Sunday, January 16, 2022

National Post Commentary on the Pandemic Response

I have an 1800 word opinion piece published in the National Post here titled "Divisive Mandatory Vaccines Further Erode Responsible Governance". 

This commentary captures my view on the lessons I think we need to learn from the past two years of our attempt to mitigate the threat posed by the virus.  



Tuesday, January 11, 2022

New Paper on Framing Longevity Science


I am happy to share the news that my chapter submission titled "Framing Longevity Science and an “Aging Enhancement”" has been accepted for publication in The Routledge Handbook of the Ethics of Human Enhancement.  This essay was written during the prolonged lockdowns of the winter and spring of 2021, and helped me retain my sanity during it all.  The gist of my argument is that it is much more important to ask the right question than it is to provide answers to the wrong questions.  The abstract:

Advances in the biomedical sciences, like the potential development of an applied gerontological intervention (or “aging enhancement”), warrant serious ethical reflection and debate to help ensure scientific innovations are pursued in socially responsible ways.  This chapter critically assesses some of the ethical issues surrounding the “framing” of life extension and, more specifically, an aging enhancement. To frame an issue “is to select some aspects of a perceived reality and make them more salient in a communicating text, in such a way as to promote a particular problem definition, causal interpretation, moral evaluation, and/or treatment recommendation for the item described”.  Four different aging enhancement frames are assessed: (1) “Is extending life natural?” (2) “How long is enough life?” (3) “What about equality?” and (4) “Why promote public health?”.  I argue that the first three frames buttress support for the “aging status quo” by suggesting that something of significant moral value is compromised or threatened by altering the rate of biological aging, and little (if anything) of significance could be expected to be gained by slowing the rate of senescence.  This contrasts with question (4), the “Why promote public health?” question, which is framed to make vivid the actual harms of the “aging status quo”, as well as the benefits of slowing the aging process.  When it comes to ethical debates concerning an aging enhancement, it is much more important to ask the right questions than it is to try to provide answers to the wrong questions.  


Saturday, January 08, 2022

A Deeper Dive Into Pandemic Reporting Issues

The catalyst for this lengthy blog post is the recent news that my province of Ontario is finally, two years later!, seriously considering distinguishing between causal and incidental COVID deaths and hospitalizations.  

This specific issue has been, for me, the single most significant and neglected issue throughout this whole pandemic.  Without transparency on this issue from day 1, the accuracy of the population health threat posed from the virus, which is then utilized to justify the stringent lockdown measures (e.g. school closures) of the past 2+ years, can be questioned.  Because most deaths and hospitalizations in general, and those actually caused by this virus, occur in older persons (age >70) it is absolutely essential to make a concerted effort to distinguish between causal and incidental deaths, ICUs and hospitalizations.  So I suppose it is better later than never, but this is long overdue.

To show why this is so vital I want to make an analogy with the way in which the province reports "Adverse Events Following Immunization", in particular deaths from the vaccine.  I draw attention to this issue not to arm anti-vaxxers with information to perpetuate vaccine hesitancy (the benefits of the vaccine far outweigh the risks, and the adverse events reported are within the normal range for other vaccines), but to show how important it is to distinguish between causal and incidental deaths from both COVID-19 and from vaccines. 

Firstly, imagine no serious attempt was made to make a distinction between causal and incidental vaccine deaths.  This would mean anyone who happened to die within a few weeks of getting the vaccine, regardless of whether they died in a car crash or of the underlying co-morbidities of advanced age, could be counted as an adverse event.  In justifying this odd public health approach health officials remarked "Out of an abundance of caution, we are reporting every conceivable adverse event so that we do not subject people to unsafe medical procedures".  If this approach was taken the whole process of immunizations would be undermined, and the population would be left at greater risk of COVID-19 mortality.  This approach would be folly because it conflates people who died with the vaccine with those who died from the vaccine.  There is a big difference between these two things.  And yet this lax approach in reporting deaths and hospitalizations with and from the virus has been taken. I think this was perhaps the biggest mistake of the world's pandemic response, because of the age profile of deaths and serious illnesses (i.e. mostly people over age 70).     

OK, so yes we must take great care to distinguish between causal and incidental deaths, whether the issue is death from COVID or from the vaccine.  But let us dig deeper.  In 2021 the province officially reports that there were 8 fatalities caused by the vaccines, but there are another 26 death cases that are currently listed as "persons under investigation" as they do not clearly meet the province's surveillance definition of death caused by the vaccine.  This definition of "death caused by the vaccine" rules out "individuals with multiple co-morbidities which may be related to the cause of death".  Here is the lengthy list of factors that rule out a death from being considered a death caused by the vaccine. 

1. Resident of a health-care institution with significant comorbidities. The cause of death was not attributed to the vaccine. 

2. Community dwelling senior with complex cardiovascular and renal conditions, wherein the AEFI may have contributed to but was not the underlying cause of death. 

3. Community dwelling senior with multiple comorbidities including heart disease and an autoimmune disorder. The cause of death was not attributed to the vaccine. 

4. An individual with VITT with death recorded in CCM (described above under Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT) and Thrombosis with Thrombocytopenia Syndrome (TTS) section). A Coroner’s investigation determined that the immediate causes of death included VITT. 

5. Individual with hypertension, wherein the cause of death was not clearly attributed to vaccine.

6. Community dwelling senior with a complex cardiovascular history. The AEFI may have contributed to but was not the underlying cause of death. 

7. Community dwelling senior with multiple comorbidities, wherein the AEFI may have contributed to but was not the underlying cause of death. 

8. Community dwelling senior with severe aortic stenosis. The AEFI may have contributed to but was not underlying cause of death.

Such scrutiny is certainly justified for without ruling such cases out it would skew our understanding of the safety of the vaccines.  However, we should apply a similar diligence to COVID deaths, ICUs and hospitalizations.  If we assume everyone who dies with a positive test result for COVID died from COVID, despite the fact that they already had serious underlying health problems, we will get a skewed picture of the pandemic. The same is true for COVID hospitalizations. And this is what has actually happened.

The COVID-19 pandemic has been a novel hybrid pandemic- the virus is both an novel infectious virus AND an emerging disease of aging. I believe the latter has been lost in both the media coverage and the public policy response to this pandemic.  And that neglect has meant we responded less effectively than we could have, imposing significant mental health burdens, educational deficits, economic burdens, etc. on younger persons (children and adults age < 50). 

I will add one last point to amplify the significance of this insight. At the moment the media headlines are dominated by COVID ICU and hospitalizations numbers.  These headlines suggest that it is the unvaccinated that are monopolizing most the hospital beds when it fact it is more accurate to say they are exacerbating the pressures placed on those resources from patients with non-COVID related health problems (the majority of which would be age-related causes- heart attacks, strokes, etc.).  

Let us unpack some of the data in Ontario's hospitals, as this goes into greater depth than the typical news story.  

The province has 2343 ICU (adult) beds, of which  1460 beds are for non-COVID patients.  I have yet to see a news headline in the past 2 years that discusses the causes, let alone ways to prevent, whatever it is that accounts for 62% of ICU beds for non-COVID patients.  At the moment there are 333 people in ICU beds with COVID.  This is 14% of the ICU beds, and of those 119 are unvaccinated.  So 5% of the ICU beds are being used by unvaccined persons, during the peak of our infection numbers.  550 ICU beds are still available, which means the total ICU bed capacity for adults is at 77% of its full capacity (23% of ICU beds remain available). [as an aside, ICU beds are not fixed and we have had two years to increase capacity vs opting for locking kids and society down as a response to pressures on healthcare resources].  Here is how Canada fares (a bit dated) among other OECD countries:

From my perspective, having studied the policy implications of the biology of aging for 15+ years, the popular narrative about the strains caused by the unvaccinated is simply a political distraction from the empirical reality.  The reality is that most ICU beds, so far in this pandemic, have been filled mostly with patients that were not hospitalized for COVID.  I could not find data on their ages but I would expect most cases are among the older age cohorts (age >60).  And of those that do have COVID in  (regardless of vaccination status) they are much more likely to be older.  This is just one symptom of the much larger health predicament we face with population aging.

This Lancet Public Health piece notes the tsunami of dementia that is coming by the year 2050.  Unless we alter our myopic fixation on the proximate causation of disease and death (which this pandemic has further entrenched in the medical sciences and media), we will not be able to meet the health challenges of today's aging world.



Friday, January 07, 2022

Mandating Vaccines for COVID-19? No.

While I am not a fan of disclosing personal medical information on social media, tonight I will because I feel compelled to say something in response to our Minister of Health’s suggestions that mandatory COVID-19 vaccines should be on the table. So firstly… I am fully vaccinated, and I have also had the booster.

87.75% of Canadians over age 12 are fully vaccinated. According to Our World in Data, Canada ranks #6 in the world for vaccination against COVID-19. So well done!
Despite that good news, it was very disheartening, indeed shocking, to hear our Minister of Health suggest that mandatory COVID-19 vaccines should be on the table. Let’s start by noting some data from Health Canada’s database on vaccinations.
While it is a common term I will use in this post, referring to people as “unvaccinated” is not very helpful. It “others” people, and often implies that they are ill or diseased when that is not the case. Instead we should refer to these folks as people whose immune system has not been enhanced with vaccines to offer superior protection against COVID-19. Lest we forget, a year ago all of us were “unvaccinated”.
So who in Canada is unvaccinated? Here are a few details from Health Canada:
Provinces and territories: highest vaccination rate is Newfoundland and Labrador, and the lowest vaccination rate is Nunavut.
Sex: Females have a 3% higher vaccination rate than males.
Age: highest vaccinated age group is age > 80 at over 95% fully vaccinated, lowest is nearly 83% for ages 12-29 (young kids not counted).
But what is not listed are other important categories that could be morally relevant in assessing the pros and cons of mandating vaccines: such as race, education level, income, incarcerated or free, etc.
In my opinion, the vaccine passports already implemented in Ontario and elsewhere were deeply problematic- they were socially divisive and (mostly) ineffective (given the fact that we are where we are with lockdown again). And now that they didn’t achieve what the planners had hoped they are doubling down on this intimidation strategy, which I presume they simply hope will have popular support since it is not predicated upon empirical evidence and a proportionate weighting of the (long-term) pros and cons.
There is much more at stake with this issue than just getting out of this current pandemic. There is the kind of society that will be left standing post-pandemic. There is the potential distrust and damage we do to future vaccine compliance and public health more generally if we mandate people to take something that they are opposed to taking.
For me, taking the vaccine was a no brainer. I took it to protect the health of my community, my family and for my own health. But I am somewhat scientifically literate, am familiar with the cost/benefit reasoning that goes into public health decision-making, etc. I realize that not everyone sees this complex moral and empirical landscape in the same way as I do. And lastly, I am a male over age 50, so the risks to me are different than the risks to a 20 year old (especially a person that has already recovered from COVID-19).
The core moral conviction of the medical sciences, often (though inaccurately) attributed to the Hippocratic Oath, states “First do no harm”. Threatening fines and further isolation upon many of Canada’s most vulnerable populations is too hefty a price to pay for the speculative societal benefits its proponents are pandering. Let’s get out of this pandemic with a society and culture we can still be proud of. We have sacrificed too much already.


Positive Biology for the 21st century

As we enter year 3 of this pandemic, with media headlines consumed with yet more negative news about the spread of (new variants) of SARS-CoV-2, I thought I would share a few timely snippets from my book chapter titled "'Positive Biology' and Well-Ordered Science":

The philosophical question I would like to contemplate in this chapter is:  “What constitutes “well-ordered science”?”… I lay some preliminary foundations for addressing this question by elaborating briefly on the virtue epistemological construal of knowledge as “success from ability”.

….The world is a complex and constantly changing environment, and thus knowledge itself will be not fixed or static.  The normative value of different types of knowledge will be context-specific.  In one context certain empirical insights about the world might prove to be vital in helping us protect a population from disease and premature death.  But those same empirical insights might be, in a different context, of much more limited use and significance because the most pressing external threats to human populations are different. 

….Since the rise of epidemiology in the 19th century, the central question which has been the primary focus of both clinical medicine and public health is- what causes disease?  In this chapter I argue that this fixation on disease-research (evident in oncology, cardiology, psychiatry, etc.) must now (i.e. in the 21st century) be supplemented by a zeal to also invest in, and support, basic scientific research into the causation of exemplar positive phenotypes. 

…. I urge that the study of pathology be supplemented by the study of the determinates of exemplary positive phenotypes (e.g. healthy aging and happiness). 

…. Rather than fixating solely on the causation of pathology, positive biology encourages the study of the biology of centenarians, the emotional resilience of those who experience growth and development from adversity (vs those who become depressed or develop addiction), the genetic and environmental factors that contribute to self-esteem, healthy relationships and secure attachment, etc.  By transcending negative biology’s fixation on negative phenotypes, positive biology may be able to yield significant prescriptions that help the human populations of the 21st century flourish in spite of the fact that we face a potentially precarious and uncertain future.  



Saturday, December 25, 2021

Year in Review (2021)


Time for my annual “year in review” blog!

In many respects the year 2021 felt like a repeat of the year 2020 (sigh!), as half of both years were spent in isolation, lockdown and me doing online teaching and my kids at home doing online learning [sic].  After a brief 3 month stint with in-person teaching from Sept- November, it looks like I will be going back to online teaching again to start the 2022 academic year (this despite the University having imposed a vaccine mandate and mandatory face mask policy on all faculty, staff and students back in Sept 2021).   

The mantra “you can never be too cautious” seems to be the default mode of reasoning for our province’s public health experts and politicians for the past 18 months, and sadly it has (IMHO) demonstrably proven itself to be a failed mode of reasoning and rather ineffective way of communicating to the general public how to responsibly balance different types of risks and benefits.  The narrowly conceived public health goal of success since May 2020 has been equated with “not overwhelming healthcare with severe COVID-19 illness”, but this has overlooked the reality that the mental health toll of the prolonged mitigation efforts (which will be measured in years, not months or weeks), especially on the young, to delay the spread of the virus has also increased demands on healthcare though sadly little, if any, support has been available.  So our long-term “delay the spread of the virus indefinitely” strategy has been compounding many pre-existing (and very serious) public health problems.  The irrevocable negative impact on childhood, adolescent and young adult obesity rates, education and development, as well as mental health will be devastating for a whole generation.     

Tragically I think it will be many more years before an impartial and evidence-based assessment of these issues can take place.  At the moment most are still in the grips of fear of a virus we still do not know very much about, and thus the precautionary principle has been peddled as responsible public health decision-making to make folks at least feel safer.              

The big new development with the pandemic in 2021, beyond the media obsessively tracking and reporting all the “variants of concern” (first Delta, and then the ominous sounding OMICRON) was the COVID-19 vaccines, hailed as the solution out of the pandemic once sufficient numbers of people were vaccinated.  Contentious debates and policies pertaining to vaccine passports, and then boosters, ensued.  And thus 2021 ends with record-breaking numbers of positive cases in my city and province, but the impact on serious illness and death remains to be observed and assessed.    

Despite the persistence of this pandemic for 2+ years, I still stand by my initial assessment that COVID-19 itself is not the most significant public health predicament of the past century, nor of today (which does not imply that it is not a significant public health problem, it certainly is (especially for older populations)). 

However, there is one caveat I will add now given how things have played out since May 2020- if we include the adverse health, educational and financial consequences of the prolonged mitigation measures most developed countries have pursued for nearly two years- such as  the impact on anxiety, isolation, mental health, obesity, suicide, domestic abuse and marital breakdown, unemployment, educational deficits, delays in other medical interventions, impact on the economy, etc.- the pandemic’s full impact is significantly larger.  My initial assessment did not anticipate that countries would pursue a strategy of long-term virus mitigation until vaccines (and then boosters) were widely available and beyond.  To be honest if you had asked me back in May 2020 what the chances were that such a strategy would have been adopted long-term (that is, after the initial 3 month lockdown (when little was known about SARS-CoV-2) I would have said “zero”.  That was my view not simply because of the clear adverse side-effects of such policies on mental health, liberty and the economy, but because there was no empirical basis for thinking such a strategy was viable in the long-term (in terms of both compliance from the general public and in terms of doing anything other than simply delaying the spread of the virus till such measures were relaxed).  Unfortunately the adverse health impact of these mitigation measures will persist for years after the public’s fixation on SARS-CoV-2 (and the virus’s evolution) has dissipated.  We could call this effect “Long COVID lockdown”.  But, I digress!

Watching the mental health toll of the lockdown measures- on family members and friends, and my students and reading the rapidly emerging data from empirical studies on these effects (on anxiety, addictions, obesity, undiagnosed diseases, etc.)- has been absolutely devastating to witness.  I intend to spend the next decade of my research canvassing the toll of both the virus and the public health successes, experimental “pivots” and disastrous blunders.  What I had thought would initially be a 1-2 year research project will now take probably closer to 10 years to research, write and complete.  I have decided to prioritize doing a competent and thorough job of analyzing these empirical and policy issues vs just rushing to get something published. 

In the coming winter (2022) term I am teaching a new 4th year seminar titled “The Politics of Pandemics and Epidemics” which applies a public health ethics lens to the societal challenges of mitigating the health risks from 4 infectious diseases (malaria, HIV/AIDS, Ebola and COVID-19) and 3 non-infectious “epidemics” (obesity, the “war on drugs” and gun violence).  Teaching this new course regularly will permit me to expand my public health research interests beyond the issues I have focused on for the past 20 years (e.g. the genetic revolution and aging research).       

Despite the continued upheaval of the pandemic, I was inspired on both the teaching and research fronts in 2021.  In the winter term of 2021 I continued with my online teaching, especially for the large class of 270 students, designing extended lecture videos on Rousseau, Burke and conservatism, Black political thought, Wollstonecraft and feminism, utilitarianism, Marx and Fanon. 

2021 proved to be an exceptional year for my research and writing.  As an introvert I was fortunate to be able to make the most of the time in isolation by diverting my energies almost exclusively to reading and writing.  I published my first article on the COVID-19 pandemic, and wrote (and then had quickly accepted for publication and actually published) 2 articles on the 50th anniversary of “the war on cancer” (here and here).  And a book chapter on toleration also appeared in print, a long article on how to theorize about justice in the genome era, and I wrote the first draft of half of a new textbook on the history of political thought (this project will consume most of my attention through 2022).  The year 2021 was probably my most productive year ever for research, because there wasn’t much else I could do for most of the year.   

What will the year 2022 bring?  In terms of science and innovation, I am hopeful serious progress will continue to be made with respect to the development of an applied gerontological intervention.  I still maintain that such an intervention will end up being this century’s most significant advance in public health because advanced age is the most significant risk factor not only for cancer and COVID-19 mortality, but for most disease, frailty and disability.  This is not a story you are likely to hear in the evening news.  But what gets “clicks” on news stories, or “likes” on social media often bears little, if any, resemblance to what is actually going on, from a “big picture” perspective, with today’s aging populations. 

I am optimistic the year 2022 will see us at least get into a different collective mindset about (i.e. accepting that we must learn to live with SARS-CoV-2 and return to normal life) this pandemic, given that the ending of this pandemic will not likely be televised. All the best for a New Year!



Thursday, December 16, 2021

50 Years of the other "C-Zero"

If you had 10 Canadians gathered together in a room, and you asked “How many of you think you will develop cancer?”, odds are no one would raise their hands. 

Like divorcing after marriage, no one thinks they will get cancer (or divorced!).  But like divorce, cancer is something many people will experience (4 out of 10 Canadians), and a few will even have multiple cancer diagnoses (and divorces!).  Approximately 2.5 out of 10 of my compatriots will die from cancer.(stats here)

Cancer is not only a problem for my compatriots.  Globally cancer kills approximately 10 million people every single year.  Cancer is the second leading cause of death in the world.  Nearly half-a-century ago President Nixon declared a “war on cancer”, the goal of which was to eliminate cancer as a cause of death.  Let’s call this project CANCER-ZERO.  The video above outlines the first 40 years of this campaign.

50 years later, with billions of research dollars being invested in cancer research every single year for nearly half a century, not a not a single type of the 200+ types of cancer have been eliminated.  Not a single one.  Let that sink in.  It is reason for humility, humility for how little we truly understand the complexities of our biological lives and humility for what science can realistically deliver. 

In the video Dr. Otis Brawley, then Chief Medical Officer of the American Cancer Society remarks:  

“I wish that we had tried to convince people that this was an investment in research that was long-term. I wish some people had not assumed we would make tremendous insights very quickly. Unfortunately human nature is such that if people had realized that this was a 40, 50 or 60 year commitment they would not have gone for it”.    

Despite the failure to realize CANCER-ZERO, the war on cancer has brought significant improvements in preventing, diagnosing and treating cancer.  We now know we can reduce some cancer risks through smoking cessation and other lifestyle changes (e.g. exercise, diet, etc.).  Improvements in diagnostics can help us catch cancer in the earlier stages of development, which makes a significant difference for survival rates.  And better cancer treatments have been developed, improving survival and quality of life for cancer patients.

50 years of the “war on cancer” has taught us that CANCER-ZERO is more of a fantasy than a feasible public health aspiration.  And the fact that most people go about living their lives in denial about their cancer risks is a mix of good and bad news.  It is good news because you do not want people ruminating about their 40%+ lifetime risk of cancer!  But at the same time, you want folks to be aware of the reality that their lifestyle choices can modulate their cancer risk factors (increasing or decreasing them).

And this takes us to the final and most significant reflection on the war on cancer.  50 years of rising cancer deaths have made vivid the importance of aging as the most significant risk factor for cancer (as well as the other diseases of late life).  I already wrote plenty about that earlier this year, so if you would like to hear more feel free to check out this article and this article.

But cancer is not exclusively a disease of older persons.  The latest issue of Lancet Oncology has this comprehensive study on the global cancer burden in adolescents and young adults (aged 15–39 years). In 2019 there were approximately 1.19 million cancer cases and 396 000 deaths due to cancer among people aged 15–39 years worldwide.

Let us see where the next 50 years of public health and advances in the biomedical sciences take us!



Friday, December 10, 2021

Framing an Aging Intervention (reflections 2)


For many years now I have been a proactive champion of the scientific field of study that I think will have the most significant impact on the health and economic prospects of humanity this century- “geroscience” and an applied gerontological intervention that retards the rate of molecular and cellular decline.  

And a great deal of my research has focused on the societal challenges of framing, and prioritizing, this area of science when most people do not even perceive the harms of senescence as a public health problem, are mostly ignorant about the biology of aging and are unaware of the recent scientific discoveries in altering the rate of aging. 

What is worse than indifference to this area of scientific research is the open hostility and opposition people (even eminent "public intellectuals") often have towards it.  And this blog post addresses this concern by noting that much hinges on how one “frames” the moral imperative to alter aging.

        To cut the chase, the wrong question to ask, in my opinion, is to ask- “Should we pursue life extension?”  This is the wrong question to ask because it is ambiguous, and thus it is likely to be prone to skewed moral evaluations of the stakes involved with “extending life”.  For example, some might interpret this question as asking them if they would want to life forever, to be immortal.  Others might, reasonably, infer the question implies an extension of the period of frailty, disease and disability at the end of life by delaying death for as long as possible.

        Because the aspiration of “life extension” lacks precision, talk of “life extension” typically raises a wide array of intuition-based concerns, such as whether we would be bored living hundreds of centuries, or how this would likely impact the global population size and environment, etc., or if this would create a new caste society between those with “normal life” and those with “extended life”.

            The proper way to frame the moral imperative to retard human aging is to ask the right question.  And that question is:  “Should we aspire to reduce the risks of morbidity, frailty and disability in late life?”  The answer to that question is “Yes, of course we should!” 

            To make vivid the different moral stakes at interest between the aspiration to “life extension” and increasing the human “healthspan”, compare the contrasting moral sensibilities the following two aging scenarios invoke.  The first scenario (Scenario 1) describes what many would take to be a dystopic life extension future, and the second scenario (Scenario 2) is a more utopian one.  It is the latter that an applied gerontological intervention could help us realize, but the “aging status quo” is taking us in the direction of (a less extreme version of) Scenario 1.

Scenario 1:  Extended Life = Extended Survival (accompanied by extended and more severe frailty, disease and disability)

Over the next half a century population A increases its life expectancy at birth by 40 years, from age 80 to age 120.  This increase in life expectancy is primarily achieved by simply forestalling death in late life.  The procurement of additional decades of life in late life is achieved not by altering aging, but from advances in improving survival to the upper limits of maximal longevity.  Through a combination of novel and expensive drug development, coupled with extensive public health expenditures in long-term care facilities and palliative care, patients can now survive for decades on chemotherapy and radiation, reliant upon ventilators, etc. enduring dementia and other severe diseases, frailty and disability for decades.  The majority of the people surviving past age 110 have little psychological continuity to their former selves, as new diseases of the brain emerge with the extreme longevity achieved (but with minimal improvements in treating these cognitive disorders). 

The only real achievement for population A in this scenario, from a population health perspective, is increased survival and a prolongation of the period of disease, frailty and disability in late life.  The “longevity dividend” (Olshansky et al 2007) achieved in society A is very costly, with ever increasing healthcare expenditures being invested in preventing death in late life with little to no regard for the “quality of life” of people in late life.  Family members learn to normalize the practice of spending many decades visiting family members in long-term care facilities, and those family members over age 100 typically can not live independently and many are no longer capable of actively participating in family life. 

Consider now a contrasting future of life extension: 

Scenario 2:  Extended Life = Extended Healthspan (increasing health and decreasing frailty, disease and disability).

Over the next half a century population B increases its life expectancy at birth by 40 years, from age 80 to age 120.  This increase in life expectancy is primarily achieved by extending the human healthspan, which means a substantive delay and compression of disease, frailty and disability in late life.  The procurement of additional decades of life is achieved by a relatively inexpensive drug that re-programmes the human metabolism to mimic the longevity effects of caloric restriction (without people having to endure the deprivation of actually consuming less calories than that required for a normal diet).  With this public health advancement it takes the average person 120 years to biologically age what use to be achieved in 80 years.  Furthermore, at the end of life there is a compression of morbidity, meaning the period of time people suffer age-related health maladies (e.g. disease, frailty and disability) is shorter than the period they experienced before the aging intervention.  Thanks to this aging drug, most people will be capable of working well past age 100, though many decide to spend the additional years of healthy life volunteering in their communities, helping out with childcare duties for their grand and even great grandchildren, etc. 

People in this second scenario enjoy more health in late life, and thus the “longevity dividend” in population B also brings significant economic benefits.  By expanding the opportunity for people remaining productive in late life, and reducing the public expenditures typically spent helping persons manage the co-morbidities of late life, population B reaps significant economic, as well as health, benefits.   

The two contrasting scenarios of populations A and B are deliberately exaggerated in terms of stark negative and positive health and economic outcomes, to reveal how such details activate different moral sensibilities in terms of our considering the desirability of “life extension”, for both individual lives and populations.  Population A realizes perhaps the worst outcome most people could envision for aging populations- prolonging the suffering, disease and frailty of diminishing health in late life at an exorbitant social cost.  Such a society fanatically values “quantity” of years survived over the “quality” of the life lived, something most people would disagree with.  Surviving many additional decades of life with progressive and severe infirmities and minimal psychological wellbeing is not something most people would see as a desirable outcome.

The “longevity dividend” realized in scenario A is one that prioritizes “adding years to life”  instead of “adding life to years”.  Scenario A is not a cost-effective, nor morally laudable, aspiration.  The quality of life secured by the 40 year increase in longevity is very relevant to our assessment of the value of such an increase in the lifespan.  And with the details provided in Scenario A, many people might (reasonably) take the view that the society would have been better off not aspiring to increase life expectancy further than the original age of 80 years.

In scenario B the “longevity dividend” is the opposite of that in A.  Population B realized the goal of “healthy aging” vs simply delaying death.  The health benefits secured in B are meaningful and substantive because people enjoy more health, and thus life extension is simply a by-product of increasing the healthspan vs the intended goal.    The reason I believe geroscience is the most significant area of scientific research, and an applied gerontological intervention the most important public health intervention of the 21st century, is that such an intervention could make a future like Scenario B a reality.  No cure for any specific disease of aging would come even close to making this a reality.  In fact a cure for just one disease of aging is compatible with the realization of the dystopic future described in Scenario 1.  But an intervention that simultaneously delays and compresses the diseases, frailty and disabilities of late life will could a significant health impact on the 2 billion people who will be over age 60 by the middle of this century.