As regular readers know, I advocate for the development of treatments for aging based on periodic repair of the low-level cellular and molecular damage that causes aging. There is at least one detailed plan of action on how to produce the necessary treatments, the Strategies for Engineered Negligible Senescence (SENS) research proposals. Enough is known to work on this with a good expectation of success. Outside of factions within the stem cell research community this is still at this time a minority path in the scientific community, however. Most research groups are much more interested in developing a greater understanding of the fine details of metabolism so as to alter it in order to slow down aging. Unfortunately this latter path is nowhere near the point of producing a working plan, and it has proven to be enormously expensive and time consuming to investigate even tiny slices of the necessary reach of knowledge. See the much hyped past decade of research on sirtuins, for example, that has consumed the cost of implementing SENS in the laboratory several times over without producing any meaningful treatment.
In this piece, the author chooses the hard, slow, expensive, largely unknown path of altering the fundamental operation of metabolism as the better way forward for egalitarian reasons - that a one-time alteration that slows aging is better than a frequent treatment to repair aging because it is somehow more equal, or less prone to ongoing costs. This seems silly. For one, even setting aside the much greater difficulty and time required to develop means of altering metabolism, that approach cannot produce rejuvenation as it only slows down the pace of damage accumulation. Thus it cannot help the old, and it cannot extend healthy life indefinitely. Repair therapies can in principle achieve these goals, it's just a matter of how well they repair the damage. When it comes to costs, the mature evolution of SENS-like repair treatments would be a mass-produced infusion given by a bored clinician once every twenty years or so. Mass produced infusions such as TNF inhibitors today cost less than $10,000, even in the dysfunctional US medical system. So this seems like another example of death for everyone before even the vague possibility of inequality for someone, a position sadly prevalent in many areas of our society:
Let me give you my nightmare scenario for a world of superlongevity. It's a world largely bereft of children where our relationship to our bodies has become something like the one we have with our smart phones, where we are constantly faced with the obsolescence of the hardware and the chemicals, nano-machines and genetically engineered organisms under our own skins and in near continuous need of upgrades to keep us alive. It is a world where those too poor to be in the throes of this cycle of upgrades followed by obsolescence followed by further upgrades are considered a burden and disposable. It's a world where the rich have brought capitalism into the body itself, an individual life preserved because it serves as a perpetual "profit center".
The other path would be for superlongevity to be pursued along my first model of healthcare focusing its efforts on understanding the genetic underpinnings of aging through looking at miracles such as the bowhead whale which can live for two centuries and gets cancer no more often than we do even though it has trillions more cells than us. It would focus on interventions that were cheap, one time or periodic, and could be spread quickly through populations. This would be a progressive superlongevity. If successful, rather than bolster, it would bankrupt much of the system built around the second model of healthcare for it would represent a true cure rather than a treatment of many of the diseases that ail us.
Yet even superlongevity pursued to reflect the demands for justice seems to confront a moral dilemma that seems to be at the heart of any superlongevity project. The morally problematic features of superlongevity pursued along the second model of healthcare is that it risks giving long life only to the few. Troublingly, even superlongevity pursued along the first model of healthcare ends up in a similar place, robbing from future generations of both human beings and other lifeforms the possibility of existing, for it is very difficult to see how if a near future generation gains the ability to live indefinitely how this new state could exist side-by-side with the birth of new people or how such a world of many "immortals" of the types of highly consuming creatures we are is compatible with the survival of the diversity of the natural world.
I see no real solution to this dilemma, though perhaps as elsewhere, the limits of nature will provide one for us, that we will discover some bound to the length of human life which is compatible with new people being given the opportunity to be born and experience the sheer joy and wonder of being alive, a bound that would also allow other the other creatures with whom we share our planet to continue to experience these joys and wonders as well. Thankfully, there is probably some distance between current human lifespans and such a bound, and thus, the most important thing we can do for now, is try to ensure that research into superlongevity has the question of sustainable equity serve as its ethical lodestar.