Is there any evidence that more old people will make special contributions now lacking with an average life expectancy close to 80? I am flattered, at my age, by the commonplace that the years bring us wisdom — but I have not noticed much of it in myself or my peers. If we weren’t especially wise earlier in life, we are not likely to be that way later.
I have often been struck, at funerals of the elderly, of the common phrase that while the deceased will be missed, he or she led a “full life.” Adding years to a life doesn’t necessarily make it any fuller.
We may properly hope that scientific advances help ensure, with ever greater reliability, that young people manage to become old people. We are not, however, obliged to help the old become indefinitely older. Indeed, our duty may be just the reverse: to let death have its day.
On Dying After Your Time
by Daniel Callahan
http://www.nytimes.com/2013/12/01/opinion/sunday/on-dying-after-your-time.html?
This fall Google announced that it would venture into territory far removed from Internet search. Through a new company, Calico, it will be “tackling” the “challenge” of aging.
The announcement, though, was vague about what exactly the challenge is and how exactly Google means to tackle it. Calico may, with the aid of Big Data, simply intensify present efforts to treat the usual chronic diseases that afflict the elderly, like cancer, heart disease and Alzheimer’s. But there is a more ambitious possibility: to “treat” the aging process itself, in an attempt to slow it.
Of course, the dream of beating back time is an old one. Shakespeare had King Lear lament the tortures of aging, while the myth of Ponce de Leon’s Fountain of Youth in Florida and the eternal life of the Struldbrugs in “Gulliver’s Travels” both fed the notion of overcoming aging.
For some scientists, recent anti-aging research — on gene therapy, body-part replacement by regeneration and nanotechnology for repairing aging cells — has breathed new life into this dream. Optimists about average life expectancy’s surpassing 100 years in the coming century, like James W. Vaupel, the founder and director of the Max Planck Institute for Demographic Research in Germany, cite promising animal studies in which the lives of mice have been extended through genetic manipulation and low-calorie diets. They also point to the many life-extending medical advances of the past century as precedents, with no end in sight, and note that average life expectancy in the United States has long been rising, from 47.3 in 1900 to 78.7 in 2010. Others are less sanguine. S. Jay Olshansky, a research associate at the Center on Aging at the University of Chicago, has pointed out that sharp reductions in infant mortality explain most of that rise. Even if some people lived well into old age, the death of 50 percent or more of infants and children for most of history kept the average life expectancy down. As those deaths fell drastically over the past century, life expectancy increased, helped by improvements in nutrition, a decline in infectious disease and advances in medicine. But there is no reason to think another sharp drop of that sort is in the cards.
Even if anti-aging research could give us radically longer lives someday, though, should we even be seeking them? Regardless of what science makes possible, or what individual people want, aging is a public issue with social consequences, and these must be thought through.
Consider how dire the cost projections for Medicare already are. In 2010 more than 40 million Americans were over 65. In 2030 there will be slightly more than 72 million, and in 2050 more than 83 million. The Congressional Budget Office has projected a rise of Medicare expenditures to 5.8 percent of gross domestic product in 2038 from 3.5 percent today, a burden often declared unsustainable.
MODERN medicine is very good at keeping elderly people with chronic diseases expensively alive. At 83, I’m a good example. I’m on oxygen at night for emphysema, and three years ago I needed a seven-hour emergency heart operation to save my life. Just 10 percent of the population — mainly the elderly — consumes about 80 percent of health care expenditures, primarily on expensive chronic illnesses and end-of-life costs. Historically, the longer lives that medical advances have given us have run exactly parallel to the increase in chronic illness and the explosion in costs. Can we possibly afford to live even longer — much less radically longer?
This rise in chronic illness should also give us pause about the idea, common to proponents of radical life extension, that we can slow aging in a way that leaves us in perfectly good health. As Dr. Olshansky has tartly observed, “The evolutionary theory of senescence can be stated as follows: while bodies are not designed to fail, neither are they designed for extended operation.” Nature itself seems to be resisting our efforts. (Swift’s Struldbrugs, it is often forgotten, had immortal life but with it all the afflictions of aging, and so were declared legally dead at 80.)
What’s more, an important and liberating part of modern life has been upward social and economic mobility. The old retire from work and their place is taken by the young. A society where the aged stay in place for many more years would surely throw that fruitful passing of the generations into chaos.
The fundamental difficulty here is that we cannot proceed in the usual way with this medical research, taking small steps, seeing the results and then, if they are positive, moving further. It will take decades for the changes in length of life to play out to allow assessment of their benefits and harms. By then it may be too late to reverse the damage. One likelihood, even in just a few years, is that older people who stay longer in the work force, as many are now forced to do, will close out opportunities for younger workers coming in.
And exactly what are the potential social benefits? Is there any evidence that more old people will make special contributions now lacking with an average life expectancy close to 80? I am flattered, at my age, by the commonplace that the years bring us wisdom — but I have not noticed much of it in myself or my peers. If we weren’t especially wise earlier in life, we are not likely to be that way later.
I have often been struck, at funerals of the elderly, of the common phrase that while the deceased will be missed, he or she led a “full life.” Adding years to a life doesn’t necessarily make it any fuller.
We may properly hope that scientific advances help ensure, with ever greater reliability, that young people manage to become old people. We are not, however, obliged to help the old become indefinitely older. Indeed, our duty may be just the reverse: to let death have its day.
When Life Goes On, and On …
http://www.nytimes.com/2013/12/05/opinion/when-life-goes-on-and-on.html
To the Editor:
Re “On Dying After Your Time,” by Daniel Callahan (Sunday Review, Dec. 1): Mainstream aging research neither promises radical immortality nor seeks to keep old people sick longer. Aging is a driving factor in the most prevalent and costly chronic diseases. Research indicates that interventions slowing aging delay the onset of these diseases. Therefore, they extend not only life span but also health span, the disease-free and functional period of life.
Fundamentally, the goals of aging research are not dissimilar from efforts to prevent or treat Alzheimer’s or other chronic diseases in that they both seek to improve quality of life in the elderly. The difference is that interventions in aging may prevent not just one but a range of debilitating diseases simultaneously.
The reality is that the world is rapidly getting older. With baby boomers leaving the work force, there won’t be enough workers to pay the ever-increasing Medicare costs of the retired. Extending health span will lower Medicare costs and allow aging people to stay engaged.
Interventions that slow human aging will provide a powerful modality of preventive medicine: improving quality of life by keeping people healthy and productive while also providing economic benefits for society.
BRIAN K. KENNEDY
President and Chief Executive
Buck Institute for Research on Aging
Novato, Calif., Dec. 2, 2013
To the Editor:
Daniel Callahan argues against trying to extend the human life span. His arguments are based on three fallacies: life extension will not be accompanied by good health; people of advanced age who continue to work will take jobs away from young people; and Medicare for those over 65 will become exorbitantly expensive.
First, there is no evidence that life extension will not be accompanied by good health. Indeed, medical advances increasingly provide better health to the elderly. The coming practice of personalized medicine, stem cell therapy and gene therapy will eventually convert many chronic conditions to curable acute conditions, vastly improving the lives of both the young and the old.
Rather than a case of senior citizens taking jobs away from younger people, there will be a larger population whose needs will require a larger work force. As for Medicare, coverage beginning at 65 will be an anachronism. If life extension approaches 100, it is not reasonable for Medicare coverage to begin before 80.
J. LESLIE GLICK
Tampa, Fla., Dec. 1, 2013
To the Editor:
Daniel Callahan’s essay about “dying after your time,” which includes my view, raises important questions about aging, health and longevity. Most have already been answered.
Medicare costs will rise as the population ages, but my and my colleagues’ research demonstrates that delayed aging would reduce health care costs in the United States by $7.1 trillion by 2060.
Postponing death by treating diseases only after they arise will lead to even more dire cost and health projections than those mentioned by Mr. Callahan. If “primary prevention” is the wave of health maintenance in the future, then delayed aging is prevention with a capital P because it would postpone all fatal and disabling diseases simultaneously.
Aging research offers the prospect of new ways to live longer more healthfully; life extension is not the goal.
Mr. Callahan’s concern about older people crowding out younger people for jobs is also unfounded. We saw warnings of this kind before when women began to join the work force. A result was that women added nearly $3 trillion to the economy, and businesses owned by women employ nearly 16 percent of the work force.
If health at any age is highly valued, then a healthier older population is worth its weight in gold. Aging science is likely to be the next revolution in public health; it should be embraced, not feared.
S. JAY OLSHANSKY
Chicago, Dec. 1, 2013
The writer is a professor of public health at the University of Illinois at Chicago.
To the Editor:
I applaud Daniel Callahan’s essay. I am pushing 86, and I’ve been a wife, mother, grandmother and great-grandmother. I have taught and studied, earning a Ph.D.
I have seen some of Asia and Africa and much of Europe and the United States and have experienced sublime art, music, drama, dance and great literature. I have cooked good food and eaten at three-star Michelin restaurants. What is the way ahead?
The medication for my Parkinson’s disease lowers my blood pressure, increasing instability and exhausting me. Will another fall break the other hip and switch me from a walker to a wheelchair? I cannot help with my great-grandson as I did with his father; I cannot hold him until I’m seated. The medication also increases the possibility of dementia.
My lupus prescription can with time worsen my macular degeneration. I’m too tired and too unstable, and I find it difficult to read a Times recipe to contribute to the family Thanksgiving meal without assistance.
What follows to make my full life fuller?
JEAN ULITZ MENSCH
New York, Dec. 2, 2013
To the Editor:
Anti-aging research is not, as Daniel Callahan apparently believes, about prolonging the wheelchair-and-walker phase of life but about preserving youthful health and vigor so that there will be far fewer of the elderly in poor health.
I’m always amazed at the number of people who vigorously support the search for better prevention and treatment of heart disease, cancer and Alzheimer’s but who find moral difficulties in the search for better prevention and treatment of those plus a host of other maladies, all simultaneously. That is what anti-aging research is about.
STEVEN N. AUSTAD
Boerne, Tex., Dec. 1, 2013
The writer is a professor at the Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center.