DO GO HEALTHY INTO THAT GOOD NIGHT

Dis­quiet over the ethics of age­ing re­search is mis­placed. There are some ethi­cists who ob­ject to such re­search be­cause chang­ing age­ing would be a de­nial of the es­sen­tial, nat­u­ral lim­its of hu­man ex­is­tence.

Cosmos - - View Point -

MY FA­THER, AT 96, liked to dress him­self for the day but he was very slow. “The body be­trays, Lau­rie,” he said to me.

I re­sponded by read­ing to my fa­ther a pas­sage from Thomas More’s Utopia, which I had been study­ing as part of pre­par­ing a pre­vi­ous col­umn for Cos­mos.

“Thus old men are honoured with a par­tic­u­lar re­spect, yet all the rest fare as well as they. Both din­ner and sup­per are be­gun with some lec­ture of moral­ity that is read to them,” More writes. “From hence the old men take oc­ca­sion to en­ter­tain those about them with some use­ful and pleas­ant en­large­ments; but they do not en­gross the whole dis­course so to them­selves dur­ing their meals that the younger may not put in for a share; on the con­trary, they en­gage them to talk, that so they may, in that free way of con­ver­sa­tion, find out the force of ev­ery one’s spirit and ob­serve his tem­per.”

The force of ev­ery­one’s spirit: my fa­ther re­peated the words and smiled.

The process of age­ing – in which “the body be­trays” – seems to de­fine not only one’s health but one’s so­cial sta­tus, and it is not fair. But what if the phys­i­cal process of age­ing could be ad­dressed, like med­i­cal sci­ence has ad­dressed other phys­i­cal ill­ness? That is the ques­tion Dr Nir Barzi­lai wants to an­swer.

Among other po­si­tions, Barzi­lai is di­rec­tor of the In­sti­tute for Age­ing Re­search at the Al­bert Ein­stein Col­lege of Medicine in New York. He is fas­ci­nated by the same ques­tion as my fa­ther: how is it that the self is some­how car­ried by a body that of­ten fails long be­fore the mind?

His work was fea­tured in the last is­sue of this magazine ( Cos­mos 75, p42). As writer El­iz­a­beth Finkel noted, this in­cludes col­lab­o­rat­ing with the Amer­i­can Fed­er­a­tion of Anti-age­ing Re­search to de­sign a trial to test the drug Met­formin for its anti-age­ing ef­fects. Met­formin, which has been given to peo­ple with Type 2 di­a­betes for two decades, seems to have other ef­fects. Stud­ies in­di­cate that, in ad­di­tion to con­trolled di­a­betes, pa­tients us­ing it also have bet­ter car­dio­vas­cu­lar health, less ev­i­dence of cancer, and seem to be, in gen­eral, phys­i­cally stronger and more cog­ni­tively alert.

Though Met­formin did not seem to lengthen life, it did seem to give peo­ple health­ier years be­fore they died. Is this drug some­how able to tar­get an un­der­ly­ing molec­u­lar process that causes phys­i­cal de­cline as­so­ciated with age­ing?

Barzi­lai and his col­leagues have pro­posed a dou­ble-blind clin­i­cal trial with two arms, one where healthy older adults take met­formin, and one where they don’t. Af­ter five years, re­searchers should have enough data to know if the drug causes a sta­tis­ti­cally sig­nif­i­cant im­prove­ment in what is called “healthspan”.

“Here is a clin­i­cal trial with a drug that is cheap, read­ily avail­able, and well char­ac­terised,” Barzi­lai told me re­cently. “The side-ef­fect? You might live longer, and cer­tainly more healthily.” The US Na­tional In­sti­tutes of Health (NIH) has re­fused to fund the project, how­ever, on the ba­sis that “age­ing is not a dis­ease”.

Here is where eth­i­cal is­sues arise. There are some ethi­cists who ob­ject to such re­search be­cause chang­ing age­ing would be a de­nial of the es­sen­tial, nat­u­ral lim­its of hu­man ex­is­tence.

The trou­ble with that ar­gu­ment is it has been em­pir­i­cally dis­proven. For most of his­tory only the wealthy lived into old age. The life­span for the poor was (and still is) about 35. An­tibi­otics, statins and vac­ci­na­tions have meant the rad­i­cal ex­ten­sion of life­span; and the world, one can justly ar­gue, is richer for it.

It is not only an eth­i­cal ques­tion. Dis­eases and re­ha­bil­i­ta­tion from age­ing cost so­ci­ety a great deal, Barzi­lai points out. These eco­nomic is­sues are se­ri­ous, as any­one who cares for an age­ing rel­a­tive knows first-hand. Old and sick peo­ple need con­stant, ex­tremely costly care. Barzi­lai points out that even if his re­search could of­fer the el­derly two more years of health and in­de­pen­dence, it would save huge amounts of money as­so­ciated with end-oflife health care.

There is an­other im­per­a­tive. Baby Boomers, those born be­tween 1940 and 1960, are now ap­proach­ing old age, cre­at­ing an unprecedented bur­den.

Met­formin, should it de­lay dis­ease on­set, might for few cents a day shift the bur­den of dis­ease rad­i­cally, and give years of bet­ter health to mil­lions. It would be a step to­wards the utopia en­vi­sioned by More, mak­ing old age a place for wis­dom, gen­eros­ity and grace, not a time of loss. It is the right thing to do.

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