Osteoporosis and risk of fracture: reference class problems are real

Slowing down decay: biological clocks in personalized medicine

This article discusses so-called biological clocks. These technologies, based on aging biomarkers, trace and measure molecular changes in order to monitor individuals' "true" biological age against their chronological age. Drawing on the concept of decay, and building on ethnographic fieldwork in an academic laboratory and a commercial firm, we analyze the implications of the development and commercialization of biological clocks that can identify when decay is "out of tempo." We show how the building of biological clocks rests on particular forms of knowing decay: In the academic laboratory, researchers focus on endo-processes of decay that are internal to the person, but when the technology moves to the market, the focus shifts as staff bracket decay as exo-processes, which are seen as resulting from a person's lifestyle. As the technology of biological clocks travels from the laboratory to the market of online testing of the consumer's biological age, we observe shifting visions of aging: from an inevitable trajectory of decline to a malleable and plastic one. While decay is an inevitable trajectory starting at birth and ending with death, the commercialization of biological clocks points to ways of stretching time between birth and death as individuals "optimize" their biological age through lifestyle changes. Regardless of admitted uncertainties about what is measured and the connection between maintenance and future health outcomes, the aging person is made responsible for their decaying body and for enacting maintenance to slow down decay. We show how the biological clock's way of "knowing" decay turns aging and its maintenance into a life-long concern and highlight the normative implications of framing decay as malleable and in need of intervention.