He doesn't sound angry. He smiles, nods encouragingly at long questions, toys with his horn-rim glasses.
Even his words don't sound particularly angry. It's just something in the energy, the way he hurls his facts at you, bombards you with figures. Dr. Robert N. Butler is a man who rages to tell what he has to tell all at once, all in one bristling sentence. For he knows we are running out of time.
"We have the mandate of a major corporation," says the director of the National Institute on Aging, "but the resources of a mom and pop country store."
The Population Revolution is here, he told a Gerontological Society convention recently. China's population has nearly doubled just since 1949. Already it spends a third of its gross national product on children's basic needs. What will it be like when those children get old? What will it be like in America when the wartime babies get old, in 2020?
In a period of retrenchment and stabilization -- "which is a nice word for stagnation" -- the era of "the politics of austerity," Butler is frantically calling for expansion, major reforms, new vision in geriatrics.
In his first year as the charter director of NIA, he took on 167 speaking dates.
"We need to have far more impact on the medical schools," he says. "They've been really negligent in dealing with treatment of the old. Forty percent of the people who come in contact with a doctor are older people, yet he isn't getting the special training for this that he should have."
The Pulitzer Prize-winning author remembers well the time when as an intern at Columbia he gave barbiturates to a man of 72, only to see him go on a wild rampage down the corridor. "The elderly can have radically different reactions to drugs from other people. In 1953 I hadn't been prepared for this. I hadn't been told."
Trying to set up geriatric training centers in America's 125 medical schools, NIA put out a query, got responses from 53 schools, gave funds to 11 top schools across the country.
"We have no coherent, rational system for policymaking," Butler told the 500 conventioneers who had made it to his 8:30 lecture. Railing at the "ramshackle, haphazard policies" on funding science, at the drop in American science financing even while Germany, France, Japan and Russia increased theirs, he asked scientists and science advocates, from individual congressmen to foundations, to join forces in creating a consensus on priorities.
At times his rapid-fire barrage seemed to be coming from several directions at once. For instance:
"The over-65s average five diseases apiece. It's an exciting field, but we've brainwashed ourselves into thinking it's more interesting to work with the young."
"Medicare and other health-care programs are designed for people of 35. Most of the problems of the aged aren't covered. Yet 55 to 57 cents on every U.S. dollar relates to geriatrics."
"In the next few years Alzheimer's disease [a form of senility] will be as famous as Downs' syndrome. It affects half the people now in nursing homes. It is a major cause of death. As many as 1.5 million people over 65 may have it."
"Fifty percent of all cancers are diagnosed after age 65, 80 percent after age 54. We must study what aging has to do with this increasing vulnerability to cancer."
An energetic 52 himself, the man who coined the term "ageism" gives off sparks when he contemplates the stereotyping of the elderly.
"Senility is not inevitable. It can be reversible if treated early enough.
After all, diseases of the body can influence the mind through oxygen and blood flow, supply of sugar to the brain and so forth."
The stereotypical notion that families abandon their elderly -- and therefore, according to some bureaucratic thinking, an increase in Medicare funds would only mean more abandonings -- is simply wrong, he said.
Half the people in nursing homes have no families. That's why they're there.
"If all we do is create an attitude of futility about the old, we'll never get new people into the field." He wants students to see more of the old, hence the NIA geriatric centers in medical schools.
Dr. Butler's own experience with older people dates back to his infancy, when his parents separated and he was sent to live with his grandparents on a New Jersey farm.
"My grandfather, then in his 70s, was a gentleman chicken farmer," Butler writes in his Pulitzer Prize book "Why Survive?: Being Old in America." The grandfather, Robert's close friend and teacher, "disappeared suddenly when I was 7....Why? Why had he died? Why did people die? There was no talk, no funeral, only a protective silence that was more confusing than shared sorrow."
During the Depression, Robert lived with his grandmother. They lost the farm and went on relief, "eating government-surplus foods out of cans with stigmatizing white labels." Later he sold newspapers and fixed bicycles. w
"Experiencing at first hand an older person's struggle to survive, I was myself helped to survive as well."
Butler went on to Columbia and Langley Porter Clinic in Berkeley, worked for the National Institute of Mental Health as a research psychiatrist in the '50s before founding Chestnut Lodge's geriatric unit. He has three children by his first marriage; he married again in 1975.
One longstanding interest is ballet, for his mother danced with the Albertina Rasch Ballet. Now 75, she lives in Washington.
"A stunning woman," he said. "The picture of health and vigor."
Dr. Butler was a founder of the National Ballet of Washington and served on its board until it was disbanded in 1972.
Again this year, as he has at other society conventions, Butler met informally with students. It is becoming a tradition. He told them that while the Institute on Aging has only been operating as an entity for about four years, it has been part of NIH since 1940, when a farsighted private foundation actually gave a $10,000 grant to the federal government for geriatric studies. NIA's budget has risen from $15 million to $70 million under Butler.
And things are beginning to happen. Private day-care centers for the aged, such as San Francisco's community-based On Lok and the Minneapolis day-care operation, are being put in touch with each other. There are some 5,000 senior centers in the country.
A modest 22-year-old study of diet and how it changes from age 16 to 102 is being conducted in Baltimore and monitored by NIA.
There are new studies of bone softening in the aged, of exercise and memory slippage, often exaggerated by the anxious middle-aged. And on Dec. 4 ground will be broken for a $24-million nutrition center at Tufts University, funded by NIA and the Department of Agriculture.
"There's so much we don't know," says Butler. It is one of his themes. Just in passing, almost as a memo to himself, he noted that trace metals in the body, especially aluminum, may have something to do with senility. A lifework waiting for someone to take it up . . .
Also in passing, because it is so much a part of his life, he mentioned the worst stereotype of all: that old people are sick, feeble, deranged and generally a drag.
"Only 5 percent of America's aged are in nursing homes," he said. "Only one in five will ever have anything to do with a nursing home."
Which means of course that the other 95 percent are not sick, not feeble, not deranged and no more a drag than anybody else.
Butler was introduced at the convention by University of Michigan research psychologist Wilma Donohue. She turned 79 a week later.