When I began to prepare to write this article, I was clear and confident about my direction. Anti-aging technologies, I was sure, are a snare and a delusion--an appeal to vanity, to narcissism and denial of reality. Instead of techno-utopian delusions, I would argue for a more "ecological" vision of life where youth and age are both accepted as part of the natural life cycle. It is a line of thought I have held for many years, and what is more comfortable than familiar opinions?

But the more I thought about my skepticism and hostility to life-extension technology, the more uneasy I became. Gradually, as I reflected on my uneasiness, I found it more and more difficult to rationalize my strong rejection of life extension. This uneasiness came to a head when I was attending a high school reunion, after nearly forty years, and a classmate casually remarked that we didn't look much like our parents looked at the same age: That is, we didn't look as old. Glancing around the room, I realized it was true. I also realized that I was not unhappy about that fact: I would prefer youth, or at least indefinite middle age, instead of celebrating the condition of age to which I had devoted the bulk of my professional life in gerontology.

So there it is. The anti-aging response was in me, undeniably. But I was uncomfortable with that response, actually of two minds about it. Emotionally, I liked the idea of looking young, being young. Intellectually, as a gerontologist, I knew all the reasons why I was opposed to anti-aging medicine. Out of my own ambivalence, then, came an inner dialogue between advocates and opponents of life-extension technology. What follows is a summary of that ongoing dialogue, followed by observations about why I believe anti-aging medicine and life-extension technology increasingly constitute an ideological crisis for mainstream gerontology today, a crisis likely to intensify throughout the twenty-first century as new techniques for longevity increasingly become available.

In order to be clear about what is at stake in the dialogue that follows, let me first distinguish between two forms of life extension:

1. "Weak" life extension means increased average life expectancy--say, from 76 to 100, combined with compressed morbidity, with maximum lifespan remaining unchanged (at around 120 years).

2. "Strong" life extension means dramatically increased life expectancy--say, from 76 to 200 years, with continued compression of morbidity, and maximum lifespan rising to something like 240 years.

With this distinction in mind, consider the following scenarios for the future:

Weak life extension: Scenario for the year 2045.

Today the richest man in the world is not Bill Gates, but Tom Tower, who founded Senex Corporation in 2010. With the development of Geromatrix, a telomere-enhancing drug, Dr. Thomas Tower effectively patented the Fountain of Youth. Soon afterward discoveries flowing from the Human Genome Project resulted in progressive eradication of cancer, heart disease, and Alzheimer's. Normal retirement age has now been raised from 67 to 80. Today there are over two million centenarians in America, and people spend decades attending Elderhostel classes in their retirement. Still, no one has yet lived beyond age 128, when cellular reserve capacity suffers a mysterious terminal drop. Research continues on how to extend maximum human lifespan still further, but the impact of our new "longevity society" has already been dramatic.

Strong life extension: Scenario for the year 2075.

The world has changed dramatically in the past 75 years. Some of the oldest baby boomers are still alive, but they will soon die off. Not so their children and grandchildren born after the turn of the twenty-first century. In their childhood these children got the benefit of telomeric induction therapy, which delays puberty until age 25 and doubles normal life expectancy and maximum lifespan. As a result, it is expected that "bi-centenarians" will be common in years to come. Indeed, the current generation can expect to live two centuries or more, largely in excellent health. The result has already been a dramatic upsurge of concern about environmental protection, since so many people can now look 200 years into their own future. Savings rates have risen, and health promotion and accident prevention measures are widely popular. Marriage is no longer a lifelong commitment but a "renewable contract" in 50-year increments.

There is clearly a difference between the future envisioned under weak versus strong life extension. The weak version is an extrapolation of the world we know--very different, but still the human life-course as we have come to understand it throughout human history. Not so the world under strong life extension. Under strong life extension, people would be able to know their great-great-great-great-great grandparents. If strong life extension had been in effect in centuries past, we would be doing oral histories of people who had known and worked with George Washington, and we would still have Civil War veterans alive for Ken Burns to interview in producing a TV series.

What can we say philosophically about these two scenarios, these two versions of life extension? Are they both desirable or not? Given prospects for life-extension technology, at least as a theoretical possibility, let us consider some arguments, pro and con, that can be offered in response to this potential technology, for both the weak and the strong versions. The arguments mainly arise in relation to the following topics.

Futility.

Proposed anti-aging interventions will fail. The only proven method of life extension for mammals is caloric reduction in infancy, which is impractical for human purposes. Searching for a Fountain of Youth has always been a delusion.

Counterargument: Past failures prove nothing. By analogy, transformation of chemical elements was the futile claim of alchemy until nuclear reactors were invented. The fact that anti-aging interventions have failed in the past is no proof that they must fail in the future, especially since at least one intervention (caloric reduction) has already been proven to work. Other remedies may be waiting to be discovered.

Quackery.

Because the search for anti-aging methods is futile, anti-aging medicine will be harmful and fraudulent. People need to be protected from quack remedies; anti-aging medicine should be denied legitimacy.

Counterargument: This kind of paternalism is familiar but unjustified. Perhaps, on paternalistic grounds, we could protect people from things that are harmful, but not from those that are useless. Anti-aging medicine already attracts wide public interest, whatever the geriatric establishment thinks. If we believe in freedom, we must permit people to pursue anti-aging interventions.

Side effects.

When anti-aging remedies are introduced, they produce unexpected side effects. For example, human growth hormone reverses some age-related decrements but raises susceptibility to cancer. Other anti-aging interventions can be expected to have similar harmful side effects.

Counterargument: We can compensate for side effects. When organ transplants were introduced, there were side effects from suppressing immune function. But, over time, these problems have proved manageable. Similar harmful side effects from anti-aging interventions are likely to be successfully addressed with medical progress.

Diversion of scarce resources.

Diverting scarce biomedical resources to anti-aging research is wasteful, since the odds of success are remote and the consequences for society are problematic. Funding should go instead for more conventional research to ameliorate age-related diseases, as the National Institute on Aging contends.

Counterargument: A tradeoff decision isn't ours to make. Funding for anti-aging research mainly comes from private corporations, not government anyway. The situation is comparable to cloning: Research will go on either here or overseas, whatever we think. Tradeoffs will be decided in the marketplace, not at the policy level. Moreover, anti-aging research will have benefits in ameliorating age-related diseases. It is impossible to separate anti-aging research from other forms of geriatric medicine.

Prolonged disability.

A successful anti-aging intervention cannot guarantee that the disabilities of age will be cured at the time life-extension becomes available. Anti-aging gains are likely to be partial, so we end up extending longevity before curing the diseases or disabilities of age. The result could be longer life for people with Alzheimer's disease, just as Jonathan Swift predicted in the fate of the Struldbruggs in Gulliver's Travels.

Counterargument: Swift's Struldbrugg scenario has already come to pass in today's nursing homes. It doesn't follow that we made a mistake to save lives or to let people grow old; rather, we should work harder at curing diseases and disabilities of age. Anti-aging interventions simply extend the biomedical revolution. Progress is always uneven.

Ecological imbalances.

Longevity rates among different biological species emerged over extended evolutionary time and reflect a complex ecological balance. Introducing life-extension technologies would result in explosive growth in the elderly population, outstripping carrying capacity for healthcare and social support and producing imponderable consequences for society as a whole.

Counterargument: Why be pessimistic? This argument simply restates a version of the epidemiological transition that has already occurred, during industrialization and modernization when death rates declined before birth rates. The result was to create temporary ecological imbalances that were corrected as birth rates dropped. Pessimists believe that population aging must exhaust our carrying capacity, but so far they have been proven wrong. With social innovations, such as productive aging, the future could be very bright.

Boredom and pathology.

The fictional Makropoulous Case describes the dismal negative consequences of living too long. The heroine of that story lived 300 years and eventually got bored and turned down further life extension. Human beings are simply ill-prepared for longevity outside the current range of normal human life. People would soon fall into boredom or social pathologies engendered by a lifespan beyond what we are familiar with.

Counterargument: Life extension will require creating new institutions to help people overcome boredom and social pathologies--second careers, lifelong learning, new varieties of marriage and other forms of social relationships, for example. History suggests that we can come up with new social inventions to cope with dramatic increases in longevity.

Virtues of aging.

Aging, death, and finitude are essential conditions for human flourishing. Working within limits is what artists do in the act of creativity. To live without limits would not provide a basis for the human virtues that give life its creative meaning.

Counterargument: Life extension is not immortality and doesn't do away with the finitude of existence. Life extension may even make the threat of "premature" death more poignant. Acts of artistic creation entail limits imposed by social convention (e.g., the form of a sonnet or a symphony). So too, extended life may require different new conventions. By analogy, instead of a short lyric poem, we aim for a longer epic poem. The extension of life will open greater possibilities for human expression and fulfillment on a larger scale. Why then should we be afraid of life extension?

Gerontological Correctness?

Why indeed should we be afraid of life extension? Many politically progressive people are suspicious of innovations such as human cloning and genetically modified foods; they are likely to be suspicious of life-extension technology, too. Indeed, within mainstream gerontology, anti-aging medicine is widely viewed with hostility and skepticism (an incipient form of "gerontological correctness"?). But we are entitled to wonder: Are the arguments against anti-aging medicine valid, or are the opponents of anti-aging medicine (including me) simply gerontological Luddites?

The response of mainstream gerontology to anti-aging medicine reminds me of an old joke about the man who borrows a pot from his neighbor and doesn't return it. Eventually the neighbor asks for his pot back. The one who borrowed it says nothing at first, then blurts out, "First, I never borrowed a pot from you. Anyway, I returned it last week. And besides, that pot was no good to begin with." What is it that bothers us about the technology of life extension? Is it perhaps the fear that it might--just might--work? Try the following thought experiment. If someone came forward tomorrow with a "magic pill," a proven life-extension technology with no harmful side effects, wouldn't that dramatically change this whole debate, much in the same way that ru-486 (the so-called morning-after pill) has begun to change the character of the abortion debate?

Let me put the question in more personal terms. Wouldn't you be tempted to take the magic pill yourself? This is the same question we might have asked Alice before she went down the rabbit hole. Each of us must answer the question ourselves, but we also ought to ask ourselves what it is that makes us afraid of life-extension technology. Do we believe that life-extension technology doesn't work, or that it can't work, or that it shouldn't work? As in the joke about borrowing the pot, these are three very different responses.

"Superlongevity is simply not possible," states Leonard Hayflick, discoverer of the Hayflick Limit, the important finding of the maximum number of cell divisions which empirically correlates with biological aging (see this issue, page 20). By "superlongevity" Hayflick is referring to what I have termed "strong" life extension. Hayflick clearly states the mainstream position of biogerontology, as expounded as well by Olshansky and Carnes (2001) in their book The Quest for Immortality: Science at the Frontiers of Aging. These authorities may well be right, as I am inclined to agree.

But not everyone agrees with the mainstream position. For more than a decade, the biologist Michael Rose has increased the maximum lifespan of fruit flies by using straightforward inbreeding techniques. And the Danish scientist Kaare Christensen flatly disagrees with Hayflick. Christensen argues that "there is no evidence that human lifespan is approaching a limit," noting that the population of centenarians has doubled every decade in recent times. Here one cannot escape the memory of Lord Kelvin, who proudly declared that radioactivity must be a hoax, or the case of the French physicists who proclaimed that heavier-than-air flight was impossible--just a few years before the Wright brothers took off into the air at Kitty Hawk. Again, we come back to the question, Do we believe that life extension technology doesn't work, or that it can't work, or that it shouldn't work?

Thinking back to my high school reunion, I remember noting that virtually all the women at the reunion had dyed their hair. They looked great--unlike the men, who had more flab and were balding and gray-haired (as one of the women whispered to me). Each morning at breakfast I take multivitamins and even an anti-oxidant pill--not that I'm convinced that these things are needed but, as that ad for the lottery says, "Hey, you never know." So I wonder: Am I already using anti-aging technologies?

Facing the Shadow

Anti-aging technology, I've come to suspect, is for gerontology and geriatrics what Jung calls "the shadow element": It is that deep aspect of ourselves that is rejected and repudiated but is still very much a part of who we are, as recent debates about "successful aging" confirm. In the end, I wonder, can we distinguish anti-aging technology from other interventions that we are willing to accept under the label of health promotion and successful aging?

Let us call it a boundary problem--the fact that we can't easily distinguish anti-aging technology (bad) from health-promotion interventions (good), which most of us take for granted. But this is not the end of the matter. Let us also recognize that scientific curiosity has a way of turning up discoveries that unexpectedly change the way we look at the world. A good example is the discovery of gene linkage that has prompted interest in genetic screening for Alzheimer's disease, a discovery made in the course of cholesterol research. Or the fact that we eventually recognized that bacteria cause ulcers. Or that some forms of superconductivity can take place at far higher temperatures than scientists thought possible.

But room temperature superconductivity (which may eventually prove possible) doesn't mean anyone accepts the claims of "cold fusion" that were proclaimed not so many years ago. The problem is, at the frontiers of science, it is not always easy to distinguish the hoax or error from the genuine discovery. What the history of science shows is that accidental discoveries have a way of popping up in ways we cannot imagine ahead of time. So we have to wonder, in the opening years of the twenty-first century, what new discoveries in biomedicine will change the way we look at aging, perhaps even make us question the mainstream dogma that "aging is not a disease"? What is "normal" and what is a "disease," after all? The answer turns out to be very much dependent on historical context.

So despite my uneasiness and ambivalence about life extension, I am left with what we may call the "Sorcerer's Apprentice" question, namely: With anti-aging technology, how will we ever succeed in putting the genie back in the bottle? We may well be afraid of the promises, false or true, made on behalf of life-extension technologies. But as the book by Olshansky and Carnes makes clear, the quest for immortality will not soon go away. New promises, and new possibilities, lie beyond the horizon where we cannot see.

Perhaps our best response to the possibility of life-extension technology should be akin to our response to global warming. We must not blindly deny that something is taking place; nor should we insist that proof be airtight. In the nature of the case, we can only deal with probabilities, with the weight of evidence, which is very strong for global warming. Yet, disturbingly, the very facts offered as evidence for this phenomenon suggest how difficult it will be to halt a powerful trend once already in place. As with global warming, we might think about life-extension not as a science fiction scenario for the future but rather as something already taking place under our noses, a trend that may prove to be inevitable, given the momentum of technology in place. The question then becomes how to adapt to it, how to live in a world radically different from the one we have been accustomed to, whether with rising sea levels or rising lifespans.

Whether we endorse life-extension technology or not, we might take the view that we must learn from the recent past and develop means for adapting creatively to a challenge unprecedented in human history. The answer to the question, Who's afraid of life extension? is, I am, just as I am afraid of global warming. If life extension does indeed represent the shadow element in us, an object of hope and fear, then we must face the issue head-on--it won't go away--avoid any temptation toward "gerontological correctness." It is far too easy to dismiss proponents of, or believers in, life-extension technology as simply deluded or just plain wrong. We need to face the shadow more directly and ask ourselves again and again: Do we believe that life-extension technology doesn't work, or that it can't work, or that it shouldn't work? 1

H. R. Moody, Ph.D. is director, Institute for Human Values in Aging, with the Brookdale Center on Aging and the International Longevity Center, New York.

Reference: Olshansky, S. J., and B. A. Carnes. 2001. The Quest for Immortality: Science at the Frontiers of Aging. New York: Norton.