Coping with Methuselah: The Impact of Molecular Biology on Medicine and Society

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9780815700395: Coping with Methuselah: The Impact of Molecular Biology on Medicine and Society


Many medical authorities predict that average life expectancy could well exceed 100 years by mid century and rise even higher soon thereafter. This astonishing prospect, brought on by the revolution in molecular biology and information technology, confronts policymakers and public health officials with a host of new questions. How will increased longevity affect local and global demographic trends, government taxation and spending, health care, the workplace, Social Security, Medicare, and Medicaid? What ethical and quality-of-life issues are raised by these new breakthroughs? In Coping with Methuselah, a group of practicing scientists and public policy experts come together to address the problems, challenges, and opportunities posed by a longer life span. This book will generate discussion in political, social, and medical circles and help prepare us for the extraordinary possibilities that the future may hold.


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About the Author:

Henry J. Aaron is a senior fellow in Economic Studies at the Brookings Institution, where he holds the Bruce and Virginia MacLaury Chair. Among his many books are Can We Say No? The Challenge of Rationing Health Care, with William B. Schwartz and Melissa Cox (Brookings, 2006), and Reforming Medicare: Options,Tradeoffs, and Opportunities, written with Jeanne Lambrew (Brookings, 2008). William B. Schwartz is an expert on national health policy and is a professor of medicine at the University of Southern California. He was formerly chairman of the Department of Medicine and Vannevar Bush Professor at Tufts University and was also president of the American Society of Nephrology.

From The New England Journal of Medicine:

Coping with Methuselah is an important book about the future of the human lifespan, the possibility of a revolution in longevity (i.e., a significant extension of life), and the social and economic consequences that would result from living much longer lives than we do today. The book is the product of the collaborative efforts of 17 scholars, including three medical scientists (Drs. William B. Schwartz, John T. Potts, and Alan M. Garber); a large team of reputable economists, most of whom are from the Brookings Institution; an ethicist, Alexander Capron, from the University of Southern California; and a journalist, Nicholas Wade, of the New York Times. To transform the diverse expert opinions into a coherent book, two meetings among the contributors were organized: a planning meeting, which was held at Stanford University in 2001, and a conference, which was held at the Brookings Institution in Washington, D.C., in 2002. In addition to these efforts to harmonize the experts' opinions, the editors have provided six of the book's seven chapters with accompanying detailed comments (which are sometimes as long as the chapters they complement). These have been written by other experts -- in most cases, former discussants and opponents at the earlier meetings -- which makes for particularly interesting and useful reading because of the diversity of opinions. The book consists of two parts: one on the likelihood of a revolution in longevity, which is very interesting to read and which I would recommend to everyone, and a larger and more specialized part written by economists that addresses the crucial question "Can we afford longevity?" These are complex issues that relate to the changes in health care, the labor market, and the financing of Social Security, Medicare, and Medicaid -- all very important topics -- that nonetheless may be challenging for noneconomists to understand. The authors admit that there are no simple solutions to the forthcoming socioeconomic problems caused by an aging population, and, therefore, they consider several different scenarios and strategies to cope with the economic and health consequences of a further extension of life. The book suggests that life extension will not necessarily lead to economic disaster and a bankruptcy of the social support systems if society has properly prepared for the anticipated revolution in longevity by a gradual increase in the retirement age. This increase could be achieved in a gentle way by the creation of economic and other incentives for later retirement and by the establishment of a working environment that is friendlier to seniors. Contrary to common wisdom, the age at retirement is not written in stone; instead, it has changed dramatically in recent history. For example, the rate of participation in the U.S. male labor force at age 65 declined in the 20th century, from 75 percent in 1910 to 30 percent in 1990; now this trend seems to have reversed, as demonstrated by Gary Burtless in his chapter, "Labor Market Effects of Dramatic Longevity Improvement." The most enjoyable part of the book is the editors' 15-page introduction, which nicely summarizes the major ideas and findings and clearly spells out the possibility of a revolution in longevity. Aaron and Schwartz conclude the introduction by writing, "We think that the scenario addressed in this book -- a world in which living to a hundred or even beyond will one day be common if not typical -- is a reasonable extrapolation of the revolution in molecular biology that is only now gaining momentum." Also enjoyable is chapter 1, "The Impact of the Revolution in Biomedical Research on Life Expectancy by 2050," by Potts and Schwartz. This chapter, which is followed by reinforcing comments by Wade, describes the forthcoming arsenal of scientific methods and techniques in regard to regenerative and anti-aging medicine; these methods and techniques lead many scientists to believe that a healthy extension of life is not a fantasy any longer, but a feasible scientific project. This chapter may be a good starter for students and physicians. "The Changing Face of Health Care," by Alan M. Garber and Dana P. Goldman, is followed by a different perspective in John B. Shoven's chapter, "The Impact of Major Improvement in Life Expectancy on Financing of Social Security, Medicare, and Medicaid." Whereas Shoven provides an optimistic scenario on the basis of current favorable trends of declining disability rates among seniors, Garber and Goldman present alarming data showing that disability rates are increasing for all adults under the age of 60. Obesity, diabetes, and asthma are on the rise, and this fact could destroy the hope that the current decline in disability rates among seniors will continue in the long term. All physicians, no matter how busy, should take a look at the introduction and the first chapter of this important book. There is no doubt that it will be extensively cited and used in all subsequent debates on the future of medicine and sustainable health care. Leonid Gavrilov, Ph.D.
Copyright 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

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