Pure speculation

What is it about the new year that gets minds to speculating
about the future? (See the NYTimes article about the future of the Net, for
instance.) Last week Mike Mitchell brought to FICenter members’ attention the
ideas that had been posted at Edge: The World Question Center asking people to
answer the question: “What do you believe is true even though you can’t prove
it?”

If there was ever an invitation to think large this is it.
It’s like a shot the full length of the court just before the buzzer sounds in
basketball. So here’s my shot.

I believe life here on Third Rock moves relentlessly toward
something not seen in biology before: complex living systems that perpetuate
themselves, not by reproduction, but by regeneration—in a word: immortality. I
don’t mean just stretching life out indefinitely but redirecting basic
biological processes toward error correction, restoration and rejuvenation.

Life has succeeded in multi-cellular organisms by producing
new members, shedding old ones, and passing the baton—nuclear material—from one
generation to another. But it seems to me an emerging possibility is to
continually renew the existing organism and sustain it indefinitely.

But here’s the kicker: I’ve realized just recently my own
life, my career in cancer, is part of that journey. Dealing with cancer is one
of the key dysfunctions of biology that is driving us to depths of biological
knowledge that will be the foundation for even greater biological goals. The
molecular intricacies of cancer causation and of curative intervention are
taking us inevitably to the heart of fundamental cellular processes. We still
have a long ways to go, but when we get there a substantial proportion of what
we need to know to have a new biology will be documented. Until recently I
hadn’t thought of a career in cancer control being about fundamentally changing
life, but now I do.

So what needs to be done? Well, U of Pittsburg biologist
Stanley Shostak says in his book, Becoming Immortal:

What then is needed to make human life immortal? Life’s flux
must be limited to individuals; genetic advantages must benefit individuals;
waste and selfishness must be played out within individuals. All this is within
our reach! Human beings can be made immortal through the simple device of
replacing germ cells with stem cells.
Immortal human being will be sterile,
and their bodies will remain permanently in prepubescent state, but stem cells
will keep them perfectly balanced between development and aging, between growth
and decay.

Now there’s some food for thought.

We have time to think about it. Every time we take a look at
cancer or other complex biological phenomenon we tend to find more complexity
and subtlety that we expected. My gut feel about how much we know of what we
need to know is that we know about 20%. That may actually be optimistic. But
the remaining 80% is not unattainable. It will take a tremendous learning
effort at tremendous cost. But we have the time and the motivation. Defeating
communicable and chronic diseases was the vision of what’s possible in the 20th
Century. I think immortality is the emerging vision or “meme” of the 21st.
Defeating death is a natural successor to defeating a specific malady like cancer.

Some immortality enthusiasts are predicting the achievement
of that breakthrough in a couple of decades. I think they’re wrong on the
timeline if not on the ultimate outcome. It takes 15 years just to get a drug
from the lab bench to the bedside, so the drastic interventions needed to
affect mortality will take decades: the rest of this century, or maybe more.

Of course, reinventing biology will reinvent sociology as
well. People intuitively understand that, so the upheaval over the immortality
movement has already begun. The radical nature of the resulting social change
will come not just from ending death but from, concomitantly, ending the
imperative of reproduction. Death rate near zero; birth rate near zero. These
ideas are still considered by many to be on the lunatic fringe (okay, so include me), but not as far out
on the fringe as even a decade ago.

Why do I believe this even if I can’t prove it? A couple of
months ago at a meeting I heard a presentation by Leonard Schaeffer, the board
chair of WellPoint, one of the nation’s largest health insurance companies. He
said Americans want three things: to look good, to feel good, and to live
forever. He wasn’t being ironic or facetious. He sees these indicators in the
demands and expectations of health insurance clients every day. He says what
people think of as “health” isn’t determined nearly as much by the medical
profession as it was a century or even a half-century ago; it’s now shaped by
consumer demand. In a market-driven economy like the US and, increasingly, like the rest
of the world, products and services to meet deep consumer desires will attract
the resources to produce them.

The kerfuffle around this will be enormous, of course. It’s
already begun. But in the long run, I think the human desire to avoid death will
take us there.

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