by Chris Sweeney | December 4, 2016 6:06 am
One night this past summer, I decided I didn’t want to die. Don’t worry. I’m not infected with a deadly pathogen, and as far as I know there are no cancerous cells massing inside of me. No, the urge to indefinitely extend my stay on Earth was rooted in a moment of pure bliss: My wife peed on a pregnancy test and the result came up positive. The wellspring of joy that followed soon gave way to the OMFG realization that—despite how invincible I may feel after downing a six-pack—I am a mere mortal who can be struck down at any point.
To instantly improve my chances of survival, my gut instinct led me to go online and order a bike helmet, something I should have done years ago. It turns out that my looking like a safety-conscious geek brings significant peace of mind to both my wife and me. Other than reducing the chances of my brain splattering on the pavement during the morning commute, though, I didn’t know what else I was supposed to do. I’m 33. I exercise. My diet is decent, and I’ve never had any major health issues. Of course, family history plays a big role in all of this, and there, I’m a grab bag of genetics. My dad’s mom developed Alzheimer’s disease at 63 and died at 69. My maternal great-grandmother, on the other hand, subsisted on meat and potatoes and peanut M & Ms and lasted nearly 105 years.
It’s not surprising, of course, that creating a new life makes my own inevitable end feel more concrete. On a typical day-to-day and year-to-year basis, aging is an abstraction: From the moment the egg is fertilized, there is never a point in life at which we stop getting older. Yet time is so subtle that it can seem nearly imperceptible. Sure, a few aches and pains or wrinkles come into play, but it’s not like you go to bed on your 40th birthday and wake up a crotchety sack of liver spots. On the long, slow road to growing old, major events like a pregnancy or the loss of a parent serve as important mileposts that remind us where we’ve been and show us where we’re going.
The more I chewed it over, though, the distinction between aging and dying became blurrier. After all, it is accurate to define aging as one of the biggest risk factors for an assortment of potentially fatal ailments. Alzheimer’s, Parkinson’s, heart disease, cancer, stroke—the older you get, the more likely it is that you’ll be affected by one of these killers. In that regard, aging is fast becoming a public health crisis. The number of Americans over the age of 85 is expected to increase by 350 percent from 2000 to 2050, and there will be almost 84 million of us older than 65 halfway through this century. These dramatic demographic shifts are poised to disrupt just about every facet of American life, yet our federal government spends only $3.67 per person on aging research.
That said, I’m bullish on advances in medicine. It’s hard not to be when you live here. Within 2 square miles of my apartment in Cambridge are labs that belong to the pharmaceutical powerhouses Novartis, Pfizer, Sanofi, and Takeda, not to mention the campuses of MIT and Harvard. Just across the Charles are hospitals regularly pulling off miracles, engineers building artificial organs, and evolutionary biologists contending that there is no theoretical limit to how long a human cell can live.
In an attempt to stack the odds of survival firmly in my favor, I spent a few days playing Juan Ponce de León, chasing down the foremost doctors and scientists in hopes of figuring out how we age, why we die, and how to cheat the system. Spoiler alert: I didn’t find the Fountain of Youth. But what I discovered has proven far more valuable.
In the grand scheme of things, getting old is a shockingly new experience. So explains Shalender Bhasin as he sits behind foot-high stacks of paper in his office at Brigham and Women’s Hospital. “Of the 10,000 generations of men and women who have lived on this planet, only the men and women of the last three generations could have hoped to live past their reproductive years,” says Bhasin, who serves as the director of the hospital’s Claude D. Pepper Older Americans Independence Center. “Aging is a very recent and powerful event.”
At the turn of the 20th century, he explains, life expectancy was somewhere in the thirties. War, famine, pestilence, mosquito-borne diseases, and parasite-ridden water put enormous pressure on our ancestors’ chances of survival. Then, in the span of a mere 200 years or so, we made huge strides in sanitation systems, developed vaccines and antibiotics, forged peace pacts, conquered nature, and revolutionized agriculture. Today, Bhasin says, “Men and women are expected to spend half of their life past their primary reproductive years.”
So the good news is that we’re living longer than ever—in the United States, the average life expectancy is now 78.8 years. The bad news is that the years we’ve managed to add on to the tail end of life can be the physiological equivalent of garbage time during a Patriots blowout, and our bodies are on the losing end. As we age, many of us end up dealing with a compounding effect of bad health, or what doctors call comorbidities. A hip fracture at age 80, for instance, might exacerbate a chronic disease such as diabetes, which a few months later could result in an extended hospital stay that exposes you to pneumonia or a drug-resistant staph infection. As the saying goes: When it rains, it pours.
Unfortunately, it’s a trajectory too many of us will follow, making the delivery of care more complex—and more expensive. “So much of our healthcare expenditure is being devoted to caring for people during that rapid phase of decline,” Bhasin says. “I’m not sure we’re doing a lot of societal good or individual good.”
Part of the problem is a health system—from how doctors are trained to how hospitals are reimbursed—that favors prolonging life to a fault. Our behavior, though, also plays a big role. As patients, we tend to run away from discussions about aging and dying until we have the proverbial gun to our head and tensions are highest. Aging is framed as a battle, and the ammunition is anti-aging creams, youth-promoting supplements, and prescription pills that strike at the symptoms of bad health but not the root causes.
Bhasin, for his part, recommends a shift in mindset across the board. Rather than continuing to fixate on extending our lifespans, we should focus on ways to extend our health spans and live more meaningfully, however you choose to define that. It seems similar to what most of us want, anyway: The Pew Research Center surveyed more than 2,000 Americans a few years ago and found that only 9 percent of them would choose to live past the age of 100.
So is there a good time to die? The folks surveyed by the Pew study seemed to think so: The majority wanted to live between 79 and 100 years, with 90 being the most desired age on average to perish.
Exiting Earth after 90 years seems like a fair deal. Here’s the catch: After listening to Bhasin, I want 89.9 of those years to be spent in good health. Rather than ticking slower and slower toward death like a cheap wristwatch, I want to naturally explode off the wall and shatter into a million pieces like a cuckoo clock gone haywire when the hour hand strikes midnight.
It may sound like a ludicrous demand, but it’s not entirely baseless. There is growing interest from scientists of all stripes in finding a way to compress those nasty comorbidities and disabilities that come with aging into a shorter period of time toward the end of life. Recent studies have yielded radical extensions of lifespan and health span in lab animals. Getting there in humans, however, isn’t going to be easy, and it requires us to consider how our species made it this far in the first place. “The reason we age is not because we have genes in us programmed to drive aging,” says William Mair, an assistant professor of genetics and complex diseases at Harvard’s School of Public Health. “Aging is fundamentally a side effect of other things that we’ve evolved to have.”
In other words, over the course of humanity’s evolution, we favored fitness, vigor, speed, and strength—qualities that allowed us to thrive when it was time to chase down a deer for dinner. The genes that conferred these traits and allowed our ancient ancestors to survive could also have been associated with chronic diseases and cognitive decay later in life, but it didn’t matter because nobody was around long enough to suffer from them. “It’s survival of the fittest, not survival of the oldest,” Mair quips.
I first spoke with Mair this past October, only a few days after researchers at the Albert Einstein College of Medicine, in New York, published a study stating that there is a natural limit on how long humans can live—somewhere around the 115-year mark. If the authors are correct, that means the record for the longest-known human lifespan, which belongs to a French woman who died in 1997 at age 122, will not be broken any time soon.
Mair, however, found the study to be frustratingly shortsighted. He agrees that our bodies likely have an upper limit at this moment in time, but there is no intellectual basis to rule out the possibility that, in the future, human cells will be able to live as long as cells from a quahog clam—an animal that has been known to survive for more than 500 years in the wild. Evolution occurs over an incredibly long time, Mair explains, and we’ve only just begun regularly living into our seventies.
To an outsider, Mair’s musings might seem like the heady science of academia. None of us will be around 10,000 generations from now to see how it pans out. But these big ideas underpin some of the most promising advancements in aging research and may well lead to interventions that allow us to grow older while delaying the bad stuff. This year, a team at the Mayo Clinic reported that through genetic engineering it had extended the lifespan of mice by as much as 35 percent and pushed off the onset of age-associated health effects. In 2015, a Swiss scientist found that modifying a gene that kills unhealthy cells in fruit flies extended the insects’ lifespan by as much as 60 percent.
Mair himself is trying to determine why and how our metabolism flies off the rails as we get older, and if controlling it will keep us alive longer. In studies of nematode worms—ugly little creatures with roughly the same number of genes as humans—he’s found that severely restricting their diets allows them to live longer and age slower. Mair suspects the phenomenon is linked to an energy sensor in the worm’s cells called AMPK. It’s a crucial process to understand, as some of the most prevalent chronic diseases in the world—including diabetes and heart diseases—are linked to metabolic dysfunction in humans.
The deeper that scientists dive into these biological puzzles, the more complex aging reveals itself to be. Most of us speak of it as a piecemeal degradation of our bodies—a bum ticker, a bad back, a faltering brain. But that’s not really how it works. “You could think of aging as something that happens separately to each part of the body,” says Amy Wagers, a professor at the Harvard Stem Cell Institute. “But probably more accurately it’s something that happens in a concerted way, not only to the individual cells and organs, but also in the ways they talk to one another.”
Few scientists have endured as many Fountain of Youth and vampire jokes as Wagers. Several years ago, she reported that pumping the blood from a young mouse into an old mouse had remarkable rejuvenating effects thanks to a protein called GDF11, which seems to appear in higher levels in young blood. The benefits were dramatic and wide-ranging: The older mice recovered from injuries quicker; their hearts were suddenly cleared of the age-related thickening that comes with time; and they regained muscle mass. It’s not that Wagers had succeeded in actually reversing aging. Instead, she says, she restored functions that were lost to it.
From the start, all I wanted from my conversations with Wagers and Mair was a quick fix to ensure my 89.9 good years: Order a vial of young blood on the Internet, for example, or supercharge my AMPK sensors by eating heaps of a bizarre berry grown only in the foothills of Mongolia. Unfortunately, they had no such suggestions. Fascinating and forward-looking as their research may be, the truth is they’ve barely scratched the surface.
Instead, the advice they doled out was the same as just about every primary-care doctor’s: Exercise, get enough sleep, definitely don’t smoke, eat well, and try not to dwell on it.
Given the underwhelming nature of these recommendations, I asked Wagers whether devoting a career to understanding how we’ll break down later in life has soured her on the prospect of getting old. “In all honesty,” she says, “aging is better than the alternative.”
As I rode my bike home from wagers’s office, helmet firmly strapped to my head, I thought back to a conversation I had last year with Angelo Volandes, a physician at Massachusetts General Hospital who focuses on end-of-life care. To get people to talk openly about death, he recently started making short videos to help families understand what life-prolonging care in a hospital setting might look like when the end is imminent.
But Volandes sees no point in waiting until we’re confronted with these decisions to get the ball rolling. The idea is that a tiny bit of preparation can go a long way when it comes time to make the really tough choices. For someone who deals with such a sensitive issue, Volandes is funny, gregarious, and blunt, and the first time we spoke he told me that my wife and I should absolutely be talking about what a good death means to us despite our relative youth and wellness. “We have to be open with these conversations, whether you’re 92 or 22,” he explained.
His reasoning is sound: Shit could hit the fan at any moment, and it’s a lot better to know what your partner would want if, God forbid, a breathing tube were jammed down his or her throat in an emergency. This isn’t just about drafting wills and drawing up detailed estate plans. It’s about having a conversation with those who mean the most to you to get everyone on the same page.
Sensible as it may seem, I didn’t heed Volandes’s advice that first time around. My wife and I have talked about death, but it always ends up laced with punch lines about pulling the plug on each other and layered in self-deprecating snark. Looking for a bit of motivation, I gave Volandes a call and updated him on my status: The wife is pregnant, the possibility of death suddenly seems real, and the only thing I’ve done about it is purchase a $180 bike helmet.
First off, Volandes told me, take a deep breath: The bike helmet is one of the best and most effective steps I could have taken if I’m serious about extending my chances of survival: “The likelihood of something catastrophic happening to you is almost definitely in the form of an accident at your age.”
Other than that, his suggestions seemed to align with Bill Belichick’s “ignore the noise” philosophy during game week. All the hype—the age-defying potions, the miracle diets, and the promising breakthroughs just around the corner—only sets us up for false expectations. And though people like Bhasin, Mair, and Wagers are doing incredible research, science is slow and imperfect.
As I’m beginning to learn, part of becoming a parent is gaining a greater understanding of the fragility of life. As Volandes puts it, a good life is a life that eventually comes to an end, and there’s nothing wrong with acknowledging that up front. “This is a conversation that you have to have,” he says, “and you have to be honest with yourself and you have to be honest with your spouse.”
A few nights after chatting with Volandes, my wife and I took a walk through Cambridge, up through Central Square and into Kendall. We strolled by the Novartis research center and past Pfizer’s lab, talking about death and our growing family.
It didn’t need to be a long or sad conversation to be fruitful. We agreed that if anything happened to one of us at this point, we’d illegally scatter the ashes near the top of a hill at the park where we got engaged. We talked about how we wouldn’t want doctors to throw everything at us for the sake of living a few more weeks if we ended up brain damaged and couldn’t communicate. We agreed that these are the plans as of now, and that the plans will certainly change as our family grows older together.
It wasn’t the easiest conversation we’ve ever had, nor was it the hardest. As we circled back down our street and approached our home, all the good of the future came into sharper focus. The distinction between aging and dying was no longer blurred, and the days ahead never looked so bright.
One night this summer, I decided that I didn’t want to live forever. I just want to live a good life and die a good death when the time comes. And most important, do it all in the company of those I love.
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