Tuesday, October 28, 2008

Why Worry About Aging? (Part 2)

This post continues the issues addressed in this earlier post.

While we face an almost infinite array of risks to our health and survival, it is important to recognize the fact that not all risks of harm are equal.

Some risks of harm have a very low probability of being realized (like being hit by lightening, which is around 1 in 10 000 000). Other risks have a high probability (like risk of dying from cancer, which is almost 1 in 4 for males, and 1 in 5 for females, in the U.S.).

Some risks concern harms that are minor (like your washing machine breaking). Other risks concern things that are very severe (like disease and death).

As a species we have evolved ways of avoiding some risks. For example, if you inadvertently place your hand on a hot stove your body will quickly process the danger and send the message to your brain in the form of “PAIN! MOVE HAND! QUICKLY!”. And if you cut your arm a complex process of “wound healing” will be set in motion. Inflammatory leukocytes will be sent to the wound site to protect against infection, and different tissue and cell behaviors will be triggered by the genes we have inherited from living in a world prone to mammalian skin wound.

And as a society we have adopted measures (like laws) to avoid some risks. For example, in the province of Ontario wearing a seat belt is the law. It wasn’t always the law. However, empirical evidence showed that the risk of serious injury and death (like putting your head through the windshield) could be reduced by wearing a seat belt. And now we all wear seat belts.

When we think about risks rationally- instead of letting our perceptions be shaped and molded by emotive responses to vivid images of particular kinds of risk- it makes best sense to focus on the most probable and severe harms. Furthermore, when thinking about possible solutions to these risks of harm we should consider the costs and likelihood that we can actually do something to mitigate these harms.

Putting all this together... the biggest mistake a society could make is to ignore the most certain and severe harms that could have been most likely mitigated for little cost.

Thus the following four issues are vital:

1. The certainty of the harm (e.g. 0.1% vs 70% chance)
2. The severity of the harm (e.g. broken leg vs death)
3. The likelihood of mitigating the harm (e.g. 0.1% vs 70%)
4. The cost of mitigating the harm ($1 billion vs $1 trillion)

To make serious headway in getting people to “worry about aging” we thus need to highlight all four of these issues.

Firstly, we know that senescence causes death and disease. The scientific consensus is in. So the risks of aging are very high (and eventually become a certainty of harm for most people on the planet).

The harms of aging are also very severe. Aging increases one’s risk of disease and death. So the empirical evidence clearly shows that aging scores very high on (1) and (2). These facts alone show that aging is a BIG problem.

How about issues (3) and (4)? People are most likely to (mistakenly) assume aging research scores low on both these fronts. That is, people are skeptical that we can actually modify the biological processes of aging. But there are countless experiments in a variety of organisms that show aging is not immutable. And so the goal of retarding human aging scores reasonably well on (3). And once you add considerations (1) and (2) into the mix, it becomes evident that the current neglect of aging research is unjustified.

People will also falsely assume that (4) will require vast amounts of money. But here one must put things in their proper context. A lot of money compared to what? What we spend on national defence? National defense spending in the U.S. has reached approximately $1,600 per capita, compared to $97 per capita for federal spending on biomedical research (source)

But then the story gets even more dire when we consider how much of the funding invested in biomedical research goes towards the science that could actually make serious headway against the diseases of aging- aging research. In the year 2006, the National Institutes of Health was funded at $28 billion and yet less than 0.1% of that funding was spent on understanding the biology of aging (source).

Should we increase that spending? Yes! By how much? Well, now that is an intelligent and important conversation for us to have. The answer depends on the findings of (1), (2) and (3). Contrary to what many people think, slowing aging might be as simple as taking a “a longevity pill” that mimics the effects of calorie restriction. Taking this daily vitamin could delay all the diseases of aging and increase the number of healthy years humans all around the globe could expect to live. In fact numerous clinical trials involving an anti-aging molecule are already taking place in humans right now! So this is the science of today, not a 100 years from now.

If a longevity pill could be developed, these benefits could be enjoyed by all future generations. Generations that would be spared from the ravages of the diseases of aging. Hence why I think we really need to “worry about aging”.


Sunday, October 26, 2008

From "Aging on the Brain" to "The Aging Brain"

Following on from the series of recent posts I have done on aging in the past few weeks (like this and this)... the latest issue of Annual Review of Pathology contains an interesting article entitled "The Aging Brain" by Bruce Yankner, Tao Lu and Patrick Loerch. Here is the abstract:

Aging is accompanied by cognitive decline in a major segment of the population and is the primary risk factor for Alzheimer's disease and other prevalent neurodegenerative disorders. Despite this central role in disease pathogenesis and morbidity, the aging of the brain has not been well understood at a molecular level. This review seeks to integrate what is known about age-related cognitive and neuroanatomical changes with recent advances in understanding basic molecular mechanisms that underlie aging. An important issue is how normal brain aging transitions to pathological aging, giving rise to neurodegenerative disorders. Toxic protein aggregates have been identified as potential contributory factors, including amyloid β-protein in Alzheimer's disease, tau in frontotemporal dementia, and α-synuclein in Parkinson's disease. However, current models of pathogenesis do not explain the origin of the common sporadic forms of these diseases or address the critical nexus between aging and disease. This review discusses potential approaches to unifying the systems biology of the aging brain with the pathogenesis of neurodegeneration.


Friday, October 24, 2008

Evolution, Explanations and Medicine

Over the past few months I have been reading chapters from this excellent book, and this has motivated me to write this post on evolution.

Consider the following events from a typical Monday morning.

(1) I wake up.
(2) My stomach grumbles with hunger.
(3) I walk downstairs to the kitchen.

Now if someone asks me to explain events (1), (2) and (3), I might say something like the following:

"I awoke because my alarm went off. I was hungry because I had not eaten for 8 hours. And I went downstairs to the kitchen because that is where my food is".

Now this kind of explanation makes perfect sense. It focuses on the immediate causes of (1), (2) and (3). And we structure, and make sense of, our world by piecing together information concerning different immediate or proximate causes.

But to return to (1), (2) and (3), we might ask: why do I sleep? Why do I feel hunger pains? And why do I have legs? These are more profound questions, ones that require us to adopt a "big picture" perspective that goes beyond the modes of query typical of making sense of our immediate day-to-day lives.

So when we frame the questions of (1) - (3) in this way we are not looking for a proximate explanation, but rather for "ultimate" or evolutionary explanations.

In Evolution in Health and Disease, the editors describe natural selection as a principle that must hold when certain conditions are present: variation in traits, variation in reproductive success, correlation of trait variation with reproductive success, and inheritance of trait variation.

They provide the useful example of water glasses in an inexpensive furnished apartment that has been repeatedly rented:

They can be explained by natural selection. Some collection of glasses came into the apartment. The fragile ones broke. The attractive ones left when renters departed. The nonfunctional ones with odd shapes were thrown out. What is left is what you find- a collection of sturdy, ugly, functional glasses. (8-9)

And the principle of natural selection provides us with an explanation of the events that unfold every morning of our lives. The events of my mundane Monday morning are in fact the result of endless trade-offs and adaptations that have taken place over billions of years.

We sleep because it aids the recovery of many different system levels (e.g. cellular and network), helps conserve energy, and helps with learning, etc. There are many theories concerning the functions of sleep, but the fact that sleeping is universal among animals suggests that it is very important to survival. Go 24 hours without sleep and you will soon realize how vital sleep is to your ability to function. The amount of sleep needed varies among species. A fruit fly, for example, can sleep up to 12 hours a day.

Why do we feel hunger pains? Well, it helps remind us that we need food, and when severe enough it will fixate our attention solely on the goal of "GETTING FOOD!". This is advantageous because it increases the likelihood that we receive a steady supply of the energy needed to survive and reproduce. A species that requires the diet needed to sustain human life would not survive long if it were not hardwired to satisfy our basic material needs.

And we have legs because they are beneficial for a creature (like us) that lives on land. If we lived in the ocean like clown fish then we wouldn't have legs (or be humans!). And if we shared the evolutionary history of birds we would have wings and feathers and be able to fly (though thanks the the magnificent human brain, we have created machines that now permit us to fly).

And so the trivial events of a regular Monday morning in fact reveal the incredible journey of evolution, and the development of the human species.

Why, you might ask, tell us this tale? Well, the emphasis we place on proximate explanations, well often very useful and appropriate, can also limit our understanding and perceptions of the challenges we face. For if my Monday morning was simply explained by the immediate causes of awakening from my sleep, being hungry and getting my breakfast, we would miss the incredible insights that evolutionary biology can contribute to our understanding of the world and our species. And these include important insights for medicine. In particular, to the aspiration to retard human aging.

To make the link from evolution to medicine, let me tell another story. The story is about Billy and his grandfather William. Billy is your typical 16 year-old boy. He is "girl crazy" and is trying to work up the courage to ask a girl from his class out on a date. Billy spends most of his free time chatting to his friends about girls, lifting weights so he can have more success with his efforts at romance, and he also spends a lot of time worrying about his clothes and hair.

Billy's grandfather, William, is 76 years-old. He has a variety of hobbies- he likes to paint and play chest, he volunteers and spends time with his grandchildren. But recently William has become increasingly more concerned about his limited mobility and chronic joint and muscle pain. Furthermore, he was recently diagnosed with high blood pressure and is at risk for a variety of other ailments. And thus his doctor has recommended he take a daily dose of medications to ease his pain and reduce the risks of more serious problems.

Billy and William are your typical 16 and 76 year-old. And yet there is an important link between Billy's obsession with girls and his grandfather's failing health. Evolutionary biology explains why Billy and his grandfather are in the situations they are in. The force of natural selection is set by the age at which reproduction first occurs in a population. And thus the surge in Billy's testosterone levels and overall gonadal function, and Williams chronic health problems, reflect the trade offs that have been made between reproduction and survival. Historically, very few humans lived to the age of William, and thus investing in repairing damage late in life would not improve the success of reproduction. Furthermore, investing scarce resources in long-term repair would be inefficient and potentially wasteful. This is known as Kirkwood's "disposable soma" thesis- aging occurs because natural selection favors a strategy in which organisms invest fewer resources in the maintenance of somatic cells and tissues that are necessary for indefinite survival of the individual.

Rose describes it this way:

Henry Ford sent one of his engineers to a scrapyard to find out which parts of defunct Model T’s still had some usable life left. When the engineer reported back with a list of the durable parts, Ford instructed his engineers and suppliers not to make those parts so good that they outlasted the rest of the car. This strategy culminated in “planned obsolescence”, an ugly tradition in American manufacturing.... Evolution is regrettably similar. (91)

Should we treat the trade-off between survival and reproduction that happens to exist at this stage in the evolutionary history of humans with deference? A trade-off that has been shaped by natural selection and the extrinsic risks that once permeated the world, and yet one that will bring disease to an unprecedented number of humans living in this century? The answer is clearly “No”. We should search for safe and effective ways of modifying the biological processes of aging, so that people can expect to live more healthy lives. Utilizing the insights of evolutionary biology, biogerontologists are now searching for ways to modify the biological processes of aging. But many people fail to understand the importance of this research because they only understand the proximate, rather than ultimate, causes of disease. To fixate only on proximate causes limits our understanding of the things that cause disease. We only look at the immediate causes- like smoking, diet, particular genes, etc. But we must also aspire to grasp "the big picture", and Darwinian medicine helps us do this.

Those who embrace the aging "status quo" must square this with other elements on the "evolutionary status quo". Take our immune system. Do we favor the immunity "status quo"? No. For if we did, we should abandon immunizations and return to the high rate of child-mortality that existed in the past. Should we not strive to also reduce late-life morbidity and mortality? Do aged individuals not deserve protection from these harms? Indeed, we already aspire for these things, which is why we fund cancer research, AD, etc. So why not fund research that might permit us to delay all age-related afflictions?

And lastly, think about human emotions, and happiness. Should we just accept our evolved natures, with all their virtues and vices? The editors of Evolution in Health and Disease make this excellent point:

We did not evolve to be happy: rather we evolved to be happy, sad, miserable, angry, anxious, and depressed, as the mood takes us. We evolved to love and to hate, and to care and be callous. Our emotions are the carrots and sticks that our genes use to persuade us to achieve their ends. But their ends need not be our ends. Goodness and happiness may be goals attainable only by hoodwinking our genes. (13)

So evolution offers many profound insights that have important implications for medicine, as well as moral and political philosophy. Once we give attention to both the proximate and ultimate causes of morbidity and mortality, our aging blinders will be discarded. Our perception of the greatest challenges facing humanity this century will change. And the things we perceive to be obstacles to promoting public health will also change. Ignorance and irrationality are among the greatest threats to public health this century. And so we should think of strategies for reducing their prevalence.


Thursday, October 23, 2008

Parental Interventions- Environmental vs Genetic

In my "Genetics and Justice" class today we discussed and debated the issue of parents pursuing environmental vs genetic pursuits to influence the development of different phenotypes in their offspring.

My own position on this issue is best captured in my paper "Virtue Ethics and Prenatal Genetic Enhancement". But here I want to float a few further thoughts that came out of the class discussion today.

The reality is that parents have, for better or worse, an enormous impact on the life prospects of their children. They have the primary responsibility for raising, nurturing and loving their children.

Before we turn to the issue of parents being able to directly intervene in their offspring through genetic intervention, let's consider how parents can already modify the biology of their children through environmental intervention.

(1) Nutrition. The food a child consumes (fruits, vegetables, fat, protein, etc.) is profoundly influenced by their parents. The groceries parents purchase determines the "menu of options" available to a child for all the meals at home, lunches packed and taken to school, etc. And nutrition has a profound impact on the physical and mental development of a child. It influences their height, weight, health of their bones and brain development. So what we feed our children influences their biological development. It can set them on the path to health and intelligence, or it can set them on the path towards obesity, disease and intellectual challenges.

(2) Physical Activity. Parents influence the amount of physical exercise their children get. Walking vs driving to school. Playing sports, etc. These all impact the physical, mental and behavioural development of children. These activities can aid muscle development, coordination, self-confidence, team work, patience, etc. Conversely, permitting children to live physically inactive lives can seriously compromise their health and welfare.

(3) Cognitive Development. The neighborhood parents decide to live in influences the educational opportunities open to their children in terms of the quality of their schools. So does the time and effort a parent devotes to reading with their children, helping with their homework, being supportive, etc. The decision to have other siblings also impacts the educational environment a child is exposed to at home (e.g. learning to share with a sibling).

(4) Moral/Social development. Parents can also encourage or discourage friendships for their children which influence many aspects of a child's psychological development. Parent's can help instill a work ethic in their children or they can spoil them. They can raise them to respect certain moral codes or ignore their moral education. Parents can expose their children to religious practices that alter the biochemistry of their brain.

OK, so when we look at the full picture of the range of environmental interventions that parents are free to pursue, we see it is a complex, multifaceted story. But what is evident is that these conventional interventions impact the biological development of children. Indeed, the rise of childhood obesity in the past two decades is clear evidence of how (1) and (2) can pose very significant risks to the health of our offspring. Recognising the risks inherent in environmental interventions is important for it dispels any distorted perception we may be inclined to have that environmental interventions are "risk free". They are not. Many parental actions and inactions, while not falling into the realm of "criminally negligible", still harm their children.

Now when to turn to the prospect of a genetic or pharmaceutical intervention that directly influences the biology of a child parents are likely to rule these interventions out of hand as "unnatural" and "too risky". But I think this is jumping the gun. It all depends on the details. What level of risk is appropriate for direct (vs indirect) interventions? And how effective would these interventions be in enhancing valued characteristics (like health and intelligence)? Children already receive vaccinations that enhance their immune system, even though they have some small risk of harm. So we cannot rule direct enhancing interventions out of hand without more details.

In other words, I think the jury is still out on what may prove to the most effective strategies for parents to pursue to create the conditions for their children to flourish. To date we have subjected our children to the massive social experiment know as "the family", where the biological parents you are born to typically have an enormous amount of discretionary power in terms of pursuing environmental interventions that will influence your identify and biology. And so at this stage we have incomplete data concerning the pros and cons of permitting parents to have this power, and what the pros and cons might be if we had safe and effective genetic interventions.

And finally, we need to critically reflect on what the benchmark for "success" is with respect to parental interventions. What do parents owe the children they have brought into existence? Do they owe them just the minimal requirements dictated by the law (e.g. a life free of abuse and neglect)? Or do we owe them more? And if so, what can best help us provide this for them- environmental or genetic interventions (or both)?

I think we should keep an open mind about this. It's easy for parents to overestimate their ability to give their children "the best". I myself would not rule out any intervention that was demonstrated to be a safe and effective way to develop valued phenotypes in children. The grand social experiment of "the family" has its pros and its cons. And the merits of a genetic intervention should be measured by and against those same standards.


Monday, October 20, 2008

Why Worry About Aging?

Humans are vulnerable to seemingly endless intrinsic and extrinsic risks. Consider for a moment the multitude of environmental risks we face each day. These range from being in a traffic accident and consuming contaminated food we purchased at the grocery store or a restaurant to being assaulted or falling down a stairway.

Taking some risks is unavoidable. Locking oneself inside their home all day will not insulate one from risks of harm. For such behaviours have their own risks- like malnourishment, muscle atrophy and jeopardizing one’s mental health! Furthermore, no one lives on an isolated island like Robinson Crusoe. So even one’s home is only as safe as one’s neighbourhood... country... planet.

Given the diverse and pervasive nature of the risks facing any given population, we need to think clearly and rationally about managing these risks. As individuals, we must consider the consequences of our lifestyle- like our diet and physical activity. These actions can have a dramatic impact (for better or worse) on our health prospects. And governments must prioritize the various policies they could pursue to protect and improve the health prospects of the population.

Given the magnitude of the stakes involved in these kinds of deliberations about risk, it should be apparent that such deliberations are among one of the most important things individuals and societies could do. For if we invest all our energies into tackling the smallest and most trivial of risks, we then leave ourselves vulnerable to the most probable and costly of harms. Tragically, we do not do a good job of thinking rationally about risk (see this great book, for example).

Examples of the errors we commonly make about thinking sensibly and consistently about risks are all too common. For example, think of the case of an overweight smoker who decides to stop consuming anything with aspartame because they are worried about its possible adverse effects on their health. Or a mother who smokes while pregnant and then worries about having her child immunized for fear that it will cause her child to develop autism.

And governments do not always fare much better. Recall this post and the obsession the Bush Administration has paid to reducing the likelihood that any American will die from terrorism. And yet this Administration has done little to prevent the 300,000 deaths a year associated with obesity and excess weight, or the 400,000 deaths a year associated with cigarette smoking. And while global action to tackle climate change often dominates the news, there is little attention paid to things that could actually aid the globally disadvantaged now (and for little cost), like providing bed nets for malaria and removing farming subsidizes.

There is a vast array of empirical research that examines how individuals and groups reason poorly about tackling risks. These range from problems of limited knowledge and biases to group polarization. I am now spending a good deal of my time reading this literature and doing so has proved very useful in bringing together diverse threads of my academic research. Here I will mention just one- the importance of aging research.

When people ask me what I am working on I inevitably mention aging and the aspiration to retard human aging. This provokes many different responses. The most common response is a sense of surprise that we might actually be able to do something about aging. This is of course understandable, for if one had not been following the field of biogerontology for the past few years one might assume that aging is immutable, for that was a common belief. But this belief has been proven wrong- aging is not immutable.

Once I note this people often persist in their scepticism, and express doubt that we could actually develop a technology that could slow aging in humans (rather than just in mice). Again, this scepticism is understandable, indeed some scepticism is warranted. But I often ask them how much scepticism they have about finding a cure for cancer, or reversing climate change. And when it comes to these issues they are pretty optimistic about the likelihood that these goals could be achieved.

So I push them a bit further... and it becomes evident that this optimism is not based on any scientific experiments that demonstrate a particular therapy could cure all 200+ types of cancer, or that climate experiments demonstrated that we could reverse the rise in global temperature. What their optimism is based upon is the desire to achieve these things, that they would create enormous benefits for humanity. Again, I understand the appeal of this line of thinking. We want to believe that we can achieve those things that would really do a lot of good in the world.

Well, when it comes to aging the good news is there is an even sounder scientific basis for thinking we could actually retard human aging AND the magnitude of these benefits (say slowing aging by just 7 years) would be even bigger than a cure for cancer or reversing climate change. And so these points provide all the more reason for getting behind longevity science!

And so this takes me to the title of this post- “Why Worry About Aging?” Well, let me give you a few reasons. Firstly, we should worry about aging because aging is one of the biggest risks factors for death and disease in the world. Odds are, most people you know who have died in your lifetime were older than you are. This is not just a coincidence! Aging increases the risks of morbidity and mortality. After age 28, your risk of death increases almost exponentially. Biodemographers estimate that every 7 years during your adult life your risk of frailty, disability and death doubles. That is a very sobering insight!

So given the magnitude of the harms of aging, coupled with the fact that scientists have made incredible advances in understanding the biology of aging (like which genes can increase the lifespan of a species), you would expect everyone to be worried about aging. Is this so? My own sense is that this story is mixed and complex.

As individuals, few adults are overjoyed with the fact that they have aged yet one more year every time they celebrate a birthday. In fact, I think it is only children who really *celebrate* a birthday. Most adults grumble and complain about getting older. They would prefer not to be reminded of how old they are with a cake filled with a wide stack of candles.

And so at some level everyone knows, to some degree, that aging is a big problem for them as individuals. No one enjoys the fact that their risk of cancer, heart disease, stroke, AD, etc. will continue to rise for all of their remaining years. When in certain moods, we can all admit this. But we don’t want to go on and on about it every day. It’s depressing! And so we tend to bury these feelings deep inside and go on with our daily activities wearing “aging-blinders”.

And so we find there is an enormous disconnect between what the public actually demands of their governments- like protection from terrorists, tackling abortion , etc.- and what would actually substantively improve their lives. If you really want government to reduce your chances of death and disease, then get behind aging research. If there was no chance that scientists could actually develop a drug or intervention that could modify the rate at which the molecular and cellular damage of aging occurs then it would be cruel to tell people to “worry about aging”. But given where the science actually is, it is irrational and irresponsible *not* to tell them to worry about aging. Especially when people fear so many things that really do not pose a great threat to their health and well being.

And this highlights another challenge for longevity scientists- trying to motivate people to get behind aging research by telling them they have good reason to worry about aging, and yet at the same time not depressing people so much that their mental health is jeopardized! So I don’t subscribe to instilling “fear of aging”. Fear is usually the enemy of sound, responsible policy-making. But I admit that walking the “worry about aging” line is a challenging and fine line to tread.

People are often very disturbed when I start telling them about the realities of aging; like how it increases our risks for disease and death. They wonder how I sleep a night. They fail to see that my concern with aging is not primarily driven by a concern about my own health prospects (though of course I do care about that), but rather about the impact aging will have on the future of humanity. Senescence will cause more disease and death this century than anything else. What does trouble me most at night is that fact that we invest very little in the science that could actually substantively improve the life prospects of those living in both poor and rich countries.

And so I think more public discussion of why would should worry about aging can be a good thing. The way I look at it is like this- we all worry about something. And it is best to worry about those things that (a) are really a big (rather than small) problem and (b) are problems we could actually do something about. Once you realize there is a scientific basis for believing that aging satisfies (b), then you will want to get people more worried about aging and supporting aging research.


Thursday, October 16, 2008

The Real-Life Complexities of Health Inequalities

Egalitarians take issue with the existence of inequality. Inequality itself is, for true egalitarians, bad.

While I am not an egalitarian myself, I am very interested in the issues that underlie egalitarian intuitions. And what I find really surprising is that many political philosophers who call themselves "egalitarians" seem to care little about the causes of real inequality in the world. Either they naively belief that these causes are self-evident or they don't really see these empirical considerations as relevant to their overall comprehension of the justice of a particular distributive outcome. I think this is a real problem. And if egalitarians took these concerns more seriously, I believe this would result in their being less egalitarian (perhaps abandoning that description all together).

This is at least what has happened to me over the past dozen years. My rejection of egalitarianism is not ideological. It is not because I believe redistribution violates some value that ought to take primacy (like liberty). In fact I support redistribution. So I also reject libertarianism. But I see myself as a contextual pluralist. When we consider the specifics of any particular dimension of well being (be it wealth or health), we see that orienting our sensibilities and deliberations around the value of distributional equality is severely limiting and problematic.

Of course equality is an important value, and sometimes it can do a lot of important work. But when applied to some metric of distributional equality, I believe it is, at best, inert, and at worst, it can do more harm than good.

In previous posts I have highlighted factors that many egalitarian philosophers ignore. Like the fact that our choice of partner has been a key force in producing unequal family incomes. Or how gender, affluence, parental encouragement and exposure to sports all have an impact on a child's schooling abilities. Such empirical realities add many different considerations to our deliberations concerning what ought to be done to create a more fair society. And in this post I will add some further considerations to these points.

Once we seriously consider a specific kind of inequality, we often find that what really troubles us is not inequality per say, but that some are more vulnerable than they need be. What troubles us is objective, not relational, considerations. And thus the solution is not to strive to reduce inequality itself, but rather to improve the situation of those who are vulnerable. And so the principles at stake here (e.g. priority or sufficiency rather than equality) are important for they can have a profound impact on our understanding of the policies we ought to pursue.

Take the health inequality that exists between the rich and the poor in an affluent country like the United States. This study in the NEJM, for example, suggests that, from the years 1960 to 1986, the link between mortality and lower educational level became stronger. In other words, the wealthy and educated enjoyed a greater decrease in mortality rates (during this time period) than did those who were poor and poorly educated.

What are we to make of this kind of data? Is it good news or bad news? I believe it is both. It is good that there has been a reduction in mortality among some Americans. Such accomplishments should not be discarded or viewed as trivial. And yet this same data should also trouble us. It should trouble us not because there is inequality, but because there is a vulnerable group of people whose health needs are not being sufficiently addressed. And if there is something we can do to also increase their enjoyment of health we should do it.

These two conflicting sentiments become evident if we ask ourselves- would we have preferred it to be the case that everyone, rich and poor alike, had a higher risk of mortality? That situation would be more equal, but it would not, "all-things-considered", be preferable. And so the value of equality itself, while it may capture our sensibilities at a superficial level, only serves to muddy the terrain when we take the realities of life (like our intrinsic vulnerability)seriously.

A paper in the latest issue of Health Economics effectively illustrates this point. The paper is entitled "WHY HAS THE HEALTH INEQUALITY AMONG INFANTS IN THE US DECLINED?" The author examines infant inequality among the rich and poor in the US from the years 1983 and 2000. This gap, measured by the Apgar score, neonatal mortality and infant mortality, has actually narrowed over the past two decades.

This data is surprising given that income inequality has increased over this time. So egalitarians should be intrigued by these findings. At first blush, it might appear that the narrowing of this gap is good. However, the reality, once we examine the distinct factors that have caused this inequality, is that the story is a mixed one. Not everything that has caused this reduction in health inequality is good. And recognising the real life complexities of health inequalities should make us realize that it is not equality itself that we should strive for.

So what accounts for this reduction in health inequality among infants? Lin identifies 3 central mechanisms that account for this reduction in inequality- (1) maternal behavior changes, (2) demographic changes, and (3) access to medical care.

So first, the good news. The single biggest factor in reducing this inequality is adequate prenatal care. Lin argues that "all else being equal, access to proper medical care accounts for 39.5% of the closing gap in low Apgar score, 28.4% of the closing gap in infant death, and 29.3% of the closing gap in neonatal death". This finding is not surprising, and it highlights the importance of access to healthcare. But access to medical care is only half the story. (1) and (2) actually account for 40% of the reduction in infant inequality. And once we consider (1) we see that certain aspects of the reduction in inequality are not good.

For example, highly educated parents are more likely to utilise fertility treatments, which increase the chances of multiple births. And this in turn increases the risks of complications and death. In other words, one important factor that explains the reduction in infant health inequality is the fact that the children of highly educated parents now have an increased risk of complications and death. And thus this "leveling down" explains part of the reduction in inequality. This is important to note, for it is clearly something that, despite its impact on reducing inequality, is bad (not good). The goal should be to reduce, not increase, the risks facing infants. And yet this is lost if we place the primary focus on reducing inequality itself.

Demographic changes also help explain the reduction in infant health inequality. Lin argues that Hispanics are healthier than African-Americans and similar in health to non-Hispanic whites. And this is the case even though Hispanics have a comparable socioeconomic situation to African-Americans and a lower situation when compared to the non-Hispanic white population. Part of this is explained by the fact that Hispanics have lower rates of smoking and drinking. And yet when it comes to maternal nativity, these positive effects are limited to immigrant (foreign-born) Hispanics (and not American-born Hispanic women). Lin suggests that this might be due to what is known as the "healthy migrant effect"; that immigrants are selected for their good health and robustness.

And so foreign born mothers actually explains part of the reduction in infant health inequality. And this finding also highlights another interesting and surprising finding from Lin's analysis-- that the immigration flux has brought health improvements to the health of the poorest infants in the United States.

Lin's examination of the real-life complexities of infant health reveals the complex factors that influence healthy inequalities. These range from obvious things like access to medical care to immigration and the age of parents. What can we learn from all of this? I think these insights have important implications for what the fundamental distributive principles of justice are (e.g. equality vs priority, etc.) and thus will have a profound impact on what we take the central prescriptions of justice to be.


Wednesday, October 15, 2008

The Social Costs of Physical Inactivity

Healthcare, and healthcare reform, is a major policy issue that often dominates political debates. This is evident in both recent Canadian elections (especially 2004, though the issue did not really get much attention in the 2008 election) and the upcoming US Presidential election.

Of the various things we can ask of our elected officials, perhaps no question is more important than the question- how will you improve our health prospects?

But do we ever stop and think that we, the citizenry, also have a responsibility to take action that could ease the demands on healthcare and improve the health prospects of the population? We seldom hear much about this. Sure our family doctor might encourage us to live a more active lifestyle and modify our diet, but do we really see this as a moral obligation that goes beyond basic "self-regarding" concerns? Most do not, but we ought to.

On many occasions on this blog (here, here and here) I have lamented the fact that obesity and physical inactivity is one of the most pressing issues of our times. And framing the costs of inactivity in terms of self-regarding concerns (like our increased risk of cancer, heart disease.... even death!) does not always prove an effective strategy for getting governments and individuals to tackle the situation.

If only someone could quantify what the social costs of inactivity are .... wait, the latest issue of Health Economics has this interesting paper on that very topic!

So what are the social costs of physical inactivity? The paper examines the Canadian situation and concludes:

This paper suggests that, on average, active people use significantly fewer healthcare services compared with inactive people, and physical inactivity imposes substantial costs on the publicly funded healthcare system. The paper provides an estimate for the excess use of healthcare services by physically inactive people. The use of inpatient services for an inactive individual is about 38% more than that of an active individual. Inactive people also use more physician and nurse services. On average, an inactive individual uses 5.5% more family physician visits, about 13% more other physician services, and 12% more nurse services compared with an active individual.

A moderate level of physical activity also increases utilization of healthcare services. Although the difference is not statistically significant for inpatient services, moderately active individuals use more physician services compared with active individuals. Holding other things constant, moderately active people use 2.4% more family physician services, and 5.8% more other physician services compared with
active people.

These results imply that the total social cost of physical inactivity imposed on the publicly funded healthcare system is substantial. Total numbers of additional healthcare utilization due to insufficient level of physical activity is about 2.37 million family physician visits, 1.33 million other physician visits, 0.47 million nurse visits, and 1.42 million hospital stays. These are the estimates of social cost for the publicly funded healthcare system in Canada. However, there are other healthcare services such as pharmaceuticals covered by other health insurance programs. Therefore, it is likely that there are additional external costs due to excess use of pharmaceuticals and other healthcare services not covered by public insurance programs.

Like aging, we are blind to the social costs of physical inactivity. By opening our eyes to the self-regarding and other-regarding costs of physical inactivity, we get a better sense of the demands of justice and the urgent action that is needed to create a more fair and humane society. So be kind to your compatriots- get out and exercise today! That is something everyone can do and it really will make the world a better place to live.


Some Reflections on the '08 Election

So the Conservatives have won another minority government. This outcome was expected. Many might wonder what the point of having this election was. What is really worth the $300 million it cost Canadians? I actually believe it was. And here I will offer some thoughts on what I think this election outcome really tells us.

As I noted before, yesterday was the first time in my life that I did not vote for the Liberal Party. Sadly the Liberals fulfilled the fate I predicted back when Stéphane Dion was elected leader in 2006. Dion's defeat is actually good for Canada and it says something encouraging about the health of democracy in Canada.

Why do I (one who usually supports the Liberals) say this? Because Dion had sought the highest political office on a ill-conceived populist appeal to an issue that is not even a domestic issue. Furthermore, in doing so he proposed compromising the basic tenets of redistributive justice and demonstrated the policy naivety typical of an academic (e.g. that the Green Shift would also tackle poverty in Canada). So I am actually relieved the Liberals were handed this defeat.

The Liberal defeat (coupled with the Green Party's failure) tells us that you cannot base a country's domestic policy on a global issue that we cannot, no matter how much we would like to, control. Contrary to what environmentalists would have us believe, Canada cannot control the global temperature of the world. And so Dion's claim that "it is the right thing to do" is empty. Hence the flat support he received last night. Our political parties should focus on those things the Canadian government can actually influence- like our economy, health care, education, etc. That is the loudest message coming out of last night's election results. And if we actually listen to that message, then perhaps it was worth $300 million.

Let's hope the Liberals can re-group and get their priorities straight. And they must also act (more) responsibly when the time comes, as I believe it must, to choose a new political leader. Liberals can no longer arrogantly assume that they will be the governing party no matter who they choose to lead and no matter what the substance of their platform. And so I believe that last night's result conveyed an important message, one that reflects well on that state of democracy in Canada.


Friday, October 10, 2008

Discarding Our “Aging-Blinders”

This is a long, but important, post...

This term at Queen’s I am teaching my favourite undergraduate course entitled “Genetics and Justice”. This course examines the ethical, social and legal implications of the genetic revolution. And yesterday the class had a spirited debate and discussion on the aspiration to retard (and even eliminate) senescence.

To set the context for the class, we first watched this video which presents the cutting edge research on longevity science. And we then read “Pursuing the Longevity Dividend” and debated the proposal to invest $3 billion a year in aging research. In the last part of the class two students gave seminar presentations on arguments for radical life extension. The first was on Nick Bostrom’s paper “The Fable of the Dragon Tyrant”, the second on Aubrey De Grey’s “Life extension, Human Rights, and the Rational Refinement of Repugnance”.

Those who have read some of my academic work, or past entries on this blog, will know I am an advocate of longevity science. I am very interested in hearing the arguments and reactions people have to the aspiration to slow human aging, for I myself shared some of these reservations when I first began thinking about these issues. But over time I realized that many of my initial reactions or concerns to longevity science were either misinformed or focused on concerns that are, in the big picture of things, minor when compared to the enormous benefits of extending healthy life.

So here I want to reflect a bit on some of the issues that arose in our class discussion and debate concerning tackling human aging. For this exercise actually aids me in my own research and deliberations, as I attempt to get a clearer sense of the arguments for and against retarding human aging.

I began by asking my students, who are all in their final year, how many of them have taken a university course that addressed some of the health or social implications of human aging. Only one student had taken a course that briefly addressed an issue pertaining to aging. It was a course on the welfare state and examined social provisions like pensions. But besides that, no one had taken a course that engaged with the kinds of issues that we were about to discuss.

My own education as a student was very similar to that of my current students. None of the courses I had taken in my 9 years of University addressed the issue of aging. Of course if one had taken a degree in gerontology, rather than philosophy or political science, things would be very different. But it is surprising that aging does not figure more prominently in programs that have a heavy policy focus (like political science) or deal with profound questions concerning ethics and justice (like philosophy).

So the current neglect of the empirical realities of humans, and human societies, is, in my opinion, one of the greatest shortcomings of the current state of higher education. And a central goal of my career aspirations is to help remedy this intellectual deficit. But it is a difficult aspiration. Disciplines, and researchers, work within established paradigms and there are lots of incentives for “going with the flow” and large disincentives for going against the grain.

Take contemporary philosophical discussions of distributive justice, for example. There are lots of incentives for working within the current established paradigm- you are more likely to get your work published in the established journals, make connections with other like-minded researchers, be invited to give talks, etc, etc. And if one is early in one’s career- either trying to land that first job or get tenure- these things matter a great deal. And I believe this explains part of the reason why scholars interested in distributive justice almost completely ignore the realities that we are temporal beings and that this has significant implications for the basic structure of society. The risks of forging new ground, especially early in one’s career, often outweigh the proposed (career) benefits. And so there is a strong bias for working within the status quo. And if the status is impoverished, as I believe it is, this is a problem.

For those in mid-career and beyond, other kinds of considerations can impede a scholar’s ability (or rather willingness) to go against the grain. It is much easier to continue building on one’s earlier work rather than start over again building a new foundation. And a major shift that involves learning extensive empirical knowledge, or crossing traditional disciplinary boundaries, requires a curious intellect and commitment, and that fire might not burn in the belly of many post-tenure scholars.

Thus a discipline like political philosophy (and ethics) can continue on for decades without anyone realizing that we are wearing “aging-blinders”. And now that there is a scientifically credible basis for believing that we may be able to alter the rate at which molecular and cellular damage occurs to our bodies and minds, we must discard these “aging-blinders”.

Having said all the above, it is important to note the really incredible advances that are being made in the study of the biology of aging and Universities are starting to take this seriously (though I think it is fair to say scholars in the humanities and social sciences have not caught up with these advances, hence the large vacuum I mentioned above). Many universities and non-profit organizations are spear-heading serious study and engagement with human aging. Below I link to a random sample of some links to give you a taste of some of the interesting work being done (click the links below for a “snapshot” of these):

1 2 3 4 5 6 7 8 9 1011 12 13 14 15 ...

Scholars in the humanities and social sciences should take human aging seriously as it raises many profound questions in need of serious scholarly attention. What contribution could a philosopher, for example, aspire to make? Let me give it a shot....

OK, so let’s get down to some details about how we might set the stage for the claim that human aging is actually a very important ethical and social issue that should receive far greater attention than it currently does. It is important to recognise that there are many, many challenges facing humanity this century. And we constantly hear our elected officials championing the importance of different national and global goals. From the war on terror and climate change, to infectious disease, conflict and poverty- we face many problems and it is not easy to determine what our biggest priorities ought to be.

When thinking about priorities one could invoke many different dimensions of wellbeing. For example, addressing the current economic crisis is a priority because it has an impact on people’s retirement savings, their ability to pay their mortgages, their employment, etc. So financial wellbeing can certainly be one dimension we invoke to help us get a handle on priorities.

But there is an even more fundamental dimension of wellbeing than financial wellbeing- and that is being (and staying) alive in the first place. Of course a financial crisis that leads to unemployment is a problem. But a financial crisis that leads to unemployment and starvation and death, well that is a much BIGGER problem. And so human deaths, while not the only measure of the magnitude of the severity of a problem, ought to play a prominent role in our deliberations about priority setting.

OK, so what causes most human deaths? We must be careful how we answer this question. If we ask it historically (i.e. what killed most humans in the past?- say a 100 years ago, or 10 000 years ago, etc.) then the answer will be very different than if we ask it as a forward-looking question (i.e. what will most likely kill the world’s 6.4+ billion population?). Furthermore, it is sometimes tricky to identify just one thing as the cause of death. Sometimes many factors play a role (e.g. diet, inactivity, etc.). Putting aside these points, let’s look at the things that killed humans in the year 2005.

According to the World Health Organization, approximately 58 million people died in the year 2005. And if we examine what was (primarily) responsible for these deaths, we can get a better sense of what our biggest priorities ought to be.

Some estimates suggest that around 150 000 people died from climate change in that year. Road crashes killed 1.2 million (and injured or disabled another 50 million). HIV killed 2 million, and cancer 7.6 million.

So let’s stop here. When presented with this kind of data we begin to see how big certain problems are in relation to other ones. Cancer, for example, is a leading killer. And so is poverty. And these factors are often interconnected. Most of the 7.6 cancers deaths in 2005 were in low and middle income countries. Furthermore, the death toll does not settle the priority issue- we must also consider what it would cost to tackle the issue in question as well as the likelihood that our action would bring about the desired result. But the death toll does add some vital insight to the determination of what the magnitude of any particular problem is. And so comparing the numbers in this way is useful in helping us grasp a sense of the “big picture”.

Now, where does aging figure in the story of human death? Pinning down the numbers is a source of contention. But some estimate that aging is responsible for 2/3rds of all human deaths, worldwide. That would mean that somewhere in the neighbourhood of 38 million deaths in 2005 were age-associated. Given the staggering numbers involved here, you would think that we are trying everything we can to lower the prevalence of age-related death. Sadly, we are not. Why is this the case? (see this)

Two things are important to bear in mind here. Firstly, these death trends are new and unprecedented in human history. Historically, most human beings that lived on this planet died well before the diseases and afflictions of senescence would be visited upon them. Thomas Hobbes was right- life was “nasty, brutish and short”. However things look very different for the 21st century. Now unprecedented numbers of human beings, 2 billion by 2050, are expected to live beyond 60 and they will fall prey to the diseases of aging. Our risk of disease, frailty and death *doubles* every 7 years during our adult life. And we must take urgent action to try to alleviate the disease and suffering that will come with the world’s expanding, aged population.

OK, so those are the kinds of considerations that have won me over to the “aging is a big problem” camp (and I hope they will motivate you to think about these issues as well). Aging is a global problem. It is also clearly a domestic problem for the developed countries. Most of your family and loved ones will suffer one of the diseases of aging- cancer, heart disease, stroke, etc. And so if you care about the fate of these loved ones then you should care about longevity science.

Now if, as I contend, aging is such a big problem, we need to ask- can we really do anything about it? And unless one has been closely following advances in aging research, one could be forgiven for thinking the answer is no. But that is false. There is a sound scientific basis for thinking that we can intervene in the biological process of aging, thus extending the number of years people can expect to remain healthy. And one of the major obstacles to our achieving this is the current neglect (and hostile attitude) many people have to the aspiration to modify the rate of aging. Permit me to now challenge some of the most popular objections people have.

Consider what I will call “Key Value Premise”: Suffering disease and death is bad. If you agree with Key Value Premise, then you must also come to grips with the reality of aging. Let’s call this “Key Empirical Premise”: aging increases our risk of morbidity and mortality; not just by a small amount- these risks increase *exponentially* with age (until around age 95, when late-life mortality plateaus).

So if suffering disease and death is bad, and aging dramatically increases these risks, then we ought to be seriously considering ways of tackling aging. When things are clearly laid out like this, it is hard to see how anyone could object to making longevity science more of a priority (who can deny the value and/or empirical premises noted above?)

Well, there are some important challenges that I think are worth taking seriously. And these reactions are ones students in my classes have raised over the years. The first objection is the claim that it is wrong to prioritize the effort to extend the lifespan when there is so much poverty in the world. A second objection is that any anti-aging intervention will no doubt be unequally accessible to the rich and poor in the world. So these technologies would simply exacerbate existing inequalities.

Let’s call the first objection the “Messed Up Priorities Objection”, and the second objection the “Inequality Objection”. And for the time being I will only address these in the context of a discussion of global (rather than domestic) justice.

These kinds of objections are the most interesting and compelling (even if, ultimately, flawed) objections to longevity science. Why is the “Messed Up Priorities” objection flawed? There are a few problems with this line of reasoning. Firstly, if one accepts Key Value Premise (that suffering disease and death is bad) then one must accept the reality that something bad will be visited upon the 2 billion plus senior citizens who will populate the world by 2050. And given the sheer number of people involved here, it seems odd to say that worrying about their disease and death is a “messed up” priority. Most of these people are people that are currently alive in the developing world. So the goal of tackling the diseases of aging is something that aspires to help (in the future) those currently alive in poor countries!

Contrary to what most people in the richest countries believe, people in other, less rich countries, are in fact living longer and will suffer the same afflictions that currently kill our own population. Recall this earlier post where I pointed out that the top 3 causes of death in the United States is identical to the leading causes of death in China. The number of human beings that suffer from chronic disease is twice the number of deaths due to infectious diseases (including HIV/AIDS, tuberculosis and malaria), maternal and perinatal conditions, and nutritional deficiencies combined! And that fact should illustrate why the “Messed Up Priorities Objection” to tackling aging is flawed.

Now there is a further detail worth addressing here. One might accept Key Value Premise, but retort that it is even worse to suffer disease and death early in life than it is to suffer these things later in life. So getting cancer at age 10 and dying is worse than getting it at age 80 and dying. I agree. But that does not change the fact that it is still bad to suffer disease and death at age 80. And when one considers how many people will suffer age-related morbidity and mortality, we are hard pressed to deny that tackling aging ought to be a top priority. I address the issue of priorities and aggregation in greater detail in this recent paper.

Now let’s turn to the “Inequality Objection”. So this objection states that we should not invest public funding in longevity science because any benefits likely to come from this science will not be equally enjoyed by all. There are many things to say here. Firstly, if we are really committed to tackling aging then we can make *equal access* to these interventions a priority. Secondly, even if one thinks it is impossible to ensure equal access to these technologies, the fact that not everyone in the world would have equal access to a novel intervention should not keep us from pursuing it. Would we object to pursuing a cancer therapy simply because it would not be immediately available to everyone in the world? No.

Thirdly, over time most medical interventions come down in price, thus resulting in more people enjoying them. And so we must ask- is it better to completely forfeit a beneficial technology if it will not be immediately accessible to everyone in the world rather than permit it to be unequally accessible for some period of time? To answer this question let’s consider the most important (though often neglected) public health technology of the past two centuries- the sanitation revolution.

All three of the countries that I have lived in have had safe, piped water connected to homes, and sewers rinsed with water. These measures have dramatically lowered the risk of disease and death in the countries I have lived in. Tragically, 40% of the world’s population still do not have access to basic sanitation. This is a gross injustice. But what is unjust is not that there is an inequality in access, but that the poor lack access to basic sanitation. So the goal would be to ensure everyone has access to basic sanitation, not to deny those countries that can afford basic sanitation these technologies. The same is true of anti-aging interventions. We should not try to prevent anyone from having access to these technologies simply because they might not be equally accessible to all. Rather, we should support policies that would ensure the largest number of people possible have access to them. And so the “Inequality Objection” is premised on a confused moral sensibility that leads to disastrous policy prescriptions.

Finally, to those who say all this talk of life extension and slowing aging is nonsense, I wish to leave you with one final statistic to mull over. Consider the incredible increase in life expectancy that the United States has enjoyed over the 20th century. In the year 1900, 18% of males born in the US died before their first birthday. By the end of the century, the cumulative mortality rate in the US doesn’t hit 18% until age 62! Through our hard work and innovation amazing improvements in our health prospects have taken place. Who knows what amazing things await humanity this century. Contrary to the pessimists who think the earth will be destroyed by climate change or terrorists, I actually think my children and grandchildren could inherit a wonderful and exciting future. And I am committed to fighting for the realization of that optimistic future! And so we must discard our "aging-blinders".


Tuesday, October 07, 2008

Harvard Receives $125 Million to Pursue Biologically Inspired Engineering

The Globe reports that Harvard University has received its largest individual donation ever- $125 million dollars. The donation was made by a Harvard alumnus and will be used to create a new Institute for Biologically Inspired Engineering. Harvard has the story here.

Here is a sample from their description of what the mission of this new Institute will be:

Over the past decade in particular, engineering, biology, medicine, and the physical sciences have increasingly converged. Through revolutionary advances in nanotechnology, genetics, and cell engineering, it is now possible to manipulate individual atoms, genes, molecules, and cells one at a time, and to create artificial biological systems. Simultaneous progress in materials science, molecular biology, and tissue engineering has enabled scientists to develop synthetic materials, microdevices, and computational strategies to manipulate cell function, guide tissue formation, and control complex organ physiology. As a result of these developments, the boundary between living and nonliving systems is beginning to break down.

The Wyss Institute will leverage these advances and facilitate new breakthroughs by advancing the science and engineering necessary to develop biomimetic materials, microdevices, microrobots, and innovative disease-reprogramming technologies that emulate how living cells and tissues self-organize and naturally regulate themselves. A deeper understanding of how living systems build, recycle, and control also will ultimately lead to more efficient bioinspired ways of converting energy, controlling manufacturing, improving the environment, and creating a more sustainable world.


Friday, October 03, 2008

How Will the Bailout Affect "Wary Cooperators"?

CNN reports here that the US Congress has passed the Wall Street bailout by a vote of 263 to 171.

There has been much debate (...well, as much as there could have been within 2 weeks!) concerning what impact, for better or worse, the bailout will likely have on the American, and world, economy.

But here I want to bring attention to concerns that I have not heard many raise. That is, what the consequences of the bailout might be on the already strained trust that Americans have in their government.

So I want to draw upon the insights that evolutionary biology (and increasingly the social sciences) have provided political scientists in recent years. The debate over human nature (e.g. whether we are naturally altruistic or self-interested) is a long debate in political thought, but social scientists have started to turn to the findings of evolutionary biology to help make sense of the fact that humans display behaviour that is best described as what Alford and Hibbing call "wary cooperators". Alford and Hibbing (2004) summarise the theory of wary cooperation as follows:

Humans are cooperative, but not altruistic; competitive, but not exclusively so. We have an innate inclination to cooperate, particularly within defined group boundaries, but we are also highly sensitive to selfish actions on the part of other groups. This sensitivity leads us to cease cooperating when that cooperation is not reciprocated, to avoid future interaction with non-cooperators, and even to engage in personally costly punishment of individuals who fail to cooperate. (709)

When people perceive others to be violating a norm of reciprocity (as in the ultimatum game) they often display altruistic punishment. That is, wary cooperators are willing to sacrifice their own monetary rewards in order to punish noncooperators.

Now I think these empirical insights, if they are valid, can tell us some very interesting things about the Wall Street bailout. Even if it is true, as those defending the bailout maintain, that bailing out Wall Street benefits Main Street, Main Street might still have a preference for punishing Wall Street because people are wary cooperators rather than rational maximizers. And so a government that pushes through legislation that contravenes the innate and genetically heritable behavioural predispositions of the members of society runs many risks.

What are those risks likely to be? A government that justifies a policy like the bailout by focusing solely on the monetary "end result" (e.g. are you financially better or worse off with the bailout) runs the risk of undermining the trust needed for the populace to accept authoritative decisions. And the Wall Street bailout has all the hallmarks of a policy that compromises the things wary cooperators are looking for with authoritative decision-making. Like the fact that the legislation was rushed through without much substantive, reflective debate concerning the merits of the plan (especially from leading economic experts). Or the fact that the process was tainted by Presidential politics; and that the revised Bill had last minute "pork barrel" add-ons, worth hundreds of millions of dollars. All of these facts would lead me to believe that the passing of this Bill, in the fashion that is was passed, will cause real a democratic deficit for America.

This deficient may just result in greater apathy about the political process. Or it might even mean that taxpayers will refuse to engage in altruistic behaviour in the future (for truly laudable causes, like healthcare reform). So I believe that it is possible that the Democrats might have sacrificed a great deal by supporting this Bill. To deny altruistic punishment, at this particular moment in time (when the rich have already enjoyed enormous tax cuts and the Bush Administration is at record low-level of approval), might have dire consequences for the legitimacy of American politics (for a Democratic or Republican President and Congress/Senate).

Are those harms more dire than the purported financial harms of not passing the Bill? I don't know. Only time will tell. But I think many have assumed that the only stakes that really matter in this issue is the monetary "end result". And I think that is a big mistake.

Findings from evolutionary biology, experimental economics, behavioural anthropology and social psychology tells us that most people are not rational maximizers. They are wary cooperators. And so the actions of the Senate and Congress this week might have quite a profound negative impact on the attitudes Americans take to their economic and political institutions (even if the Bailout was the correct financial decision, which is debatable).


Wednesday, October 01, 2008

International Day of Older Persons

Today is International Day of Older Persons. Created in 1991, this day is a special day to recognise the contribution of seniors and to bring greater attention to the changing demographics of humanity.

In that spirit, I thought I would link to my recent posts on the importance of retarding human aging. I can't think of a better day to make the case for investing in the science that would promote the health of seniors than on International Day of Older Persons. Today is the day to ask yourself, and our politicians: "What are you doing to improve the quality of life for our seniors?"

(1) Sage Crossroads Podcast on Longevity Science
(2) Are You Guilty of Gerontologiphobia?
(3) Are You Guilty of Gerontologiphobia? Part 2
(4) Bioethics Paper on Equality and Retarding Aging
(5) Longevity Genes (and Being Inspired by George Burns)
(6) Op-ed on Longevity Science
(7) BMJ Articles on Tackling Aging (Update)
(8) Rose on Evolutionary Biology and Aging
(9) Inequalities That Really Matter (but we seldom think about)
(10) More on Risks of Death and Priority Setting

*UPDATE: The World Health Organization has a useful post here, detailing the significance of changing demographics (like the fact that there will be almost 2 billion seniors worldwide by 2050, most of them living in developing countries).

Sadly, a Google News search for International Day of Older Persons reveals how little the press is paying attention to this. No major American news organization has a hit that I could find. But if you do a News search for "bail out wall street", the points I made yesterday start to look pretty persuasive (at least to me, but heck, I'm the one who made them! :))