Are We Talking About Health and Longevity All Wrong?

When living longer isn't always living better

Medical professionals disagree on some big questions about longevity.
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How do you think about longevity? It’s a hot topic — whether in the form of scientists debating whether humans can live to 200 or the tech leaders obsessed with the idea of biohacking. To cite two recent examples, in The New Yorker, Dhruv Khullar explored the growing industry surrounding longevity through a look at the work of Peter Attia, a doctor and podcaster. And Literary Hub published an excerpt from Andrew J. Scott’s recent book The Longevity Imperative: How to Build a Healthier and More Productive Society to Support Our Longer Lives.

What both Khallar and Scott zero in on is an important aspect of the longevity debate: simply living longer is not the same thing as living better. Scott writes, “as more and more of us live to old age, the danger to health has shifted to noncommunicable diseases such as dementia, cancer, diabetes, arthritis and pulmonary and cardiac-related illnesses.” Attia, meanwhile, told Khullar that he once followed a much stricter diet, only to step back from that after he realized that he wouldn’t eat sweets his kids had made.

Despite the fact that life expectancy in the U.S. has dropped for the last few years, it’s still up significantly from the middle of the 20th century. That’s good — but, as Scott points out, it can mean that people living longer might not be able to enjoy some of those extra years as much as they’d like.

Of all people, comedian Denis Leary made a variation of this observation in the early 1990s. “Smoking takes ten years off your life,” he said at the time. “Well it’s the ten worst years, isn’t it folks? It’s the ones at the end!” And if you’d prefer to hear that argument from a medical professional, oncologist and bioethicist Ezekiel J. Emanuel revealed in a 2014 article for The Atlantic that he hoped to live until he was 75 — but not necessarily later than that.

“I am talking about how long I want to live and the kind and amount of health care I will consent to after 75,” Emanuel wrote. Later, he criticized a way of thinking which “promises a kind of fountain of youth until the ever-receding time of death.”

It isn’t hard to see why trying to increase one’s lifespan rather than improving the world’s overall quality of life makes for bolder headlines. A particular diet, a technological advancement or a series of supplements is easy to quantify; the question of “are you living a good life” can be harder to pin down. It’s also one of the reasons why Scott makes the argument that this is a public health issue. In his book, he writes that “[g]overnments need to think about a twenty-first-century public health initiative aimed at supporting healthy aging.”

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There’s also a more egalitarian aspect to this. Several of the people profiled in The New Yorker mention that they’re spending money on longevity treatments in part because they have that much money to spend.

A billionaire with access to an elite medical team may well be able to extend their life by decades; their middle- or working-class counterpart will probably not have those options available to them. (If you’ve ever wondered if a dystopian novel memorably tackled this very subject, might I recommend Nick Harkaway’s Titanium Noir?) There may be an elite solution to the living longer/living better debate; still a lot of people may be left choosing between the two.

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