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The Ageless Generation
How Advances in Biomedicine will Transform the Global Economy
By Alex Zhavoronkov St. Martin's Press
Copyright © 2013 Alex Zhavoronkov
All rights reserved.
ISBN: 978-1-137-35655-0
CHAPTER 1
Approaching the Tipping Point
Decades ago, compassionate nations created welfare programs for aging seniors to provide a safety net against poverty in old age. At the time, no one anticipated that medical advances would dramatically increase life expectancy in the second half of the twentieth century, significantly increasing the size and cost of these programs. Today, senior programs are the fastest-growing and largest budget items for most developed nations.
Old-age pensions and senior health-care programs, such as Social Security and Medicare in the United States, are in desperate need of reform, but the challenges are almost insurmountable. Politicians can't even agree on where to start. Some advocate decreasing spending on these programs. Others, equally adamant, call for increasing revenue, a euphemism for increasing taxes. Still others advocate a combination of these approaches. Lost in this often-divisive rhetoric are some sobering facts. The number of seniors is increasing far faster than the number of youths entering the workforce. That means in the future there will be fewer workers paying taxes into Medicare and Social Security to support each senior. Today, the cost of these two programs is roughly $25,000 per senior. That means that if we disregard everything else in the budget — education, national defense, transportation — the average worker would need to pay over $8,000 in taxes each year to pay for these programs alone. As the number of workers per senior declines in the future, those costs will be even higher. The cost of these programs is so far out of line with reality that traditional solutions can do no more than temporarily postpone the inevitable financial crisis.
Fortunately, there is a workable solution. As remarkable as it may seem to those unaware of recent advances in anti-aging research, in the not-too-distant future medical science will possess the technology to slow and even reverse the aging process itself. Although this has gone relatively unnoticed by the general public, the past two decades have seen more advances in biomedical research than in the entire history of medicine. These advances are mostly occurring under the radar because they are often too complex to be explained in the typical 60-second news spot. They also might be years away from clinical application, which pushes them out of the major news cycle. Nonetheless, these advances are occurring at a breakneck pace.
The system I helped develop, the International Aging Research Portfolio, is one of the largest databases of government grant abstracts in the world. It tracks approximately 20 years of research funding by the National Institutes of Health (NIH), National Science Foundation (NSF), and almost a decade of research funding by the European Commission, Australia, and Canada. Although the database is far from complete, it shows that cumulative funding over the past 20 years exceeds half a trillion dollars. When private sector spending is included, total spending on medical research in the past 20 years probably exceeds $1 trillion.
We are now beginning to see substantial dividends from this research. Life expectancies are topping age 80 in many nations. Past research is also paying dividends in the sense that it laid the groundwork for faster and more frequent advances in the future. Just ten years ago, the only way to do stem cell research was to destroy embryos. Since 2008, new, promising types of stem cells have been created in laboratories that offer significant medical and ethical advantages over embryonic stem cells because they can be created without using embryos at all. National initiatives in regenerative medicine — those focused on developing medical technology to repair age-related tissue damage, grow new organs, and restore the lost function — could help alleviate the looming crisis of old-age pensions and senior health care.
Unfortunately, it will take a long time for the possibility of extreme longevity to reach mainstream acceptance. When I casually remarked to a young medical student that she and many of her peers might live beyond 100, she laughed at what seemed to be an outrageous idea. Yet in spite of such widespread skepticism, the concept of extreme longevity will eventually reach what Malcolm Gladwell calls "the tipping point" in his book of the same name. A major objective of this book is to help bring about that tipping point much sooner than it would otherwise occur.
Fortunately, regenerative medicine is in a far more advanced state than most people realize. Scientists have increased the life span of C. elegans — a type of worm — by ten times. Fruit flies — another common laboratory test subject — have lived four times longer than normal. Genetic therapies have allowed mice to reach the equivalent age of 160 in human years. This is particularly significant because mice are so genetically similar to humans. Hearts have been grown from a single cell and successfully transplanted into living, breathing animals. Humans have achieved a functional age that is 15 years younger than their biological age. Cancers have been cured in animals that are genetically very similar to humans. The pieces of the technological and medical puzzles to extend longevity and, more to the point, healthy longevity, are now coming together. The remaining pieces, or at least enough pieces to make a dramatic change in the health of seniors, can be found within a decade — if there is sufficient research funding to make it happen. The basic technology already exists to pursue research in a number of areas, all of which show promise to dramatically increase health span and life expectancy in tomorrow's seniors. What is lacking is a national sense of urgency and a strategic plan — a roadmap, if you will — to achieve these goals. In the 1960s, the United States set a seemingly impossible task, to put a man on the moon, and achieved that goal in less than ten years. We need a similar commitment today for aging research initiatives.
Another risk is that if the United States doesn't act soon, it might not be able to retain the new jobs associated with this research within its borders, relinquishing the subsequent economic boost to other nations. In a rise similar to the emergence of Japan as a technological superpower in the 1970s, China and India are rapidly catching up with the United States and Europe in biomedical research. In 2010, China revealed plans to invest $1.5 trillion over the next five years on high-tech industries, including biotechnology. At the 2011 International Conference for Bioeconomy, China announced plans to invest $308.5 billion in biotechnology research over the next five years. China expects this research to generate 1 million jobs, extend life expectancy by one year, and reduce childhood mortality to 12 percent of current levels.
In 2009, Novartis, a major pharmaceutical company, announced it would invest $1 billion in research and development in China over the next five years, including a significant expansion of its Biotech Medical Research Center in Shanghai. Those investments and jobs are now lost to the United States, but the loss of future investments and jobs could be prevented by a new national policy to create a more favorable environment for medical research and regenerative medicine.
THE STRUCTURE OF SCIENTIFIC REVOLUTIONS
The pace of technology is accelerating so rapidly that it's hard to keep up — worse, it's hard to change old ideas. Beliefs that have existed for years or even throughout one's lifetime are very hard to erase, no matter how convincing the science is behind them. In effect, a lag exists between the time a new discovery changes the existing scientific reality and the time it takes for scientists and the general public to accept that new reality as fact.
In theory, this obstacle shouldn't exist. Albert Einstein once said, "No amount of experimentation can ever prove me right; a single experiment can prove me wrong." The simple elegance of Einstein's statement captures the purity of science. One solid experiment — properly documented and independently replicated — should be all that is necessary to change scientific opinion, but in a world filled with scientific and human bias, this isn't quite what happens.
In his landmark book, The Structure of Scientific Revolutions, Harvard scientist Thomas Kuhn proposed that science does not move forward solely on objective criteria or by the linear accumulation of new knowledge. Instead, scientific "fact" is defined by the current consensus of the scientific community. When new discoveries are made, scientists are reluctant to accept anything that conflicts with widely held scientific beliefs. According to Kuhn, scientific advances must first be confirmed by enough scientists until the new theory reaches a tipping point of acceptance. At this point, it replaces the old scientific theory. Kuhn coined the phrase "paradigm shifts" to indicate the tipping point at which the consensus shifts from one major belief structure to another.
Unfortunately for both medical researchers and for individuals suffering from age-related conditions, this shift of scientific consensus can lag behind the discoveries by years. The history of medical science is rife with examples of dogmatic beliefs slowing the acceptance of medical advances. It took the medical profession over half a century to accept the benefits of hand washing as fact, the merits of which Ignaz Semmelweis discovered in 1848. Max Planck, winner of the Nobel Prize in 1918 for his discoveries in quantum physics, once dryly observed, "A new scientific truth does not triumph by convincing its opponents ... but rather because its opponents eventually die." Later, Planck would simply quip, "Science advances one funeral at a time."
Today, the medical consensus is that aging cannot be slowed or stopped, but it is only a matter of time until that paradigm shifts. Current medical advances are already keeping seniors alive longer, but not necessarily in good health. Whereas seniors survive one illness that would have been fatal only a couple of decades ago, they only live long enough to contract another equally expensive disease. The cost to senior healthcare programs will be staggering.
With so much at stake, why are only a few visionary scientists calling for more research designed to combat aging and restore function? Why has it been so difficult for this exciting new paradigm to capture the imaginations of scientists worldwide? As Kuhn explains, change takes time, yet the pace of change is now accelerating so rapidly that neither world leaders nor many scientists are able to keep up with it.
In previous generations, medical research was a painstakingly slow process, but today, it's a different ballgame thanks to the personal computer. Moore's Law — first defined by Gordon Moore in the late 1960s — forecasts that computing power will double every two years. This law has proven to be amazingly accurate in predicting the increase in computing power that has in turn exponentially increased the pace of medical discoveries. While skeptics believe that Moore's Law will only continue for a few more years because of the physical limits to how small a silicon computer chip can be made, engineers are poised to overcome the limitations with the next generation of computers — optical, DNA, spintronics, and even chemical computers that will mimic the neurons in the human brain. By the time silicon chips reach the point where they cannot be further miniaturized, one of these new computer technologies is likely to emerge in the computer of the future. The implications of the continued doubling of computing power every couple of years are almost unimaginable. Projects that took years to complete at a cost of millions of dollars will be within the reach of high school students for their science projects.
Consider, for example, one of the greatest computer projects ever undertaken. In 1989, the National Institutes of Health established the National Human Genome Research Institute with the stated purpose of sequencing the human genome. This project would take a decade to complete, and its results would eventually determine the sequence of about 3 billion chemical base pairs that make up DNA, while also identifying the 23,000 genes found in humans. About ten years ago, when this project was completed, the 13-year cost of sequencing a human genome for the first time was $3 billion — in large part due to the immense amount of computing power needed for the task.
Today, thanks to rapidly increasing computer power, genome sequencing can be done for under $10,000, and the cost continues to come down. For just $99, you can obtain a comprehensive test of tens of thousands of SNPs (single nucleotide polymorphisms or DNA sequence variations) from 23andMe, a company, named after the 23 pairs of chromosomes in human DNA, founded by Anne Wojcicki, the wife of Sergey Brin, the cofounder of Google. The process is simple. Consumers send a saliva sample to 23andMe by mail and then later access the results online. I took this test in 2009 and periodically receive updates with new information about my DNA. More than 125,000 people now use 23- andMe and other similar services to find out more about their ancestors, predisposition to several diseases, and carrier status for a variety of genes associated with disease. As databases grow, this process could eventually identify new ways for treating and diagnosing diseases, advance diagnostic medicine, and create a database that links genetic profiles with increased risk of specific diseases.
Another reason that medical technology is advancing so rapidly is that advances in many nonmedical fields are now contributing to medical science. Take mathematics, for example. You may not have heard of the Fourier transform (FT) — a mathematical technique that simplifies information — but it is used to compress vast amounts of information in everything from JPEG files to MP3 music. In medicine, FT takes the data collected during MRIs and turns it into images that assist physicians in diagnosing illnesses. Mathematical algorithms are used ubiquitously in the medical field in applications ranging from data analysis to diagnosis. Mathematics is also used in a multitude of computer models, such as using fluid dynamic equations to understand blood flow through veins and arteries. Medical images, such as MRIs and ultrasounds, are also created using mathematical formulas.
Some medical advances draw on technology so advanced that it may seem right out of Star Trek. Nanotechnology is bringing together the fields of mechanical engineering, information technology (IT), and mathematics to create tiny machines from individual atoms that would be only a few nanometers wide — thinner than a single strand of human hair. Over the years, the field of nanotechnology has expanded to include not just machines and computers but many other exciting applications. In the future, nanotubes embedded in clothing could change color at the wearer's whim or switch from breathable fabric to waterproof as the need arises. Military scientists envision nanotube fabrics that harden upon impact, creating an impenetrable barrier to projectiles, while otherwise retaining the comfort characteristics of regular fatigues. Nanotechnology shows enormous promise for medicine as well.
In 2006, scientists at Stanford University reported that near-infrared lasers — a wavelength slightly higher than visible light and harmless to human tissue — could heat man-made carbon nanotubes to 158°F in two minutes. These nanotubes were then injected into a cancerous tumor and, after allowing sufficient time for them to be absorbed by the cancer cells, were exposed to near-infrared light. The cancerous cells were killed, while adjacent cells remained unharmed.
Since thousands of nanotubes can fit inside one cell, exposing them to near-infrared lasers effectively allows scientists to target cancer at the cellular level. An obstacle to this approach had been the difficulty of delivering the nanotubes only to cancer cells and not to nearby healthy cells, but this was overcome by coating the nanotubes with folate, a B vitamin. Unlike normal healthy cells, cancer cells contain numerous folate receptors, making them essentially a magnet to folate-treated nanotubes.
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Excerpted from The Ageless Generation by Alex Zhavoronkov. Copyright © 2013 Alex Zhavoronkov. Excerpted by permission of St. Martin's Press.
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