Aging: The Disease, The Cure, The Implications

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Gregory Stock is a biophysicist, best-selling author, biotech entrepreneur, and the director of the Program on Medicine, Technology and Society at UCLA’s School of Medicine. He has written extensively on the implications for society, medicine and business of the human genome project and associated developments in molecular genetics and bioinformatics. His interests lie in the scientific and evolutionary as well as ethical, social and political implications of today’s revolutions in the life sciences and in information technology and computers.

The following transcript of Gregory Stock’s presentation at the Methuselah Foundation symposium entitled “Aging: The Disease, The Cure, The Implications” has been corrected and approved by the speaker. Video is also available.

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Aging: The Disease, The Cure, The Implications

To echo some of what Aubrey was just saying, the latter portions of the trajectory of life are pretty brutal. What we love is eventually taken away as we age: our senses diminish, we lose our friends, family, our loved ones, and eventually we die. As Shakespeare put it well,

“And so, from hour to hour, we ripe and ripe,
And then, from hour to hour, we rot and rot,
And thereby hangs a tale.”

Things haven’t changed much since Shakespeare wrote that. Dealing with aging and death has always been a challenge. People have different ways of handling it. I see it in four categories: One is to just ignore it. This is pretty easy for awhile–you can just pretend it isn’t happening, particularly when you are young and when the manifestations of aging are not really apparent at all.

Another is, you deny it. “Death is not really real, because our soul will live eternally.” Or, we will live eternally through our creations–those sorts of things. A lot of people like to feel that; it makes them feel better about the situation. Another is just to accept it. That is a common practice too, to say it is inevitable, natural, even the best thing. Leon Kass, for example, has said it is life’s finitude that gives it its meaning–as though young people who do not think about their mortality don’t enjoy life.

The final approach is to battle it. This was the strategy of Ponce de León, who was wandering around in the jungles of Florida. It could be Aubrey de Grey, too, who is trying to catalyze a serious effort to control the aging process. What is different now, though, is that suddenly, for the first time ever, it is actually quite plausible. As you heard from the comments of earlier speakers, we might actually be able to accomplish that.

What is interesting is that this is not the goal of biogerontology today. Its goal is not to control aging, or extend our natural lifespan, but to somehow compress morbidity, so that we can be healthier for a longer period of time and then fade away quickly. Initially that sounds reasonable, but at its logical conclusion, it really is completely out of sync with our aspirations. Where would it lead us?

Imagine that you actually could retain youthful vigor for a normal human lifespan–70, 80 years. Then in a matter of a month you would, salmon-like, deteriorate, and be gone. Just enough time to say your goodbyes.

I don’t think that would be a blessing, because without the ever-worsening debilities that wrench us away from our lives, that separate us from the process of living and our interactions with others, it would be very difficult to depart. Not only that, we would leave this gaping hole behind us among all the people we were interacting with. It would be very painful, not something that we would welcome. Certainly, if human lifespan is immutable, then more health is a great thing, but our true aspirations are not for compressed morbidity. They are for longer, healthier lives.

What is amazing is that this aspiration is actually a plausible goal today. So, why not go for it? It seems as worthy a project as space exploration, or creating an atom bomb. I will argue that to not pursue this is a huge mistake. It would be a failure of our generation and would be seen as such by future generations. We should mount a war on aging, where aging is not seen as a disease, but the key disease–the one that afflicts absolutely everyone. It cripples, it kills, and it might be treatable.

Perhaps not for us, but for our children, what a legacy that would be! Or maybe, it could be, for us–yesterday I got a fortune cookie that said that I was “going to enjoy great longevity,” which is encouraging to me… but it did not say whose longevity. So, I’m not sure.

Seeing aging as a disease is not yet mainstream, but our concept of disease has shifted a great deal. It has shifted from viewing it as a cluster of adverse symptoms to a state of being that places us at increased risk of adverse consequences. Aging is just this–it is what makes us old. It is what brings on cancer, heart disease, Alzheimer’s, Parkinson’s–all of the aging-related diseases. It debilitates, it kills. The idea of striving for an extended lifespan has until now seemed futile. It has also been colored with the sense that it is somehow unworthy and narcissistic.

We celebrate the nobility of self-sacrifice, the heroism of risking death for others, for the common good. Reaching for extended lifespan evokes images of cowards on the deck of the Titanic pushing women and children aside as they race for the lifeboats, of hypochondriacs counting their vitamins, or of those engaged with caloric restriction who are starving themselves and look emaciated for a little bit of extra life, or of vampires sucking the blood of innocents. These are the images associated with seeking extra life, but if there were meaningful breakthroughs in aging research, it would change all that. It would draw the pursuit into the realm of mainstream medicine, rather than fantasy. Seeking extra years would seem common sense… like using antibiotics, vaccines, or the many other things we do that play god. Why would you not do that?

The question is, can we really justify spending the money and resources to go after these breakthroughs? To put that in perspective, I will propose that there should be a serious, aggressive, publicly-funded program with the expressed goal of trying to extend vital, healthy lifespan, by retarding the aging process itself. I think there is a good justification for this. First, let me be absolutely clear about what I am proposing. Not privately funded: no one would argue against private funding–people can spend their money the way they want. I’m talking about taking public funds, and not targeting specific diseases–there is a lot of that already–but the aging process itself. Nor am I talking about a timid exploration to see whether this is plausible, how long it would take, or whether we should spend the money… I mean a robust, well funded effort to really go after it–something like the Manhattan Project.

Should we take a shot at what previous generations have only dreamed of? It was not even possible to do something like this before. Let’s be clear: we are talking about human enhancement, and people don’t like the idea of enhancement. Of course, if you controlled aging, it would be therapy as well, because there are so many diseases of aging, and the focus would be healthspan, because an added twenty or thirty years of decrepitude is not what most people aspire to.

More life without more health would not be of great value. And, ironically, this seems to be the focus of a great deal of medicine today. Why is that? It seems to me that part of it is because our views about what is acceptable begin to change as we get to those points where we begin to see things that would have been unbearable initially and we come to say, “actually, it’s not that bad.” I remember a time when I thought that to wear glasses would be something unbearable. It does not seem that way anymore, and I can hardly believe that I felt that way. The second thing is that we don’t want to acknowledge that given current options, lots of times death is really the best choice. We are very uncomfortable with making decisions about when to pull the plug.

I could get into the structure of what such an anti-aging program would be and how it would be funded. But make it simple. Think of something like the California Stem Cell initiative, Proposition 71–some three billion dollars devoted to embryonic stem cell research. The question is, what is the justification?

There are strong arguments. The first and most obvious is that if it were successful, there would be very substantive individual benefits. A lot of people will argue that this is not the case, but it seems pretty obvious to me. Were those interventions possible, lots and lots of people would embrace them enthusiastically. I don’t base this on some theoretical projection about how people will behave–people already spend a fortune on trying to attain just the appearance of continued youth. Given all the things that we spend on cosmetic interventions–if something real existed, it would be seized.

Individual benefit, however, is not enough to justify the use of public funds in a massive program, because some people do not desire the possibility. And many people believe success is unachievable, or at least a very low probability. There are many other goals that people see as important too. A program like this would be aligned with individual benefit and our desires, but there have to be other compelling reasons to justify it. Fortunately, there are.

The second reason is that broad social benefit would result. There are the obvious social benefits, of course, since social value is really the sum of individual value, so if individuals are benefiting, then so is society. What metric should we use other than the way people evaluate their own lives–other than in terms of the things that people want. It is obvious that there will be social benefits of this sort, if there are individual benefits, if a lot of people are helped and not many people are injured. Robert Topel, an economist who looks at these sorts of things, claims that we value our lives to the tune of about five million dollars, as evidenced by the choices we make about how much to spend to reduce risks or to preserve health. Thus there is a lot of monetary value for life extension to capture.

There is a significant social benefit, however, that is not quite as obvious: it takes a long time to get to the point where you can contribute effectively to the world–where you have figured out how things work and you can really handle yourself well in life. There is a lot of expenditure that society makes in education to get you to that point, and yet then, you are just beginning to slow down. That’s not very good, and later in life, most people are largely withdrawing resources. If you could expand the period of one’s prime by twenty years, what an efficiency that would be! What a contribution. Topel tried to calculate what the value was of previous extensions in life expectancy (it roughly doubled from 1900 to now), and he has calculated using pretty arcane methods that it is some three trillion dollars a year. Basically, half of our increased standard of living comes from increased life expectancy.

That’s a pretty big value, but still, one could still argue that there are lots of worthy demands on public money. So, what are the other justifications? Some are even stronger, and are really obvious. For example, the direct monetary return to the public would far exceed the cost. If you were able to extend lifespan and just delay aging, even a little bit, you would have huge savings in health care costs, which come to half a trillion a year, and in retirement benefits, if you made some obvious adjustments to social security. A program to achieve delays in the onset of all the debilities of old age could have such a tremendous payback that it would be justified even if the probability of success were almost minuscule. If you are talking about a trillion dollars spent in these programs each year, it does not take much to justify a few billion dollars.

Another reason is that the funding of a program to extend healthspan could be very fair. By that I mean, it could be funded by the people who will derive value from it. It could be funded virtually entirely by a reduction in future benefits to seniors, and there are a lot of people who would be quite comfortable with the idea of reducing their future benefits (particularly, ones that may be taken away anyway), for the chance at extended longevity. Moreover, such a program would not have to compete with present spending allocations, if you used bond offerings that would become due at later periods. This is a second reason that this program is very difficult to argue against.

A third is that such a program would be so aligned with other efforts that we have already embraced. It is consistent with the vast push to treat diseases of aging, because if you actually could make progress with the underlying mechanisms of aging, it would have an automatic impact on those other diseases. That is a third reason.

A final reason is that it would be such good business. The program would be of terrific value to any entity or nation that embraced it aggressively. An example of this is the whole environmental movement, where to be at the leading edge of that swell of green effort is very valuable compared to being at the trailing edge. I think it is clear that the global appeal of added health and longevity is such that if it really comes to pass that we can make interventions in aging, a fortune is going to be made in various spin-offs. If you really have a center of that activity, here rather than elsewhere, it will be of enormous value. You definitely want to be ahead of this curve.

I said that one way of structuring this program — and I think a very good way — would be an initiative like California Prop 71. Do it in a structured ten-to-twenty-year program, and don’t waste the money like you did on the California Stem Cell Initiative, where a lot of it is being sucked into buildings. You could actually hire a thousand post-doctoral researchers. Imagine that: a thousand researchers — for maybe a hundred million a year — that would be devoted to that area. What would be all the spin-offs in medicine and gerontology from an effort like that located here in California, or wherever it was? To me, that prospect is something that you could sell in an initiative, even with reductions of future benefits of some sort, which people tend to undervalue anyway because they are so distant. Not to do this would be to squander all the possibilities coming out of the revolution in biotechnology and molecular biology.

This is happening right here in our lives at this instant in time. The revolution in molecular biotechnology was not created simply to find out how biology works — although we are all curious — it was motivated by the hope of applying this knowledge to ourselves in some way that would benefit and add to our lives. I think that future generations, if we delay this sort of thing, will wonder how we could have been so blind as to not do this, thereby potentially rendering them among the last generations not to enjoy the benefits of this progress, rather than among the first to use them.

To summarize, here we are at the start of a new millennium. Future humans are going to look back at this moment and they are going to see it as this challenging, chaotic moment in history. They are going to say, “What an extraordinary moment to have been alive. That was the instant when all the things occurred that shaped our lives and the nature of our society. Artificial intelligence, telecommunications, the human genome project, understanding human biology, space exploration…” All these things are going on right now.

In my view, the ragged frontiers of aging is where the real action is going to be in the next century. That is because our next frontier is not, as imagined in the 1960′s, space. It is our own bodies. It’s us–because we care a lot more about us than we do about out there. Getting old is central to our lives, so this is going to be a tremendous focus as it becomes understood that we really might intervene in the processes of aging. There is going to be a huge swell of effort. Thank you very much.

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2 thoughts on “Aging: The Disease, The Cure, The Implications

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