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13 January 2022

Measuring – and forecasting – the health of the planet

Filed under: challenge, healthcare, Millennium Project — Tags: , , — David Wood @ 12:09 pm

An invitation to join a Millennium Project Delphi Study on the State of the Future

Assessments of individual health have been on my mind a lot recently, as I’ve observed my own physical body display less resilience in the face of stress than was the case when I was younger. (See my previous two blog posts, here and here, for the gory details.)

But alongside questions about the health of individuals, a larger set of questions loom. How is the health of global society as a whole? Are we headed toward major reversals, which could knock us collectively off course, akin to how diseases such as Covid-19 have intruded, often horribly, on individual lives?

Indeed, in any such assessment of the overall health of global society, what should we be measuring? Which factors are “symptoms” and which are closer to being “root causes”?

The Millennium Project has been addressing that subject on a regular basis since its formation in 1996. It regularly publishes updates on what it calls “The 15 global challenges” and, in a wider survey, “The State of the Future”.

What distinguishes the Millennium Project analysis from various other broadly similar enquiries is the “Delphi” method it uses to reach its conclusions. This involves an iterative online interaction between members of an extended community, who are asked their opinions on a number of questions, with the option for participants to revise their opinions if they read input from other respondents that brings new considerations to their mind.

The reason I’m mentioning this now is that a new Delphi survey is now starting, and there’s scope for a number of my acquaintances to take part. (Dear Reader: That includes you.)

This survey is being structured differently from previous years, and is using a new tool. Participants will be asked to offer estimates on 29 metrics for the year 2030 – including the best and worst potential value the indicator might have in 2030. You’ll also be asked which of the metrics are the most important (and which are the least).

To help you provide answers, the system already contains data points stretching several decades into the past.

The metrics include:

  • Income inequality (income share held by highest 10%)
  • Unemployment (% of total labour force)
  • Life expectancy at birth (years)
  • Physicians (per 1,000 people)
  • Literacy rate, adult total (% of people ages 15 and above)
  • People using safely managed drinking water services (% of population)
  • CO2-equivalent concentration in the atmosphere (ppm)
  • Energy efficiency (GDP per unit of energy use)
  • Electricity production from renewable sources (% of total)
  • Individuals using the Internet (% of population)
  • Proportion of seats held by women in national parliaments (% of members)
  • Number of conflicts between different states
  • Refugee population

You won’t have to answer all the questions. Instead, you can direct your attention to the questions where you feel you have some particular insight. You can browse the other questions at a later time. And, as mentioned, you can revisit some of your earlier answers once you see comments made by other participants. Indeed, it is in the interaction between different comments where the greatest insight is likely to arise.

If you think you’d like to take part, please get in touch with me. Note that the Millennium Project will give priority to people with the following roles: professional futurists, scientists (including social scientists as well as natural scientists), policymakers, science and technology experts, advisors to government or business, members of NGOs, UN liaison, and professional consultants.

The Delphi questionnaire will remain open until 31 January, 2022. The findings of the questionnaire will feature in a London Futurists event later in the year.

18 December 2021

My encounter with a four-armed robot

Filed under: aging, healthcare, robots — Tags: , , — David Wood @ 8:45 pm

I didn’t actually see the robot. My mind had already been switched off, by anaesthetists, ahead of my bed being wheeled into the operating theatre. It was probably just as well.

Image source: HCA Healthcare

Later, when my mind had restarted, and I was lying in recovery in my hospital ward, I checked. Yes, there were six small plasters on my abdomen, covering six small wounds (“ports”), that the urology surgeon had told me he would create in order for the da Vinci robot to work its magic.

Image source: Mayo Foundation for Medical Education and Research

The point of the operation was to remove the central core of my prostate – an organ that sits toward the back of the body and which is difficult to access.

The prostate wraps around the urethra – the channel through which urine flows from the bladder into the penis. The typical size of a prostate for a man aged twenty is around 20 ml. By age sixty this may have doubled. The larger the prostate, the greater the chance of interference with normal urine flow. In my own case, I had experienced various episodes over the last ten years when urination was intermittently difficult, but matters always seemed to right themselves after a few days. Then at the beginning of September, I found I couldn’t pass any urine. What made matters more complicated was that I was away from home at the time, on a short golfing holiday in Wiltshire. The golf was unusually good, but my jammed up bladder felt awful.

Following an anxious call to the NHS 111 service, I was admitted to the Royal United Hospital in Bath where, after a couple of false starts, an indwelling catheter was inserted through my urethra. Urine gushed out. I felt relieved as never before.

In a way, that was the easy bit. The harder question was what long-term approach to take.

A six-week trial of a muscle-relaxant drug called Tamsulosin had no impact on my ability to pass urine unaided. Measuring the size of my prostate via a transrectal ultrasound procedure clarified options: it was a whopping 121 ml.

The radiologist said “This is not the largest prostate I have ever seen”, but it was clear my condition was well outside the usual range. Not only would changes in medication or diet be very unlikely to produce a long-term solution for me. But most of the more standard prostate operations (there are a large family of possibilities, as I discovered) would not be suitable for a prostate as large as mine. The risks of adverse side-effects would be too large, as well as recurrence of prostate pressure in the years to come.

That led my consultant to recommend what is called a robotic-assisted simple prostatectomy. The “simple” is in contrast to the “radical” option often recommended for men suffering from prostate cancer. In a simple prostatectomy, the outer part of the prostate remains in place, along with nerve and other connections.

Over several hours, whilst my mind was deanimated, the robotic arms responded to the commands issued by the human surgeon. Some of the ports were used to introduce gas (CO2) into my abdomen, to inflate it, creating room for the robotic arms to move. Some ports supported illumination and cameras. And the others channelled various cutting and reconstruction tools. By the end, some 85% of my prostate had been removed.

It might sound cool, for a technology advocate like myself to receive an operation from a high-precision robot. But in reality, it was still a miserable experience, despite the high-calibre professional support from medical staff. The CO2 left parts of my body unexpectedly swollen and painful. And as time passed, other swellings known as oedemas emerged – apparently due to fluid.

I learned the hard way that I needed to take things slow and gentle as I recovered. In retrospect, it was a mistake for me to walk too far too soon, and to take part in lengthy Zoom calls. My sleep suffered as a result, with shivering, sweating, coughing fits, and even one black-out when I went to the bathroom and felt myself about to pass out. I had the presence of mind to lower my head quickly before the lights went out altogether. I came to my senses a few moments later, with my upper torso sprawled in the bath, and my lower body hanging over the edge. Thank goodness no serious damage ensued from that mini collapse. The only good outcome that night was when I took a Covid test (because of the coughing) and it came out negative.

Ten days later, things are closer to normal again. It’s wonderful that my internal plumbing works smoothly again, under my control. But I’m still being cautious about how much I take on at any time.

(If you’re waiting for me to reply to various emails, I’ll get round to them eventually…)

More good news: tests on the material removed from my body have confirmed that the growth was “benign” rather than cancerous. My wounds are healing quickly, and I am almost weaned off painkillers.

I have no regrets about choosing this particular surgical option. It was a good decision. Hopefully I’ll be playing golf again some time in January. I am already strolling down some of the fairways at Burhill Golf Club, carrying a single club in my hand – a putter. I drop a golf ball when I reach the green. Sometimes I knock the ball in the hole in two putts, or even just one. And sometimes it’s three putts, or even more. But the fresh air and gentle exercise is wonderful, regardless of the number of putts.

The bigger lesson for me is a message I often include in my presentations: prevention is better than cure. A stitch in time saves nine.

Earlier attention to my enlarging prostate – either by a change of diet, or by taking medicines regularly – may well have avoided all the unpleasantness and cost of the last few months.

As for the prostate, so also for many other parts of the body.

This year, I’ve been thinking more and more about the good health of the mind and the brain. With my reduced mobility over the last few months, I’ve had time to catch up with some reading about brain rewiring, mental agility and reprogramming, the role and content of consciousness, and ways in which people have recovered from Alzheimer’s.

Once again, the message is that prevention is better than cure.

If you’re interested in any of these topics, here’s an image of some books I have particularly enjoyed.

3 September 2021

Aging, slowing down, becoming a cyborg

Filed under: aging, healthcare — Tags: , , , , , , — David Wood @ 8:02 pm

Here’s a personal note. I’ve had to change quite a few of my plans, due to an unexpected medical issue.

(It’s nothing to do with Covid. The details are below, for readers with a stomach for indelicate topics.)

That issue completely disrupted my activities yesterday and the day before, and it is likely to cause further disruptions in the weeks and months ahead – depending on how my body responds to various treatments.

In any case, I’m going to have to slow down a bit. I may need to cancel some of my provisional travel plans, and spend less time in front of screens and keyboards.

Please accept my apologies in advance if you’re waiting to hear from me about something, and I seem to be unduly slow in responding.

I said my medical issue was “unexpected”, but that’s not the whole story.

I’ve known for some time that potential danger was building up in my body.

It’s an aspect of aging. Our bodies perform remarkably well while we’re in our youth, but over time, various sorts of damage and dysfunction start to build up.

In early years, that damage doesn’t matter much. The body is healthy enough to carry out repairs, and to produce workarounds to compensate for the decline in performance.

Eventually, however, the dysfunction becomes too severe, and results in greater amounts of harm, disease, frailty, and (in due course) death.

That’s why, for example, human mortality (along with the mortality of many other species) accelerates exponentially over time.

If you analyse the data from the UK’s National Life Tables for how many people at any particular age, you’ll find the following:

  • A ten year old has only one chance in around 10,000 of dying before their next birthday
  • A 35 year old has one chance in around 1,000 of dying before their next birthday
  • A 60 year old has one chance in around 100 of dying before their next birthday
  • An 85 year old has one chance in around 10 of dying before their next birthday.

(I did that particular analysis a few years ago. An analysis of the most recent life tables data may show slight differences.)

You’ll spot the pattern.

The pattern isn’t exact. (Otherwise no 110 year old would ever reach the age of 111. Which is what an extrapolation of the previous figures would suggest.)

But it holds to a first approximation. It was first stated in 1825 by London-based actuary and mathematician Benjamin Gompertz, and is sometimes expressed as follows: After the age of around 35, human mortality doubles every eight years.

And it’s plausible that what underlies this observed trend is a gradual increase in damage throughout the biological structures of the body – including damage in those aspects of our biology responsible for repair and regeneration.

That’s the general pattern. One specific example involves the prostate organ. Over time, in some men, the prostate grows and grows, to the extent that it constricts the urethra which passes through it. That constriction slows the flow of urine from the bladder to the outside world.

(As I said, this is an indelicate subject. But it can in some cases become a matter of life and death.)

And that’s what has happened to me.

I’ve known for some time that my prostate had grown large, and was interfering with my “plumbing”.

I now regret that I didn’t pay more attention to that growing risk. I was too easily reassured by observing that the problem seemed to wax and wane. I remember hearing that, for many people, the issue remains tolerable throughout their life. Indeed, the NHS webpage on the topic starts as follows (my emphasis):

Benign prostate enlargement (BPE) is the medical term to describe an enlarged prostate, a condition that can affect how you pee (urinate).

BPE is common in men aged over 50. It’s not a cancer and it’s not usually a serious threat to health.

I knew there were medicines that might help, such as Tamsulosin (brand name “Flomax Relief”) – but that they had side-effects.

So I gave the matter little attention.

But two days ago, my problems passing urine suddenly became a lot worse. I had a constant desire to “go”, but an inability to produce more than the tiniest trickle (after a lot of, err, stressing and straining).

To complicate matters, I was away from home. With my wife and two other couples, I was meant to be enjoying a three day golfing holiday in the picturesque Wiltshire countryside.

Yesterday morning, having failed to reach my own GPs online or by phone, I called the NHS 111 service. To cut to the chase, I was advised to get to a hospital as soon as possible. They made an appointment for me at a hospital in Bath, around 30 minutes car journey distant. And soon after that, I was being examined by an excellent team of NHS staff.

When someone’s bladder is full, it’s normally around 400 to 600 ml in volume. Ultrasound scans showed there was around 900 ml of urine in my bladder. No wonder I was feeling so uncomfortable.

I hadn’t expected to be in hospital that day, but thank goodness I was there.

I’ll skip over all the phases of analysis and treatment, and just mention that I am now slightly more of a cyborg than before. I’ve had a cleverly engineered piece of plastic inserted into my body, allowing me to drain my bladder at will, using a tap at the end of a tube which protrudes. It’s called an indwelling catheter.

It’s most likely only a temporary solution, until my response to Tamsulosin (the drug mentioned earlier) is assessed.

For the time being, my mobility is restricted, until I get used to this new attachment.

And my mind is, how to put it, rather shaken at the turn of events.

But things could have been a great deal worse. I’m deeply grateful for the rapid, painstaking response of the dozen or so members of the Royal United Hospital Bath who took such good care of me.

In moments of lucidity during these hours, I reflected on how much we all depend on each other. Rugged individualism only goes so far.

In the meantime, I’ll move forward with at least some of my projects, including the online London Futurists events already scheduled. They include one on (guess what?) aging, in two weeks time, and one on “Cryptocurrencies for profound good?” taking place tomorrow.

Opening image credit: Wolfgang Eckert from Pixabay.

14 May 2020

The second coming of the Longevity Dividend

Filed under: books, healthcare, market failure, politics, rejuveneering — Tags: , , — David Wood @ 8:25 am

Please find below an extended copy of my remarks at today’s online Round Table of the Business Coalition for Healthier Longer Lives, jointed hosted by the UK’s APPG (All Party Parliamentary Group) on Longevity and Longevity Leaders.

(The stated goal of today’s Round Table is “Development of values for the Business Coalition for Healthier Longer Lives”.)

I’m David Wood, and I’ve been researching future scenarios for over 30 years.

The concept I want to put on the table today is that of the Longevity Dividend.

It’s actually a kind of second coming of the Longevity Dividend, since the idea was first proposed some 14 years ago by a quartet of distinguished longevity researchers (PDF).

It’s a good concept, but didn’t take hold in its first coming, for reasons I’ll get to shortly.

The core idea is that it is economically sensible – that is, financially wise – for society to make investments in research,

  • not just into individual aspects of aging,
  • nor just into individual diseases of aging,
  • but rather into the common root causes of many of the diseases and other adverse characteristics of aging

– that is, research into items we would nowadays call the hallmarks of aging.

The argument is that such investments wouldn’t just be positive from a humanitarian point of view. They would also be very positive from a medium-term financial point of view.

We can sum up their likely benefits in the age-old saying, a stitch in time saves nine. Healthier long-lived people are better contributors to the economy, and better consumers of the economy, rather than being a nine-fold drain.

To move forwards with this concept of the Longevity Dividend, we have to acknowledge that the calculations of costs and benefits are inherently probabilistic.

There are no guarantees that any particular research investments will prove successful. But that’s no reason for society to avoid making these investments into the hallmarks of aging. VCs already know well how to adjust their portfolios on account of probabilistic calculations.

The reason the first coming of the Longevity Dividend didn’t get very far, in the public mind, was that people implicitly rated the probabilities of these therapies succeeding as being very low. Why speculate about potential economic benefits of biorejuvenation interventions if these interventions have little chance of working? However, with lots of more promising research having taken place in the last 14 years, it’s no longer possible to wave away this calculation of significant benefits. So it’s time to bring the Longevity Dividend into the centre stage of public discussion.

The Longevity Dividend has a partner concept: that of Super Agers. They’re people who reach the age of 95 with minimal experience of cancer, heart disease, dementia, or diabetes. Of course, these Super Agers do succumb to one or other disease in due course. Often an infection. But the total healthcare cost of these people, throughout their long lives, is usually less than the total healthcare cost of people who have shorter lives. Quite a lot less total healthcare cost.

So one way to realise the Longevity Dividend would be to put more research into understanding what’s different about Super Agers.

But why isn’t this happening (or not happening much)? We need to go deeper into this topic.

We need to reflect on the general poor regard that society places in practice into any measures that prevent diseases rather than curing them.

Previous discussions in this series of Round Tables have highlighted how our societal incentive structures are deeply flawed in this regard.

Without addressing this misalignment, there’s unlikely to be much progress with the Longevity Dividend.

So one of the big outcomes of our collective deliberations must be to demand sustained attention to the question of how to alter society’s overall priorities and incentives.

And there’s an important lesson from history here, which will be my final remarks for now. That lesson is that the free market, by itself, cannot fix problems of flawed societal incentives. That kind of thing needs political action. But the politicians can be aided in this by industry groups stepping forward with specific agreed proposals.

It’s similar to how factory owners actually helped pressurise politicians in this country, two centuries ago, into changing the law about children working in their factories.

These factory owners saw that economic incentives were pressurising them into employing children, against their own humanitarian instincts. Many of these factory owners, as individuals, felt unable to stop hiring children, for fear of being out-competed and going out of business. It needed a change in law to cause that practice to change. And networks of factory inspectors to ensure conformance to the law.

Working out a similar change of law in the early 2020s is surely a key practical activity for this business coalition, so that prevention moves to centre stage, and with it, the concepts of Longevity Dividend and Super Agers. Thank you.

Further reading

For an extended analysis of the economic arguments about the Longevity Dividend, see Chapter 9, “Money Matters”, of my book The Abolition of Aging.

For the reasons why people disregard the economic and other logical arguments in favour of society investing more in a potential forthcoming radical extension of healthy human longevity, see Chapter 10, “Adverse Psychology”, of the same book.

For the example of the coalition to change the laws on child employment, see the section “When competition needs to be curtailed” in Chapter 9, “Markets and fundamentalists” of my book Transcending Politics.

 

12 May 2020

Five scenarios to unwind the lockdown. Are there more?

Filed under: challenge, healthcare, politics, risks — Tags: , , — David Wood @ 1:55 pm

The lockdown has provided some much-needed breathing space. As a temporary measure, it has helped to prevent our health services from becoming overwhelmed. In many (though not yet in all) countries, the curves of death counts have been slowed, and then tilted downwards. Financial payments to numerous employees unable to work have been very welcome.

As such, the lockdown – adopted in part by individuals and families making their own prudent decisions, and in part due to government advice and edict – can be assessed, provisionally, as a short-term success, given the frightful circumstances in which it emerged.

But what next? The present set of restrictions seems unsustainable. Might a short-term success transition into a medium-term disaster?

The UK’s Chancellor of the Exchequor, Rishi Sunak, recently gave the following warning, referring to payments made by the government to employees whose companies have stopped paying them:

We are potentially spending as much on the furlough scheme as we do on the NHS… Clearly that is not a sustainable situation

What’s more, people who have managed to avoid meeting friends and relatives for two or three months, may become overwhelmed by the increasing strain of separation, especially as mental distress accumulates, or existing family relations rupture.

But any simple unwinding of the lockdown seems fraught with danger. Second waves of infection could shoot up, once social distancing norms are relaxed. In country after country around the world, tentative steps to allow greater physical proximity have already led to spikes in the numbers of infections, followed by reversals of the relaxation. I recently shared on my social media this example from South Korea:

South Korea: bars and nightclubs to close down for 30 more days after health officials tracked 13 new Covid cases to a single person who attended 5 nightclubs and bars in the country’s capital city of Seoul

One response on Twitter was the single word “Unsustainable”. And on Facebook my post attracted comments criticising the approach taken in South Korea:

It is clear Korea is going to be looking over its shoulder for the indefinite future with virtually no immunity in the population.

I have considerable sympathy with the critics: We need a better solution than simply “crossing fingers” and nervously “looking over the shoulder”.

So what are the scenarios for unwinding the lockdown, in a way that avoids the disasters of huge new spikes of deaths and suffering, or unprecedented damage to the global economy?

To be clear, I’m not talking here about options for restructuring society after the virus has been defeated. These are important discussions, and I favour options for a Great Reconsideration. But these are discussions for another day. First, we need to review scenarios for actually defeating the virus.

Without reaching clarity about that overall plan, what we can expect ahead is, alas, worse confusion, worse recrimination, worse health statistics, worse economic statistics, and a worse fracturing of society.

Scenario 1: Accelerate a cure

One scenario is to keep most of society in a state of social distancing until such time as a vaccine has been developed and deployed.

That was the solution in, for example, the 2011 Steven Soderbergh Hollywood film “Contagion”. After a few setbacks, plucky scientists came to the rescue. And in the real world in 2020, after all, we have Deep Learning and advanced biotech to help us out. Right?

The main problem with this scenario is that it could take up to 18 months. Or even longer. Although teams around the world are racing towards potential solutions, we won’t know for some time whether their ideas will prove fruitful. Bear in mind that Covid-19 is a coronavirus, and the number of successful vaccines that have been developed for other coronaviruses is precisely zero. Technology likely will defeat the virus in due course, but no-one can be confident about the timescales.

A variant of this scenario is that other kinds of medical advance could save the day: antivirals, plasma transfers, antimalarials, and so on. Lifespan.io has a useful page tracking progress with a range of these potential therapeutics. Again, there are some hopeful signs, but, again, the outcomes remain uncertain.

So whilst there’s a strong case for society getting more fully behind a considerable number of these medical research projects, we’ll need in parallel to consider other scenarios for unwinding the lockdown. Read on.

Scenario 2: Exterminate the virus

A second scenario is that society will become better at tracking and controlling instances of the virus. Stage by stage, regions of the planet could be declared as having, not just low rates of infectious people, but as having zero rates of infectious people.

In that case, we will be freed from the risk of contracting Covid-19, not because we have been vaccinated, but because there are no longer any infectious people with whom we can come into contact.

It would be similar to how smallpox was gradually made extinct. That virus no longer exists in the wild. One difference, however, is that the fight against smallpox was aided, since 1796, by a vaccine. The question with Covid-19 is whether it could be eradicated without the help of a vaccine. Could it be eradicated by better methods of:

  • Tracking which people are infectious
  • Isolating people who are infectious
  • Preventing travel between zones with infections and those without infections?

This process would be helped once there are reliable tests to ascertain whether someone has actually had the virus. However, things would become more complicated if the virus can recur (as has sometimes been suggested).

Is this scenario credible? Perhaps. It’s worth further investigation. But it seems a long shot, bearing in mind it would need only a single exception to spark a new flare up of infections. Bear in mind that it was only a single infectious hotspot that kick-started this whole global pandemic in the first place.

Scenario 3: Embrace economic reversal

If Scenario 1 (accelerate a cure) and Scenario 2 (exterminate the virus) will each take a long time – 18 months or more – what’s so bad about continuing in a state of lockdown throughout that period? That’s the core idea of Scenario 3. That scenario has the name “Embrace economic reversal” because of the implication of many people being unable to return to work. But would that be such a bad thing?

This scenario envisions a faster adoption of some elements of what has previously been spoken about as a possible longer term change arising from the pandemic – the so-called Great Reconsideration mentioned above:

  • Less commuting
  • Less pollution
  • Less time spent in offices
  • Less time spent in working for a living
  • Appreciation of life freed from a culture of conspicuous consumption
  • Valuing human flourishing instead of GDP
  • Adoption of a Universal Basic Income, and/or alternatives

If these things are good, why delay their adoption?

In short, if the lockdown (or something like it) were to continue in place for 18 months or longer, would that really be such a bad outcome?

The first problem with this scenario is that the lockdown isn’t just getting in the way of parts of life that, on reflection, we might do without. It’s also getting in the way of many of the most precious aspects of life:

  • Meeting people in close physical proximity as well as virtually
  • Choosing to live with a different group of people.

A second problem is that, whilst the true value of many aspects of current economic activity can be queried, other parts of that economy play vital support roles for human flourishing. For as long as a lockdown continues, these parts of the economy will suffer, with consequent knock-on effects for human flourishing.

Finally, although people who are reasonably well off can cope (for a while, at least) with the conditions of the lockdown, many others are already nearing the ends of their resources. For such people, the inability to leave their accommodation poses higher levels of stress.

Accordingly, whilst it is a good idea to reconsider which aspects of an economy really matter, it would be harsh advice to simply tell everyone that they need to take economic decline “on the chin”. For too many people, such a punch would be a knock-out blow.

Scenario 4: Accept higher death statistics

A different idea of taking the crisis “on the chin” is to accept, as a matter of practicality, that more people than usual will die, if there’s a reversal of the conditions of lockdown and social distancing.

In this scenario, what we should accept, isn’t (as in Scenario 3) a reversal of economic statistics, but a reversal (in the short-term) of health statistics.

In this scenario, a rise in death statistics is bad, but it’s not the end of society. Periodically, death statistics do rise from time to time. So long as they can still be reasonably controlled, this might be the least worst option to consider. We shouldn’t become unduly focused on what are individual tragedies. Accordingly, let people return to whatever kinds of interaction they desire (but with some limitations – to be discussed below). The economy can restart. And people can once again enjoy the warmth of each others’ presence – at music venues, at sports grounds, in family gatherings, and on long-haul travel holidays.

Supporters of this scenario sometimes remark that most of the people who die from Covid-19 probably would have died of other causes in a reasonably short period of time, regardless. The victims of the virus tend to be elderly, or to have underlying health conditions. Covid-19 might deprive an 80 year old of an additional 12 months of life. From a utilitarian perspective, is that really such a disastrous outcome?

The first problem with this scenario is that we don’t know quite how bad the surge in death statistics might be. Estimates vary of the fatality rate among people who have been infected. We don’t yet know, reliably, what proportion of the population have been infected without even knowing that fact. It’s possible that the fatality rate will actually prove to be relatively low. However, it’s also possible that the rate might rise:

  • If the virus mutates (as it might well do) into a more virulent form
  • If the health services become overwhelmed with an influx of people needing treatment.

Second, as is evident from the example of the UK’s Prime Minister, Boris Johnson, people who are far short of the age of 80, and who appear to be in general good health, can be brought to death’s door from the disease.

Third, even when people with the virus survive the infection, there may be long-term consequences for their health. They may not die straightaway, but the quality of their lives in future years could be significantly impaired.

Fourth, many people recoil from the suggestion that it’s not such a bad outcome if an 80 year old dies sooner than expected. In their view, all lives area valuable – especially in an era when an increasing number of octogenarians can be expected to live into their 100s. We are struck by distaste at any narrow utilitarian calculation which diminishes the value of individual lives.

For these reasons, few writers are quite so brash as to recommend Scenario 4 in the form presented here. Instead, they tend to advocate a variant of it, which I will now describe under a separate heading.

Scenario 5: A two-tier society

Could the lockdown be reconfigured so that we still gain many of its most important benefits – in particular, protection of those who are most vulnerable – whilst enabling the majority of society to return to life broadly similar to before the virus?

In this scenario, people are divided into two tiers:

  • Those for whom a Covid infection poses significant risks to their health – this is the “high risk” tier
  • Those who are more likely to shrug off a Covid infection – this is the “low risk” tier.

Note that the level of risk refers to how likely someone is to die from being infected.

The idea is that only the high risk tier would need to remain in a state of social distancing.

This idea is backed up by the thought that the division into two tiers would only need to be a temporary step. It would only be needed until one of three things happen:

  • A reliable vaccine becomes available (as in Scenario 1)
  • The virus is eradicated (as in Scenario 2)
  • The population as a whole gains “herd immunity”.

With herd immunity, enough people in the low risk tier will have passed through the phase of having the disease, and will no longer be infectious. Providing they can be assumed, in such a case, to be immune from re-infection, this will cut down the possibility of the virus spreading further. The reproduction number, R, will therefore fall well below 1.0. At that time, even people in the high risk tier can be readmitted into the full gamut of social and physical interactions.

Despite any initial hesitation over the idea of a two-tier society, the scenario does have its attractions. It is sensible to consider in more detail what it would involve. I list some challenges that will need to be addressed:

  • Where there are communities of people who are all in the high risk tier – for example, in care homes, and in sheltered accommodation – special measures will still be needed, to prevent any cases of infection spreading quickly in that community once they occasionally enter it (the point here is that R might be low for the population as a whole, but high in such communities)
  • Families often include people in both tiers. Measures will be needed to ensure physical distancing within such homes. For example, children who mix freely with each other at school will need to avoid hugging their grandparents
  • It will be tricky – and controversial – to determine which people belong in which tier (think, again, of the example of Boris Johnson)
  • The group of people initially viewed as being low risk may turn out to have significant subgroups that are actually at higher risk – based on factors such as workplace practice, genetics, diet, or other unsuspected underlying cases – in which case the death statistics could surge way higher than expected
  • Are two tiers of classification sufficient? Would a better system have three (or more) tiers, with special treatments for pregnant women, and for people who are somewhat elderly (or somewhat asthmatic) rather than seriously elderly (or seriously asthmatic)?
  • The whole concept of immunity may be undermined, if someone who survives an initial infection is still vulnerable to a second infection (perhaps from a new variant of the virus)

Scenario 6: Your suggestions?

Of course, combinations of the above scenarios can, and should, be investigated.

But I’ll finish by asking if there are other dimensions to this landscape of scenarios, that deserve to be included in the analysis of possibilities.

If so, we had better find out about them sooner rather than later, and discuss them openly and objectively. We need to get beyond future shock, and beyond tribal loyalty instincts.

That will reduce the chances that the outcome of the lockdown will be (as stated earlier) worse confusion, worse recrimination, worse health statistics, worse economic statistics, and a worse fracturing of society.

Image credit: Priyam Patel from Pixabay.

5 December 2019

Nano comes to life

Filed under: books, healthcare, nanotechnology, Oxford — Tags: , , , — David Wood @ 12:44 am

To make progress in biotechnology, the discipline of software engineering will be key. Right?

After all, life is the outcome of what is known as the genetic code. Our biological metabolism is the execution of that code in our cells, extra cellular structures, organs, various circulatory systems, and so on. Admittedly, that code lacks documentation, and has no comments to guide our understanding. Indeed, it has been described as worse than the worst of human-written “spaghetti” code. Such is the complexity. But in due course, we can expect the painstaking application of methods of reverse software engineering to induce biology to give up its deepest secrets. Right?

Not so fast. The message in the recent new book by Oxford University Professor Sonia Contera, Nano Comes to Life, is that if we want to make better progress with biology, we need to increase our understanding of physics. Yes, physics – including mechanics, surface tension, electrostatic forces, dynamic motion, and so on.

Consider our DNA. Parts of our chromosomes consist of genes that cause our cells to create various proteins. The mapping of elements of chromosomes to specific proteins is, indeed, governed by a genetic code. The elucidation of that code has been one of the great triumphs of scientific endeavour in the last hundred years. That same endeavour, however, threw up a puzzle: large parts of our DNA – perhaps the majority of it – seem to be “junk”. It consists of multiple copies of genes that no longer create proteins. Various ideas developed for why these DNA segments exist – viewing them as self-serving, or “selfish”: they exist because they are copied into new generations, and that’s all there is to say about the matter.

However, there’s more than one level to think about our DNA. Yes, it consists of genes. But it also exists as a complex 3D structure, which folds and coils. Depending on the precise folding and coiling – and on whether some molecular groups known as methyls or acetyls are added into a kind of skin for the DNA – different genes are exposed to chemical interactions. We say that different genes can be turned “on” or “off”. Without the long chains of intermediary so-called “junk” DNA between various genes, these 3D interactions wouldn’t take place. The folding and coiling would be different. In other words, junk DNA may be purposeful after all, not in terms of its biochemical interactions, but in terms of its mechanical interactions.

One suggestion in Nano Comes to Life is that mechanical pressure on a cell can result in pressure on the nucleus of the cell, which can, in turn, change the precise 3D shapes of various chromosomes, altering which genes are turned on or off. In other words, external stresses and strains from the environment could directly alter the genetic expressions inside cells.

The limits of reductionism

The suggestion just given is but one example of a thesis which Nano Comes to Life brilliantly highlights: we should avoid becoming carried away with the methodology of reductionism. Reductionism looks for the causes of complex phenomena in a fuller analysis of the constituent parts of the larger system. To understand human biology we need to understand cells. To understand cells we need to understand chemistry. To understand chemistry we need to understand physics. To understand physics we need to understand mathematics. All that is true… but it is not the whole story.

I confess that when I hear people criticising reductionism, I become apprehensive. I half expect the conversation to continue as follows: we cannot understand biology in terms of chemistry, so that proves that aliens did it. Or that psychic telepathy exists. Or that humans are designed by a supernatural deity. Or that magic dwells deep in the universe. Or some other (unjustified) leap of faith.

However, emphatically, that’s not the kind of criticism of reductionism that you’ll find in Nano Comes to Life. Instead, the message is a kind of restatement of the saying often attributed to Einstein:

Everything should be made as simple as possible, but not simpler.

In other words, true progress in biology is likely to come, not from single-minded pursuits of individual lines of thinking, but, instead, from the interplay of multiple levels of understanding. That interplay can give rise to emergence.

Progress in multiple fields

Nano Comes to Life contains an impressive survey of fast progress that is being made in multiple labs around the world (in research universities and in commercial settings) precisely by adopting this multi-level thinking. The book brings readers up to date with remarkable recent research breakthroughs in techniques such as:

  • DNA nanotechnology (including DNA origami),
  • novel protein synthesis via nanotechnology,
  • nanomaterials and transmaterials – which combine features of biological materials with those from outside biology,
  • the creation of replacement organs, as well as “organs on a chip” (very useful for drug testing purposes),
  • targeted cancer drug delivery systems,
  • avoidance of the threat of growing antibiotic resistance,
  • enhancing the immune system,
  • and other aspects of what is known as nanomedicine.

The book also provides fascinating insight into the history and practice of cutting-edge laboratory science.

The context: a vision delayed

I’ve been aware of the field of nanotechnology since some time around the year 1990, when I came across the very first book written on that subject. That book was Engines of Creation: The Coming Era of Nanotechnology, by Eric Drexler (first published in 1986). Reading that book that significantly raised my awareness of the scale of the profound positive transformation that technology could in due course enable in the human condition. Reflecting the importance of that book on the subsequent trajectory of my thinking, a picture of me holding my copy of it was my cover photo on Facebook for a number of years.

(Thanks to Yanna Buryak for snapping this picture of me at just the right moment.)

Eric Drexler’s 1986 book foresaw the eventual deliberate systematic manipulation of matter to create myriad nanoscale levers, shafts, conveyor belts, gears, pulleys, motors, and more. In ways broadly similar to the marvellous operation of ribosomes within biological cells, specially designed nanofactories will be able to utilise atomically precise engineering to construct numerous kinds of new material products, molecule by molecule.  But whereas the natural nanotechnology of ribosomes involves processes that evolved by blind evolution, synthetic nanotechnology will involve processes intelligently designed by human scientists. These scientists will take inspiration from biological templates, but can look forward to reaching results far transcending those of nature.

But despite the upbeat vision of Engines of Creation, progress with many of the ideas Drexler envisioned has proven disappointingly slow. Although the word “nanotechnology” has entered general parlance, it has mainly referred to developments that fall considerably short of the full vision of nanofactories. Thus we have nanomaterials, including nanowires and nanoshells. We have techniques of 3D printing that operate at the nanoscale. We have nanoparticles with increasing numbers of uses. However, the full potential of nanotechnology, envisioned all these years ago by Drexler, remains a future vision.

What Sonia Contera’s book Nano Comes To Life provides, however, is a comprehensive summary of progress within the last few years – and grounds for foreseeing continuing progress ahead.

Why the 2010s are the new 1830s

A clear sign of progress – at last – with nanomachines was the award of the Nobel Prize for Chemistry in 2016. This prize was jointly received by Fraser Stoddart from Scotland, Bernard Feringa from the Netherlands, and Jean-Pierre Sauvage from France, in recognition of their pioneering work in this field – such as finding ways to convert chemical energy into purposeful mechanical motion.

As the Nobel committee remarked, nanomachines in the 2010s are at a roughly similar situation to electrical motors of the 1830s: the basic principles of the manufacture and operation of these machines are just becoming clear. The scientists in the 1830s who demonstrated a variety spinning cranks and wheels, powered by electricity, could hardly have foreseen the subsequent wide incorporation of improved motors in consumer goods such as food processors, air conditioning fans, and washing machines. Likewise, as nanomachines gain more utility, they can be expected to revolutionise manufacturing, healthcare, and the treatment of waste.

It is these future revolutions which feature in Nano Comes to Life – particularly in the field of medicine and health. Importantly, these future revolutions are described in the book, not as any kind of inevitable development, but as something whose form and value will depend critically on choices taken by humans – individually and collectively. Indeed, in an epilogue to the book, the author points to a number of encouraging trends in how scientists, technologists, general citizens, and artists, are interacting to raise the probability that the full benefits of nanotechnology will be spread widely and fairly throughout society. It’s another example of the need to think about matters at more than one level at the same time.

The messages in that final section are ones with which I wholeheartedly agree.

Postscript: For a deeper dive

To hear Sonia Contera present her ideas in more depth, and to join a public Q&A discussion about the implications, check out the London Futurists event happening this Saturday (7th December).

1 October 2019

“Lifespan” – a book to accelerate the emerging paradigm change in healthcare

Filed under: AGI, aging, books, healthcare — Tags: , , , , , , , , — David Wood @ 6:11 am

Harvard Medical School professor David Sinclair has written a remarkable book that will do for an emerging new paradigm in healthcare what a similarly remarkable book by Oxford University professor Nick Bostrom has been doing for an emerging new paradigm in artificial intelligence.

In both cases, the books act to significantly increase the tempo of the adoption of the new paradigm.

Bostrom’s book, Superintelligence – subtitled Paths, Dangers, Strategies – caught the attention of Stephen Hawking, Bill Gates, Elon Musk, Barack Obama, and many more, who have collectively amplified its message. That message is the need to dramatically increase the priority of research into the safety of systems that contain AGI (artificial general intelligence). AGI will be a significant step up in capability from today’s “narrow” AI (which includes deep learning as well as “good old fashioned” expert systems), and therefore requires a significant step up in capability of safety engineering. In the wake of a wider appreciation of the scale of the threat (and, yes, the opportunity) ahead, funding has been provided for important initiatives such as the Future of Life Institute, OpenAI, and Partnership on AI. Thank goodness!

Sinclair’s book, Lifespan – subtitled Why We Age, and Why We Don’t Have To – is poised to be read, understood, and amplified by a similar group of key influencers of public thinking. In this case, the message is that a transformation is at hand in how we think about illness and health. Rather than a “disease first” approach, what is now possible – and much more desirable – is an “aging first” approach that views aging as the treatable root cause of numerous diseases. In the wake of a wider appreciation of the scale of the opportunity ahead (and, yes, the threat to society if healthcare continues along its current outdated disease-first trajectory), funding is likely to be provided to accelerate research into the aging-first paradigm. Thank goodness!

Bostom’s book drew upon the ideas of earlier writers, including Eliezer Yudkowsky and Ray Kurzweil. It also embodied decades of Bostrom’s own thinking and research into the field.

Sinclair’s book likewise builds upon ideas of earlier writers, including Aubrey de Grey and (again) Ray Kurzweil. Again, it also embodies decades of Sinclair’s own thinking and research into the field.

Both books are occasionally heavy going for the general reader – especially for a general reader who is in a hurry. But both take care to explain their thinking in a step-by-step process. Both contain many human elements in their narrative. Neither books contain the last word on their subject matter – and, indeed, parts will likely prove to be incorrect in the fullness of time. But both perform giant steps forwards for the paradigms they support.

The above remarks about the book Lifespan are part of what I’ll be talking about later today, in Brussels, at an open lunch event to mark the start of this year’s Longevity Month.

Longevity Month is an opportunity to celebrate recent progress, and to anticipate faster progress ahead, for the paradigm shift mentioned above:

  • Rather than studying each chronic disease separately, science should prioritise study of aging as the common underlying cause (and aggravator) of numerous chronic diseases
  • Rather than treating aging as an unalterable “fact of nature” (which, by the way, it isn’t), we should regard aging as an engineering problem which is awaiting an engineering solution.

In my remarks at this event, I’ll also be sharing my overall understanding of how paradigm shifts take place (and the opposition they face):

I’ll run through a simple explanation of the ideas behind the “aging-first” paradigm – a paradigm of regular medical interventions to repair or remove the damage caused at cellular and inter-cellular levels as a by-product of normal human metabolism:

Finally, I’ll be summarising the growing momentum of progress in a number of areas, and suggesting how that momentum has the potential to address the key remaining questions in the field:

In addition to me, four other speakers are scheduled to take part in today’s event:

It should be a great occasion!

17 July 2018

Would you like your mind expanded?

Filed under: books, healthcare, psychology, religion — Tags: , , , , , — David Wood @ 10:15 pm

Several times while listening to the audio of the recent new book How to Change Your Mind by Michael Pollan, I paused the playback and thought to myself, “wow”.

Pollan is a gifted writer. He strings together words and sentences in a highly elegant way. But my reactions to his book were caused by the audacity of the ideas conveyed, even more than by the powerful rhythms and cadences of the words doing the conveying.

Pollan made his reputation as a writer about food. The most famous piece of advice he offered, earlier in his career, is the seven word phrase “Eat food, not too much, mostly plants”. You might ask: What do you mean by food? Pollan’s answer: “Don’t eat anything your great grandmother wouldn’t recognize as food.”

With such a background, you might not expect any cutting-edge fireworks from Pollan. However, his most recent book bears the provocative subtitle What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence. That’s a lot of big topics. (On reflection, you’ll realise that your great grandmother might have had things to say about all these topics.)

The book covers its material carefully and patiently, from multiple different perspectives. I found it engaging throughout – from the section at the beginning when Pollan explained how he, in his late 50s, became more interested in this field – via sections covering the evolutionary history of mushrooms, thoughtful analyses of Pollan’s own varied experiences with various psychedelics, and the rich mix of fascinating characters in psychedelic history (many larger-than-life, others preferring anonymity) – to sections suggesting big implications for our understanding of mental wellbeing, illnesses of the mind, and the nature of spirituality.

If any of the following catch your interest, I suggest you check out How to Change your Mind:

  • The likely origins of human beliefs about religion
  • Prospects for comprehensive treatments of depression, addiction, and compulsive behaviour
  • The nature of consciousness, the self, and the ego
  • Prospects for people routinely becoming “better than well”
  • Ways in which controversial treatments (e.g. those involving psychedelics) can in due course become accepted by straight-laced regulators from the FDA and the EMA
  • The perils of society collectively forgetting important insights from earlier generations of researchers.

Personally, I particularly enjoyed the sections about William James and Aldous Huxley. I already knew quite a lot about both of them before, but Pollan helped me see their work in a larger perspective. There were many other characters in the book that I learned about for the first time. Perhaps the most astonishing was Al Hubbard. Mind-boggling, indeed.

I see How to Change your Mind as part of a likely tipping point of public acceptability of psychedelics. It’s that well written.

In case it’s not clear, you ought to familiarise yourself with this book if:

  • You consider yourself a futurist – someone who attempts to anticipate key changes in social attitudes and practices
  • You consider yourself a transhumanist – someone interested in extending human experience beyond the ordinary.

30 September 2016

A declaration for radical healthspan extension

Filed under: aging, healthcare, medicine, rejuveneering, Uncategorized — Tags: , , , — David Wood @ 5:26 pm

I’m writing during a short break in the proceedings of the 2016 Eurosymposium on Healthy Ageing, which is being held in central Brussels.

The organisers have in mind that attendees could issue a declaration at the end of the event, tomorrow, Saturday 1st October – a date which happens to be Longevity Day.

Please find some draft text for this declaration. Lots of other text has been proposed too, but this is a fairly minimal version.

Before the text of the declaration is finalised, I’m interested to hear comments:

  • What should be added – or omitted?
  • What’s unclear?
  • What do people particularly like about it?
  • What improvements might be made to the language?
  • What changes (if any) would convince you to add your signature to it?
  • What’s a good way to conclude the declaration?

Please let us know!

Note: Many thanks are due to various members and supporters of Heales for suggesting text – especially Didier Coeurnelle.

(Update 6pm Brussels time 1st October – the draft text has evolved. The latest version is below.)

declaration-v3

The Brussels Declaration for Radical Healthspan Extension

The defeat of aging lies within our collective grasp. It’s time to seize this remarkable opportunity.

This 1st of October 2016, during International Longevity Day, the Eurosymposium on Healthy Ageing (EHA) meeting in Brussels proclaims the possibility and the imperative of a moonshot project to overcome all age-related diseases within 25 years by tackling aging as their root cause.

The result will be a world:

  • Where healthcare is far less expensive
  • Where human well-being can be radically extended
  • Where people place greater value on the environment and on peace, in view of their expectation of much longer lives
  • Where the right to life is more precious than ever, because life is longer.

Key steps in this initiative will include:

  • A paradigm shift stressing the need for research on aging itself, rather than only on individual diseases of old age
  • The removal of regulatory and other barriers which prevent or disincentivize companies from developing treatments for aging itself
  • An accelerated program to test anti-aging interventions on a much larger scale than anything that exists at the moment, leading to multiple human clinical trials of genuine rejuvenation biotechnologies by 2021.

These programs will require a coordinated effort at national and international level, integrating diverse existing and novel research approaches. They need to be financed by both public and private organizations, and create inclusive, affordable solutions available on equal terms to everybody.

25 May 2016

The Abolition of Aging – epublished

Filed under: aging, books, healthcare, rejuveneering, The Abolition of Aging — Tags: , , — David Wood @ 4:12 pm

TAoA Cover page v11

I’m happy to report that my new book was epublished today, for Amazon Kindle. It’s “The Abolition of Aging: The forthcoming radical extension of healthy human longevity”.

You can find it on Amazon US, Amazon UK, …

It’s not a book about reprogramming our (silicon-based) devices – the kind of thing that used to be on my mind in my smartphone industry days. Instead, it’s about reprogramming our biology.

My reasons for writing this book are contained in its foreword. For convenience, I append a copy of the foreword at the end of this blogpost.

Physical copies of the book should be available from some time next month, for readers who prefer atoms to bits. I am planning to create an audio version too.

You can find more details about the book on its own website:

  • Advance praise, from people who have read pre-publication copies
  • The book’s description and dedication
  • An expanded table of contents
  • A community page, for further information about topics covered in the book.

If anyone has comments or queries about anything they read in the book, they’re welcome to raise them as responses to this blogpost.

Foreword

(This content is part of the introductory material of the book “The Abolition of Aging”.)

Within our collective grasp dwells the remarkable possibility of the abolition of biological aging.

It’s a big “if”, but if we decide as a species to make this project a priority, there’s around a 50% chance that practical rejuvenation therapies resulting in the comprehensive reversal of aging will be widely available as early as 2040.

People everywhere, on the application of these treatments, will, if they wish, stop becoming biologically older. Instead, again if they wish, they’ll start to become biologically younger, in both body and mind, as rejuvenation therapies take hold. In short, everyone will have the option to become ageless.

Two objections

The viewpoint I’ve just described is a position I’ve reached following extensive research, carried out over more than ten years. My research has led me to become a strong supporter of what can be called “the rejuveneering project”: a multi-decade cross-disciplinary endeavour to engineer human rejuvenation and thereby enable the choice to abolish aging.

But when I mention this viewpoint to people that I meet – as part of my activity as a futurist, or when I catch up with my former colleagues from the smartphone industry – I frequently encounter one of two adverse reactions.

First, people tell me that it’s not possible that such treatments are going to exist in any meaningful timescale any time soon. In other words, they insist that human rejuvenation can’t be done. It’s wishful thinking to suppose otherwise, they say. It’s bad science. It’s naively over-optimistic. It’s ignorant of the long history of failures in this field. The technical challenges remain overwhelmingly difficult.

Second, people tell me that any such treatments would be socially destructive and morally indefensible. In other words, they insist that human rejuvenation shouldn’t be done. It’s essentially a selfish idea, they say – an idea with all kinds of undesirable consequences for societal harmony or planetary well-being. It’s an arrogant idea, from immature minds. It’s an idea that deserves to be strangled.

Can’t be done; shouldn’t be done – in this book, I will argue that both these objections are profoundly wrong. I’ll argue instead that rejuvenation is a noble, highly desirable, eminently practical destiny for our species – a “Humanity+” destiny that could be achieved within just one human generation from now. As I see it, the abolition of aging is set to take its place on the upward arc of human social progress, echoing developments such as the abolition of slavery, the abolition of racism, and the abolition of poverty.

It turns out that the can’t/shouldn’t objections are interlinked. They reinforce each other. It’s often because someone thinks an effort is technically impossible that they object to any time or finance being applied to it. It would be much better, they say, to apply these resources to other philanthropic causes where real progress is possible. That, allegedly, would be the moral, mature thing to do. Conversely, when someone’s moral stance predisposes them to accept personal bodily decline and death, they become eager to find technical reasons that back up their decision. After all, it’s human nature to tend to cherry pick evidence that supports what we want to believe.

Two paradigms

A set of mutually reinforcing interlinked beliefs is sometimes called a “paradigm”. Our paradigms guide us, both consciously and unconsciously, in how we see the world, and in the kinds of projects we deem to be worthwhile. Our paradigms filter our perceptions and constrain our imaginations.

Changing paradigms is hard work. Just ask anyone who has tried to alter the opinion of others on contentious matters such as climate change, gun control, regulating the free market, or progressive taxation. Mere reason alone cannot unseat opinions on such topics. What to some observers is clear and compelling evidence for one position is hardly even noticed by someone entrenched in a competing paradigm. The inconvenient evidence is swatted away with little conscious thought.

The paradigm that accepts human bodily decline and aging as somehow desirable has even deeper roots than the vexatious political topics mentioned in the previous paragraph. It’s not going to be easy to dislodge that accepting-agingparadigm. However, in the chapters ahead, I will marshal a wide range of considerations in favour of a different paradigm – the paradigm that heartily anticipates and endorses rejuvenation. I’ll try to encourage readers to see things from that anticipating-rejuvenation paradigm.

Two abolitions

Accepting aging can be compared to accepting slavery.

For millennia, people from all social classes took slavery for granted. Thoughtful participants may have seen drawbacks with the system, but they assumed that there was no alternative to the basic fact of slavery. They could not conceive how society would function properly without slaves. Even the Bible takes slavery as a given. There is no Mosaic commandment which says “Thou shalt not keep slaves”. Nor is there anything in the New Testament that tells slave owners to set their slaves free.

But in recent times, thank goodness, the public mind changed. The accepting-slavery paradigm wilted in the face of a crescendo of opposing arguments. As with slavery, so also with aging: the time will come for its abolition. The public will cease to take aging for granted. They’ll stop believing in spurious justifications for its inevitability. They’ll demand better. They’ll see how rejuvenation is ready to be embraced.

One reason why slavery is so objectionable is the extent of its curtailment of human opportunity – the denial of free choice to the people enslaved. Another reason is that life expectancy of slaves frequently fell far short of the life expectancy of people not enslaved. As such, slavery can be counted as a major killer: it accelerated death.

From the anticipating-rejuvenation perspective, aging should be seen as the biggest killer of all. Compared to “standard” killers of the present day, such as drunken driving, terrorism, lead fumes, or other carcinogens – killers which rouse us to action to constrain them – aging destroys many more people. Globally, aging is the cause of at least two thirds of human deaths. Aging is the awful elephant in the room, which we have collectively learned to ignore, but which we must learn to recognise and challenge anew.

Every single week the rejuveneering project is delayed, hundreds of thousands more people suffer and die worldwide due to aging-related diseases. Advocates of rejuveneering see this ongoing situation as a needless slaughter. It’s an intolerable offence against human potential. We ought, therefore, to be powerfully motivated to raise the probability of 50% which I offered at the start of this foreword. A 50% chance of success with the rejuveneering project means, equally, a 50% chance of that project failing. That’s a 50% chance of the human slaughter continuing.

Motivation

In the same way as we have become fervently motivated in recent decades to deal with the other killers mentioned above – vigorously campaigning against, for example, drunk drivers and emitters of noxious chemical pollutants – we ought to be even more motivated to deal with aging. The anger that society has directed against tobacco companies, for long obscuring the links between smoking and lung cancer, ought to find a resonance in a new social passion to uncover and address links between biological aging and numerous diseases. If it’s right to seek to change behaviours and metabolism to cut down bad cholesterol (a precursor of heart disease) and concentrated glucose (a precursor of diabetes), it should be equally right to change behaviours and metabolism to cut down something that’s a precursor of even more diseases, namely, biological aging.

This is a discussion with enormous consequences. Changes in the public mood regarding the desirability of rejuveneering could trigger large reallocations of both public and private research expenditure. In turn, these reallocations are likely to have major implications in many areas of public well-being. Clearly, these decisions need to be taken wisely – with decisions being guided by a better understanding of the rich landscape of rejuveneering possibilities.

An ongoing surge of motivation, wisely coordinated, is one of the factors which can assist the rejuveneering project to overcome the weighty challenges it faces – challenges in science, technology, engineering, and human collaboration. Stubborn “unknown unknowns” surely lie ahead too. Due to these complexities and unknowns, no one can be sure of the outcome of this project. Despite what some rejuvenation enthusiasts may suggest, there’s nothing inevitable about the pace of future medical progress. That’s why I give the probability of success as only around 50%.

Although the end outcome remains unclear, the sense of discovery is increasing. The underlying scientific context is changing rapidly. Every day brings its own fresh firehose of news of potential breakthrough medical approaches. In the midst of so much innovation, it behoves us to seek clarity on the bigger picture.

To the extent that my book can provide that bigger picture, it will have met at least some of its goals. Armed with that bigger picture, readers of this book will, hopefully, be better placed to find the aspect of the overall rejuveneering project where they can make their best contributions. Together, we can tilt that 50% success probability upwards. The sooner, the better.

(If you found this interesting, you may like to read “The discussion ahead” next.)

 

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