Some argue that aging is a dignified and life-enriching process. But the accumulation of damage to the body exacts a terrible price in human suffering.
A novel study that attempts to paint the most accurate and detailed description yet of how Americans experience pain has found that a significant portion of the population -- 28 percent -- are in pain at any given moment and those with less education and lower income spend more of their time in pain. Those in pain are less likely to work or socialize with others and are more inclined to watch television than the pain-free.
The study, which appears in the May 3 issue of The Lancet, was prepared by Alan Krueger, a professor of economics at Princeton University, and Arthur Stone, a professor of psychiatry and behavioral science at Stony Brook University. The work is the first of its type, according to the authors, to quantify a "pain gap" in American society, with the "have-nots" suffering a disproportionate amount in relation to the "haves."
This focus on a "pain gap" distracts from the more basic problem: our bodies wear out as we age and the accumulated damage causes pain. Our limited capacity to regenerate our bodies means that many of us suffer as we age.
One problem is that manual laborers suffer more wear and tear on their bodies.
Workers in blue collar jobs reported higher occurrences and more severe pain than did those in white collar jobs. For blue collar workers, pain was lower when they were off work than when they were working. The 13 percent of people who reported a work-related disability experienced very high rates of pain, and accounted for 44 percent of the total amount of time that Americans spent in moderate to severe pain.
But keep in mind that 56% of those suffering moderate to severe pain did not get it as a result of a work-related injury. Some get injuries in sports, car accidents, and in other activities. Others get damaged by rheumatoid arthritis and other auto-immune disorders. Still others just get worn out joints and connective tissue from the aging process. The result is chronic pain and suffering. Shouldn't we want to develop regenerative therapies to reverse this decay and end the suffering that so many of us are otherwise destined for?
Once you get the painful injury the suffering lasts for decades.
Alarmingly, those in pain were likely to suffer over years, even decades. "The pain doesn't go away in many cases, when people stop working," Krueger said. Pain was higher and more common for older individuals, but the amount of pain reported remained relatively constant for individuals from their mid-40s to their mid-70s.
We need stem cell therapies, tissue engineering techniques, and gene therapies that will fix damaged tissue and eliminate the causes of chronic pain.
An aging population is going to create far heavier cost burdens to treat a sicker population.
San Francisco, CA (Friday, October 26, 2007) — Although estimates have been adjusted downward in light of the most recent data, researchers still predict sharp increases in the U.S. incidence and prevalence of end-stage renal disease (ESRD) in the years ahead, according to a paper being presented at the American Society of Nephrology's 40th Annual Meeting and Scientific Exposition in San Francisco.
"The expected number of patients with ESRD in 2020 is almost 785,000, which is an increase of over 60 percent compared to 2005," comments Dr. David T. Gilbertson of the U.S. Renal Data System (USRDS) and the Minneapolis Medical Research Foundation, Minneapolis, Minn. Using data available through 2005, the study updates previous estimates based on data through 2000.
The development of tissue engineering technologies and stem cell therapies to repair failing organs will some day drastically reduce the cost of medical care. The sooner these treatments come the more we will save. Treatments that are not effective typically cost more than treatments that are effective. Degenerative diseases of old age that slowly kill people over a period of years are expense to treat. Growth of replacement organs or use of stem cell therapies to do repairs will cost less once those treatments become available.
A group of researchers from Britain, Australia, Brazil, the United States, China, Japan, and Sweden has published a report in the British medical journal The Lancet arguing that barring advances in treatment the number of people in the world suffering dementia due to aging will more than triple by the year 2040. (requires free registration)
We have generated expert consensus estimates of age-specific dementia prevalence for different world regions using the Delphi technique. We estimate that 24 million people have dementia today and that this amount will double every 20 years to 42 million by 2020 and 81 million by 2040, assuming no changes in mortality, and no effective prevention strategies or curative treatments. Of those with dementia, 60% live in developing countries, with this number rising to 71% by 2040. The rate of increase in numbers of people with dementia is predicted to be three to four times higher in developing areas than in developed regions.
Obviously, lots of advances in medical treatments will occur in the interim. Some advances will increase longevity by keeping old bodies alive longer. Those sorts of advances will increase the number of people with longevity by allowing more people to live to an age where their brains fail. On the other hand, medical advances that prevent Alzheimer's Disease and other causes of dementia will surely be developed as well.
Prevention of brain aging is much harder than rejuvenation of the rest of the body. The reason for this is simple: We will develop ways to grow and build replacement parts for most of the body. But our brains hold our identities. We can't get a brain replaced with a younger brain without replacing ourselves with a different person. Now, maybe some day nanotechnological methods will allow us to replicate our memories in another brain and that new brain will think it is us. Though I would not view a copy of me as being me. But given such advanced technologies why not instead apply those nano-devices to instead fully repair the brain we already have?
The costs of millions of demented people are enormous. People with early onset Alzheimers are lost from the workforce. Regardless of age of onset the costs of caring for each patient are high because the patients gradually lose the ability to care for themselves. Both families and governments shoulder large portions of the costs. The burden per working person is rising as the average age of populations rise. Taxes will go up in all the developed countries in the next decade and levels of service will simultaneously be cut in order to pay for the growing population of old folks.
These costs of caring for the demented and of old people suffering from other maladies are a strong argument for a huge increase of government funding for research to develop rejuvenation therapies (what Aubrey de Grey calls Strategies for Engineered Negligible Senescence or SENS). Once developed such therapies will become far cheaper to administer than the costs of caring for an aging population. People who are too worn out to work will, once rejuvenated, be able to return to work. Many will once again become net payers of taxes rather than net recipients of taxes paid by younger workers.
Brain rejuvenation combined with technologies to boost cognitive function will cause an enormous increase in average human productivity. The increases in human productivity will pay back the costs of medical research many times over.
We are going to pay for the aging population one way or another. I prefer to pay for it by solving the underlying problem: reverse aging. That way of paying for it requires larger government expenditures in the short to medium run but will avoid much larger government expenditures in the long run while simultaneously allowing us to become young again.
Jane Brody of the New York Times asks an important question about the growing incidence of obesity.
I can't understand why we still don't have a national initiative to control what is fast emerging as the most serious and costly health problem in America: excess weight. Are our schools, our parents, our national leaders blind to what is happening - a health crisis that looms even larger than our former and current smoking habits?
Brody is right. Obesity is causing more damage than smoking does. Brody is reacting to a new book Diabesity : The Obesity-Diabetes Epidemic That Threatens America--And What We Must Do To Stop It by pediatric endocrinologist Francine R. Kaufman MD. Brody says type II diabetes is rapidly growing.
In just over a decade, she noted, the prevalence of diabetes nearly doubled in the American adult population: to 8.7 percent in 2002, from 4.9 percent in 1990. Furthermore, an estimated one-third of Americans with Type 2 diabetes don't even know they have it because the disease is hard to spot until it causes a medical crisis.
Type II diabetes is the type where the body becomes insensitive to insulin. It accelerates a variety of degenerative diseases (heart disease, kidney failure, stroke, peripheral vascular diseases that lead to amputations, blindness, and much more) just as type I diabetes does.
Obesity does a lot more harm beyond causing type II diabetes. Obesity causes neural cell loss in the temporal lobe and is a risk factor for dementia. Rudolph Liebel of Columbia University and other researchers have found that fat cells release over 2 dozen compounds that cause harmful changes the body. The more fatty tissue you have the more of those compounds are excreted into the bloodstream. Increased obesity may even lead to decreasing life expectancies.
Kaufman and Brody blame fast food for this state of affairs. But fast food is in large part the result of advances in agriculture that made the production of starches incredibly cheap. Measures to change grade school and high school cafeteria menus are certainly called for. Kids should be taught to avoid foods that increase obesity. Parents should be discouraged from keeping junk food around the house. Junk food vending machines should be removed from schools and places of employment. But while all these obvious measures will help my guess is they will make only a small dent on the problem.
One problem mentioned by Brody is that lots of kids can not safely bike to school or play outside afterward. Part of the danger here is the distance between schools and homes and the heavy road traffic that makes bicycling too risky. But neighborhoods made dangerous by criminals also contribute to obesity. However, part of the problem in many instances is irrational fear on the part of parents. Child kidnappings and other crimes against children more rare than news reports lead many to believe. Parents who imagine a larger threat than exists keep their kids indoors more than is necessary. Still, longer prison terms for pedophiles and child kidnappers and a generally harder line toward criminal activity would probably create conditions more conducive to good health of all children.
Our biggest problem is that we are not evolutionarily adapted to the environments we have created. We could build bike trails, lock up criminals for even longer periods of time, and make other changes to suburban and urban enviroments to make it easier safer to get exercise in our daily routines. But many of the changes would be expensive to implement and have little popular support. For most communities the needed zoning ordinance changes that would enable, for example, bike trails or pedestrian trails would had to have been implemented decades ago. The communities have already been built. There is no room for sidewalks and trails. Schools have already been built surrounded by very busy streets and highways.
A more basic problem is that today food is cheap but we evolved under conditions where calorie deficiency malnutriton was very common. So we are designed to eat too much. As biotechnology advances food prices will rise more slowly than inflation. So food will become cheaper still. Access to food will become even easier. Its preparation will become ever more automated. Blaming this on McDonalds and Carls Jr really misses the bigger technological picture.
Programs and proposals to encourage weight loss also ignore history: The long running torrent of diet books, talk show discussions, and commercial weight loss companies produce lots of yo yo dieters whose weight goes up and down many times. Sustained weight loss is the exception for dieters.
Brody mentions lots of ideas for her idea of a national initiative to control obesity. But she ignores the one obvious option that will eventually provide more benefit than everything else she mentions: the development pf appetite suppressing treatments. We need an increase in funding for research to develop therapies that suppress appetite and cause fat cells to burn off their stored fat. The appetite suppressants will be the best solution. Eventually we will even have gene therapies that permanently adjust metabolism so that appetite declines when a person begins to become overweight. A few billion dollars per year spent funding research into the mechanisms of appetite control would pay back orders of magnitude in avoided diseases, greater physical and mental vigor, and longer healthier lives.
Markets can take rather unexpected turns. The cruise ship market could grow by leaps and bounds if millions of retirees move permanently onto ships.
Living on a cruise ship is a feasible and cost-effective option to assisted living facilities, and the services offered on a cruise ship parallel — even surpass — what is provided in senior care facilities, according to a study in the November issue of the Journal of the American Geriatric Society.
“Offering many amenities, such as three meals a day with escorts to meals, physicians on site and housekeeping/laundry services, cruise ship could be considered a floating assisted living facility,” said Lee Lindquist, M.D., instructor of medicine at Northwestern University Feinberg School of Medicine.
“Seniors who enjoy travel, have good or excellent cognitive function and require some assistance with activities of daily living are the ideal candidates for cruise ship care,” Lindquist said.
Lindquist, who is also an attending physician in the divisions of geriatric and general internal medicine at Northwestern Memorial Hospital, compared costs over a 20-year life expectancy after moving to assisted living facilities, nursing homes and a cruise ship, including costs of treating acute illness, Medicare reimbursement and other factors.
She found that the net costs of cruise ship living were only about $2,000 higher ($230,000 vs. $228,000) than those associated with the assisted living facilities but resulted in higher quality over the 20-year period.
Lindquist’s plan would include integration with regular passengers, with seniors selecting a cabin to inhabit as home during their prolonged cruise, whereas other passengers would disembark as usual.
I picture David Brin's Earth novel with all the old folks wearing video cameras tied to the net. They'd get off the ships and all the locals would complain that every time an old folks' ship docks there's just no privacy in town.
I do not understand the cost totals. The per year costs for nursing homes run into the 6 figures. Perhaps the numbers above are average per year?
One might expect a bigger price gap. But think about how the competitive environment differs for cruise ships versus nursing homes. Most nursing homes do not compete in a national market, let alone an international market. Whereas each cruise ship probably faces many more competitors than do nursing homes. Also, because most cruise ship passengers do not stay on board very long and return business is important the cruise ships have to be appealing to a much larger number of people to keep each cabin filled and the cruise ships need to satisfy each of them to get them to come back.
Is there any way to extend on this idea to make medical care provision more competitive? Imagine surgery ships that ply a long coast all competing to provide the cheapest, safest, most comfortable, and effective hip replacements or knee replacements or plastic surgeries. No need to travel to Beverly Hills to get the best. If it is elective surgery you seek then you could just wait for the ship to dock that you believe has the best combination of reputation, service, and cost.
Update: Here is some comparative yearly data from The Economist:
A year in an “assisted-living facility” costs Americans, on average, around $28,500 a year. In large cities such as Chicago, costs are even higher, topping $40,000. Living in a dedicated cabin aboard the Royal Caribbean's Majesty of the Seas, on the other hand, rings in at a rather competitive $33,260 a year.
Zack Lynch sees mental health problems as rising in importance.
As people live physically longer and healthier lives, mental health will become the preeminent social and political issue of our time. Living longer physically does not mean living in better mental health. Mental health is the springboard of thinking, communication skills, learning, emotional growth, resilience, and self-esteem.
With longer life spans, the potential for mental illness follows. For example, dementia, the loss of function in multiple cognitive domains, increases with age. The largest number of persons with dementia occurs in people in their early eighties. As the number of people living over 80 years explodes to over 20% of the US population by 2040, dementia will take over as the leading cause of disability. That is, if appropriate tools for stemming cognitive decline, cogniceuticals, don't materialize.
Well, I'd put WMD proliferation, inter-civilizational conflicts, robot take-overs, nanotech goo, and a few other issues up there in competition for preeminent social and political issue going into the future. However, I think Zack is right and perhaps for more reasons than he intends.
First of all, as Zack points out, the aging of populations is causing a much higher incidence of Alzheimer's Disease, vascular dementia, and other neurodegenerative diseases. Worse still, I believe that it will be easier to stop and reverse aging in other parts of the body than in the brain. So we may find ourselves getting younger in other parts of our bodies as our brains continue to age. Why? Because we can replace bigger parts in other parts of the body whereas in the brain we can not replace whole subsystems without losing a part of ourselves and we can't replace our whole brain without completely wiping out our identity.
We will be able to grow replacement hearts, livers, kidneys, and other organs. By growing a replacement we can restore some organ's functionality to youthful levels. To make our brains young again we will need to repair it in situ with gene therapy and other highly targetted therapies that repair existing neurons and remove wastes from around and within cells. Certainly such therapies will be developed and those therapies will also be used on other parts of the body as well. But other parts of the body will be repairable by a wider range of techniques and some of those techniques will very likely be developed faster than the smaller set of techniques that will be usable in the brain.
Stem cell therapies have some uses in the brain for rejuvenation. For instance, hippocampal stem cell reservoirs will need to be replenished with youthful adult stem cells. Also, stem cells will be useful for repairing some of the damage caused by Parkinson's Disease. However. stem cells are not the right solution for Alzheimer's Disease where the real need is to prevent large scale neuronal cell death in the first place.
Removal of amyloid plaques via immunotherapies and other therapies may turn out to be the trick that prevents Alzheimer's. But that will not make neurons young again. Our brains will still age and a slower rate of cell death and accumulation of cells that are in the sensecent state or otherwise impaired will still gradually reduce our intellectual capacity.
So then do we face a future of older brains in younger bodies? Perhaps, but probably only as a transitional phase. Still, this transitional phase will be a serious enough problem that efforts to develop brain rejuvenation therapies should be a high priority in anti-aging research. Many of those therapies will have uses in other parts of the body as well. But the really big win from brain rejuvenation therapies will come from increased worker productivity. An increasing portion of all work is mental work and rejuvenated brains would do more to increase economic productivity than rejuvenated bodies.
There is yet another reason why mental health is going to be more important in the future: Technological advances are going to make individual humans capable of greater acts of destruction and so the individual urges for aggression and destruction are going to become more dangerous to the human race as a whole. Of course this problem is more than just a mental health issue and I do not mean to trivialize all political conflicts by labelling them as cases of mass mental illness. In fact, let me go on record as stating my opposition to the tendency of labelling all anti-social behavior as signs of mental health problems. There are a lot of other factors to consider and we shouldn't medicalize all human behavior. Still, mental health problems really are going to become politicallly more important as humans become more powerful as a result of technological advances.
Advocates see robots serving not just as helpers - carrying out simple chores and reminding patients to take their medication - but also as companions, even if the machines can carry on only a semblance of a real dialogue.
The ideal results: huge savings in medical costs, reduced burdens on family and caretakers, and old and sick people kept in better health.
"This technology is really needed for the global community," said Russell Bodoff, executive director at the Center for Aging Services Technologies in Washington, D.C. "If you look 30 years out, we have what I would call a global crisis in front of us: that we will have many more aging people than we could ever deal with."
Japanese elderly are being cleaned by automated human washing machines.
MACHIDA, Japan- With an electronic whir, the machine released a dollop of "peach body shampoo," a kind of body wash. Then, as the cleansing bubbling action kicked in, Toshiko Shibahara, 89, settled back to enjoy the wash and soak cycle of her nursing home's new human washing machine.
Some argue for immigration to supply workers to care for a growing population of the aged. But in order for that solution to work in the short term the immigrants must be so numerous to drive their wages down to the point that their wages are low enough to be affordable by elderly on fixed incomes. But if their wages are that low two problems immediately become apparent:
- Care workers for the elderly whose wages are low enough to be affordable by the elderly (or to the governments that will pay for their care) will have to have incomes so low that they will pay little in taxes. Therefore they will have to be subsided by higher income workers for their own health care, education, and other services.
- Low wage workers will pay little into retirement funds. Therefore when they retire there will not be sufficient funding to pay for their own care. Use of imported low waged workers ends up becoming a financial pyramid scheme.
If import of cheap labor is not a viable solution then there are only two cost-effective solutions to the financial problems caused by aging populations:
- Automate the care of the elderly. Automation reduces the need for human labor and there is no limit to how far it can drive down costs.
- Slow and even reverse aging. This is the far more powerful solution since it solves the underlying problem. Plus, it will cause the economy to grow. If people can stay younger longer then they can work, support themselves, and pay taxes for more years.
It is pretty simple. Either we need to eliminate the use of human labor to take care of the elderly or we need to stop the transformation of younger bodies into elderly bodies. Now me, I prefer the second option (and I hope you do too). But since the development of rejuvenation therapies may take two or three decades it makes sense to also pursue the first option to reduce costs in the short and medium term. But since the projected costs of taking care of the elderly are going to become so huge it would also be very cost-effective to spend more on biomedical research aimed at developing rejuvenation therapies.