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Laboratoire d'Ophtalmologie, Hôtel Dieu, Université Paris-France.
Address correspondence to Leslie Robert, Laboratoire d'Ophtalmologie, Hôtel Dieu, Université Paris 5, 1 place du parvis Notre Dame, 75181 Paris cedex 04, France. E-mail: lrobert5{at}wanadoo.fr
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Abstract |
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 Top Abstract Anti-Aging MedicineWhat Can (and Should...References |
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Ambroise Paré (1509–1590), the famous French surgeon, who invented the arterial ligature, subdivided human life into 4 periods: puerility, adolescence, youth, and virility, then old age. Old age was divided into 2 parts: from 35 to 49 years and 50 years and older, which was divided into 3 phases: 1) some manly virtues maintained; 2) imbecility of virtues; and 3) extreme imbecility, impatience, and reversion to a second childhood.
In the second half of the 19th century and early 20th century, some major clinical professors of the Viennese School (for instance Wagner-Jauregg, who initiated the malaria-heat shock for tertiary syphilis) began to write books on aging, perhaps motivated by their own ascendency in age. Much of the early approach to aging appears to have emphasized attempts at rejuvenation. The first largely publicized experiments of rejuvenation date to the end of the 19th century. Brown-Sequard, a French endocrinologist (1817–1894), self-injected aqueous testicular extracts with self-reported "miraculous" rejuvenating effect. As testosterone is not hydrosoluble, the pharmacological basis of this self-observation remains doubtful.
Biogerontology emerged in the first half of the 20th century when more reliable and scientific observations were reported. The still largely cited experiments of McCay with the low caloric diet increasing life expectancy of rats dates from the 1930s (5). The first reliable and reproducible experiments on tissue-aging produced by Fritz Verzar in Basel, Switzerland, date from the 1950s [see (6), for a review]. These observations were important for several reasons. They demonstrated that extracellular tissue components, such as collagen fibers, age independantly of other cellular components (postsynthetic, molecular aging). It was later discovered that the Maillard reaction—the result of direct (non enzymatically catalyzed) interaction between reducing sugars (glucose and others) and amino groups on proteins was responsible for some of the changes observed in the extracellular matrix [see (7) for review]. By the 1970s and 1980s, experimental gerontology was growing at a very rapid rate resulting in acceptance by the academic community and a solid score of important publications in areas ranging from molecular and cellular biology to demographic and epidemiological studies [e.g., see (8–14) for monographies on aging].
French clinical geriatrics has experienced a bumpy road. In France, a certain number of hospitals are entirely devoted to geriatrics, but geriatric homes are still insufficient to house all the older people unable to live alone. Geriatrics as a medical specialty is only partially recognized. Professorships do not exist in geriatrics, internists specialized in geriatrics are in competition with other internists for this nomination. Similar situations prevail in several other European Countries. In the standard medical curriculum only some faculties offer optional courses in gerontology and geriatrics. There are however post-graduate courses in gerontology. French gerontological society includes besides clinicians, members of the scientific community.
The inadequacy of the geriatric system was however cruelly exposed by the 2003 August heat wave producing an excess casualty of about 15,000 older French citizens. According to Profressor Françoise Forette, a specialist of age-related dementias, about 50% patients with an early Alzheimer's disease remain undiagnosed and account for a high proportion of frail and vulnerable older patients who deserve and require care from nurses with geriatric training. Such well trained nurses are in short supply in France. [The present proposition of the French Government to better subsidise care for the elderly is to "sacrifice" one day of yearly holiday with the income devoted to the above purpose.]
Another ageing-related field emerged in France known as "Aesthetic Medicine." Practitioners of this discipline earned a medical degree but do not follow the typical University curriculum leading to clinical professorship. Some are specialized in plastic surgery (similar to cosmetic surgery in the United States), others combine endocrinology, physiotherapy and similar medical disciplines. They are members of the French Society of Aesthetic Medicine which holds annual scientific meetings and hosts the Journal de Médecine Esthétique. The national meetings include sessions on basic sciences organized for instance on mechanisms of connective tissue aging as skin and similar topics related to the amelioration of the appearance of aging. Unlike the unfounded fountain of youth claims of the anti-aging industry, responsible physicians in France do have at their disposal a number of tools and strategies to make important differences in the quality of life of their old patients. This is particularly true for cardiovascular medicine where weight loss strategies, smoking cessation, and nutritional, exercise and pharmacological interventions certainly did play an important role in the decrease and postponement of fatal outcomes related to cardiovascular disease (15). Its low incidence in France contrasting with a relatively copious nutrition used to be designated as the "French paradox."
Courses in aesthetic medicine have recently received significant attention by the medical community. In 2002, there were 250 attendees (as compared to 30–40 in previous years), many of them formerly specialized in other disciplines (e.g., radiologists, anesthesiologists) at the Pharmacy Faculty of Paris course. A number of factors appear to be influencing the increased interest in this area including sky-rocketing medical insurance premiums, a relatively new phenomenon in France that is all too well known in the United States. Another force at work seems to be the growing number of older individuals with disposable income that are the main targets of anti-aging. In France the social observation was made among men and women age 50 and older, more youthful appearing person were more likely to keep their jobs, thus inducing for societal impetus to seek aesthetic medicine or anti-aging interventions. [IBM France used to put their staffmembers in preretreat from their 51st year (16)]. Speaking with some potential clients of anti-aging, I learned with some surprise that some older women find it psychologically unacceptable to consult a geriatrician.
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ANTI-AGING MEDICINE |
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One possible reason for the increasing interest in anti-aging medicine is the real financial pinch many professionals in the health care industry are feeling given the keen competition for faculty hospital appointments, increasing malpractice insurance fees, and increasingly limited reimbursement by social security with limitation of the medical honorarium. Thus they are exploring alternatives for securing income.
The above reasons insure the success of the A4M and World Congress meetings. Some basic scientists are invited to lecture, as I did myself last February (on basic mechanisms of aging) This gave me the opportunity to listen to some lectures by other faculty members. I recall the lecture of a highly regarded pharmacology professor who presented a lecture on age-related dementias. Every projection enumerating the symptoms of a given disease was followed by a projection enumerating the drugs, vitamins, and other so-called remedies that can be prescribed to such patients with no mention of their potential efficacy. Such lectures were very popular because they suggested ready-made recipes for "anti-aging" consultations. We shall see in the next few years where this new trend will lead. One major difference between France and the United States is that "anti-aging" neutriceuticals (DHEA, melatonin) can be obtained in France only by prescription whereas in the United States they are on free sale. In France, only vitamins are available over the counter. Thus, France is relatively lucky to still have some control over the situation.
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WHAT CAN (AND SHOULD BE) DONE |
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Footnotes |
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Received October 9, 2003
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This article has been cited by other articles:
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  G. E. Alkema and D. E. Alley Gerontology's Future: An Integrative Model for Disciplinary Advancement. Gerontologist, October 1, 2006; 46(5): 574 - 582. [Abstract] [Full Text] [PDF]
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