After the last death: Doctors, academics debate the possibility, value of a 150-year lifespan

40155_mainDr. Joon Yun, benefactor of the $1 million Palo Alto Longevity Prize and President of Palo Alto Investors, LLC. Photo by Veronica Weber.

Halloween was approaching and Dr. Joon Yun was explaining why he wanted someone to hack our bodies.

“Every day 150,000 people die worldwide and the majority of them (are) due to age-related illness,” Yun, 46, said while seated in the board room of Palo Alto Investors LLC, an investment management company of which he is president. “We’ve got the technology to hack the aging code and end aging. Question is not ‘if’ but ‘when’ we want it to happen.”

Yun, a bespectacled physician turned investor, is the benefactor of The Palo Alto Longevity Prize, a $1 million science competition aiming to end aging by restoring the body’s homeostatic capacity and promoting the extension of a sustained and healthy lifespan.

The Prize is the latest in a spate of anti-aging efforts being mounted throughout the Bay Area. Google’s Calico Project has gained the most attention because of the corporate brand and the impenetrable secrecy surrounding it. The Buck Institute in Marin County was featured in The Atlantic’s October cover story “What Happens When We All Live to 100?”

The same issue featured an essay by Ezekiel Emanuel, “Why I Hope to Die at 75.” Emanuel dismisses efforts to extend healthy longevity and equates age with decrepitude, an attitude that longevity experts including Yun consider laughably outdated.

“I’ve gotten so many emails from people linking to the story,” Yun groaned. “Somebody should start a new magazine called The Pacific. The Atlantic is an old way to think of things. Look west; look to the future.”

Six teams of scientists and medical researchers from around the country are competing for the Longevity Prize’s two $500,000 awards, the Homeostatic Capacity Prize and the Longevity Demonstration Prize. The former will go to the first team to demonstrate that it can restore homeostatic capacity of an aging mammal to that of a young adult. The latter will go to the first team that can extend the lifespan of its mammal by 50 percent of acceptable published norms using an approach that restores homeostatic capacity.

Homeostatic capacity refers to the ability of one’s physiology to self-correct and stabilize in response to stressors. Young people typically have a strong homeostatic capacity; it’s what allows their bodies to heal from injuries and recover quickly from illnesses.

Yun and the researchers leading the teams believe that homeostatic capacity erodes with age. Diabetes, hypertension and other afflictions that correlate with age may be consequences of an aging body’s inability to self-stabilize.

So what if the erosion of homeostatic capacity can be stalled or reversed? Would it end aging as we know it?

“Nobody wants to live another 40 years in bad health,” Yun said. “We want to make life longer and healthier. Imagine being 70 years old and as healthy as a horse.”

Of course, the ultimate goal is to apply any successful findings by the teams to humans. A 50 percent increase in today’s average lifespan would take today’s baby boomers to around 110 years. The oldest person in recorded history lived to 122. It’s already common to hear that today’s young people will have an average lifespan of 100 years, which would take them to 150 years if the Longevity Demonstration Prize’s results were successfully applied in time.

While Yun would welcome a healthy 150-year lifespan, even that is a baby step compared to what he thinks is, at least theoretically, possible: a healthy lifespan beyond biblical proportions. A normal 25-year-old has a one in 1,000 chance of dying from outside forces in a given year. If declining homeostatic capacity were not a factor, a 1,000-year healthy lifespan is theoretically achievable. The mortality rate of a healthy 15-year-old is 0.01 percent in a given year, which could theoretically translate to a 10,000-year lifespan.

To be sure, immortality is not the explicit goal of the Prize, but the successful abolition of aging would certainly make death the next target.

“We hope that, if we are successful … sustained homeostatic capacity will have the consequence of making death a statistic rather than an inevitability,” Yun said.

In that world, people would still die. Externalities like accidents, wars and crimes would still claim lives. But the hope is to make natural aging and death a thing of the past. In short, the fight is, ultimately, not just against disease and aging but about the very notion of longevity itself.

In fact, there already exists something that is proven to slow the erosion of homeostatic capacity and increase healthy longevity: exercise. Dr. Walter Bortz, 84, is a physician and author who teaches medicine at Stanford University. He is best known for being an advocate for a 100-year lifespan and has written dozens of articles and several books on the topic.

“Aging is not a disease!” said Bortz, as he and his wife, Ruth Anne, sipped wine and looked out over Palo Alto from the hills of Portola Valley recently.

“Neither is aging the same as frailty. Frailty and bodily decline are a result of disuse. These conditions considered to be aging-driven diseases — Alzheimer’s, diabetes, hypertension — are not related to aging at all; they are a result of lack of energy,” he said.

For evidence of the connection between exercise and healthy aging, look no further than the Bortzes: They’ve been doing marathons for decades and are regularly seen running in their neighborhood.

To be sure, they are no fans of getting older and being reminded of their age, but they are adamant that getting older is separate from being healthy.

“I just turned 84, and it was horrible,” said Ruth Anne Bortz, lamenting her accumulation of years and the approach of 100.

“Better than being dead at 84,” her husband quipped dryly.

Unlike Yun, Bortz is doubtful that an extended lifespan is possible through scientific intervention.

“There is no ‘switch’ that can be hacked and flipped to stop aging,” he said. “The decision to live a good lifestyle, to exercise, eat well, and most of all have a good mental attitude can make health persist regardless of age.”

According to Bortz, exercise initiates the expression of genes that help maintain a healthy physiology. He is not alone in connecting exercise to healthy longevity.

“The science on exercise and its effects on healthy aging are truly remarkable,” said Dr. Laura Carstensen, director of the Center on Longevity at Stanford University, a think tank focused on “redesigning long life” and building a culture that supports it.

The Center researches science and technology that can be used to solve problems facing the aged, particularly relating to mental acuity, physical mobility and financial security.

Yun does not deny that exercise and good habits contribute to maintaining health, but he believes it can’t go far enough.

“The problem is that people have been doing that for thousands of years and they are all dead,” Yun said. “The grand slam would be to maintain a young person’s capacity, and I’m not sure if we could accomplish that through only conventional behavioral methods including exercise and a balanced diet. To truly restore homeostatic capacity would require an intervention at the programmatic level.”

But Bortz is deeply skeptical of efforts to extend life beyond 120 years. The author of “The Roadmap to 100” doesn’t think a book titled “The Roadmap to 150” will ever be written.

“Not possible. We’ve been a species for eons, and the oldest person to have ever lived in recorded history is 122. There are only 120 super-centenarians (people who are 110 or older) worldwide. Why is that? Because there is a finitude due to entropy,” he said.

Still, Yun points out that science may break his way — and possibly in a way more provocative than the idea of a 1,000-year-old person.

“Our cells are programmed to deteriorate and die, a process called apoptosis. However, some of these cells that are programmed to die are mutating and programming out their apoptosis genes. Today we call that phenomenon cancer,” he said. “Cancer cells are essentially immortal. Today, cancer is considered one of the worst scourges in human history, but what if it holds the key to persistence rather than death?”

Sonia Arrison, a founder, academic adviser, and trustee at Mountain View’s Singularity University and a member of the Palo Alto Longevity Prize’s Advisory Board, has already written the book Bortz thought would never be written. “100 Plus” is about what society will be like when, not if, people live to an average of 150 years. (See sidebar.)

“I wrote the book because I want people to be aware of the technology that is making its way and not to be complacent,” said Arrison, 42, whose company’s mission is “to educate, inspire and empower leaders to apply exponential technologies to address humanity’s grand challenges.”

“All of this longevity technology will happen, but the question is ‘Will it happen to you? Do you want to be the last generation that only got to live to 80 or part of the first generation that got to live to 150?'” she said, her bright eyes as optimistic as her book.

A 150-year average lifespan would force changes in the economy and even relationships, but according to Arrison they’ll be similar to what society is already seeing, just more dramatic.

“We’ll likely have serial long-term relationships, more changes in friendships, more marriages. The nuclear family will be less common,” she said.

All the benefits she foresees are centered on choice: more choices for family structures and planning, more choices for career structure, and more economic prosperity.

Of course, a longer lifespan will force challenges on society — the biggest one, according to Arrison, being a “longevity divide.”

“We already see it today. A person in Atherton lives to their mid-80s and a person in East Palo Alto lives to only their mid-60s. It’s likely that, at least in the short term, when longevity technology hits the market that the divide will increase,” she said. “But I think, as with all other technology, it’ll become cheaper over time until just about everyone can access it if they choose. But I would take all the challenges increased longevity will pose over death and aging and disease any day.”

But such radical change in human longevity in such a short period of time could cause radical societal blowback. The last major extension of longevity occurred when average life expectancy nearly doubled from around 40 years in the beginning of the 20th century to nearly 80 by the millennium. This created generational conflicts that culminated in the 1960s and ’70s.

The teenagers and college students of 1968 were the first generation to live under an “oligarchy of the old.” The counterculture was, in many ways, the young attempting to shift the balance of power away from their parents and grandparents. In a demographic light, the young were rebelling against the consequences of extended longevity.

Carstensen, who was a teenager during that period in American history, remembers the generational animosity.

“At Woodstock we considered old people, and at that time it was 30 and up, to be oppressive. We felt we had the answers and that we would be moral and fix the problems. As boomers aged we went off and did other things and kind of lost that. It would be interesting to me if boomers came to be the change agents for longevity, which would be great and ironic,” she said.

For Carstensen, lifespan gains made in the last century are more than just a biological phenomenon.

“Longevity is one of the greatest cultural achievements in human history,” she said.

However, the achievement has outpaced institutions and cultural evolution, which, having been very slow to adapt, could lead to various crises. There’s little reason to believe society and institutions would catch up to yet another doubling of longevity in a timely manner, which would only dramatically compound today’s challenges.

“We continue to live our lives as if our life expectancy is what it was before. Our education system still ends for the majority of people before reaching age 23.

Working for 40 years, then retiring for another 30 years, is becoming economically unsustainable as well as damaging our well-being,” Carstensen said.

The health care system is what is most in need of dramatic change.

“Recent scientific advances have been largely about solving acute diseases not chronic diseases, which are the ones we are now facing,” she said. “Our system and institutions are organized to attack separate diseases rather than addressing what seems to be the underlying cause: unhealthy aging.”

Displayed on a shelf next to her desk is a board game based on Hasbro’s Game of Life but with a few alterations: Instead of life beginning in school and ending in a retirement home, it begins at birth and ends at death. It’s also structured to not be a race to the finish; in some parts it benefits players to take longer routes.

“Preparing for a long, stable, fruitful life does not begin in old age; it begins at the very earliest stages,” Carstensen said.

The point is not just rhetorical; there are more pediatricians than geriatricians associated with the Center on Longevity.

However, the Center is not interested in extending life, and Carstensen doubts the teams competing for the Palo Alto Longevity Prize will realize its ultimate goals of a radically longer health-span.

“We thought long and hard on calling ourselves the Center on Longevity rather than the Center for Longevity. I’m largely on the fence about increasing lifespan. I see a real need for improving the quality of our lives and accommodating the years we’ve been given,” she said.

Nonetheless, Carstensen said she believes the efforts of the six teams could lead to discoveries that will make healthy aging easier.

Silicon Valley technologists are neither the first nor only ones to joust at aging and death. Philosophers and writers of all times and places have deeply considered the condition and implications of decay and mortality. The great Irish poet William Butler Yeats, famous for having written his poems late in life, is often quoted as saying, “Sex and death are the only things that can interest a serious mind.”

In the present day, poet and Stanford professor Kenneth Fields has just completed a new collection of poetry that considers aging. The 75-year-old bears the physical marks of a tumultuous life lacking in both health and boredom, which brings to mind Hunter S. Thompson’s quip about how the body of someone who lived a full life should arrive, thoroughly used up, at the grave.

“Aging is the diminishing window of time between when you feel like urinating and when you actually are urinating,” Fields wryly remarked during a poetry reading on campus. However, while he would welcome restored physical health, he is not sure he would want an extended life, much less the abolishment of natural death.

“Things are beautiful because they are transient and don’t last forever,” he said. “I’m reminded of Sappho’s Hymn to Aphrodite. Sappho has had her heart broken and asks the immortal goddess Aphrodite for help. And Aphrodite is amused by her. ‘Who is it this time that’s broken your heart?’ she disinterestedly asks Sappho. It makes the point that Aphrodite can’t take these powerful, human emotions personally or seriously because she is immortal.”

“It’s questionable whether death is ‘evil’,” said Huw Duffy, a second-year doctoral philosophy student at Stanford. “You could say that death is bad for many or most people without concluding it would be good if we did not die after a couple hundred or thousand years or ever.”

Duffy turns to “The Makropulos Case,” in which Bernard Williams wrote about why immortality would be unappealing.

“There are two alternative outcomes of immortality or a radically long lifespan: extreme boredom to the point of not wanting to live or loss of identity or psychic connection with your earlier self,” Duffy explained. “It’s not at all clear that we would still want to go on being the same person for much more than 100 years.”

According to Williams, in order to have the desire to live for another lifetime, one would have to radically change one’s identity at the most fundamental level. That may sustain a meaningful life, but the idea of how different a person could be from who he or she is now should lead to questions of why a person should care about a future self staying alive in the first place.

Carstensen and Bortz share in the skepticism.

“You are going to die; get used to it,” Bortz said. “All of us hate the idea of oblivion. It’s antithetical to our sense of self. But I take solace in the fact that when you die, you leave behind ripples as the atoms in your molecules are transferred back to the world. All of life is energy transfer, from the sun to everything else. I think 100 years is plenty of time.”

Said Carstensen: “We humans have been searching for the Fountain of Youth since we realized we are mortal. We’ve gone from going on sailing expeditions to the laboratory, but the aim remains the same. To be honest, I don’t find such efforts even interesting.

“I study motivation, and I think a lot of human motivation comes from the idea of a bounded life. If we were limitless there wouldn’t be any urgency. I think death is what makes life precious. We have to do what we can because we don’t have all the time in the world,” she said.

These qualms are fine and good to Yun and Arrison. For them it’s about choice.

“We are not proscribing this for anybody; all we are doing is providing the option,” said Yun.

Arrison writes as much in her book while being decidedly opposed to any government involvement (outside of urging the FDA to ease its approval processes) in funding and developing anti-aging technology, fearing that it could ultimately lead to government-mandated eugenics. She believes the free market will do a good enough job distributing any longevity-increasing technology.

For his part, Yun finds moral support for having a choice in poetry, particularly Dylan Thomas’s “Do not go gentle into that good night.”

“Thomas, pained from the death of his father, rages against death. It is a call to action. I think when people take death to be inevitable they create stories for themselves that console them and make it seem acceptable,” Yun said.

But for all Yun’s and Arrison’s moral fervor, the notion of choice without guarantee of equal access is unsatisfying to Stanford University Assistant Professor of Philosophy Jorah Dannenberg.

“This may start out as the sort of thing anyone will be able to decide to opt-out of if he or she doesn’t want to do it. But when enough people decide to do something like this, it will result in all sorts of social and economic pressure on anyone who may have reservations.

“Look at smartphones,” he said. “They certainly have an upside, but the fact that they’re nearly ubiquitous in certain circles generates certain powerful expectations that are difficult or impossible for any one person to cancel. The choice to significantly extend one’s life strikes me as that kind of choice, except the stakes are so much higher. The social and economic effects of others’ choices will make it hard or even impossible for those who might really prefer not to do it.”