘functional genomics is a tool-box … the question is how to use it in the correct way’.Footnote ² At a meeting of the London Regenerative Medicine Network and in other presentations, Aubrey de Grey used the ‘stopping the super-tanker’ metaphor to describe halting the ageing process, and repeatedly drew the analogy with the trials and proving of powered flight – from the Wright Brothers to jet planes – to envisage the future of anti-ageing ‘therapies’. He also talked about ‘escape velocity’ to describe the point at which progress in lengthening the life span overtakes the rate of decline in life expectancy with age. Across the whole field of biogerontology, particularly in anti-ageing promotional material, there are many images of clocks, and hour-glasses stand for time and when inverted for the goal of overcoming ageing (this image is used in the Alcor Inc. (2005) promotional DVD).Footnote ³

Military metaphors in four types of anti-ageing activity

I will examine in turn examples of war metaphors from the four identified types of anti-ageing ambitions and interventions: cosmetic, medical, biological and immortalist. Instances in cosmetic anti-ageing are many and varied. They are used by the cosmetic brand Dove (a Unilever company) in its advertising and are prominent in the publicity material of the American Academy of Anti-Aging Medicine and many other promotional organisations, to the extent that these metaphors characterise an argument. References to a ‘war on ageing’ are used very frequently by companies to sell anti-ageing products or treatments that play on the fear of a loss of physical attractiveness (Table 2).

Table 2. Uses of military metaphors in the promotion of cosmetic anti-ageing products

Note: All the cited websites were accessed in March 2007.

In medical anti-ageing discourse, researchers and practitioners use military metaphors, including, for example, some heart specialists who attended the 2006 ICFGA. Introducing his presentation on the use of stem-cell technology to repair damaged hearts, a Sicilian transplant surgeon asked, ‘What is the real emergency for society that both clinicians and scientists are trying to solve?’ His rhetorical answer was ‘end-state organ failure’. This implied that the role of medicine and science is to ‘defeat’ death. My notes on the imagery used at the medical-academic and biology conferences suggests, however, that the use of military images is quite rare, which may be because at a scientific conference the participants self-define as scientists and shun ethical, and particularly polemical, expressions. Non-science metaphors are more appropriate when communicating to a broad audience, and are more common in popular science journals such as Nature and Scientific American than in professional journals like Cell.Footnote ⁴

Turning to the biology of ageing, the biochemistry and physiology of the ageing cell has been a source of great interest for decades, and many scientists in many countries are dedicated to understanding cell processes and their relation to ageing. The biologists concerned with cell replication processes relevant to ageing use various metaphors to explain and characterise their understanding. The terms ‘immortality’ and ‘senescence’ have undergone an interesting transformation within cell science from metaphors to technical terms (Vincent Reference Vincent2006b). In their conference presentations, biogerontologists frequently make classical (Greek and Roman) references – Prometheus came up several times at the 2006 ICFGA – indicating a desire to associate with a particular intellectual and educational tradition. A common strategy is to anthropomorphise biological or biochemical components – to talk about cells ‘deciding’ or about a ‘very intelligent molecule’. Other images are invoked, for example, stem-cell therapists talk about the ‘live’ products as like ‘chemicals’ or ‘drugs’. The Klotho gene is referred to as the ‘killing gene’.Footnote ⁵ There were exceptions but overall few military metaphors were heard at fundamental-biology conferences or have been found in the discipline's professional journals. At the conferences, there is much talk of damage and repair. Although not strictly military metaphors, these references to conflict have connotations of what ‘ought’ and ‘ought not’ to be happening in a cell, and this discourse is pervaded with the normative sense that ageing is ‘bad’.

There are biologists with positions in the leading British and American universities whose stance on anti-ageing is that it provides a route to immortality (Hall Reference Hall2003). These immortalitists frequently use military metaphors. For example Joao Pedro de Magelheas, a postdoctoral fellow at Harvard Medical School who works on ageing, describes his motivation in the following terms:

I want to conquer aging because aging is and will be the major cause of suffering and death among the ones I love. I want to end aging to safeguard the future because I want to choose my future instead of being ruled by this hostile force. I want to cure aging because otherwise I will die. I don't know if I'll succeed, but I know I will not quit since to quit is to die (Magalhaes Reference Magalhaes2006: unpaginated).

At the London Regenerative Medicine Network meeting of October 2005, Aubrey de Grey, billed as from the Department of Genetics, University of Cambridge, in his presentation referred to ‘the war on ageing' as a ‘real war’, and spoke of doing ‘serious damage to ageing soon’. De Grey is associated with the Alabama registered Immortality Institute for Infinite Lifespans. He appeared, for example, on a publicity card for their November 2005 conference, together with their motto and main mission, ‘Conquering the blight of involuntary death’ (Immortality Institute 2002), and has published a paper entitled, ‘The war on aging’, in a volume sponsored by this organisation (de Grey Reference de Grey and Klein2004b). De Grey's website presents a cute, furry mouse, which is characterised with splendid irony as ‘ammunition in the war on ageing’.Footnote ⁶ The image publicises a Methuselah Mouse prize that aims to promote the science of extended human longevity: the prize money raised to date stands at $4,513,673, and will be awarded to whoever creates the longest-ever-lived mouse. De Grey and others have raised considerable private finance to support their research, and the immortalitists' fund-raising documents are creative. One is presented as a medieval vellum scroll (Figure 1). De Grey's website also uses an extended military metaphor and polemical language that contrasts greatly with more precise and cautious academic scientific usage.Footnote ⁷

Figure 1. The anti-ageing declaration accompanying an advertisement for the Methuselah Mouse Prize of the Methuselah Foundation, Lorton, Virginia. Source: http://www.mprize.org/index.php?pagename=threehundredlist

Interpretations and conclusions

What is the nature of the foe in the war on ageing? Should we not consider making peace with it? We can classify the different meanings ascribed to old age and reference them against the enemy and tabulate the weapons and strategies used in the war (see Table 1). Figure 2 sets out the same data as Table 1 on two dimensions, the first being the scale of the human life span extension that is claimed or sought, from none or negligible to immortality, and the second the level of scientific credibility or authority. Many claims of the anti-ageing advocates are highly contested, and many scientists judge them to be ‘unscientific’. The scientific status of advocacy documents and statements can be gauged by the originator's academic position and the type of publication (with peer-reviewed papers having the greatest scientific authority). The ‘credibility scale’ runs roughly from the marketing staff of commercial companies that have no medical or biological accreditation, to professional scientists with a position in a major university (particularly in a well-established laboratory) and many peer-reviewed papers in leading scientific journals. Figure 2 shows that mainstream science, in the sense of hypothesis testing and knowledge generation using experimental methods, can be applied to the entire spectrum of anti-ageing activities, from cosmetics to the search for infinite longevity.

Figure 2. The dimensions of contemporary anti-ageing medicine.

War images are most often used by those who promote the interventions (the left side of Figure 2). They are elements of the rhetoric used to address non-specialist audiences but have limited scientific credibility (‘scientific’ evidence is cited but generally not from mainstream sources). ‘Hard’ scientists are not immune from using metaphors, but in their exchanges they generally use more exact analogies. For example, the term ‘senescence’ is a technical term in biogerontology and frequently used in the study of cell processes. War images tend to be used by those who are excluded from recognised science – those who are struggling to get inside the respected networks and who most frequently address non-specialist, non-scientific audiences.

Dramatic military metaphors and images are useful for fund raising and publicity, but less so for gaining recognition by established biomedical and clinical science. One leading London biologist described the cosmetic and immortalist anti-ageing practitioners whom he wished to exclude from science as ‘quacks and loonies’ (cf. Gerontological Research Group 2002). The cosmetic charlatans can readily be excluded from mainstream science as ‘quacks’, but less easily excluded are those who draw on science to develop or supply cosmetics, particularly cosmetic surgeons. Immortalists are generally excluded by mainstream science as ‘lunatics’, for putting forward fantasies that are beyond the known capability of science. When ‘immortalists’ conduct research in respected biology laboratories and attract large amounts of private funding, however, the ‘exculsion’ is inconsistent (Shostak Reference Shostak2002; Hall Reference Hall2003).

How does mainstream academic biogerontology differentiate its activities from those of ‘quacks and loonies’ and establish its superior legitimacy? To which values and symbols do they appeal to establish their authority? Mainstream biogerontological science does not loudly advertise its ability to extend human longevity by longer and longer periods, but rather repeatedly appeals to the goal of increasing the ‘healthy life span’. These scientists present themselves as studying fundamental biological processes in order to improve the health of older people – they ignore or dismiss the construction that the objective is to extend the lifespan, although concede that this may be a consequence. By emphasising the goal of a longer ‘health span’, mainstream scientists seek to distance themselves from ‘quacks and loonies’. Cosmetics are treated as trivial, and the dubious goal of immortality is seen as a chimera and as irrelevant because it is not primarily concerned with disease. The rhetorical use of the ‘health span’ was noted during four of my interviews with scientists at the 2006 ICFGA. They described the goal of their work variously as, ‘[so] we can age in better health not as “old-old” but [in] healthy old age’, ‘not so much to prolong ageing but to reduce societal costs and pain’, ‘to ease the ageing process, why not? The aim is to ease suffering not necessarily to prolong life’, and to work on ‘caloric restriction [because it] prevents cancer and could really improve the quality of life. Maybe it will also extend the lifespan to 150 years but that is not the driving force’.

The ‘health span’ concept is the dominant mode of explanation but is not without problems. Much epidemiological research has shown that lifestyle factors, such as diet, exercise, mental activity and avoidance of stress, are significant influences on health extension. This opens the door not only to scientific studies of lifestyle influences on longevity but also to a role for ‘anti-ageing’ interventions and medicine that are close to ‘new age’ lifestyle marketing and ‘alternative’ therapies – both of which are in evidence at the conferences of A4M and its offshoots across the world. The use of the ‘health span’ concept does not entirely avoid the moral and social dilemmas associated with a fundamental increase in the achieved human lifespan. Irrespective of the conditions in which we live, is it desirable to extend human life per se? Some people, including influential scientists, clearly think that it is. William Haseltine, head of Human Genome Sciences, an important pioneering genomics biotechnology company, is cited by the US President's Council on Bio-Ethics (2003: 162) as having declared that ‘the real goal is to keep people alive forever’.Footnote ⁸

Immortalists commonly (if often implicitly) have a fixed view of the age at which they wish to live the rest of their lives. They see their own biological ageing as being halted at 13, 25 or 32 years, or some other preferred chronological age. It could be argued that this is a middle-aged perspective. Older people look back at several life transitions and there is research evidence that they adapt to bodily change (Oberg Reference Oberg and Fairclough2003). Immortalists seem to lack a positive vision of themselves in their later life stages, as for instance characterised by maturity, experience and adjustment. They discount the social process of ageing and do not seem to have an understanding that society and social relationships do not stand still, and that neither they nor an idealised body can be fossilised at any particular chronological age. The war on ageing is conceived entirely around a biological model of ageing and excludes any understanding of human ageing as complex social and psychological processes.

To sum up, the most prolific use of military metaphors is by the promoters of cosmetic interventions and immortalists. These components of contemporary anti-ageing science most appeal to non-scientific audiences. On the other hand, the medical specialists and the biologists of ageing disguise the contradiction of their approach to old age by use of such terms as ‘healthy life span’, which avoids having to confront the moral dilemmas of extending the lifespan for its own sake. The rhetoric of a ‘war on ageing’ positions the practitioners of anti-ageing medicine on moral high ground, as valiant warriors against a terrible fate. ‘Science’ claims intellectual and epistemological superiority, but for this to be sustained, its failures or slow progress have to be explained away as a function of insufficient funding and resources. Because scientific knowledge is culturally understood as the progressive and ‘true’ knowledge, it is seen as infallible in its potential control of bodily mechanisms (Vincent Reference Vincent2006a). Importantly this rhetoric positions older people as ‘the defeated’. Older people are characterised by the different elements of anti-ageing science as having lost their good looks, succumbed to disease, become overwhelmed by senility, and as surrendering to death. Constructing older people as the defeated adopts another battle metaphor, denies the possibility of positive models of old age, and reinforces the fear of ageing and death. These attitudes to human ageing require us to redouble our efforts to avoid old age. In claiming the legitimacy of science as the source of true knowledge, anti-ageing science and its battle against ageing undermines old age as a necessary and potentially positive and fulfilling stage of the lifecourse.