• Living to 100 and beyond, but how much?

    The WSJ had a piece up over the weekend on the potential for people in the US living much, much longer lives:

    The number of people living to advanced old age is already on the rise. There are some 5.7 million Americans age 85 and older, amounting to about 1.8% of the population, according to the Census Bureau. That is projected to rise to 19 million, or 4.34% of the population, by 2050, based on current trends. The percentage of Americans 100 and older is projected to rise from 0.03% today to 0.14% of the population in 2050. That’s a total of 601,000 centenarians.

    But many scientists think that this is just the beginning; they are working furiously to make it possible for human beings to achieve Methuselah-like life spans. They are studying the aging process itself and experimenting with ways to slow it down by way of diet, drugs and genetic therapy. They are also working on new ways to replace worn-out organs—and even to help the body to rebuild itself. The gerontologist and scientific provocateur Aubrey de Grey claims that the first humans to live for 1,000 years may already have been born…

    The scientists working on these issues respond to such concerns by stressing that their aim is not just to increase the quantity of life but its quality as well. A life span of 1,000 may be optimistic, they suggest, but an average span of 150 years seems well within reach in the near future, with most of those years being vital and productive.

    Hmm. I’m not sure.

    The major thrust of the piece is that people living longer can increase the economic output of a country; I don’t dispute that. The piece also argues that life expectancy has increased over time. I don’t dispute that either. What I take exception with is the idea that this is really due to our long crusade attempting to conquer death.

    Most of the progress seen over the last few centuries has less to do with medicine, and more to do with public health, than many might think. Proper nutrition does wonders for increasing the life expectancy of a people. Clean water and hygeine can do amazing things as well. Curing childhood disease can also majorly impact a people’s average life expectancy at birth. There’s also an argument to be made that wealth increases life expectancy as much as life expectancy increases wealth. It doesn’t get much more compelling than this:

     

    But just because more and more people ate living past 100 does not mean that they will soon live to 150. Moreover, the WSJ article is very much weighted towards amazing technological advances to prevent death. Things like “organ printing”, replacing worn-out body parts, and an “extracellular” matrix focus on the back end of life to extend this.

    This strikes me as a very American approach. We focus on the end of life, and seek to push back the boundary from that end. But (and this again seems sort of American), that ignores all the good we can do on the front end. An article in Nature discussed human ageing:

    Human senescence has been delayed by a decade. This finding, documented in 1994 and bolstered since, is a fundamental discovery about the biology of human ageing, and one with profound implications for individuals, society and the economy. Remarkably, the rate of deterioration with age seems to be constant across individuals and over time: it seems that death is being delayed because people are reaching old age in better health.

    In other words, it may be that human beings deteriorate at a pretty constant rate once they hit a certain age. So, the more healthy they are when they hit that age, the longer they will have to decline, and the longer they live. If this is true, then what we really should focus on is population health on the front end. If we can make humans healthier when they hit old age, they will live longer.

    This would not result in people living to 150, likely, and certainly not 1000. But it would argue that the best thing we could do is focus on a health care system that makes people as healthy as possible before they get old, rather than focus on extending life once they do.

    We haven’t been so good at that in the past. It would be tragic if we once again missed an opportunity to do an enormous amount of good for an enormous number of people because we were focusing on the wrong things.

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