Geriatrics : Gateway to Next Medicine

As Current Medicine faces the mandate for massive reformulation geriatrics provides the template. In it are found the critical new basic science that underlies life-long health, and the time honored tradition of “caring.” Keywords: Aging, death, disuse syndrome, epigenesis, frailty, geriatrics, hypokinetic disease, medication, sedentary death syndrome. EVERY PROJECTION CONCLUDES THAT THE GRAY DAWN OF MEDICINE IS HERE. Demographic and economic data confirm the reality that the medical system faces transformative challenges. There are now 40.3 million Americans over the age of 65 (16% of total population) the health care of whom costs one trillion dollars per year (36% of total cost). These numbers will soar. Meanwhile geriatric medicine exhibits structural lag stuck in the acute care model in an era where needs are categorically different. The article “Geriatrics: the Fruition of the Clinician” was published in 1974 by Steel and Williams [1]. Rereading it evokes a different era. The Steel, Williams article reflected the lowly status of geriatrics within the general medical curriculum at that time. They suggested that the prejudice of ageism infected both the academic and political realms thereby stigmatizing the whole reach of geriatrics. Steel and Williams referred to geriatrics as the “step-child” of medicine, but asserted that the extended scope of geriatrics, its “caring” imperative, should represent the fruition rather than a step-child relationship. A major part of the diminished prestige of geriatric medicine four decades ago was the lack of a sturdy conceptual platform. The entire area of aging related issues was a backwater of scientific pursuit. DIFFERENTIATING AGING The recent decades have generated immense advances in biology. The dominant strategy of scientific inquiry is reductionism that seeks a deeper understanding by focusing on progressively smaller parts of the whole. The culmination of the reductive strategy of big science was the pursuit of the human genome project. Within it was promised the ultimate comprehension of the Holy Grail of Life. The resultant genocentrism transfixed the biological sciences, including geriatrics. Billions of dollars and decades of research effort were spent in the reductive search for a grand unifying theory, “The Theory of
Everything.” [2]. The principal *Address correspondence to this author at the 167 Bolivar Lane, Portola Valley, CA 94028, USA; Tel: 650-854-2213; E-mail: [email protected] Presented at Annual Meeting, American College of Physicians, Philadelphia 2009, USA. research strategy involved attempts to relate a specific gene to a disease. Notably, identification of “the aging” gene has proven to be futile. Martin estimates that 6000 genes are involved in human aging [3]. It, like virtually all human ailments, is polygenic. Reductionism reached its limit. Insistence on the genome as the object of study failed leaving an intellectual vacuum [4]. Abandonment of the gene focus changed attention to the organism as a whole, the phenotype. The organism is ordained not only by its genotype but is importantly influenced by environment, the Nature/ Nurture interface. The nexus of the organism with its environment is the new platform for study.