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After Words


1998: 'Successful Aging'

John Rowe is used to having his work go unread by the general public. The author or co-author of more than 200 journal articles, book chapters, and reviews, Rowe has been a prolific and highly regarded researcher in the field of gerontology.

But his work has mostly been read by other scientists. If he was known to the public, it was as the president of Mount Sinai Hospital in New York City, a position he has held since 1988.

So he was surprised when his 1998 book Successful Aging (co-written with Robert Kahn of the University of Michigan) struck a nerve with nonscientists.

"I thought when I wrote the book that my mother would be the only one to read it," he says. "But it's in its 11th printing."

Based on more than 14 years and $10 million of research by an interdisciplinary team assembled by Rowe and financed by the John D. and Catherine T. MacArthur Foundation, the book analyzes the latest findings about aging and uses those results to refute many of the common misconceptions about what it means to be old.

The book has been widely praised by critics and medical writers.

Jane Brody of The New York Times devoted two of her weekly health columns to the book. Successful Aging "is a highly readable, myth-shattering treatise directed at people of all ages who are interested in achieving the goal for humanity established by the ancient Greeks--to die young, as late in life as possible," Brody wrote last summer.

The book was featured by bookseller Barnes & Noble as a recommended gift at Christmas.

And, almost a year after its publication, Rowe and Kahn continue to appear on national media such as ABC's Good Morning, America and CNN.

What's behind all the hoopla?

Rowe, the scientist, is at a loss.

"This is my first book like this," he says.

But Rowe says reviewers tell him they're impressed with the book's grounding in scientific research in a publishing niche that is rife with simplistic panaceas that are little more than modern versions of traveling medicine shows.

"I asked Jane Brody why she liked the book so much and she said, 'I receive a hundred books a week, but yours was the only one with 45 pages of references.'"

The book is based on the work of 16 scientists who looked at issues of aging from biological, sociological, and psychological perspectives. The project came about in 1984, when the MacArthur Foundation approached Rowe, who was then a professor of gerontology at the Harvard School of Medicine, about leading a team of scholars to investigate a "new gerontology."

Up until then, most studies of aging looked at the loss of function commonly associated with age and the debilitation brought on by disease, rather than focusing on preventing disease so that people can live healthier as well as longer.

Defining "successful aging" as a three-part goal--1) enjoying a low risk of disease and disease-related disability, 2) retaining high mental and physical function, and 3) maintaining an active engagement with life--the authors came to some surprising conclusions.

The first is that aging well is largely something each individual can control by exercising more, dropping bad habits (particularly smoking), and eating a well-balanced diet.

"We are responsible, in large part, for our own old age," Rowe says. "It's not genetically determined. The body is not resistant to change."

The other major finding was the important role psychological and social influences play. People with a high sense of self-esteem--the sense that they can do things for themselves--and those who have strong social support networks on average age more successfully than people who score low in those categories.

"We looked at all sorts of biological possibilities--blood tests, urine tests, hormones--and they all washed out, they didn't have an impact," Rowe says. "Self-esteem was the big influence.

"And that, I think, shows the value of an interdisciplinary approach," he says. "It wasn't just a bunch of biologists looking at this. If we'd all been biologists, we wouldn't have discovered the effect of self-esteem."

The year 1998 also was busy for Rowe in his role as chief administrator for Mount Sinai. The hospital and its medical school merged with the New York University Medical Center, making Rowe the chief executive officer of Mount Sinai­NYU Medical Center and Health System and president of the Mount Sinai School of Medicine. The merger created an organization with an annual budget of about $1.6 billion and more than 20,000 employees.

Rowe says combining the staffs of two major medical centers was bound to create some friction, but has generally gone well.

On the business side, many operations of the two centers have been combined, but Rowe has tried to ensure that the way each hospital deals with patients is treated with a little tender loving care.

"We want to be careful on the clinical side not to create one, huge, homogeneous institution," he says. "I think it's very important to preserve the style, the feel, and the atmosphere of each institution as much as we can."

1970: Questioning Everything

The focus on the patient that Rowe speaks of is something he learned while at the School of Medicine and Dentistry, he says--crediting the Rochester faculty with teaching him the value of the personal touch: "They really taught us to listen to the patient."

Paul Griner '59M (MD), a former professor of medicine and who is now vice president of the Association of American Medical Colleges, recalls Rowe as bright, creative, and questioning.

"I remember Jack Rowe as a particularly enthusiastic, curious student who was reluctant to accept pronouncements as dogma unless they were supported by scientific evidence of validity," Griner says.

William Peck '60M (MD), who is now executive vice chancellor for medical affairs at Washington University in St. Louis, also remembers Rowe as "remarkably poised and articulate."

"He had the confidence and knowledge to challenge the faculty with probing questions," Peck affirms.

Scott Hauser

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