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.
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.