Sunday, September 30, 2012

International Day of Older Persons (A Day for Serious Reflection)

Tomorrow is the international day of older persons. The video below captures some of the issues I believe are worth reflecting upon on this important day.

For those looking for the quick version of the message, there is this video:

And my published papers on this topic are:

"Biogerontology and the Intellectual Virtues" Journal of Gerontology: Biological Sciences (2012)

"Positive Biology" as a New Paradigm for the Medical Sciences" Nature's EMBO Reports (2012)

"Equality and the Duty to Retard Human Aging" Bioethics(2010)

"Global Aging, Well-Ordered Science and Prospection" Rejuvenation Research (2010)

"Why Aging Research?"Annals of the New York Academy of Sciences (2010)

"Framing the Inborn Aging Process and Longevity Science" Biogerontology (2010)

"Mind the Gap: Senescence and Beneficence" Public Affairs Quarterly (2010)

"Towards a More Inclusive Vision of the Medical Sciences" QJM: An International Journal of Medicine (2009)

"Aging Research, Priorities and Aggregation" Public Health Ethics (2008)

"A Tale of Two Strategies: The Moral Imperative to Tackle Ageing" Nature’s EMBO Reports (2008)

"Has the Time Come to Take on Time Itself?" British Medical Journal (2008)

“Sufficiency, Justice and the Pursuit of Health- Extension” Rejuvenation Research 10(4) (2007)

Make sure you let the older persons in your life know how loved and valued they are, and while you are at it, be sure to write to your member of parliament and let them know you support biogerontology, the field of scientific research that could help us add more health to late life by retarding the rate of molecular and cellular decline.


Saturday, September 29, 2012

The Duty to Extend the “Biological Warranty Period” (Part 2)

This post continues on from the one yesterday.

I aspire to develop a contextual moral analysis which brings to the fore the importance of the duty to extend the biological warranty period of humans living in an aging world. So first some reflections on the methodological issues at play in this type of exercise.

Moral philosophers are concerned with how we ought to live, both as individuals and collectively as societies. We thus devote considerable attention to the question: what do we owe to each other? By reflecting upon, discussing and debating this general question a wide variety of actions, institutions and societal practices become subject to critical scrutiny. Ethics thus helps provide a foundation upon which we can orient the concerns of related fields of inquiry, such as legal, social and political philosophy. For example, a better understanding of what we owe to each other can help us evaluate and assess the basic rights and freedoms that ought to be accorded constitutional protection, or the principles most appropriate for guiding the design of the political economy, the institution of the family, healthcare and education.

The details of what we owe to others no doubt depends, to a large extent, upon the context of the societies and situations we find ourselves in. What we owe to each other in a perfectly just, affluent, closed society composed of healthy, productive people (as envisioned by Rawls (1971), for example) might be very different from what we owe in a partially compliant, indebted, open and aging society. How much abstraction should the theorist employ if the ultimate goal of tackling ethical issues is to help enhance our capacity for practical reason? Should we aspire, as the most eminent twentieth century neo-Kantian moral philosopher John Rawls proposes, to permit abstract scenarios (e.g. the original position) and our moral intuitions to frame and guide the intellectual exercise, oscillating back-and-forth between moral principles (and priority rules) chosen in a hypothetical thought experiment and our established moral judgements?

The “a priori”, or predominately “a priori” (there are some qualifiers on Rawls, for example, such as his concern for economic incentives in his discussion of pareto optimality), approach to ethics typical of Kantian and neo-Kantian moral theorising can be contrasted with the approach of empirical ethics. Philosophers engaged in the latter believe that “ethical theorizing should be an (in part) a posteriori inquiry richly informed by relevant empirical considerations” (Doris and Stich). Proponents of such an interdisciplinary approach to ethics believe that “intellectually responsible philosophical ethics is one that continuously engages the relevant empirical literature” (Doris and Stich)”. Taking empirical considerations seriously thus means that ethical theorizing will often be provisional, as the circumstances individuals and societies face will inevitably change over time, and so too will our understanding of the relevant empirical considerations at play.

So the argument I intend to develop in this new paper will be an exercise in empirical ethics. It takes seriously the reality that the aging populations of today face novel health challenges (e.g. high prevalence of chronic disease and disability) never experienced before in human history. The moral landscape thus needs to adapt to reflect this novel empirical reality. I begin with a basic moral principle- the duty to aid- and explore the implications empirical considerations from demography, evolutionary biology and biogerontology have for the way we think the duty to aid should be employed in the early 21st century.

What is the context of the human species today? Human populations are aging. Our populations are living longer lives than they ever have in human history, and we are having fewer children. The phenomenon of global aging will have a profound impact on the demands of morality.

Recall from my last post that I intend to utilize Singer's highly successful approach to raising awareness about global justice to the cause of raising awareness about global aging and biogerontology. So permit me to play on the comparison some more.

Here is how Singer began his paper on global poverty over 40 years ago:

As I write this, in November 1971, people are dying in East Bengal from lack of food, shelter, and medical care. The suffering and death that are occurring there now are not inevitable, not unavoidable in any fatalistic sense of the term. Constant poverty, a cyclone, and a civil war have turned at least nine million people into destitute refugees; nevertheless, it is not beyond the capacity of the richer nations to give enough assistance to reduce any further suffering to very small proportions. The decisions and actions of human beings can prevent this kind of suffering. Unfortunately, human beings have not made the necessary decisions. At the individual level, people have, with very few exceptions, not responded to the situation in any significant way. Generally speaking, people have not given large sums to relief funds; they have not written to their parliamentary representatives demanding increased government assistance; they have not demonstrated in the streets, held symbolic fasts, or done anything else directed toward providing the refugees with the means to satisfy their essential needs.

If I could update and modify Singer's introduction for my purposes, I would pen something like the following:
As I write this, in September 2012, people are dying in both developed and developing countries from the chronic diseases (e.g. cancer, heart disease, stroke, Alzheimer’s, etc.) of late life. The estimated 220 million people who will die of chronic disease in a decade was not inevitable, not unavoidable in any fatalistic sense of the term. Because natural selection has prioritized reproduction over somatic maintenance, hundreds of millions of once healthy and productive people now suffer chronic pain, disability, and disease. At the individual level, people have, with very few exceptions, not responded to the situation in any significant way. Generally speaking, people have not given large sums to fund scientific research on the biology of aging and experimental interventions to retard the rate of molecular and cellular decline. People have not written to their parliamentary representatives demanding increased government investment in such scientific research; they have not demonstrated in the streets, held symbolic fasts, or done anything else directed toward helping to redress the late-in-life vulnerabilities we have inherited from our evolutionary history.

I believe Singer's contextual moral analysis of global poverty provides a useful starting point from which one could advance a moral analysis of the issues that arise in today's aging world.


Friday, September 28, 2012

The Duty to Extend the “Biological Warranty Period” (Part 1)

Over the coming months I intend to post a few thoughts that I am developing for a new paper on the duty to extend the human "biological warranty period" (via retarding the rate of molecular and cellular decline).

The impetus for writing this paper came from a conference invitation to write a paper in the general area of moral philosophy. I thought long and hard about what to offer, as I have a few ideas and papers I am developing in that general area.

At first I suspected I wouldn't want (or need to) write another paper on tackling aging, given that I have recently written a number of such articles on that topic.

But then I asked myself if there was more I wanted to say about this topic, something that might appeal, specifically, to moral philosophers. I quickly realized that there is. I still yearn to write something substantial which could, hopefully, help spur more debate and reflection on these topics. So I began to reflect on what the nature of such a paper would be.

I turned to the field of applied ethics and asked myself the following question-- which philosophy paper in ethics has had the greatest impact in terms of bringing greater awareness to, and rationale reflection of, a pressing societal concern that was largely ignored (by philosophers and the general public)?. My immediate answer was this paper by Singer on global poverty.

Writing in 1971, Singer wanted to bring attention to the neglected issue of global poverty, and the duties the affluent have to mitigate the disadvantage of those in distant lands. The fact that the vulnerable live very far away does not erode the strength of the moral duty to aid them.

Many aspects of Singer's argument are important for my project, though my specific topic is different from his (i.e. tackling aging rather than poverty).

Firstly, Singer's moral analysis (even if one is not completely persuaded by it) takes seriously the empirical realities of the world. So it is a contextual ethical analysis. When thinking about "what we owe to others" we must take seriously the fortunate position of some, and the unfortunate position of others. This is one of the great appeals of Singer's contribution. It is a moral argument embedded in the challenges of its time. Its primary objective is to enhance our practical reason.

This methodological approach is one I myself am sympathetic with. For the 21st century, I think the aging of the human species is *THE* challenge of our times. Unlike poverty, which is a problem it is easy for most people to perceive as a problem (even if they do not do enough to tackle it), one has to do a great deal of work to make vivid the magnitude of the challenges of global aging. My strategy for doing this is to develop my argument through the lens of life history theory, so that we have a better understanding of the biological trade-offs involved in the pre-reproductive (childhood), the reproductive (adulthood) and post-reproductive (late life) stages of the human lifespan.

Natural selection prioritizes reproduction over longevity, which means we have greater opportunities for health in the pre-reproductive and reproductive periods of life, *provided we live in environments conducive to health*. Civilization has created such environments (though they are far from perfect). This has lead to a rise in life expectancy, from below 30 years (the historical norm for 99% of our species' history) to a life expectancy of around 67 in the world today. This means a child born in the world today can expect to live long enough to become a senior. This is great news, but it also brings formidable challenges (one which requires us to change the moral landscape in significant ways).

Sanitation, material prosperity, antibiotics, and changes in behaviour (e.g. birth control) have dramatically increased life expectancy but this has not altered our biological warranty period (which limits life expectancy to around 85 years).

Improvements to our environment, like access to clean drinking water and safe and affordable food, greatly reduces early and mid-life mortality. The same for immunizations against infectious diseases, small pox being the most obvious example. But promoting health in late life is a completely different challenge. As we age we are susceptible to multiple diseases and disorders- cancer, stroke, heart disease, arthritis, declining vision, bone fracture, muscle loss, cognitive decline, hearing loss, etc. Chronic disease is set to be the scourge of the 21st century, as we expect to have 2 billion people worldwide over the age of 60 by the middle of this century. The World Health Organization estimates that 220 million people worldwide will die from chronic disease in the decade from 2005-2015 (and 75% of these deaths will be among people over the age of 60). This figure is truly staggering, and the human and economic toll of chronic disease on such a large scale is difficult for us to even grasp (for nothing even comes close to it, not even all the wars of the 20th century).

Because it is difficult to grasp the magnitude of the harms of senescence most people simply take the current rate of aging, and the diseases and disability that result from it, as "a given". As if aging is natural, and death from aging something that has always happened to our species. But both of these assumptions are wrong. The aging of a species is not in fact natural, it is an artifact- a product of human intervention. The only species that age on this planet are those that humans protect from predation and starvation so that they live longer lives, and eventually expire the biological warranty period imposed by evolution through natural selection. Once a population begins to outlive the biological warranty period, there is an explosion in the prevalence of chronic disease, pain and disability. And this is the scenario of humanity today.

By drawing attention to the lack of available food, Singer brought attention to one (important) part of the story of how we can promote the opportunities for all humans to live flourishing lives. Singer formulates the following principle, which is the theoretical foundation of his argument for tackling poverty:

If it is in our power to prevent something bad from happening, without thereby sacrificing anything of comparable importance, we ought, morally, to do it

This principle, I argue, can also be applied to the duty to extend the biological warranty period of humans. Suffering disease and disability during the post-reproductive period of life is bad (just as it is bad to suffer these same afflictions in the pre-reproductive and reproductive periods of life).

To illustrate this point, we could modify Singer's famous example of a child drowning in a shallow pond. But imagine the person in need of help was not a child, but was instead the grandparent of the child. The grandparent slipped on a rock in the shallow pond while playing with her grandson and hit her head on a rock. Now, unconscious on the ground of the shallow pond, she will drown unless someone lifts her up and out of the pond (her grandson is too weak to do this).

Singer invokes the story of the drowning child to show that distance has no moral relevance to our duty to help. If the drowning child was your neighbour's child, or the child of someone living in a poor country on the other side of the planet, you still have a pressing moral imperative to help.

The same logic ought to apply to the duty to help people at ALL stages of the human lifespan (not just when they are children). And the form of assistance ought not to be limited to just the provision of food.

Now I realize there are numerous challenges which face extending a Singer-like argument to tackling aging. Here are some that I anticipate objectors making:

(1) There is a solution to eliminating poverty, but no intervention exists which can extend our biological warranty period.

(2) Singer's principle only requires us to prevent something bad (like starvation), but not to promoting good (like life extension).

(3) Singer's principle has the proviso that we are only obligated to prevent harm when doing so would not result in imposing burdens or harms that are of comparable importance. But extending the human lifespan could bring about consequences that are even more dire.

I intend to elaborate on, and respond to, these points in future posts. My brief response to each point is as follows:

1. Eliminating poverty, like retarding aging, is still in the experimental stage. So the objection (a) underestimates the complexity of tackling poverty and (b) underestimates the advances that have been made in the field of biogerontology over the past decade.

2. Extending the biological warranty period, just like the provision of food, can be described as either "conferring a benefit" or "preventing harm". In the case of food, providing basic aid could be described as "providing people with food (a benefit)" or "preventing starvation" (preventing a harm). The same can be said about the provision of an intervention that retards aging. Stated positively it is "expanding the opportunities for health in late life (a benefit)", but the same thing can be described as "preventing harm by delaying (and possibly compressing) morbidity and mortality".

3. Concerns that extending the biological warranty period of humans will cause overpopulation, exacerbate global inequalities, etc. must be premised upon sound empirical insights (rather than knee-jerk reactions) and we must have a sense of proportionality. Critics of aging interventions often underestimate the magnitude of the harms of the current rate of aging and overestimate the potential harms of slowing aging. So while there are legitimate concerns at play here, these are not likely to be weighty enough to constitute an objection to retarding the current rate of biological aging.

More to follow.


Tuesday, September 18, 2012

Aging Research in Canada (Some Reflections)

Yesterday I attended this interesting talk on the 5 year priorities and vision of Canada's Institute of Aging.

Many interesting issues arose in the talk and the discussion that followed that illustrate the ongoing challenges which the field of biogerontology faces. I thought I would offer some thoughts here on my blog about the issues that struck me as important ones that need to be addressed if research on aging is to become a true societal priority (as I believe it should be).

I will limit my comments to three issues:
(1) projections of rises in life expectancy
(2) concerns of generational fairness (e.g. why spend money on aging when we could use those funds to help kids)
(3) the role of socio-economic factors in health in late life.

(1) Life Expectancy: Can We Estimate the Future Based on the Past? NO

At one stage during the talk a statistic was mentioned that 50% of the children born today in Quebec will live to 100 years of age. What are we to make of such a claim? The best response is the one made by biodemographers who point out that biology constrains math. While we can create mathematical projections of how long people will live in the future, based on past increases in rises in life expectancy, this is flawed because it does not consider the biological limitations of the human species. Gaining extra healthy years is easier to do when life expectancy is low than it is when life expectancy is high. Here is an example that is often used to explain this-- suppose that the world record for the 100 meter sprint is 0.5 seconds faster today than it was 10 years ago (from 10.0 seconds to 9.5 seconds). From this, we could make a mathematical projection that 100 years from now, the world record for the 100 meter sprint will 4.5 seconds. That is of course ridiculous. New training techniques and equipment might help a sprinter shave off 0.5 seconds when the record is above 10.0+ seconds, but it does not follow that we will continue to shave off 0.5 seconds every 10 years. Humans can only run so fast. Take this same logic even further. In 200 years, the world's fastest sprinter should be able to run 100 meters in -0.5 seconds!!! This is faulty reasoning when applied to sprinting, and it is faculty reasoning when applied to predicting rises in human life expectancy.

For a population to approach a life expectancy near 100 years we would have to eliminate most cancers, heart disease and stroke. Considering we have not yet eliminated any one of these diseases, the suggestion that we will continue to increase life expectancy at the same rate as we have in the past is simply unfounded. Take mice in the laboratory. On average, they could life about 2 years if they are fed, protected from predators, etc. Can we get them to live significantly longer by trying to treat all the diseases that afflict them in late life? No. They can live significantly longer (and healthier) lives by eating a calorie restricted diet, by activating longevity genes, etc. The message to take from this-- we will only "add life to years (rather than years to life)" if we tackle aging itself. Centenarians (those that live to 100+ years) are an exceptional case. And genes are a major determinant of exceptional longevity. We should invest more research dollars into the biology of aging than we do into any one specific disease of aging (e.g. cancer, heart disease, etc.). Unfortunately my sense is that we don't come even close to this. Biogerontology continues to be disadvantaged as a field of scientific inquiry given the domination of the conceptual assumptions of "negative biology".

2. Generational Fairness: How much to Spend on the Young Vs Old?

During the discussion period someone raised that point that some might argue we should divert the funding on aging to helping the young. I have a few responses to this. Firstly, it is interesting that this point arises when the topic is research on aging but not research on disease. The vast majority of research dollars are spent on disease research, and these diseases primarily afflict the elderly. But biogerontology is typically singled out for the generational fairness objection. So my quick response is this-- we would save money by tackling aging itself (rather than every disease of aging) and could invest those savings into research that aids the young. But my more expansive answer is to point out that the generational fairness issue is predicated on some flawed assumptions. Namely, that research on aging won't benefit the young. Most children in Canada will suffer chronic disease, it is just a matter of time. When they become seniors they too will suffer from AD, hearing impairment, arthritis, cancer, stroke, diabetes, heart disease, etc. So an investment into the biology of aging IS an investment into the health of those young today. It could benefit them when they will need it the most (i.e. when their bodies and minds become highly vulnerable to disease in late life).

3. Socio-economic Inequalities and Life Expectancy

During the discussion period someone raised the point that we ought to be addressing socio-economic disparities rather than studying aging itself. Their point was that differences in life expectancy stemmed from differences in education and wealth rather than any biological differences between people. My response: that is partly true, and partly false. Yes socio-economic factors (especially education) are important. They explain the differences in life expectancy between "average people" (by which I mean those individuals that not possess the genes associated with a short or exceptionally long life).

Here is a recent study that examines the impact race and education have on differences in life expectancy in the United States. There is a difference of 14.2 years for White men who have 16+ years of education and Black men with less than 12 years of education. This is a significant problem that should be addressed. However, there is an even larger health disparity that people often ignore. The greatest health disparity between people does not track race, education or wealth (hence why it is largely off the radar). What it tracks is genetic inheritance . Those born with the "golden genes" associated with the exceptional longevity of centenarians and supercentarians (110+) enjoy decades more health and life than the average person. And the longest lived are not elite athletes, nor are they are graduates from IVY league schools, nor are they from extremely wealthy families (though they are more likely to be female than male). The biology of these individuals is different than that of most people in terms of the trade-off made between longevity and reproduction. This results in them living longer, healthier lives, at a cost of delaying and reducing their reproductive ability. This cost to reproduction is not so severe that it means one cannot have children. Most adults in this country delay and reduce their reproductive abilities already by using contraception. So the biological cost of exceptional longevity needs to be placed within its proper context. The value natural selection places on reproductive fitness ought not to be equated with the value we actually place on it.

This concludes the points I wanted to make. My sense of things, from hearing about the vision of the Institute and the new priorities it has identified, is that the Institute of Aging in Canada still struggles to get the respect, funding and support it deserves. This is no doubt due to many factors, such as the dominance of disease research, misconceptions about the true causes of health disparities, misguided sensibilities of fairness, ageist attitudes, and a general ignorance of the biology of aging and evolutionary biology in general. This makes selling the science to politicians and the general public a really tough sell. But I believe it is something that must be done if we hope to add healthy years to late life. So we must soldier on....


Tuesday, September 04, 2012

Gene Therapy Restores Sense of Smell

Nature Medicine reports on some gene therapy experiments to restore the sense of smell.