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In this chapter, I aim to extend the argument introduced in section 2.3, to show that technological improvements starting in the next decade can, and should, dramatically raise the quality of people’s health all over the world.  The results of these improvements can, and should, include:

• The eradication of many diseases
• The significant enhancement of fitness levels and strength levels
• The increasing availability of replacement body parts and organs, that function better than the originals
• The uses of gene selection, gene therapy, and genetic re-programming to improve both our children and ourselves
• The radical increase of life expectancy.

Many people feel, on the contrary, that such developments are unlikely.  They can point to the following concerns:

• Despite a decades-long “war on cancer”, multiple kinds of cancer still exist, with high mortality rates.
• Despite increased spending on drugs research, the number of important new drugs reaching the market is declining.
• Although life expectancy is rising, the rate of increase is itself declining: the rate of increase has been less, for quite some time, than in the early decades of the previous century.
• Healthcare budgets around the world are under growing strain, from populations in which greater proportions of people are frail, elderly, and in need of expensive medical care.

Indeed, medical progress in the first decade of this century can be assessed as “disappointing”, when compared against previous expectations.  The second half of the twentieth century had been a time of explosive growth in growth in high technology medicine, with many examples of stunning progress:

• Effective chemotherapy for many diseases
• Widespread use of sophisticated vaccination
• The development and application of the corticosteroids
• Prosthetic medicine – including cardiopulmonary bypass, renal replacement waste extraction therapies, synthetic arterial vascular grafts, and cardiac valves.

With that context, the closing decades of the last century saw confident predictions from both academic and clinical researchers that the opening decade of this century would see the first truly effective therapeutic drugs for (amongst other conditions) cancer, heart attack, stroke, multisystem organ failure, and immunomodulation (control of rejection and much improved management of auto-immune diseases).  Optimistic predictions were also made regarding the perfection of long-term organ preservation, widespread use of the total artificial heart, and the clinical application of the first drugs to slow or moderate biological aging.  However, few of these anticipated gains have materialized.  What’s more, numerous drugs that seemed promising in animal trials for multisystem organ failure, stroke, heart attack, cancer, or immunomodulation, failed when corresponding human trials took place.  In short, it looks like the pace of therapeutic advance has slowed.  This relative slowdown can be attributed to:

• Diminishing returns, as many of the “low hanging fruits” of particular lines of research have already been taken
• Realisation of the tremendous underlying complexity (“messiness”) of human biological processes
• Increasing pressure on healthcare budgets.

Let’s look more closely at the point about pressure on healthcare budgets.  Progress in medical treatment requires investment.  Money has to be spent to develop new treatments.  But healthcare already consumes gargantuan amounts of funds.  For example, the NHS (National Health Service) in England was said in 2004 to be the third largest employer in the world, with almost 1.3 million employees – behind only the Chinese Army (2.3 million) and the Indian State Railways (1.5 million).  Worse, it looks like healthcare costs are set to keep on increasing.  Healthcare costs tend to dramatically increase with age – but in almost every developed country, demographic changes such as smaller family sizes mean that the ratio of older to younger is rising significantly.  According to research by the Lifestar Insitute World Health Iniative:

• Five years ago, long-term non-communicable diseases cost the United States $1.3 trillion per annum.
• By 2013 they’ll cost $2.4 trillion per annum.
• By 2023, $4.2 trillion.
• An overwhelming majority of these costs are attributed to age-related conditions.
• Chronic age-related disorders account for the majority of healthcare costs for the entire developed world.

Financial cutbacks in the wake of recent growths in national indebtedness threaten further strains on healthcare expenditure.  What is to be done?

4.1 Converged medicine

Rather than simply relying on “more expenditure of the same type as before”, we can expect big wins from different kinds of healthcare expenditure.  Here’s an example, as told by the Milken Institute:

• In 1950: It was estimated that polio would cost the United States $100 billion to treat by the end of the century.
• In 1952: 58,000 polio cases were diagnosed nationally.  Polio was declared an epidemic.  1,200 people died.
• In 1955: The Salk polio vaccine was introduced.  Extensive positive publicity followed, including a 1956 picture of Elvis Presley receiving the vaccination.
• In 2000: The cost of treating polio was $100 million – one thousandth of the 1950 estimate.

Preventing a disease, evidently, can be far cheaper than treating the disease itself.  Not only should we count the direct costs of medical treatment.  We must also count the costs of absenteeism and “presenteeism” -  the latter being sick employees who show up for work, but who perform with reduced productivity and lower quality.  Estimates commonly put these indirect costs (absenteeism and presenteeism) as being significantly higher than the direct medical cost of illnesses.  Healthy individuals contribute to society more, rather than being a drain on its resources.  Preventing diseases makes good economic sense as well as good moral sense.

Preventing diseases from reaching a serious stage involves a combination of:

• Lifestyle changes (for example, stopping smoking, or healthier eating practices): it is believed that 70% of healthcare expenditure is spent on lifestyle-related diseases
• Early and accurate diagnosis, followed by timely cure, before the problem has become stubborn.

Significant healthcare cost savings can also be realised from treatment that is less invasive than before – such as micro-surgery (“peephole surgery”) – and by having more treatment that can take place without the patient needing a long stay in a hospital bed.

Despite the apparent recent slowdown in medical progress, mentioned above, I believe that medical progress is ripe to accelerate fast again.  Many of the enablers of this acceleration will come from fast-developing technology fields outside of traditional medicine, rather than from within it. These enablers will include:

• Improved low-cost health sensors coupled with ubiquitous inexpensive wireless communications, allowing early warning of impending medical issues
• More reliable expert systems that use more sophisticated AI to quickly evaluate patient symptoms to suggest the most likely diagnoses
• Community self-help, when isolated sufferers of rare conditions are able to provide mutual support over online social networking sites
• Personalised medicine, which takes advantage of information from analysis of individual human genomes to ensure that each patient receives treatments that are well-matched to them
• A transformation from macro-surgery via micro-surgery to nano-surgery, in which highly localised minimally invasive treatment can take place
• Use of robots to perform auxiliary nursing tasks
• Significantly more powerful computer modelling of biological systems, reducing the need for slow and risky direct human trials
• Breakthroughs in the use of stem cells to grow improved human organs
• Synthetic biology, in which techniques from software engineering can be applied to generate and manipulate new life forms with widespread application in healthcare.

Here’s just one example – an extract from the introduction to a review paper “Nanotechnology – A Review Of A Revolution In Cancer Treatment” written by Shreeraj Shah:

Nanotechnology … recently has emerged as one of the most propitious field in cancer treatment … a medical boon for diagnosis, treatment and prevention… It supports and expands the scientific advances in genomic and proteomics and builds on our understanding of the molecular underpinnings of cancer and its treatment… One [approach] includes localized delivery of heat and the localized imaging of biological materials through nanoparticles. The delivery may be in vitro or in vivo and is useful for the localized treatment of cancer and disorders involving over proliferation of tissue. Another approach relates to a novel process of manufacture of nanoparticles of substantially water insoluble materials from emulsions. These emulsions have the ability to form a single liquid phase upon dilution of the external phase, instantly producing dispersible solid nanoparticles. The formed nanoparticles can be used in a wide range of therapeutic treatments of cancer. An additional approach comprises of solid tumors having an acidic extra cellular environment and an altered pH gradient across their cell compartments… A widespread understanding of these new technologies can provide essential breakthroughs in the fight against cancer.

In short, medicine should benefit dramatically from technology convergence.

In a way, there’s nothing new here.  Medicine has always benefited from technology convergence: sometimes slowly, sometimes more quickly.  However, what’s different now, thankfully, is the scale of the technology convergence that’s possible.

Note that I say that this acceleration is possible – it’s not inevitable.  The outcome will depend, not just on technical matters, but on wider “system” matters such as social organisation, public motivation, and the full enablement of innovation.

Let’s look more closely at one aspect of converged medicine: the improvements in medical treatment that are enabled by advances in ubiquitous wireless communications and low-cost computing.  In turn, this splits into numerous different possibilities.  Here are just a few:

• Consider the example of prescribed drugs not being taken properly.  It is estimated that 40% of prescriptions are not taken at all by patients, and another 30% are taken incorrectly (for example, at the wrong time of day, or in the wrong amounts).  Patients sometimes form their own views as to whether treatments are working, and adjust their drug intake accordingly.  On other occasions, the variation from intended treatment is accidental, rather than deliberate.  In principle, small sensors could record when drugs are removed from their containers, and could alert physicians to abnormal usage.  This would cut down, both the costs of wasted (unused) drugs, and the costs of dealing with flare-ups and complications from faulty prescription taking.
• Up to 1 in 10 Americans suffer from asthma or a related chronic obstructive pulmonary disease (COPD) in which the lung is damaged, making it hard to breathe.  According to some forecasts, COPD may be the third largest cause of death in America by 2020.  People who suffer this disease are typically given one or more inhalers, with instructions on how to use them.  However, it is estimated that at least 50% of patients fail to use their inhalers properly, and that 45% of all the costs involved in treating COPD arise from this non-adherence.  Smart sensors on the inhalers would, again, provide physicians with important information, and could also play a role in helping patients to improve their use of the inhalers.
• Many of the health measurements that district nurses perform, when they visit patients in their homes, could in principle be done by the patient (or other people in the household), with easy-to-use test kits.  The results can then be uploaded for the district nurse to monitor.  This eliminates travel time and allows many more tests to take place in parallel.
• Video conferencing (whether by Skype on PCs, or by 3G mobile phones, or by dedicated channels over cable TV, etc) can enable tele-medicine, in which consultations can take place without requiring the co-location of the patient and medical specialist.  As a variant on this idea, a patient and a remote health worker might be co-located at one end of the call, with a specialist on the other end.  Alternatively, the remote specialist could be an expert AI system, that guides the health worker through a series of questions and answers regarding the patient.
• Devices such as smartphones can provide users with regular reminders and prompts regarding their declared intentions to change their lifestyle in certain ways.  The device could provide instant information about the appropriateness of various possible food purchases at a grocery store or in a restaurant.  A user might send a text to a dedicated number, saying “Woops, I’ve just eaten another doughnut”.  The system could text back encouragement, admonition, advice, and so forth.

In summary, as stated in a May 2010 New York Times article “High-Tech Alternatives to High-Cost Care“:

This trend promises to shift a lot of the diagnosis, monitoring and treatment of disease from hospitals and specialized clinics, where treatment is expensive, to primary care physicians and patients themselves — at far less cost.

However, in each of the above cases, the new system requires both technical and non-technical changes.  Lots of people could be anxious about aspects of the new system, and could therefore oppose it (either actively or passively).  In different ways, the new system might be seen as risking:

• The confidentiality of patient healthcare data
• The reliability of information gathered
• The quality of the advice delivered to the patient
• Confusion in the mind of the patient, who has to learn a new system
• Higher costs, due to additional equipment being needed
• Reduced profits, due to reduction in the usage of some existing expensive treatment
• The performance of a department’s budget (even though, for example, the hospital as a whole might benefit).

Since there are a lot of potential risks involved, there is a strong pressure to “play safe, and stick with the system we already use”.  But that attitude prevents converged medicine from having a chance at success.

Breakthrough innovation often requires new business models, new social connections, and new ways of thinking, as well as new technology.  It often requires the formation of new companies, operating with new processes.  For example, the companies that made successful minicomputers were different from the ones that had made successful mainframe computers.  Moving forward one more generation, the companies that made successful personal computers were different again.  Likewise, different sets of companies have been involved at the different stages in the development of mobile phones.  Sometimes existing companies manage to adapt, and transform themselves, but they typically only do so under the pressure of faster moving new companies.  More often, it’s not only that new companies emerge to take advantage of disruptive new technologies; it’s that new kinds of companies emerge.

My advice here – in line with the advice I gave in the previous chapter – is that, to drive progress with converged medicine, change agents need to bring a variety of different sets of expertise to bear (just as for the productisation of any other major technology disruption).  Depending on the circumstances, the full range of required expertise can span technology, ecosystem design, business models, community engagement, user experience, agile project management, lean processes, and system integration.  That’s a tough task, but it’s by no means impossible.  As I said above,

• The outcome will depend, not just on technical matters, but on wider “system” matters such as social organisation, public motivation, and the full enablement of innovation.

In a way, the most important factor might be the one I’ve labelled “public motivation”.  How seriously do the public really want significant improvements in healthcare to take place?  This level of motivation is going to have a huge impact on the amount of improvements that actually occur.  Will people generally continue to acquiesce with the idea that “sickness and death come to us all, sooner or later”?  Or will there be a determined and sustained outcry in favour of taking full advantage of the potential of converged medicine?

4.2 Better than well

Most of us have some powerful instincts about the allocation of resources to possible healthcare.  Consider the following hypothetical scenario.  You come across the scene of a nasty accident.  Two people are involved, both urgently needing medical attention.  The thing is, matters are so urgent that it’s likely that only the first person you help will survive.  Suppose one of the casualties is a 15 year old girl, and the other is her 75 year old grandmother.  Apart from the accident, both have been in good health.  Now both are equally imperilled.  You’d love to find some clever way to help both, but it seems you have to choose between the casualties.  Any delays risk both casualties dying.

In the heat of the moment, who do you choose to save?

You probably reasoned something like this: The young girl still has her whole life before her; the grandmother has already had a fair innings.  I’d prefer to save both.  But if I have to choose, I choose to save the youngster.

This reasoning is informed by a deep-rooted sense of fairness.  Our desire to promote fairness goes a long way.  Psychological tests have confirmed, on many occasions, that people tend to want to punish “free-riders” who cheat a system to gain an unfair advantage.  This desire to object against cheats often even makes people raise a complaint in an aggressive way that endangers the well-being of the person making the complaint.  From a purely selfish point of view, the most prudent course of action would be to keep quiet.  However, it seems that, in this case at least, our heritage can lead us to act in ways that benefit the well-being of our group or society, rather than our own narrow interest.  It’s likely that this heritage exists in part in our genes, and in part in our culture.

Our sense of fairness is one factor that may lead us to preferring to allocate resources to young patients instead of elderly ones.  It also leads us to prioritise “healing the sick” rather than “enhancing the healthy”.  But in this section, I want to argue that we can, and should, do both.  That is, rather than just seeking to raise everyone’s health to a level that is “well”, we should support people raising their health to a level that is “better than well”.  We should place no bar, for example, on people paying for Lasik laser eye surgery that improves their vision beyond 20-20.

If there is merit in people being healthy, there is extra merit in people being super-healthy.  Just as healthy people, on the whole, contribute more to society than people who are ill, super-healthy people can contribute even more again.  They make fewer errors due to tiredness.  They have stronger powers of concentration.  Their hands are less likely to wobble.  They are less prone to becoming irritable.  They see things more clearly.  They are less vulnerable to knocks and injuries.

In addition to providing an increased value to society, super health can provide significantly greater autonomy and choice to individuals, for leisure and recreation as well as for work.  This includes abilities:

• To see new colours, outside the ordinarily visible spectrum
• To enjoy swimming underwater for longer, without needing to carry an oxygen tank
• To go long periods of time without needing to eat, drink, or “take a bio break”
• To quickly acquire new information or learn new skills
• To fly like a bird – using wings and superhuman strength.

Some of these enhancements are longer-term ambitions.  They’re not all equally urgent.  But I see them as all lying within the scope of what converged medical technology can and should deliver.  In other words, I oppose any attempts to draw an unchangeable distinction between “natural” and “unnatural” uses of medicine.  I deny a firm demarcation between “therapy” (“cures” – that bring us health) and “enhancement” (that take us beyond health).  That’s because “health” is, itself, relative.  Someone who is judged as healthy, compared to one population, may well appear less healthy, compared to another group.  Should we pick one group of people and say that the legitimate purpose of medical technology is just to bring everyone up to the average level of health as experienced in that group at that time?

That kind of benchmark can make pragmatic sense at a given time, when there’s a limited amount of funding available.  But it makes no sense as an absolute limit, fixed for all time.  As treatments become cheaper and more effective, and as more funds are made available, the benchmark can improve.  For example, the benchmark might stipulate, at one time, that people of a certain age have the right to have only x% probability of dying from a particular kind of cancer within the next 12 months.  But over time, that benchmark probability value might change from x% to (x/10)%.

Here’s another way to think about this.  Compare a “health benchmark” with a “broadband communications benchmark”.  A country might at one time set a policy that 25% of all households should have broadband access with speed at least 10 Mbps.  But a few years later, due to improved technology, it might upgrade the targets, so that 50% of all households should have broadband access with speed at least 100 Mbps.  That’s progress.  What’s more, it would be a very stern government that forbade private citizens from spending additional money to gain even faster connections than the minimum specified in the target.  In the same way, it would be a very stern government that forbade private citizens from spending additional money to lower their death risk from a particular disease to a figure under the current national target.

How does this fit with our deep-rooted sense of fairness, mentioned earlier?  Some people might try to stick with the viewpoint that:

• Healthcare must always be made equally available to every citizen.  No one should be able to receive advance access to any treatment that is new, advanced, or otherwise different.

This achieves fairness – of a sort – by levelling down.  But another approach is to allow individuals to receive additional treatment, so long as the expectation exists that the treatment will in due course be available to everyone.  It’s like the way that new items of consumer technology are often initially expensive, but reduce in price over time, allowing more and more people to buy them.  That’s been the case with colour TVs, mobile phones, microwave ovens, and much more.  This is the viewpoint that:

• Healthcare must in due course be made equally available to every citizen.  Individuals are able to receive advance access to any treatment that is new, advanced, or otherwise different, so long as this is a prelude to anticipated wider availability.

This second viewpoint supports wider experimentation with treatments that are still provisional, allowing physicians to observe and learn about novel interactions.  It permits people to use treatments that can enhance performance, rather than just return performance to a nominal target known as “average health”.  As an important example, it supports experiments with genetic selection and enhancement:

• Using various methods (such as viral vectors or homologous recombination) to alter the genetic makeup of parts of someone’s body
• Analysing the genetic makeup of a set of in-vitro fertilised embryos pre-implantation, to decide which one(s) to insert into a mother’s womb
• Altering the genetic makeup of an embryo pre-implantation
• Similar experiments with egg and sperm cells pre-fertilisation.

This kind of genetic engineering can convey immunity to specific diseases – and, as such, can play a vital role in preventive medicine.  Moreover, in families where, for example, the first three children have all been boys, it would allow parents to have a girl for their next child.  In principle, it allows the replacement of the roulette lottery of natural conception with a set of deliberate choices.  Again, it will be possible to avoid characteristics that are, statistically, associated with drawbacks later in life – such as unduly short stature, or a genetic tendency to obesity.

Of course, there are potential drawbacks to such treatments:

• There could be medical drawbacks, with unexpected side-effects of genetic alterations (because, after all, genes often have complex overlapping influences).
• There could be social drawbacks – if, for example, a culture used sex selection to choose a disproportionate number of boy babies, or height selection to choose a disproportionate number of tall children (with an idea, perhaps, of children becoming basketball superstars).
• There could be legitimate moral concerns, if rich parents were able to give their children a very large genetic advantage, that others could subsequently not catch up: the playing field would be so far from “level” as to cause a fundamental separation of humans into “genetic haves” and “genetic have nots”.

In view of such issues, it is understandable that some people seek to ban this kind of treatment altogether.  But to my mind, that reaction is far too extreme.  There are other ways to address these issues, apart from banning the underlying technology.  For example, the best way to prevent a society having a disproportionate number of baby boys is to ensure, via powerful education, that everyone appreciates the benefits of both girl and boy children.  A powerful social conscience will also ensure that genetic treatments quickly become available to everyone – not just at time of conception, but also (in due course) later in people’s lives.  It’s because I believe in Education+ and Society+, that I’m also able to believe in Health+.

Extensive technological support for “better than well” is the inevitable consequence of the ongoing improvements in medicine – including converged medicine.  We should avoid being blocked from accessing this future.  Let’s not be diverted into opposing enhancement, by:

• A misguided sense of fairness – instead, the end result will be equality of opportunity at a much higher level
• The effects of the “status quo” bias, in which people tend to be unwittingly biased into thinking that the present situation (for example, current levels of health) represent the optimal possible
• Scaremongering by people who claim some kind of special religious or moral authority – these claims are out of place in the modern world
• A surfeit of unimaginative fiction writing, which sees only bad consequences of human enhancement therapies; see the fine book “Babies by design: the ethics of genetic choice” by Ronald Green for an illuminating analysis of the shortcomings of that kind of fear-laden prognostication
• Spurious associations with the forceful and discredited “eugenics” movement of the first half of last century; no one here is talking about compulsion or extermination
• General apprehension that attempted human enhancements are likely to have bad consequence – instead, improved education and improved social processes can head off these consequences.

Social support for “better than well” will form part of a broader movement demanding widespread enlightened and thoughtful application of technology to transform and improve the human condition.  Rather than fearing the outcomes as being culturally disruptive, we should be able to embrace them as assisting humanity on the profound route to much greater wisdom, vitality, and fulfilment.

4.3 Rejuveneering

Rejuveneering is a term introduced by longevity researcher Aubrey de Grey, as short hand for “rejuvenation engineering”.  It describes treatments which will rejuvenate individuals – repairing the damage that is generally known as “aging”.  It will allow people to retain, later and later into their lives, levels of fitness, appearance, and productivity previously typical only of younger people.  It’s the natural extension of phrases that are already commonplace, such as “fifty is the new forty” and “sixty is the new fifty”.

We are already aware of some significant precursors of rejuveneering:

• Hearing aids, spectacles, cataract operations, hip replacements – all allow people to remain active and productive for longer.
• Drugs such as Viagra extend sexual potency.
• Cosmetic surgery repairs physical damage to the skin.
• Better diet and better exercise extend the healthy portion of lifespans.

Rejuveneering takes these trends further.  The goal is to reduce the likelihood of people becoming ill (or losing their productivity) due to age-related conditions.  Rather than people in their 70s, 80s, 90s and beyond placing a disproportionate burden on the healthcare budget, these people should just need the same (small) amount of support as people in their 20s, 30s, and 40s.  Rather than the elderly being frail and dependent, needing to be supported by others, they will be full of zest and vigour, able to continue working, playing, studying, teaching, or doing anything else that they wish.  These people won’t just look younger (as a result of smart cosmetic surgery); they will feel younger, and act younger.  And, critically, they’ll be no more likely to die of illness or disease than younger people.  At present, the incidence of disease such as heart problems, diabetes, Parkinson’s, and Alzheimer’s rises markedly for someone beyond 70.  There will be no such trend for people who fully benefit from rejuveneering.

Full-scale rejuveneering is an audaciously ambitious goal.  It will take many steps to achieve it.  Initial treatments are likely to flush out minor amounts of bodily damage – somewhat similar in vision to a “detox diet”.  Later treatments should address wider amounts of this damage.  In due course, it will be similar to what happens with the maintenance of vintage cars.  These cars have far exceeded their originally envisaged lifespan – by means of owners painstakingly fixing and replacing parts which suffered from the wear and tear of the passage of time.  Rejuveneering will do the same with human bodies.  Exactly how this works will be the subject of extensive ongoing research.  But even a partial success will provide patients with a boost in longevity.  For example, suppose that some treatments are initially provided to someone with biological age 60, and result in the patient effectively having biological age 50.  Ten years later, the likelihood is that treatments will be more thorough, so re-application this time might result in the patient regaining an effective biological age of 45.  You get the idea.  The result is that people can expect to live indefintely long lives – barring accidents or the onset of an incurable new disease.

Aubrey de Grey has identified seven major classes of cellular and molecular damage in aging bodies:

1. Cell loss (tissue atrophy)
2. Mutations in cell nuclei (such as lead to cancer)
3. Mutations in cell mitochondria
4. Death-resistant cells
5. Tissue stiffening
6. Extracellular aggregates (junk outside cells)
7. Intracellular aggregates (junk inside cells).

He has also made suggestions for the kinds of treatment that could remove each of these types of damage.  Research proposals are shared at the regular SENS conferences held at Cambridge in the UK.  These involve many of the general ideas covered in the “Converged medicine” section earlier.  No doubt further new types of ideas will emerge as research intensifies.

Rejuveneering is an important special case of people being made “better than well” via new technologies.  It will bring at least four kinds of benefit:

• Dramatic reductions in the very considerable healthcare bills from age-related diseases and infirmities
• Reduction of the loss of wisdom and skills when people die prematurely (or aging otherwise causes them to become withdrawn or inactive)
• Reduction in the fear of aging and death which hangs over people and which often causes them to adopt bizarre irrational beliefs
• Reduction in the existential pain of apparently permanent separation from beloved friends and family members.

Many questions can be raised regarding rejuveneering.  Here are just a few – along with outline sketches of answers:

Q: Won’t people become bored with indefinitely long lifespans?  A: we’re not just talking about life extension; we’re taking about ongoing life expansion, in which there are so many new experiences to explore.  We’re not just “adding years to the life”; we’re “adding life to the years”.

Q: Won’t society become stifled by the ongoing presence of elderly people from previous generations?  How will younger generations get a chance to flourish?  A: If people such as Richard Feynman and Albert Einstein could have lived longer, I doubt they would have stifled the growth of new ideas.  On the contrary, they would have nourished them and embellished them.  What’s more, rules could be devised and agreed to ensure some element of rotation in personal responsibilities – akin to the rules which prevent US presidents from serving more than two terms in office (even if they are still highly popular).

Q: Won’t life extension lead to runaway over-population?  A: Not necessarily.  It’s true that the population would rise.  But, over time, we will find more and more places where humans can enjoy living – fuelled by the abundant energy that is being emitted from the sun (and from other sources).

Q: Won’t life extension put existing social relations under intolerable strain?  Who is going to commit to a marriage “until death do us part” if that death might be thousands of years in the future?  A: It’s true, life extension will pose new challenges to society.  But we can work out improvements and solutions over the decades and centuries ahead.  These problems are far less pressing than the original problem of premature aging and personal annihilation (involuntary death).

Q: Won’t life lose it’s meaning, without the impending shadow of death hanging over us?  A: I see that as a very diminished view of the value of life.  Most likely, that view comes from a religious heritage, which in turn only grew in power because of the unthinkability of rejuveneering.  But now that rejuveneering is becoming practical, it’s time to rethink our value systems.  In other words, it’s time for Humanity+.

Q: What about people who are dying before rejuveneering has the chance to be developed?  Can they have any hope?  A: As part of a renewed societal focus on rejunveneering, society should also prioritise research into cryonics – the idea that people who are declared clinically dead could be put into a state of deep suspension (for example, at a very low temperature) until such time as medical technology has developed a cure for the condition from which the person was suffering.  At that time, the person could be brought out of suspension (“re-animated”) and the Health+ cures applied.  In this way of thinking, someone who is declared “clinically dead” still has the potential for revival, provided no irretrievable brain damage occurs.  Sufficiently careful suspension and re-animation processes could, therefore, provide what has been termed “an ambulance into the future”.  The re-animation will use the radically enhanced technology of the future.

Q: Won’t treatments such as “better than well” and “rejuveneering” impose huge financial strains?  A: On the contrary, they’ll save a lot of money.  It’s true that the process to research and develop the treatments will initially consume resources.  However, these will be resources well spent.

Q: Won’t these treatments lead to a division in society, between “the enhanced” and “the unenhanced”, with the latter being forced to do lots of drudge work?  A: Drudge work is becoming increasingly mechanisable.  Rather than being done by humans, it will be done by robots (by automation).  And rather than the treatments only being available to a few people, reduced costs will allow them to become available to everyone.

Q: Isn’t this talk of cryonics just a fantasy?  And isn’t the idea rejuveneering likewise dependent on a naive over-simplification of the gross messiness of human biology?  A: These questions under-estimate the tremendous potential of converged medicine, and (more generally) of Technology+.  For example, imagine the kinds of treatments that could be devised and carried out by humans enhanced by hugely powerful artificial intelligence systems.  Keep reading, for a broader picture of what’s becoming possible.

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