Wednesday, July 23, 2008

BMJ Articles on Tackling Aging (Update)

As I noted 2 weeks ago, my latest paper on tackling aging come out in the BMJ. And this was the first time I have been contacted by media to talk about something I have published. And so the past two weeks have been very interesting in terms of opening my eyes even further to the challenges longevity science faces. So I thought I would write down a couple of these thoughts and reflections here.

Firstly, support for legitimate longevity science is hampered by the vast number of products currently being sold as "anti-aging" therapies without any science to substantiate their claims. See here, for example. And thus one has to be very careful when convincing people that (1) aging is something that ought to be retarded (as it increases our risks of morbidity and mortality); and yet at the same time convince them that (2) we might actually be able to slow human aging and yet (3) none of the current products being sold on the market have been demonstrated to do this (indeed, they might be harmful). The latter point is emphasized, for example, in this excellent piece in the Scientific American by Jay Olshansky, Leonard Hayflick and Bruce A. Carnes.

Now if one is pressing (as indeed I am) (1) and (2), it is of course understandable that people will be want to do something about aging (and thus be tempted to violate (3)). But when asked "So what can I do to slow aging?" my response is "(a) support increasing the amount of public funding we invest in the biology of aging and (b) encourage linkages between different fields of research-- from genetics and evolutionary biology to engineering and statistics". Well, as you can imagine, many people will find that answer rather flat! They want the solution and they want it now (today)! The same is true about climate change. Few people have an interest in being told the best solution is investing in new R&D and might be long-term. Patience never was a human virtue. But Rome wasn't build in a day.

Now with regards to retarding human aging (unlike climate change), the time-frame for success might actually be a decade or two. Recall my previous post here, that the first anti-aging molecule will be tested in humans this year. Things are moving fast. So while people need to be convinced of (1) and (2), we also need to caution them about trying to find solutions in the wrong places (turning to "alternative" medicine). Otherwise more and more money will be wasted on inefficacious products rather than on basic scientific research. And so reviving our optimism for scientific research is extremely important when it comes to longevity science.

Another issue that arose from some interviews concerns healthy lifestyle. One interviewer asked me what I do to stay healthy. And I responded that "I exercise, watch what I eat, I don't smoke, and limit my consumption of alcohol". Of course this is then appears in print as things I do to "slow my own aging", and only until a longevity pill is created. Of course I did not say that. Healthy lifestyle does reduce the risk of disease but there is no basis for saying it actually modifies the processes of aging. Calorie restriction does, but I would not recommend any person pursue that severe lifestyle as a means of extending their health span. Healthy lifestyle is very important (as I have noted many times here, here and here), and it would not be replaced by the creation of a longevity pill. But the latter may also prove to be a very effective way of delaying and preventing the diseases of aging. And so, like exercise and diet, it should be part of the strategy of preventative medicine.

And finally, the BMJ has a "Rapid Response" feature which permits readers to comment on articles. And the response I received is one I often encounter when I talk about the aspiration to retard human aging. Surprisingly the comment is from a GP, who says:

"I don't understand the claim made that we cannot afford NOT to tackle ageing. The logical outcome of the 'advances' trumpeted by Colin Farrelly would surely be extension of active life and corresponding high consumption by wealthy populations with their high carbon footprint - at the expense of the poor - with a postponement of all the problems that beset old age at whatever time it occurs. There would be just the same burden of dementia, degenerative disease etc., just a few years later. What would be the net contribution of this change to overall welfare?"

Today I downloaded my response to this comment which I hope will appear on the website tomorrow. But the points raised by this comment clearly illustrate the immense challenges facing those (like myself) who want to convince people that keeping people healthy for longer is a good (not bad) thing. Unfortunately many people believe we would be doing the world a favour by dying sooner rather than later! And I must admit that proposition strikes me as absurd, especially coming from a GP who is charged with caring for their patients. Here is my response to the comment:

Thanks for your rapid response asking “Why slow aging?”.
A few comments pertaining to your concerns about extending the healthy lives of, as you put it, “wealthy consumers”.

(1) As you are a GP, I hope you do not see expanding the health prospects of your patients as something that comes “at the expense of the poor” and thus something contributing nothing to overall welfare. By this logic doctors in the developed world ought to deny *all* medical treatment to their patients so that their patients die as soon as possible, thus minimizing their carbon imprint! And I find it hard to think of a more perverse opinion for a GP to hold. People in the developed world are human beings (not just “consumers”), and thus they do not deserve disease or death.

(2) why assume slowing aging would only benefit those in the wealthiest countries? Many developing countries are aging the fastest. And the aged in poorer countries will be even more vulnerable to the disadvantages of senescence. And so slowing aging would also expand (not harm) the health opportunities for those in developing countries.

(3) You claim that retarding aging would simply postpone “all the problems that beset old age”. There are two things to say about this.

Firstly, there is good reason to believe that slowing aging would also compress morbidity and mortality. Longevity scientist David Sinclear nicely summarised the aspirations of this research in a recent interview in the journal Rejuvenation Research. Sinclear claims:

“My stated goal is to keep people out of nursing homes for as long as possible. It is known that the longer a person lives, the shorter the period of his or her chronic disability or illness. People who live a very long time die relatively quickly. Thus, the goal would be to reach 90 years of age, feel well, still be a productive member of society, be able to play tennis, and see your grandchildren graduate from college. Then, in a matter of weeks, go through the final stages of life and die. In that way we would suffer less and be less of a burden on our families and society.”

Secondly, even if slowing aging merely delayed the problems of old age, it would still be a significant and laudable accomplishment. This is so because it would increase the number of healthy years we can expect to live. All else being equal, it is better to suffer disease and death later in life than earlier. We wouldn’t abandon medical research for early onset diseases like CF just because, eventually, these patients would suffer age-related diseases like cancer or heart disease.

No medical intervention can achieve more than a delay of death and disease. A cure for cancer would not stop the people who would have died of cancer from dying or suffering from heart disease, Alzheimer’s, diabetes, etc. And so the value of slowing aging should be measured by its likely impact on our health prospects. Contrary to respondent, I believe slowing aging has the potential to result in a significant improvement to overall welfare.