Counterclockwise

CHAPTER ONE

Viva Las Vegas

I AM SITTING ON ONE OF SEVERAL THOUSAND CHAIRS SET up in long, neat rows in a room roughly the size of a football field located deep in the bowels of the 1-million-square-foot Mandalay Bay Convention Center. There is no bay. And Mandalay (a city in Upper Burma) is a good 8,000 miles away. Much closer--next door, in fact--is the 30-story Luxor pyramid (a mere 100 feet shorter than the Great Pyramid of Giza), and just down the street is a two- thirds-scale Arc de Triomphe.

You have guessed that I am in Las Vegas.

I am here for the 18th Annual International Congress on Anti-Aging Medicine and Regenerative Biomedical Technologies. I mention the locale, this ersatz landscape, this topography of illusion and pretend, because it is more than venue. It is theme and subtext. Vegas is both a working city and a fantasy playground, a place for dreamers and risk takers run by eagle-eyed entrepreneurs and hardheaded businessmen. Which is, in many ways, how I come to think of this conference during my three days in attendance: an almost seamless blend of fantasy and reality, of science and hucksterism, of life-changing research and unadulterated opportunism.

The twice-yearly conference (the other venue is, predictably, Orlando, home of that other commercial fantasy-scape, Disney World) is sponsored by, and the public face of, the American Academy of Anti-Aging Medicine, known as A4M. It is an interesting--and controversial--organization, an upstart in the world of mainstream medicine, a group that, like the specialty it represents, has attracted both true believers and harsh critics. A nonprofit organization that trains and certifies physicians in anti-aging medicine, it began with 30 like-minded doctors in the early 1990s and has grown to include more than 22,000 members in 100-plus countries. A4M's conventions got off to an unconventional start in 1993, when a small group of physicians gathered for the opening of an anti-aging clinic in Mexico. The founder of the clinic, a 59-year-old businessman, was an early adopter of and proselytizer for the use of human growth hormone. He'd been flying down to Mexico to get injections and, after reporting miraculous anti-aging results, decided to start a clinic of his own.

Today, although A4M "board certifies" physicians in anti-aging medicine, the specialty itself is not recognized by established medical organizations like the American Medical Association and the American Board of Medical Specialties. Some physicians, intrigued by functional or regenerative medicine (the other terms used for the anti-aging approach), have embraced the new specialty. Others call it a "sham" and a "racket" because of both its powerful entrepreneurial bent--the clinics and therapies and treatments and supplements that can directly enrich a specialist's practice--and the less-than-gold-standard science that supports it. Much (not all, but much) of the science behind commercial anti-aging therapies does not come from large-scale, placebo-controlled, double-blind human studies. Although that approach is not without its critics, its carefully constructed scientific investigations are designed to be as objective as possible, removing the chance for the investigators themselves to influence the outcome, controlling for factors that might affect the results, and including a (human) test group large enough to generalize from. Studies like this are phenomenally expensive. They are undertaken with an eye toward FDA approval of a drug or treatment and the subsequent bonanza that approval can mean for a drug company. But many anti-aging treatments are supplement based. Supplements are classified as food, not drugs, so FDA approval is not needed, and that means large-scale human studies are not required--and, because of their prohibitive cost, not undertaken. Thus reports on the successes of various therapies come from small studies, animal studies, and that bane of every scientist's existence, anecdotal evidence.

The organization doesn't do itself any favors with its stance of aggressive self-promotion. And it probably doesn't help the cause of mainstream acceptance that the founders of A4M, Ronald Klatz, MD, and Robert Goldman, MD, are not shy. And by "not shy" I mean: They are showmen. Klatz, credited with coining the term "anti-aging" and hailed by BusinessWeek as its "guru," is the author of 32 books with, as his Web site will tell you, "over 2 million copies in print." He was an early and enthusiastic proponent of using human growth hormone to purportedly reverse aging, and his Grow Young with HGH was a national bestseller in the late 1990s. He is an enthusiastic producer of podcasts and a tireless self-marketer.

Klatz's A4M partner and friend, Robert Goldman, calls himself "anti-aging's global ambassador." And he is. The man travels the world, consulting and teaching at universities from Central America to South Asia. He sits on boards, creates companies, gets handed keys to Italian cities, and actively- -and I do mean actively--promotes physical fitness. He holds 20 world strength records, including one for 13,500 consecutive situps and another for 321 consecutive handstand pushups. You will find him in Guinness World Records. You will also find him at this A4M convention, waiting in the wings as his colleague, Dr. Klatz, opens the show.

The convention center's main ballroom is so cavernous that, even though I am sitting only a third of the way back from the stage, I can hardly make out Klatz's face. Happily, there is a movie-theater-size screen on each side of the dais that projects the image to me and the 5,000 or so other people from 60 countries who have gathered here to learn the latest about anti-aging research from more than 100 presenters.

Klatz, 10 feet tall on screen, is not, alas, the best advertisement for his specialty. He is thick-necked, a little portly, and a little out of breath, all of which I find oddly comforting. His message this morning is upbeat and inspirational--in both medical and commercial terms. He is a coach speaking to his players, players who love and believe in the game. And want to win.

"Anti-aging medicine is transforming the practice of medicine and transforming the world," he tells us. "It is a new intelligence for the entire planet." Klatz says that anti-aging medicine is the world's fastest- growing medical specialty, the "hottest trend" in health care. In case there's any doubt as to what this means to the audience gathered in the convention hall, he ends his welcome with this statistic: By the year 2015, revenue in the global anti-aging market will exceed $200 billion.

Dr. Goldman is next up. I was hoping he would do a few handstand pushups, but instead he delivers a brief, passionate message about wellness that positions anti-aging medicine at the forefront of best practices. "It is about health, not illness," he says. "Conventional medicine waits until something breaks to fix it. Anti-aging medicine intervenes before that happens. It is about prevention." I find the message powerful and convincing. The two doctors, in less than five minutes, have managed to get me on their team. And they're just getting warmed up.

Third at bat, and apparently a regular at these conventions, is Ken Dychtwald, PhD, a psychologist, gerontologist, author of 15 books, filmmaker, and, as he later tells us, "old hippie" and friend of spiritual figure Ram Dass. He is 60 with a full head of curly hair, the posture and stance of a 30-year-old, and the energy and excitement of a revivalist preacher. He says that 65 was selected as the marker of old age back in the mid-1800s. Up on the screen flashes a slide of the iconic painting Whistler's Mother, painted when she was 65. Her back is curved. She's got jowls and a turkey neck. Then he clicks the remote in his hand and next to Whistler's Mother there appears a photo of Sophia Loren at 65. Let me just say that Whistler's mother suffers somewhat by comparison. The audience laughs, then claps.

He clicks through a slide show featuring active, adventurous, tech-savvy, vibrant older people. He shows a picture of John Glenn suited up for his final space journey at age 77. Glenn looks clear-eyed and resolute, strong and vital, ready for the challenge. "People want to be healthy so they can continue to dream and create and do meaningful things," he says. I can't help myself: I clap.

Dychtwald says he wants to do away with the term "retirement." Me too. I think of stewed prunes and All-Bran for breakfast, fishing trips, knitting projects, those special recliners with the lever that tips the seat forward so you can get your aging ass out of the chair. As Dychtwald talks, I look up "retirement" on my smartphone. "The act of retreating," says the entry. "The act of withdrawing into seclusion." That's not what I have in mind for the latter part of my life. Whatever else happens at this convention, I tell myself, I will keep Ken Dychtwald's message in mind. Staying youthful, vital, and healthy can have a purpose.

Before the opening speeches this morning, I spent a solid hour studying the convention booklet with the goal of plotting my own schedule for the next two and a half days. The booklet, a hefty, magazine-size publication larded with advertising, lists every paper presentation, speech, and seminar, from the marquee presenters who will address thousands in the ballroom to the unknowns assigned to one of the dozens of small seminar rooms. With four or five presentations scheduled for every hour, it's a challenge to figure out a plan. I want to see what doctors and researchers in this yet-to-be- recognized specialty of anti-aging think is most important, where they are pinning their hopes, what they see on the horizon. If anti-aging is, as Klatz says, the "hottest new trend," I want to know what the hottest new trend is within the hottest new trend.

Once upon a time, in the mid-1700s, the biggest thing in anti-aging involved placing five virgins in a small airtight room, piercing a hole through the wall of the chamber, and inserting the long neck of a flask used for distilling. The warm breath of the young girls would flow into the flask and condense into a "clear water, which is a tincture of admirable efficacy," a few drops of which could make the old young again. Dr. Johann Cohausen, whose theory this was, was only half kidding. Both a physician and a medical satirist (did you know that was a job category?), he lived to be 105.

Alas, I'm not expecting any presentations on virgin's breath today. I head out to my first session, the focus of which is inflammation--not the puffy- sprained-ankle kind of inflammation but internal inflammation, along the walls of arteries, in the brain, the kind that leads to cardiovascular disease and Alzheimer's, the kind that ages you from the inside out. This researcher, a fast-talker with a PowerPoint slide show only a biochemist could love, says that 90 percent of all chronic disease has an inflammation component--and that half of us suffer from at least one of those diseases. Chronic illness is both a marker for and an accelerator of aging.

Now she launches into the villains in this story: the unhealthy lifestyles of so many of us. She cites research suggesting a direct link between food-- particularly sugary foods and foods rich in omega-6 fatty acids, like cottonseed oil and tub margarine. Her slides, with lipoprotein, CRP, IL-6, and TNF-alpha flowcharts, are simultaneously incomprehensible and utterly convincing. She talks about chronic stress and the stress hormone cortisol, about the evils of cigarettes and obesity, known for doing so much other damage to the body and now also indicted in the body's inflammatory response. She's not thrilled about EMFs and cell phones. I scribble notes about taking CoQ10, vitamin D, and bioflavonoid supplements, which she says are powerful antiinflammatory, and wonder if I should get my cortisol level checked . . . especially right now, as I try to process all this information, copy down as many citations as I can, eavesdrop on a heated, albeit whispered, conversation behind me (the cell phone controversy), and check my schedule for the next session. I wonder: Can attending an anti- aging conference age you?

I'm off to Hyaluronic Acid: The Anti-Aging Answer for the Whole Body. I've never heard of hyaluronic acid, and my knowledge is not greatly enhanced by learning, in the presenter's introduction, that hyaluronic acid is an anionic, nonsulfated glycosaminoglycan distributed widely throughout connective, epithelial, and neural tissues. Whatever it is, we used to have a lot more of it when we were younger. Its presence accounted for our soft skin, vibrant circulatory system, healthy connective tissue, and limber joints. It appears to be a lubricant and repairer of tissues, the sort of molecule you want on your side. I'm not keeping up with the steady stream of slides, but I am understanding the basic idea: The plum-to-prune or grape-to-raisin phenomenon that is an unhappy external hallmark of aging occurs not only at the skin level, but also throughout the body. And it occurs, at least in part--this guy says in large part--because of decreasing levels of hyaluronic acid. The stuff is integral to our 50 to 100 trillion cells, our 60,000 miles of blood vessels (stats courtesy of one of the few slides I could actually comprehend), our ocular and oral health, our everything. As levels decrease as we age, we prune up from the inside.

I learn that medical use of hyaluronic acid has been around since the 1970s. It's been used in various eye surgeries, in the treatment of osteoarthritis, to help alleviate eczema, and, since 2003, as a wrinkle- plumping injectable. (Restylane and Juvederm are the brands you might recognize.) But this presentation is not about topical applications or injectable substances. It is about biochemically altering the body, which is really what much of this pioneering anti-aging research is about. In this case, it is about giving the body the hyaluronic acid it no longer makes or helping it make more so that we can be, inside and out, more plum than prune. It's one of those "this is the key to anti-aging" ideas--and there are many being forwarded at this conference--that sound too good to be true.

One of the overlooked benefits of aging is that your too-good-to-be-true antennae become increasingly sensitive to too-good-to-be-true ideas. My first thought is: Isn't the body far, far more complicated than this? It can't be that you tweak one chemical and fix everything. My next thought is that tagline from a long-ago margarine commercial: It's not nice to fool Mother Nature. That night, doing follow-up research back in my hotel room, it doesn't take me long to discover that hyaluronic acid, for all its wonderful actions in the body, is also an integral part of cancer metastases and angiogenesis (the growth of new blood vessels to nourish a tumor). So if I trick my body into producing more hyaluronic acid in an effort to stay plum-and grape-like, could I also be setting the stage for big problems? This is when one of those nonexistent large-scale, double- blind, placebo-controlled studies would come in handy.