Longer life spans raise new issues

Pathologist and gerontological researcher Richard Miller said that while aging can be postponed in mice, what that means for humans is as yet undetermined. Photo by Marcia L. Ledford

The biblical life span of “threescore years and ten” (70 years) could one day be 112, with a few people perhaps living as long as 160 years, according to one of the nation’s leading researchers on the biology of aging.

“Aging can be postponed, at least in mice, and we ought to learn how to do it in people,” said Richard A. Miller, professor of pathology and research scientist in the Institute of Gerontology, at the conference “Death and Its Enemies.”

The Dec. 1–2 conference, which attracted 400 registrants in the fields of medicine, nursing, law, history and ethics, was sponsored by the University’s Life Sciences, Values and Society Program and the Open Society Institute’s Project on Death in America. Participants discussed the social and ethical implications of discoveries that could extend longevity during the 21st century. The Life Sciences, Values and Society Program is part of the the Life Sciences Initiative—a campuswide effort to expand learning in the rapidly advancing scientific fields of genomics, chemical and structural biology, cognitive neuroscience, and bioinformatics.

Miller described aging as “a process that progressively converts healthy young adults into less healthy older adults, with gradually increasing risk of illness, injury and death.” He noted that all mammals age in a similar way even though life spans among mammals can vary up to 30-fold, depending on the species.

Research has shown that restricting calories can extend the life span of some rodents by up to 40 percent, Miller said. Scientists don’t know if this will hold true for primates. Also, it probably is not practical for people to voluntarily severely restrict their calories, he added.

International Longevity Center President Robert Butler said aging is becoming a human rights issue. Butler also is founding director of the National Institute on Aging. Photo by Marcia L. Ledford

Miller said researchers have found that at least five single gene mutations can extend the life span of mice 20 to 50 percent. He cited a dwarf gene mutation that extends life span by about 50 percent in some mice and that also is seen in humans—including the “Little People” of Krk in Croatia, among whom the average adult is 4 feet 5 inches tall and lives about 50 percent longer than people of average height amongst the rest of the world’s population.

Unfortunately, Miller said, improving longevity has been considered an unattainable goal, and only a small fraction of the United States research budget is devoted to the basic biology of aging. Also, it is a matter of economics. Drugs that slow aging can’t be tested in time to show a quick profit for CEOs, and existing unregulated products purported to slow aging are highly profitable even though they don’t work.

He called the U.S. Patent Office’s refusal to consider patent applications on breakthroughs that promise to slow the aging process “a political tragedy.”

Aging is becoming a human rights issue, said Robert N. Butler, president of the International Longevity Center. He noted that nursing homes and services for the elderly frequently fail to respect the rights of older persons. Also, longevity varies dramatically by country, with the average life span ranging from 52 years in Uganda to 82 in Japan, said Butler, who also is the founding director of the National Institute on Aging.

The 19th and 20th centuries saw the advent of public insurance, pensions, health care, expansion of “mature markets” for goods and services aimed at older adults, and the rise of organizations such as the American Association of Retired Persons. We also have been confronted with new moral and ethical issues, including the equitable allocation of resources across generations, physician-assisted suicide, medical rationing and euthanasia. Enemies of death in the 21st century, Butler predicted, will include advances in the life sciences.

Centenarians, who now number 74,000 worldwide, are expected to increase to 840,000 by 2050 and to five million by 2100. What will we do with this “longevity dividend?” asked Butler, who noted that Sophocles wrote his last play, Oedipus at Colonus, at age 90.

Commenting on Butler’s presentation, Kathleen Foley, director of the Project on Death in America and professor in the Cornell University Medical College, said her project’s goals include improving understanding of the dying experience for patients; identifying barriers to appropriate end-of-life care; and providing competent, compassionate care for the dying. Currently, 50 percent of patients in the United States receive inadequate pain care in their last three days of life, said Foley, who has done pioneering work in pain management.

Foley said we need to transform the culture of death and dying in the United States to bridge the gap between curative therapy and hospice care. The terminally ill fear inadequate pain relief, that they will be in a vegetative state for an extended period of time and that they will not have the chance to say “goodbye” to someone, Foley said.

Although 1.6 million patients are being cared for in nursing homes in the United States, we don’t have an adequate plan for long-term care, Butler said. Eighty percent of nursing home residents are women. Women also provide most home health care. While U.S. politicians are proud of the nation’s budget surplus, the surplus has accrued at the expense of Medicare and Medicaid patients, and ultimately, at the expense of women, Butler asserted.

The conference was organized by Robert A. Burt, visiting professor of law from Yale University.