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  #381  
Old 06-24-2019, 02:27 PM
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https://www.theguardian.com/us-news/...oor-inequality

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'It's totally unfair': Chicago, where the rich live 30 years longer than the poor

Spoiler:
In rich white Streeterville, Chicagoans can expect to live to 90. In poor black Englewood, it’s just 60 – the most divergent of any US city

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Sun 23 Jun 2019 02.00 EDT Last modified on Sun 23 Jun 2019 13.52 EDT
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The Englewood neighborhood in Chicago. The gulf between the two communities which share a city, a mayor, a police force and a school system is just as apparent by the numbers.
The Englewood neighborhood in Chicago. The gulf between the two communities which share a city, a mayor, a police force and a school system is just as apparent by the numbers. Photograph: Christian Science Monitor/Getty Images
Walking down 69th Street in Englewood, Chicago, near where she grew up, Michelle Rashad gestures to a rundown retail shop, across from a long open lot.

“At this store, there’s a Muslim brother who sells some fruits and vegetables some days,” says the 27-year-old. “But that might be the only piece of fruit you can get for another mile. Most [of] it has been like this since I was a kid. At least since I can remember.”


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The stores here – the few that haven’t been boarded up or burned to the ground – sell mostly packaged goods from behind thick plates of ballistic-proof glass. Even at the Subway sandwich shop a few blocks down, the healthy option in the area, customers have to shout their selections to overcome a muffling bulletproof encasement around the food and register.

On a bustling Tuesday afternoon in Streeterville, meanwhile, it’s hard to believe those Englewood streets are just eight miles away. On an open space between the Ritz-Carlton and the Lurie children’s hospital, vendors hawk farm fresh tomatoes, cucumbers and squash in sheer abundance. There are handmade crêpes and fresh pastries. There is small-batch artisanal tofu.

The gulf between the two communities which share a city, a mayor, a police force and a school system is just as apparent by the numbers. A recent analysis from the City Health Dashboard, published by the department of population health at New York University, found that the two neighborhoods have the most divergent life expectancy of any in the US that share the bounds of a city.

In predominantly white Streeterville, Chicagoans can expect to live to 90. In Englewood, where the population is virtually all black, life expectancy is just 60.

“There’s a concept that is increasingly being understood, that your zip code has as much to do with your health as your genetic code,” said Dr Marc Gourevitch, chair of the NYU department and the principal architect of the health dashboard.

“Another way to look at that is that your zip code shouldn’t determine whether you get to see your grandkids. And at some level, that’s how I see and feel about these kinds of data. It’s shocking.”

Back on 69th Street, Rashad reflected on this 30-year disparity.

“That’s the difference of an entire generation,” she says, incredulity in her voice. “But I won’t accept that. Englewood won’t accept that.”

Englewood has long held a reputation as one of Chicago’s most violent neighborhoods.
Facebook Twitter Pinterest Englewood has long held a reputation as one of Chicago’s most violent neighborhoods. Photograph: Christian Science Monitor/Getty Images
‘Traumatic situations’
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Streeterville is almost a caricature of physical and economic health. The lakefront neighborhood, a mere 14 blocks north to south, is home to a Northwestern University campus and three hospitals. On a late spring day, teens toss footballs and volleyballs as joggers zig-zag with leashed dogs in tow. On a full-length track in front of a pair of highrise condominiums, Kate Gardner jogs. She can’t muster one complaint about life in Streeterville, save for a few weeks of unseasonably cool weather.

“I know we’re lucky to be here, and that other people in the city don’t have it so good. It’s totally unfair,” she says.

The different health outcomes are multifaceted and correlate to almost every socioeconomic factor. The median income in Streeterville is nearly $100,000 a year, according to the US census. In Englewood, smack dab in the center of Chicago’s Southside, it’s a quarter of that. More than 80% of Streeterville residents have a college degree, compared with 8.2% in Englewood.

Then there’s the violence and the trauma it brings. Walking down 69th, Rashad stops to point.

“That’s where, freshman year, my 14-year-old friend was killed,” she says. “A stray bullet went straight through the window while she was getting ready for school. And I have to walk past that block.

“We’re constantly having to walk past these traumatic situations. You can literally look at the sidewalk where you’ve once seen blood or people bleed out, and you have to go to school, you have to go to work.”

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Englewood has long held a reputation as one of Chicago’s most violent neighborhoods. According to the Chicago Tribune, between 2000 and 2017 there were more than 4,800 shootings here.

Erin Vogel, co-executive director of I Grow Chicago, an Englewood-based community nonprofit, says 100% of the children the group works with have lost someone they know to gun violence and have heard gunshots while in their home.

“93% of them have literally seen a shooting with their own eyes,” she says. “There’s a young man who I work with who just turned 15, and in his 13th year of life, five of his friends were murdered. He saw two of them.”

The violence, of course, drives down life expectancy and health outcomes. But health inequities also drive violence. Take lead poisoning. For decades, Englewood had one of the highest rates of residential lead contamination in the country. Research has shown that lead poisoning in children is associated with dramatic spikes in impulsiveness and aggression.

“Irreversible brain damage just because of where you live, and you’re too poor to go anywhere else? It’s not fair. You’re cheating kids,” said Rashad, now executive director of Imagine Englewood If, a community group founded largely to draw attention to the lead crisis.

It wasn’t always this way.

“It was a Mecca!” exclaims lifelong resident Djanie Edwards, rattling through a list of vanished community anchors like the Sears store and the old Empress theatre. Everyone who remembers the community before the decay of the 1980s and 1990s points to the abandonment as perhaps the biggest change.

“There wasn’t all these open lots everywhere, these were houses,” Edwards says, at the headquarters of Resident Association of Greater Englewood (Rage), the only occupied building on its block. In seven lots, only two structures are standing.

Edwards remembers a time before local jobs began to move overseas, like at the Nabisco bakery where Rashad’s father worked most of his life. Unemployment opened the door to drugs, drugs fostered an environment of violence, the community fell into poor health and dysfunction.

“When cocaine hit there was such a rapid decline, and it affected individuals across the spectrum,” said Rodney Johnson, whose family arrived in the community in 1966. He was one of many who left in the 1980s but he has now returned, in part to deploy his skills as a public health researcher.

Johnson is one member of a team of “community health navigators” who this week began conducting a door-to-door survey. One of the most pressing questions they’re trying to answer is why there seems to be a disconnect between services that are actually available in the community and residents who do not use them.

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“The ironic thing is there are a lot of health resources available here,” said Cecile De Mello of Englewood Rising, one of the community groups involved in the research. “We want to know what are the barriers to people taking advantage of care opportunities in the community. Is it issues around safety? Is it issues around transportation? Is it that people feel helpless, and that they need motivation to help them get into care?”

Teens play basketball in Ogden Park in the Englewood neighborhood in Chicago, Illinois.
Facebook Twitter Pinterest Teens play basketball in Ogden Park in the Englewood neighborhood in Chicago, Illinois. Photograph: Christian Science Monitor/Getty Images
‘The Promise Land’
It’s not all doom and gloom. There are patches of hope, like the abandoned lot Tina Hammond bought across from her home for $1, thanks to a city program. She and her husband made it into a green space with colorful planters, murals and space for community events like free yoga. They named it The Promise Land.

“It shouldn’t be that we have to have money or a certain income to get this kind of stuff,” Hammond said. “That’s why I envision just a beautiful space, something to get your mind off all the wretchedness that’s going on in life and all on these blocks. A place to just go and sit, relax and bring calm.”

There’s economic development too, bringing more healthy options to a community long described as a “food desert”. De Mello found her way to community work after being heavily involved in the siting of a Whole Foods market in Englewood, focusing on making sure products were affordable and accessible.

Violence is trending down too – though the reasons are still hotly contested.

More than anything, community groups like I Grow Chicago are giving residents hope. Their “peace house”, across the street from a community garden, is a frenetic jumble of answers to unmet needs. Visitors might be there for anything from toilet paper and toothpaste to a Reiki healing session.

Ora Bradley, who has lived in Englewood most of her life, spoke to the Guardian at the peace house as Reiki masters “smudged” the room with palo santo.

“There was a time I wanted out of this neighborhood so badly,” said Bradley, who watched her son Julius get caught in the drug game, spending time in jail.

She says the I Grow Chicago campus, which has essentially taken over her block, is nothing short of a godsend. The organization trains community members in construction and is refurbishing homes as community space or affordable housing.

Bradley says she still wants to leave, but for a very different reason. She wants to donate her home to I Grow, to make it part of its growing “peace campus”.

“There’s a desire that’s been placed in my heart to do this for our children,” she says, “and I can’t let it go”.


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  #382  
Old 06-26-2019, 04:45 PM
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https://www.thinkadvisor.com/2019/06...&utm_term=tadv

Quote:
How Likely the Government Thinks You Are to Die This Year

Spoiler:
The life insurers that issue annuities are keenly interested in whether annuity holders will die this year.
They hope, as kind human beings, that the annuity holders will live long and healthy lives, but shorter lives would cut contract benefits payouts.
Issuers come up with death rate forecasts for a particular year by using their own customers’ data; industrywide data collected by consultants, reinsurers and industry groups; and information collected by government agencies.
The National Center for Health Statistics, part of the U.S. Centers for Disease Control and Prevention (CDC), is one of the top mortality information providers in the world.
The CDC has released several mortality-related tables this week. One, United States Life Tables, 2017, shows how likely people at specific ages from 0 to 100 were to die in 2017.
Newborns had a 0.577% chance of dying between the day they were born and the day they turned 1.
The CDC assumes, for simplicity’s sake, that people who are 100 have, roughly, a 100% chance of dying — even though 99-year-olds, for example, had only a 31.6% chance of dying in 2017.
For a look at the CDC probability estimates for the risk of dying at selected ages from 25 through 75, in percent, based on 2017 vital statistics data, see the data cards in the slideshow above.
Resources
A copy of the life new tables is available here.
Correction: The CDC’s estimate of the probability of death for people age 60 was given incorrectly in an earlier version of this article. The estimate, based on the 2017 data, is 0.909%.

https://www.cdc.gov/nchs/data/nvsr/n...r68_07-508.pdf
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  #383  
Old 06-30-2019, 10:18 PM
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OVERDOSES

https://www.wsj.com/articles/overdos...90-11561541406
Quote:
Overdose Deaths Likely to Fall for First Time Since 1990
Health officials and scientists warn U.S. is far from defeating drug epidemic

Spoiler:
For the first time in decades, drug-overdose deaths in the U.S. are on the precipice of declining.

Authorities are still counting fatalities around the U.S. from 2018, but provisional data from the Centers for Disease Control and Prevention are pointing lower. Those data predict there were nearly 69,100 drug deaths in the 12-month period ended last November, down from almost 72,300 predicted deaths for 12 months ended November 2017.

If the trend holds through December, annual drug deaths will fall for the first time since 1990, when overdoses killed about 8,400 people.

"I think we're probably looking at a decline," said Robert Anderson, chief of the mortality statistics branch at the CDC's National Center for Health Statistics.

There is little cause for celebration, health officials and epidemiologists say. The death rate remains swollen by powerful synthetic opioids like fentanyl, and Mr. Anderson warned a new deadly analog could arrive anytime. The rise of methamphetamines and related deaths remains a worrisome trend.

Health authorities are eager for any hint of progress. Overdoses have killed roughly 870,000 people during this nearly three-decade rise, with particularly heavy tolls in the last several years, CDC data show. "I'm ready to say that the opioid crisis is in early remission, yet at high risk of relapse," said Jim Hall, an epidemiologist at Nova Southeastern University in Florida.

One driving factor has been broadened access to the overdose-reversal drug naloxone, often known by the brand name Narcan, according to authorities in places like Rhode Island, Ohio and Pennsylvania. This can entail putting more doses directly in the hands of at-risk drug users. When asked why fatalities in the Pittsburgh area fell 41% to 432 last year -- the lowest level since 2015 -- Allegheny County Chief Medical Examiner Karl Williams said: "In a word, Narcan."

Pennsylvania's drug deaths are still being counted, but there was likely a statewide decline last year, a spokesman for the Drug Enforcement Administration office in Philadelphia said. The DEA tabulates overdoses for the state.

Authorities there and beyond also credit efforts to get overdose victims from emergency rooms on a path to treatment. This can entail connecting them with peer-recovery coaches, handing them free naloxone kits and following up after they head home.

Another possible factor is that some of the most vulnerable people have already died, said Magdalena Cerda, director of the new Center for Opioid Epidemiology and Policy at New York University Langone Health, adding that more studies are needed in this area. Also, hard-hit states may be regressing toward more average levels after years of death rates inflated by opioids, she said.

"It's likely a combination of all those things together," she said, noting that the rates of overdose are still many times higher now than they were in the peak of the crack-cocaine crisis decades ago.


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Old 07-01-2019, 03:48 PM
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HEART DISEASE

https://quillette.com/2019/06/12/the...heart-disease/



There are a variety of graphs/tables in there, but I will copy over only two:





The author used less-than-ideal screenshots.
From the quoted article:

Quote:
In what can only be described as a landslide victory for the matriarchy, men turning 35 are half as likely to make it to 45 as their female counterparts.
No way. The article was pretty well-written up to that statement.
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Old 07-01-2019, 03:58 PM
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From the quoted article:



No way. The article was pretty well-written up to that statement.


I assume they mean 'twice as likely to die before turning 45'??? Even that sounds high, but at least within the realm of possibility, especially considering the opiod epidemic is hitting males more than females IIRC.

Belongs in the innumeracy thread.
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Old 07-16-2019, 06:28 AM
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MILITARY SUICIDES

https://www.wsj.com/articles/militar...ce-11563096602
Quote:
Military Unit, Ravaged by War, Regroups Back Home to Survive the Peace
Suicides drive Bravo Company veterans to test whether reuniting will help overcome lingering effects of battle

Spoiler:
Nearly a year ago, the combat-hardened paratroopers of Bravo Company realized things were getting too dangerous. They weren't working as a team. Too many men were dying. Nobody seemed to know how to stop the bloodletting.

And that was a decade after they got home from war.

During an 11-month tour of Afghanistan's notorious Arghandab Valley,three soldiers from Bravo Company, Second Battalion, 508th Parachute Infantry Regiment were killed in action and a dozen more lost at least one leg or arm. In the 10 years since they returned to the U.S., two B Company soldiers -- isolated from their buddies, struggling with their demons -- have killed themselves, more than a dozen have tried and others admit they have considered it.

"Derek, Grant, Timmy -- all those guys died at their own hands," said Sgt. FirstClass Robert Musil, listing close friends from Bravo Company and other units he served in who had killed themselves. "All those men were warriors. If they can do it, what's stopping me?"

Bravo Company's traumatic tour and high suicide rate have drawn the attention of the Department of Veterans Affairs and an advocacy group called the Independence Fund. The agencies declared men from the unit -- including Sgt. Musil -- to be at what the fund calls "extraordinary risk" of succumbing to addiction, isolation and suicide. They decided to use Bravo Company as a testing ground for a new approach to suicide prevention among veterans.

VA mental-health services have often focused on the individual veteran and clinical care, such as therapy sessions with professionals and mood-stabilizing drugs. Innovations in alternative therapy have included yoga sessions, acupuncture and service animals. But even in group sessions, veterans don't usually connect with those they served beside in combat.

On a weekend this past spring, the VA and the Independence Fund brought 98 remaining Bravo Company veterans together to test a theory: Just as they relied on each other to survive in combat, they could again rely on each other to survive the lingering effects of war.

They laughed. They cried. They talked about their fears. They whitewater-rafted. They took a few shots of Jameson Irish whiskey. They met with VA counselors. And they tried to rebuild the fraternity that had frayed since they returned home.

"You are your brother's keeper," said Sgt. Musil, a core member of the company.

When Sgt. Musil came back from Afghanistan, he unplugged from the others who had seen what he had seen in combat. He didn't talk much to anyone about that year in southern Afghanistan. He deleted his social-media accounts. But the memories festered. His marriage fell apart.

Sgt. Musil stayed in the Army, deploying again and again, spending as much time as possible working, he said, to prove to himself he hadn't been affected.

Then the suicides began, including the sergeant's best friend, Alan, who during what seemed to be a flashback shot two neighbors before apparently realizing what he had done and turning the gun on himself.

Over the past decade, the men rarely got together, and when they did, it was likely for a funeral. In September, there was another one when a Bravo Company veteran, Derek Hill, shot himself after returning from a job as a contractor in Iraq.

That suicide prompted company leaders, the Independence Fund and the VA to take action.

"We have the mantra that we're the strongest on the planet, that we're indestructible," Sgt. Musil said of the paratroopers. But, he admitted, "we're scared."

The meetings, group activities and VA-led counseling sessions can provide the most effective suicide prevention possible, health experts say.

The VA budgeted nearly $18 million for suicide prevention last year, mostly for counselors and hotlines.

But the most recent VA statistics show suicide rates are rising for the youngest veterans, and that among all adults, former troops are 50% more at risk than civilians.


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Old 07-24-2019, 09:46 AM
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https://www.wsj.com/articles/death-r...ts-11563854580

Quote:
Death Rates Rising for Young, Middle-Aged U.S. Adults
Opioid epidemic and stalled progress against heart disease have dragged down life expectancy

Spoiler:
Death rates are rising for young and middle-aged U.S. adults, and the outcomes for whites, blacks and Hispanics are diverging, according to a new government analysis.

The report by the Centers for Disease Control and Prevention, to be published Tuesday, adds new detail to a grim picture of worsening health trends across the nation, as the opioid epidemic and stalled progress against heart disease have dragged down life expectancy.

U.S. Hispanics have long experienced lower death rates than blacks or whites. But the drug-overdose epidemic is affecting the longevity of younger Hispanics, according to the report and experts on health in the U.S. Hispanic population.

"People are just now starting to recognize that the opioid epidemic is not just a white phenomenon," said Andrew Fenelon, an assistant professor of health policy and management at the University of Maryland who has studied health behaviors and advantages in life expectancy among U.S. Hispanics.

Across all ages, death rates have declined, albeit more slowly in recent years. The decline in the U.S. death rate slowed in recent years for all ethnicities, including Hispanics, according to the report. While the death rate for Hispanics fell 2% each year between 2000 and 2011, that slowed to less than 1% annually from 2011 to 2017, according to the CDC report.

The death-rate decline also slowed for black Americans during those years. It barely budged, meanwhile, for white Americans.

But among younger adults age 25-44, death rates rose 21% for white and black adults and 13% for Hispanic adults between 2012 and 2017, according to the report.

Most young victims in that age group died of injuries, including drug overdoses and suicides, said Sally Curtain, a health statistician at the CDC's National Center for Health Statistics, and an author of the new report.

Homicides have also risen, as well as deaths related to heavy use of alcohol, she said.

"It's not all driven by drug overdose, but it's pretty much all injury deaths," she said.

Death rates also rose 6.9% for white and 4.2% for black middle-aged adults ages 45-64 from 2012-2017. They were essentially flat for Hispanics after dropping steadily in previous years.

The data paint a differing picture for younger U.S. Hispanics, whose death rates are rising, and older generations, who have remained healthier. Most Hispanics over age 50 are foreign-born, and many came to the U.S. as workers, while more of the younger generations are U.S. born, said Mark Hugo Lopez, director of global migration and demography research at the Pew Research Center.

Immigration to the U.S. has slowed since 2007, Mr. Lopez said.

The CDC analysis includes Hispanics who are U.S. residents, both those born abroad and in the U.S. Most Hispanics living in the U.S. are of Mexican descent, and the CDC said its report mostly reflects trends that apply to that Hispanic subgroup.


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Old 08-21-2019, 03:11 PM
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https://www.technologyreview.com/s/6...rable-disease/

Quote:
What if aging weren’t inevitable, but a curable disease?
If this controversial idea gains acceptance, it could radically change the way we treat getting old.

Spoiler:
Each Cyclops had a single eye because, legend has it, the mythical giants traded the other one with the god Hades in return for the ability to see into the future. But Hades tricked them: the only vision the Cyclopes were shown was the day they would die. They carried this knowledge through their lives as a burden—the unending torture of being forewarned and yet having no ability to do anything about it.


This story is part of our September/October 2019 issue
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Since ancient times, aging has been viewed as simply inevitable, unstoppable, nature’s way. “Natural causes” have long been blamed for deaths among the old, even if they died of a recognized pathological condition. The medical writer Galen argued back in the second century AD that aging is a natural process.

His view, the acceptance that one can die simply of old age, has dominated ever since. We think of aging as the accumulation of all the other conditions that get more common as we get older—cancer, dementia, physical frailty. All that tells us, though, is that we’re going to sicken and die; it doesn’t give us a way to change it. We don’t have much more control over our destiny than a Cyclops.

But a growing number of scientists are questioning our basic conception of aging. What if you could challenge your death—or even prevent it altogether? What if the panoply of diseases that strike us in old age are symptoms, not causes? What would change if we classified aging itself as the disease?

David Sinclair, a geneticist at Harvard Medical School, is one of those on the front line of this movement. Medicine, he argues, should view aging not as a natural consequence of growing older, but as a condition in and of itself. Old age, in his view, is simply a pathology—and, like all pathologies, can be successfully treated. If we labeled aging differently, it would give us a far greater ability to tackle it in itself, rather than just treating the diseases that accompany it.

“Many of the most serious diseases today are a function of aging. Thus, identifying the molecular mechanisms and treatments of aging should be an urgent priority,” he says. “Unless we address aging at its root cause, we’re not going to continue our linear, upward progress toward longer and longer life spans.”

It is a subtle shift, but one with big implications. How disease is classified and viewed by public health groups such as the World Health Organization (WHO) helps set priorities for governments and those who control funds. Regulators, including the US Food and Drug Administration (FDA), have strict rules that guide what conditions a drug can be licensed to act on, and so what conditions it can be prescribed and sold for. Today aging isn’t on the list. Sinclair says it should be, because otherwise the massive investment needed to find ways to fend it off won’t appear.

“Work to develop medicines that could potentially prevent and treat most major diseases is going far slower than it should be because we don’t recognize aging as a medical problem,” he says. “If aging were a treatable condition, then the money would flow into research, innovation, and drug development. Right now, what pharmaceutical or biotech company could go after aging as a condition if it doesn’t exist?” It should, he says, be the “biggest market of all.”

That’s precisely what worries some people, who think a gold rush into “anti-aging” drugs will set the wrong priorities for society.

It “turns a scientific discussion into a commercial or a political discussion,” says Eline Slagboom, a molecular epidemiologist who works on aging at Leiden University Medical Center in the Netherlands. Viewing age as just a treatable disease shifts the emphasis away from healthy living, she says. Instead, she argues, policymakers and medical professionals need to do more to prevent chronic diseases of old age by encouraging people to adopt healthier lifestyles while they are still young or middle-aged. Otherwise, the message is “that we can’t do anything with anybody [as they age] until they reach a threshold at the point where they get sick or age rapidly, and then we give them medication.”

Another common objection to the aging-as-a-disease hypothesis is that labeling old people as diseased will add to the stigma they already face. “Ageism is the biggest ism we have today in the world,” says Nir Barzilai, director of the Institute for Aging Research at the Albert Einstein College of Medicine in New York. “The aging community is attacked. People are fired from work because they are old. Old people cannot get jobs. To go to those people with so many problems and now tell them, ‘You’re sick, you have a disease’? This is a no-win situation for the people we are trying to help.”

Not everyone agrees it has to be a stigma. “I am clearly in favor of calling aging a disease,” says Sven Bulterijs, cofounder of the Healthy Life Extension Society, a nonprofit organization in Brussels that considers aging a “universal human tragedy” with a root cause that can be found and tackled to make people live longer. “We don’t say for cancer patients that it’s insulting to call it a disease.”

Notwithstanding Sinclair’s comment about “linear, upward progress,” just how long humans could live remains bitterly contested. The underlying, fundamental question: Do we have to die at all? If we found a way to both treat and beat aging as a disease, would we live for centuries—millennia, even? Or is there an ultimate limit?

Nature suggests that endless life might not be inconceivable. Most famously, perhaps, the bristlecone pine trees of North America are considered biologically immortal. They can die—chopped down by an ax or zapped by a lightning bolt—but left undisturbed, they typically won’t simply fall over because they get old. Some are reckoned to be 5,000 years young; age, quite literally, does not wither them. Their secret remains a mystery. Other species appear to show signs of biological immortality as well, including some sea creatures.

Such observations have led many to contend that life span can be dramatically extended with the right interventions. But in 2016, a high-profile study published in Nature argued that human life has a hard limit of about 115 years. This estimate is based on global demographic data showing that improvements in survival with age tend to decline after 100, and that the record for human longevity hasn’t increased since the 1990s. Other researchers have disputed the way the analysis was done.

Barzilai says efforts to tackle aging are needed regardless. “We can argue about if it’s 115 or 122 or 110 years,” he says. “Now we die before the age of 80, so we have 35 years that we are not realizing now. So let’s start realizing those years before we’re talking about immortality or somewhere in between.”

Whether or not they believe in either the disease hypothesis or maximum life spans, most experts agree that something has to change in the way we deal with aging. “If we don’t do something about the dramatic increase in older people, and find ways to keep them healthy and functional, then we have a major quality-*of-life issue and a major economic issue on our hands,” says Brian Kennedy, the director of Singapore’s Centre for Healthy Ageing and a professor of biochemistry and physiology at the National University of Singapore. “We have to go out and find ways to slow aging down.”

The aging population is the “climate change of health care,” Kennedy says. It’s an appropriate metaphor. As with global warming, many of the solutions rest on changing people’s behavior—for example, modifications to diet and lifestyle. But, also as with global warming, much of the world seems instead to be pinning its hopes on a technological fix. Maybe the future will involve not just geoengineering but also gero-engineering.

One thing that may underlie the growing calls to reclassify aging as a disease is a shift in social attitudes. Morten Hillgaard Bülow, a historian of medicine at the University of Copenhagen, says things started to change in the 1980s, when the idea of “successful aging” took hold. Starting with studies organized and funded by the MacArthur Foundation in the United States, aging experts began to argue against Galen’s centuries-old stoic acceptance of decline, and said scientists should find ways to intervene. The US government, aware of the health implications of an aging population, agreed. At the same time, advances in molecular biology led to new attention from researchers. All that sent money flowing into research on what aging is and what causes it.

In the Netherlands, Slagboom is trying to develop tests to identify who is aging at a normal rate, and who has a body older than its years. She sees anti-aging medicine as a last resort but says understanding someone’s biological age can help determine how to treat age-related conditions. Take, for instance, a 70-year-old man with mildly elevated blood pressure. If he has the circulatory system of an 80-year-old, then the elevated pressure could help blood reach his brain. But if he has the body of a 60-year-old, he probably needs treatment.

Biomarkers that can identify biological age are a popular tool in aging research, says Vadim Gladyshev of Brigham and Women’s Hospital in Boston. He characterizes aging as the accumulation of deleterious changes across the body, ranging from shifts in the populations of bacteria that live in our gut to differences in the degree of chemical scarring on our DNA, known as methylation. These are biological measures that can be tracked, so they can also be used to monitor the effectiveness of anti-aging drugs. “Once we can measure and quantify the progression through aging, then that gives us a tool to assess longevity interventions,” he says.

Two decades on, the results of that research are becoming apparent. Studies in mice, worms, and other model organisms have revealed what’s going on in aging cells and come up with various ways to extend life—sometimes to extraordinary lengths.

Images corresponding to select entries from timeline
DIVISION OF RARE AND MANUSCRIPT COLLECTIONS, CORNELL UNIVERSITY LIBRARY (MCCAY); WELLCOME IMAGES, A WEBSITE OPERATED BY WELLCOME TRUST (MEDAWAR); RIEMEN SCHNEIDER (EMBRYO); SCIENCE HISTORY INSTITUTE (BLACKBURN); HANNAH DAVIS (FRUIT FLY); DOMINIK1232/WIKIMEDIA COMMONS (NEMATODE); AURBINA/WIKIMEDIA COMMONS (EASTER ISLAND)
Milestones in the history of aging research
1934
Clive McCay discovers the concept of caloric restriction by finding that rats live longer if they consume limited diets.
1952
Zoologist and anatomist Peter Medawar proposes the idea of senescence—cellular aging—and argues that aging is linked to reproduction, in a theory he calls “early-life fitness.”
1961
Biologists Leonard Hayflick and Paul Moorhead discover that human cells derived from embryonic tissue divide a finite number of times: the “Hayflick limit.”
1977
Elizabeth Blackburn at Yale discovers that telomeres, the structures at the ends of chromosomes, have unusual properties and vary in size with age.
1980
James Fries argues that every person is born with a maximum potential life span, and the average is 85 years.
1981
Michael Rose at the University of California, Irvine, breeds a strain of fruit fly that can live four times longer than normal.
1993
Cynthia Kenyon and her colleagues at UCSF discover the daf-2 mutation, which doubles the life span of nematodes.
2000
Leonard Guarente and colleagues at MIT identify SIR2, a gene that can extend life span by about 30% in yeast. They also link it with NAD+, a molecule critical for metabolism.
2002
James Vaupel proposes that the average life span has no upper limit, and that 150-year-olds will be common by 2150.
2006
Matt Kaeberlein, formerly of Guarente’s lab and now at the University of Washington, shows that rapamycin, a drug isolated from soil bacteria on Easter Island, can increase the life span of yeast cells.
2010
GlaxoSmithKline halts research on resveratrol because it caused kidney damage in a clinical trial.
2016
Nir Barzilai and colleagues discover that metformin can prolong the life span of silkworms without reducing body weight.
2019
A research team from Mayo, Wake Forest, and the University of Texas, San Antonio, announces promising results from early human trials of senolytics.
Most researchers have more modest goals, with a focus on improving what they call “health span”—how long people remain independent and functional. And they say they’re making progress, with a handful of possible pills in the pipeline.

One promising treatment is metformin. It’s a common diabetes drug that has been around for many years, but animal studies suggest it could also protect against frailty, Alzheimer’s, and cancer. Giving it to healthy people might help delay aging, but without official guidance doctors are reluctant to prescribe it that way.

One group of researchers, including Einstein College’s Barzilai, is trying to change that. Barzilai is leading a human trial called TAME (Targeting Aging with Metformin) that plans to give the drug to people aged 65 to 80 to see if it delays problems such as cancer, dementia, stroke, and heart attacks. Although the trial has struggled to raise funding—partly because metformin is a generic drug, which reduces potential profits for drug companies—Barzilai says he and his colleagues are now ready to recruit patients and start later this year.

Metformin is one of a broader class of drugs called mTOR inhibitors. These interfere with a cell protein involved in division and growth. By turning the protein’s activity down, scientists think they can mimic the known benefits of calorie restriction diets. These diets can make animals live longer; it’s thought that the body may respond to the lack of food by taking protective measures. Preliminary human tests suggest the drugs can boost older people’s immune systems and stop them from catching infectious bugs.

Other researchers are looking at why organs start to pack up as their cells age, a process called senescence. Among the leading candidates for targeting and removing these decrepit cells from otherwise healthy tissues is a class of compounds called senolytics. These encourage the aged cells to selectively self-destruct so the immune system can clean them out. Studies have found that older mice on these drugs age more slowly. In humans, senescent cells are blamed for diseases ranging from atherosclerosis and cataracts to Parkinson’s and osteoarthritis. Small human trials of senolytics are under way, although they aren’t officially aimed at aging itself, but on the recognized illnesses of osteoarthritis and a lung disease called idiopathic pulmonary fibrosis.

Research on these drugs has highlighted a key question about aging: Is there a common mechanism by which different tissues change and decline? If so, could we find drugs to target that mechanism instead of playing what Harvard’s David Sinclair calls “whack-a-mole” medicine, treating individual diseases as they emerge? He believes there is, and that he has found a stunning new way to rewind the aging clock.

In unpublished work described in his coming book Lifespan, he says the key to his lab’s work in this area is epigenetics. This fast-moving field focuses on how changes to the way genes are expressed, rather than mutations to the DNA itself, can produce physiological changes such as disease. Some of the body’s own epigenetic mechanisms work to protect its cells, repairing damage to DNA, for instance; but they become less effective with age. Sinclair claims to have used gene therapy to effectively recharge these mechanisms in mice, and he says he can “make damaged optic-nerve cells young again” to restore sight to elderly blind animals.

We have been here before. Many scientists thought they had found a fountain of youth in animal studies, only to have the results dry up when they turned their attention to people. But Sinclair is convinced he is on to something. He says he’ll soon publish the results in a scientific journal for other researchers to examine.

Because aging isn’t officially a disease, most research on these drugs exists in a gray area: they don’t—or can’t—officially tackle aging. For example, Barzilai’s metformin project, the closest the world has right now to a clinical trial for a drug that targets aging, aims to prevent diseases associated with aging rather than aging itself, as do the trials on senolytics. “And one of the side effects is you might live longer,” he says.

Barzilai won’t go so far as to say aging should be reclassified as a disease, but he does say that if it were, discoveries might happen faster. Studies like TAME have to give people a drug, then wait years and years to see if it prevents some of them from developing an age-related disease. And because that effect is likely to be relatively small, it takes huge numbers of people to prove anything. If aging were instead considered a disease, trials could focus on something quicker and cheaper to prove—such as whether the drug slows the progression from one stage of aging to another.

The Healthy Life Extension Society is part of a group that last year asked the WHO to include aging in the latest revision of its official International Classification of Diseases, ICD-11. The WHO declined, but it did list “aging-related” as an extension code that can be applied to a disease, to indicate that age increases the risk of getting it.

To try to put research into treatments that target aging on a more scientific footing, a different group of scientists is preparing to revisit the issue with the WHO. Coordinated by Stuart Calimport, a former advisor to the SENS Research Foundation in California, which promotes research on aging, the detailed proposal—a copy of which has been seen by MIT Technology Review—suggests that each tissue, organ, and gland in the body should be scored—say, from 1 to 5—on how susceptible it is to aging. This so-called staging process has already helped develop cancer treatments. In theory, it could allow drugs to be licensed if they are shown to stop or delay the aging of cells in a region of the body.

Reclassifying aging as a disease could have another big benefit. David Gems, a professor of the biology of aging at University College London, says it would provide a way to crack down on quack anti-aging products. “That would essentially protect older people from the swirling swamp of exploitation of the anti-aging business. They’re able to make all sorts of claims because it’s not legally a disease,” Gems says.

In February, for instance, the FDA was forced to warn consumers that injections of blood from younger people—a procedure that costs thousands of dollars and has become increasingly popular around the world—had no proven clinical benefit. But it couldn’t ban the injections outright. By calling them an anti-aging treatment, companies escape the strict oversight applied to drugs that claim to target a specific disease.

Like the Cyclops, Singapore has been given a glimpse of what is to come—and officials there do not like what they see. The island nation is on the front line of the gray surge. By 2030, if current trends continue, there will be just two people working there for every retired person (by comparison, the US will have three people in the workforce for every resident over 65). So the country is trying to change the script, to find a happier and healthier ending.

With the help of volunteer subjects, Kennedy of Singapore’s Centre for Healthy Ageing is preparing the first wide-ranging human tests of aging treatments. Kennedy says he’s aiming to trial 10 to 15 possible interventions—he won’t say which, for now—in small groups of people in their 50s: “I’m thinking maybe three or four drugs and a few supplements, and then compare those to lifestyle modifications.”

The Singapore government has prioritized strategies to deal with the aging population and Kennedy wants to create a “test bed” for such human experiments. “We have made great progress in animals,” he adds, “but we need to begin to do these tests in people.”



David Adam is a freelance writer and editor, and the author of The Man Who Couldn’t Stop.
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Old 09-03-2019, 03:49 PM
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http://contingencies.org/calculating-despair/

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Calculating Despair—Unpacking the costs of drug abuse, alcoholism, and suicide
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Fewer Deaths May Mean Increased Pension Liabilities
Lane Clark & Peacock expects UK mortality projections to show longer life expectancies.


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The ongoing slowdown in life expectancies improvements in the UK over the last few years reversed course in 2019, which could lead to increased pension liabilities, according to a report from investment consultant Lane Clark & Peacock (LCP).

The firm said that based on the relatively low number of deaths reported so far this year in the UK, it expects mortality projections to show slightly longer life expectancies, therefore increasing pension liabilities.

“Following the highest number of deaths for two decades in 2018, the potential reversal in trend in the first half of 2019 may come as a surprise to some,” Michelle Wright, LCP’s head of trustee consulting, said in a statement. “It further illustrates the importance of understanding the significance of longevity risk to your pension scheme and considering taking action to mitigate against continued uncertainty when it comes to the life expectancies of members.”

However LCP said it is too early to tell whether the data for 2019 signals a rebound for stalled improvements in life expectancies for the average person in England and Wales seen since 2011, or if it is an anomaly.

LCP’s annual longevity report analyzed recent trends in mortality, and the firm said that updating life expectancy projections for mortality trends can have significant financial implications for defined benefit pension plans.

The firm said it expects the next version of the Continuous Mortality Investigation (CMI) projections model, which is slated for publication in 2020, to produce slightly longer life expectancies.

LCP also noted there is a difference between the life expectancies improvements for the average person than it is for the average for pension plan participant. The firm said analysis suggests that the average defined benefit pensioner has experienced higher rates of improvement than those among the general population in recent years, although it added that this will vary based on socio-economic backgrounds.

Other findings from the report include:

Liabilities for a typical plan could increase 6% to 8% if major developments in cancer treatment mean the proportion of deaths due to cancer are eradicated over next 20 years.
The dominant subtype of flu, and flu vaccine effectiveness, is one of the most important factors in determining the number of winter deaths.
Many plans are exposed to higher longevity risk in their retired members than their non-retired members.
The Netherlands, Germany, France and the US are also experiencing significant reductions in life expectancy improvements since 2011.
“It is important to understand the demographics of your pension scheme members, such as their socio-economic class, in order to have an informed view of their life expectancy,” said LCP Partner Chris Tavener. “With this in mind, trustees and sponsors should consider moving to the latest model for projections and fine tune it so it is appropriate for their scheme.”


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