Securing the Longevity Dividend
Posted by Jeriaska on March 7th, 2008
Professor of Epidemiology of the University of Chicago, Jay Olshansky helped to introduce the concept of the Longevity Dividend: pursuing the sum of health, social, and economic benefits attained from a seven year delay in aging. A leading proponent of research into increased human longevity, he gave a presentation at the “Securing the Longevity Dividend” event in Chicago organized by the Institute for Ethics and Emerging Technologies. There he argued for the necessity of reducing health risks by slowing the biological process of aging.
The following transcript of Jay Olshansky’s July 23, 2007 IEET talk “Securing the Longevity Dividend” has not been approved by the speaker. Audio is also available, courtesy of the Institute for Ethics and Emerging Technologies.
Securing the Longevity Dividend
I’m going to be discussing something I think many of you are now familiar with. This is a manuscript that we published last year in The Scientist. I want to acknowledge right from the beginning my colleagues and friends with whom I have been working, Dan Perry from the Alliance for Aging Research, Rich Miller from the University of Michigan, and Bob Butler, who runs the International Longevity Center in New York, and he is also interestingly enough, for reasons that will be made clear later, the founding director of the National Institute on Aging.
Now, I want to tell you an interesting story. I’m a long time Chicago resident, and as it turned out I came into this field because of this woman right here. Her name is Bernice Neugarten. I was a graduate student at the University of Chicago from 1977 to 1983. Bernice was in Human Development, quite a well known person, and I took a class from her. At some point she came up to me in that classroom because of a discussion we had had, and she asked me this question: “Should the U.S. government invest funds in an effort to slow aging in people?” This was 1977. Now, she handed me a copy of this book, which I am going to bet not a single person in this room has ever seen.
The book is entitled Extending the Human Lifespan: Social Policy and Social Ethics. I will tell you now, I wish I had read this before we had written this article for The Scientist. I would say that 90 to 95% of everything we are going to discuss here today was discussed thirty years ago by people that you are going to recognize. In fact, let me show you some of the individuals. The articles that are in here are absolutely amazing.
Here are the authors, many of whom are dead, including Bernice, by the way. She died several years ago. There is Len Hayflick, Havighurst and Sacher. Sacher was also at the University of Chicago and at Argon National Laboratory, where I worked for many years. Look at the titles of these articles: “Extension of the Lifespan: A National Goal?” This is a rather interesting article by Goddard. Look here down at the bottom. “What is the Likelihood of Major Life Extension?”
So, these are not new questions–these are old questions. They go back at least thirty years. I wanted to put in this quote here from Goddard from ’77. “When one examines the resources being allotted to the field today, it is quickly apparent that aging research is a relative low priority at the national level. It has been estimated that we spend $2 in cancer research for every three cents spent in research on aging.” This is a very interesting conclusion that he had come to.
Now, let me just give you the bottom line, and then I will give you the rationale behind it. The main argument in this manuscript was fairly straightforward, and that is, the time has arrived for us to make an investment that we have never made before, and that is an effort to slow the biological process of aging in people. We are making this argument now for a number of reasons, one of the most important of which is–and you are speaking to a very conservative individual here–I am willing to say something now that I was not willing to say just five to ten years ago. That is that I believe the technology and the field of aging has advanced sufficiently that many of us now believe that it is not just a plausible goal to slow aging in people, but a necessary goal–something that we must pursue in the coming decades, for reasons that I am going to demonstrate shortly.
This is the rationale. I will go through each of these very briefly. Future significant gains in healthy life must result from gains made against old age mortality. The current medical model, which is the disease-specific model, is eventually going to run out of steam, some of us would suggest sooner rather than later. There is a demographic imperative that I’m already familiar with. We have already spent vast sums of money on saving and extending lives. Last, but certainly not least, there is the value of life itself.
Before we get into any of these other issues, it’s really important to understand how we got to where we are today. For those of you who are not familiar with the demographics at all, what you are looking at here is a distribution of death. If you were to take a hypothetical group of 100,000 babies born in 1900, applied to those babies the death rates observed in that year, and plot out the ages at which they all died, you would get a distribution of death that looks like this one right here.
Can anyone tell me what this bump is here at age twenty? This is for females only. Maternal mortality–childbirth. Even if you made it past these first couple decades of life, even in 1900 you had a reasonably good chance of living out into your sixties, seventies, and eighties. During the course of the 20th century, we essentially redistributed death from the young to the old. We brought down infant, child and maternal mortality dramatically, so the area under the curve remains exactly the same.
Here is a distribution of death for U.S. females in the year 2000. The vast majority of the rise in life expectancy that occurred in this century, occurred not because of any major breakthroughs in medical technology, but principally because of advances in public health that enabled us to save the young. That led to a thirty-year increase in life expectancy at birth, from 49 to 80, within a single century. This cannot be accomplished again. We’ve done it–we succeeded. So the only way to achieve any significant increase in healthy life is to play a totally different ballgame at this end of the age structure. We now have to extend life among the elderly. They face a totally different set of conditions than those that were faced by individuals earlier in the century.
Here is an illustration of the rise in life expectancy up until 2000 for males and females in the U.S. There are some people who like to take these lines and perform a linear extrapolation. There are others, myself among them, who suggest we are perhaps on the verge of a decline in life expectancy, for reasons I am not going to discuss today. But it is important to realize that the importance of this rise in life expectancy was associated with reductions in early age mortality. The majority of this increase in life expectancy was the result of reductions in middle aged mortality. And the majority of the increase in life expectancy in this region is the result of declines in old age mortality. That is all that is left for us to achieve significantly–declines in old age mortality.
As an illustration of this, I performed a decomposition of the gains in life expectancy as a function of age to illustrate that for men, for example, in the first decade of the century the vast majority of the increase in life expectancy was the result of declines in death rate for people under the age of twenty. By the last decade of the century, close to 70% was associated with reductions in older age mortality–the same thing for men. We are in a different world today than the one that we were in a century ago. All the action is going to have to be at older ages.
We published this in 1990. If you hypothetically eliminate most of the major diseases today like heart disease, cancer or stroke, you only get about a three-year increase in life expectancy at birth. This is part of the reason why we suggest that this disease-specific approach is going to run out of steam. There is only so much that can be gained by eliminating heart disease, cancer and stroke. Hypothetically, even if you did, you would only get a life expectancy of about 90 for the population. The only way to go beyond that is to do something that is fundamentally different, and that is to go after the biological process of aging itself.
This is the typical medical model that is currently in use. In fact, it is the basic medical model of the National Institute of Health. I have no serious problem at all with the basic medical model. I sort of see it as a hurdle approach to life. These aren’t in any particular order, by the way. When you face a particular disease or disorder, medical technology, our geriatrician friends at the University of Chicago, will lift us up over these hurdles until we face the next one. We will then run, which is to say ‘live our lives,’ until we face another hurdle. Then medical technology will help us over that one. It was believed for a long time by many that there was some sort of brick wall or biological limit to life. We now know this is not true. What we have instead is another hurdle, except in this case, you will notice, I pulled up the top end of that hurdle, implying we will not be jumping over that hurdle anytime soon. That implies immortality. Some might suggest this is plausible; I don’t think it is. At least not anytime soon.
What we are suggesting is that to go after these particular diseases and disorders is to take this hurdle and push it out to older and older ages. If you could move the aging hurdle, the basic biological process of aging, you drag everything else along with it. All of these diseases and disorders would be reduced dramatically with a minor postponement of the biological process of aging.
The demographic imperative should be fairly straightforward. For those of you who are familiar with age pyramids, this is a demographer’s trick. You cut the age pyramid in half and turn it on its side, and what do you see? You can see the age wave. Here, this is the number of males by age, zero to five, all the way up to 100 and over. This is what the age pyramid looks like for the year 2000. You can see that we know the Baby Boomers born between 1946 and 1964 will begin reaching the age of 65 in the year 2011. So, we are just a few years away. Aging, really, has not hit yet at the population level. There is the wave: a permanent demographic transformation that is inevitable, and it is not just the United States. It is global. It is going to happen everywhere.
We are already investing in the longevity dividend. In fact, we have been investing in the longevity dividend for decades. How do we do this? We save the lives of people at various ages throughout the age structure already. We immunize our children—what is the goal? The extension of healthy life. We spend vast sums of money on creating and developing new mechanical devices to extend lives for individuals. This has been growing on for decades. The pharmaceutical industry is huge. It is primarily an investment in the extension of healthy life.
I suspect many people in this room have gone through various surgical procedures of one form or another. I personally would have died at the age of twenty had it not been for a surgical procedure. I’m living on what I refer to as “manufactured time.” These types of surgical procedures are at the foundation of extending the duration of healthy life. We are becoming increasingly effective at detecting diseases earlier and earlier. We spend vast sums of money on developing and using these technologies. Indeed, it is an investment in the extension of healthy life. I hope you see the common theme here. All of these are focused on specific diseases, for the most part.
Last, but not least, there is the value of life. When you finally read this book from 1977, there is some fascinating philosophical arguments about the value of life and the extension of healthy life. These happen to be my kids, by the way. Here they are when they were very young. For those of us who have kids, we will invest any money that we have to extend the lives of our children. We will do what we can to make them live longer and healthier lives. Here they are today at 20, 23 and 19. I would argue that the value of their life today is of equal value to their life when they were young.
In our world today we tend to devalue people as they grow older, especially people who are at extreme old age. Here is my father, who is so alive at the age of 91. This is not my mother–this is an alleged supercentenarian from China who is supposedly 110. The argument I would make here, and I believe we at least partially made it in our manuscript, people at this age deserve a day of life just as much as these individuals at this age. We should not be devaluing people because they are older. That is the most important lesson I learned from Bernice Neugarten three decades ago. And yet, we tend to withdraw medical technology from these individuals, because they’ve already lived their life.
Some would suggest that perhaps because these individuals have fewer days of life left that those days are more precious. I’m not going to get into that philosophical argument. I’ve talked to my dad about this very issue–he’s not ready to die. When he looks at himself in the mirror, he tends to look only at his eyes, because there he sees the person that he sees inside of himself, which is that 39 year-old vibrant individual. He then, of course, looks down to the rest of his body and he says, “What happened?” He’s been betrayed.
The main argument that we are making in this manuscript is the pursuit of the extension of healthy life, which means in our view that efforts to delay aging are more likely to succeed if we have as our goals improvements in public health, extension of the period of health and vigor, and reductions in frailty and disability at all ages. We argue that if we succeed in this effort to slow the biological process of aging, we will probably live longer, although I’m asked all the time, “Jay, how much longer do you think we will live?” And my answer may surprise some of you. I don’t really care how much longer we would live as a result of our effort to slow the biological process of aging in people, because that is not my goal. Ironically enough, from the language of this manuscript from 1977, it was the conclusion of many people three decades ago. This came about within two years of the founding of the National Institute on Aging. We are hear to prolong the period of healthy life. If we live longer as a result, that should be considered a bonus.
This is one of the main conclusions of the manuscript itself. “By slowing aging we will do what no drug, surgical procedure, or behavior modification can ever do–extend your years of youthful vigor and simultaneously postpone all the costly, disabling, and lethal conditions expressed at later ages.” If we came up with a pill that could that could lower your risk of cancer, would you take it? In fact, many people are taking those very pills. The pill that we are talking about now will do this, and much more. It will postpone everything until later ages and, we believe, produce a series of social and economic benefits for individuals and nations that would by far succeed, for example, the cure for cancer.
Now, I know many of you have heard the ridiculous arguments on why we should not be pursuing efforts for slowing aging in people: runaway population growth. As it turns out, I did some calculations–In the middle part of the 20th century we had extremely high growth rates. A 1% growth rate means the population doubles in about 70 years. A 2% growth rate means the population doubles in about 35 years. So if you double the growth rate, you halve the doubling time of population size. With a 3% growth rate, population doubling time is about 26 years. That’s where we were in 1950. If we achieve immortality today, growth rate becomes defined by the birth rate. The birth rate is roughly 1.5 per 100, which means the doubling time of the population would be roughly 53 years, which would be twice as high as it was during the post-World War II era.
I don’t anticipate immortality is in the cards. Even if it was, it would not produce growth rates that are anywhere near what we experienced during the middle of the 20th century. If you have zero mortality for a long time, you’re going to run into problems. I don’t anticipate zero mortality anytime soon. My friend Aubrey might disagree.
This one I’ve heard recently: If we invest in the longevity dividend, the funds will be taken away from traditional health promotion and disease prevention. I could not disagree more. This idea of a longevity dividend is not intended to take money away from traditional efforts to go after disease. We are not saying, “Take money away from cancer research.” What we are saying is, Invest in a new technology. The type of technology that can achieve what we are already committed to–going after specific diseases–but also the most effective way to extend healthy life in this century, which is to slow aging itself.
This is my favorite ridiculous argument. Life extension would make us more frail and disabled, effectively extending the period of old age. For anyone who has read any of the literature in this area, what we are suggesting would have the exact opposite effect. The extension of healthy life would essentially shorten the period of old age, extend the duration of healthy life and enable people the opportunity to choose what they are going to do with that extra time.
It is hard to imagine anyone disagreeing, especially my 91 year-old father and that 110 year-old Chinese woman, if we could offer them extra years of healthy life, would they take it? There is not anyone that I know of who would answer “no” to that question.
The operative word that we are using in this manuscript is “Delay.” The target we set in this particular manuscript is a seven year delay in aging. Some might ask why a “seven” year delay in aging. There actually is a very good rationale for this.
This is what death rates look like. This is the distribution of death for the U.S. population in 1900. This is what the death rate looks like in the year 2000. Just to illustrate, it took roughly an entire century to transform a 75 year-old female into that of a 65 year-old female. In other words, a 75 year-old female in 1900 is equivalent to a 65 year-old female today. It took a whole century to achieve that type of transformation. The main reason why we chose a seven year delay in aging is because the doubling time for most everything that goes wrong with us as we grow older is about seven years.
In other words, I’m 53 today. My risk of death if I make it to the age of 60 will be double what it is today, and it will be double that when I reach the age of 67. If you slow aging by seven years, you cut the risk of death by half. In fact, you cut the risk of everything that is negative associated with growing older in half.
Some of you may want more than seven years. You have to begin with something. We set seven as a goal that we believe is measurable and achievable in the lifetime of people in this room today. For reasons that I think are obvious, this will be particularly important to politicians.
Here is an illustration of the incidence of age-specific hip fractures among white females. You can do the economic costs associated with the value of cutting hip fractures in half and I think you will get a good idea, just in regard to one issue, what the benefits would be.
When this article came out in The Scientist a year ago, Dan Perry and Rich Miller and I went to Washington and we met with Senator Harkin and other senators about this idea of the longevity dividend. The really lit up to it. Senator Harkin came back to us and said, ‘Could you please provide language for the ’08 appropriations bill that we could include?’
You have to work very slow and methodical in an effort to get politicans to do anything along these lines, but we believe we did it. We gave them the language, and just two weeks ago the appropriations bill for ’08 passed the Senate :
The Committee commends the NIA for work it has done to improve understanding of the biological factors that regulate the processes of aging. These new discoveries have led many scientists to believe that it may become possible to postpone the onset of a wide range of fatal and disabling diseases, in a coordinated fashion, by retardation of the aging process. It is widely understood that chronic illness is a powerful driver of medical costs, which in the United States are expected to reach $16 trillion by 2030. To alleviate this financial burden and to develop interventions that can extend health and longevity, the Committee urges the NIH to increase dramatically its annual investment in the biological basis of aging.
Why is this important? If this gets past the president, the NIH now has to follow this language, which means what you will see is specific requests for applications to understand and pursue the longevity dividend itself.
A dramatic increase in the NIH budget designed to pursue the longevity dividend has to get past the president. I don’t know what the president’s view is on this particular topic, but getting this language in the appropriations bill was absolutely critical for us. Dan Perry was amazing in his tireless effort to get this language in there.
Let me illustrate to you using this image why pursuing the longevity dividend is so important. Remember that distribution of death from 1900 to 2000 that I showed you earlier? This is a truncated version of that beginning at age 50. What I have done is I’ve taken this last region of the lifespan and divided that into three regions. I have placed on that a background of frailty and disability–the things that go wrong with us that do not necessarily kill us as we grow older.
What we have done during the course of the 20th century is we have pushed increasingly larger segments of the population into older and older regions of the lifespan. Why is that critical? Because in this region of the lifespan there is a great deal of plasticity in our ability to influence what goes wrong with us as we grow older. That is why diet and exercise works; it works very effectively among all the pharmaceuticals, surgical procedures, and so forth.
There is a great deal of plasticity, we have learned, in this region of the lifespan–65 to 85. We are taking advantage of that plasticity now. The problem is that in this region of the lifespan there is considerably less plasticity, and this is where we are pushing almost everyone. If we continue with the disease-specific approach, if we continue only to make inroads against heart disease, cancer and heart disease, we will push everyone into this region of the lifespan.
What we are suggesting is what Gruenberg referred to in 1977 as the failures of success. We may very well live longer, but the additional survival time may be filled with frailty and disability. That is the very thing we want to avoid. It is the very thing we believe we can postpone with efforts to slow the biological process of aging. All we are asking for is this: a deceleration in the rate of aging, reducing the risk of everything associated with aging that is negative by half.
This is what we want to avoid. “Remember the twenty years you added to your life through healthy living? Well, these are them.” We do not want to prolong old age. That is the exact opposite goal. In fact, whenever I hear the argument made that what we are pursuing will make us frail for a longer time period, what little hair I have on my head stands up. That is the opposite of what will happen if we slow the biological process of aging.
I gave this presentation in Australia last year and Len Hayflick was in the audience. He came up to me afterward and said, “Jay, I agree with everything that you have said here, but you haven’t given me the answer to how it’s going to be done.” I’m going to tell you right now, I don’t know how it’s going to be done.
We don’t need to know the mechanics of how we are going to slow the biological process of aging to set this up as a rational goal to pursue. We didn’t know how we were going to attack cancer when we decided cancer was worth attacking. We actually didn’t know how to attack infectious diseases very effectively during the time in which we decided to go after infectious diseases. The same holds true for heart disease and for stroke.
Here are some interesting avenues that have already been pursued. Studying the genetics of extremely long-lived people. These people we know had won the genetic lottery at birth. Understanding what those genes are, what gene products are being produced by those particular genes and how they influence disease expression I think is critical. Understanding caloric restriction and how it works, and perhaps developing caloric restriction mimetics is another area. Compounds with properties that appear to slow aging, such as resveratrol, I think have the potential to do the same thing.
To me it does not really matter which one of these work. We should be pursuing them aggressively. I’m going to end with this quote, which comes from a Bernie Strehler paper from 1974. I think Bernie Strehler was the first one to have really made the argument for the pursuit of the longevity dividend. Honestly, there really is not anything I’m telling you that is new. This is from the second-to-the-last paragraph of his manuscript:
To reach the golden era: Why are all these biological and human possibilities not being pursued with the vigor and inventiveness their potential promises? The answer is perhaps a kind of societal senescence. Could those who control policy and funding for the necessary fundamental research needed to bring the reality within reach of those of us now alive themselves be ensnared in the time’s net? Is the parochial promotion of professional status and career the moon behind which a sun of understanding lies? Are the available funds so necessary for the pursuit of today’s ephemeral problems that we stand blindfolded before a lovely unfolding landscape?
