Why We Need a War on Aging

Based on presentation given at 2009 World Economic Forum in the Live Long and Prosper session, January 28, 2009 by Professor Julian Savulescu.

1. There is no normal human life span, or if there is, it was very short.

Life-expectancy for the ancient Romans was circa 23 years; today the average life-expectancy in the world is circa 64 years.

For the past 150 years, best-performance life-expectancy (i.e. life-expectancy in the country where it is highest) has increased at a very steady rate of 3 months per year.

2. Aging is the biggest cause of death and misery in humanity.

100 000 people die per day from age-related causes.  150 000 people die per day in total. Cardiovascular disease (strongly age-related) is emerging as the biggest cause of death in the developing world.

3. Progress is possible

The goal should be to extend the HEALTHY, PRODUCTIVE lifespan, not to just keep people alive longer on respirators or in old people's homes. This is embodied in the concept not of life span but “health span”.  The easiest way to do this is to prolong healthy life not attempt to compress morbidity

The more we understand about the biochemical processes involved in senescence the more we find that they look like disease processes. The accumulation of lysosomal aggregates and amyloid plaques, extracellular protein-protein cross-linking, nuclear and mitochondrial mutations, cell atrophy, cell senescence, and cell loss without replacement: these processes may all be implicated in both pathology and senescence.   At the level of genetics and biochemistry, there simply does not seem to be any meaningful distinction between "processes predisposing to or constituting disease" and "normal aging".

 Aging is not an evolutionary adaptation. Aging, rather, is what happens when various bodily systems evolved to maintain health gradually accumulate defects and begin to malfunction. In the Pleistocene, when life-expectancy is estimated to have been a mere 20 years, too few of our ancestors survived to ripe old age for evolution to favor investment in stronger anti-aging defenses than those we now possess and are forced to rely upon, notwithstanding their evident inadequacy in the modern era where many causes of premature death have been removed.

 The tortoise, by contrast, whose ancestors were less accident-prone thanks to their protective shells, enjoys anti-aging defenses robust enough to give it a lifespan of upwards of 150 years. It is humbling to reflect that somewhere on the Galapagos Islands a giant tortoise might still be around who watched the landing of Charles Darwin.

We will all age, if we live long enough. We should understand why turtles age slower than us. And we should use that knowledge to stave off aging.

Last week brought exciting breakthrough. Scientists identified ajellyfish which could be immortal.

Turritopsis nutricula is the only known animal that is capable of reverting to its juvenile polyp state. Jellyfish usually die after propagating but Turritopsis reverts to a sexually immature stage after reaching adulthood and is capable of rejuvenating itself.

Theoretically, this cycle can repeat indefinitely, rendering it potentially immortal.  The jellyfish and its reversal of the ageing process is now the focus of research by marine biologists and geneticists. It is thought to achieve the feat through the cell development process of transdifferentiation, in which cells transform from one type to another.

The switching of cell roles is usually seen only when parts of an organ regenerate. However, it appears to occur normally in the Turritopsis life cycle.

Medically-induced rejuvenation of organs and tissues is no longer science fiction: it is simply the application of regenerative medicine to the molecular and cellular damage of aging. Just as for the repair and maintenance of man-made machines, this approach can in principle postpone age-related ill-health indefinitely. People would remain physically and mentally as vigorous and functional as young adults, and death would only be from causes that currently affect young adults, such as accidents. The consequent elimination of Alzheimer's disease, cardiovascular disease, type II diabetes, most cancers, arthritis and inumerable other age-related diseases would have astronomical economic benefits, vastly outweighing the expense of developing and delivering these therapies. Even for those who consider that the chance of success in developing these therapies is low, the risk/benefit balance of investing significantly in the attempt to develop them is unequivocally in favour of such an investment.

Anti-aging research is scandalously under-funded.  In the US, a vast proportion of the funding doled out by the National Institute of Aging is given to research on Alzheimer's disease. According to one estimate (from circa 2004), only about 0.02% of the money spent by the National Institutes of Health (of which the NIA is part) is spent on fundamental aging research. I think funding ought to be perhaps 1,000 times greater. Even if we only hastened progress to a cure for aging by one year, that is brought it forward by one year, that’s about 30 million lives saved. Every year we delay finding a cure, 30 million people die.

Objections can be overcome. Of course extending healthy lifespan might create various problems and challenges.  But for any possible problem that might arise, one question that we must not fail to ask ourselves is: "Is this problem so bad that it is worth sacrificing up to 100,000 lives per day to avoid having to solve it?"  If the answer is obviously no, then we should look for solutions.

Here are two final objections:

1. Obligations to Future Generations

We have an obligation to die and turn the world over to the next generation.

How long each generation should live raises deep questions about intergenerational relations, quality of life and burden of care. However healthy and able older people may be economically productive, self supporting and a source of knowledge, experience and care for younger generations, liberating younger people to work. The answers are not clear, especially when life extension is coupled with life enhancement.

At any rate, since few of us believe there is a positive moral obligation to have children, that is to create future people, the obligation to create new generations must be weak

2. Loss of Meaning

Many people fear that a longer life would result in boredom and a gradual loss of meaning. This would be more likely if one was a solitary Methuselah. But in a world where many of those close to us also lived longer, the greatest source of human well-being – deep human relations – would remain intact and arguably grow richer as that network expanded across generations.

There is little empirical support that longer good life loses meaning. Research shows that life-satisfaction remains relatively stable into old age. One survey of 60,000 adults from 40 nations discovered a slight upward trend in life-satisfaction from the 20s to the 80s in age

With the advent of human enhancement– enhancement of cognitive powers, physical abilities and control of mood – this is likely to be even less of a problem.

The challenge is to create longer and better life. But that too is within our grasp. We should aim for drugs to prevent normal memory decline, interventions to keep us physically and mentally active. Viagra is a good example. It deals with one effect normal human aging. 20 million men in the US find it of benefit and it no doubt contributes to meaning in their lives in some way.

And surely it is up to individuals to decide whether their lives come to lack meaning. For our part, we would take the longer life.

Our goal should be more, much more, longer and better life. We need a war on aging.

Billions of dollars have been spent preparing for a flu epidemic. The Spanish flu killed 20 million people. Aging kills 30 million every year. It is the most under-researched cause of death and suffering relative to its significance. Whatever breakthroughs occur in medicine or health care generally, at the moment we face the inevitability of ageing. That might not be necessary.

Authors:

Julian Savulescu, Programme on the Ethics of the New Biosciences, James Martin 21st Century School, University of Oxford

Nick Bostrom, Oxford Future of Humanity Institute, James Martin 21st Century School, University of Oxford

Aubrey de Grey, Methuselah Foundation