SECOND OPINION:Ageing successfully is not all about fitness, writes DES O'NEILL
THAT PEACE is not made with your friends is a concept that has gained wide currency. In medicine this translates as shaping our debates and advocacy in dialogue where there is true opposition and dissent. I was reminded of this during the annual open week of the Royal College of Physicians in Ireland.
The opening session, a public debate on ageing, might have been an episode of preaching to the choir between geriatricians, gerontologists and the advocacy sector for ageing. Instead, the college invited a “motivational” speaker from the United States, the title of whose book, Younger Next Year, encapsulates the unintentional and pernicious ageism of much popular commentary on ageing.
As it happens, the author, Chris Crowley, a retired lawyer from the US, promotes a lifestyle of aerobic exercise, diet and social connectedness. However, much of his writing is couched in language that positions ageing as (a) a phenomenon exclusively of later life, and (b) something to be avoided and deferred so that the goal is to be “younger”.
This negativity towards ageing underpins ageism, whereby we devalue the very experience of ageing. We age throughout the lifespan, and failure to appreciate one’s stage in the process is recognised by phrases such as “Peter-Pan syndrome”. Ageing in later life brings growth as well as loss, exemplified by great artists such as Matisse or Louise Bourgeois, and in everyday life by the exemplary safety record of older drivers, despite high levels of illnesses that might compromise driving safety.
So, after his folksy and charming delivery, our debate afterwards allowed the panel to emphasise that we shared his aspiration to postpone frailty, but not ageing. Concern was also voiced about the risk of equating ageing successfully with fitness, with disability viewed somehow as a failure.
Clearly, successful ageing strategies must support the concept of adequate support for those affected by age-related disability. A final message from a specialist in genitourinary medicine on the panel, on sexually transmitted diseases in later life, added a suitably contemporary flavour to an excellent evening.
The other big debate of the week was on value for money with high-cost medications. Here the college played a valuable role in a small country where doctors are shy about expressing unease about advocacy that might be disruptive of equity and the common good. We rarely get a chance to pair the issues that attract emotionally charged headlines and airtime on Joe Duffy with the thankless but necessary task of formulating coherent and equitable policy in difficult financial circumstances.
Prof Michael Barry, a physician who has undertaken sterling work in developing the discipline of pharmaco-economics in a country with a tradition of an unfettered free-for-all in access to medications – with most of the tab picked up by the State – debated with Senator John Crown, whose advocacy for new (and expensive) cancer medications was recently marked by a Bill proposing to make the Minister for Health sign off on any refusal to fund a new cancer medication.
This Bill was seen by many as well meaning but unfortunate: not only did it appear to use a national parliamentary position to prioritise medications from one’s own specialty, as well as undermining pharmaco-economic debate, but also seemed to change a collective decision into a personalised one, ie “Minister X would not sign for the cancer medication for my daughter/wife/parent.”
The resulting Seanad debates confirmed Bismarck’s aphorism that it is better not to see laws or sausages being made – or, in this instance, not being made.
The college debate was lively, heated and insightful, although one contribution for which I have a personal allergy is that of doctors using the word “bureaucrat” in a dismissive and contemptuous fashion, without thought that we all have aspects of our practice and manner that challenge others.
However, I think most of those attending could work out which approach best combined humanity, equity and the hard grind of supporting in equal parts the vocal and those without a strong voice.
Des O’Neill is a consultant in geriatric and stroke medicine
A version of this column originally appeared as a BMJ blog