A New Path

In the 1990s, Dr. Joseph Raffaele was practicing internal medicine and teaching at Dartmouth Medical School. Like any other busy internist, he routinely saw middle-aged patients who complained that they just didn’t feel as good as they used to. And all he could tell them was, in essence: Well, you used to be young.

It began to dawn on him that there was something fundamentally wrong with the way he was practicing medicine.

Dr. Raffaele, then in his mid-thirties, was a physician with a philosophy degree from Princeton and a first-rate medical education under his belt. And he was simply following traditional medicine’s attitude about the aging body. You’re either sick—meaning you have a disease—or you’re well. If you have a disease, you can be treated. If it’s just that you don’t feel as good as you used to, can’t do all you once could—that’s just life. You can exercise more, watch your diet, get the sleep you need. Other than that…

“What I realized was that I was practicing disease-oriented medicine with patients who had no disease,” Dr. Raffaele says. “So I wasn’t really helping them with probably 50 percent of the complaints they came in with. I’d screen for all the usual diseases and tell them, ‘There isn’t anything wrong with you, you’re just getting older.’ And I began to think that’s not really an acceptable answer. And it wasn’t how I wanted to spend the rest of my life.”

There was one other thing weighing on Dr. Raffaele’s mind as he considered traditional medicine’s largely futile and fatalistic approach to aging: The memory of watching his own parents’ precipitous declines as they reached their 70s after both lived healthy and active lives until then.

“What that taught me was that even if you do all the right things in terms of exercise and diet and keeping the mind active, the natural aging process can gradually take away active, quality years of life unless you intervene.”

Dr. Raffaele’s partner in practice, Dr. Ronald Livesey, was already in that middle-age group himself, and he had been thinking about these questions on his own. They began talking. Were there ways to intervene in aging? To even think about that question meant thinking about what aging is—why it happens, how the processes play out differently among the various organ systems, and in what ways they’re the same.

“I was seeing patients even in their early forties who were healthy by all the standard measures but complained that they weren’t feeling good,” Dr. Raffaele recalls. “And I wondered why that was the case even if they had no disease.” In fact, he wondered why even he, not yet 40, was already starting to have some of those complaints himself.

“I was doing exactly what my father did, going to the gym, swimming five days a week without fail. I did tests on myself and I was doing relatively well for my age. But I was still dragging myself through the office by the end of the week more than I felt I should be at 37.”

Dr. Raffaele began to do some research. He found his way to a seminal 1957 paper by George C. Williams, an evolutionary biologist whose theory of aging was one of the 20th Century’s most influential works on evolution.

“In a nutshell,” Dr. Raffaele explains, “the idea is that Mother Nature doesn’t want to invest in keeping a body healthy and vital past its peak reproductive age because it’s a waste of resources, in a sense. The aging process is what happens after Mother Nature loses interest. This means there’s no grand, highly orchestrated plan by nature for how we age, as there is for how we develop from birth through our twenties. And we can see that in the way that we all age so differently.”

The evolutionary theory of aging was the turning point for Dr. Raffaele. If Mother Nature doesn’t care how we age, he thought, might that mean that she wouldn’t stand in the way if we come up with ways of intervening?

His interest piqued, Dr. Raffaele attended a meeting in California of a small group of physicians who were practicing what was being called anti-aging medicine. He heard specialists in various fields of clinical medicine discuss their perspectives of the diseases most associated with aging—cardiovascular disease, cancer, Alzheimer’s—and research that was beginning to support therapies for intervening in the aging processes.

“They were treating oxidative stress and restoring the hormones of aging to youthful levels,” Dr. Raffaele recalls. “Not just estrogen and progesterone in menopausal women, but all the hormones—DHEA, growth hormone, testosterone. I saw that this was really the future of medicine” Dr. Raffaele says. “To forestall the diseases of aging by improving health and function. It was what I always wanted to do in medicine.”

Dr. Rafaelle and Dr. Livesey eventually decided to take a bold step into the future: to leave the comfort of their traditional internal medicine practice in New Hampshire and move to New York and open a new kind of medical office. PhysioAge Medical Group opened in 1997.

“It was one of those ‘build it and they will come’ dreams,” Dr. Raffaele says. “And we sat and waited for the phone to ring.”

In the years since, the doctors have built a highly successful practice on Manhattan’s Central Park South, while taking a role as innovators in the field. They have pioneered the use of biomarkers to assess the aging processes of each of a patient’s organ systems, and of the body as a whole, and prescribing precise and highly individualized therapies, ranging from nutritional supplements to hormone replacement therapies, aimed at slowing them. Since opening PhysioAge, Dr. Raffaele now 51, has himself been on a regimen that includes diet and exercise, supplements, testosterone and human growth hormone therapy. “I’ve been taking my own therapies for the last 15 years,” he says, “and in most of the tests we do to measure biomarkers of aging, I haven’t changed that much. That to me is validation.”

Dr. Raffaele joined the field once called anti-aging medicine in its early years. A decade and a half later, he’s part of an emerging specialty now known as age management medicine. It is growing rapidly—in influence as well as practice—as clinical research expands into promising new areas such as the development of supplement to activate the enzyme telomerase to help cells keep dividing and live on.

“We’re seeing an explosion of studies addressing how we can affect the aging process,” Dr. Raffaele says. “What’s exciting to me is that I can go to conferences and read papers, and then see these new approaches and therapies working in my practice on a daily basis. When I first started in this field, I wondered if there would be a study that would blow the whole thing up. But each time something comes out it’s a further corroboration of the direction we’ve been going in. That the concept that you can slow down the aging process, and in some aspects reverse it, is a real and tenable approach.

“I almost liken it to where physics was decades ago, where we see aging as a unified process, in a sense. Each organ system has its way of aging, but we know why aging occurs as an overall process. And potentially how we might intervene with therapies that may eventually allow us to live not only longer than the maximum human lifespan but with the vitality and function of a 50- or 60-year-old until we’re 80 or 90. That’s very exciting.”

And, yes controversial. “I will get calls from physicians who are treating patients in conjunction with me, questioning what I’m doing because they haven’t taken the time to understand the perspective that sees aging as a process that is the bedrock of all the diseases that take place later in life. And I think the reason there is skepticism about treating the aging process is because it is a process, a universal process, and not a disease.

“And that is the essential difference between traditional medicine and age management medicine. Traditional medicine waits until there is disease and then treats. Age management medicine recognizes what scientists who study aging know: That aging, as a biological phenomenon, is a continuous decline in function and ability to withstand stress that increases your risk of dying. That’s a bad thing. And if you can treat that, it might forestall the diseases that we later treat routinely.”  •