Institute For The Future

Why replacing hormones seems different from replacing ankles

Readers of the New York Times received an odd juxtaposition over the last couple days that can be roughly summed up as: A small but growing number of older Americans will be headed to hospitals for ankle replacement surgery, and that's totally acceptable; at the same time, a small but growing number of middle-aged Americans is looking to ward off some of the effects of aging by taking supplements and hormones, and that's totally controversial. The major difference appears to be that while ankle surgery is aimed at repairing a problem, taking supplements seems aimed at making people better than well. And I have to say, I recognize that this feels like a relevant distinction, even though I think it doesn't make any logical sense.

 

Let me explain.

 

The story about ankle surgery is the sort of story that's pretty familiar: Older people have some wear and tear on their ankles, new medical procedures make fixing said ankles more feasible, older Americans like the surgery and the restored mobility. For example, one ankle surgery patient said:

 

“Before the surgery, I couldn’t sleep at night,” said Mr. Keaveney, of Locust Valley, N.Y. “Now I’m able to climb ladders. I have absolutely no pain. I was even playing soccer with my grandkids a few months ago.”

 

 

The second story on hormones strikes a different chord. Noting that the concept is being described as "age-management medicine," the Times says that one such patient "gobbled vitamins" and notes that he "grabs a pinch of abdominal skin and injects himself with human chorionic gonadotropin, or H.C.G., a hormone distilled from the urine of pregnant women." The language throughout is less than flattering and cites anecdotal cases of illness and violence to imply that the whole practice of age management might be a frighteningly dangerous vanity project that can lead to death and murder.

 

To be fair, the science behind "age-management medicine" is shaky, and had the story ran in isolation--without a separate story a day or two later lauding the potential of ankle joint replacement surgery--I probably wouldn't have given the overall tone of the piece a second thought. Some wealthy people who are concerned about aging spend a lot of money on mostly unproven treatments. No surprise there.

 

But I think the language and tone point to a critical and somewhat hidden distinction most of us, myself included, are inclined to make: We're generally comfortable with treatments, like ankle joint replacement surgery, that bring us back up to a baseline of normal functioning. And we're generally opposed to medical improvements beyond that. Witness the ongoing anger at baseball players, like Mark McGwire, who took steroids a decade ago. Using hormones like steroids to get up above the baseline is, at least as many people see it, a moral outrage.

 

Now, this isn't necessarily logical. There's no clear reason, as best I can tell, that it's awesome to repair a broken ankle using medicine but outrageous to prevent a broken ankle using medicine. That said, I think it's a distinction many of us subconsciously make.

 

Which means a couple things, I think. First, we're generally inclined to reject medical augmentations. And secondly, as a result, we're going to see a lot more stuff get medicalized. We can already see this with the clinical phrase "age management medicine," much of which, based on the Times piece, could accurately be described as "exercise" as "careful dieting." But the clinical term caries the weight and prestige of science, and in the process, it's attracting patients, money and controversy.

 

In other words, those lines-between treatment and augmentation, between the rigors of science and the whims of lifestyle choices--aren't as clear as we'd like them to be. And they're likely to become increasingly important and contentious.