Imagine for a moment that the inhabitants of a town beside a river are hampered by their inability to get across the river. They have been talking about getting across the river for so long, and without any meaningful progress towards that goal, that it has become a polarized topic by now. Most people won’t mention crossing the river these days because it has become the subject of tall tales and ridicule. The town is growing, however, and now it has a concrete works and enough revenue to order all the rest of the materials needed for a bridge. Accordingly, a bridge faction arises, but is almost immediately set upon by another, larger faction who think that a better use for the concrete and the funding would be a nice platform overlooking the river, and a road leading up to it. Wouldn’t that be a benefit to the town, and safely certain in comparison to actually having to set up pilings and cranes and all the rest of what might be needed to build a bridge? Both of these factions amount to only a handful of people in total, however, and are largely ignored by the rest of the town, whose support they need in order to move ahead.
This sketch is somewhat akin to the situation we find ourselves in when it comes to biotechnology and aging. The people who want to take credible paths to human rejuvenation, bringing aging under medical control, now that such a goal is possible given the technology to hand, are a minority in comparison to the people who want to do no more than slightly slow down aging. The difference in the potential benefits produced by these two courses of action is night and day: one does very little, the other is a road to agelessness and an end to all age-related disease. The difference in cost is likely minimal in the grand scheme of things. Yet the majority of that part of the aging research community interested treating aging as a medical condition are following the objectively far worse path, rather than the objectively far better path. Meanwhile, the majority of the public pays no attention and has little to no interest in the topic – despite the fact that this is, quite literally, a matter of life and death.
Thus, there are two battles of importance when it comes to advocacy for the treatment of aging. The first is to create widespread public support for longer, healthier lives and the research needed to achieve that goal. We currently live in a world in which most people are all for cancer research and heart disease therapies, but opposed to or disinterested in research that targets aging, the root cause of those conditions. Progress at the large scale requires greater public support for this cause than presently exists. The second battle is to ensure that the right projects are funded: comprehensive rejuvenation, not a slight slowing of aging. Bringing an end to aging, not just tweaking it a little. Both goals are equally possible, but at present the better of the two has far less support and funding. That this second battle is still being fought, and needs to be fought if we are going to see significant progress in our lifetimes, is why articles like the one quoted below appear every so often – though not as often as they should.
In about the year 2000, a commandment came down from the very heights of the Geriatric Olympus: “Thou Shalt Not Study Life Extension. Nay, nor shall thou speak wistfully of such a prospect. For it is written that life extension scares the bejesus out of the gods of policy.” The fear haunting policy makers is that medical progress will result in longer lives without better health – the specter of millions of empty shells in wheelchairs populating ever-expanding nursing homes. Ever since this commandment, the ruling concept has been “quality, not quantity.” We don’t want to live longer – just better.
This concept ignores two realities: firstly, that we do want to live longer; secondly, that at a population level, it is impossible to live longer without living better. Conversely, living better means living longer. At one level, these realities are too obvious to require explanation. However, policy gods work at the level of abstract concepts, and strange things can happen when abstractions are substituted for actual experience.
We do want to live longer. As any clinician knows, those with serious chronic illnesses not only cling to life but for the most part enjoy it and are grateful for the opportunity. Even in places with easy access to un-messy and legally sanctioned suicide, there are not that many takers. And it is virtually impossible to separate quality from quantity in human life. Measures that reduce disease also increase longevity, and vice versa. There are rare examples where quality and quantity might diverge – perhaps chemotherapy and radiation for
glioblastoma multiforme is one – but I challenge clinicians to come up with common examples. Aggressive end of life care does not increase quantity. Palliative care does not shorten life and in some trials even extends it.
Thirty years ago, there were serious articles by various experts about how the (then) continued increase in life expectancy would lead to an epidemic of Alzheimer’s and thence to a need for more nursing homes, more wheelchairs, more of everything unpleasant and costly. But that was silly. People live longer because they are healthier, not because some magic pill or machine keeps decrepit, barely functioning organisms alive. Yet the commandment outlawing enthusiasm for life extension requires researchers to start their publications with statements about wanting only to improve quality, not quantity of life.