Again on ageing as a disease: A rectification

My previous post was somewhat confusing even to myself. To be completely frank, I think it was a little bit of a fuck-up. Several people have commented about it, for example on Reddit or Facebook, pointing out among the rest that whether or not ageing is a disease isn’t just semantics and it isn’t pointless. (To the people commenting on Facebook, I’d like to say that I’m sorry I didn’t reply to your comments, but for some reason I was stuck as ‘Rejuvenaction’ on those posts, and Pages don’t seem to be allowed to comment on group posts. I tried to switch to my personal account to no avail. I figured out a workaround, but at this point it’s a bit too late.)

What I meant to say is that arguing whether or not ageing is a medical condition is far less important than treating its root causes, and as long as we focused on this task, we could postpone the debate to a later time. The finer points of establishing if ageing fits the definition of ‘disease’ to the letter would waste precious time we could spend saving lives instead; we should definitely not wait until the issue has been settled before we start developing rejuvenation biotechnologies. (And we are not waiting at all, luckily.) However, classifying ageing as a disease is very important and not at all pointless, as Reason of FA! explained in this post. In a nutshell, if the ageing processes that lead to age-related diseases were considered pathological, research on how to interfere with them would likely receive more funding, and drugs that target ageing itself could be approved by the FDA. (The FDA only approves drugs that target recognised diseases; if ageing isn’t recognised as one, no drugs targeting it would be approved.) I think there might be a chance that some bona-fide anti-ageing drugs would be approved even if ageing wasn’t recognised as a disease—for example, drugs that clear the amyloid plaques that build up in the brain would essentially be rejuvenation therapies preventing Alzheimer’s disease, and as such I suppose they would be approval material for the FDA, even if they did’t recognise ageing itself as a disease; nevertheless, it’s clear that things would be easier in terms of getting funding and approving drugs if the whole ageing process was classified as a disease.

That being said, if we want to decide if ageing is a disease, we really do need to have good definitions of both terms. It turns out that defining ‘disease’ is not a simple problem, and apparently WHO themselves don’t have an official definition. They do have a definition of health, though, which says among the rest that ‘ Health is […] not merely the absence of disease or infirmity’; the lack of an official WHO definition of disease makes their definition of health a bit problematic, in my opinion. I suppose they rely on the intuitive idea of ‘disease’ we all have, but as a mathematician, I find this decidedly insufficient. If you look up ‘disease’ on Wikipedia, you’ll find this:

A disease is a particular abnormal condition, a disorder of a structure or function, that affects part or all of an organism.

I don’t like this definition very much, because it might imply that a ‘normal’ condition isn’t a disease; however, the incidence of age-related disease grows higher and higher with age, to the point that I don’t see how they couldn’t be considered ‘normal’ past a certain age; that’s why I prefer a definition along the lines of ‘a definite pathological process having a characteristic set of signs and symptoms’.

As for the definition of ‘ageing’, I stick to Aubrey de Grey‘s definition, i.e. that ageing is the process of accumulation of damage the body inflicts itself as a side-effect of its normal operations. In the post we’re discussing, I said that even according to this definition, ageing wasn’t a disease, but only a cause of disease; I used a comparison I found very fit, i.e. that ageing is to age-related diseases what viruses are to infections. However, upon more careful reflection, this comparison is a bit misleading. It’s true that a virus is not a disease; however, a virus isn’t a process either, unlike ageing. A better comparison would be between age-related damage and viruses. The accumulation of damage could then be (rather loosely) compared to an infection, in the sense that both are processes that happen over time: They begin, they progress, and eventually give rise to symptoms and full-blown diseases.

Now, at least according to the second definition of ‘disease’ I provided, ageing seems to be one, because it is a pathological process (although an extraordinarily long one) that has a characteristic set of signs and symptoms. While symptoms and visible signs of ageing don’t show up until late in life, more subtle signs (accumulation of senescent cells, or cross-links, for example) are present inside your body basically at all times. The reason I call it a ‘pathological’ process is that the damage caused by ageing is, as said, a side-effect of your metabolism; it’s a bug, not a feature, left around by evolution because it was generally not serious enough to prevent you from reaching reproductive age. It’s a disease that stays silent until a certain threshold is reached—again, pretty much like an infection until there are enough viruses around to wreak havok.

Ultimately, ageing may or may not be a disease depending on the definition of ‘disease’ we want to adopt. With enough nitpicking, ageing may well not be a disease according to some definitions, but in principle we could change definitions around so much that Alzheimer’s disease stops being a disease and mountain climbing suddenly becomes one. (This is an intentionally ridiculous example.) I have no problem admitting that this is not what my previous post seemed to say, and I honestly have no idea how I managed to twist my own thoughts around so much that they ended up contradicting things I wrote before. I have a hunch I had grown a bit too fond of the metaphors I used in that post, which again seemed fitting but were confusing. I’m not a fan of revisionism, so my previous post is going to stay up right the way it is, just with a link to this one.

As a side note, some now-recognised age-related diseases were considered to be part of ‘normal’ ageing in the relatively recent past. Seems to me ‘normal’ is a safety-blanket word that we use to feel okay about not doing anything to change something that is not good and difficult to change. Or maybe, it’s just that we like feeling ‘normal’. If you’re 78 and your doctor says you’ve got high blood pressure, he’ll also probably reassure you and say that ‘at your age, it is normal’. So what? That only means that it’s common for a person of your age to have unhealthy blood pressure, and it’s in no way different from saying that it is normal for a smoker to have their lungs full of crap. It’s normal alright, but it is very bad nonetheless.

Health before semantics

Update: If you read this post, I recommend you also read this one. It clarifies a few things I got wrong or expressed poorly here.

Whether or not ageing ought to be considered a disease is still matter of controversy, both among experts and laypeople. Particularly, the latter tend to turn up their noses at the thought of ageing being pathological and not ‘normal’, especially if they’re outside the life-extension/rejuvenation community. Clearly, they ignore the fact that ‘normal’ and ‘pathological’ aren’t mutually exclusive at all. It’s perfectly normal to suffer from hearing loss in old age; notwithstanding, it is out of the question that hearing loss is a pathology and we have developed several ways to make up for it. It presently can’t be cured, because like all age-related diseases, it can only get worse as long as the age-related damage that causes it keeps accumulating.

In my humble opinion of quasi-layperson (I’m nowhere near being an expert, but I do think I know about ageing more than your average Joe), whether or not ageing is a disease is merely a matter of semantics, depending largely on what we want to label as ‘ageing’—not to mention how we define ‘disease’.

If we say that ‘ageing’ is the set of age-related pathologies that affect a given person, then ageing isn’t a disease any more than a box of crayons is itself a crayon. Nonetheless, if you have a box of crayons then you have a bunch of crayons; if you have ageing as we defined it, then you have a bunch of diseases, and the grand total of your ailments doesn’t change whether you consider ageing as a disease as well or not. Quite frankly, I’d pick the box of crayons over ageing any time.

We could define ‘ageing’ differently. We could define it as the damage accumulation processes that eventually give rise to the pathologies of old age. This is a much more sensible definition, because it emphasises the fact ageing is a process that happens gradually over time, starting on day 1. You don’t ‘get’ ageing late in life; you were born with it. When ageing is in its early stages, for example in your 20s or 30s, you can’t really call its effects a ‘disease’ any more than you can call a spec of dust a ‘dust cloud’; when you’re 20, you’re no more ‘sick’ with ageing than a table with a single dust spec on its surface is ‘dusty’. However, during later stages of ageing pathologies are the norm, and the progression of the ageing process exacerbates them further. According to this definition, ageing is still not a disease, but its the cause of many diseases, in pretty much the same way a virus is not the disease it causes: Rhinoviruses are not the common cold; they merely cause it. (This is where the analogy stops. All ageing and viruses have in common is that they both cause diseases. Ageing is certainly not an infectious pathogen!) Notice that, even though HIV, for example, is not itself a disease, we can all agree that we should get rid of it because it causes a horrible disease, namely AIDS. For the same reason, even if ageing did not fit our definition of disease, it is clear that it causes horrible diseases; this should be enough to stop bickering over semantics and just focus on getting rid of ageing already.

We could also think of ageing as an ‘über disease’: A disease whose symptoms are diseases themselves; a ‘disease of diseases’. This is more along the lines of what Aubrey de Grey calls ageing, and he’s not wrong, because what we currently see happening in old age is essentially the sum of different age-related pathologies all happening at more or less the same time.

If you ask me, even without going into the details of the biology of ageing, I’d say that, strictly speaking, it’s probably not a disease (some say it’s neither a disease, nor a non-disease), but it obviously causes crippling pathologies; however, if classifying ageing as a disease may help us get sooner to a world free of age-related diseases, I’m definitely in favour of doing it. I’ll gladly discuss the semantics of the matter after the diseases of old age will no longer be a problem. (*)

(*) Please, do have a look at my first comment below for a further clarification of my stand on the matter.

Reductio ad absurdum

If you’ve ever tried to advocate for rejuvenation, you know it is hard. Usually, people deem the idea as crazy/impossible/dangerous well before you get to finish your first sentence. Living too long would be boring, it would cause overpopulation, ‘immortal’ dictators, and what you have. However, you’ve probably never heard anyone use the same arguments to say that we should not cure individual age-related diseases. This is largely because people have little to no idea about what ageing really is, and how it cannot be untangled from the so-called age-related pathologies. These are nothing more, nothing less, than the result of the life-long accumulation of several types of damage caused by the body’s normal operations. Unlike infectious diseases, the diseases of old age are not the result of a pathogen attack, but essentially of your own body falling apart. As I was saying, people are largely unaware of this fact, and therefore expect that the diseases of ageing could be cured one by one without having to interfere with the ageing process itself, as if the two weren’t related at all. The result of this false expectation would be that you could cure Alzheimer’s, Parkinson’s, etc., but somehow old people would still drop dead around the age of 80 just because they’re old. That’s like saying they died of being healthy.

Back to reality, this can’t be done. To cure the diseases of old age, you need to cure ageing itself. If, for whatever reason, you think that curing ageing as a whole would be a bad idea and it should not be done, the only option is to not cure at least some of the root causes of ageing. Consequently, some age-related pathologies would remain as untreatable as they are today.

Now, the typical objections raised against rejuvenation tend to sound reasonable at first. To some, the statement ‘We should not cure ageing because it would lead to overpopulation’ sounds self-evident. However, if we consider the implications of this statement, things start getting crazy. As said, not curing ageing implies not curing some of its root causes, which in turn implies not curing some age-related diseases. Therefore, the sentence ‘We should not cure ageing’ implies ‘We should not cure [insert age-related disease here]. What happens when we reformulate typical objections to rejuvenation in this fashion?

  • Generic:
    We should not cure ageing, because otherwise fewer people would die and this might lead to overpopulation.
  • Specific:
    We should not cure Alzheimer’s disease, because otherwise fewer people would die and this might lead to overpopulation.

  • Generic:
    We should not cure ageing, because it would be unnatural.
  • Specific:
    We should not cure atherosclerosis, because it would be unnatural. (The f*ck did I just read?!)

  • Generic:
    We should not cure ageing, because it would be only for the rich and cause inequality.
  • Specific:
    We should not cure cancer, because it would be only for the rich and cause inequality. (THE F#CK DID I JUST READ?!?!)

  • Generic:
    We should not cure ageing, because there are more urgent issues.
  • Specific:
    We should not cure type 2 diabetes, because there are more urgent issues. (Right. Now let me watch this new Hollywood mediocre blockbuster whose making was an absolute priority.)

  • Generic:
    We should not cure ageing, because longer lifespans would be boring.
  • Specific:
    We should not cure cerebrovascular diseases, because longer lifespans would be boring. (Well, I can see how an ischemic attack would spice your life up.)

  • Generic:
    We should not cure ageing, because the future looks too grim to live.
  • Specific:
    We should not cure arteriosclerosis, because the future looks too grim to live. (We should not cure all age-related diseases—effectively making the future worse than whatever it looks like right now—because some people think the future will be so horrible that THEY won’t want to live any more and for some weird reason specifically prefer to be killed by an age-related disease, even though all of this incidentally implies that most of the rest of the world too will die of age-related diseases, including those who disagree with this crazy argument. Sounds reasonable.)

I don’t think I need to point out why the statements listed under ‘specific’ are utterly ridiculous. (Which, in case you were wondering, is the reason for the title of this post. It’s latin for ‘reduction to absurdity’ and it is a type of mathematical proof, also known as proof by contradiction. What I did here is not a proof by contradiction, but the ‘reduction to absurdity’ bit is definitely there.) I’m all for discussing potential problems brought about by the defeat of ageing, so that we can prevent them from ever happening; however, I’m not going to buy a pig in a poke and accept blatant nonsense as valid objections to rejuvenation. Also, choosing which age-related diseases should be left untreated for the sake of not curing ageing as a whole is not an interest I’m planning to pick up any time soon.

The point of rebutting objections to rejuvenation

If you’ve hung around here long enough, you probably know I have two pet peeves: ageing and money. If we assume the saying ‘Only two things are certain in life: death and taxes’ is true, then we’re forced to conclude that I advocate for the (indirect) elimination of the only two certainties in life. So, if you came here looking for certainties, I’m afraid you’re in the wrong place.

I’m (mostly) not joking. Lately I’ve been working a lot on the Answers to objections section, which together with a few discussions I’ve had on the Internet, got me thinking about the point of rebutting objections to rejuvenation. Generally, when I discuss the subject with somebody who’s not at all sold on the idea of rejuvenating people, I get the feeling they expect me to prove beyond doubt that nothing can possibly go wrong, either along the way between here and an ageless world or once that world has been reached. If my feeling is correct, opposers to rejuvenation may expect that my rebuttals are meant to prove that neither a post-ageing world, nor the journey to it, will present any problems or challenges.

This expectation is utterly unrealistic. It’s actually worse than that—it’s completely wrong. There’s no way in hell I (or anyone else) could guarantee that we won’t have a dictator ruling a nation for six centuries, or that environmental problems won’t be exacerbated, etc. The reason I can’t promise none of the above will happen is the very same reason why rejuvenation opposers can’t promise any of the above will happen: Nobody can actually predict the future.

Arguments against rejuvenation only sound reasonable because they appeal to our fears and to the blame-the-humans attitude of so many people. If you trust only your gut feelings and don’t bother examining facts and data, anti-rejuvenation arguments can easily seem obviously true. Accepting an anti-rejuvenation argument requires far less mental work than understanding why the same argument isn’t as sound as it appears, but that doesn’t make anti-rejuvenation arguments any more ‘obviously true’ than their rebuttals. It is impossible to know for a fact whether or not rejuvenation will cause any given problem before we get there.

Proving that no problems will arise as a consequence of defeating ageing is not the point of rebutting objections to rejuvenation. That’s not what any of my answers does. All they do is showing that objections to rejuvenation rely more often than not on fallacious reasoning, ignorance, fears, misconceptions, and wrong assumptions taken for established fact. In short, what we do when rebutting objections to rejuvenation is showing they aren’t valid reasons to let ageing continue crippling and killing us. At the same time, answers to objections show why all those predictions of doom and gloom aren’t as likely as they may appear. There’s no certainty to be found anywhere, but this doesn’t really matter—had we refrained from doing anything that wasn’t proved to be 100% risk-free throughout history, we’d probably still be living in caves.

Remember: Objections to rejuvenation are about hypothetical future problems that are far from being certain. Ageing and all the suffering and deaths that come with it are a very tangible fact, happening here and now. This alone should be sufficient to forget about objections altogether and focus only on putting an end to ageing. However, rebutting objections has also another purpose: It fuels discussion. Apart from raising awareness of the problem of ageing and the feasibility of its defeat, discussion prepares us to face the new challenges an ageless future might bring. The way to a world without ageing is still long, which gives us all the time we need to prevent eternal dictators, overpopulation, and all sorts of dystopian scenarios from ever materialising.

Update bundle #3

Last update: 20.01.2017.

Happy New Year! Yes, I realise I’m a bit late for that one, but I’ve been quite busy in the last month. I spent good part of my Christmas holidays and of January working on some improvements to Rejuvenaction, and yet others are planned. Let me tell you about them.

The largest change is the new version of the overpopulation objection. I’d been wanting to revise it for some time already, and I added a lot more meat to it in the process. I split it into three separate sections dealing with different aspects of the problem; each of them goes much more into detail than before. Comments and suggestions are welcome, especially if you notice any mistakes that I may have overlooked.

I answered two more objections, namely Rejuvenation will be too expensive to create and Rejuvenation won’t happen within my lifetime.

I also created a page containing all answers in short, whose purpose should be self-explanatory. Each short answer on this page links to the corresponding full answer both on Rejuvenaction and LEAF (if available). More generally, each time you see this icon

leaf

it means the article you’re reading has a counterpart on LEAF which I linked to and you may want to check out.

I also retouched some other articles here and there, and shortened the titles of menu items for the sake of navigability. Should you find any broken links anywhere, please let me know. With all the changes I made, it’s bound to have happened somewhere.

Next, I’m planning to add more content to the section about ageing and SENS, but it’ll take a while before I even begin, so don’t hold your breath.

On an unpleasant note, the crowdfunding campaign for CellAge has only two days left to go and has reached only 29% of the goal. If you can help push that percentage a bit higher, please do.

UPDATE: The CellAge fundraiser has been extended until February 24th, and is currently 30% funded. We’ve got over a month’s time to make it 100%!

New objection answered: Dystopian future

Another common objection to rejuvenation and life extension is that the future isn’t promising: The world is on its way to its ultimate doom; poverty, hunger, discrimination, dictatorships, wars, and a bunch of other catastrophes of your choice are going to happen and make life on Earth horrible, so why bother living longer? The main reason is that none of this is actually true, but there are also other reasons. Find out more in my answer to the dystopian future objection.

LEAF’s new website is up and running

I’m happy to announce that the Life Extension Advocacy Foundation, or LEAF, has launched their new website. Perhaps I should say ‘our new website’, as I have the privilege of being part of the team. Among the many resources available on the website, there’s a rich FAQ section, explaining the biology of ageing, the technologies we can use to defeat age-related diseases, and answers to objections to and concerns about rejuvenation. Check it out, and while you’re at it, have a look at our latest crowdfunding campaign for CellAge, currently 7% funded.