Is life after 75 worth living? This UPenn scholar doubts it.

What makes a life worth living as you grow older?

Is life after 75 worth living? This UPenn scholar doubts it.
  • Dr. Ezekiel Emanuel revisits his essay on wanting to die at 75 years old.
  • The doctor believes that an old life filled with disability and lessened activity isn't worth living.
  • Activists believe his argument stinks of ageism, while advances in biohacking could render his point moot.

A few years ago oncologist and bioethicist Dr. Ezekiel Emanuel wrote a provocative essay in The Atlantic titled "Why I Hope to Die at 75." This picked up a lot of traction as Emanuel was the chair of the University of Pennsylvania's department of medical ethics and health policy, and one of the leading figures in creating Obamacare. Ezekiel is also brother to the former mayor of Chicago, Rahm and Hollywood agent Ari.

Emanuel has declared he will refuse medical interventions, antibiotics, and vaccinations once he turns 75. The crux of his argument is that older Americans are living too long in a disabled and "diminished" state of life. He wants to make his friends and others think about how they want to live as they grow older, as he put it, "I want them to think of an alternative to succumbing to that slow constriction of activities and aspirations imperceptibly imposed by aging."

There are some experts today that are still opposed to this kind of thinking. Ageism activist and writer, Ashton Applewhite, finds a great deal of unsubstantiated claims in Emanuel's argument. Likewise, Emanuel's ideas may also soon become obsolete — biohackers such as Dave Asprey believe we're on course to living up to 180 years old.

Emanuel recently caught up with MIT's Technology Review in an interview where he talked about the social implications of longevity research and why he doesn't support extending life spans.

Dr. Ezekiel Emanuel on Aging

While nobody wants to die, Emanuel believes that the alternative, degeneration, is worse: "living too long is also a loss," he states in his original essay. For a great deal of Americans these kinds of disabilities and loss of health severely limits what they can do and accomplish.

There are few different sets of arguments strewn throughout this essay. One of those being that there are not that many people who'll continue to be "active and engaged" in their lives. While Emanuel points out that there are outliers who stay physically fit and healthy into their nineties, they're just that — outliers, for which he believes the majority of people are not. That is one measure Emanuel determines on whether a life is worth living or not.

Right around the time this essay was originally written, Ashton Applewhite countered this type of thinking by calling out the problematic nature of the argument:

"It is regrettably American to value doing over being, an ethos that Ezekiel Emanuel epitomizes and that serves us poorly in late life. No wonder he views the prospect with such dread and contempt."

This opens up the question as to whether being mentally stimulated is also enough to warrant wanting to live longer. It's not hard to imagine a person calm and aged serenely content to be, rather than living in some kind of action-packed lifestyle.

Emanuel continues on by regarding aging as something that, ". . . transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic."

He also counters the cultural idea of what he calls "the American immortal." That is, the amount of time and energy people spend obsessing about exercise, diets, and longevity plans to live as long as possible. Emanuel says,

"I reject this aspiration. I think this manic desperation to endlessly extend life is misguided and potentially destructive. For many reasons, 75 is a pretty good age to aim to stop."

The doctor doesn't intend on ending his life actively at 75, but he won't be trying to prolong it either.

When asked what's wrong with simply enjoying an extended life, Emanuel replied in a somewhat flippant manner:

"These people who live a vigorous life to 70, 80, 90 years of age — when I look at what those people 'do,' almost all of it is what I classify as play. It's not meaningful work. They're riding motorcycles; they're hiking. Which can all have value — don't get me wrong. But if it's the main thing in your life? Ummm, that's not probably a meaningful life."

He also suggested that our obsession with longevity is driving away attention from the health and well-being of children. "One of the statistics I like to point out is if you look at the federal budget, $7 goes to people over 65 for every dollar for people under 18," he says.

Applewhite takes issue with this statement here (video located below).

Problematic argument with an ageist strain

The author and activist opposed Emanuel's original article when it came out and believes that the idea remains problematic. Regarding his point that more federal dollars go to older people than to children she stated in an email that:

"… [The idea] is classic, misguided zero-sum thinking of the sort that needlessly pits the generations against each other. There is plenty to go around if resources are more equitably. The old do not profit at the expense of the young."

Most importantly, it is not legal — or ethical—to allocate resources by race or by sex. Doing so by age is equally unacceptable. Period.

She also takes issue with the idea that our older years are not of high quality to some categorical degree due to disability brought on by age — be it mental or physical. Applewhite points to the large amount of people living fine and fulfilled lives who have disabilities.

Yet, she does concede that quality of life is subjective. As does Emmanuel, while he disagrees with the sentiment he still supports the choice of people wanting to live as long as possible.

Biohacking our way to a healthy immortality?

There are a whole host of radical ideas that seek to improve the human condition. Whether it's Aubrey De Grey's ideas to live to over 1,000 years old or the work that biohacker Dave Asprey has funded and started.

While the science still isn't settled, we can't discount the idea that we'll one day live even healthier and more robust lives in our twilight years.

Dr. Emmanuel's ideas may become irrelevant if we succeed in this quixotic and eternal dream.

U.S. Navy controls inventions that claim to change "fabric of reality"

Inventions with revolutionary potential made by a mysterious aerospace engineer for the U.S. Navy come to light.

U.S. Navy ships

Credit: Getty Images
Surprising Science
  • U.S. Navy holds patents for enigmatic inventions by aerospace engineer Dr. Salvatore Pais.
  • Pais came up with technology that can "engineer" reality, devising an ultrafast craft, a fusion reactor, and more.
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COVID and "gain of function" research: should we create monsters to prevent them?

Gain-of-function mutation research may help predict the next pandemic — or, critics argue, cause one.

Credit: Guillermo Legaria via Getty Images
Coronavirus

This article was originally published on our sister site, Freethink.

"I was intrigued," says Ron Fouchier, in his rich, Dutch-accented English, "in how little things could kill large animals and humans."

It's late evening in Rotterdam as darkness slowly drapes our Skype conversation.

This fascination led the silver-haired virologist to venture into controversial gain-of-function mutation research — work by scientists that adds abilities to pathogens, including experiments that focus on SARS and MERS, the coronavirus cousins of the COVID-19 agent.

If we are to avoid another influenza pandemic, we will need to understand the kinds of flu viruses that could cause it. Gain-of-function mutation research can help us with that, says Fouchier, by telling us what kind of mutations might allow a virus to jump across species or evolve into more virulent strains. It could help us prepare and, in doing so, save lives.

Many of his scientific peers, however, disagree; they say his experiments are not worth the risks they pose to society.

A virus and a firestorm

The Dutch virologist, based at Erasmus Medical Center in Rotterdam, caused a firestorm of controversy about a decade ago, when he and Yoshihiro Kawaoka at the University of Wisconsin-Madison announced that they had successfully mutated H5N1, a strain of bird flu, to pass through the air between ferrets, in two separate experiments. Ferrets are considered the best flu models because their respiratory systems react to the flu much like humans.

The mutations that gave the virus its ability to be airborne transmissible are gain-of-function (GOF) mutations. GOF research is when scientists purposefully cause mutations that give viruses new abilities in an attempt to better understand the pathogen. In Fouchier's experiments, they wanted to see if it could be made airborne transmissible so that they could catch potentially dangerous strains early and develop new treatments and vaccines ahead of time.

The problem is: their mutated H5N1 could also cause a pandemic if it ever left the lab. In Science magazine, Fouchier himself called it "probably one of the most dangerous viruses you can make."

Just three special traits

Recreated 1918 influenza virionsCredit: Cynthia Goldsmith / CDC / Dr. Terrence Tumpey / Public domain via Wikipedia

For H5N1, Fouchier identified five mutations that could cause three special traits needed to trigger an avian flu to become airborne in mammals. Those traits are (1) the ability to attach to cells of the throat and nose, (2) the ability to survive the colder temperatures found in those places, and (3) the ability to survive in adverse environments.

A minimum of three mutations may be all that's needed for a virus in the wild to make the leap through the air in mammals. If it does, it could spread. Fast.

Fouchier calculates the odds of this happening to be fairly low, for any given virus. Each mutation has the potential to cripple the virus on its own. They need to be perfectly aligned for the flu to jump. But these mutations can — and do — happen.

"In 2013, a new virus popped up in China," says Fouchier. "H7N9."

H7N9 is another kind of avian flu, like H5N1. The CDC considers it the most likely flu strain to cause a pandemic. In the human outbreaks that occurred between 2013 and 2015, it killed a staggering 39% of known cases; if H7N9 were to have all five of the gain-of-function mutations Fouchier had identified in his work with H5N1, it could make COVID-19 look like a kitten in comparison.

H7N9 had three of those mutations in 2013.

Gain-of-function mutation: creating our fears to (possibly) prevent them

Flu viruses are basically eight pieces of RNA wrapped up in a ball. To create the gain-of-function mutations, the research used a DNA template for each piece, called a plasmid. Making a single mutation in the plasmid is easy, Fouchier says, and it's commonly done in genetics labs.

If you insert all eight plasmids into a mammalian cell, they hijack the cell's machinery to create flu virus RNA.

"Now you can start to assemble a new virus particle in that cell," Fouchier says.

One infected cell is enough to grow many new virus particles — from one to a thousand to a million; viruses are replication machines. And because they mutate so readily during their replication, the new viruses have to be checked to make sure it only has the mutations the lab caused.

The virus then goes into the ferrets, passing through them to generate new viruses until, on the 10th generation, it infected ferrets through the air. By analyzing the virus's genes in each generation, they can figure out what exact five mutations lead to H5N1 bird flu being airborne between ferrets.

And, potentially, people.

"This work should never have been done"

The potential for the modified H5N1 strain to cause a human pandemic if it ever slipped out of containment has sparked sharp criticism and no shortage of controversy. Rutgers molecular biologist Richard Ebright summed up the far end of the opposition when he told Science that the research "should never have been done."

"When I first heard about the experiments that make highly pathogenic avian influenza transmissible," says Philip Dormitzer, vice president and chief scientific officer of viral vaccines at Pfizer, "I was interested in the science but concerned about the risks of both the viruses themselves and of the consequences of the reaction to the experiments."

In 2014, in response to researchers' fears and some lab incidents, the federal government imposed a moratorium on all GOF research, freezing the work.

Some scientists believe gain-of-function mutation experiments could be extremely valuable in understanding the potential risks we face from wild influenza strains, but only if they are done right. Dormitzer says that a careful and thoughtful examination of the issue could lead to processes that make gain-of-function mutation research with viruses safer.

But in the meantime, the moratorium stifled some research into influenzas — and coronaviruses.

The National Academy of Science whipped up some new guidelines, and in December of 2017, the call went out: GOF studies could apply to be funded again. A panel formed by Health and Human Services (HHS) would review applications and make the decision of which studies to fund.

As of right now, only Kawaoka and Fouchier's studies have been approved, getting the green light last winter. They are resuming where they left off.

Pandora's locks: how to contain gain-of-function flu

Here's the thing: the work is indeed potentially dangerous. But there are layers upon layers of safety measures at both Fouchier's and Kawaoka's labs.

"You really need to think about it like an onion," says Rebecca Moritz of the University of Wisconsin-Madison. Moritz is the select agent responsible for Kawaoka's lab. Her job is to ensure that all safety standards are met and that protocols are created and drilled; basically, she's there to prevent viruses from escaping. And this virus has some extra-special considerations.

The specific H5N1 strain Kawaoka's lab uses is on a list called the Federal Select Agent Program. Pathogens on this list need to meet special safety considerations. The GOF experiments have even more stringent guidelines because the research is deemed "dual-use research of concern."

There was debate over whether Fouchier and Kawaoka's work should even be published.

"Dual-use research of concern is legitimate research that could potentially be used for nefarious purposes," Moritz says. At one time, there was debate over whether Fouchier and Kawaoka's work should even be published.

While the insights they found would help scientists, they could also be used to create bioweapons. The papers had to pass through a review by the U.S. National Science Board for Biosecurity, but they were eventually published.

Intentional biowarfare and terrorism aside, the gain-of-function mutation flu must be contained even from accidents. At Wisconsin, that begins with the building itself. The labs are specially designed to be able to contain pathogens (BSL-3 agricultural, for you Inside Baseball types).

They are essentially an airtight cement bunker, negatively pressurized so that air will only flow into the lab in case of any breach — keeping the viruses pushed in. And all air in and out of the lap passes through multiple HEPA filters.

Inside the lab, researchers wear special protective equipment, including respirators. Anyone coming or going into the lab must go through an intricate dance involving stripping and putting on various articles of clothing and passing through showers and decontamination.

And the most dangerous parts of the experiment are performed inside primary containment. For example, a biocontainment cabinet, which acts like an extra high-security box, inside the already highly-secure lab (kind of like the radiation glove box Homer Simpson is working in during the opening credits).

"Many people behind the institution are working to make sure this research can be done safely and securely." — REBECCA MORITZ

The Federal Select Agent program can come and inspect you at any time with no warning, Moritz says. At the bare minimum, the whole thing gets shaken down every three years.

There are numerous potential dangers — a vial of virus gets dropped; a needle prick; a ferret bite — but Moritz is confident that the safety measures and guidelines will prevent any catastrophe.

"The institution and many people behind the institution are working to make sure this research can be done safely and securely," Moritz says.

No human harm has come of the work yet, but the potential for it is real.

"Nature will continue to do this"

They were dead on the beaches.

In the spring of 2014, another type of bird flu, H10N7, swept through the harbor seal population of northern Europe. Starting in Sweden, the virus moved south and west, across Denmark, Germany, and the Netherlands. It is estimated that 10% of the entire seal population was killed.

The virus's evolution could be tracked through time and space, Fouchier says, as it progressed down the coast. Natural selection pushed through gain-of-function mutations in the seals, similarly to how H5N1 evolved to better jump between ferrets in his lab — his lab which, at the time, was shuttered.

"We did our work in the lab," Fouchier says, with a high level of safety and security. "But the same thing was happening on the beach here in the Netherlands. And so you can tell me to stop doing this research, but nature will continue to do this day in, day out."

Critics argue that the knowledge gained from the experiments is either non-existent or not worth the risk; Fouchier argues that GOF experiments are the only way to learn crucial information on what makes a flu virus a pandemic candidate.

"If these three traits could be caused by hundreds of combinations of five mutations, then that increases the risk of these things happening in nature immensely," Fouchier says.

"With something as crucial as flu, we need to investigate everything that we can," Fouchier says, hoping to find "a new Achilles' heel of the flu that we can use to stop the impact of it."

The misguided history of female anatomy

From "mutilated males" to "wandering wombs," dodgy science affects how we view the female body still today.

Credit: Hà Nguyễn via Unsplash
Sex & Relationships
  • The history of medicine and biology often has been embarrassingly wrong when it comes to female anatomy and was surprisingly resistant to progress.
  • Aristotle and the ancient Greeks are much to blame for the mistaken notion of women as cold, passive, and little more than a "mutilated man."
  • Thanks to this dubious science, and the likes of Sigmund Freud, we live today with a legacy that judges women according to antiquated biology and psychology.
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