Saturday, May 30, 2009

The Availability Heuristic and the Inborn Aging Process

Two weeks ago I gave a new paper entitled "Why Aging Research? The Moral Imperative to Retard Human Aging" to a group of scientists who work on biomedical gerontology at this conference in Quebec.

This talk was a unique experience for me as it was the first time I gave a talk to an audience where most people believe that (a) aging is a serious health problem, and (b) it is a problem we can actually do something about.

Why is it the case that this particular audience, unlike most audiences I address, hold beliefs (a) and (b)? The answer is simple- because this audience was composed of scientists who spend their lives studying and manipulating the biological processes of aging. So they are well aware of what happens to the biology of different species as they age, and the different kinds of interventions (e.g. dietary restriction, genetic manipulation, etc.) that can modulate the rate of aging.

Over the 3 days of the conference I met many interesting people, listened to some fascinating talks about experiments on worms, mice, and flies, and also had fascinating philosophical debates about aging and the "good life". In fact this conference was among one of the most enjoyable and rewarding conferences I have ever attended.

While at the conference I met people involved with the LifeStar Institute, and was invited to join their list of advisors. I was happy to accept, and urge you to watch the compelling and moving video on their web site.

Over the past few weeks I have also been busy making revisions to the paper that this talk is based on. And in this post I would like to bring together many of the thoughts I have been pondering. So, down to the details....

Here is a thought experiment:

Rank, from the most probable to the least probable, the following list of risks of mortality:

1. You and your loved ones will die from climate change.
2. You and your loved ones will die from a terrorist attack.
3. You and your loved ones will die from cancer.
4. You and your loved ones will die from a stroke.
5. You and your loved ones will die from Alzheimer's Disease.
6. You and your loved ones will die in a car accidence.
7. You and your loved ones will die from homicide.
8. You and your loved ones will die from pollution.
9. You and your loved ones will die from a poor diet.
10. You and your loved ones will die from the inborn aging process.

Once you have come up with your rankings, do the ranking again, but this time change the content of the first part of each sentence so it reads:

"Most people living in the world today will die from...."

These two tests do many things. Firstly, they test how accurate (or rather inaccurate) our intuitions about the major risks of mortality that we and our loved ones face are with the facts. Secondly, they test how accurate our intuitions are about the risks that face humanity as a whole.

One risk factor on this list is by far the greatest risk factor to your health, the health of your children and loved ones, and the health of the world's population-- aging (which is also implicated in risks 3,4, and 5).

I know, I know, many are sceptical about this claim. "If aging kills so many people, how come the Centre for Disease Control doesn't list aging as the leading cause of death?", you might reasonably ask. My short reply: "Because the current classifications for death, as is explicit in the title of the CDC, focuses exclusively on the proximate (e.g. specific diseases) rather than ultimate causes of mortality".

Most deaths in the world today (see here and here) are caused by chronic disease (like cancer, heart disease and stroke). And most chronic diseases afflict people in late life (over age 60). Why is this the case? Why do most cancer deaths, strokes, heart attacks, etc. occur after the sixth decade?

Evolutionary biology provides the answer. Most people alive today will die from the chronic diseases of aging. And the ultimate cause of this situation is evolutionary neglect. The inevitability of death due to hazardous external environments (e.g. predation, starvation, etc.) means that reproduction is made a higher biological priority than is indefinite maintenance. Natural selection does not influence the post-reproductive period of the human lifespan, hence why our bodies and minds begin to fall apart when they do.

But there is another problem. Because evolutionary neglect is not something we can directly observe (unlike melting polar ice caps and 9/11 terrorist attacks), few perceive the current rate of aging for the problem that is really is. No one walks into a nursing home and says: "Well, it is evident that evolutionary neglect has really left the human species vulnerable to frailty and disease in late life, let's do something about this!". The media does not report gripping stories on the impact evolutionary neglect has on scarce health care resources. Nor do politicians get elected by promising to combat the effects of evolutionary neglect. This is a problem, a big problem. It means we end up neglecting the leading cause of disease and death in the world. That's a perverse situation. Indeed, it's harder to think of a more perverse situation! And this is why I have dedicated so much of my research and energies into trying to help raise greater awareness about these issues.

In a rational world, aging research would be at the forefront of a global collaborative initiative to improve the health and economic prospects of today's aging populations (and all future generations).

But humans are not rational. We suffer many cognitive biases. One prominent bias is the availability heuristic. Risks that are easily brought to mind are given a higher probability; and conversely, the less vivid a risk, the more likely we are to underestimate the probability of their occurring.

The two tests above reveal how prominent this heuristic is in your own comprehension of the risks facing yourself, your loved ones and humanity. Because death by aging is not something that is vivid is most people's minds (though it is in the minds of the scientists who study the biology of aging and thus know all too well how it affects a species functional capacities), odds are you probably underestimated it as a risk of mortality. When you attempt to picture the scenario of someone dying from aging you probably picture a peaceful, painless death- perhaps a centenarian who, while asleep, suffers heart failure and dies immediately. Sadly this is not the reality. Very few humans have the "longevity genes" that centenarians have. Most people have the genes typical of the adults who populate nursing homes. The only thing separating you from them is the number of years you have been alive. Normal aging entails a period of chronic disease, which means a prolonged period of painful, and expensive, existence.

The reality is that almost everyone you and I know will die from the chronic diseases caused by the inborn aging process. This means your children will probably die from the same diseases that killed your parents and grandparents.

If there was nothing we could do to alter this state of affairs then it would be depressing and pointless to go on about all this. But we now know that ageing is not immutable. Humans do not have to endure the disease and frailty that the current rate of aging imposes on us. Retarding aging would add more years of health and compress morbidity at the end of life. The goal of age retardation is thus among one of the greatest priorities for humanity this century.

Sadly, not only does the availability heuristic impair our ability to perceive the risks of the inborn aging process, but it also impairs our ability to accurately evaluate the magnitude of the benefits of age retardation.

Here is another thought experiment:

Imagine what would happen if a safe and effective drug was developed that could retard human aging (by mimicking calorie restriction), thus adding 20-30 years to the human healthspan. What would the consequences of this be?

Many people's intuitions immediately gravitate towards negative consequences that can easily be make vivid in their minds- like global overpopulation and growing health inequalities between the rich and poor. But these consequences, which come up a lot in discussions of these issues, are not premised on empirical evidence. They are based on the availability heuristic.

So what are the most likely consequences of a drug that retards human aging? Well, like immunizations- that have helped reduce early-life morbidity and mortality- the most obvious consequence would be a reduction in late-life morbidity and mortality. Fewer people would get cancer, have a stroke, suffer from arthritis, be frail, suffer from dementia, suffer bone fractures, burden their families by requiring constant care, etc. So the population would be healthier and economies would flourish. But these realities are much harder to make vivid in our minds than the imagined negative consequences. It is so much easier to imagine worst case scenarios, even if they have no basis in reality. And this impedes some of the most important scientific advancements of our time.

Thus two distinct legacies of our evolutionary history present formidable challenges. The first, the inborn aging process, causes most disease and death in the world. And given how many aged people there are in the world (600 million over age 60 today, and this will rise to 2 billion by 2050) the inborn aging process will kill, for the first time ever, more people this century than any other cause. Each year chronic disease kills more people than three centuries of the "Black Death" plague killed.

The second legacy of our evolutionary history are cognitive biases, like the availability heuristic. We have evolved to perceive risks through our five senses. So a charging tiger is easily perceived as a risk. But evolutionary neglect is not. To make serious headway against aging we must also make serious headway against the faulty heuristics we commonly premise our decision-making on.

If you really care about the future your children will inherit from us, then I urge you to join the battle against chronic disease and the battle against irrationality. And championing the cause of aging research is at the forefront of both of these battles. Our children do not have to suffer the same fate that our parents and grandparents suffered in late life. Please support the science that could help reduce most disease and death in the world. Please support aging research.


Friday, May 29, 2009

Light Therapy for Sleep

Two topics that regularly appear on my blog are sleep and aging. So I thought it was appropriate to post about this study which intersects the two topics. Light stimulus might help the elderly sleep. Here is the abstract:

Light treatment has been used as a non-pharmacological tool to help mitigate poor sleep quality frequently found in older people. In order to increase compliance to non-pharmacological light treatments, new, more efficacious light-delivery systems need to be developed. A prototype personal light-treatment device equipped with low brightness blue light-emitting diodes (LEDs) (peak wavelength near 470 nm) was tested for its effectiveness in suppressing nocturnal melatonin, a measure of circadian stimulation. Two levels of corneal irradiance were set to deliver two prescribed doses of circadian light exposure. Eleven older subjects, between 51 and 80 yrs of age who met the selection criteria, were exposed to a high and a low level of light for 90 min on separate nights from the personal light-treatment device. Blood and saliva samples were collected at prescribed times for subsequent melatonin assay. After 1 h of light exposure, the light-induced nocturnal melatonin suppression level was about 35% for the low-light level and about 60% for the high-light level. The higher level of blue light suppressed melatonin more quickly, to a greater extent over the course of the 90 min exposure period, and maintained suppression after 60 min. The constant exposure of the low-light level resulted in a decrease in nocturnal melatonin suppression for the last sampling time, whereas for the high-light level, suppression continued throughout the entire exposure period. The present study performed with healthy adults suggests that the tested personal light-treatment device might be a practical, comfortable, and effective way to deliver light treatment to those suffering from circadian sleep disorders; however, the acceptance and effectiveness of personal light-treatment devices by older people and by other segments of the population suffering from sleep disorders in a real-life situation need to be directly tested.

More details about the research can be found here.


Tuesday, May 26, 2009

Musical Aptitude

When I was a child I took piano lessons from the ages of 7 to 13. I struggled with the piano and eventually gave it up. I regret that decision.

After a quarter of a century + reprieve from playing the piano, my wife and I recently purchased a used one in the hopes that our children might show an interest in playing. It's still early days, but a few nights a week the family is drawn into the living room to hear each of us play our own "creative works". It's great fun. And I believe music is an important part of a child's (and adult's) cognitive and imaginative development. With all the lures of today's technogadets (like cell phones, video games and facebook) I think it is important for children to be exposed to the cultural richness embodied in music and musical instruments.

Sadly I let the piano, and music more generally, fade away from my life from around my late teens till my late 30's. But with a piano now in the house, I am trying to rekindle my love of music.

Besides playing a few simple notes that are a hit with the kids (like the theme to Star Wars and Indiana Jones), I have, with the help of this guy, been able to learn one of my favourite songs ("100 Years") in just a week or so of practice. To amuse, rather than inspire!, my children I have recorded my own amateur efforts below and made this video (please refrain from laughing, I need encouragement and support not ridicule :))

Hopefully over time I can improve, learn some new songs and see if I can learn to read music (again).

Based on my own personal experience I think it is obvious that I do not possess a natural aptitude for music. But some people do. And this study in the latest issue of PLOS One found that there is a genetic association between musical aptitude and intrinsic attachment behavior. The study focused on 19 Finnish families (343 members) with professional musicians and/or active amateurs. "Creativity in music" is defined as composing, improvising and arranging music at high-level creative functions (which obviously excludes me!). The researchers discovered that creative functions in music have a strong genetic component (apologies to my kids, but there may be hope with my wife's genes!).

Here is the abstract of the article:

Artistic creativity forms the basis of music culture and music industry. Composing, improvising and arranging music are complex creative functions of the human brain, which biological value remains unknown. We hypothesized that practicing music is social communication that needs musical aptitude and even creativity in music. In order to understand the neurobiological basis of music in human evolution and communication we analyzed polymorphisms of the arginine vasopressin receptor 1A (AVPR1A), serotonin transporter (SLC6A4), catecol-O-methyltranferase (COMT), dopamin receptor D2 (DRD2) and tyrosine hydroxylase 1 (TPH1), genes associated with social bonding and cognitive functions in 19 Finnish families (n = 343 members) with professional musicians and/or active amateurs. All family members were tested for musical aptitude using the auditory structuring ability test (Karma Music test; KMT) and Carl Seashores tests for pitch (SP) and for time (ST). Data on creativity in music (composing, improvising and/or arranging music) was surveyed using a web-based questionnaire. Here we show for the first time that creative functions in music have a strong genetic component (h2 = .84; composing h2 = .40; arranging h2 = .46; improvising h2 = .62) in Finnish multigenerational families. We also show that high music test scores are significantly associated with creative functions in music (p<.0001). We discovered an overall haplotype association with AVPR1A gene (markers RS1 and RS3) and KMT (p = 0.0008; corrected p = 0.00002), SP (p = 0.0261; corrected p = 0.0072) and combined music test scores (COMB) (p = 0.0056; corrected p = 0.0006). AVPR1A haplotype AVR+RS1 further suggested a positive association with ST (p = 0.0038; corrected p = 0.00184) and COMB (p = 0.0083; corrected p = 0.0040) using haplotype-based association test HBAT. The results suggest that the neurobiology of music perception and production is likely to be related to the pathways affecting intrinsic attachment behavior.


Friday, May 22, 2009

Main Menu (May 2009)

Wednesday, May 13, 2009

The Myth of "Homo Primaeva"

This long post is really part 2 of my earlier post on "The Missing Piece? The Fight for Science (and Justice)" which I posted back in December.

I am preparing a talk I am giving to a group of scientists who work on biomedical gerontology. The title of the conference session I am participating in is "Why Aging Research?" Over the past 3 years this question has consumed my deliberations and research. So I am really looking forward to giving this talk.

In fact, if it weren't for the question "why aging research?", I probably would have finished my book on "genetic justice" about 3 years ago! By considering the topics of aging and aging research I have been forced to think much deeper about a number of issues, like:

(1) who are the least advantaged?

(2) what ought we to say about the unchosen health inequalities between the young and aged

(3) the projected rise in chronic disease this century

(4) how to handle the concerns of aggregation that arise in a population that is getting older

(5) the complex challenges of mitigating disadvantage

(6) the impact natural selection has had on our lives

and (7) inspired me to read new books I never would have likely read....

This lengthy diversion into the field of aging and biogerontology has meant that the draft of the 90 000+ words of my book continues to accumulate dust while I indulge my curiosity about these other (related) concerns.

Has this diversion of my attention been worth it? Absolutely! I have published articles on aging research in journals in bioethics, science and medicine. I have a much firmer grasp of the things that actually cause most disease and death in the world today. And I now appreciate the brilliance of Darwin and the potential of Darwinian medicine to revolutionize our approach to the medical sciences.

But perhaps one of the most valuable lessons of this diversion into the field of aging research is that it has taught me a lot about the shortcomings of my own discipline- political philosophy.

The fact that I work on issues that are, to but it mildly, "on the margins" of the discipline mean that I have had to critically reflect much harder on the question- why ageing research? If I decided to tackle a more mainstream issue (like multiculturalism or global justice) I wouldn't be expected to justify why I decided to invest my time and energy into topics. But because the topic of aging research lacks "intuitive appeal", I am compelled to think much harder and deeper about these issues. For example, I have had to consider what the role of science is in a fair and just society. And how a fair society should respond to the challenges of changing demographics. Sadly neither of these questions get much attention from political philosophers. So over time I have come to realize that my interests in science and aging are not odd after all. Far from it. What is odd is that the political philosophers who claim to have an interest in justice neglect both of these important issues. So let me offer a brief diagnosis of why I think this is the case.

Political philosophers ask many questions, but one of the central questions in the field is: what constitutes a just society? For contemporary theorists, this has largely involved asking questions like: What principles should govern the distribution of wealth and income? How should a just government respond to value pluralism and the reality of cultural inequality? How much weight should be placed on the protection of basic rights and freedoms? etc. These are questions most of us probably have pretty detailed answers to.

But when it comes to science policy things are very different. Earlier this month President Obama give this excellent speech to the National Academy of Sciences. He pledged to invest 3% of GDP for science research (basic and applied research). He also vowed to improve education in math and science. This represents the largest investment in scientific research and innovation in American history. With such a monumental investment being made in science one has to wonder: what do we (i.e. political philosophers) have to say about all this? Surely the National Academy of Sciences are part of the "basic structure" of society and thus an investment of this scale must raise some important questions of justice that we can contribute some insights to. But I wonder how many of us have discussed this issue in our classes? How many conferences and edited volumes are in the works tackling the diverse issues of justice that arise in this context?
.......long awkward silence.........sound of crickets.....(well there is at least one encouraging sign of life here)...............

I think our silence on these issues is a real shame. We have little to contribute to these issues because we have chosen to invest our time and energies elsewhere. And I think we need to take a long, hard look at where we have taken the discipline.

If we are asked about the distribution of wealth and income we have a handful of principles and theories at hand. Ditto if you ask us how governments should respond to the cultural inequalities that exist in multicultural societies. And ditto again if you ask us about what we owe to the poor in distant lands, or the value we ought to place on basic rights and freedoms. But ask us what constitutes good and bad science policy and you are bound to hear nothing but a long, awkward silence.

To avoid any misunderstanding, I push us on these points not because these interests and questions just happen to be ones I am interested in tackling. Rather, these issues and questions have come to preoccupy my own interests in recent years because they are so important to society. But it is hard to make headway on them because one has to basically start from scratch. There are few sources to turn for inspiration on how to broach these topics (though I have recently discovered the work of John Dewey, which has proved extremely valuable and inspiring).

To move things forward in a constructive fashion I believe it is helpful to look at how we arrived at this situation. So what I offer now is my attempt at a partial "diagnosis" of our neglect of one area of science policy- biogerontology.

Political philosophers like to gang up on economists so let me drawn a parallel between the shortcomings of economics and the shortcomings of contemporary debates about justice among political philosophers. The dominant theoretical paradigm in economics is rational choice theory which presumes humans are "homo economicus" (rational man). That is, that we are rational agents that act in ways that will maximize our utility. However, there is growing empirical evidence from many fields (like psychology, neuroscience, etc.) that shows that people often do not act this way. We suffer many cognitive biases and commonly invoke faulty heuristics that lead us to make irrational decisions. We also care about reciprocity and are willing to reward those who act in a cooperative manner while punishing those who do not even when these actions are costly to the individual.

Given the reality of our decision-making capacities, if economics is to thrive as a discipline it will need to be re-cast in ways that are not constrained by assumptions which have been shown to be untenable (like the assumption that we are homo economicus).

Similar concerns apply to the assumptions of political philosophers and our debates about distributive justice. But instead of invoking a vision of "homo economicus", we employ what I will call the myth of "homo primaeva" (which means "youthful man"). Why do I say this? Well, imagine that Martians came to Earth and could only learn about human life on our planet by reading just the past 40 years of debates in political philosophy. While they might learn that some inequalities in our life prospects are caused by brute luck (some people are born into rich families, others into poor families), others by expensive tastes, and that the philosopher John Rawls expanded his theory of justice from the domestic realm to the international arena, etc., the Martians could be forgiven for thinking that adult humans did not age. That is, they would assume that adult humans when through life with the same health and economic prospects of an adult in their 20's.

Of course this assumption is obviously false. Our economic and health prospects vary as we age. But we seldom acknowledge this reality in our discussions of the demands of justice. What explains this implicit assumption of "homo primaeva"? Maybe part of it has to do with the nature of the insulation of academia. While it is true that we, as professors, age, the students we teach don't appear to age. When I started teaching 10 years ago the average age of my students was 20. Ten years later they are still 20! And in 20 more years they will still be 20. So the insulation of academia might explain part of what is going on here.

But more seriously, a more likely explanation has to do with the skill-set contemporary political philosophy seeks to develop. And so one main culprit (though I admire him greatly!) is John Rawls. One of Rawls's "simplifying" assumptions is that all the participants in the social contract are healthy, productive members. And "poof!"... just like that, the myth of "homo primaeva" was planted and flourished over the next 40+ years.

Rawls invoked this simplifying assumption to help bracket particular complexities like healthcare, and in so doing come to an understanding of how wealth and income should be distributed and the weight to place on rights and freedoms. The problem is that this one simplifying assumption pretty much erases many of the central questions of justice that are in need of being addressed. To bracket them, so that attention can be placed on wealth, income and rights and freedoms gives one the impression that science and health policy are secondary, or even tertiary concerns. And that has certainly been the (unfortunate) consequence for the field 4 decades later.

The reality today is that the inborn aging process is now the major risk factor for disease and death after around age 28 in the developed countries and limits average life expectancy at birth to approximately 85 years (source) Aging predisposes our bodies to fall apart, making us vulnerable to chronic diseases like cancer, heart disease and stroke. Advances in evolutionary biology point us in the direction of potential interventions in the aging process that could expand the opportunities humans could have for health. Our neglect of human biology and science in general is unjustified.

As I have noted before, I subscribe to the ancient conception of "philosophy"- that is, "love of wisdom". And practical wisdom requires us to grasp the "big picture" and develop a sense of proportionality. Unfortunately I fear I am in the minority, for the field currently favors precision over proportionality. Hence it is unlikely that aging will likely become a "hot topic" in political philosophy any time soon. Maybe 20 years after an anti-aging intervention is developed and significantly improves global health by reducing the risk of chronic disease political philosophers will take note and then begin to contemplate what would happen if you add a person's age to the list of things that we don't know behind the Rawlsian "veil of ignorance". And then, after another 20 years of further debate, a consensus would arise that, like the sanitation revolution, it was a good think we funded some aging research.

But wait a minute.... I'm not even sure there is a consensus that the sanitation revolution was an important event. So perhaps things look even more grim for the discipline!

The short-term carrot sticks of academia (like tenure and promotion) provide strong incentives for philosophers to burrow away with their specialization rather than forge interdisciplinary interests and insights. This is odd given that philosophy, of all disciplines, should be receptive to interdisciplinary aspirations. Where would the contributions of Aristotle or Hobbes be if they shared the current disdain for science and empirical knowledge? Let's quash the myth of "homo primaeva". By doing so we can help narrow the gap between ideal and non-ideal theory, the gap between the humanities and the sciences, and the gap between theory and practice. And I think this would reap a fruitful and important bounty.


Wednesday, May 06, 2009

Talk on Enhancement and the "Status Quo" Bias

Yesterday I drove down to Bowmanville, Ontario to give a 90 minute talk to approximately 50 students at Clarington Central Secondary School. They were Grade 12 students taking courses in politics and philosophy. My talk addressed the issues of enhancement, aging and the "status quo" bias.

I want to thank Trish for inviting me down and thanks also to all the students that raised lots of good questions at the end of my talk. I really enjoyed the exchange, and it was interesting to see what the attitudes of the younger generation are to these issues. Below I summarize some of the main points from the talk, and my response to some of the questions raised.

Last week President Obama announced that the largest investment in scientific research and innovation in American history will be made. This raises many interesting questions concerning the role of science in helping us create a more fair and humane world. And here I will limit my discussion to novel advances being made in the biomedical sciences and the great benefits they could provide us with this century.

I started things off with a discussion of the PEPCK-Cmus Mice and showed the class this brief video. These are transgenetic mice that researchers at Case Western Reserve University created back in 2007. The results were published in the Journal of Biological Chemistry (see here) . These genetically enhanced mice can run twice as far as a normal mouse, they live longer and can remain fertile longer than regular mice. They can also eat twice as much as a normal mouse but only weigh half as much.

These "enhanced" mice have had their metabolism re-patterned. If (and it is a big *if*) re-patterning the human energy metabolism were to confer the same magnitude of enhancements on humans, then some people could live to a 140 years of age, a woman could still have a baby at age 80, and you could over-eat and still be healthy.

So the question I wanted the class to focus on was this: Is it ethical to biologically “enhance” humans (to improve upon evolution)? [I noted that this question was loaded, and would explain why later)

Suppose this was (relatively) safe to do in humans, [roughly equivalent to the risks associated with immunizations or playing sports], how many people think the idea of enhancing humans like this is a bad idea? How many think it would be great?

I was surprised by how many students said this would be great (over half the class). When I ask my fourth year University students this question most think it would be a bad idea. But in this class the advocates outnumbered the critics.

I then asked them to consider this. Imagine that a new “exercise machine” was created that could do the same thing for humans. It could really make you twice as strong, live longer, remain fertile for longer, etc. And let's suppose this was scientifically proven rather than just hype from the company selling the machine. How many people would like to work out on this machine? And how many would prefer to go to the gym and use the older machines that would be less optimal for their strength and health? Most thought you should use the better machine.

I then asked how many who opposed enhancing humans via genetic intervention or drugs were in favour of this same thing via exercise (there were quite a few). And I told them they were the people I would be trying to get to think critically about their position on these issues. Why are they in favour of enhancing humans via exercise and not via a drug, especially when (as my example presumed) the effects of enhancement were the same.

I asked for some initial answers. One student mentioned that people deserve these benefits if they work for it but not by popping a pill. I replied that this is a common reaction. But if we think about our attitudes towards health, we probably wouldn't want to endorse a principle of desert as the appropriate principle. In other words, do we really want to say that those who exercise less *deserve* diabetes, cancer and an earlier death? That's harsh. Furthermore, there are many reasons why people's lifestyles vary (how much time they have, how affluent and educated they are, whether they live in a climate or city conducive to outdoor activities, etc.). So the role of personal responsibility in this context is a tricky one.

OK, so my concern was why some people's intuitions change when the means of enhancing humans is altered. Those who favour enhancement via the exercise machine must explain why they don't support enhancement via drugs.

My explanation for this is that these people suffer from the cognitive bias known as the "status quo bias". This bias is a strong desire to keep things the same. There are plenty of examples from this in real life. Here is a simple example.

Suppose your best friend is dating a guy you know is a jerk. You ask her why she stays in the relationship. And she responds "Because he's the best boyfriend in the world!". To which you think "How can you say that when you have only had two previous boyfriends!!". When one considers all the possible boyfriends there are in the world, what are the odds that the really BEST boyfriend just happens to also be in your Grade 10 Chemistry class and live within a 1 mile radius of where you just happen to live? This applies in many aspects of our decisions- economic decisions, decisions about where to live, etc. We often place weight on the status quo for no other reason than it is what we are familiar with. And lots of people suffer from the "enhancement status quo". That is, they believe that pursuing external environmental enhancements (education, going to the gym, etc.) is inherently good, but altering our biology via drugs or genetic intervention is inherently bad.

What I find surprising is that people seem pretty confident that the human body's current energy metabolism just happens, at this stage in our evolutionary history, to be the best! That we shouldn't aspire to improve upon it like we have with the PEPCK-Cmus Mice.

So how do we combat this enhancement status quo bias? Here is a great paper on that topic. For this talk my suggestion was that if we reveal the real costs of the status quo, then people might realize that perhaps it is not that great to try to keep the status quo. Just like your friend might realize she should dump her boyfriend once she has all the relevant information about him at hand (e.g. that he cheats and lies to her), perhaps we would chose to "dump" our current energy metabolism in favour of one that makes us stronger and healthy for longer when we reflect on the harms of the status quo.

To bring this into focus I addressed the issues of aging and aging research. I won't re-visit all of these issues here as I have posted on them many times before. But I highlighted (1) what the costs of aging are, and (2) how close the science is to making the aspiration of retarding aging a reality.

At the end of all of that I returned to my initial question: Is it ethical to biologically “enhance” humans (to improve upon evolution)?

But that question is not the correct way to phrase things. The real question is: Is it ethical to “enhance” humans? The answer is clearly “yes”. We enhance ourselves through education, immunizations, clothing, eye glasses etc. No one champions that "status quo" of our vulnerability to measles and mumps, or our failing vision, tooth decay, or susceptibility to freeze to death without appropriate clothing, etc. Every day we utilize enhancements.

Once we realise that, we are likely to take the view that it would be unethical not to enhance humans! Limiting access to immunizations and education, for example, would be viewed as an injustice.

So the best means to achieve the goals of health, intelligence, etc. ought to be considered on their merits- their efficacy, safety, costs, etc. We shouldn’t pre-judge these issues by assuming we already know what the best way to achieve these goals are. Such arrogance neglects how little we really know about our biology.

[some extra points are added here...]
One of the greatest dangers to creating a better world is the status quo bias. The next time you defend a policy that is premised on an assumption like "the current rate of aging is the ideal" or "the current global temperature is the ideal" or "our current cognitive capacities are the ideal" ask yourself if you have fully considered all the costs and benefits of the status quo and potential alternatives. Odds are your "gut reaction" does not track these complex variables. Would you prefer public policies to be premised on "gut reactions" or a comprehensive assessment of the all the relevant, available data? I prefer the latter.

Unfortunately good intentions alone are not enough to create a better world. If they were we would have realized these ideals a long time ago. Humans have always possessed good intentions, but what we have lacked is the knowledge to know how realize these intentions. Hence why it is imperative that we cultivate a culture the celebrates scientific habits of mind and a respect for the great good that science can (and has) created.

After the talk some great questions were raised. I've tried my best to recall the points raised and briefly summarized the questions and my responses (with some addition points added) below.

Question (1): people have to die from something, so what good would slowing aging really accomplish? Also, wouldn't this cause overpopulation?

Response: It is true we all have to die of something, there is no "immortality" drug. However, our attitudes towards age-related risks of mortality should be the same we take towards every other possible cause of death. Namely, we want to *minimize* those risks. We wear seat belts, look both ways before crossing the street, etc. in an attempt to avoid death. And there are an almost infinite list of ways to die. No one says- let's just accept the current deaths from car accidents, adverse reactions to drugs, war, poverty, etc. by saying "well, people have to die of something!".

So why only bring this objection up with age-related risks? [in other words, consider this modified version of the question- "given people have to die of something, what good would stoping war, cancer or poverty really accomplish"]? Of all the possible risks to be complacent about the risks of aging should be last on our list. Why? Because aging is among the greatest risk factors and it is something we might be able to do something significant about. If we have to be complacent about some risks lets pick those that are very small and ones we can't change anyways .

On the second point, many people believe that the world is overpopulated. They also seem to think the evidence for this is the fact that some people live in poverty. Well, it is worth noting that there has never been a period in human history when some humans did not live in poverty. In fact, just 2 centuries ago everyone lived in poverty. So poverty existed when the world had less than 1 billion people. And poverty exists today when the population is over 6.5 billion. But the cause of poverty is much more complex than the # of people. Life is not a zero sum game (meaning more life for some need not come at the cost of less life for others).

But even if slowing aging caused problems associated with overpopulation, you have to weigh up the harms of that versus the harms of letting billions of people die prematurely from chronic disease. And my view is that the harms of the "aging status quo" present much more certain and greater harms than the potential negative consequences of age retardation.

Question (2) A question was raised concerning the moral hazards that might be involved with developing a drug that accomplishes these things. Won't this just perpetuate inactive lifestyles because people think they just need to pop a pill?

Response: good question. The reality is that such a pill, in conjunction with a healthy lifestyle, could help us reap the most optimal health consequences. So we would have to educate people about what the pill actually does. It would be a supplement, not a replacement to a healthy lifestyle. Of course there are dangers of people being misinformed. And that would have to be addressed.

Question (3) what about this leading to greater inequalities between the rich and poor? How do we ensure developing countries have access to an anti-aging intervention?

Response: All existing enhancements (education, immunizations, eye glasses, opportunities for exercise, etc.) are unequally accessible to people in the world. So this inequality problem is not unique to an enhancement that retarded aging. Is it better to have these enhancements, even if they are unequally available to all in the world, than to have never developed them in the first place? I think the answer is clearly "Yes" [if you think the answer is "No" then what you are saying is you really would prefer for everyone to revert to a life expectancy below 30 years, which is what the norm has been for humanity for 99.9%+ of our species' history).

Recognising that enhancements are unequally accessible doesn't mean we should not fight for greater access to them . Of course we should. And what is particularly important to campaign for is access to those interventions that are most cost-effective, that would reap the greatest benefits for the smallest cost. And I believe an anti-aging pill would be just such an intervention. So if we make age retardation a priority for global health, there is no reason all couldn't reap these benefits.

Unfortunately many people in the developed world fail to realize that less affluent countries also suffer from the chronic diseases of aging. Many seem to think all people outside the most developed countries die from HIV and malaria, when the truth is that most die from the same things that kill us- cancer, heart disease and stroke. The WHO estimates that in the decade between 2005 and 2015, 144 million people will die of chronic disease in lower middle income countries like China and India. So retarding aging would be a benefit to those in less affluent countries. Indeed, staying healthy and productive is much more vital in a poor society because workers cannot rely on health care and pensions to aid them in later life. So slowing aging is also a matter of development economics.

One last point to consider. A public health intervention like providing clean drinking water requires large-scale urban and rural planning, construction, enforcement of compliance, etc. These "post" R+D costs and challenges are unlikely to be such a problem with a drug that retards aging. So when thinking about what access to an anti-aging pill might be like consider something like the birth control pill rather than sanitation. The UN has the data here on World Contraceptive Use.

It is true that women in the developed world enjoy greater access to the birth control pill than women in developing regions (16% to just 6%), but things are more complex because there are many different ways of using birth control. So IUD's are used more widely in less developed regions, as is female sterilization. And access to the pill is complicated by issues like religion. Unless the Pope comes out in support of a ban on an anti-aging pill we should assume these obstacles would not arise with a pill that reduces the risks of morbidity and mortality in later life.

Question (4) But the danger with tampering with our genes is that we won't know all the consequences of this. Every day we are learning about new toxins in the food we eat that cause cancer. Epigenetics reveals how complex the interaction is between genes and environment. So how can you say it would be ethical to enhance humans by tampering with our genes when we don't know what the full consequences will be of this ahead of time.

Response: But everything we do on a day-to-day basis influences our genes- the food we eat, our lifestyle, etc. So there is no option of "leave our genes the way they are!". And most of the things we do now that influence our genes and biology are done in ignorance of the full consequences they will have on our health prospects.

The best we can do is go by the data we have, try to get new data, and make an informed decision. We know what the costs of the current rate of aging are. They result in death and disease for most people before age 85, that is a certainty for our species (though the rare individual may live a 100 years of disease-free life). So we will see unprecedented levels of chronic disease this century unless we do something about aging.

A decision to pursue age retardation has to be made on the basis of (a) the grounds for believing such an intervention can be efficacious (so it would have to be shown to work in other organisms (like mice), and a plus would be that it has a demonstrated therapeutic effect for treating human diseases in clinical trials); and (b) its safety (this is where the clinical trials for treatment prove useful again).

There are no guarantees. But that holds for everything we eat and consume. And if, among all the various things we currently do consume that are good, bad,indifferent and unknown (which are most things) for our health, we suddenly invoked the "status quo" bias and decided not to pursue an anti-aging intervention even though it had a proven track record of improving health in other organisms (including mammals) AND a proven track record for safety in clinical trials for humans, then we would be irrational. But these are important issues, and we need to wait for more of the data to come in before we can decide how best to proceed.


Monday, May 04, 2009

Vitamin D and Children

I've been following the debates on vitamin D for some time now. Today's Globe has this story about a study on the health risks in children who are deficient in vitamin D. Here is a sample:

The first Canadian study to investigate vitamin D levels in toddlers has found that more than 80 per cent of the children tested didn't have enough of the sunshine vitamin and nearly a third had such low amounts that doctors classified them as deficient.

...."Vitamin D deficiency is associated with a number of chronic medical conditions," observed Jonathon Maguire, a researcher at Toronto's Hospital for Sick Children and lead author of the study, who called the results "concerning."

....There has been a flurry of medical interest in vitamin D because of tantalizing hints that it plays a far wider role in promoting good health than just helping ensure proper bone development, for which it is well known. New research has linked deficiencies to many cancers, heart disease, to such autoimmune conditions as MS and diabetes and even influenza.


Sunday, May 03, 2009

President Obama on Science

If you haven't watched President Obama's speech to the National Academy of Sciences from last week I strongly encourage you to. This speech, and his pledge to invest 3% of GDP for science research (basic and applied research), is consistent with the position he expressed prior to being elected. And it is consistent with this position.

The Obama Administration thus appears to represent a very fortunate about-face from the arrogance, short-sightedness and ignorance of the previous Administration.

My favourite lines from Obama's speech: "Under my Administration, the days of science taking a bad seat to ideology are over". And "[we must] encourage young people to build and invent-- to be makers of things, not just consumers of things" Hear! Hear!

Us "Canucks" can only watch with envy as our own government bumbles along.


UPDATE: the headlines from today's Globe is "Top AIDS researcher lured away ". Ouch!