Dr. L. Stephen Coles, a physician and researcher at UCLA Medical School who for years has studied centenarians, made a radical statement to the audience that had gathered last month for the annual conference of the American Academy of Anti-Aging Medicine.
There is no such thing as anti-aging medicine, he declared to the organization he has belonged to for a decade. The good news, he added, is scientists may achieve real breakthroughs that could lead to longer and healthier life spans -- in 20 to 30 years.
Most of the audience at the Las Vegas meeting groaned, and there was a smattering of boos, said people who attended.
After Cole's remarks, Robert Goldman, a Chicago osteopath and cofounder and chairman of the anti-aging academy known as A4M, got up and disputed everything Coles had just said. If the medical community waits two or three decades for breakthroughs, he said, many in the audience would be dead. He asked everyone who believed in anti-aging medicine to applaud.
Most of the audience clapped heartily.
"Nearly everyone there was a true believer," said Jay Olshansky, an A4M critic who is a professor at the University of Illinois School of Public Health. "It's like a religion."
After all, many of the 1,100 physicians, nutritionists, physical therapists, plastic surgeons, chiropractors and diet specialists who gathered at the A4M conference at the posh Venetian Hotel had paid more than $1,000 to learn about the latest anti-aging therapies, from human growth hormone treatments to nutritional supplements to "cosmeceutical" creams. Many of their patients and clients are clamoring for such treatments to make them look and feel better. And there is money to be made: By some estimates, the market for aging-related products is $42 billion annually.
The Las Vegas incident highlights an intensifying rift in the rapidly evolving business and science of aging. In one camp are doctors and businesspeople who are trying to sell an eager public on the idea that you can turn back the clock or reverse aging.
In the other are those who believe there is little or no scientific foundation for anti-aging products and treatments, and that some may pose a health risk. Many physicians, researchers and scientists, delving into the physiological aspects of human aging, view A4M's activities with disdain, saying that the organization is an inappropriate blend of scientific and commercial interests.
These detractors contend that there is more at risk in the debate than A4M's viability and credibility. They fear that support for scientifically rigorous research into aging -- examining topics such as why muscle mass diminishes and we become frail as we age -- may be tainted by a group that welcomes companies that sell wrinkle creams, hair-growing potions, sexual enhancement pills and hormone treatments such as those on exhibit at last month's conference.
"It's like an open-air circus," said Dan Perry, executive director of the Washington-based nonprofit group, Alliance for Aging Research, who noted a jarring difference between some exhibits and lectures and the scientific and technical presentations on such subjects as Alzheimer's disease that also were part of the conference. "There aren't any boundaries," he said.
Moreover, A4M's publications and website seem to suggest that aging is indeed a disease for which cures exist. The official slogan of the A4M, founded in 1993, is "Aging is not inevitable! The war on aging has begun!" A promotion on the website for Goldman and A4M president Ron Klatz's book, "The New Antiaging Revolution: Stopping the Clock" states: "The science of anti-aging medicine is creating a new paradigm of health care and is taking a new approach to aging and to medicine, showing us a new reality for humankind, an adulthood free from the fear of disease, infirmity and lingering death in old age."
Aging research has been slow to gain credibility, in part, because scientists have had to counter a history of charlatanism and profiteering that goes back centuries, Perry said. In the 13th century, for instance, British mathematician and scientist Roger Bacon -- ahead of his time in believing the world was a sphere rather than flat -- contended that inhaling the breath of young virgins could rejuvenate elderly men.
Serious research into the physiological process of aging wasn't begun until the 1980s, Perry said. Even today, with a growing baby-boom population, aging research gets only a tiny chunk of federal spending on medical research -- about $1 billion of the $27 billion spent annually by the National Institutes of Health.
Meanwhile, boomers can't seem to get enough of products touted as anti-aging remedies, including vitamins, herbs and dietary supplements.
Physicians aren't the only ones leery of A4M. Moments before Coles' speech, Primedia Inc., a New York-based publishing and exhibition company that had been A4M's partner for the last five years in running the conference, announced that it was severing ties with A4M. Primedia asked Coles to serve as program director for separate conferences later this year.
"We were never really comfortable with the content," Herb Greenebaum, Primedia's marketing manager, said in a telephone interview. "We are going to try to bring it onto a much more scientific footing."
For its part, A4M, which claims 11,000 members worldwide, said it initiated the breakup. Moreover, A4M's Goldman dismisses other gerontology and aging research organizations as promoting a "cult of death."
"We don't have 20 to 30 years to wait, and if you listen to them, you'll just grow old and die," Goldman said last week in a telephone interview.
"We are saying that there is something we can do now, that there are a lot of exciting things in the pipeline. But our people want to employ them today," Goldman said. He believes that physicians should be able to pick and choose products they believe in, and the conference provides an opportunity for them to see what's available.
To date, many scientists say there isn't anything that has been proved to reverse or slow aging in humans. Few would dispute that maintaining a healthy diet, exercising, reducing stress and getting regular checkups and screenings will help ward off disease, thus extending one's life span. Meanwhile, people also are living far longer than they did a century ago, primarily because many deadly diseases have been eradicated or effective treatments found.
And scientists say there has been real progress in the study of how cells age.
"You don't die from aging, but it ultimately makes you more vulnerable to disease," said Arlan Richardson, a biochemist who directs the Barshop Center for Longevity and Aging Studies at the University of Texas Health Science Center in San Antonio. "Something happens to the organs so disease processes can occur."
For example, Richardson's recent studies indicate that rodents who consume 30% to 40% fewer calories than their counterparts not only live longer, they also age better, meaning that they do not develop the same unhealthy symptoms that most rats do before they die.
Better quality at the end of life, not just longevity, is a prime objective, Richardson said. "I have parents in their 80s who are not worried about dying, but are concerned about their quality of life and whether they will become invalids."
If the same principle proves true in humans -- the tests have not been done yet -- Richardson suspects that it may have to do with "insulin-signaling" within cells; essentially, the less signaling that occurs, the healthier cells remain. Drugs could be developed to reduce the signaling.
"Once we've identified what contributes to aging, there's nothing magic about changing it," said Richardson, suggesting that aging research today is about where cancer research was in the 1960s.
For his part, Coles believes the key is in the genes and the proteins they express. "Queen bees and worker bees have the same genes," he says, but the queens live 12 years while the workers live just one. Although there has been a great deal of research in the human genome -- there are 25,000 to 35,000 genes -- little is known about the 250,000 proteins that they code to create such differences in life spans and quality of life, Coles said.
Coles has studied many people who have lived past 100 and even 110. The only factor they seem to have in common is that "they were very good at choosing their parents," he said.
Although unhealthy habits such as smoking can have an impact on longevity, Coles said, even those behaviors haven't affected some of the world's oldest people because, for some reason, their genes seem to offer some resistance to disease. The oldest woman in the world, who died in France in 1997 at age 122, smoked until she was 100, Coles said.
Their long life spans, Coles said, have nothing to do with medicine, because most didn't see any doctors till they were 90.
"What we need is a bridge plan to get you from where we are today to 20 years in the future, by eating right, doing right exercise, reducing unnecessary stress and trying not to work in a place where [you are] driving on a freeway and getting stuck in traffic everyday because you know it will be frustrating -- to get to the point where real anti-aging medicine will be available," he said.
Richardson also believes increased funding for aging research may be more cost-effective than putting the money into research on other diseases.
"I don't want heart disease or cancer either," he said. "But with cancer, you might be hospitalized for several months, but if you're like President Reagan and have Alzheimer's, you might be totally dependent for years."