Monday, August 18, 2008

Public Health Ethics Paper on Aging Research

My paper entitled "Aging Research, Priorities and Aggregation" has been accepted for publication in the journal Public Health Ethics. Here is a sample from the paper:

Humans are intrinsically vulnerable to disease, disability and death. There are many distinct things that can jeopardize a person’s health prospects. From birth defects and poverty, to cancer and serious accidents, a diverse array of genetic and environmental hazards can increase the risk of morbidity and mortality. Because so many diverse factors influence the health prospects of both individuals and populations, it is often difficult to grasp the “big picture” in terms of the priorities and potential strategies we should pursue to expand the opportunities for healthy life.

One important, yet often neglected, risk factor is age. The older an adult gets, the greater their risk of morbidity and mortality...So the current situation is one where we invest very little in understanding the biological processes that cause the most prevalent diseases and yet we spend an exorbitant amount of money trying to treat each of the diverse afflictions that come with aging (e.g. cancer, Alzheimer’s, diabetes, etc.). To help redress this imbalance, the advocates of “The Longevity Dividend Campaign” (Olshansky et al 2006) have called on Congress to invest $3 billion dollars annually into understanding the biology of aging. That would amount to approximately 1% of the current Medicare budget.

What explains the current neglect of aging research? The answer to this important question is no doubt multifaceted and complex. In “Extending Life: Scientific Prospects and Political Obstacles” Richard Miller posits nine reasons for the current neglect of aging research. These range from scientific obstacles- like the time it takes to complete aging experiments in mammals- to political obstacles like the scarcity of lobbyists for basic aging research (compared to the lobbies for specific diseases like cancer or Alzheimer’s). One major obstacle that Miller specifically draws attention to as an impediment to manipulating longevity is what he calls “gerontologiphobia”. He describes this as follows:

There is an irrational public predisposition to regard research on specific late-life diseases as marvelous but to regard research on aging, and thus all late-life diseases together, as a public menace bound to produce a world filled with nonproductive, chronically disabled, unhappy senior citizens consuming more resources than they produce. No one who speaks in public about longevity research goes very far before encountering the widespread belief that research on extending the life span is unethical, because it will create a world with too many old people and not enough room for young folks. (Miller 2002, p. 170)

Given that many people see longevity science itself as unethical, it is not surprising that proposals to invest greater funding into tackling aging, rather than research on specific diseases, will likely be met with strong opposition and protests that this is unfair. For the latter proposal implicates the allocation of scarce resources, and thus it raises complex questions of distributive justice. Is it fair, the critic will ask, to divert resources dedicated to saving lives (e.g. with possible treatments for cancer, AD, etc.) to medical research that seeks to merely extend lives? Let us call this the Fairness Objection to prioritizing aging research.

In this paper I will examine, and critique, this Fairness Objection to making aging research a greater priority than it currently is. The Fairness Objection presumes that support for the Longevity Dividend is limited to a simplistic utilitarian justification. Utilitarians invoke a mode of justification that is, at base, aggregative. Thus the critics of utilitarianism charge that it is a moral theory that maintains that imposing high costs on a few could be justified by the fact that this confers benefits on others, no matter how small these benefits may be as long as the recipients are sufficiently numerous.

At first blush it might appear that the advocates of the Longevity Dividend Campaign are making precisely this kind of utilitarian argument to help buttress support for aging research. Given that aging has a statistical frequency of 100%, one might regard the aspiration to retard human aging as a goal that would create small benefits for a very large number of people, and these benefits would come at the cost of potentially saving the lives of those who would need treatments for specific diseases (like cancer, AD, diabetes, etc.).

I develop two arguments to refute the Fairness Objection. Firstly, the Fairness Objection mischaracterizes the utilitarian argument for retarding human aging. It does so by invoking the fallacious conceptual distinction between “saving lives” and “extending lives”, as well as making a number of mistaken assumptions concerning the likely benefits of retarding human aging. Secondly, I argue that the Longevity Dividend Campaign can also be supported on contractualist, in addition to utilitarian, grounds. Because the harms of senescence are what Thomas Scanlon (1998) calls “morally relevant” to the harms of disease (i.e. they cause death, disability, suffering, etc.), contractualists can permit aggregation within lives. And thus no one could reasonably reject, I contend, a principle that makes the aspiration to tackle human aging more of a priority than it currently is.