Sunday, January 17, 2010

Medicine and Aging

In this week's Sunday Times magazine, Tom Dunkel writes about one man and his doctor working together to slow or reverse the aging process and about other organizations promoting similar treatments.  He also includes rebuttal from other doctors who reject this as "quackery".

In the midst of the current health care debate the cost burden of the elderly looms large and reducing elder disability costs could be very helpful.  The fact that the body changes and deteriorates with age is not in question.  But this can be interpreted three ways:  1) the changes are programmed into the species to eliminate those who have reproduced to make room for the next generation.  2) the changes are a remnant of human design which reduces current homo sapiens longevity unnecessarily.  or 3) "Aging" is a disease like any other,  subject to research to cure or prevention.

According to the first view, humans should do nothing to interfere with the aging process because it is part of the normal evolutionary cycle from generation to generation.   The second and third views, with slightly different justifications,  support the process of finding ways to arrest or prevent aging by stopping or reversing the biological factors that contribute to it.  While Dr Comite is quoted in the article as distinguishing between "optimal health during life" and preventing death,  the latter is the much stronger motivation for persons engaged in these programs.  Though women have always been observed to experience  the aging process,  as a consequence of the disappearance of menstrual cycles,  the concept of male aging is not as grounded in public perception.  It is interesting that this article concentrates on the example of a male trying to prevent aging.

Is this a good idea for men?
Ignore medical comments that all this is quackery.   Certainly some of the treatments are simply placebos,  but there is clear evidence that hormone supplements have impact on the body.   There are measurable effects.  But are the treatments effective in preventing "aging" or promoting "optimal health"?  and without undesirable side effects?   Endocrine treatments often have undesirable side effects,  like those experienced with administration of corticosteroids,  or estrogens and birth control pills.   Nature seems to reduce certain hormones with age to prevent certain effects,  which allows worsening others.   Which negative consequences are preferred?  Should people have the right to choose?  And should medicine be free to research the potential consequences and develop "antidotes" to prevent them?   In short, should our scientific community  explore ways to prevent the changes of aging and "optimize health" for as long as possible in the population? 

This is not simply a scientific question, despite the impression given by Mr Dunkel in the article.  It is a MORAL issue.  If a plant were discovered in the Amazon tomorrow which conveyed eternal life should it be developed and distributed to everyone at whatever cost?    If there are really vampires in the world somewhere,  should we allow ourselves to be bitten so that we can enjoy eternal existence (albeit in this case in the dark only)?

When the question is framed in this way, " optimal health" mutates into "escaping death",  and the finiteness that gives meaning to human life is gone.   The moral answer for most of us,  even given our fear of death,  would be "no.  This is not a good thing to do."  But then,  where is the line between the two?   When does "optimizing health" become "trying to prevent death".   Drawing this line in the research and treatment of aging is the moral question: when does improving life become attempting to prevent death and ultimately change the meaning of life?

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