b. Social Effects of These Anti-Aging Interventions

Our future likely will catch us unawares. In March 1995, Science magazine asked 60 prominent scientists what they saw in the future for science. All sorts of interesting scenarios ranging from physics to economics were set forth—some plausible, some fanciful, all imaginative. But not one of these scientists speculated about the effect of our increasing knowledge of aging processes on our future. In 2001, a similar survey of 25 other prominent scientists again failed to mention the manipulation of aging and senescence (Brockman, 2002). It appears as if scientists are as skilled in predicting the future as are ordinary people, in that we cannot recognize it until it has taken place. But some pioneers have envisioned this future when others did not (e.g., Boulding, 1965), and so it has not been totally unforeseen. The outcome is still worth discussing, even if this author is as fallible as the others, and even if these predictions should be read with a skeptical eye.And so the question is: Given the two scenarios we have developed above, then what might be the effects of each on our society?

1) Scenario I: Continuation of Present Trends

The continuation of our current efforts to prolong the life expectancy of older adults has important implications for the society as a whole. In recent years, the media have aired or printed lengthy articles discussing the social and economic effects that the aging of the ”baby boomer" generation will have on this country's economy and society. The predictions, on the economic front at least, have been uniformly pessimistic, given the high cost of medical and long-term care over the greater number of years the elderly will likely live.

What effects would these pressures have on the society? One interesting data set consists of the dependency numbers, in which people under the age of 15 or over the age of 65 are considered to be dependent on the financial and social efforts of the 16-to-64 age group. This simple assignment overlooks the different contributions and needs of young and old, but gives us a clear idea of the problem. Less developed countries which have not yet undergone the demographic transition have an age structure in which 62% of the population (i.e., 15-64 years) must work to support the other 38%, the overwhelming majority of which are young children (Table 15-1). But the demographic transition changed everything. The data of Table 15.3 show that in developed societies historically a large majority of the population has been dependent on the efforts of the working 20 to 40 percent. In modern times, the total dependency ratio peaked in 1960, will reach its nadir in 2010, and should return to historical levels by 2050. The dependency ratio today is about the same as it was in 1940, which many self-appointed commentators on the topic refer to as ”the good old days." So it is not the dependency ratio itself that is so upsetting.

Table 15-3 about here (old 14-1)

What is different is that the mix of older people requiring retirement support has shifted from a 5:1 ratio of young to old in 1940 to a 2:1 ratio today, and is predicted to reach a 1:1 ratio by the year 2030. The greater number of older people has raised problems with most ‘pay as you go' funded retirement plans, such as Social Security in the U.S. The number of workers per retired beneficiary was at 16 in 1950, 4 in 1965, a bit more than 3 today, and is predicted to fall to 2 by 2030. The significant increases in the life expectancy of older adults means that more individuals need retirement support for a longer period of time. This has led to many commentators pointing out that the predicted outlays will make it impossible to continue the current Social Security and Medicare arrangements without change for the next 40 or 50 years, while at the same time adequately funding the increasingly more expensive educational needs of the younger generation plus fund the necessary capital accumulation needs of the working adult population. This monetary shortfall has the potential to lead to a generational ‘war', which is a situation to be avoided at all costs since no one would really win such a confrontation. Much of this commentary is not correct because the individuals concerned are more concerned with short term political issues than with dealing accurately with the facts. However, objective commentators such as Peter Peterson (2004) point out that the long term financial future of the U.S. (and some other developed countries as well) is quite dismal, given that we are running huge budget and trade deficits at the same time that age-dependent retirement and medical benefits are scheduled to increase as the baby-boomer generation reaches retirement age in the near future. There is simply not enough money available to pay all these bills. By 2040, the General Accounting Office predicts that the deficits will approach 25% of the gross domestic product (Peterson, 2004, p. 236). This situation gives rise to calls to restore fiscal balance by raising taxes or otherwise effectively doing away with these obligations in future.

The Social Security fund is solvent until 2043, when it will begin running a small deficit . That deficit is smaller than the tax cuts enacted by the current administration, which suggests that the decision to run a deficit is a voluntary political decision and correctable (White, 2003). The affordability of social security is a relative political judgement and can be swayed by other policy choices and expenses. After 2077, the deficit becomes large, and we should be planning now on how to avert those deficits. Congress raised the Social Security taxes in 1983 specifically to avoid a predicted long-term deficit of the fund. Since that year, American workers have paid $1.8 trillion dollars more into Social Security than was paid out in benefits. Those monies were to be reserved to pay the future retirement benefits of the baby boomer and future generations. The fund was, in effect, converted from a pay-as-you-go into a pay-in-advance-fund. That $1.8 trillion dollars was not to be conmingled with the general fund, but the temptation to do so lured every administration for the past forty years into borrowing the funds for current expenses, replacing the cash with Treasury securities, and spending the loan proceeds on paying the ordinary expenses of running the federal government (Johnson, 2003). Now that the monies must be paid back from future revenues, and since Social Security is an entitlement program under federal law, the political community seems to favor cutting benefits or raising taxes or partially privatizing the fund. Thus part of the fevered rhetoric surrounding the Social Security deficit is an attempt to disguise the absence of the monies by blaming the old for living so long. The old are peeled off from their children and left to stand on their own. There may be political reasons for doing this, but are there principled reasons? Heaven forbid we blame the politicians for their chicanery.

A recent review of the social security systems in a number of countries suggests that people decide whether to retire or continue working based on all sorts of different and conflicting reasons that have to do with their health, financial status, and family concerns, as well as pension plan requirements, the presence or absence of labor shortages in their field and resulting corporate early retirement or extended work incentives, and government policies (Crown 1998). Trying to understand our future based on the assumption that people respond to only one signal (e.g., social security policies) is simplistic and will likely give rise to unrealistic and perhaps overly pessimistic scenarios.

The Medicare program is under severe financial pressure as a result of the increasing costs of medical care, particularly for the pharmecuticals which have largely been responsible for the increased longevity of older adults (Hacker and Marmor, 2003). This is a real problem but one which is beyond the scope of this book (except to point out that increasing the health span would do much to decrease those costs, as will be discussed later) (but see Peterson, 2004).

It is, however, quite accurate to point out that the increased longevity of the old will alter the pattern of intergenerational transfer of resources. Traditionally the older adults transferred via inheritance some private resources to their children, completing the pattern depicted in Figure 14-5. But the public nature of the Social Security system insures that older adults will now receive substantial resource transfers from the middle aged adult population, thus decreasing the resources available to educate and otherwise care for children. Not only will the elderly increase their share of the total available financial resources but they will likely decrease the amount they pass on to the younger generation. Increasing numbers of those living into the 85+ age bracket will need to spend down their estates just to survive. These trends may tend to reverse the pattern of intergenerational transfers under which we and our societies evolved (Figure 14-5).

The tenor of the current debate gives one the impression that we face a dismal future. The net result of this overly pessimistic perception is that we view the results of the unparalleled success of the 20 th century's biomedical research efforts as a problem rather than as a societal achievement of which to be proud . What we are facing is a new challenge born out of that success. No society has ever figured out what to do with people who are financially dependent, increasingly healthy, and experienced at the same time. No other society has ever been fortunate enough to have this problem to face, so we have no precedent. But we should not let political players and ”media" commentators, neither of whom are known for foresight, define the unprecedented successes of our society as a dire problem. What has happened is simply that our past success has given us a new set of problems to solve.

Let us deal with this mistaken perception by first addressing the question of health care costs for the elderly. Some older empirical data do show that hospital charges increase as a function of age, being some 6 percent higher in patients older than 85 years (see, for example, Rosenthal and Landefeld 1993). However, a large-scale study covering all 60-year-old and older patients in Massachusetts (Perls and Wood 1996) showed that hospitalization costs peaked in the 70- to 79-year-old group and significantly decreased thereafter (Table 15-4). In fact, an inspection of these data suggests that the highest costs were incurred by members of the population who were younger than 79 years old and died in the hospital. These individuals constituted about 3.1 percent of the population, but utilized about 7 percent of the total hospital costs incurred by the approximately 680,000 discharges for this population. In contrast, the people who were 90 years or older and died in the hospital constituted about 0.6 percent of the population and accounted for about 0.6 percent of the total hospital costs. As opposed to rhetoric, these data suggest that the hospital care funding crisis cannot be laid at the feet of the elderly. Even the elderly who were not in good health (and who died in the hospital) used only their proportional share of the health care dollar. The disproportionate share was taken not by the elderly but by the people in their sixties and seventies—the late middle-aged and early old. Since the current median life span for the population is now in the mid- to late seventies, depending on gender and socioeconomic status, it appears as if the people who were not in particularly good health and died before or around the median life span can be viewed as ”causing" the funding crisis. Failure to live long is both expensive and unpatriotic. Nonetheless, we cannot deny that the large numbers of baby boomers who will soon be entering their retirement years will put a severe financial stress on the system if only because there are so many of them relative to the working population.

Table 15-4 about here (old 14-2)

The contributory causes of death listed in Figure 6-11 may be the proximal causes of the extensive and expensive hospital stays characteristic of those people who do not live long. To be sure, better health habits and preventive regimes might alleviate this situation in future cohorts. The current campaign against obesity may be one sign that health and political and civic leaders are now prepared to advocate the advantages of a healthy lifestyle. However, our discussion of lifestyle factors in Chapter 6 pointed out that it is very difficult to persuade people to give up their unhealthy lifestyle even though they know that the change will significantly extend their life, and so expensive preventable age-related diseases may prove to be with us for some long time to come.

If we discard the elderly and their experience, we raise the possibility of an intergenerational warfare for a too-small pot of money (Binstock, 2004b). Both the young and the elderly require support for their particular needs. Since the elderly are conscientious voters, the young either cannot or will not vote, and the middle-aged are likely to be split on the issues, the young likely will lose in the short run. In addition, once the middle-aged accept that they too will grow old someday, they may likely vote their future interests over those of their children. But this would be a Pyrrhic victory in that diversion of funds away from the educational needs of the young would eventually wound the elderly. One alternative strategy is to use the fiction of Social Security deficits as a lever with which to decrease the costs (i.e., benefits). This might have the effect, particularly among the poorer elderly, of increasing their ‘premature' mortality and thus reducing the number of older individuals receiving such funds. This would also be a Pyrrhic victory, particularly since many working individuals no longer have defined benefit private pensions nor have they been able to save much other assets towards their retirements. It is not clear how this large number of individuals would be able to afford their retirement. It is likely that many will not be financially able to fully retire, nor be healthy enough to continue working fulltime They will perhaps just get by unless and until they need ongoing expensive prescription drugs, and then they might have to choose between necessities. There are, however, reasonable financial reforms that can be done without harming needy elders (e.g., see Peterson, 2004) and these should be implemented.

The retirement age was drifting downward in recent years, although it may now be stabilizing. If it were to keep pace with growing life span, the official age would now have to be in the low 70s. Presently, most people work no more than 45 years, from the ages of 20 to 65, and they must use their earnings from these years to fund a retirement of about 5 to 20 years. Most of their heavy medical expenses take place in the last year or two of life (see Table 15-4), although the outpatient pharmecutical expenses probably cover a much longer period of time. Their funding is inadequate to the combined tasks, and this constitutes the origin of the current problem. Since older people are healthier now than in the past, the solution to this dilemma might be to continue working until age 70 or longer. This might be only a part-time job in the last years of work; such ”bridge jobs" are fairly common today. Those earnings would fund a retirement, of about 15-20 years. Perhaps the extra time will be spent in a different career, where the pay is lower, the demands lighter, and payoff comes in emotional satisfaction. Child care is one such obvious secondary career choice; mentoring teens and young adults is another; advising new businesses is yet another. Regardless of how the gift of extra time is spent, the extra years or so of compounding interest on all or part of an individual's prospective retirement funds would likely generate enough additional funds to fully fund the longer retirement and supply the capital accumulation necessary for society's other needs, such as education of the young. Not everybody has to exercise this option for the Social Security problem to disappear.

Of course, not every working person would welcome such a future. People laboring at physically difficult, stressful, or repetitive jobs might look forward to the end of work, as might individuals who wish to pursue their interests in such things as travel or their hobbies. But in the absence of sufficient private funds, they may have no choice but to continue working.

Is there any independent evidence to support this contention? There is no solid data yet, but the harbingers are all about us. Eighteen per cent of men and 10% of women over the age of 65 are still in the workplace. Some do this because of the economic considerations of getting a bigger pension later, but others have personal reasons such as the need to be involved and stay connected. Will these numbers increase in future? Betty Friedan once wrote:

The idea of retiring at 65 is obsolete; it is based on an outdated life expectancy. Should we have two or three careers? Once liberated from the need to prove yourself and be promoted, the second career can be chosen with different considerations. We are on the verge of having to do a lot of new thinking for a society in which the working years last until age 80. … The mix at work will be different. There will be periods for study, for job training, for sabbaticals, for time out for children and adventure. Work will become more flexible as it sinks in that people will spend many more years at work." (New York Times, Dec. 14, 1997).

In keeping with this view, over 70 percent of baby boomers reportedly plan to continue working at least part time after age 65 (Cook, 2003). But this may be due in part to their inadequate savings. The trend towards early retirement seems to have stopped (Burtless, 2003). Clearly the changing health status and age structure of the population is changing society's expectations of the elderly. But the top 20% of the elderly currently receive 46% of all elderly income, while the bottom 40% receive only 15% (Cook, 2003). This wealth disparity suggests that a numerically large minority of older people will not benefit from these ongoing changes in elder health. For those people with sufficient private financial and mental resources, the ability to choose between work and play will likely be a liberating one. For people without such resources, the lack of a choice may embitter them and sour their ‘golden years'.And when they run out of their physical and financial resources, then the rest of society will have to choose whether to support them by intergenerational resource transfers so as to let them live out their lives in some modicum of dignity; or else just thrust them aside to live and die alone but out of our sight, as we do now with the ‘oldest-old'.

Given the numerical disparity between the young and the old, it is possible that funding for the education of youth may have a lower priority than assisting the elderly. But as Peter Peterson wrote in the May 1996 issue of the Atlantic Monthly ,

If we are going to rely on just 1.6 to 2.0 workers to support every retiree, as the Social Security Administration forecasts suggest, then we should want today's children to become the best educated, most skilled, and most productive citizens imaginable. How does that square with our current rush to cut discretionary spending and defund social programs, from Head Start to vocational schools, that have long provided education and training? How can we generate the funding and the political support to educate our young in today's overburdened economy? How can we make the twenty-first century the century for our children?"

And what will be our response as parents and grandparents to the words of Dietrich Bonhoeffer, who said ”The ultimate test of a moral society is the kind of world it leaves to its children." A Hobson's choice between our children and our parents and grandparents lies in our future unless we take steps now to avoid such a dilemma. .

2). Scenario II: Extended Health Span

Given the above evidence that pharmecutical and genetic interventions can bring about a delayed onset of senescence/extended longevity phenotype in mammals (including primates), is it likely that the same phenotype can be induced in humans? Many scientists believe that, given the correct conditions, humans will express the same proportional response to caloric restriction (~40 increase in life span) as do our model organisms, and the data presented in Chapter 6 is certainly consistent with this point of view. Others suggest that the rat and mouse are inherently short lived animals, and so perhaps their CR response is an adaptation evolved to allow them at least one chance at effective reproduction. In this case, then one might not expect longer lived mammals with multiple chances at reproduction to have the same adaptation in either quantitative or qualitative terms. Labrador retriever dogs, for example, show a maximum life extension of only ~14 months, or about a 10% response, when subjected to CR (Kealy et al., 2002; de Grey, 2004). Elephants are known to cope with food shortages by using behavioral strategies, perhaps in place of a traditional CR response. On the other hand, human parents must live for 20 years past their last reproduction in order to effectively reproduce (see Figure 14-05) and so this requirement might provide the selection pressure for the mainenance of a conserved CR response in a very long lived mammal. Presently there are no completed CR data on other long-lived species, and so we have no firm basis for resolving this question. In the absence of data, let us simply say that pharmecutical interventions based on a CR mechanism might increase the maximum human life span by as little as five or as much as thirty-five years. There are two outcomes of this data gap. First, the most appropriate reaction to scientific optimism is an intelligent scepticism. Second, regardless of the actual number of years to be attained, there is broad agreement that the life span will be significantly increased.

Given this broad consensus, it is important to recognize that there are always those would oppose any interference with the present human life cycle. Their arguments need to to be addressed by scientific optimists and pessimists alike, and that is what we shall do in this section. The counter-arguments presented below are based on the assumption of a maximum CR response simply for the sake of simplicity; the objections stand regardless of the actual number of years bestowed by the intervention.

Since it is likely that some feasible method of inducing a delayed onset of senescence phenotype will be developed in the near future, what then would be the likely social outcomes of having a health span of ~70 years followed by a ‘senescent' span of ~30+ years? It depends in part, I think, on the cost and on the difficulty of the procedure. By high cost, let us assume the therapy at that time would be equivalent to the cost of an average house. By low cost, let us assume that the therapy costs about the same as a family sedan. Let us further assume that the therapy needs to begin no later than the mid-twenties or so, for maximum effect. Of course, if the therapy consists of an ongoing pharmecutical regime, as is likely, then the costs would shift to a lifetime of monthly costs equivalent to the mortgage or auto loan payment. Let us make one other tentative assumption. The ongoing CR studies on primates do not yet show any alteration of their reproductive hormones (see Table 6-04). Other laboratory animals showed a coordinate extension of both reproduction and the health span. Given the tight link between reproduction and longevity, this primate exception is unexpected and may not be confirmed as the study proceeds. But perhaps this is a hint of a difference between primates and rodents? If so, then its existence would be a constraint on the limits of manipulability of the human reproductive system, and I incorporate it into our speculations, unlikely though it might be, as a conservative parameter.

Speculations on the social effects of extended longevity have a long history. Forty years ago, before modern biogerontology appeared, the economist Kenneth Boulding (1965) wrote a balanced but pessimistic account of these effects. In his view of life extension scenarios, Petersen (1998) considered the effect of high cost and low cost life span extension on five variables: change in the social system; shifts in personal values and outlooks; how the idea of work will evolve; the economic effect; and the need for personal security. My modification of his matrix is provided in Table 15-5 and this may serve as a structure for our discussion. Anecdotal though it may be, the fact that three people independently considered the same societal factors likely to be altered by extended longevity suggests a possible consensus on the important variables. I do not present these comments with any belief that they have much accuracy as a prediction of what the future might bring, but rather as a foil with which to engage the reader's imagination (or indignation) and stimulate you to do your own thinking about likely possibilities. But as you do, keep in mind the fact that our Homo sapiens ancestors chose a niche and a way of life that allowed us to live long and to invent the new social roles and networks emblematic of modernity (see Chapter 14). Our Neanderthal cousins did not make that life history choice, did not evolve longevity, and are no longer here (Caspari and Lee, 2004). The continued survival of no species is guaranteed, but rather rests on the quality of their most recent adaptation. I believe the options suggested in Table 15-5 offer us much the same challenge that once faced our ancestors. Should we as a society choose not to explore the longevity extension scenarios before us, then are we emulating our ancestors or our extinct cousins? Our ancestors faced an increasingly complex world and adapted to it by evolving an extended longevity, which gift of time allowed them time to learn new facts and strategies and to incorporate them into their increasingly complex culture. I believe that longevity is a hallmark of our species, and if we reject it unthinkingly, then we may be choosing a bleak future.

Table 15-5 about here

      Table 15-5

First, there is an unspoken assumption that a prolongevity therapy will be avidly adopted by everyone. But that assumption conflicts with standard economic knowledge showing that people are reluctant to save for their future retirement (i.e., have a low time preference for their money) and there is no reason to assume that young people, confronted with current bills, will be any more eager to pay money now for some benefit in the far distant future than they are today, unless special pricing strategies are employed (Avila, 2004). One might think that health care providers would be inspired to make the therapy available as a long term cost savings strategy (e.g., long lived healthy people should have lower medical costs in future). However, in a market economy such as in the U.S.A. , the medical care providers are mostly private companies with a necessarily short time horizon. They realize no short term savings from providing prolongevity therapies to their clients today, and the potential savings to be reaped from lower health care costs some 30 or 40 years in the future are irrelevant to their current financial plans. Thus there is a reasonable chance that only the wealthy and those obsessed with longevity will agree to pay now for the intervention, and so there is a real likelihood that we might inadvertently create a long lived oligarchy of the rich and the fanatics. That would be a dismal failure. On the other hand, societies with a national (i.e., non-profit) health plan of some sort may find that their government may have a time frame long enough to counterbalance present costs with future savings , and so would have an economic incentive to adopt the prolongevity therapy. It would be ironic if a prolongevity therapy developed by biotech companies in a market economy led to the first appearance of extended longevity in societies with a non-profit driven health care program. This would be a “triumph of the commons”, as pointed out by Avila (2004). However, if the legal system encourages the marketing of the therapy as an anti-disease intervention rather than a pro-longevity treatment, then middle-aged people may develop a high time preference and opt for the cure (Murphy and Topel, 2003). Unfortunately, current biological data suggests that the later the therapy is started, the smaller will be the benefits, for the longevity extension is proportional to the amount of accumulated damage present in the cell at the start of the intervention.

Secondly, not every person will accept the therapy even in those societies that adopt it. In a free society where the autonomous rights of a competent adult to make their own decisions is the basis of our laws, no one should be forced or coerced to accept a personal change that is against their principles. The Amish have rejected much of the modern world and have, by and large, kept their traditional ways and prospered. Many but not all people would accept the therapy and these dissenters would, by serving their own ends, also serve as an example and a reminder to those who take the therapy that the meaning of life does not necessarily reside in the number of your years but rather in their quality. Their continued presence and prosperity will serve to insure that the decision to take the therapy continues to be, in principle at least, the free decision of an understanding adult mind.

Third, people may be heathy until age 90, but child bearing will still need to take place before the woman turns 45 or so in both cost scenarios. Women able to afford the high cost therapy (a four figure monthly payment for the next 70+ years) will likely come from the rich minority (upper 1%) of the population. Their rational option would be to choose to focus their youthful energies on child rearing, knowing they will have ample time later for a career. Under the low cost scenario, women might be able to afford the therapy costs ( a three figure monthly payment for the next 70+ years) but not the luxury of delaying work for a decade or two, and so the contemporary juggling of child and career familiar to today's working women might still be commonplace then. It is not clear to me that fecundity will necessarily decrease under either scenario, for the prospect of a long productive life might make many women realize that they now have the time to be a good mother to two or three children and still have time to tackle the important career work later. Given the longer working life, financial institutions may well develop loan packages that allow working women to borrow modest sums against their future earnings in order to finance their child care costs now. The prospect of a quantitative change in one variable - more time - often leads to a qualitative change in the question from an ‘either-or' to a ‘both' option. That might be operative here as well.

Fourth, families will change but perhaps not as drastically overall as might be foretold. Divorce is common today for rich and poor. There is little reason to believe it will decrease once people begin to develop highly individualized life span trajectories. An increase in serial monogamy will greatly extend families and the webs of reciprocal obligations inherent in them. Such webs may serve to restrain rampant egotism, just as they do today. On the other hand, divorce may increase but not as much as some might fear either. Some couples may find each other to be their best partner precisely because the new social structure does allow them both to change and grow, and to continuously reinterest each other. Perhaps we might have a society in which there are increases in both serial monogamy and diamond anniversaries. Under the high cost scenario, these changes will be limited to the wealthy; while the low cost scenario will allow most people to face these challenges. What is sure is that the number of five and six generation families will increase.

Fifth, the whole idea of work and career will change for long lived people under both cost scenarios. One person might want to work in the same field for ~70 years and become a true master of their craft. Some observers have worried about the loss of creativity if some person stayed that long in one field. This is a real worry but we will solve it by inventing new social rules and roles. For example, perhaps college professors should no longer be granted tenure for life if they are taking life extension therapy, but should rather be tenured for a maximum period of perhaps 30 years after which time they must compete successfully with others for the position or leave to begin a new career. We term limit politicians. Why not professors? And if professors, then why not CEOs and other positions which demand creative policy decision making? But we need not throw away all that prior experience if we invent some sort of advisory boards through which term-limited people can still influence current decisions. Other concerns will likely engender other social innovations and we need not enumerate them all here but simply keep in mind that they will occur. Other individuals might opt for two or three serial careers in different fields, perhaps intercalated with periods of education or training for their next vocation. Still others might elect to alternate work and play, such that vacations might take longer and be more focused on some personal goal. And perhaps part of the cost of the therapy might be offset by a socially encouraged stint of helping others in some sort of community service. What we can count on is that in every society, there are those that do not save for a variety of reasons. There is every reason to believe that the social safety net will still be necessary in the future unless we are willing to step over the bodies.

Sixth, if only the rich live long, then they might be more interested in balancing environmental quality with economic growth. Their tendency to live apart in environmentally sound areas might be constrained by their increased awareness of the global nature of environmental change. They would probably retain control of their wealth for longer periods of time and so philanthropy might decrease. The social benefits conferred by the likes of the Rockefeller, Mellon, Carnegie, or Gates foundations would have to be generated by some new social institution. A low cost therapy, by extending the lives of many people, would change the nature of the economy. Many industries would have to be reconfigured or reinvented in order to deal with the change in the age structure of the population. The reshaping of the future economy might well dwarf the changes in the present economy brought about by the demographic changes of the past half-century.

Seventh, no matter how each individual spends their health span, and no matter whether they are rich or not, they will still have at least 60 years of savings (even allowing for advanced education to age 30) with which to fund a ‘senescent' span of ~35+ years. Of course, it is most unlikely that the pharmecutical doubling of the health span will work in one who is following an unhealthy lifestyle. And if we do live a healthy lifestyle, then the data of Table 8-9 strongly suggest that living healthy may well extend our senescent life span in addition to any extension of our health span brought about by the future drug treatments . Part of the prescription of living long will be the requirement to eat moderately and healthy, to routinely do significant aerobic and resistance training, and to stay mentally and emotionally alert. When such people do enter the ‘senescent' phase, they will likely show few if any disabilities and be even healthier than is the current cohort of older people. There is every reason to believe that such people will also not retire at the age of 90 or 100, but that their health will allow them to continue to be economically productive for many years to come. Thus their “retirement” years (whatever that may mean in that future society) will benefit from the multiplicative effect of compound interest acting on their savings over a 70-90 year period rather than just a 35-45 year period as today. Their ability to accept lower annual returns on their investment may encourage the funding of enterprises with a high social/low profit return. Perhaps they will be the new substitute for the foundations.

Eighth, if the therapy is widespread, few people taking it would be willing to engage in high risk professions such as police or the armed forces because of the risk of losing such a potentially long life. This will not be a new development, for in the U.S. today it is not the children of the rich that join the police or fire departments, or enlist in the army. Enlisting for such dangerous services in the future may still be the only way by which young people not on the therapy (because of cost or genetic incompatibility with the drugs or by choice) could climb the social ladder to riches and fame. It will also increase the already dangerous gulf between the (presumably) long-lived political leadership and the (presumably) short-lived enlisted personnel.

Ninth, Kirkwood (1999) wrote a novella in which he explored the outcomes of a high cost therapy. It is not clear that people would long tolerate the idea that they cannot have the therapy that will keep them alive and healthy simply because they do not have the money. The creation of a rich long-lived oligarchy, encouraged by the economic analysis mentioned in the first point above, may be unstable and engender its own destruction via an emphasis by the mob on ‘equalite'. Guillotines have a way of making people, and their life spans, much the same size. Similar sentiments might be expressed within the low cost option by that minority not on the therapy because it is somehow ineffective or incompatible with their particular genome, and this might bring about the development of alternative personalized life extension therapies in response.

All of the above speculations ignore the rest of the world. But the billions of people in the developing world will learn of the efficacy of our experiment in anti-aging interventions, and may agitate for their own version of it. The pharmecutical companies involved may not hesitate to sell it to them. If the appropriate economics can be worked out, these societies are likely to adopt anti-aging interventions. The next stable equilibrium point for the world may occur only when all societies have undergone both the demographic and anti-aging revolutions.