December, 2014

Going, Going, ........

By Michael J. Katin, MD

Rarely does a public figure comes forth with a proposition that is universally accepted by his Colleagues, but that's exactly what happened when Dr. Ezekiel Emanuel contributed an article to the October, 2014, issue of The Atlantic dedicated to "The New Science of Old Age." Dr. Emanuel's essay was entitled "Why I Hope to Die at 75" and, to be truly accurate, some comments were made encouraging him not to wait.

Dr. Emanuel has had a long and distinguished career, with degrees from Amherst, Oxford, and Harvard, He was distinguished by getting both an MD and PhD from Harvard, with the PhD being in Political Philosophy. He then did an Internal Medicine residency at Beth Israel and Medical Oncology fellowship at Dana Farber. He was on the faculty at Harvard before becoming Chief of the Department of Bioethics at the National Institutes of Health. His next position was as a Special Advisor for Health Policy to the Office of Management and the Budget before his current position as the head of the Department of Medical Ethics and Health Policy at the Perelman School of Medicine. He is distinguished as being one of 13 "Penn Integrates Knowledge" Professors at the University of Pennsylvania, also having an appointment in the Department of Health Care Management at the Wharton School. One would wonder to which level he can rise next.

It would be helpful to have a consensus as to when live truly ceases to be beneficial to the individual. Interestingly, Dr. Emanuel, despite not wanting to make it past 75, has been an outspoken critic of euthanasia and assisted suicide. The distinction between these two terms is somewhat vague, since they both wind up with the same outcome, but perhaps in "assisted suicide " there is the specification that the deceased had approved the plan but with the irony that such a plan would probably have been made under the influence of analgesics. Informed consent for a surgical procedure cannot be accepted, of course, if the pre-operative patient has already been medicated. Will it be permissible for a person to write a living will that, in fact, is a dying will, prior to illness, assuming that person's perspective would not change when the occasion actually arises? The instinct for self-preservation might kick in at the last minute, especially since we don't know for certain what comes after death; or, is it understandable to want to die rather than to endure a hopeless, painful, meaningless existence -- wait, isn't that what life usually is anyway? Doesn't it make sense to want to get it over with when we are worn out and have no new adventures to anticipate?

We deteriorate with age. Despite the fact that aging is the most common disease of the elderly, and is very easily diagnosed, not much has been done to treat it. Would it not be time to start a Manhattan Project to cure aging, now that we have already funded projects to map out DNA, study brain function and combat Ebola? Since elderly Americans and metrosexuals represent a large voting bloc, whichever political party decides to promote this will be guaranteed electoral success. In addition, it would subsidize a new generation of students to go into biological sciences rather than to become venture capitalists and lawyers. There already is a cult of youth that leads 75-year-olds to buy Nike products and Harley-Davidson motorcycles -- how fantastic would it be for these industries if their customers continued to survive and even increase in number? The economy would boom!

Anti-aging research is nowhere as advanced as it should be, but at least one person has made a major contribution. Alessandro Laviano has done ground-breaking research, proving that older organisms can have the aging process stopped or even reversed! These organisms happen to be mice, but at least it's a start.

The most basic technique was to surgically connect a young mouse to an older mouse, which resulted in rejuvenation of the older mouse's organs! Does this mean we will eventually see older humans with dozens of mice attached to their bodies?* Not very practical, but similar benefits were achieved with administration of young mouse plasma to an older mouse and also with more selective infusions, such as with growth differentiation factor 11. In addition, Cohen and Kanfi at Bar-Ilan University in Israel have shown that sirtuin 6 can increase lifespan in mice by 15%. (although only in male mice). Discovery of these factors could make illicit use of HGH obsolete. However, protracted use of mouse products would have potential unexpected effects, and it would be far safer to employ human to human transfers.

If these discoveries are found to work in humans, there would be an instant market for employment of Millennials who are currently living in their parents' homes, unable to establish an identity. The Boomer generation, dedicated to self-improvement and self-indulgence, will eagerly pay whatever it takes to drain younger persons of their precious bodily fluids. Boomers will then continue to survive and to be able to stay in charge for another 50 years. Now we just have to hope that development is something our civilization can survive.

*or possibly a leather mouse stem cell coat could be considered