-Caveat Lector-

From: "J. R. Molloy" <[EMAIL PROTECTED]>

December 20, 1999
http://www.nytimes.com/yr/mo/day/oped/20groo.html

Who Wants to Live Forever?
By JEROME GROOPMAN

My grandmother lived vigorously to the age of 100. She was raised in an
impoverished shtetl in czarist Russia, arrived in America the day McKinley
was
shot, lived in a cold-water tenement, sewed garments in a crowded, filthy
sweatshop and delivered four children at home. I always assumed she carried
genes for longevity and a strong constitution. There were some in her
family,
similarly healthy and long-lived, who inherited those genes, and others,
less
blessed, who did not.

It was a matter of good fortune, and nothing fundamental could be done to
alter
the outcome. Yet as we look into the next century, we see science poised to
determine a person's life span directly, by modifying his genes. Pills would
replace parents as the key to vigorous longevity. Although providing long
and
healthy lives is a laudable goal, the consequences of this approach raise
deeply
disturbing questions.

Genes for long life were first found in fruit flies. Last month, a
breakthrough
occurred in higher animals. Mutant mice were created, through genetic
engineering, that lacked a normal cell protein called SHC. All mammals,
including human beings, have this SHC protein. The mutant mice were healthy
and
lived one third longer than their normal counterparts. Their cells were
notably
resistant to oxidants, molecules that wear down tissues the way they rust
metal.
Of course we are not mice, and the SHC protein may not have the same effects
on
oxidation in our cells. But the proof of principle is powerful. Analogous
genetic changes in people could routinely make us into centenarians.

Genetic diagnosis, though, will come before any specific treatment. People
will
learn of their natural chances to live to a certain age and their risks of
having a variety of diseases. This knowledge will make it increasingly
urgent to
create drugs to modulate the effects of genes linked to illnesses. Such
drugs
will be designed, in large part, using supercomputers that will screen
chemicals, to see which ones might work, in a virtual format before
empirical
testing in cells and animals.

The natural and steady degeneration of tissues is accelerated by disease.
Illnesses become deadly when they overwhelm the body's defenses and its
mechanisms for repair. Longevity appears to involve delaying normal aging
while
protecting against disease.

Data on centenarians published this year suggest what is needed to live past
100. Many centenarians had close relatives in their 90's and early 100's.
They
were like my grandmother, physically and mentally vigorous, and were largely
free of illness until shortly before their deaths. Their survival apparently
involved not only genes for longevity, but also genes that reduce
susceptibility
to disease.

The converse painfully makes the same point: families with genes that
predispose
them to serious illness, like the genes for breast cancer or the
hyperlipidemia
genes for heart attack and stroke, are marked by untimely deaths.

We will be faced with the difficult decision of which life-limiting genes
and
proteins to remedy first. Should we address the most prevalent killers, like
atherosclerosis, or the maladies that affect younger people, like juvenile
diabetes? Will some racial and ethnic groups be given short shrift, since
minorities often have unusual genes predisposing them to rarer disorders?
Will
diseases that happen to affect congressmen, celebrities and corporate chief
executives be favored, getting periodic infusions of money for research and
development?

No American believes that anyone should be denied the benefits of science
for
financial reasons. So, even after priorities are set, who will pay for the
longevity treatments, which probably will begin at an early age and extend
100
years or more? Certainly the drugs will be costly, but might health costs
ultimately be reduced if we can successfully delay illness and extend
productivity for five or more decades? Will the process of dying also become
less costly, since it may occur rapidly as the drugs wane in effect or are
withdrawn, in contrast to the slow, stuttering decline that is now the
expensive
norm?

Regardless of who is first in queue, and regardless of the
cost-effectiveness of
the treatments over time, only those in wealthy and prosperous nations will
have
access to them. This will make global demographics even more lopsided than
they
are now, as people in the United States and Europe live well past 100 while
Africans and Asians continue to die young, as they have for centuries.

In the industrialized world, family dynamics will change as five or more
generations know each other. The ballooning healthy population will sharply
increase global demand for food, shelter and everything else. The natural
resources and cheap labor to respond to these material needs will come from
the
developing world, as they do now, but the drain from those areas will be
magnified. Unless the rate of new births slows, we will have Malthusian
strife
within a Methuselahan culture. Will a limitation on reproduction be
voluntary or
become coercive?

The quest for longevity holds a tight grip on the human imagination, forming
the
fabric of ancient myths and the core of explorers' dreams. A long, vigorous
life
is posited as the solution to much of our suffering and many of our
dilemmas.
Yet as science brings this goal into reach, the inequalities of the past and
the
present threaten its realization. We disregard these issues at our peril.

Jerome Groopman, a professor of medicine at Harvard, is the author of "The
Measure of Our Days" and the forthcoming "Second Opinions."



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