Is Living Longer Worth It?

CHICAGO -- In advance of the World Transhumanist Society's annual confab, Transvision 2007, the Institute for Ethics and Emerging Technologies (IEET) held a pre-conference meeting in a non-descript ballroom at the Fairmont Hotel. The room was packed with 50 or so people interested in the issue of securing the "longevity dividend." Not everyone in the audience would call themselves "transhumanists" but all were interested in figuring out how to sell longer lives to the public. This was not a crowd of wild-eyed utopians. The audience was diverse -- about one third women and two-thirds men, and ranged from doctors, professors, and economists to people who had lived in alternative communities and even a few high school students. One might think that longer, healthier lives should be an easy sell, but, in fact, there are people who believe that dramatically extending human lives would be a bad idea.

I attended the IEET conference as a speaker, to give a talk on the political economy of the longevity dividend. What is the longevity dividend? It's a way of rebranding the quest for extending human lives in a politically palatable way. The idea behind the longevity dividend was expressed in an article in The Scientist which argued that research should be directly targeted at slowing the aging process by seven years. As University of Illinois-Chicago demographer Jay Olshansky put it at the conference: It is a new paradigm for health promotion and disease prevention in the 21st century. Olshansky, one of the co-authors of the article in The Scientist unveiling the campaign to push for the longevity dividend, argues that slowing the aging process by seven years would mean that age-related diseases-cancer, cardiovascular disease, Alzheimer's-would be cut in half at every age. "If we succeed in delaying aging, the bonuses will be an extension of healthy life and a drastic reduction in health care costs," said Olshansky.

Olshansky argues that the old paradigm of directly targeting diseases is about to run out of steam. Even if all cancer, all heart disease and all diabetes were eliminated, it would add only 3 more years to average life expectancy in the United States. So if researchers want to achieve big gains in lifespan and healthspan they have to go after the aging process itself. For adults the doubling time for risk of death is seven years. If you slow aging by seven years, you cut the risk of death at any age in half, and cut the risk everything else that goes wrong with the body in half too. The idea is not to make people older longer, but to make them younger longer. Not being libertarians, Olshansky and other advocates for the longevity dividend want to reprogram $3 billion in federal biomedical research to target aging itself.

At the conference, David Meltzer, a medical economist from the University of Chicago, warned that the longevity dividend could have downsides too. For example, one should consider what follow on costs may flow any particular intervention. For example, someone is saved from a heart attack, he or she may now live long enough to get cancer which could cost more to treat. In addition, Meltzer noted that most analyses of the benefits of medical interventions measure only future medical costs. But that fails to account for total costs by including future consumption -- food, clothing, housing -- in the calculations as well.

Meltzer also argued that quality of life must be included in the calculations of net benefits and costs stemming from medical interventions. For example, Meltzer showed various interventions that were cost-effective, e.g., influenza vaccinations, and treating 40-55 year-old men for high cholesterol provided more benefits than costs. However, treating a 75 year-old with late-stage colon cancer does not -- their quality of life is terrible and the very costly treatment will likely add only few months of extra life. Meltzer was not amused by my comment that when you take into account all of the money spent on health care, that the cheapest patient is a dead patient. In the end, after all of his cautions, Meltzer acknowledged that most current health interventions that increase life expectancy are worthwhile in terms of medical cost effectiveness.