Monday, April 25, 2011

David vs Goliath

*Originally posted in Nov. 2009*

The story of humanity is a fascinating and inspiring one.

Despite the great adversity our species has, and continues to, face, we are capable of great compassion, imagination and inspiration. Indeed, it is perhaps these human traits that have helped us overcome the almost insurmountable obstacles we have faced in our species' evolutionary history.

What we are today reflects the challenges we have had to overcome in the past. From our two eyes and two hands, to our emotions like love, hope and fear, we are a complex history of biological and, more recently, cultural evolution. The inhospitable and unpredictable environments in which our species lived has given us aggression and compassion, emotion and reason, fear and happiness.

To help us overcome starvation we developed tools for hunting and farming. To help us overcome infectious disease we created the sanitation revolution and vaccinations. Our ability overcome diverse and complex forms of adversity is admirable.

The history of humanity is thus one of struggle (with all of its accompanying tragedy) but also one of hope (with all of its accompanying inspiration). Hope for a better state of affairs. One where humans have more opportunities to enjoy health, love and happiness. This aspiration to make things better is, I believe, what makes us truly human. And it is an aspiration that links us to our distant ancestors.

The title of this post is "David vs Goliath". Humanity is David, and Goliath represents all the things that have, and continue to, challenge the health and welfare of humans. The specific form of Goliath alters over time. Reflecting on the causes of death in the 20th Century, for example, we see that Goliath was warfare (including two World Wars), totalitarianism, and, most importantly, infectious disease. The Flu pandemic of 1918, for example, killed an estimated 50 000 000 people, which is more than 3 times the estimated number of deaths caused by four years of “Great War” in 1914-18. And small pox is estimated to have killed between 300 and 500 million people in just the 20th century.

In the 21st century, Goliath is CHRONIC DISEASE (e.g. cancer, heart disease, stroke, etc.). Just 1 year of chronic disease today kills as many people as 300 years of the Black Plague.

In the decade from 2005 and 2015, the World Health Organization estimates that 220 million people will die from chronic illness, 144 million of these deaths will be in lower middle income countries like China and India.

To slay the Goliath of today humanity must be more compassionate, more imaginative, and more inspiring than it has been in the past. Slaying Goliath in the 21st century will require, I believe, an aggressive effort to understand the biology of aging, and then the development of interventions that modulate the rate of aging, so that humans can enjoy more disease-free life and a compression of morbidity at the end of life.

Why we age, and become frail and diseased, is a legacy of our evolutionary history. In short, because life in the state of nature was "nasty, brutish and short" the force of natural selection does not apply to the post-reproductive period of the human lifespan. So most disease and death today are caused by evolutionary neglect. And given the size of today's aged populations, unprecedented numbers of humans will suffer the ravages of chronic disease.

The vision of David battling Goliath came to me today as I happened across the following video this morning and was deeply moved by it. It is an interview with J.M. Smith, an evolutionary biologist who died in 2004. While a student Smith studied fruit fly genetics with J.B. Haldane.

In this interview Smith discusses the illness and death of his teacher, who died of cancer. This brief video moved me in many ways. It captures the human ability to display humour and determination in the face of adversity, as well as love and friendship. It captures humanity's most redeemable qualities, as told by one the greatest scientists of the 20th century.

It is only fitting to quote a passage from Haldane's famous poem on cancer:

I wish I had the voice of Homer
To sing of rectal carcinoma
Which kills a lot more chaps in fact,
Than were bumped off when Troy was sacked

To slay Goliath this century we must build on the work of great minds like Haldane and Smith. We must transcend the "disease model" approach to the medical sciences, and develop Darwinian medicine.

And aging research is at the frontier of this more robust and ambitious vision of medicine. Modifying the biological clocks we have inherited from our Darwinian past would be this century's most important advance in public health. For age retardation would help protect the 2 billion people who will be over the age of 60 by 2050 from the chronic diseases that currently ravage unprecedented numbers of aged people in the world today. In order for this biological revolution to occur we must also undergo a cultural revolution. We need a rational and humane culture. We need more compassion, more imagination and more (new sources of) inspiration.

And we all have a moral responsibility to help spur on this cultural revolution and become 21st century humanists.