Extending Life or Compounding Misery?

Longevity advocates envision third careers. Critics see only debility and expense.

People with late-stage Alzheimer's disease share the same vacant expression. Gone is any twinkle in the eye or the most basic recognition of self, time, or place. The bitter irony is that people who fall prey to this dread disease are often otherwise healthy and can go on to live many years in this state of wakeful oblivion.

In the past 50 years, humankind has made great strides in boosting life expectancy. And if current research into the biological mechanisms of aging yields the results that some people desire, we might someday be able to extend our lives another 20, 50, or even 100 years. If we did, would we sentence ourselves to decades of dementia or other disability, the helpless prisoners of enfeebled minds and bodies? If we could avoid that fate by figuring out how to live longer and healthier lives, should we seize the opportunity, snatching as much time as possible from the maw of death?

Enhancing human longevity to the point where we live to be 150 might be far in the future--if it is even possible--but the debate over whether humans should pursue such a goal is simmering today.

Philosophers, scientists, ethicists, and politicians are pausing to consider the potential impact that life extension would have on society. Proponents of lengthening human life span--such as Ron Bailey, science correspondent for Reason magazine--argue that living a longer, healthier life will improve our happiness and well-being, as individuals and as a society. Others advise caution. Francis Fukuyama, a political scientist at Johns Hopkins University, questions whether we will be able to escape infirmity as we extend longevity, and he is deeply dubious about what real benefits, if any, will accrue to humankind as we attempt to delay the inevitability of death. Bailey and Fukuyama squared off on this issue during the first SAGE Crossroads debate (see "What are the possibilities and the pitfalls in aging research in the future?").

At the heart of the debate are deep-seated preconceptions about what it means to age. Human experience informs us that life is a one-way street with youth at the beginning, decrepitude at the end, and Mother Nature directing the inevitable flow of traffic into the great beyond. Modern medicine has been busy erecting speed bumps along the way--drugs and treatments that allow us to zoom past infections and diseases and coast into our golden years. But scientists who are studying ways to slow the aging process itself might be on the way to building a permanent detour.

Optional Death?

According to the World Health Organization (WHO), the average life expectancy worldwide jumped from 41 to 62 years between 1950 and 1990. That number is projected to rise to 70 years by 2020. The increase seems like good news for those wishing to live longer, but Fukuyama wonders whether the additional years will be healthy ones.

Case in point is the growing prevalence of Alzheimer's disease. Fukuyama argues that this increase is due to more people living past 65 and into the years of prime susceptibility to dementia. The picture of the weakening brain locked in an ever-healthy body is an alarming one, and Fukuyama worries that neurodegenerative diseases, including Alzheimer's and Parkinson's, could potentially leave the long-lived elderly in misery. "I think [that extending old age] is not as unalloyed a good as people think it is," says Fukuyama.

Advocates of lengthening human life span, however, take hope from laboratory studies indicating that simple animals can live not only longer but healthier. When researchers change single genes, worms can survive up to five times as long as their untreated compatriots--the equivalent of more than 300 years for humans. And the long-lived animals remain frisky well after their normal counterparts have passed on. The results extend beyond worms: Mice raised on restricted diets live 30% longer than their well-fed kin, and other laboratory favorites such as fruit flies and yeast are also buzzing and begetting into extreme old age.

These studies reveal that the rate at which organisms age is not fixed and that we might be able to alter the fundamental mechanism that drives the aging process. This research differs dramatically from the traditional approach of investigating diseases one by one. Rather than targeting lung cancer, for instance, researchers who study aging address the degradation that occurs in the entire physical system--a deterioration that predisposes people to cancer, heart disease, diabetes, arthritis, Alzheimer's, and all of the illnesses associated with advanced age. The ability to slow aging could have a dramatic effect: Some gerontologists estimate that curing both heart disease and cancer would increase life expectancy by less than 10 years. Stephanie Lederman, executive director of the American Federation for Aging Research, says that much work needs to be done to convince policymakers that research on aging is worthwhile. Incremental advances in longevity aren't enough, she says. Some people are uncomfortable with the notion of lengthening human life span, yet many of the same individuals support research aimed at thwarting the big age-related illnesses. "If you cure cancer, nobody is going to ask you about policy implications," Lederman says.

If the onset of all of these diseases can be delayed, "people will be able to work through the time when they would have been sick," says Dale Bredesen, a neurobiologist and director of the Buck Institute for Age Research in Novato, California. Other advocates of life extension agree. "The point of aging research," says Bailey, "is not to enable us to be older longer but rather [to] allow us to be younger longer."

A Second Middle Age

This enhanced productivity helps paint the rosy picture of the New Old Age that longevity advocates like to present. As major age-related diseases such as cancer, diabetes, and heart disease are either cured or significantly delayed, members of this camp argue, we can reframe life to enjoy a "second" middle age that is as productive and healthy as the first. Instead of retiring at age 65, quitting tennis at 70, and slipping into the front-porch swing at 80, the whole scenario could shift 10 to 20 years down the age spectrum, says Bredesen.

"If people have healthier, longer life spans, they will have more to contribute over time," says Bailey. Those contributions include second careers that expand knowledge and produce tax revenues for the rest of society.

The desire to survive is natural. "Everyone wants a longer, healthier life," says Bailey. A quick look at the thousands of scientifically unproven yet commercially successful "antiaging" supplements sold daily is ample proof of that. "Very, very many people, if offered continued vitality, would take it," says biologist Gregory Stock, director of the Program on Medicine, Technology, and Society at the University of California, Los Angeles.

With more quality time to spare, Bailey says, older people would find new and meaningful ways to live and work, perhaps discovering the right career after a few misfires and becoming more valuable as a resource to friends, family, and business associates. Furthermore, in a society of longer-lived individuals, people might be less shortsighted than they are now. The accumulated wisdom brought by extended life spans might increase our concern about the environment, argues Bailey. In addition, he adds, "people would need to be nicer to each other because they'll be around longer."

Long life, however, might not make us better, brighter, and more worldly, notes Fukuyama. From a cultural and political standpoint, death has advantages. The elderly take their old ways of thinking with them to the grave, making room for new ideas, he says: "A lot of adaptations to new situations--politically, socially, environmentally--really depend on one generation succeeding another."

Buyer Beware

Discussion of whether we should prolong life span is particularly important now. Even without the ability to foil the aging process itself, seniors are rising in numbers: According to the Federal Interagency Forum on Aging, the population of Americans who are over 65 is expected to double to 70 million by 2030. And the cusp of the baby boom generation will begin to retire in 2010. The Congressional Budget Office (CBO) estimates that federal spending for Social Security, Medicare, and Medicaid combined will reach 15% of gross domestic product in 2030--a figure that is double the current percentage.

And fewer younger Americans will be around to foot the bill. While the number of seniors doubles, the number of working-aged Americans will grow by only 15%. "Moreover, even after all the baby boomers are retired, the number of elderly people is expected to keep rising at a faster rate than the number of nonelderly people as life spans continue to lengthen," said former CBO Director Dan Crippen in 2001 congressional testimony. Although many policymakers fear the drain this demographic will have on Social Security and Medicare, advocates of aging-related research counter that these programs can be kept viable if we learn to keep people healthier as they age so they don't need the safety-net systems to such a great extent. "The only true social security is in basic research on biological aging," says Bredesen, because healthy people won't need anyone to take care of them and will keep working. Data already indicate that Americans are living longer with less disability. According to Duke University demographer Kenneth Manton, more than eight of 10 Americans over the age of 65 are now able to take care of themselves, handling such daily activities as eating, dressing, bathing, cooking, and cleaning. This figure represents a 25% decline in disability between 1982 and 1999, when Manton conducted his study.

Whose Life Will Be Longer?

The statistics on declining disability are good news for Americans. But of the 580 million people presently over age 60 worldwide, 355 million live in developing countries. Hypertension, cancer, blindness, and diabetes are afflicting more people than ever before, and physicians in the Third World presently lack the resources to treat these common ailments of the aged.

According to WHO, "The emerging social and public-health consequences of aging, especially in developing countries, need to be taken very seriously. In the majority of these countries, poverty, lack of social security schemes, continuing urbanization, and the growing participation of women in the workforce all contribute to the erosion of traditional forms of care for the elderly."

This disparity in health care between industrialized and developing nations raises troubling issues about the equitable distribution of potential longevity enhancement, says Leon Kass, an ethicist at the University of Chicago. "Critics worry that technology's gift of long or immortal life will not be granted to everyone, especially if, as is likely, the treatments turn out to be expensive," writes Kass in an essay entitled L'Chaim and Its Limits: Why Not Immortality? "Would it not be the ultimate injustice if only some people could afford a deathless existence, if the world were divided not only into rich and poor but into mortal and immortal?"

Kass also presents a more philosophical argument against life span enhancement: Life wouldn't be as interesting if it lasted forever. "Could life be serious or meaningful without the limit of mortality?" Kass writes. "Is not the limit on our time the ground of our taking life seriously and living it passionately? To know and to feel that one goes around only once, and that the deadline is not out of sight, is for many people the necessary spur to the pursuit of something worthwhile." Dramatically extending life expectancy would undoubtedly affect society and culture in ways that we can't even imagine today. But longevity advocates point out that the incremental increases in life expectancy that we are currently experiencing have already changed the way we think and live. From Modern Maturity magazine to octogenarians starting new companies, the gold watch at 65 already seems quaint.

As it stands, the dual engines of human desire and modern scientific enterprise will likely someday lengthen the human life span. Advocates of such a future are optimists. "I don't see the problems, I see the benefits," says Bailey. "Critics look at the last troubled 5 years of the Alzheimer's patient and forget the 15 great years that got them there."

But Fukuyama can't get that empty stare of dementia out of his mind. "I'm not against progress," he says. "We just need to think carefully. We may get what we wish for."

Randy Barrett is a freelance writer and journalist based in Falls Church, Virginia. His back hurts in the morning, and he is now certain that youth is wasted on the young.