A history of the future: the emergence of contemporary anti-ageing medicine

Social Inequality and the Future of U.S. Life Expectancy

Despite decades of progress, the future of life expectancy in the United States is uncertain due to widening socioeconomic disparities in mortality, continued disparities in mortality across racial/ethnic groups, and an increase in extrinsic causes of death. These trends prompt us to scrutinize life expectancy in a high-income but enormously unequal society like the United States, where social factors determine who is most able to maximize their biological lifespan. After reviewing evidence for biodemographic perspectives on life expectancy, the uneven diffusion of health-enhancing innovations throughout the population, and the changing nature of threats to population health, we argue that sociology is optimally positioned to lead discourse on the future of life expectancy. Given recent trends, sociologists should emphasize the importance of the social determinants of life expectancy, redirecting research focus away from extending extreme longevity and towards research on social inequality with the goal of improving population health for all.

Anti-aging technoscience & the biologization of cumulative inequality: Affinities in the biopolitics of successful aging

This paper charts the emergence of under-remarked affinities between contemporary anti-aging technoscience and some social scientific work on biological aging. Both have recently sought to develop increasingly sophisticated operationalizations of age, aging and agedness as biological phenomena, in response to traditional notions of normal and chronological aging. Rather than being an interesting coincidence, these affinities indicate the influence of a biopolitics of successful aging on government, industry and social science. This biopolitics construes aging as a personal project that is mastered through specific forms of entrepreneurial individual action, especially consumption practices. Social scientists must remain alert to this biopolitics and its influence on their own work, because the individualization of cumulative inequalities provides intellectual and moral justifications for anti-aging interventions that exploit those inequalities.

From the margins to mainstream: How providers of autologous ‘stem cell treatments’ legitimise their practice in Australia

This article examines how Australian providers of unproven autologous ‘stem cell treatments’ legitimise these products and their practices. We focus on the strategies employed by providers in their efforts to create and sustain a market for procedures that have yet to be proven safe and clinically efficacious. Drawing on the work of Thomas Gieryn and Pierre Bourdieu and the findings of research involving an analysis of direct-to-consumer online advertising of clinics that sell purported ‘stem cell treatments’ and interviews with clinicians who provide them, we examine the mechanisms by which medical legitimacy for these products is established and defended. We argue that Australian providers employ a number of strategies in order to create medical legitimacy for the use and sale of scientifically unproven therapies. A key strategy employed by providers of stem cell treatments is to use markers of social distinction, drawing strongly on the symbols of science, to confirm their legitimacy and differentiate their own practices from those of other providers, who are posited as operating outside the boundary of accepted practice and hence illegitimate. We argue there is a paradox at the heart of the autologous stem cell treatment market. Providers aim to create legitimacy for their work by emphasising the potential benefits of their ‘treatments’, their expertise and the professionalisation of their practices in an environment where regulators are yet to take a firm stance; they are also required to undertake the challenging task of managing patients’ hopes and expectations that both enable and potentially jeopardise their operations and revenue. We conclude by suggesting that providers’ creation of symbolic capital to establish medical legitimacy is a crucial means by which they seek to bring unproven ‘stem cell treatments’ from the margins of medicine into the mainstream and to portray themselves as medical pioneers rather than medical cowboys who exploit vulnerable patients.

Incarnation and the dynamics of medical promises: DHEA as a fountain of youth hormone

For more than a decade, the sociology of hope and expectations has gained growing influence in the social studies of health, medicine, and healthcare. This literature has stressed the role of representations of the future-through images, metaphors, theories, or visions-in the medical sector and analyzed the translation of these discursive contents into social practices and organizations. This article builds on these results and intends to explore a dimension that has received less attention: the incarnation of medical promises. Looking at the evolving case of a particular molecule, dehydroepiandrosterone (DHEA)-which has been promoted from the mid-1990s onwards as a "fountain of youth" pill-, we emphasize that testimonies by and portrayals of those who are undergoing a treatment with uncertain risks and benefits, and representations of their bodies in the media, can play a key role in the performativity of a medical promise. We analyze this incarnation as a specific "form of veridiction" and stress its normative dimension. This leads us to underline how evidence-based medicine and experiential knowledge-which are often analyzed as two opposite sources of information-can intricate and give rise to the same incarnation dynamics.

Ageing and memory medication: social rationales and consumption practices

This article focuses on the social rationales underlying the consumption or rejection of medication for memory by the elderly. Our analysis is set within the wider frame of the current use of psychopharmaceuticals for the enhancement of everyday performance, discussing its relationship to new cultures of ageing. Our results, from a recently concluded study, point to different patterns of investment in memory in old age. On the one hand, we found a willingness to consume medication for memory - a heterogeneous disposition split between the imaginary of disease and that of performance enhancement. On the other hand, we found a cultural resistance and scepticism towards the use of psychopharmaceuticals for performance purposes. This suggests that a new frame of psychopharmaceuticalization of old age - represented by memory medication - is prompting different rationales, ranging from consumption to resistance.

The role of expectations, hype and ethics in neuroimaging and neuromodulation futures

The production of expectations or future-goals for the development of techniques which “read” and modulate brain function, represent an important practical tool for neuroscientists. These visions-of-the-future assist scientists by providing focus for both individual and cross-disciplinary research programs; they encourage the development of new industrial sectors, are used to justify the allocation of government resources and funding, and via the media can help capture the imagination and support of the public. However, such expectations need to be tempered by reality. Over-hyping brain imaging and modulation will lead to disappointment; disappointment that in turn can undermine its potential. Similarly, if neuroscientists focus their attention narrowly on the science without concomitant consideration of its future ethical, legal and social implications, then their expectations may remain unrealized. To develop these arguments herein we introduce the theoretical concept of expectations and the practical consequences of expectations. We contextualize these reflections by referring to brain imaging and modulation studies on deception, which encompass the measurement-suppression-augmentation range.

[Anti-aging medicine: notes on a socio-technical controversy]

After some decades of struggle, geriatrics and gerontology have become the legitimate sciences of aging. Today, their status is being questioned. In its short history, anti-aging medicine has taken root as a medical practice that questions how to address biological aging. In so doing, all medicine is questioned. Here, we explore in particular how this controversy is structured around the founding principles of the sciences of aging. Is there any basis for these questionings? How have they been treated by those who have received them? Taking a socio-technical viewpoint, it is worth considering that for geriatricians and gerontologists, the need to criticize anti-aging medicine also raises some important reflections about how the sciences of aging address their subject.

Chronic illness: a revisionist account

This article challenges the generally accepted thesis that the emergence and dominance of chronic illness over the last half century is due to the receding tide of acute infectious diseases and an ageing population. Instead, through an analysis of contemporary reports in the Journal of the American Medical Association, it is argued that the construct of chronic illness emerged as part of a new focus on the downstream consequences of disease and as a means of transferring what had been seen as the natural processes of ageing and senescence into an explanatory model based on pathological processes. The widely accepted idea of an epidemiological transition in illness prevalence has served to conceal the ways in which medicine has extended its remit and suppressed alternative explanatory frameworks.

Neuroculture, active ageing and the 'older brain': problems, promises and prospects

This article explores the characteristics of a newly emergent 'neuroculture' and its relationship to cultures of ageing; in particular, the social meanings associated with 'active ageing' and 'cognitive health' and the discourses and sciences around memory and the 'ageing brain'. The argument proposes a critical perspective on this relationship by looking at the shifting boundaries between standards of normality and abnormality, values of health and illness, practices of therapy and enhancement, and the lines demarcating Third Age (healthy, active and agentic) and Fourth Age (dependency, loss and decline) periods of ageing. Conclusions offer further reflections on the complex questions that arise regarding expectations, hopes and ethics in relation to the promises and perils of a neurocultural future.