Tuesday, October 30, 2007

Excellent Video Debate on Tackling Aging

I just came across this fascinating video of Richard Miller and John Trojanowski debating the topic “Alzheimer's Research and Basic Science of Aging: Is There a Better Balance?”. The discussion addresses a number of important issues concerning sorting out priorities in a situation of scarcity, plurality of worthy causes in need of funding, and uncertainty concerning the likely benefits of scientific advances. How much should we invest in tackling Alzheimer’s disease (AD) versus aging itself?

Here are some facts about Alzheimer’s from the Alzheimer’s Association:

There are now more than 5 million people in the United States living with Alzheimer’s.

Every 72 seconds, someone develops Alzheimer’s.

The direct and indirect costs of Alzheimer’s and other dementias amount to more than $148 billion annually.

And what facts can we amass to reveal what the costs of aging are? That is a very tall order indeed, and not something one can easily find from a vocal lobbying group or association. This article is a good place to start if one wants to get a sense of what the benefits of even modest success in slowing aging (by just 7 years) could be. We know that aging greatly increases our risk of many diseases- not only Alzheimer’s disease, but also heart disease, stroke, cancer, diabetes, etc., etc., not to mention the fact that it also makes us less resistant to infection, increases the risk of bone fracture, cognitive decline, etc.. Those interested in the impact aging has on our brain might find this lab of interest. These researchers conclude that while aging does not result in the decline of all cognitive functions, it does affect certain functions like top-down processing and use of prior knowledge.

One could go on and on, listing a variety of disadvantages that are visited upon us as we age.

So IF we could slow down the biological processes of aging we might be able to far exceed the health benefits we could confer upon the population by curing some of the most prevalent diseases.

But of course there is disagreement and skepticism concerning what is actually possible here. One might object: “Just because we can retard aging in mice (thus extending their opportunity for healthy life by 40%) doesn’t mean we can do it in humans”. That may be true, but it surely gives us a very good reason to further explore this. Doesn’t it? After all, the headlines are often filled with stories about the breakthroughs of therapeutic experiments on mice (in fact I often link to these stories). And while we should be cautious about making the leap from these experiments to the claim that we could do it in humans, we typically view such empirical evidence as very promising and worthy of further exploration. So we should adopt the same attitude towards experiments on the aging process.

One point that comes out in the interview, when John Trojanowski is pushing the point that Alzheimer’s is deserving of the lion’s share of (existing) funding, is that we are so close to developing effective treatments. And thus, because the likelihood of the benefits being realized (and realized soon) is higher, it should receive greater attention.

I agree that, all-else-being equal, more weight should be placed on benefits that are more likely to be realized that not, and that benefits that can be realized in 5 years count more than those that might be realized in 50 years. But of course all else isn’t equal if the comparison is between the benefits of treating just one age-related disease versus postponing all age-related diseases and disadvantages. Things are no doubt complicated by the fact that the likelihood of success and the likely timescales are contestable. But the magnitude of the current imbalance between the amount being spent on AD versus tackling aging is not, I believe, justified on the rational grounds of a cost-benefit analysis.

As Miller notes, part of the problem is that anti-aging research isn’t sexy. There are no prominent figures that can help rally public support for the cause (like Nancy Regan has for AD, or Michael J. Fox for stem cell research). This really shows how ingrained our existing skeptical prejudices are. For we all see the ravages the passage of time inflicts on the health prospects of our loved ones (as well as ourselves). And yet it is really hard to convince people that the effort to postpone these disadvantages through anti-aging research is a laudable goal. One worthy of a much greater investment of public resources.

The fact that the discussion in this interview is between funding research for AD vs research in aging is of course a reminder of how dire the situation is with funding basic scientific research. The choice shouldn’t be an either/or decision. Unfortunately it is. And thus the current generation are forfeiting potential health benefits that they and all future generations could enjoy. As Miller points out at one stage in the interview, just one day of the opening-day revenues of the movie Spider Man 2 equals the budget of 5 years scientific work on the biology of aging. That poignantly reveals who perverse our priorities really are. Miller also makes an excellent point that scientists alone can’t win this battle. And that others, like journalists, have to help get these issues on the radar of the public. I think his plea also applies to academics, especially those in the humanities and social sciences. When was the last time you sat down with your students and intelligently discussed the moral imperative to retard human aging? It’s a discussion we need to have! Especially if we are serious about Taking People as They Really Are.

So the real challenge for us is to determine what would constitute a fair and proportionate response to different kinds of disadvantages. During the video discussion it becomes evident that the funding for basic science into aging is a very small fraction of the funding spent on Alzheimer’s. Miller estimates that 6 cents from very $100 dollars that the NIH spends on scientific research is devoted to the basic science on aging. I believe that this is an injustice, to both the current and future generations. Tackling aging is, in my opinion, one of the most interesting and important issues facing us this century. The 21st century will witness an unprecedented number of human beings suffer from age-related disadvantage. And thus this is an issue normative theorists ought not ignore. If one is serious about promoting the opportunities for healthy, flourishing life, then one has to get serious about taking on aging itself.