Tuesday, June 24, 2008

Cancer Study in Canada

The latest issue of Science has this report about the ambitious Canadian Partnership for Tomorrow Project. Here is a sample from the story:

Canada has joined the global stampede of countries gathering biological data over decades on a large population cohort in hopes of better understanding the genetic, social, and environmental factors that affect human health.

The Canadian Partnership for Tomorrow Project, launched last week, will follow 300,000 adults over the age of 35 for 30 years, gathering saliva, blood, urine, fecal, and toenail samples as well as answers to questions about the health effects of influences including diet, physical fitness, and environmental conditions. The goal is "a comprehensive data set for research into the causes of cancer," says Heather Bryant, vice president of cancer control for the Canadian Partnership Against Cancer in Toronto, a federally funded organization helping to lead the study. But she says the project will also "provide a platform for numerous other research topics."

The project builds on a cancer-risk study in Alberta that examined the interaction of lifestyle, behavioral, environmental, and genetic factors. Five provincial public health agencies have kicked in an initial $82 million to recruit participants in what is expected to be a $3.5-million-a-year effort. Researchers have already obtained funding to probe the effects of vitamin D in northern climes, measure compliance with public health recommendations for physical activity, and chart the effects of dietary supplements as varied as alcohol, vitamins, and traditional native diets, notes Phillip Branton, head of the Canadian Institutes of Health Research's Institute of Cancer Research, who will oversee research.

And this info sheet contains some useful data on the toil of cancer in Canada:

Cancer incidence and mortality
• Cancer incidence continues to rise annually in Canada by two to three per cent, while the number
of people living with cancer is growing at least twice that rate2
• This year approximately 166,400 Canadians will be diagnosed with cancer
• An estimated 40 per cent of Canadian women and 45 per cent of Canadian men will develop cancer during their lifetime2
• Canada’s growing and aging population is leading to an increase in cancer cases
• Approximately one out of every four Canadians will die from cancer
• This year approximately 73,800 Canadians will die from the disease

Cost of cancer
• At more than $12.2 billion annually, cancer is the most costly illness in losses due to premature
mortality (assessed as lost labour productivity, including wages, CPP/QPP, EI and workers
• In 2002, cancer accounted for about $17.9 billion in costs (direct and indirect) in Canada
• Hospitalization of cancer patients costs approximately $2.1 billion a year, in addition to physician
costs and drug treatment costs
• In 1998, $210 million was spent on drugs for cancer treatment

Thursday, June 19, 2008

Petroleum, Patriarchy and Marx

The latest issue of APSR has a fascinating article by Michael Ross entitled "Oil, Islam, and Women". Ross argues that oil production, not Islam, explains why gender inequality is greater in the Middle East. Here is the abstract:

Women have made less progress toward gender equality in the Middle East than in any other region. Many observers claim this is due to the region's Islamic traditions. I suggest that oil, not Islam, is at fault; and that oil production also explains why women lag behind in many other countries. Oil production reduces the number of women in the labor force, which in turn reduces their political influence. As a result, oil-producing states are left with atypically strong patriarchal norms, laws, and political institutions. I support this argument with global data on oil production, female work patterns, and female political representation, and by comparing oil-rich Algeria to oil-poor Morocco and Tunisia. This argument has implications for the study of the Middle East, Islamic culture, and the resource curse.

Ross's conclusions would be, I contend, supported by the Marxist interpretation of human history that I advanced here (and discussed here). The superstructural differences that exist between Western democratic countries and oil-rich Muslim countries (like the status of women) are ultimately explained by what occurs at the level of the productive forces present in these different societies. So the rights of women in largely oil-producing countries would be roughly comparable, and the rights of women in countries that developed low-wage export-oriented industries (in textiles, garments, and agricultural goods) should be comparable.

Of course one would need to do an extensive empirical comparison to see if my hunch is correct. But I think Ross's study suggests that there may be a good deal of empirical truth to what I take to be the two central tenets of historical materialism. Namely: (1) the superstructure supervenes naturally on the economic structure; and (2) the relations of production supervene naturally on the forces of production.

These two Marxist theses could help us understand why we find the different patterns of gender inequality that exist in the world, and what action would be needed to do something about improving the treatment of women.


Wednesday, June 18, 2008

Rose on Evolutionary Biology and Aging

Two weeks ago I was in Vancouver for the 2008 Congress , giving this talk and this talk, respectively, to the Canadian Philosophical Association and Canadian Political Science Association.

On the flight to and from Vancouver I read Michael Rose's excellent book The Long Tomorrow. And I wanted to make a few notes about the book here for my future reference.

Rose is Professor of Evolutionary Biology at the University of California, Irvine. You can watch a very engaging presentation by him here.

On his web page he lists among his interests “the evolution of aging and immortality”. No doubt the latter is likely to raise some eyebrows! And longevity science would profit from having more bold and imaginative thinkers like Rose.

The Long Tomorrow is a very accessible and engaging book. It’s a fascinating read on many different levels: taking us through Rose’s work on evolution and aging; providing us with unique insights into the way science and scientists work (e.g. importance of getting funding, the hostility many have to the notion of extending the human health span, the time it takes to complete longevity experiments); and also providing us with a glimpse into Rose’s own personal life- his dedication to work, the family tragedies he has faced, etc.

Rose pursued his PhD at the University of Sussex, where he worked on aging and fruit flies. He recounts coming across an article by J. M. Wattiaux, whose work focused on the effect of parental age on the offspring produced at that age (see this, for example).

Wattiaux’s results lead Rose to the importance of the force of natural selection. Rose claims:

Natural selection discards bad genes, genes like those that cause fatal childhood progeria. Bad genes cause these effects by producing inborn errors of metabolism: letting toxins accumulate, impairing brain function, and so on. Many of the diseases that kill infants are the products of such bad genes... Natural selection keeps genes with such devastating early effects rare, because the afflicted individuals die before reproducing. Bad genes destroy themselves when they kill the young…. But at later ages, the force of natural selection becomes weak. It leaves genes with late bad effects alone, because natural selection has stopped working. Its force has fallen toward zero. Bad genes that only have late effects will not be removed by natural selection. They can accumulate. There is no more automatic Darwinian screening (p. 42).

And the force of natural selection, argues Rose, is set by the age at which reproduction first occurs in a population. The force of natural selection is strong before the age of reproduction. Thus, if reproduction is postponed, the force is high longer. And this lead Rose to what he calls “the single most important breakthrough in the long history of research on aging: the deliberate creation of long-lived animals” (p. 43).

Given how long aging research takes, it makes good sense to test the claim about age of reproduction and longevity on a species that doesn’t live very long. And this is where the fruit fly becomes very important. And Rose created Methuselah flies, flies that postponed aging by reducing early fertility.

The creation of the Methuselah flies thus revealed the tradeoff between reproduction and survival. Rose notes numerous examples as evidence of this tradeoff. Pacific salmon, for example, die immediately after reproduction. However, if they are castrated they can live years longer than intact salmon. The same is true of soybean plants. Rose contends that this tradeoff is also evident in humans. For example, he notes (p. 57) that twentieth-century eunuchs, who were victims of eugenic legislation (because of their low IQ), actually had their longevity significantly increased. And so these kinds of data explain the evolution of aging:

...genetic tradeoffs between later and early ages. Specifically, early reproduction tends to trade off against later survival. And since the weakening force of natural selection tilts the balance against later survival, evolution will tend to produce oversexed youth and decrepit old age, because it favors genes that enhance early reproduction at the expense of later survival. (p. 60)

Rose also notes other factors that influence longevity. For example, body size (p. 64). Animals come in a variety of different sizes. And most (but not all.. dogs, for example, are an exception to this) large animal species live longer than smaller animals. Why is this so? Why do cows and pigs live longer than mice and rabbits? Why do the latter not possess the genetic potential to live as long as humans?

External environmental hazards play an important explanatory role in this story. And so Hobbes’s insight that life is “nasty, brutish and short” in the state of nature, does not equally apply to all species. The smaller you are, the shorter your life tends to be. And the reason for this is that there exist greater threats to your long-term survival.

The number of predators that threaten an animal's existence will decline the larger an animal is. Thus these larger animals will tend to live longer. And “if a species lives longer in nature, the force of natural selection will be increased at later years. Larger organisms can reproduce at later ages because they are more likely to be alive then, so the force will remain high at later ages. This fosters selection of genes that will tend to keep the larger alive still longer.” (64-5).

Rose also notes that, in addition to large animals, flying animals also enjoy greater longevity. And the reason for this is that they are better able to escape predators. They can also fly vast distances to find food. And so flying animals tend to live longer in the wild; thus they have more chance of future reproduction. “[A]ll else being equal, the force of natural selection favors the continued survival of flying animals more than those that can’t fly. Thus evolution produces parrots that can easily live 60 years, if not longer, while rodents of the same size that don’t fly die in six years” (p. 65).

In addition to body size and wings, having a thick shell (like turtles do) helps a species live longer. “Having a thick shell is an evolutionary anti-aging device, because it reduces mortality and thereby increases the force of natural selection at later ages” (p. 66). I love the way Rose describes the turtle’s shell as an “evolutionary anti-aging device”. For many opponents of longevity science object that retarding aging is “unnatural”. To which we can point to turtles and say “Anti-aging devices occur in nature as well!”

Indeed, a central insight that Rose emphasizes throughout the book is that evolution shows us “the vast potential for altering aging physiologically within one generation, without changing genetics” (p. 69). And the fascinating example of honeybee queens illustrates this point. The queen can live longer than five years, while the worker bee often dies after a few months. While in their eggs both bees have the potential to develop into queens. But queen bees are fed a royal jelly that triggers a series of physiological realignments in the bee.

Rose provides a great analogy between evolution and the production of Ford cars in Chapter 12. And the analogy reveals why it is that we have the limited lifespans we currently have. Here it is:

Think of the automotive industry. 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 to such high specifications. Ford didn’t want to waste money making 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. (p. 91)

Chapter 13 is entitled “Woody Allen and Superman” and in this chapter Rose turns to the provocative idea of “immorality”. He notes that centenarians do not usually lead lives of great debility (p. 101). Rose cites some important papers (authored by “the gang of Jims”) which establish that aging stops, or even reverses, at late ages. The experiments published here showed that a nonaging phase of life followed aging. This is truly fascinating! And I was not aware of this.

Rose and Larry Mueller then published this 1996 paper which showed that aging was followed by a period in which death rates did not increase. How does this translate to aging humans? Rose explains:

Over 95 years of age, human mortality rates stop increasing exponentially with age. Our death rates are phenomenally high in our nineties. But the only reason so many people survive into their second century is that there is an end to the rampant acceleration in death rates that occurs from age 15 to 90….Aging is not an infinitely high wall on mortality, rising faster and faster as we get older, until everybody is dead. It is a ramp that takes us from a phase of low childhood mortality to a much later phase of high, but relatively stable, mortality. Postponing, retarding, or otherwise mitigating aging does not require pushing back a wall of death of infinite height. It requires smoothing out a ramp of mortality, and possibly lowering the height of the top of the ramp (p. 108-9)

Where do all these amazing discoveries leave us? How close are we to actually developing an anti-aging intervention for human beings? Rose characterizes things this way. From all of human history until 1980, the prospect of postponing human aging was negligible. From 1980 to 2000 those prospects were hopeful but not outstanding. Since 2000 (with the sequencing of the human genome), the prospects of postponing human aging have become excellent.

And this is why I personally believe that longevity science could lead us to the greatest medical breakthroughs of this century. Rose’s book is a must read for those interested in evolutionary biology and aging. And as I noted above, the book is very accessible to non-scientists and provides many rich insights into the workings of fruit flies, humans, science and many other things. Reading The Long Tomorrow has further strengthened my conviction that moral and political philosophers ought to seriously consider the implications of longevity science. Otherwise we risk letting dogma and fear delay the imperative to increase the opportunities for healthy life. If more philosophers paid attention to the exciting scientific work being done in this area, then we could help bridge the unjustified divide between political philosophy and science policy.


P.S.- Those interested in aging research should check out this site for information on the "Aging: The Disease, The Cure, The Implications" Conference at UCLA on June 29th.

Tuesday, June 17, 2008

Small Victory for Children's Rights

Back in March I posted this, which noted the harms of smoking, especially on children who are subjected to the harms of second hand smoke (all for the sake of their parents satisfying the addictive effect on brain dopamine levels).

Why any parent would endanger the health of their children for their own addictive-induced pleasure is beyond my comprehension (see my previous post on love).

I'm pleased to see that the Ontario government has passed a law that bans smoking in a vehicle when a child is present. The Globe has the story here. Here is an excerpt:

Ontario became the latest Canadian province to ban smoking in a vehicle with a child present after a government-backed private member's bill passed in the legislature with the support of all three parties yesterday.

Smoking in Ontario workplaces and public areas, such as bars and restaurants, is already illegal in Ontario, but the new ban will provide an additional level of protection to children under the age of 16, said Health Promotion Minister Margarett Best.

"This is about protection of our most vulnerable citizens - children who do not have a voice," Ms. Best told the legislature.


Monday, June 16, 2008

My Perfectionist Account of Ethics

I've been meaning to post a few details about my "conception of the good" for a number of months now. The process of arriving at this view has been a long one, and this account of morality is something I have only come to affirm in the last 2 years or so. This account has been shaped by both my professional and personal life. My general thoughts today will draw exclusively from the latter (my inspiration from the former comes from an excellent article by David Brink on what he calls "metaphysical egoism", as well the work of Socrates, Plato, Aristotle and many other philosophers and thinkers).

Here I offer these brief comments not for the purposes of developing a rigourous philosophical account of ethics, but rather to emphasis the practical implications of the view I now endorse. So the goal of this post is to offer some insights that might help us flourish as human beings (rather than just as scholars)!

This account of ethics and the good is not something that explicitly guides my day-to-day decision-making. Rather, invoking and developing this account of the good helps me make sense of my own life (my aspirations, desires, fears and anxieties) and inspires me to further develop and grow as a reflective, moral agent. So in terms of trying to relate this account of the good to my own life, I appreciate the virtues of seeing this account as a "provisional" view, a kind of life-long "work in progress"! And I think that is the healthy way to approach the challenge of living a decent, moral life.

Let's start with the "foundations" of a theory of morality. Despite being raised in a somewhat religious household and attending two Catholic elementary schools, I am now (and have been for a number of years) a firmly committed (indeed, militant) atheist. To ground something as important as morality on the superstitions of the existence of fairies, pixies or gods is, well... let's just say it is something I no longer seriously entertain. There are so many interesting, fascinating things to learn and contemplate that I find it a real bore investing one's energies in talk of "the supernatural". The life we have "here and now" is the only life we have to live. Such is the fate of all living things (though this is not reason to despair!...).

Where, then, do we turn to in terms of laying the foundations of morality? This is perhaps the biggest challenge facing secular ethics.

Kantians derive their account of ethics from a maxim (like the Categorical Imperative (CI)) that rational agents can derive a priori. So to be a moral agent that can grasp the fundamental philosophical issues of morality, one must be able to detach themselves from their own passions and desires. The importance of autonomy continues on in contemporary neo-Kantian accounts of justice. John Rawls, for example, founds his account of "justice as fairness" on the importance of the separateness of persons (and replaces the CI with his decision procedure known as the original position).

Rather than emphasis the importance of autonomy and the separateness of persons, my conception of morality and the good emphasizes the fact that we are interrelated. More specifically, that we are psychologically connected and continuous with others. So the values and aspirations of my children and wife are part of my own values and aspirations (and vice versa). To love another is to extend oneself in them (to hear their voice in your own mind, even when they are not physically present).

Interpersonal (as well as intrapersonal) self-extension is thus the key to the account of ethics that I personally subscribe to. In other words, love is the foundation of morality and the good life. I know that will sound corny to many, but I think this has the potential to provide us with a sophisticated account of morality that actually has some real explanatory power (in terms of explaining the way we really do behave) and it can also generate some sage prescriptions in terms of how we ought to live our individual and collective lives.

So how does self-extension permit us to flourish, and how does it generate other-regarding duties? This vision of ethics begins by accepting humans for what we really are-- we are temporal, social beings with limited and fallible cognitive capacities. These limitations pose numerous problems for us as we contemplate how we ought to live (e.g. limited information, biases). To overcome these shortcomings we need to place a premium on our deliberative capacities. And we cannot do this if we go through life as isolated "Robinson Crusoes".

The fact that humans are not self-sufficient at producing a complete deliberative good provides us with an incentive for fostering interpersonal self-extension. By extending ourselves in others we enlarge our menu of options (thus gaining new information, new insights, etc.). The details of how different kinds and degrees of self-extension promotes one's eudaimonia is of course a very complex issue. And I won't be able to get into all the details here. In part because I think this ethic has real force only when it is developed as a "particularlist" ethic (that is, when worked out in the confines of one's own life, with all the diverse variables that arise with respect to different people's lives and circumstances). But let me offer some general points, for a coherent account of ethics must be able to make such points if it is to serve as a guide for people in diverse circumstances.

Firstly, it is worth emphasising how forging intimate relations with others expands our deliberative good. Take the family, which I believe is the most important institution. The love between a child and parent enhances the deliberative good of all. By caring and loving for a child a parent's deliberative good is enhanced in numerous ways. It permits one to better understand the vulnerability of our species, and the importance of trust and love. Once a parent has held their new born child in their arms, fed him, changed him and helped settled him in bed, he or she will see all of humanity in a new light. Becoming a caring, loving parent changes your identity in numerous ways.

Likewise, being a child loved by parents and grandparents profoundly shapes one's perception of the world. You learn the values of love, trust and reciprocity. You appreciate the challenges people and relationships face, as they can grow and evolve. Such relationships permit us to profit immensely from the experiences and wisdom of those who have faced the challenges that now await us. Rather than stumbling through life, searching blindly for love, happiness and financial security, hopefully the virtues and knowledge instilled in us by those we have historically depended upon will help us better navigate these challenges.

I could go on... mentioning how forging links with those of the opposite sex (be it a mother, sister or wife) can open one's eyes to patriarchy... how witnessing the eventual physical and cognitive decline of a loved grandparent can help one prepare for the challenges of the future as well as appreciate the many things we tend to take for granted (like our health).

Developing our deliberative capacities requires we go beyond just extending ourselves in our friends and families. There are very good reasons for fostering self-extension in a diverse range of people who are not intimates (e.g. compatriots, non-nationals). Doing so enlarges our menu of options, and helps us overcome the biases and limits of our time and place. This can be accomplished by staying abreast of the world's news, reading novels, appreciating art, etc. There are many different ways of becoming psychologically connected and continuous with others. And forging these relations often motivates us to aid others.

So let me finish these brief reflections with this final point. If one wants real happiness, then they should aspire to consult with many different people and sources. "Many minds" are better than one! The same advice would apply to a healthy polity. Society should consult with many different deliberative bodies before deciding how to proceed. We rely on the input of elected legislatures and executives, as well as the specialized expertise of judges and administrators. A virtuous person, like a virtuous society, will rely on the counsel of many. The big mistake is to think that one can be self-sufficient at living a good life, something which I think autonomy-based accounts of ethics risk doing.

So anyone who asks the question "How should I live my life?" is heading in the right direction because they have already developed the habits necessary for living a reflective life. At the end of the day I think Socrates was correct: "the unexamined life is not worth living". And you are more likely to examine your life critically if you extend yourself in others. So a loving philosopher (by which I mean one who "loves wisdom", not someone employed as an academic philosopher!) is perhaps the ideal of the moral agent!

Martha Nussbaum poignantly captures the real meaning of love in her interview in the Guardian here. The interviewer asks her "What does love feel like?" To which she responds "It's not a feeling, it's a relationship, a way of life".

To aspire to love, to actually love and to be loved... that, my friends, is the truly good life! Our desire for love is evident in the great art works of humanity, like this passionate poem, the beautiful painting of "Mère à l'enfant" by Picasso above, and this song. May we all find love and flourish!


We are Losing the Battle Against Childhood Obesity (Part 3)

Continuing on with the theme I have posted about before (see here and here)-- childhood obesity. I am sympathetic with this story which suggests that childhood obesity is a form of neglect or abuse.

And there is an insightful Times piece entitled "How America's Children Packed On the Pounds" here. Here is a sample:

In the 1950s, kids had three cups of milk for every cup of soda. Today that ratio is reversed, meaning they get all the calories and none of the nutrients.

....The problem is, all those calories come at a price. Humans, like most animals, are hardwired not just to eat but to gorge, since living in the wild means never knowing when the next famine is going to strike. Best to load up on calories when you can—even if that famine never comes. "We're not only programmed to eat a lot," says Sharman Apt Russell, author of Hunger: An Unnatural History, "but to prefer foods that are high in calories." What's more, the better we got at producing food, the easier it became. If you're a settler, you eat a lot of buffalo in part because you need a lot of buffalo—at least after burning so many calories hunting and killing it. But what happens when eating requires no sweat equity at all, when the grocery store is always nearby and always full?

What happens is, you get fat, and that's precisely what we've done. In 1900 the average weight of a college-age male in the U.S. was 133 lb. (60 kg); the average woman was 122 lb. (55 kg). By 2000, men had plumped up to 166 lb. (75 kg) and women to 144 lb. (65 kg). And while the small increase in average height for men (women have remained the same) accounts for a bit of that, our eating habits are clearly responsible for most. Over the past 20 years in particular, we've stuffed ourselves like pâté geese. In 1985 there were only eight states in which more than 10% of the adult population was obese—though the data collection then was admittedly spottier than it is now. By 2006, there were no states left in which the obesity rates were that low, and in 23 states, the number exceeded 25%. Even those figures don't tell the whole story, since they include only full-blown obesity. Overall, about two-thirds of all Americans weigh more than they should.

Wednesday, June 11, 2008

How Dignified Are Appeals to "Dignity"?

The standard Dictionary definition of dignity is "the state of being worthy of honor or respect". Many human actions are classified as immoral because they allegedly contravene the requirements of dignity. What should we make of such vague claims? Not much.

Steven Pinker rips the new President's Council of Bioethics Report on Human Dignity and Bioethics in his aptly titled review "The Stupidity of Dignity". Here is a sample:

...The problem is that "dignity" is a squishy, subjective notion, hardly up to the heavyweight moral demands assigned to it.

...Although the Dignity report presents itself as a scholarly deliberation of universal moral concerns, it springs from a movement to impose a radical political agenda, fed by fervent religious impulses, onto American biomedicine.

...How did the United States, the world's scientific powerhouse, reach a point at which it grapples with the ethical challenges of twenty-first-century biomedicine using Bible stories, Catholic doctrine, and woolly rabbinical allegory? Part of the answer lies with the outsize influence of Kass, the Council's founding director (and an occasional contributor to TNR), who came to prominence in the 1970s with his moralistic condemnation of in vitro fertilization, then popularly known as "test-tube babies." As soon as the procedure became feasible, the country swiftly left Kass behind, and, for most people today, it is an ethical no-brainer. That did not stop Kass from subsequently assailing a broad swath of other medical practices as ethically troubling, including organ transplants, autopsies, contraception, antidepressants, even the dissection of cadavers.

And this editorial in the latest issue of Nature also rips into ethical appeals to the concept:

The law introduced by Switzerland in 2004 to protect the dignity of animals, plants and other life forms is now in conflict with the country's research agenda. Two top Swiss universities have been forced to appeal to the supreme court in a bid to secure the right to perform perfectly reasonable experiments that have been banned because they are said to offend the dignity of the non-human primates involved. The problem in this instance lies in an interpretation of the law that flies in the face of research reality.

The Swiss law is at odds not only with beneficial research but also with good sense. Even plant scientists potentially face restrictions on the kinds of genetic engineering they are allowed to do, and debates have arisen about the abuse of dignity in decapitating wild flowers.

These two stories nicely illustrate how lapses in our moral thinking can adversely impact the flourishing of human societies.


Tuesday, June 10, 2008

Causes of Death

Governments can pursue many different priorities to help improve the life prospects of their compatriots.

In order to ensure our priorities are in fact sound, we must have an accurate sense of the "big picture" of the challenges facing us.

What are the biggest problems we face? And which of those problems are things we could actually do something about?

It is often hard for us to grasp the big picture because, as individuals, we have a very limited perception of the challenges facing society as a whole. Our perceptions are often shaped by the experiences of our own lives. For example, if one is robbed or their home is flooded, then these personal experiences may influence one's perception of what they believe society's biggest problems are (e.g. crime and flooding).

We can overcome these biases by relying on credible empirical findings rather than appeals to our individual life experiences.

I assume we can all agree that the death of our compatriots ought to figure prominently in our deliberations about society's priorities. Of the various things we should try to do, preventing people from dying is among the top of that list. So what causes most of our compatriots to die?

If you travel over to the Centre for Disease Control website you can find out what caused the death of Americans in the year 2003.

Half of all deaths were caused by cancer and heart disease. But this is not the whole story. To really see what is at play here we need to consider the role *age* plays in this story.

So let's consider the deaths of people between the ages of 20-40. What are the leading causes of death for Americans in this age category? Well, disease doesn’t even figure in the top three causes. First there are accidents, which account for 30% of the deaths in this category. Second is suicide, at 12%. And third is homicide at 11%. Cancer doesn’t come in till number 4, and it accounts for only 9% of deaths, and heart disease 8%. So suicide kills more people in this category than cancer or heart disease! And accidents kill more than those two diseases combined!

These statistics reveal the importance of age. Given that accidents kill more young people than cancer and heart disease combined, and yet these two diseases account for half of all deaths, it is thus obvious who is most likely to die- the aged.

Of course we all know this, though we might not want to admit it. Just pick up your local newspaper and flip through the obituaries. The vast majority of these deaths will be among people who are over the age of 65.

The fact that aging kills so many of our compatriots should trouble us. And it ought to mean that tackling aging should figure prominently in our priorities. Of course this leads to the second point I mentioned above- what problems can we actually do something about. I assume most people are not sceptical that scientific advances could lead to new treatments, even cures, for cancer, heart disease, diabetes, AD, etc. And yet if you ask these same people if they believe longevity science could lead to anti-aging interventions they will scoff. But such scepticism is not based upon an assessment of the scientific merits of such interventions. Longevity scientists had made incredible advances in the past decade, and it has been demonstrated that aging is not immutable. Indeed, later this week I plan on posting a few thoughts on this excellent book, which I read last week.

So to conclude. If one believes that the death of our compatriots is a serious concern then one also ought to believe that aging is a big problem. For aging is implicated in the major causes of death. Of course death does not exhaust the range of disadvantages aging visits upon us (it also causes frailty, infertility, impotence, blindness and many other things), but the role aging plays in death alone ought to be sufficient grounds for launching a serious effort to retard human aging.


Sunday, June 08, 2008

Times Piece on Potential of Pharmacogenetics

The Times has this interesting story on the importance of personalized medicine and the important role genetic testing can play in helping us achieve this goal. Here is a sample:

A therapy tailored to individuals’ genes has transformed the treatment of a chronic disease, in a ground-breaking advance for personalised medicine.

Hundreds of diabetes sufferers in Britain were able to switch from insulin injections to cheaper, more effective drugs after a simple test showed that they had a particular genetic form of the disorder.

The test, which is available on the NHS, could benefit up to 20,000 with the condition, many of whom are wrongly told that they have type 1 diabetes, and save the NHS at least £30,000 over each patient’s lifetime. A second genetic test could identify another 30,000 people with a mild form of diabetes, who often require no treatment at all.

The success of the test highlights the growing potential of pharmacogenetics – the new medical science of diagnosing diseases with reference to a person’s genetic profile, allowing for much more effective therapy. Scientists believe that within the next decade this approach will be applied to the treatment of other chronic conditions such as heart disease and type 2 diabetes.


Monday, June 02, 2008

JAMA Commentary on Prevention

The latest issue of the JAMA has an interesting Commentary Article by Steven H. Woolf entitled "The Power of Prevention and What It Requires". Here is a sample:

Benjamin Franklin's adage that an ounce of prevention is worth a pound of cure is worth remembering at this worrisome time for health care and the economy. The prevalence of chronic illnesses in the United States is projected to increase, from 133 million persons in 2005 to 171 million in 2030.1 Health care spending accounts for 16% of the gross domestic product and may reach 25% by 2025.2 Rising health care costs are eroding corporate profits and threaten Medicare solvency, state budgets, pensions, and the viability of employer-sponsored health insurance.

....Even though disease prevention has its limitations, its potential benefits are profound. Chronic diseases, which account for 75% of health care expenditures,4 are precipitated by modifiable risk factors. The relationship between the obesity epidemic and diabetes incidence is illustrative. Targeting risk factors such as obesity can influence disease rates and costs on a scale that few biomedical advances can match. A new diabetes drug can make headlines if it reduces glycohemoglobin levels by 0.5%,5 whereas exercise can lower the incidence of diabetes by 50%.1 Four health behaviors (smoking, diet, physical inactivity, and alcohol use) account for 38% of all US deaths.1 Other forms of primary prevention can intervene more dramatically, as when vaccines all but eradicate infectious diseases. Secondary prevention (screening) can reduce colorectal and breast cancer mortality by 15% to 20%.

....Turmoil in health care and the economy may be shifting the dynamics for health promotion and disease prevention. Policy makers speak more about prevention, although the gestures are piecemeal (eg, better insurance coverage). History teaches that citizens and leaders make sweeping changes when they sense a mutual threat. Lifestyles change and schisms give way to accommodation when national security feels threatened (eg, wartime, climate change). Finding the economy and public health in decline may be what rouses the public to get serious about prevention. Self-interest (living longer and healthier) and common interest (economic stability) may inspire the personal sacrifice of getting healthy and the collective sacrifice (by the private sector and the state) of mobilizing the resources to make it happen.