If the Purpose of Medicine Is To Save Lives...

As Anne C. says, "if the purpose of medicine is to save lives, medicine shouldn't limit its sphere of effectiveness only to younger people." I am reminded of a recent item in the science press:

A year of added life more valuable for the young, study suggests

"Our paper reviews recent studies related to how society values health gains for people of different ages," Eisenberg said. "These studies generally suggest that health gains for people at younger ages should receive higher priority than equivalent health gains for older people. When we incorporate these values into standard cost-effectiveness analysis methods, then interventions for young people, such as recently developed vaccines for HPV or meningitis, look significantly more appealing from a cost-effectiveness perspective."


"This study illustrates that the way we have been performing cost-effectiveness studies devalues the effect of interventions on children relative to adults and seniors," said Freed, who also has an appointment in the school of public health.

"As a nation, we must take a fresh look at how we measure the benefit of interventions focused on children. Likely, they represent the best investment we can make in our country's health now and in the future."

The paper does not suggest that society should divert health care from adult and senior programs, Eisenberg stressed. It is unknown how often economic methods such as cost-effectiveness analysis are actually used to allocate health care dollars---many other factors contribute to the decision making process, particularly in a decentralized health system such as ours, he said. Rather, the study suggests that age should be accounted for in future economic calculations and that the evidence on societal values for this issue should continue to be developed.

When people say "society" in this sort of context, they really mean "whichever govenment pen-pusher happens to be put in charge; a person who cares nothing for you, your specifics or your wishes" - a ringing endorsement for not letting "society" have any say in any matter. People are quite capable of making their own choices based on value, using information specific to the case at hand. You wouldn't let a random stranger drive your car - why let faceless government employees decide whether you live or die? Step up to the plate and help make sure that the medical technology you want to see is developed and available in time for your old age!

If you look for the greatest source of suffering and death in this world, you will find aging:

Because saving lives is the most valuable thing anyone can spend their time doing, and since over 100,000 people die every single day of causes that young people essentially never die of, you'll save more lives by helping to cure aging than in any other way.

There is no greater single target for medicine - and yet we advocates for healthy life extension are forced to fight an uphill battle to effectively direct research to this end. There may be a cancer research establishment, an Alzheimer's establishment, even an aging research establishment, and so forth, but there is no longevity research establishment.

People are working on it, in a variety of ways. But, again, there is no longevity research establishment at the present time. No research and development community is aimed squarely and forthrightly at the defeat of aging in the same way as the cancer establishment is dedicated to ending cancer. What an irrational state of affairs this is - doesn't it make you want to step in and help change the world in this one important way?

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I think that priorities will change as older people (due to falling birth rates in the last few decades) make up an ever-growing percentage of "society". People over 65 are already the fastest-growing demographic group -- and they vote.

Posted by: Infidel753 at March 15th, 2007 6:39 AM

I strongly disagree that aging is the biggest cause of suffering for humankind. If you try to tell the other half of the world who makes less than a dollar a day that aging is their problem, they'll laugh at you at best. It's hard to care about growing old when you're dying already of hunger and thirst or easy-to-treat diseases like scurvy.

There are diseases that affect young people as well that cause immense suffering. I'm only 21, but don't see life as much worth living since I was diagnosed with bipolar disorder two years ago. Why would someone like me care about extending my lifespan when I can barely remember what happened five minutes ago, have completely meaningless and inappropriate emotions, and often stay up for five days straight with this intractable mania?

While I made a donation to the mprize a long time ago, I now donate to groups for the mentally ill. Heck, I'll die at 30 if my mind could be fixed. You haven't yet convinced me that enough other causes of suffering have been resolved to begin work on a huge task like curing aging.

Posted by: Mike at March 15th, 2007 7:46 PM

It might be more correct to say that aging is the main cause of suffering and death in the technologically-advanced countries. It's perfectly appropriate for the advanced countries to focus on the kinds of progress which are most useful to their own populations, especially since vaccines, antibiotics, and nutritional science developed in the West have already brought more benefit to the Third World than anything the Third World itself has been able to develop independently. The Third World has already received much outside help in emerging from poverty and eradicating the diseases of poverty, whereas Europe, Japan, and Russia received little or none when they were doing those things.

In any case, if the advanced countries do defeat aging, the Third World will also benefit from this eventually, just as it does from other technological advances.

As for mental disorders, they are obviously terrible for those whom they afflict, but this is a small percentage of the population of the advanced countries, whereas aging eventually afflicts everyone. Fighting aging does not mean that everything else must be neglected. Indeed, the improved understanding of brain function which the fight against aging will probably bring will likely be useful in fighting mental disorders as well.

Posted by: Infidel753 at March 16th, 2007 5:11 AM

"society" would make better decisions about aging research if it were directly democratic and not representative democracy.

Posted by: nick at March 16th, 2007 3:00 PM

While severe mental illness (defined as bipolar I disorder and schizophrenia) may only affect 2% of the population, the percentage affected by major depressive disorder, for example, can be estimated to be as high as 25% throughout the lifespan.

I think we're taking too narrow a view when looking only at mental illness, however. How about conditions like narcolepsy? Lupus? Rheumatoid arthritis? Type 1 diabetes? Chronic fatigue syndrome? Lyme disease? All of these conditions disproportionately affect young people much more often than older people.

I would much rather see EVERY person in this country given the chance to live a completely healthy (but finite) life, rather than only a few people given the chance to live an indefinite life.

It all comes down to politics. I used to be smart but was demoted when I could no longer continue my software engineering job effectively. You, and other healthy people, continue to move up in the world and make more money. Who's going to be able to donate more money to their cause of choice?

Posted by: Mike at March 16th, 2007 5:15 PM

Nobody is advocating that "only a few people" be given the chance to live an indefinite life. As the technologies to defeat aging are developed, they will very rapidly become available to the general population, at least in the advanced countries. That's how it has always worked. Think about it: today, with life-threatening or quality-of-life-critical health conditions, how many treatments -- even quite new ones -- are available only to the rich?

This tendency of the availability of new treatments to diffuse to the general population will work even more rapidly and strongly in the future, because costs will be coming down more quickly as computer data processing (whose costs fall at a rapid exponential rate) becomes a steadily bigger component of just about everything.

I see no risk that the benefits of anti-aging technology will be confined to a minority. The majority would not stand for it.

Posted by: Infidel753 at March 17th, 2007 4:49 AM

You say that curing aging will result in all sorts of better outcomes for society. Will it, or will it just result in a better outcome for you and I? I would argue that we should be pursuing health extension, not life extension. We should be working to cure every disease known to man so that people die quietly without suffering when they reach old age. If life extension results from such research, then great. If not, then society will still be far better off - even at the expense of you and I - and will be better off much sooner than if we pursued life extension first.

This is a tragedy of the commons.

We may, one day, achieve immortality. But I disagree that it is the most important goal to achieve. Is it possible that many of the people in the life extension community are motivated by a biological fear of death, rather than their stated desire to make society better?

Several commenters to "The Edge's Annual Question" (www.edge.org) stated their most dangerous idea is that people might someday overcome their fear of death. How? Because they know that they are a part of something bigger, and that there are billions of "them" that will continue to exist long after they are gone. There is a huge difference between inborn biological fear of death and an intellectual desire to exist. Everyone needs to ask themselves whether their motivation is the former or the latter.

With that in mind, perhaps death isn't so bad after all. If we would stop worrying about death and start improving life instead, I think the world would be a much better place.

Posted by: Mike at March 17th, 2007 12:48 PM

But compared with where humanity was a couple of centuries ago (and for all of history before that), your proposed alternative goal of curing all disease (other than aging) is already 99% accomplished. The child mortality rate used to be around 50%, and epidemics used to sweep away millions at a time, so that the majority of people died at less than half the age they typically reach now. Compared with that, we already live in an almost disease-free world. There's just one great killer disease left: aging. It's the one that now kills nearly all of us, because we've eliminated almost everything else that used to kill us before we got old enough to suffer it.

Even you, with that bipolar disorder, would be better off if all efforts were concentrated on eliminating aging. Under the scenario you advocate, if bipolar disorder were curable tomorrow, you would live a few decades free of it and then die of old age. If aging were eliminated, you would live to see the day (even if it were considerably later) when bipolar disorder was eventually curable too, and you would then live on free of it, but forever (or as long as you chose).

There is nothing wrong with being motivated by the wish to avoid something (death) which one fears. I am not shy at all about acknowledging that that's what motivates me. The vast majority of people, confronted with a choice between life and death at the immediate moment, would choose to live (even if they would voice doubts about the unfamiliar concept of "eternal life" in the abstract). If the computational processes of my brain irreversibly stop and I am no longer thinking and having experiences, then I am dead and gone -- airy abstractions about being "part of something bigger" or "living on" in some worthless metaphorical sense are no comfort at all. Telling people to "overcome" this feeling is telling them that they should want what you want them to want, instead of what they actually do want. In a free society, that's a nonstarter.

Posted by: Infidel753 at March 17th, 2007 4:16 PM

Hi Infidel,

First, I still think you're approaching the issue of death from the "biological inborn trait" viewpoint. This fear is just an emotion, and emotions differ from reality. Perhaps it's hard for you to understand this, because your emotions actually make sense and are appropriate for the situations you experience.

Think about this - what if your brain were wired differently so that you felt happy about dying and looked forward to it instead of being fearful? That's happened to me before, and I realized that it's just emotion that makes you fearful about death, not anything INNATELY BAD about death itself. It's only how you perceive it. You can even change your perceptions given enough time and effort.

There's people like you, who are fearful of death, people like me who became suicidal because mania caused me to be happy about death, and people in between, who think death is just a part of life. None of these viewpoints is the sole "correct" view, and just because most people feel emotions about death one way doesn't make that way the right way to think about it.

Second, I agree that curing both aging and bipolar disorder would be the best approach. However, the best way to accomplish the most is sometimes to pick off the "lowest-hanging fruit" first.

I sincerely doubt that we can cure aging within our lifetimes, or even reach the escape velocity that de Grey describes. However, I would say that we can cure bipolar disorder or any one of those other diseases I listed. Why? Because curing aging is 10,000 times harder than curing bipolar disorder.

We could live our entire lives in misery suffering from non-age-related diseases and then die of old age anyway - because we didn't solve the problem of aging in time. Or, we could invest in curing diseases that already have a great deal of support from society and are a whole lot easier to cure.

In this way, we would actually be doing what's best for ourselves and would provide us with the greatest benefit.

On a side note, curing aging and then bipolar disorder could be the wrong order for me even if we are successful at curing aging. The chances are about 20% that I will die by suicide before I reach old age. And if "old age" increases by 60 years, then the chance rises to 40%, because I'll have twice as much time where I could have more episodes. Thus, the argument that I can just "survive" until bipolar disorder is cured is not a valid one in this case.

Posted by: Mike at March 18th, 2007 12:53 PM

I really think we are close to exhausting the subject.

The overwhelming majority of people in the advanced countries are not "living entire lives in misery suffering from non-age-related diseases", nor are they in danger of doing so. I certainly sympathize with your situation in being one of the exceptions, and I would not argue that research on curing bipolar disorder and schizophrenia should be neglected (nor has it been). You, on the other hand, seem to want society to neglect or abandon research on curing aging, which is by far the most promising avenue for saving the health and the very lives of the greatest number of people in the advanced nations. That's what I object to.

I am not an expert on the technical issues involved in curing aging. However, Aubrey de Grey is. The best judgment I can make based on what I have been able to learn is that, if sufficient resources are committed, his twenty-year time frame for the eradication of aging is at least plausible.

I totally disagree with your dismissal of the natural human desire to avoid death. Yes, it is a biological instinct, but it is precisely such instincts which are among the most immutable and powerful of our drives, and there is nothing illegitimate about them. The sex urge is also a biological instinct, but that does not make our enjoyment of sex any less real, nor does it make that enjoyment ignoble or illegitimate.

More to the point, I enjoy the experiences life has to offer. My death would mean that I would no longer be able to have those experiences. It would also rob me of the ability to observe the future development of humanity, about which I am intensely curious. Therefore death is indeed objectively bad. Your view may differ, but I suspect most people's view of the matter would be closer to mine.

You are 21 (you said); I'm 46. This may account for some of the difference in our perspectives. I have never had a really serious medical problem, but there have been times in my life when I felt suicidal for other reasons. In hindsight, I now know that it would have been utterly foolish to give in to that impulse. I can barely even remember the problems that filled me with such despair at those times, but the places I've been and the people I've met and the experiences I've had since then (all of which I would have missed out on if I had died) are vividly treasured. This has given me a powerful sense of the value of my life, and a hunger to see it continue as long as possible.

Finally, I think a concerted focus on extending the healthy human lifespan would actually be likely to bring about the defeat of diseases like bipolar disorder and schizophrenia earlier, not later, because it would lead to accelerating improvements in our ability to understand brain functionality. My expectation is that if de Grey is right and we can defeat aging in twenty years, those mental disorders will actually be defeated in less time than that.

Posted by: Infidel753 at March 18th, 2007 6:30 PM
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