Sarkisian and Lachs [1] propose forsaking the concept of geriatric failure to thrive in medical practice. The authors see no difference between this concept and the concept of "naturalness of death," in which aging in very elderly persons is viewed as terminal decline, much the same as any decline during any terminal condition [1]. The authors also suggest that depression can be confused with the symptom complex of failure to thrive. Although anorexia and weight loss are common in both conditions, depression may or may not be a part of the latter syndrome. More important, many other reversible conditions should be considered in the differential diagnosis, but natural aging cannot be accepted as a biological basis for failure to thrive [2]. The theory of naturalness of death requires an acceptance of the conclusion that physical and cognitive decline and death are inevitable, no matter how lucky we are. Thus, to apply a bioscientific medical approach for the care of people 80 years of age and older is ultimately a "wasteful use of limited resources" [3].

The idea of naturalness of death at a certain age is not new. At the end of the 19th century, however, age 55 to 60 years was considered the time for natural death. At the beginning of this century, Elli Metchnikoff, one of the founding fathers of clinical gerontology and Nobel prize winner, conceptualized that the dreadful four "Ds" of geriatrics-decline, deterioration, dementia, and death-are not a part of normal aging; he proclaimed death at age 60 as an "enemy" of medicine [4]. At that time, this view was considered heretical and unrealistically optimistic. Since then, there has been an explosion in studies on normal and pathologic aging. The latest study on cognitive and functional status of the normal oldest old (85 to 99 years of age) showed that the patients had difficulty in performing various neuropsychological tests; however, overall functional ability was not impaired and was similar to that of persons 65 to 84 years of age [5].

Many clinical conditions could be responsible for failure to thrive. When these conditions are promptly recognized and treated, the "failure to thrive" condition reverses, and physical and social functions subsequently improve and stabilize. Many experienced geriatricians have witnessed these gratifying outcomes on numerous occasions. The goal of the academic medical community is to provide a solid scientific underpinning to these observations, not to dismiss them.