An interesting, but somewhat depressing look at the upcoming crisis in geriatrics, over at the New Yorker.

What struck me about it was the assumption that the decline is inevitable, and that we have to focus on managing it, when in fact we need to put a lot more effort into technologies that can stop aging, and even reverse it. The assumption is that living too long is a problem, and it is, if we don't figure out how to maintain and restore the ability of the body to repair itself.

[Via Alan Boyle]

Rand,

For an alternative view of the problem of aging, see the Fight Aging! website: http://www.fightaging.org/.

in fact we need to put a lot more effort into technologies that can stop aging, and even reverse it.

Why? I'm not being a smart-ass, Rand, the question deserves serious thought. Society has limited resources. Should we really devote so much of them to trying to stave off death? Maybe it's not such a bad idea to devote them to making the life we already have -- which is clearly near the limit established by our genes -- a lot nicer, more productive, et cetera.

If I had to choose between dying at 85 versus 80, or having my children lead far happier and productive lives, I'd go for the latter.

Heck, if I had to choose between lingering on, bedbound and in pain, from 70 to 85, versus being able to climb mountains and boff young women right up until 75, at which point I drop dead, I'd go for the shorter but more enjoyable life.

Society has limited resources. Should we really devote so much of them to trying to stave off death?

Well, we're currently devoting a lot of them to keeping many people alive, and miserable. Why not instead devote them to keeping people alive, and productive?

Or are you proposing that we simply euthanize them?

Why not instead devote them to keeping people alive, and productive?

I thought that was the point of the article: if you have to choose -- and economics say usually we do -- then choose to keep people happy and productive, and don't just see extending life as the goal that trumps all others. It sounded like you were saying phooey on this quality of life stuff (what you called "managing the decline"), we need to shift those resources into dying as late as possible ("stopping aging"). That seems to value life, any life, as more important than the quality of life. With which I'd disagree, along with the "300", I guess.

But on reflection, maybe you're saying something else. Maybe you're saying all this effort on managing symptoms (walkers, cataract surgery, hip-replacement) is just pruning the leaves of the problem, we need to get to the root, find the biochemical intervention that prevents aging from the cells on up.

I wouldn't disagree with that. It would be wise to try to do so, even if resources need to be shifted away from amelioration and treatment. But the reason they're not is the same reason we spend way more on treating advanced heart disease, prolonging people's lives 6 months, than we do on preventing heart disease in the first place, e.g. by discovering the cellular mechanisms that lead to plaque formation and designing very early therapeutic interventions.

That reason is the same reason people worry most about hurricanes when the wind picks up sharply, not when they're pricing beachfront property. Human beings don't accurately forecast future risk. We're not evolved to, not with a lifespan "in the wild" of 20-30 years.

The big demand for treatment resources happens after your first heart attack. Few do anything in their 20s and 30s to prevent heart disease, and there's not much complaining if funds to study the disease before it ever gets started are quietly cut off, and shifted to artificial-heart or transplant work. There's just not much natural constituency for methods that only work when you're young and healthy.

For that matter, we could progress even more efficiently by just working on understanding the genetic basis for a susceptibility to degenerative changes and how to alter those genes in embryos, before birth. That would be the cheapest and most effective intervention. But the natural constituency for methods that only work before you're more than a ball of cells is pretty much nobody at all.

You half get it, Carl. My point was that we should be looking at technologies that not only retard or halt aging, but reverse it. You think there's no constituency for that?

Carl,

Rand is right. We are talking about reversing and eliminating the aging process itself. We are not talking about just prolonging life with the current band-aid fixes that allow people to live a few months longer but not curing the underelying condition.

Your misconception about life extension is a very common one and is the sigle greatest impediment to wide-spread support of anti-aging medicine.

I recommend that you check out the SENS website at www.sens.org. I especially recommend checking out www.sens.org/concerns.htm. This will answer your questions.

My point was that we should be looking at technologies that not only retard or halt aging, but reverse it.

Well now this makes even less sense to me. How the heck do we make this distinction? And why would we?

Say I'm working on heart disease, and I find some promising therapy to influence plaque formation. Does it make any sense to try to carefully define whether I'm working on "retarding," "halting," or "reversing" aging? I don't see how I could, or why I would. Should I say that if my therapy only retards or halts the growth of old plaque, and prevents formation of new plaque, then I'm retarding or halting aging, but if it actually eliminates existing plaque, then I'm reversing aging? Even if I could measure this -- and biochemistry is rarely so clear-cut -- I don't see why it's useful. It doesn't change the way I do the research, at all.

Any therapy that has beneficial effects on degeneration is going to be pushed to its maximum possible benefit by research. No one is going to put the brakes on at some point and say, oh wait, our mandate here is merely to halt aging, if we go further we'll be reversing aging and we don't want to do that. If you've got a therapy that looks like it can help people not lose muscle mass as they age, you'll try to push it as far as possible, if possible to the point where, if people have already lost mass, it will help them regain it. You're not going to stop with maintaining the status quo if you can go further. Why would you?

If you're suggesting there is some quantifiable difference in how you do research into therapies to reverse aging versus merely stop it, I'd like to hear it defined. I can't imagine one.

Mind you, there is a quantifiable difference in how you do research if your goal is preventing aging. In this case, you are willing to study therapies that will only work before aging has seriously begun, e.g. in the womb or before adulth0od. There's no point in such therapies for people who are already well into the aging process.

Which is why maybe I'm saying the polar opposite of you: I think we're already overinvested in research directed at people who are already experiencing the ravages of age. We should spend more resources on trying to prevent aging from even beginning in people who haven't experienced it yet, i.e. our youth and those not yet born. That's because this is a far more target-rich field. The chances that we can induce profound changes with cheap therapies are much higher if we start tinkering with the genes.

Heck, if we could just figure out how to fix BRCA1 and BRCA2 mutations in utero, we'd cut breast cancer rates by 25-50%, bang. Fix the ApoE mutations, reduce heart disease. Find out why certain subpopulations have sky-high HDL levels that seem to totally protect them against atherosclerosis -- these people exist, we've identified them -- and learn to give that genetic heritage to everyone, and we could make heart attacks in your 50s and 60s as rare as deaths from bubonic plague. Et cetera.

But of course, none of this stuff will work for people who already are undergoing chemo or angioplasty. And those folks are, indeed, those who are willing to pay big bucks to support research. Those in their teens and who are not yet born can't pay very much at all.