Tuesday, August 05, 2008

Are You Guilty of Gerontologiphobia? Part 2

Today I wish to reflect a bit further on some of the issues I explored in this previous post. Recall that in that post I mentioned this excellent paper on the scientific and political obstacles facing longevity science. One major obstacle that Miller specifically draws attention to as an impediment to manipulating longevity is what he calls “gerontologiphobia”. He describes this as follows:

There is an irrational public predisposition to regard research on specific late-life diseases as marvelous but to regard research on aging, and thus all late-life diseases together, as a public menace bound to produce a world filled with nonproductive, chronically disabled, unhappy senior citizens consuming more resources than they produce. No one who speaks in public about longevity research goes very far before encountering the widespread belief that research on extending the life span is unethical, because it will create a world with too many old people and not enough room for young folks.

Miller is spot on about the common response people have to research on extending the life span. And here I offer a few further thoughts on why people have this common reaction. For if we can understand why people react this way, then hopefully we will be better positioned to convince them to question the assumptions underlying these beliefs.

OK, so why would people think that spending public funds on medical interventions that would retard human aging is unfair? I believe there are two distinct concerns at play here, and they pertain to both international and intergenerational justice.

I already briefly touched on the former here. The general sentiment of this objection is that it is unethical to be very concerned about extending the lifespan of those who already live the longest lives. And thus this feeling is akin to a variation of "survivor guilt". People in the developed world feel guilty that they already enjoy more opportunities for health and wealth. And so they believe that proposals to extend human life through slowing aging are, at a minimum, in bad taste.

The interesting thing to note, however, is that these same feelings of guilt do not arise if one proposes trying to aid compatriots who suffer from cancer, AD, or heart disease. And yet treatments for these conditions would aid many people who already live long lives. So what explains this inconsistency? Very few people feel we should abandon medical treatments for the aged in our own societies, so why does the "survivor guilt" not kick in this case? I suspect it is because people tend to view those who suffer from disease (even aged compatriots) as deserving of medical treatment. And so aiding those who suffer from disease does not stimulate feelings of survivor guilt. But slowing down the aging process sounds like it is something that confers extra benefits on those who are not needy. And thus people believe it is unfair.

So how should we respond to this first issue. As I noted before, it is helpful for people to understand that the diseases of aging afflict people all around the world (not just in the richest countries). Of course we only see people dying in earthquakes, wars and floods on TV. The evening news does not report on the victims of the diseases of aging in India or China. And so our perception of what actually kills people in other parts of the world is really skewed. And so having good data at hand is essential if we want people to recognise that senescence is a global problem. Slowing down aging would help everyone, rich and poor.

Secondly, we need to hammer home the link between aging and disease. It is not just a coincidence that very few people in their 20's and 30's live in nursing homes. The lifelong accumulation of cellular and molecular damage has a profound impact on our risk of disease and death. I understand this is a tough message for an aging population to hear. But it is an important message nonetheless.

Thirdly, some discussion of how we balance concerns of partiality with those of global justice will help. We should not feel guilty that we want to extend the opportunity our children will have for healthy living. Loving parents go to great lengths to ensure their children have the best opportunities for living a healthy life. It would be perverse for a parent to say: "I think we should let our children develop cancer or heart disease when they are aged, because it would be unfair for them to live much longer than people in other countries". Once one reveals how partiality is grounded in common precepts of morality, we realise that we should not feel guilty in trying to expand our opportunities for health. Of course we do have global obligations of justice as well. And so we need to focus our energies on doing things that will really improve the situation of the globally disadvantaged. Having our children die sooner is not the solution. But providing bed nets, tackling HIV, and cutting farm subsidies, these things could actually make a real difference to the life prospects of the globally disadvantaged. And so we should feel pains of survivor guilt for failing on these things, but not for supporting medical research that could help prevent the diseases of aging. Unfortunately our emotions are often diverted to the wrong policies. And this just makes a tough situation that much harder to address.

OK, now to the second issue that gets entangled with debates about the ethics of extending the lifespan-- concerns of intergenerational justice. Interestingly, this issues cuts two different ways, both mistakenly assume that investing money in longevity science fosters a rivalry between generations (i.e. the young and the old). So those who believe slowing aging would only benefit the aged might think it is unfair to spend yet more money on the aged when there are children who lack basic healthcare. On the flip side are those who maintain that spending money on tackling aging would only benefit the next generation, but do nothing for those who are currently aged. So rather than spend money on a novel medical intervention to retard aging, they maintain, we should invest those funds in aiding those who already suffer the afflictions of aging.

Let's start with the second version of this objection- that investing money in a science that will aid future generations, but not the present generation, is unfair. Of course it really is a matter of proportionality. If one were suggesting that all or most public funds should be invested in longevity science then this criticism would have some bite. But that is not the argument being made by the advocates of the Longevity Dividend Campaign. Furthermore, this same complaint could be used to object to funding any science that may take time before it reaps benefits (ranging from alternative sources of energy to new treatments for cancer). So we need to strike a fair balance between meeting the duties we owe to those currently alive, and those who will live in the future. And finally, this science could help treat those who currently suffer the diseases of aging. Recall this post, where I noted that the first clinical trial of an anti-aging molecule is under way for patients with diabetes. Striving to reduce the risks of disease for current and future generations is a very laudable goal! We have benefited enormously from public health measures like the sanitation revolution and vaccinations. And so should strive to leave our children a world where there are even more opportunities for healthy life.

The other side of this critique of inequity between generations is the charge that tackling aging only benefits the aged. But this objection misconstrues what retarding human aging would mean for adults of all ages. It would reduce our risk of disease, frailty and death at all stages of our adult lives (not just once we are above the age of 65). As Olshansky et al note, slowing aging by just seven years would reduce the age specific risk of death, frailty, and disability by about half at every age. People who reach the age of 50 in the future would have the health profile and disease risk of today’s 43 year old; those aged 60 would resemble current 53 year olds, and so on. Thus slowing aging is not something that only benefits us at the latest stages of our lives. It benefits us during our complete adult life, by improving our health profile. And thus the assumption that this science would only benefit the old, or the young, is mistaken. It would benefit adults at all ages.