Youngyoon Amy Seo

On Becoming a Centurion:
A social science critical interpretation

March 24, 2021

            All organic life forms on earth contain carbon, one of the most abundant chemical elements on earth. It is estimated that 18% of the human body is made of carbon; it is found in our proteins, carbohydrates, lipids, and nucleic acids (Helmenstine, 2019). “Carbon is synonymous with life. Carbon bonds can be formed and broken with a modest amount of energy, allowing for the dynamic organic chemistry that goes on in our cells” (Schirber, 2009).

            A by-product of humans, carbon dioxide hastens our aging, causing normal physiological functions to deteriorate. Consequently, aging is a process, not a disease, and as we age, our bodies’ chemical elements break down and become vulnerable to a wide range of diseases, eventually resulting in death (Dinerstein, 2018). Though we age, science has stepped in to slow down the inevitable decaying process, and theoretically (or eventually), reverse it. There are consequences to this ongoing 21^st century scientific awakening, including wrestling with the medical ethics and the realities of overpopulation and overconsumption.

            Since the Green Revolution was initiated in the 1960s to agriculturally sustain the BRICs of the world, advances in scientific innovation, medical breakthroughs, and agricultural development have extended our collective lives. Over the past couple of centuries—despite consequential world and regional wars, economic depressions, debilitating pandemics, and a post-World War II global health divide—demographers estimate that life expectancy throughout the world, on average, has more than doubled. “Globally the life expectancy increased from less than 30 years to over 72 years; after two centuries of progress, we can expect to live much more than twice as long as our ancestors” (Roser, Ortiz-Ospina & Ritchie, 2013). Just five years later, researchers calculated a phenomenal six-year uptick in life expectancy for Americans, who can now reportedly live up to 78.7 years on average (Kochanek, etal, 2019). Despite longevity progress in industrial countries, global health inequities today are evident in central African countries, where life expectancy hovers just over 61 years, but these figures are narrowing (data.worldbank.org).

            Western popular culture has taken notice of the dramatic rise in longevity. On the cover of the May 2013 issue of National Geographic, a picture of a newborn baby is shown with the title caption, “This baby will live to be 120 years.” The image and caption are provocative, luring the reader into an explanation of how science and medicine have enabled people to live longer, with presumably fuller lives, provided they live in First World countries or have a genetic predisposition to longevity, such as the United States, Japan, China, and India. “In 2015, some 72,000 Americans were centenarians. That’s a whopping 43% increase from just 50,000 in 2000” (Collins, 2018). In fact, Kimberly Key (2018) argues that futurist and theoretical physicist Michio Kaku “predicts that medical advances will be able to reverse aging sometime between 2070 to 2100.” Immortality? It’s the stuff of science fiction.

            As science and medicine begin to unfurl new technologies and ways to cope with aging, becoming a nonagenarian or centurion may be the new norm. Medical professionals advocate that people should use common-sense nutrition and exercise and avoid the pitfalls of counterculture stress relief—smoking tobacco and vaping pharmaceutical-grade nicotine, recreational drug use, excessive alcohol consumption—to allow the body to age gradually over time. There is also another key ingredient to long life, and one is either born with it or not. The gene sirtuin 6 (SIRT6) “is responsible for more efficient DNA repair in species with longer lifespans … [and] illuminates new targets for anti-aging interventions [that] could help prevent age-related diseases” (Valich, 2019). Science is not only on the cusp to better understand the DNA properties that lead to gene repair, but also of mutations, which can cause cancer and other fatal diseases.

Population consequences

            As people live longer, serious consequences the world’s nations must grapple with on a grand scale include aging, overpopulation, overconsumption, and climate change. Moreover, select industrial nations in Asia and the Americas are aging at disproportionate rates. In South Korea, the total fertility rate (FTR) has been at its lowest point since 1990. “Comparing South Korea’s birth rate with other OECD (Organization for Economic Co-operation and Development) countries, South Korea is the only country showing an FTR below 1.30” (Miller, 2019). With low birth rates, an aging population remains a serious concern for the government of South Korea, given the peninsula’s bifurcated state. “Korea is aging faster than any other country in the world” (Dong-chan, 2019).

            In Mainland China, an even greater problem exists with their aging population. Two forces will collide at a time when ambitious geo-political expansion runs headlong into the costs of paying for the elderly—including the first national pension system. Statisticians and demographers spell it out clearly. “The number of Chinese older than 65 is expected to rise from roughly 100 million in 2005 to more than 329 million in 2050—more than the combined populations of Germany, Japan, France, and Britain” (French, 2016). The burden of fiscal responsibility alone falls squarely on the shoulders of Gen X, Y, and Z.

            In the United States, aging is also at a critical juncture as America’s Baby Boomer generation (1946-1964) is easing into retirement. “The number of Americans ages 65 and older is projected to nearly double from 52 million in 2018 to 95 million by 2060, and the 65-and-older age group’s share of the total population will rise from 16 percent to 23 percent” (prb.org). Strains on caring for an aged American population will be felt at the same generation levels as in China, causing financial difficulties and social isolation.

            The U.S. long-term care market size is expected to reach US$751.9 billion by 2027          … rising prevalence of dementia, Alzheimer’s, heart disorders, respiratory diseases, and mental disorders is likely to increase the burden on long-term care settings over          the coming years (prnewswire.com).

            In 1972, MIT researchers Donella and Dennis Meadows teamed up with Jorgen Randers, a Norwegian ecological economist, and William Behrens to study the planet’s capacity to support population expansion. According to Meadows, etal (1972) in the oft-critiqued MIT study, Limits to Growth, there is limited—even finite—carrying capacity in which the earth could adequately sustain its current estimated 7.8-billion population, and 11 billion in 2100 (worldometer.info). No wonder environmental activists—Swedish teenager Greta Thunberg is a prime example—are angered to inherit an abused planet.

            Therein lies the paradox of scientific and medical innovation—as medical science increases people’s life spans, there remains the inherent problem of overpopulation, and of overconsumption of limited, finite natural resources, which threatens the environment. To enhance the quality of life for longer living people from throughout the world, an increased percentage of each nation’s Gross Domestic Product is used to mitigate air, water, and land pollution. In 2019 Europe, for example, “total environmental tax revenue in the EU amounted to €330.6 billion, representing 2.4% of EU GDP and 5.9% of total EU government revenue from taxes and social contributions” (ec.europa.eu). Increased taxation in First World industrial countries will continually increase to combat the effects of global warming and climate change, as these pose an existential threat throughout the world.

            Meadows, etal predicted these dire consequences of growth 50 years earlier, but the wheels of bureaucracy are slow to react. These consequences will become more central in our planning as we continue to overpopulate our planet. It has become an economic, demographic, and environmental train wreck, yet science is expected to cobble the pieces of these colossal, critical world issues to find our future in the fabled Fountain of Youth.

            The MIT analysis in the early-1970s continues to produce like-minded models of unsustainability due to overpopulation and mismanagement of resources, including one straightforward and startling study by Elizabeth Kolbert (2014).

In an extinction event of our own making, what happens to us? One possibility is that we, too, will eventually be undone by our transformation of the ecological         landscape […] having freed ourselves from the constraints of evolution; humans nevertheless remain dependent on the earth’s biological and geochemical systems. By disrupting these systems—cutting down tropical rainforests, altering the composition of the atmosphere, acidifying the oceans—we’re putting our own survival in danger” (267).

Kolbert argues that man is undergoing a sixth extinction today in what is described as the Anthropocene period—a “human-dominated, geological epoch” (Ibid, 108).

            There are others outside the community of science who are skeptical about science in general and specifically in Kolbert’s thesis, but naysayers are increasingly outnumbered; the evidence is overwhelming that science extends lives. At the Proceedings of the National Academy of Sciences of the United States, or PNAS, Gerardo Ceballos, Paul Ehrlich, and Rodolfo Dirzo (2017) concur with Kolbert, asserting that “species extinction leads to a common misimpression that Earth’s biota is not immediately threatened, just slowly entering an episode of major biodiversity loss. This view overlooks the current trends of population declines and extinctions.” The scientific community has emerged as the guardians of all life on earth, safeguarding us from ourselves.

In our age of anti-aging

            The science of aging and our understanding of the process today have come a long way since the first conference on critical gerontology was organized at the University of Texas Medical Branch by philosopher Jan Baars in 1991. Baars spent more than 40 years analyzing aging and cites two paradoxes about the increasing aging phenomenon: “Premature cultural senescing” in which individuals live longer but are called old at earlier ages; and the desire to stay young but grow older, which is the cultural creation of a huge anti-aging industry in medicine and in commercial products that promise to maintain youth” (Whittington and Cole, 2014). Just as academic symposia are cashing in intellectually on the aging phenomenon, so, too, are others commercially, according to Psychology Today. The global anti-aging market should exceed $US216 billion in 2021, and this astonishingly high dollar amount does not include “the entire cosmetics industry or global fitness or medical technology industries that seek the same goal” (Key, 2018).

            In essence, people simply want to live longer and live life well. Living is instinctive and quintessentially [Charles] Darwinian and [Richard] Dawkins-like in nature. Life is at once competitive and inclusive, and is based on a natural selection process for future generations to build upon. Throughout human history, arresting age, delaying mortality, and living well have been at the center of societies.

            At the first Science of Aging symposium held in 2019, aging and aging-related topics included what sound like scientific exotica, but has since become the norm: “twins and telomeres in space, senescence, fibroblasts, fat and hyaluronic acid, microbiome and mitochondria, environmental inflammaging, psychological aspects of aging, and the applications of the newest scientific developments in these areas and their applications for our aesthetic patients” (McDaniel & Ogilvie, 2021). In Aging and the Art of Living, Baars (2012) would disagree with the more scientific approach to aging a decade or so later, arguing, “human aging cannot be understood alone through scientific measurement” (Whittington and Cole, 2014). Nevertheless, medical innovation is now routinely used to cater to the elderly to look and feel younger in an aging society, as well as to delay the onset of fatal diseases.

            As we age, biological, physiological, environmental, psychological, behavioral, and social processes in our bodies and minds occur, at times undetected and can go unnoticed for years. The National Institute on Aging posits that advancing age is the “major risk factor for a number of chronic diseases in humans” (nia.nih.gov). To combat aging and age-related diseases, scientists first must identify the problem and its interactions at the genetic, social, environmental, and behavioral levels. This can be time consuming, but with the revolution in technology in only its first inning, science and medicine are just starting to play ball. Georgetown University’s Dahlgren Memorial Library has collated age-related diseases for easy access to researchers from throughout the world (guides.dml.georgetown.edu).

            Psychology Today’s Kimberly Key (2018) declared that the anti-aging industry is worth an estimated $US216 billion, but Chuck Dinerstein (2018) in the same year claimed it is worth over $US260 billion. No global or national marketing executive or accountant has an accurate pulse on what the industry is worth, yet the figures are staggering. Aside from vanity, one possible reason behind the stratospheric market valuation is because the Food and Drug Administration (FDA) does not scrutinize or regulate anti-aging products, known broadly by the federal government as cosmetics. “Despite the limits on the FDA’s ability to regulate cosmetics in an age when cosmetics increasingly are taking on the attributes of drugs, the social costs of increased FDA regulation far outweigh the safety and economic benefits” (Hensel, 1995, 11-12).

A conundrum

            Loving life, regular exercise, a healthy appetite, more than enough sleep, and socializing and solving problems among other activities—these are common ingredients of an elusive recipe to live longer. Some centurions say they smoked and drank wine as they aged, while Bess Cooper at 116 years said, “Mind your own business and don’t eat junk food. Treat everyone the way you want to be treated, work hard and love what you do” (Heyne, 2013). Science says that genetics plays an important role—there is something to be said about luck, as well—but what if a person rationally decides to go against the grain of evolution to end his or her life at a predetermined, premature time? Is suicide, assisted or otherwise, a legal concept?

            Not everyone supports longer life. Contrary to instinctive life forces, Ezekiel Emanuel turned the medical ethics world upside down with his now infamous article, “Why I hope to die at 75: An argument that society and families—and you—will be better off if nature takes its course swiftly and promptly” (2014). Dr. Emanuel, one of the most respected medical professionals in the US, perhaps the world, defies medical convention. Armed with MD and PhD degrees, Dr. Emanuel is the vice provost for Global Initiatives, co-director of the Health Transformation Institute at the University of Pennsylvania, and a special advisor to the director general of the World Health Organization, yet he believes life should not go beyond 75 years of age. Why 75?

             The eminent physician-turned-administrator rejects two stereotypes about aging—the American immortal ideal and the compression of morbidity—claiming these are a “manic desperation to endlessly extend life [and are] misguided and potentially destructive” (Ibid.). The American immortal wants to cheat death and prolong life, says the good doctor, and to do so he or she will exercise, eat healthy, take vitamins and minerals, do mental puzzles to stay sharp, or whatever else is necessary to live a longer life. The compression of morbidity, developed by James Fries in 1980 at Stanford University, “postulates that as we extend our life spans into the 80s and 90s, we will be living healthier lives—more time before we have disabilities, and fewer disabilities overall. The claim is that with longer life, an ever-smaller proportion of our lives will be spent in a state of decline” (Ibid.).

            The serendipity of life is random but welcomed; we do not know when death comes knocking on our door. Living to 75 is slightly below the national average, but statisticians cannot measure the quality of life lived during those three generations. In essence, then, a person’s first 25 years is spent learning and training; the second 25 is as a professional; and, the final 25 years is ensuring familial progeny has a chance to succeed in this brave new world while completing a bucket list of must-see and must-do activities.

            Diseases, in general, and age-related diseases, specifically, often cut short a person’s life, but we have substantial medical technology to combat what threatens our lives. In one example, the dreaded infectious disease caused by the variola virus, smallpox, was eradicated in the mid- to late-1970s (cdc.gov). In another example, medical professionals today understand and treat diabetes and many forms of cancer that once caused premature death. We have flu shots, and given the deadly pandemic of 2020-2021, a group of scientists, immunologists, and virologists collaborated with the federal government to accelerate the development and distribution of the SARS-CoV-2, or covid-19 vaccine (defense.gov).

            There are, however, people who have been diagnosed with a terminal illness or are afflicted with a degenerative neurological disease who do not wish to live any longer. In the United States, are these people allowed to end their lives according to their wishes? The law is complicated and ambiguous.

            All 50 states had laws stating that assisted suicide is a felony. In cases of physician-          assisted suicide, the patient must have less than 6 months to live, be of sound mind,      make a request vocally and on paper, have it approved by multiple physicians, and            then wait 15 days, followed by another request. (mentalhealthdaily.com). Physician-   assisted suicides (mentalhealthdaily.com). 

AI, an ongoing conclusion

            Optimists view science and medicine as saviors of humanity, fixing what ails us. There is no denying the rapid aging demographic throughout the world—a direct result of scientific innovation and medical breakthroughs—but now science is turning to artificial intelligence (AI) to increase the anticipated shortages of physicians. “Geriatric diseases such as atherosclerosis, osteoporosis, cardiovascular diseases, obesity, diabetes, dementia and osteoarthritis require quick diagnosis … [there are not] enough physicians and caregivers to account for the increased demands of healthcare. The US will face a shortage of between 40,800 and 104,900 physicians by 2030” (Sanyal, 2018). As we live longer, age-related diseases become a matter of life and death, compressed into the final years of an elderly person a la Fries’ compressed morbidity model.

            Most of the options are marketed on television, smartphones, and the Internet, but since the average person on the street is not an engineer, deciding which course of action to take can be overwhelming. At Bethesda Health, Francine Toder (2018) asks a number of questions to help the elderly and their caregivers navigate the growing AI switchboard. “How do we separate the helpful from the just trendy? How do we know if a thing aids our memory or just substitutes for our thinking? How do we evaluate whether a new app makes our life easier or simply supplants our own efforts in maintaining strong brains?” But her most important question cannot be answered today: “AI will move forward at a dramatic pace, but will the machines it enhances have the requisite ethical and humanistic underpinnings to make life better? And specifically, will these algorithms promote healthy aging?” (Ibid.).

            For AI to work seamlessly at the physician-patient level in the future requires enormous data accumulation, machine learning (ML), and deep learning (DL)—cornerstones of AI. It is a nascent field of computational research, but progress has been made over the past decade. “AI unveils the mechanistic relationships taking place within the body. Today, DL and AI algorithms have been successfully developed and applied in many pharmaceutical areas” (Zhavoronkov, etal, 2019). And it’s already happening and in the public domain. A year ago, a New York City newspaper headline captured reader’s attention: Scientists successfully reverse human aging process in breakthrough study. Is this possible?

             Researchers investigated whether the therapy—which involves breathing pure oxygen in a pressurized environment—could reverse the effects of aging in 35 people over age 64. Remarkably, scientists found that the participants’ telomeres had enlarged by an average length of 20 percent while their senescent cells decreased by up to 37 per cent by the end of the trial — the equivalent growing 25 years younger (O’Neill, 2020).

            City College of New York futurist Michio Kaku would probably agree that what was once considered science fiction is now science reality. The future of medicine is AI, which will promote longer life, but there will be consequences for these and other medical advancements, consequences we cannot predict now because AI has not yet matured enough for us to experience its fullest effects.

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