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How to live when nobody dies

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Three score and ten is so 1970s. Today, the average baby born in the UK will live long enough to see the beginning of the 22nd century. Increasingly we also hear claims of longevity breakthroughs that could propel those children – and maybe even their parents – into triple digits and beyond. Is eternal life something we want outside of science fiction? And how will society cope if it is?

“The first ten million years were the worst,” said Marvin. “The second ten million years, they were the worst, too. The third ten million years I didn’t enjoy at all. After that I went into a bit of a decline.”

So opines Marvin, Douglas Adams’ paranoid android, who follows the protagonists of ‘The Hitchhiker’s Guide to the Galaxy’ around like a bumbling, grumbling storm cloud. Functionally immortal (and cursed with a “brain the size of a planet”), Marvin is the hubristic dream of eternal life printed and stamped in circuitry. While his human shipmates stumble from one disaster to another, devoting their limited talents to avoiding death at all costs, Marvin plods glumly along, bemoaning the pointlessness of an infinite existence in which there is nothing new to learn, no challenge to his intellect and in which everyone – even his closest friend, a rat that nested for a time in his foot – dies. Except him.

Marvin is archetypical of immortals. Our stories are not kind to them. The Ancient Greek gods were positively psychopathic in doling out eternal damnation as punishment for everything from stealing fire (the titan Prometheus, who was lashed to a rock and whose liver was pecked out by an eagle, every day, forever) to winning a sewing contest (Arachne, who – with perhaps limited foresight – challenged Athena to a weave-off and was transformed into a forever-spinning spider when she won). For centuries since, that’s more or less been the lot of would-be immortals: vampires are stuck in castles, the future rich keep their youth (but lose their humanity), and seekers of life-giving plants, elixirs and artefacts end up eaten, cursed or crushed under collapsing temples. If ever you are invited on a quest to find the... well, anything of eternal life, the entirety of our literary canon says: don’t go.

Yet at the same time life extension is, almost by definition, what we expect of medicine. It’s feels odd to frame chemo­therapy or cardiovascular treatments as life-extension technologies, but for cancer and heart disease patients that’s exactly what they are. More generally, we expect some small increase in life expectancy for each new generation. Every ten years, the Office for National Statistics releases data on how long the populations of England and Wales are living, and for the last five decades, life expectancy at birth has risen by around two-to-three years per decade. And when that increase stalls (as it did in the late 2010s), scientists are rounded up for television interviews and grilled over what or who is to blame.

This is a paradox of human life extension: we expect our kids to live longer than we do, but not much longer. An extra half-decade sounds about right. An extra half-century does not. The latter would seem outrageous and unfair – if it weren’t so fanciful. And yet, serious people are treating the postponement of ageing increasingly seriously. The UK’s Nuffield Council on Bioethics, by way of example, published a paper titled ‘The Search for a Treatment for Ageing’ in 2018, listing eight avenues of current life-extension research. In 2013, Google – a company associated with many things, but not life extension – funded Calico, a company which specialises in exactly that.

Various studies in mice and rats have shown what well-publicised studies in mouse and rat populations often do: that a thing (in this case, a potential anti-ageing treatment) has done something miraculous (slowed down ageing) for the mice and rats (who have since been dissected) from which we can extrapolate a comparable result for humans (who will live longer and healthier lives and not be dissected). There’s no one clear indicator that radical life extension is around the corner – but this rise in funding, debate and vivisected mouse carcasses suggests that our everyday assumption that there is a ‘right’ amount of life for people may be rooted more in experience than in rational thought.

“I haven’t really, fully absorbed how deep-​seated the irrationality is,” says Dr Aubrey de Grey, biogerontologist and co-founder of the SENS (Strategies for Engineered Negligible Senescence) Research Foundation. De Grey has been both researching and campaigning for what he calls “radical life extension” for nearly two decades. His two most recognisable features are the long grey beard that reaches almost to his waist, and his utter impatience with what he has called “The Global Trance”: the cross-cultural acceptance that one day, in the not-so-far-future, all of us must necessarily stop existing. De Grey’s view that functional immortality may not only be possible, but that its disparate foundations have already been laid in laboratories around the world, is highly controversial.

Scathing appraisals of his proposals have been made by experts across the biological sciences, who argue that the technologies he presents as joint candidates for life extension are too early in their development to be useful for decades, if ever. But taking this macro view of de Grey’s ideas feels like missing the point. SENS is far from the only organisation with the goal of increasing lifespan and it is far from the largest. But de Grey is a powerful orator, cowing audiences into listening with the air of an otherwise jovial science teacher who can’t quite believe how badly his class has done in their mock exam.

“These days I’m very strong on not only saying, ‘Look, have a sense of proportion, boys and girls: [ageing] is by far the major cause of suffering in the world. Hands up anyone who wants to get Alzheimer’s? Hands up anyone who wants anyone else to get Alzheimer’s?’,” he says, contrasting his current presentational style with the impatient brusqueness of his 2005 Ted Talk. “But now I also tend to spend a fair amount of my time being a little bit more sympathetic to this irrationality and acknowledging that it only became irrational very recently... 20 years ago, it made sense to trick oneself into putting ageing out of one’s mind and getting on with one’s miserably short life rather than being preoccupied with this terrible thing, because there was no real reason to believe that we had much chance of moving the needle – of actually accelerating the arrival of therapies that really bring ageing under control. So it kind of made sense; I have some sympathy.”

‘20 years ago, it made sense to trick oneself into putting ageing out of one’s mind and getting on with one’s miserably short life rather than being preoccupied with this terrible thing, because there was no real reason to believe that we had much chance of moving the needle.’

Dr Aubrey de Grey, SENS

De Grey and the other researchers at SENS lay out seven factors that contribute to ageing, including cell loss and tissue atrophy, cancers and mitochondrial mutations – along with novel biotechnologies that may one day mitigate their deleterious effects. SENS is not alone in suggesting potential therapies to delay ageing – other candidate treatments have included the diabetes drug Metformin, resveratrol (the chemical compound/viticultural PR mega-win found in red wine) and – gruesomely – the transfusion of the blood of young people into the elderly. Life extension, as an investment, is high-risk-enormous-reward – hence the glut of proposed therapies.

De Grey stresses that any sudden and significant change in life expectancy will not be the result of one breakthrough, but of many treatments working in concert. Attacking ageing from multiple angles will lead to what he terms ‘Longevity Escape Velocity’ – the idea that if you can develop treatments for age-related disease more quickly than they can kill people, not only does lifespan increase exponentially, but frailty is similarly delayed. ‘Lifespan’ is almost the wrong term for what life-extension proponents are seeking – a better term, already in academic use, is ‘healthspan’. Living to 150 and feeling it would be nightmarish. Proposed therapies must offer something more akin to eternal youth than eternal life.

“This is something that I have to spend an enormous proportion of my time on,” says de Grey. “Just driving [that distinction] over and over again into people’s heads that lifespan is a side-effect of healthspan. You’ve got to stay healthy to stay alive, and health is the major contributor to quality of life.”

This is the second challenge for advocates of life extension: because we haven’t evolved, literally or culturally, to view extended, healthy lives as anything but fiction, almost nobody outside of the insular debate is equipped to properly assess its risks and virtues. If you accept that a sudden jump in healthy life expectancy is coming – whether that’s 50 years or 500 – the lack of public discourse is troubling.

Very few studies have been performed to properly assess the public’s view of living dramatically longer, and those that have show little coherence among subjects. The University of Queensland performed two such studies – face-to-face studies and focus groups with 57 Australians in 2009; another, larger telephone study of 605 people in 2011. In both cases, participants’ views ranged from being strongly in favour to strongly against, with reasons for the latter position including issues of distributive justice, overpopulation, the breakdown of the traditional family unit and religious concerns. They showed, essentially, that most people don’t know what to think, but one thing that is broadly shared is a concern that radical life extension threatens a sense of fairness.

“Part of our attitude to what we think of as premature death – dying ‘before your time’, is that it’s a sort of unfairness, and that idea of unfairness absolutely permeates across society,” says bioethicist Professor John Harris. Besides teaching, Harris has acted as ethical advisor to the European Parliament, the World Health Organization (WHO), and the UK Department of Health; has published or edited more than 20 books, and written over 300 academic papers on subjects from cloning to human enhancement to the ethics of ageing – both in how we treat the elderly now and why we should be supportive of life extension in the future.

“There are limitless examples of the unfairness of some people getting what they want and others not getting what they want – not just lifespan, but money, or sex, or whatever,” Harris continues. “But we can’t eradicate that, because to eradicate that unfairness would mean always levelling down, rather than levelling up. We don’t say we’d better make sure nobody goes to university, because that would give them an unfair advantage looking for a job. The alternative to living with that unfairness – of accepting that some people get what others would like but can’t have – is not just applicable to life extension: it’s applicable to almost everything that is valued.”

The question of who would have access to life-extension therapies might be the biggest concern in the debate. The refugee crisis and the post-2008 focus on the widening gap between rich and poor – in the UK often viewed through the lens of an overstretched NHS – have raised disturbing questions about how human life is valued. The spread of Covid-19 has further highlighted how closely intertwined money and life expectancy have become, with millions of people around the world simply unable to afford to heed governments’ advice to self-isolate and miss work. Recent science-fiction has mined this inequality to great effect, perhaps most successfully in Netflix’s ‘Altered Carbon’ (based on the novels by Richard K Morgan), in which the super-rich have literally ascended to a place where they will never die, leaving the rest of humanity to exist in violence, criminality and squalor. The idea of billionaires escaping not only taxes but death as well is becoming an increasingly popular dystopia.

“We don’t know how this would play out,” Harris continues. “There are ways [we could distribute treatments]: some would be fair and some would be unfair, like not funding them through national health services. Those aren’t arguments against life extension per se, but they may be arguments about how certain societies choose to deal with the desirability of longer life. There would be many strategies open and hopefully in democratic societies they would be debated democratically.”

That distinction between life extension and what creates inequality is important. As Harris explains, the availability of life-​extending therapies tells us nothing about how they should be used.

“We are very familiar with life extension, but mostly it has appeared in the guise of life-saving strategies, like vaccination,” he says. “The vaccinations for polio and smallpox have saved hundreds of millions of lives, or to put it another way, ‘have enabled hundreds of millions of people to live who otherwise would have died’. Vaccination is an exercise in life extension – but nobody throws up their hands in horror about its huge effect on life expectancy.”

De Grey’s first answer – not just to the concern of fair distribution, but also to fears of seismic societal and institutional change that may follow major breakthroughs in healthy life extension – is also political: in functioning democracies, we have term limits on governments, and in his view any government that did not make life extension for all a priority as it became feasible would collapse in popularity with voters. His second answer is that whatever possible negatives we can imagine, it’s difficult to imagine a dystopian setting so bad that death would be preferable.

Which is not to advocate complacency: part of de Grey’s frustration with the lack of public debate is precisely that he sees these advances in increased longevity as potential flashpoints – that a revolution in healthcare poorly handled could devolve into an actual revolution. “It’s not just a matter of when [these therapies] are ready: it’s the lead-up to it,” he explains. “One thing that I’ve been putting more and more energy into is getting policymakers to understand that the planning needs to happen now, before the therapies are ready... At some point, public opinion is going to undergo a very sudden sea change.”

Handled competently, what could radical life extension offer, beyond the obvious benefits of extra time enjoying the people and things that we value? One possibility is that, in the same way that we tend to value life more the longer it has to go (people die ‘tragically young’ – nobody dies ‘tragically old’), adding decades of healthy living onto the national or global average might raise the value we place on life in general. De Grey sees evidence of this over the past century.

“[The world] has become, both at the individual societal level and also at the global international level, a much, much less violent place,” he says. “And a huge part of why [that’s happened] is that there is greater value given to life. If we look, for example, within the USA at the areas that have the greatest amount of violence, they are the areas that have the lowest life expectancy. But that’s not because a lot of people are dying from violence: it’s because a lot of people are dying from poor nutrition, lack of access to medical treatment – and so life is valued less.”

As a species we’ve become increasingly familiar with the clash between our biology and the mutagenic effects of technology upon it, but we have survived through adaptation. We think in tribes but thrive in cities. We cross the world without losing our roots. We marry our Tinder matches. If the next technological shift in our stars is the collapse of the milestoned life – birth, work, family, frailty, death – it will be because we see more opportunities than costs. We aren’t Marvins: we’re good, as individuals and as a species, at finding new things to do when the world changes around us.

“The great thing about longevity is that you wouldn’t have to choose just one career,” Harris reflects. “If I had my time again, I would probably have liked to be a biologist. And then once I had my 70-odd years as a biologist I might want to do something else. Nobody wants to just go on doing the same old stuff, but if we have the time and ability we can change. It’s one of my regrets now, at the age that I am, that while I do go on doing philosophy and writing about the things I like writing about, I would like to learn about new things and do other things.

“There are people who say, ‘Oh, you’d just get bored if you had all that time’. But I don’t think I would. I would gladly sample a few million years and see how it goes.”

Finance

The economics of immortality

Postponing ageing isn’t just a natural extension of what our healthcare system does (which, at its core, is stop people from dying) – there’s also a strong economic argument to pursue life-extension research.

According to the most recent available figures from the Office for National Statistics, the UK spent £197.4bn on healthcare in 2017 – just under 10 per cent of GDP. As life expectancy rises, so does the length of time the average person can expect to require care or live in poor health. The number of chronic conditions linked to ageing is rising (dementia, for example, currently affects an estimated 850,000 people in the UK, with that number expected to grow to one million by 2025).

The cost of fighting these age-related conditions is astronomical: according to the Institute for Fiscal Studies, the NHS spends more than twice as much on the average 65-year-old as on the average 30-year-old. Patients aged 85 and over require, on average, five times as much spending as 30-year-olds.

All of which sounds like a pretty good argument against life-extension – if we struggle to treat the elderly now, it follows that dramatically extending life should be disastrous. But there are two problems with this line of reasoning. First, it ignores the fact that life-extension is something that happens – albeit slowly – already. A child born today is predicted to live, on average, a little over eighty years – or about five years longer than a child born in 1980. An increase in age-related diseases is a crisis we’re living already.

The second problem is that the financial argument conflates age and health. No-one who advocates radical life-extension is suggesting the goal should be an extra 50 years in a nursing home. A treatment for ageing isn’t the same as a cure for death: the proposal is to extend healthy life.

The humanitarian benefits of longer and healthier lives aside, extending life while reversing the current trend (in which longer life correlates with a longer period of physical and mental decline) would not only reduce the burden on the healthcare service, but also mean that fewer people would be forced into retirement due to poor health.

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