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What Are Old People For?
How Elders Will Save the World
by William H. Thomas, M.D.


From Part One

The Botox Brigade

The surest method of wrinkle prevention is death at a young age. Those who want to live and still be wrinkle-free must take special care to hide from the sun. This could mean adopting a completely nocturnal lifestyle or following the example of the naked mole rat and retreating—permanently—to a deep, dark burrow. Less radical strategies have been proven to reduce wrinkle formation, such as limiting exposure to sunlight (and remembering to use sunscreen), eating a diet rich in fruits and vegetables, and, for those who smoke, quitting the tobacco habit. These are good things even for those who are not afraid of wrinkles: many of the tactics that can delay the appearance of wrinkles also offer protection against cancer.

When we can look past how wrinkles make us feel, it is clear that wrinkles are the natural result of living into the later decades of a normal human life. The methods we use to eradicate wrinkles, in contrast, are decidedly unnatural.

The cosmetics industry and the medical profession are allies in a war against facial wrinkles. Dermatologist Nicholas Perricone opens his New York Times best-selling book The Wrinkle Cure by claiming, “Wrinkled, sagging skin is not the inevitable result of growing older. It’s a disease and you can fight it.” If that is true, wrinkles represent a most unusual form of illness. Diseases are best known for causing suffering, limiting function, or shortening life span. Cholera, scurvy, hepatitis, AIDS, and . . . wrinkles? Plenty of murky reasoning is needed to convert wrinkles, which are a normal, natural feature of human development, into a pathological disorder. The motivation to make such a leap, though, is straightforward. Diseases need treatment and treatments cost money. Aided and abetted by hundreds of millions of dollars in marketing, the antiwrinkle business sows fear and reaps a rich financial harvest.

The cosmetics and medical industries are happy to fuel an arms race that perpetuates our fear of wrinkles. They view (and want you to view) those little lines at the corners of your eyes as advance scouts from the evil empire of old age. The first line of defense against this invasion consists of moisturizing creams that promise to restore the skin’s dewy softness. These preparations are harmless enough and work through the same benign process that puts wrinkles on your fingertips after a long soak in the tub. The water contained in the lotion is absorbed by the surface skin cells, causing them to swell. On the face, especially around the mouth and eyes, this swelling fills in the wrinkles and makes them less visible. No harm, and possibly some good, is done, but these lotions provide only temporary relief. Millions of people move on to complex and questionable pseudomedical compounds loaded with whatever vitamins, minerals, and antioxidants are currently in favor. I am not condemning these products, and I understand well why we buy and use them, but they cannot change the fact that we are, indeed, aging. In time, even the most effective of them fail to provide satisfactory results and newer, more powerful weapons must be brought to bear.

The medical profession has developed a prescription-strength antiwrinkle armamentarium. Skin peels and dermabrasion procedures strip away the outer layer of skin, laying bare the tender pink tissue underneath. The exposure of these immature skin cells creates the appearance of youth, but the effect is temporary. The glow of youth is soon lost and another painful procedure is required to re-create the illusion. More durable wrinkle eradication is available to those who are willing to go under the knife. Face-lifts solve the problem of wrinkles and lost elasticity by stretching aged skin over the face and then trimming off the excess. The surgeon’s knife is both sharp and fast, and it is easy to go too far. More than a few movie stars have emerged from a series of cosmetic procedures resembling the body-snatched aliens they may once have played on screen.

At the turn of the twenty-first century, the big new gun in the war on wrinkles was Botox, which is actually a diluted form of the deadly toxin that is produced by the Clostridium botulinum Type A bacteria and that causes botulism. In its pure form, one ounce of this substance is so potent that it could kill 1.5 million people. Early symptoms of botulism include drooling and slurred speech. The toxin is known to spread swiftly through the body. Within just a few hours it can reach and paralyze the muscles responsible for breathing. The result is an agonizing death by asphyxiation. The medicinal form of the toxin is extremely dilute, and even though it is injected directly into the patient, it rarely causes death.

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