Biogerontology, "Anti-Aging Medicine," and the Challenges of Human

Enhancement
Eric T. Juengst; Robert H. Binstock; Maxwell Mehlman; Stephen G. Post; Peter Whitehouse
The Hastings Center Report, Vol. 33, No. 4. (Jul. - Aug., 2003), pp. 21-30.
Stable URL:
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i-aging M e

--

ne,"

and
the

Slowing the aging process would be one of the most dramatic and momentous ways of enhancing
human beings. It is also one that mainstream science is on the brink of pursuing. The state of the science,
together with its possible impact, make it an important example for how t o think about research into all

entral to many discussions of limits of

biotechnology and biomedical research is the
notorious concept of "enhancement." The
concept is central because it flags a significant set of
moral concerns that are raised by the use of biomedicine to attempt to improve upon human form and
function.' The concept is notorious because it is so
hard to pin down for ;he purposes of making biotechnology policy2 The literature on the ethics of enhancement repeatedly emphasizes that, under usual
interpretations of the concept of enhancement, our
research regulatory bodies are unlikely ever to see examples of research on it. Rather, most interventions
that might be used for the enhancement of the
healthy will be developed under the aegis of perfectly

Eric T. Juengst, Robert H. Binstock, Maxwell Mehlman, Stephen G.

Post, and Peter Whitehouse, "Bioger~ntolog~,
'Anti-aging Medicine,'
and the Challenges of Human Enhancement," Hastings Cenm Report
33, no. 4 (2003): 21-30.
July-August 2003

legitimate medical concerns to treat and prevent traditionally defined disease, disability, and suffering in
the sick. If they are understood as part of traditional
medicine, the problem of policing their proliferation
shifts from the laboratory to the street, where new
enhancement interventions will appear, fait accompli,
as "off-label" applications of existing medical tools
and their regulation becomes a significantly more
challenging social project.3
There is one biomedical field, however, which is
now teetering on the brink of enhancement research
at a fundamental level and can provide an instructive
illustration of the dynamics that surround the emergence of enhancement interventions from medical research. The field of biogerontology-the study of the
biology of aging processes-is already struggling with
the prospect that its findings might be applied to produce unprecedented human longevity.
Moreover, of
all biomedicine's potential capacities to re-engineer
the human, slowing the hitherto inexorable clock of
HASTINGS C E N T E R REPORT

21

aging would be one of the most dramatic and far-reaching. This makes
the field a bellwether for other domains in human biology, like neurobiology, muscle physiology, and genetics, that might also have "enhancement" applications as their science
matures. For policymakers, the proof a
file that b i o g e r ~ n t o l o gprovides
~
field in transition may. -prove useful in
attempting to develop early warning
systems for the emergence of "off
label" enhancements in those domains.
In this paper, we concentrate on
three lessons that biogerontologists
are already learning, long before the
arrival of any actual anti-aging interventions: (1) the dangers of premature commercial exploitation of scientific goals; (2) the challenge of philo-

interventions.* Other scientists embrace the goal of controlling aging,j

and some even declare that substantive progress toward "engineered negligible senescence" or "aging reversal"
will be feasible in about a decade.6
These camps, in turn, are collaborating to repudiate the claims of a growing number of entrepreneurs and
clinicians who assert that the day of
effective "anti-aging medicine" has already arrived.- Finally on the outside
looking in are those who think all of
the above are complicit with a misguided biomedical mission to extend
the lives of older people unnecessarily.
At one level, this debase is the h n d
of political boundary setting that
often accompanies the maturation of
an emerging biomedical discipline as

bryogenesis or child or adult developmenr.12 For Hayflick,

sophical pluralism within medicine;

and (3) the virtues of open deliberations that anticipate, rather than react
to, the social repercussions of new
medical capabilities.

different factions struggle for orthodoxy,' and with which gerontology

has long experience.'O Below the surface, however, lie5 a deeper question
about the proper goals of research, a
question that has much wider implications for the future of biomedicine:
How far into the problematic business of engineering betrer humans
should we go with our efforts to unravel and control the fundamental
processes of human aging?
"Aging" is usually understood in
biogerontology as "the normal biological processes that are collectively
the single greatest risk factor for the
pathologies of old age,"" a definition
rhat is careful not to stigmatize those
processes as themselves pathological.
As biogerontologist Leonard Hayflick
puts it: "Aging is not a disease, so the
concept of seeking a cure for it is tantamount to seeking a cure for em-

have been willing- to evoke quite dramatic "anti-aging" rhetoric to describe the potential implications of
their research. Their own books, with
titles like The Quest for Immortality:

Biogerontology and Anti-aging

Medicine

fter two decades of progress and

A,

romotion at the end of the

twentieth century, the field of
biogerontology has gotten off to a
rancorous start in the new millennium. At first glance, the issue seems to
be a dispute over the boundaries of legitimacy for the field. Scientists who
are doubtful about the possibility of
ever slowing the human aging process
would like to distinguish their efforts
to understand aging from research applying the fruit of those labors to the
development of human "anti-aging"

22

HASTINGS C E N T E R R E P O R T

The notion that aging requires

treatment is based on the belief
that becoming old is undesirable.
Aging is a negative term because it
connotes deterioration, approaching pathology, and death. The
hundreds of thousands of septuagenarians who follow the sun in
their RVs, no longer have childrearing responsibilities, have good
health and a modest income will
disagree. To them, and others who
believe that their intellectual
growth does not stop, arresting
adult development at an earlier age
would be unthinkable.13
O n the other hand, many aging
researchers and their popularizers

Science at the Frontiers of Aging,

Cheating Eme: Science Sex, and Aging,
The Clock of Aging: Why WeAge, How
We Age, Winding Back the Clock, have
consistently suggested that intervening in the human aging process is the
ultimate goal of their work.I4 Similarly, other scientific authors have met
no resistance from the biogerontologists in picking up on the "anti-aging"
theme in their work to popularize it
for the public.lj O n e example,
amongst scores of stories in lay magazines, is a special millennia1 supplement of Scientific American entitled
"The Quest to Beat Aging."16
Moreover, although flamboyant,
the rhetoric of these titles is not sheer
July-August 2003

Currently marketed anti-aging

hype. It does accurately reflect the bigger private market than new disambitions, if not yet the accomplish- ease cures. Thus, after struggling for products raise a number of ethical
ments, of part of the biogerontologi- decades to win a niche in the disease- concerns. There is no reliable evical community. Even in their most oriented world of public biomedical dence that they are effective. They
cautionary recent consensus docu- research funding,l9 biogerontologists may be unsafe, causing harm to their
ments, the leadership of this research have been alarmed to discover their users. Even ineffective products that
community acknowledges that "most legitimacy being traded upon for do not produce direct harm to users
biogerontologists believe that our profit in the private sector. Coinci- still create a safety problem if they are
rapidly expanding scientific knowl- dent with the aging of the baby boom used in place of effective treatments
edge holds the promise that means generation, there has been a prolifera- to treat age-associated pathologies.
may eventually be discovered to slow tion of clinical entrepreneurswho ex- Ineffective anti-aging products also
the rate of aging."" Indeed, the Na- aggerate the state of scientific knowl- defraud consumers, a concern espetional Institute on Aging even in- edge to exploit the public's perennial cially with poor and elderly persons,
who may be parcludes "Unlocktitularly vulneraing the Secrets of
ble to marketing
Aging, Health
claims and who
and Longevity" as
may lack adequate
an important reresources for basic
search goal in its
necessities.
Strategic Plan for
Anti-aging
2001-2005, deremedies,
of
claring that "[t]he
course, have an
ultimate goal of
ancient and infathis effort is to
mous history that
develop intervenlong predates the
tions to reduce or
science exploited
delay age-related
by contemporary
degenerative
anti-aging entreprocesses in hup r e n e u r ~ . ~The
~
mans."'8
anti-aging product
If one asmarket is always
sumes, as bioready to shift to
gerontologists do,
incorporate news
that human aging The Fountain of Youth. Illustrated manuscript. ca. 1400. O David LeesICORBIS
of any new legitiis a perfectly normate scientific admal process and
vance into its promotional efforts,
not in itself pathological, it looks as if interest in anti-aging interventi~ns.~~
many biogerontologists are already Although, as the biogerontologists re- even as individual products and enintent on taking health care at least mind us, "no currently marketed in- trepreneurs come and go. Moreover,
yet been this phenomenon will not be limited
several steps beyond the treatment of tervention-none-has
disease and into the realm of biomed- proved to slow, stop or reverse human to progress in biogerontology. It is on
ical human enhancement.This makes aging, and some can be downright just those frontiers where biomedical
their experience instructive for other dangerous,"21 the use of anti-aging research is promising to allow us to
areas of research with potential en- products soared during the 1990s and enhance the biology we have hitherto
hancement applications, even where the "anti-aging movementn within inherited-in our understanding of
the intent to pursue those applica- medicine increasingly gained the athletic performance, memory, cognitrappings of legitimacy? The move- tion, and, of course, the aging
tions is not yet present.
ment was institutionalized with the process-that medical impersonators
founding of the "American Academy have traditionally found their best
The Dangers of Exploitation
of Anti-&ng Medicine," which now markets. Whether or not the medical
e first lesson that has emerged boasts 11,000 physician members profession includes personal "enfrom the biogerontologists' expe- and hosts an aggressive publicity cam- hancement" within its proper dorience is simple: while fighting disease paign attempting to relegate tradi- main, the public is interested in that
always garners more public funding tional gerontology and geriatrics, and dream. This means that the first and
than health promotion, new biomed- its critics in biogerontology, to the foremost challenge for any emerging
biomedical knowledge that could be
ical enhancements will always have a ~ a s t . ~ 3

July-August 2003

HASTINGS CENTER REPORT

23

turned to "enhancement" uses will be

the regulation
of its commercial exploitation, long before it arrives as effective technology.
Unfortunately, beyond distancing itself from these products and their purveyors, biomedicine in the United States
has an imperfect set of regulatory resources to turn to in addressing those
concerns. At the federal level, the Food
and Drug Administration bears the responsibility for assuring the safety and
efficacy of medical products. But antiaging products present the agency with
difficult regulatory challenges. Some
anti-aging interventions, like caloric restriction, arguably lie outside the FDA's
current legal authority because they are
not drugs or medical devices, but instead constitute the practice of medi~ i n e . The
~ 5 states regulate the practice of
medicine, but there are numerous gaps
and weaknesses in the system of state
oversight, and a recent report by the
General Accounting Office found that
"in general [the states] focused little attention on anti-aging and alternative
medicine products."
Another impediment to effective
FDA regulation of anti-aging products
is the Dietary Supplement Health and
Education Act (DSHEA), enacted in
1994, which allows certain products to
be marketed as "dietary supplements"
without proof of safety or efficacy. The
definition of a dietary supplement in the
act is extremely broad; virtually any
anti-aging product qualifies so long as it
does not make claims to treat a specific
disease, bears a disclaimer on the label
that the product is not approved by the
FDA, and is taken by mouth.26 Moreover, the dietary supplement laws reverse
the traditional process for proving safety
and efficacy: While the manufacturer of
a new drug or medical device is required
to establish safety and efficacy prior to
marketing,
- the burden shifts to the FDA
to show that a dietary supplement is unsafe before it can take action to restrict
its sale or remove it from the market.
Even anti-aging products that are
clearly prescription drugs or medical devices, such as injectable human growth
hormone, can escape FDA oversight
when employed for unapproved anti24 H A S T I N G S C E N T E R REPORT

aging purposes, since the Federal Food,

Drug,
- and Cosmetic Act does not restrict physician prescribing of products
for "off-label" uses. Historically, the
agency has attempted to prohibit manufacturers from promoting their products
for off-label uses, but since the passage
of the Food Drug Modernization Act of
1997, manufacturers may distribute
promotional materials for unapproved
uses so long as they are in the process of
seeking approval, and the earlier FDA
restrictions have been challenged in
court as a violation of the manufacturer's
First Amendment right to freedom of
commercial speech.27
Another factor complicating the regulation of anti-aging products is ambiguity over whether aging is a disease or a
natural process. Ironically, if anti-aging
products were limited to specific
pathologies, they would count as drugs
or medical devices and proof of safety
and efficacy would be required before
they could be marketed. But if aging is
not considered pathological, then antiaging products will be assessed like cosmetic medicine. The FDA's experience
with cosmetic medicine, including nonprescription contact lenses, breast implants, liposuction, and Botox, demonstrates the difficulty of measuring eficacy and comparing risks and benefits outside the therapeutic context.28Moreover,
if anti-aging interventions are regarded
as enhancements, health insurers will
not cover them, and manufacturers then
lose another incentive to generate safety
and efficacy data-that of convincing
insurers that their products are no
longer experimental treatment^.^?

"legitimacy" only relatively recently,

after many decades of being perceived
by the scientific community as a marginal activity. But it is also because, behind the common front that the research community displays against premature commercialization, there are still
major differences within biogerontology
about what the ultimate goals of aging
research should be.
In fact, four possible outcomes of
aging research dominate the discussions
of its prospects. One, the bare prolongation of life without attention to age-related pathologies, has no advocates in
these debates, but serves as a common
foil for the other three. Each of the other
three possible outcomes, however, does
have subscribers within biogerontology.
We call these four outcomes "prolonged
senescence," "compressed morbidity,"
"decelerated aging," and "arrested
aging." Their collision, and the confusing political affinities and tensions they
create for the field, animates the battle
for high ground in biogerontology. For
other research domains with potential
enhancement applications, they provide
a telling preview of the choices that will
lie ahead.
Prolonged Senescence

ne possible outcome of advances in

biogerontology provides a baseline
for this debate by serving
- as the scenario
everyone agrees would constitute failure
for the anti-aging research enterprise.
This is the prospect of merely prolonging the lives of the aged without mitigating the debilitations of senescence.
Natural aging advocate Francis Fukuyama calls this the "national nursing home
The Challenges of Philosophical
Pluralism in Medicine
scenario, in which people routinely live
to be 150 but spend the last 50 years in
course, many biomedical special- a state of childlike dependence on careties must deal with the inappropri- takers."30 The familial, social, and finanate exploitation of their work. Most cial problems that attend a swelling prooften, basic scientists ignore or are portion of enfeebled, sickly elderly are
amused by those who attempt to capi- Hlready becoming apparent as the Baby
talize on inflated versions of their ideas, Boom generation ages.3l Culturally, hubut they do not feel compelled to speak mans have been contemplating and esout against them. Why has biogerontol- chewing this vision of extended life for
ogy's boundary setting been so animat- millennia, through Tithonius' insectile
ed? In part, because biogerontology it- devolution to Swift's doddering "Struldself has achieved mainstream scientific bruggs."32 Even those like Fukuyama

Of

July-August 2003

hoIogy and worfna/ variation will

be difficult f a r practice! as well as conceptual reasons, Pathologizing aging is

s seductive w a y to increase public support for aging researchjZ,
and an
effective way

to argue that %hemission sf this research is not aimed st

who see compensatory social virtues in

the physical limitations of the natural
aging process do not recommend promoting those virtues by prolonging
human senescence.
Nevertheless, it is instructive to note
the different ways in which the prospect
of prolonged senescence can be used by
those involved in this debate. The apologists for natural aging warn that this is
the most likely outcome of any overenthusiastic scientific efforts to stave off
death.33 Geriatricians cite this prospect
to promote the priority of combating
the diseases and disabilities of old age
over basic biological studies of normal
agi11g.3~ Biogerontologists argue that
prolonged senescence would be the result of permitting only piecemeal interventions and could be avoided by addressing the biggest common risk factor
for age-related pathologies: aging at the
basic biological leve1.35 Anti-aging entrepreneurs project this specter as the outcome of all "aging establishment" efforts
to underscore their view that their critics
in the "death cult of gerontology" are
too conservative on behalf of aging
adults.36 Rather than using this universally rejected scenario as common
ground, in other words, each group
wields it as a rhetorical weapon against
the others' vision of the goals for aging
research.
In fact, of course, if our lives are
lengthening faster than we find ways to
sustain their vitality, it is due to a far
larger confluence of social, economic,
and cultural forces than the relative
progress of aging research efforts. Ironically, those involved in the aging reJuly-August 2003

search wars have all accepted as a sign of

failure an outcome on which even the
most dramatic aging research results can
have little impact. From the biomedical
point of view, this situation creates a
continuous demand for redoubled research efforts, the logic of which will
pull all but the most stubborn advocates
of natural aging in the direction of the
most radical anti-aging outcomes. Thus,
if postponing the current forms of ageassociated morbidity simply unmasks
new forms, we will have to turn our preventive effort to the underlying processes of aging. Then, if simply slowing
those processes still eventually yields the
same number of (super)eldkriy people
with lives of poor quality, we will have
to consider ways of arresting the
processes of aging altogether--or turn
our attention from biomedical to social
policy interventions.
There is a lesson here for other biomedical research efforts with enhancement applications: to the extent that a
bad outcome from one's research (for
example, increased incidence of skeletal
damage with use of muscle strength enhancements) is influenced by other social forces (the coercive nature of competitive sport), a purely biomedical fix
(stronger bones) will require ever-increasing levels of human re-engineering.
The alternatives are to either abandon
the research and its medical benefits
(treating muscular dystrophy) or, as scientists, to become involved in addressing the social forces at play-an idea we
discuss below.

Compressed Morbidity

ne outcome that does seem to provide some common ground for applied aging science is the prospect of
"compressing the morbidity" of the
aging process.37 The ideal envisioned in
this scenario is for all of us to lead long
lives free of chronic disease and disability, and then die rather quickly as we
reach the limits of the human life span,
"worn out" from the fundamental
processes of aging. Natural aging apologists frame this goal as attempts to hold
off the ailments of "premature" aging
limit of
and see it as the -proper
biogerontology's ambitions. Gerontologists and geriatricians seek to compensate for or cure the health problems associated with aging so that even the oldest old can live as "successllly" as possible. Basic biologists of aging go further,
to argue that "because aging is the greatest risk factor for the leading causes of
death and other age-related pathologies," intervening to decelerate the normal aging process would be the best
form of prevention for age-associated
pathology.38 O n this view, human life
expectancy (that is, the average age at
death in the population) can increase
even if the maximum fixed life span
does not.
Behind this united front on the matter of compressing the morbidity of
aging, however, lie two important philosophical questions, which will have
analogs in other areas. First, how far is it
appropriate to compress the morbidity
of senescence? At one end of the spectrum, some apologists for natural aging
H A S T I N G S CENTER REPORT

25

would limit intensive compression efforts to the prevention of "premature

death before the age of sixty-five, allowing natural senescence thereafter."
on the other
Some bi~~erontologists,
hand, anticipate a decelerated decompression, possibly even extending the
human life span. And anti-aging enthusiasts, at the other end of the spectrum, hope to eliminate the inevitability of senescence altogether,
making the experience of age-related
morbidities strictly a matter of personal choice.
It is not surprising that this question of limits is left open in the
bi~~erontological
literature: it is not a
question that aging science can address. It is a philosophical question
that depends upon the cultural meaning one gives to the physical declines

much of biomedicine tacitly

assumes,40then delaying age-associated illnesses as long as possible before
death is the obvious goal, whether
within or beyond the historical
human life span.
Other potential enhancement interventions will raise analogous questions of meaning and values which
science will not be able to address
alone. How far, for example, should
we push our ability to enhance
human cognition, should that day arrive? In and of themselves, could
faster thinking, more reliable memory, better coordination, extended
foresight, and a cleverer tongue ever
be a bad thing? As the neurosciences
begin to "compress the morbidity" of
brain diseases, the value and meaning
of intelligence will need clearer articu-

J u s t -as
the
free markst
does- met
-."
---*.
--* *"- - ---- --"--"
*-- -.->

cence" like failing eyesight. O n the

other hand, the last three categories
as
are also cited by bi~~erontologists
normal features of natural aging. But
even those who insist that aging is not
a pathological process cannot discuss
it without using metaphors and adjectives that signify deterioration and
loss.
Getting specific about "compressing morbidity," in other words, forces
a philosophical question that most of
the researchers would just as soon
avoid: beyond continued existence
through time, is there anything positive about the biological process of
aging? Gerontologists speak of "adult
development" and "late life growth,"
but if we were successful at preventing
all the biological deterioration associated with aging, would aging still

free
to forego their n~oralcoil-.- - "-hucksters
--

"" *

"

lliQ

;i" 1

scietace, predictive uncertainty about %hefuture does no9 excuse responsible

lli;"~Z
--#p
.--------.-""-"-2.4

,lid/
I ,
Ihl'ii

---,

,----

-.--".---------- ---".---

scientists from foregoing the use of their moral irnagiartstion, FortiianateBy,

$aking on t h e responsibility to
$ 6

111

help society address the implications of t h e new knowledge they produce.

associated with the aging process. For
those who see human life as a fixed
natural cycle from the dependence of
childhood to the dependence of old
age, or for whom the discomforrs of
dying are as important as the discomforts of birthing for full human experience, even delaying age-associated
morbidity beyond "premature aging"
would produce an inappropriately
distorted life experience. If the aches
of old age are as important as the
growing pains of adolescence to wellrounded human development, but
the time to be spent between is not
prescribed, then delaying and diluting
morbidity by decelerating aging to
range over a longer period might be
desirable. However, if suffering is inimical to human flourishing, as so
26

H A S T I N G S C E N T E R REPORT

lation, just as our views about aging

do today.*'
The second open question for
those who pursue this outcome for
aging research is related. In seeking to
compress the morbidity of aging, how
does one distinguish the morbidities
of aging from the normal aging
process itself? Despite the biogerontologists' insistence that aging is not
pathological, the attempt to differentiate between aging and disease is
p r ~ b l e m a t i cIndeed,
.~~
there is a good
bit of conceptual ambiguity in their
literature. The "compression of morbidity" is applied variously to "age-associated diseases" like cancer, "age-associated pathology" like muscle-wasting, forms of "debilitation" like restricted mobility, and forms of "senes-

occur? If not, then aging is a literal

version of Kierkegaard's "sickness
unto death,"43 with everything that
label implies for social responsibilities, stigmatization, and scapegoating.
Where to draw the social line between pathology and normal variation
for biomedical interventions with enhancement applications, and how to
keep them from redefining more people as defective, abnormal, or inferior,
will be difficult issues for practical as
well as conceptual reasons. Because of
our public funding priorities, pathologizing aging is a seductive way to increase public support for aging research, and an effective way to refute
the claim that the mission of this research is human re-engineering or
"enhancement." Of course, patholoJuly-August 2003

gizing aging will also convert antiaging products into health care needs,
expanding the markets for commercialization.
Ultimately, whether aging becomes pathologized or not in our society is not a matter about which the
science of aging itself will be definitive: too many other social voices are
involved. Biomedicine, however, does
have powerful standing in those negotiations, and has shown in the past
that a concerted effort by the biomedical community can effectively
shape public perceptions of health
and illness.
Decelerated Aging

f there is a central philosophical

ittension within biogeront~log~
self, it is the tension between those
who believe that eventual interventions to "slow the pace of human
aging are both plausible and desirable, and those who regard them as
both implausible and undesirable.
What specifically is meant by "slowing aging is never described in detail
in the literature that subscribes to it as
a desirable outcome. Presumably, a
decelerated aging clock would still
move through all the normal phases
of human senescence, merely at a
slower pace, extending the human life
expectancy in the process. Some suggest that the clock might even move
slowly enough to extend the aging
process beyond the range of the historical human life-span. Richard
Miller suggests that decelerated aging
might "produce 90 year old adults
who are as healthy and active as
today's 50 year olds," as well as "increase the mean and maximal human
life span by about 40 percent, which
is a mean age at death of about 112
years, with an occasional winner topping out at about 140 years."44
This vision suggests another challenge for these biogerontologists that
goes beyond explaining how they differ from "anti-aging medicine." That
is the challenge of anticipating the social implications of their success. The
"snake-oil vendors" are charged with
July-August 2003

professional irresponsibility for ignoring the potential impact of their overreaching claims on their customers'
lives and with social irresponsibility
for exploiting and exacerbating our
culture's "ageism," despite the fact
that they operate in a free market
with voluntary consumers. Should
basic scientists be held similarly accountable if they ignore the downstream consequences of their research
for individuals and society?
For "decelerating" biogerontologists, anticipating the implications of
success will mean supporting informed speculation on a number of
important social policy questions. We
are learning firsthand the social implications of a burgeoning population of
frail elderly, but we are only just beginning to anticipate the challenges of
increasing numbers of healthy active
elders.45 What would be the effect of
this prospect, for example, on the social place of those who, by choice or
circumstance, continued to age normally? If the interests of the slowly
aging align more with those of young
adults than with their aging peers, the
aging elderly could find themselves
increasingly marginalized. If "antiaging medicine" ultimately stigmatizes the aging process as pathological,
this political disadvantage could be
compounded even further by social
intolerance. O n the other hand, if
slower aging extended the years available for productive work, vigorous
and expert older workers may become
more desirable, making unfair discrimination against the less experienced young the bigger problem.
Of course, our society may never
have to face these issues: the real future will be contingent on many factors, one of the least of which may be
how the science in question pans out.
Nevertheless, just as the free market
does not free hucksters to forego their
moral conscience, predictive uncertainty about the future does not excuse responsible scientists from foregoing the use of their moral imaginati0n.~6Fortunately, basic science communities are increasingly taking on
the responsibility to help society ad-

dress the implications of the new

knowledge they produce. This essay,
for example, is the product of an effort by the National Institute of
Aging to anticipate the social impact
of biogerontological research. As the
prospects for enhancement interventions grow in other biomedical research fields, similar assessments will
be needed.
Arrested Aging

inally, at the most futuristic end

of the spectrum are those who
have been willing to contemplate relatively complete control of the basic
biological processes of aging. Some
biogerontologists envision achieving
an "engineered negligible senescence"
by continuously reversing the damage
caused by basic metabolic pr0cesses.~7
Others seek to mimic pharmaceutically the life-extending effects that
caloric restriction regimes seem to
have in other species.48 When they
speculate about how far these interventions might expand the human
life span, these researchers gravitate to
the figure of 140 years, like those who
seek merely to slow the aging process.
Under their vision, however, this
could be a 140-year life with dramatically compressed morbidity: since
they hope to achieve the "indefinite
postponement of aging," death is
likely to come from relatively acute
collapses-abruptly reaching a genetically programmed "Hayflick limit"
to human cell division in key systems,
for example-rather
than from
chronic deterioration.
Moreover, outside the active
biogerontological research community other creative scientific minds have
been willing to push even further, to
foresee the eventual advent of virtual
immortality for humankind: an increase in healthy adult life span of
such a magnitude that death at any
age-from accidents, homicides, new
diseases, or the deliberate rejection of
anti-aging interventions-will come
to be seen as "premature" and unnecessary. Michael Fossel, a clinical professor of medicine at Michigan State
HASTINGS CENTER REPORT

27

about. t h e cansequences ;sf success

is t h e domiman? con3mlon -t!~readt h a t [Inks the Issaons raised

for

bion5edieins by b i ~ g @ ~ ~ ~ k ls$rg3n;gg%s
tdtp!~
t ~~i ~
*h
its
~ ~im~ptiieatiorrw
~
for human

University, sees in the discovery that

telomere reduction may factor into
the replicative senescence of cells the
prospects of telomere-building therapies that offer "the promise of a time
when we will live longer and much
healthier lives of one hundred, two
hundred, possibly five hundred
years." Similarly, Stanley Shostack, a
professor of biological sciences at the
University of Pittsburgh, suggests
that we will be able to create immortal human beings by adapting and
implanting embryonic clones to serve
as new organs in their hosts, generating a permanent supply of new stem
cells to replenish all the tissues of the
body.
The further away from the orthodox biogerontological research community such speculations range, of
course, the more nervous biogerontologists are about them. In part, presumably, this is because of their potential as fodder for new forms of
fraudulent commercial exploitation.
But this unease also reflects a philosophical concern which is as relevant
to those bona fide biogerontologists
seeking "negligible senescence" as it is
to those foreseeing virtual immortality More than any of the other possible outcomes of biogerontological research, it is the prospect of "arresting
aging" that most directly challenges
the concept of a "natural life cycle"
and its importance for human identity.
Appealing to the "natural life
cycle" as a normative guide has interesting analogs within professional
medical ethics, where it plays an important role in the debates about for28

HASTINGS CENTER REPORT

going life-sustaining treatment.

There, one often hears that a "natural
death" is the proper goal of care for
the terminally ill and that, quite apart
from considerations of personal autonomy, extraordinary attempts to
"prolong life" artificially can sometimes be demeaning and dehumanizing for patients. This argument assumes that there is a normative natural order to life's events and their pacing in individual human lives. This
view is what Daniel Callahan calls
"life cycle traditionalism":
It is based on the biological
rhythm of the life cycle as a way of
providing a biological boundary to
medical aspiration. This view
looks to find a decent harmony
between the present biological reality of the life cycle as an important characteristic of all living organisms and the feasible, affordable goals of medicine."49

philosophical work remains to be

done to justify that resistance. Until it
is clear why preserving the human
species in its current form is important, a commitment to "life cycle traditionalism" can only count as an
idiosyncratic ideology which autonomous physicians (and their patients) in a free society should have
the right to assess, adopt, or reject as
they will. Developing a more persuasive account will require a more careful plumbing of the resources of
human wisdom-religious traditions,
cultural myths, literatbre, and philosophy-to discern what it is about
aging that is valuable to our identity,
and whether those valuable traitswisdom, equanimity, compassionare intrinsically tied to senescence or
are merely a function of time served
on earth.54
The Virtue of Anticipatory
Deliberation

For someone who holds this view,

t is tempting to dismiss the more
even if anti-aging interventions could
philosophical concerns about the
help forestall some health problems,
they cannot do so without sacrificing meaning and social value of natural
patients' essential identity as human aging as abstract and alarmist. Despite the claims of some enthusiasts,
beings.jO
It is popular today to promote the there is no evidence from any re"preservation of the human species" search to date that science will ever
by protecting humanity against allow us to "arrest aging" as dramati"species altering interventions" like cally as some fear. In fact, for the time
reproductive cloning, genetic en- being, the most important issue for
hancement, and life span e~tension.5~the aging research community is to
From defenders of our "genetic patri- distinguish itself from those who are
mony" as the "common heritage of all willing to promise such powers.
h~manity"5~
t o the "anti-post-hu- However, it would be unfortunate if
manist" life cycle traditionalists,j3 the the biogerontologists' current camof further human evolution paign obscured the need to consider
-prospect
is provoking resistance. But much the philosophical implications of

July-August 2003

their research program and the social attempt to "compress" as pathological outside as well as within the walls of
consequences of its achievement. The will be as much a social as a scientific the academy will ultimately be the
history of biomedical science shows process. But it is a process which the best way of foreseeing the significance
how unexpectedly progress can catch biogerontological community can of a real "anti-aging medicine," or any
the scientific community and society have a tremendous influence on, if it other human re-engineering project
unawares by accomplishing the "im- accepts a leadership role by initiating, of similar magnitude.
possible."
hosting, and engaging the broader
In fact, the virtue of anticipatory cultural conversation.
Acknowledgements
deliberation about such sequelae is
Third, those interested in slowing
Support for this paper comes from a
the dominant common thread that the aging process also have the re- research grant (1ROlAGHG209 16-01)
links the lessons raised for biomedi- sponsibility to contemplate the impli- from the National Institute on Aging
cine by biogerontology's struggle with cations of their success. This means and the National Human Genome Reits implications for human re-engi- participating in, supporting, and pay- search. Additional support provided
neering.
- Four different kinds of delib- ing attention to the interdisciplinary S.G. Post by the John Temleton Founerations emerge from the points social impact studies that can help illu- dation. We are indebted to the expert
above that seem particularly general- minate the possible roads ahead. A research assistance of Roselle Ponsaran.
izable to other biomedical domains.
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Biogerontology, "Anti-Aging Medicine," and the Challenges of Human Enhancement
Eric T. Juengst; Robert H. Binstock; Maxwell Mehlman; Stephen G. Post; Peter Whitehouse
The Hastings Center Report, Vol. 33, No. 4. (Jul. - Aug., 2003), pp. 21-30.
Stable URL:
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Extending Life: Scientific Prospects and Political Obstacles

Richard A. Miller
The Milbank Quarterly, Vol. 80, No. 1. (2002), pp. 155-174.
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