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- Resolution of grief. As the individual “lets go,” it becomes possible to reinvest in continuing life—for example, resum- ing former behavior patterns, seeking new relationships.
Loss of a loved one can cause guilt, shame, sadness, and a fear of dying. Bereaved persons must learn to cope with reality. This process involves gradual acceptance of the fact that a loved one has died, followed by gradual reinvolvement in day-to-day activities. Mourners typi- cally must cope with a feeling of emptiness related to the fact that a part of their emotional investment has been lost. When mourning is successful, the emotions are “reinvested” as the individual becomes reinvolved in activities. Many people believe that crying and other expres- sions of sadness are abnormal and a sign of emotional weakness. Displays of emotions may be painful to other people. However, expressions of grief are normal and healthy. Cassem37 has noted: Allowing the bereaved to express feelings is essential. The most important part of this process is to avoid the maneuvers that nullify grieving. Clichés (“It’s God’s will”), self-evident but irrelevant reassurances (“After all, you’ve got three other children”), and outright exhortations to stop grieving (“Life must go on”) should be avoided. Bereaved individuals can best deal with grief by recognizing that the sadness they feel is normal and resuming activity when they are able to do so. Friends often can help simply by acknowledging the distress of the bereaved and expressing sympathy. Mourning rituals vary from culture to culture. Physicians often see people who feel that it is wrong to feel upset. To proceed with mourning, such people may need reassurance that it is all right to grieve. An op- portunity to ventilate both positive and negative feelings toward the ill or deceased individual may also be helpful. Antidepressant and anti-anxiety drugs are usually not appropriate for treating uncomplicated grief. The act of giving a drug to a grieving person may convey the message that grief is abnormal. Some communities have support groups for those who need help. George A. Bonnano, Ph.D.,38 a prominent researcher, believes that most people bounce back quickly from loss of a loved one and do not go through the stages that are traditionally described. He cautions that people who do not seem upset may be resilient rather than in a state of denial. Normal vs Pathological Grief The length of the grieving or mourning process varies among individuals. Most people take 6 to 12 months to recover, but many take less and some take considerably more. The “success” of the grieving process should not be measured by a predetermined timetable but by the griever’s acceptance of the loss. The signs of unresolved grief include suicidal thoughts, chronic sleep difficulty, overuse of alcohol or drugs, persistent depression, fail- ure to carry out normal daily routines, and persistent symptoms resembling those of the deceased. A shift to positive and realistic plans for the future is a sign that mourning is nearing completion. Professional help is unlikely to be needed unless severe depression or social isolation persists for 6 to 12 months. liFe-extension/anti-aging QuaCKerY The wish to delay aging and prolong life is almost uni- versal. Many entrepreneurs have capitalized on these wishes and proposed modern equivalents of the “fountain of youth.” Chapter 18 describes how cosmetics manu- facturers have made unproven claims that their products can rejuvenate the skin and/or remove wrinkles. Some product lines include vitamin supplements in addition to skin creams. Other manufacturers have marketed products claimed to prevent or delay aging, boost im- munity, cure chronic disease, and/or improve memory. Some spas offer mineral water or seawater baths, mud packs, seaweed wraps, and various other services claimed to promote rejuvenation or healing. Whereas most American spas offer fitness activities, European facilities are more likely to feature “cures,” stress re- duction, and various forms of pampering. Rejuvena- tion claims are also made by physicians engaged in unfounded practices here and abroad. Fresh cell therapy, which is claimed to rejuvenate body organs, is described in Chapter 16. Chapter Twenty-One Coping with Death 449 Anti-Aging and Life-Extension Claims The limit of the human lifespan is probably not much more than 120 years. Many dietary methods, nutritional supplements, and drugs have been claimed to delay ag- ing and/or extend life. During the early 1980s, books by Saul Kent40 and Durk Pearson and Sandy Shaw41 called considerable public attention to this matter. The books were based mainly on misinterpretations or inappropri- ate extrapolations of animal experiments.42 However, the resultant publicity inspired many manufacturers to market products claimed to influence some aspect of aging. The FDA has driven some products of this type from the marketplace, but many others are still sold. Several studies in animals have shown that cutting calories 50% to 60% can significantly increase maxi- mum lifespan. However, the restriction also retards their growth and development and thus is not suitable for humans. Moreover, severe calorie restriction would be very difficult for people to sustain. Many types of immunologic manipulation have been proposed, including the transplantation of immune cells from young animals. However, no such approach has been demonstrated safe or effective in humans. The substances claimed to slow the aging process include Gerovital H3 (GH3), human growth hormone, dehydroepiandrosterone (DHEA), melatonin, superoxide dismutase, and antioxidant nutrients. GH3 was developed by Dr. Anna Aslan, a Roma- nian physician. The Romanian National Tourist Office and a few American physicians have promoted it as an anti-aging substance—“the secret of eternal vigor and youth.” Claims have been made that GH3 can prevent or relieve a wide variety of disorders, including arthritis, arteriosclerosis, angina pectoris and other heart condi- tions, neuritis, deafness, Parkinson’s disease, depression, senile psychosis, and impotence. It is also claimed to stimulate hair growth, restore pigmentation to gray hair, and tighten and smoothen skin. The main ingredient in GH3 is procaine, a substance used for local anesthesia. Although many uncontrolled studies describe great benefits from the use of GH3, controlled trials using procaine have failed to demonstrate any. Low blood pressure, breathing difficulty, and convulsions have been reported among users. Noting that para-aminobenzoic acid (PABA) appears in the urine of people receiving procaine injections, a few American manufacturers have been selling procaine tablets containing PABA with false claims similar to those made for GH3. The FDA has taken regulatory ac- tion against several “GH3” marketers, but other brands still are marketed. Human growth hormone has been shown to increase muscle mass and skin thickness when injected into elderly men who produce little or no hormone of their own. However, no study has demonstrated that it is safe and effective for long-term use for any such purpose. It is very expensive, and long-term use can cause joint inflammation and diabetes-like symptoms. At present, the only proven indication for human growth hormone is to treat children with short stature caused by growth- hormone deficiency. Butler43 has noted: Although growth hormone levels decline with age, it has not been proven that trying to maintain the levels that exist in young persons is beneficial. It is conceivable that age-related hormonal changes may serve as useful markers of physiologi- cal aging. However, this has not been demonstrated experi- mentally for either humans or animals. Although hormone- replacement trials have yielded some positive results (at least in the short term), it is clear that negative side effects can also occur in the form of increased risk for cancer, cardiovascular disease, and behavior changes. It might even turn out that lower growth-hormone levels are an indicator of health. Research findings indicate that mice that overproduce growth hormones live only a short time, sug- gesting that growth-hormone deficiency itself does not cause accelerated aging, but that the opposite may be true. . . . DHEA is a hormone that peaks around age 25 and gradually declines after that. Scientists have speculated that declining levels of this adrenal hormone play a role in aging. On the basis of animal experiments, DHEA has been claimed to cure cancer and heart disease and to delay aging. However, significant dosages in humans can cause unwanted hair growth, liver enlargement, and other adverse effects that make its use impractical. Researchers at the Mayo Clinic have concluded that DHEA and testosterone replacement do not produce Quackery and Terminal Illness The notion that terminal patients have nothing to lose by turning to quackery is dead wrong. Most people faced with a life-threatening disease can make a reasonable psychological adjustment. . . . Those who accept their fate are in the best position to use their remaining time wisely. . . . Quacks discourage people from making the difficult adjustment by reinforcing their denial. Such people usually die unprepared because preparation for death is an admission of failure. William T. Jarvis, Ph.D.39 √ Consumer Tip Part Five Other Products and Services450 the beneficial effects promised by “anti-aging” promot- ers. This conclusion was based on a 2-year, placebo- controlled, randomized, double-blind study involving 87 elderly men with low blood levels of DHEA and testosterone and 57 elderly women with low levels of DHEA. Administering these hormones did raise the subjects’ blood levels. However, it failed to produce any significant beneficial effects on body composition, physical performance, insulin sensitivity, or quality of life.44 An accompanying editorial expressed doubt that negative studies, such as this one, would cause marketers to stop calling DHEA the “foundation of youth.”45 Melatonin, a hormone secreted by the pineal gland, peaks during childhood and gradually declines. Experi- ments with small numbers of people have found that melatonin influences the “body clock” and may be useful against “jet lag” and as a sleep aid. However, the fact that melatonin declines with age does not mean that the body needs larger amounts. Claims that melatonin can protect against heart disease, cancer, and cataracts and may help people with AIDS, Alzheimer’s disease, asthma, and Parkinson’s disease are speculative. Antioxidant nutrients such as selenium, vitamins C and E, and butylated hydroxytoluene (BHT) are claimed to delay aging by soaking up “free radicals” that have escaped the body’s own “free radical patrols.” Although antioxidants can deactivate free radicals in the test tube, they have not been proved to do so in humans. Much research has been done to see whether antioxidant supplements can protect against heart disease, cancer, and other diseases. So far, no life-prolonging benefit has been demonstrated (see Chapter 11). Superoxide dismutase (SOD) is an enzyme whose tissue levels in various animal species appears related to their lifespan. However, SOD supplements have no effect in humans because SOD (a protein) is digested into its component amino acids and does not reach the tissues intact. Health professionals interested in “anti-aging” strategies have formed the American Association for Anti-Aging Medicine (A4M), which holds conferences and has a certifying board. An affiliated organization, the American Board of Anti-Aging Health Professionals (ABAAHP), was established in 1999 to provide “ad- vanced education, representation, and specialty recogni- tion of healthcare professionals,” including chiroprac- tors, Ph.D.s, registered nurses, podiatrists, naturopaths, and pharmacists. Eligible individuals who pass a 1-day examination are certified as an “Anti-Aging Health Pro- fessional.” The American Board of Medical Specialties and mainstream professional groups do not recognize these credentials. In 2001 a Government Accountability Office (GAO) report46 highlighted the potential for physical and eco- nomic harm posed by 16 dietary supplements marketed as anti-aging therapies. The report also noted that 20 companies marketing the products had been targeted by law enforcement agencies and had cost consumers approximately $36 million. In 2004, several prominent researchers47 summed up the prevailing scientific viewpoint about widely promoted anti-aging strategies: Since recorded history individuals have been, and are con- tinuing to be, victimized by promises of extended youth or increased longevity by using unproven methods that allegedly slow, stop, or reverse aging. Our language on this matter must be unambiguous: there are no lifestyle changes, surgical procedures, vitamins, antioxidants, hormones, or techniques of genetic engineering available today that have been demon- strated to influence the processes of aging. We strongly urge the general public to avoid buying or using products or other interventions from anyone claiming that they will slow, stop, or reverse aging. . . . Health and fitness can be enhanced at any age, primarily through the avoidance of behaviors (such as smoking, excessive alcohol consumption, excessive ex- posure to sun, and obesity) that accelerate the expression of age-related diseases and by the adoption of behaviors (such as exercise and a healthy diet) that take advantage of a physiology that is inherently modifiable. “Biologic Age” Testing Some Web sites, books, and expensive health spas pur- port to be able to determine your true “biological age” by comparing various physical and lifestyle variables to statistical norms. This can differ from your chrono- logical age (time elapsed since birth) and supposedly indicates how much you have truly aged. However, there is no agreed-upon, validated standard for measuring biological age. A Wall Street Journal reporter in her mid-30s who took two Web site tests scored “age 17” at one site and “age 46” at the other.48 Butler43 has stated that those who claim to measure “biomarkers of aging” and favorably affect them are not scientifically based and should not be marketed to the unwitting public. The nonprofit Living to 100 Life Expectancy Calen- dar Web site (www. calculator.livingto100.com) has an interactive questionnaire that suggests strategies based on research findings, but sites that use tests to generate product sales are not trustworthy. Personal Glimpse Chapter Twenty-One Coping with Death 451 Dubious Stem Cell Treatment Stem cell therapy is certainly a promising area for re- search. Stem cells have the ability to give rise to many specialized cells in an organism. Certain types of stem cells are already used to restore blood-forming and im- mune system functions after high-dose chemotherapy for some types of cancer, and several other restorative uses have been demonstrated. The broadest potential ap- plication is the generation of cells and tissues that could be used to repair or replace damaged organs. If scientists can learn how to control stem cell conversion into new, functionally mature cells, doctors might be able to cure many diseases for which therapy is currently inadequate. However, the claims made by commercial promoters go way beyond what is likely and should be regarded with extreme skepticism. The International Society for Stem Cell Research49 warns that undifferentiated (embryonic) stem cells are likely to cause tumors and are unlikely to become the cells needed to regenerate a tissue on their own—they would first need to be coaxed to develop into specialized cell types before transplantation. Other risks include infection, tissue rejection, complications arising from the medical procedure itself, and unforeseen risks. Novella50 has noted that it may be impossible for outsiders to determine what is actually being injected into patients at the commercial clinics. Cryonics Cryonics is the speculative practice of using cold to try to preserve the body of a dead person indefinitely. The goal is “to carry the person forward through time, for however many decades or centuries might be necessary, until the preservation process can be reversed, and the person restored to full health.”51 Proponents claim that it is possible to preserve “with reasonable fidelity” the basic biologic components of the brain and that future technology will be able to repair brain damage caused by “imperfect preservation, premortal disease, and post- mortem changes.” In 2011 there were five providers in the United States and the cost for whole-body freezing and permanent maintenance ranged from about $28,000 to $200,000. “Brain only” suspension, which is less expensive, is also available. Cryonic technology has not been demonstrated to work in laboratory animals. Even if the rest of a person’s body could be revived after hundreds of years, the brain could not. Brain cells deteriorate within minutes after death, and any still viable when freezing begins would burst during the freezing process. Cryonics might be a suitable subject for scientific research, but marketing an unproven method to the public is quackery. National Council Against Health Fraud founder William T. Jarvis, Ph.D., calls cryonics “quackery’s last shot at you.”52 suMMarY The burden of death may be eased by understanding the emotions involved and planning ahead to deal with various issues that pertain to dying. The need to prepare for death has become more pressing because machines often can keep a dying, permanently unconscious patient alive, sometimes indefinitely. An advance directive can help people control what care they receive if terminally ill. Hospice care provides another way to reduce suffer- ing for patients with a terminal illness. The technology and success rates of organ transplan- tation have improved greatly during recent years, but the cost is high and there is a serious shortage of available organs. The intensity and duration of grief and mourning depend on the nature of the relationship to the dying person and emotional makeup of the survivors. Most decisions about body disposition are made by people who are grieving and under time constraints, leaving them vulnerable to price-gouging and fraud. Many entrepreneurs have exploited fears and capital- ized on people’s wishes to prolong life and delay aging.