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[BMJ圣诞专刊]:预测漫威电影宇宙中超级英雄的衰老轨迹
2021年12月31日 时讯速递, 进展交流 暂无评论

Feature Christmas 2021: What if . . . ?

Anticipating the ageing trajectories of superheroes in the Marvel cinematic universe

Sarah T Fox, Natasha Reid, Ida Tornvall, et al

BMJ 2021; 375 doi: https://doi.org/10.1136/bmj-2021-068001 (Published 13 December 2021)Cite this as: BMJ 2021;375:e068001

Ruth Hubbard and colleagues examine the personal traits and health behaviours of five of Marvel's superheroes and envisage the challenges this extraordinary cohort might experience during ageing

Old age can be a time of great contentment, increased wisdom, and personal growth.1 In healthy ageing, functional ability is developed and maintained and enables wellbeing in older age.2 Environmental and socioeconomic setting determine ageing trajectories at a population level, but evidence from large longitudinal studies also highlights the importance of individual factors. Some of these, such as genetics, are fixed, yet others are potentially modifiable.

Superheroes are a remarkable cohort whose distinct powers, personalities, behaviours, and life events have been documented in films. Most attention focuses on their superpowers and outstanding natural abilities, rather than their ageing. It is likely that superheroes might have longevity that substantially outlasts most people. Excluding outliers (Spiderman, who recently graduated from high school, and Thor, who has lived for several millennia), most of the superheroes are estimated to be aged between 30 and 55 years. It is therefore timely for us to reflect on their health status and associations with ageing trajectories and outcomes. We examine their collective health assets and risks as a group. We also examine the personal traits and health behaviours of five of the superheroes. Our “method” is outlined in box 1, and, to avoid plot spoilers, a future is envisaged in which all superheroes survive to old age.Box 1

“Method”

Search: Audio-visual material was reviewed by all authors (range 8 hours to >50 hours per author) at home or in cinemas in Australia, with concentrated periods of study during lockdown in 2020 and 2021.

Inclusion and exclusion: 24 Marvel movies released between 2008 (Iron Man) and 2021 (Black Widow) were included. We selected five superheroes for case studies because they are well known, demonstrate notable characteristics, are reasonably diverse, and are representative of the broader superhero population with regard to age, sex, ethnicity, and super powers. The powers of the superheroes were not considered as conferring or compromising health because they have not been explored in studies of healthy ageing to date.

Limitations: We have assumed that (with the exception of Thor) superheroes will age and that their individual ageing trajectories will be modifiable by personal traits in much the same way as anyone else’s. The long term effects of being involuntarily teleported to a quantum realm for several years (a life event that many of the Marvel superheroes have experienced) could not be corroborated in animal or human studies, and thus such effects were not considered.RETURN TO TEXT

Positive behaviours and health assets

Marvel superheroes are physically active, socially engaged, and optimistic, with high educational attainment and (with one notable exception) healthy weight, all of which have been associated with a positive ageing trajectory.

Activity—superheroes regularly engage in physical activity and exercise, both associated with healthy ageing.34They often undertake high intensity interval training (HIIT), which has been linked with improved health status in ageing men.5

“Higher, further, faster, baby” Captain Marvel

Even during discussions about how to stop aliens from enslaving humanity, superheroes stand regularly and pace, increasing their step count and reducing sedentary behaviour, which should put them in good stead for reducing their mortality.678

“I can do this all day” Captain America

Social engagement—superheroes exhibit a high degree of social cohesion and connectedness, both associated with a reduced risk of dementia.910 People with strong social ties tend to live longer than isolated people, regardless of other risk factors such as smoking, alcohol consumption, and physical activity.11

"We are Groot” Groot 

Mindset and intelligence—On multiple occasions the superheroes show a positive or optimistic mindset, as well as psychological resilience and a sense of purpose, all of which have been associated with healthy ageing.1213

“I choose to run towards my problems and not away from them. Because that’s what heroes do” Thor Odinson

With the exception of Thor (whose ageing trajectory will be affected by his immortality), most superheroes do not drink heavily or smoke (Iron Man, who is observed to binge drink, is an exception). Avoiding smoking and limiting alcohol consumption have been associated with longevity and healthy ageing.14151617

Negative behaviours and risk factors

Superheroes are exposed to loud noises, air pollution, and receive multiple head injuries precipitated by high risk physical activities.

Noise—superheroes are repeatedly in close proximity to interplanetary collisions and explosions. Exposure to loud noises during military combat has been associated with hearing loss,18 which in turn is linked to an increased risk of cognitive impairment and dementia.19 Some of the superheroes, such as Hulk and Thor, have booming voices, potentially indicative of early sensorineural hearing loss.

Physical injuries—superheroes sustain multiple major head injuries, so their risk for dementia would be increased.202122 They also participate in high risk activities, which could increase their likelihood for life changing physical injury and disability.

“OMG. That was really violent” Pepper Potts

Case studies: superhero health checks

We gave a “superhero health check” to Iron Man, Hulk, Black Widow, Black Panther, and Spiderman. These characters could not be contacted for interview; nor were they available to provide consent. The data used, however, is available to view publicly, so their consent was implied. Identifying data could not be removed.

Iron Man (Tony Stark)

“Genius, billionaire, playboy, philanthropist.” Tony Stark

Health assets—Tony Stark (Iron Man) is extremely wealthy, which places him in a high socioeconomic position. This, along with his superior intelligence (he graduated from university at 17), puts him at reduced risk of dementia.2324 Iron Man’s urban lifestyle with ready access to excellent healthcare and his (eventual) marriage to Pepper Potts are additional positive drivers for a healthy ageing trajectory.2526

Health risks—The electromagnet and refined arc reactor in Iron Man’s armour prevent his premature death. It is, however, difficult to ascertain whether Iron Man’s advantageous lifestyle factors can counteract his multiple physical injuries and post-traumatic stress disorder. It is also unclear whether his armour offers sufficient protection from gravitational shifts and exposure to radiation during his occasional forays into space. If not, Iron Man is likely to experience accelerated bone loss and a substantial increased risk of malignancy.272829 His most concerning characteristic is chronic heart disease, and, not fitting neatly into categories such as heart failure or cardiovascular disease, its impact on death rate and the ageing trajectory is difficult to predict.303132

Hulk (Bruce Banner)

Health assets—No specific health assets were identified that distinguished Hulk from the cohort

Health risks—Bruce Banner transforms to the Hulk when he experiences tachycardia—specifically, a heart rate of 200 beats per minute. That this happens often suggests a predisposition to cardiac arrhythmias, which might indicate underlying cardiac disease. Atrial fibrillation, the most common atrial arrhythmia, is strongly associated with an increased risk of stroke and dementia as well as overall death rate.33343536 Symptomatic atrial fibrillation (Hulk certainly seems symptomatic) is associated with reduced functional status and health related quality of life.373839

Hulk’s body mass index (BMI) is around 120 (calculated from height 213 cm to 243 cm and weight 471 kg to 635 kg). Although being in the overweight category might be protective, obesity is associated with a higher death rate as well as dementia, and several chronic health conditions404142 and frailty.43 Hulk’s BMI also raises pragmatic concerns around future access to appropriate healthcare, in terms of health service preparedness with specialist bariatric expertise, knowledge, and equipment.44 Of further concern, Hulk seems to experience almost constant anger (“That’s my secret Captain. I’m always angry”), which might lead to increased inflammation and comorbidity in advanced old age.45

Black Widow (Natasha Romanoff)

"My mom abandoned me in the street like garbage”

Health assets—No specific health assets were identified that distinguished Black Widow from the cohort

Health risks—Natasha Romanoff (Black Widow) was taken from her family to train as an assassin and spy and exposed to adverse childhood experiences, including abuse, neglect, and interpersonal conflict. These exposures increase her risk of physical and mental illnesses with ageing because of alterations in physiological development and the adoption of damaging health related behaviours.46474849 Black Widow was forcibly sterilised, and the resulting abrupt cessation of ovarian function at a young age has been linked to diseases, including osteoporosis, cardiovascular disease, dementia, and depression.50 Although it is possible that the Black Widow underwent hysterectomy without oophorectomy, nulliparity is associated with adverse outcomes, including higher all cause death rate.51

Black Panther (T’Challa)

Health assets—The kingdom of Wakanda is the most economically and technologically developed country in the world, thanks to the metal vibranium. As sovereign, T’Challa (Black Panther) is in a privileged position. His socioeconomic status, as evidenced by educational attainment and wealth, is associated with healthy ageing and longevity, as is living in a wealthy country.232452

Black Panther is vegetarian. Plant based diets are associated with healthy ageing and reduced obesity and cardiometabolic diseases.5354

If you say one more word, I’ll feed you to my children! . . . I’m kidding. We’re vegetarians.” M’Baku, Black Panther’s brother

Health risks—Black Panther consumed a potion made from a heart shaped herb, which improved his physical and mental abilities and gave him his superpowers. Adverse effects from this herb and its impact on the ageing profile are unknown, although performance enhancing drugs in general are linked to increased death rate and a variety of adverse health effects and reduced quality of life.5556

Spiderman (Peter Parker)

Health assets—Peter Parker (Spiderman) is an orphan. Early parental loss has been associated with a host of detrimental outcomes, including substance misuse and eating disorders, reduced psychological wellbeing, and poorer self-rated health.5758 Spiderman’s nurturing relationship with his aunt May, however, and the availability of positive male role models among the other superheroes could be protective, mitigating some of these negative outcomes.59

Alright kid. You’re an Avenger now” Tony Stark to Peter Parker

Furthermore, Spiderman’s spider related abilities, including strength, flexibility, and agility, should reduce his risk of falls in old age.

Health risks—With much of Spiderman’s crime fighting occurring at night, he is not likely to be getting the recommended 8-10 hours of sleep for teenagers of his age.60 Poor sleep in adolescence can lead to obesity, lower mental health, higher levels of pain and fatigue, and higher incidents of unintentional injuries.61

The future of superheroes

To date, the Marvel superheroes’ combined efforts focus on matters such as maintaining the safety of the multiverse, the modulation of human consciousness, the creation of artificial intelligence, and the development of technology to facilitate space travel. We suggest they move their focus to dealing with challenges, such as how to provide high quality health and social care across large, ageing populations and preventing frailty and dementia. This would enable people across the multiverse, including superheroes, to experience high quality of life in older age.

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