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Comment by tchaffee | Hacker News Reader

It seems like we are so close to some huge breakthroughs in longevity. With stem cells we can do things like this.

"The extent of change caused by a heart attack is too great for the heart to repair itself or to prevent further damage from occurring. Notably, however, cardiopoietic stem cell therapy reversed, either fully or partially, two-thirds of these disease-induced changes, such that 85% of all cellular functional categories affected by disease responded favorably to treatment," says Andre Terzic, M.D., Ph.D., director of Mayo Clinic's Center for Regenerative Medicine.

https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-re...

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We have been “close” to some breakthrough with stem cells for at least 15 years now except every time it either doesn’t work or ends up causing cancer (e.g. tumorigenicity and immunogenicity).

I’ll believe it when I see it.

We are already there. The FDA has approved hematopoietic stem cell transplantation. And there are over 3000 clinical trials under way. We know already that we can effectively treat some blindness.

The reason I mentioned heart disease is because of how widespread it is and how dramatically it might increase average lifespan. For heart disease specifically it is indeed hard to tell how far away we might be from stem cell treatment being a success.

But stem cell treatment as a whole has already delivered.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367472/

Perhaps this is a naive question, but wouldn’t a preventative measure for heart disease (stopping obesity via, say, ozempic) do more for longevity than repairing the heart after dysfunction has taken root?

Not to mention the quality of life improvements from never being sick in the first place.

organ systems are interdependent, and failure or pathology can cause nonlocal effects.

cardiac hepatocirrhosis is one example.

https://emedicine.medscape.com/article/151792-overview

https://www.sciencedirect.com/science/article/pii/S221317791...

in such a case isolated treatment of pathos may help but would not be a complete treatment, and would result in chasing subsequent sequelae, over a protracted therepeutic effort.

Not sure what the relevance of cardiac cirrhosis is to this discussion?

You’re talking about an uncommon end stage complication of chronic severe right heart failure.

To the parent comment’s question: yes, prevention is better. If you prevent right heart failure you will not get cardiac cirrhosis.

The old adage of “an ounce of prevention is better than a pound of cure” is still true.

>>Perhaps this is a naive question, but wouldn’t a preventative measure for heart disease<<

preventive and corrective measures, in response to health issues should be instituted in the context of the whole organism[patient]

cardiac cirrhosis, is an example of secondary pathology related to a common set of disease conditions [heart disease].

correction of pathologic state of one organ via stem cell therapy, is a start but is not complete, heart disease is not always preventable by way of lifestyle choices, as genetic, and traumatic causes will effect occurence.

protracted illness often leads to secondary, or even, systemic issues concurrently presenting, at time of first examination.

any therapy must take this context into account.

The old adage of “an ounce of prevention is better than a pound of cure” is only true, when prevention is possible.

Cardiac cirrhosis is just a bad example, it’s difficult to estimate prevalence but it’s very rare and even then most cases don’t matter as it reflects a state of severe systemic dysfunction (i.e. patient is on deaths door for several other reasons). Fixing the heart at that point won’t accomplish anything with respects to cirrhosis. Right sided heart failure is also rare outside of advanced LHF or preventable causes of pHTN.

Congestive heart failure as a whole was attributable to preventable causes in something like 95% of cases in the NHANES cohort. The 5% of other cases is variable but sure, some are not preventable.

Point being that prevention is possible and remains the preferred approach for the overwhelming majority of people, as the parent comment was inquiring about:

> Perhaps this is a naive question, but wouldn’t a preventative measure for heart disease (stopping obesity via, say, ozempic) do more for longevity than repairing the heart after dysfunction has taken root?

Probably. Obesity also increases the risk of many types of cancers. This appears to be due to the chronic inflammation and immune system effects. In 20 years it will be interesting to see what cancer rates are in patients that have been taking GLP-1 drugs.

I think non-obese people still want effect treatments for heart disease.

Fully agree that we still need to develop treatments but from a prevention perspective if you maintain a healthy weight and diet (i.e. avoid metabolic syndrome) don’t smoke, and don’t use cocaine you should be doing really well from a coronary artery disease perspective barring some hereditary lipid disorder.

Throw on a statin at 35-40 for good measure (expert opinion, not strong evidence but many of my physician colleagues do it too).

Not all heart disease happens due to lifestyle choices. There aren't a lot of preventative treatment options for people who have a family history of heart disease.

Stopping obesity with ozempic might extend lifespan but it won’t fully correct loss of health span due to poor nutrition and lack of exercise. I don’t know if any drugs can correct for a poor lifestyle. They can correct for some major issues caused by poor lifestyle, but cardiovascular disease is only one slice of that miserable pie.

> I don’t know if any drugs can correct for a poor lifestyle.

Given their reputation for making people energetic (not having any interest I've never tried), I wonder if ecstasy and cocaine lead to exercise?

> We are already there. The FDA has approved hematopoietic stem cell transplantation.

Source? To my knowledge what’s approved is not iPSC.

Hematopoietic progenitors are a different challenge and “low hanging fruit”.

https://www.fda.gov/vaccines-blood-biologics/cellular-gene-t...

> But stem cell treatment as a whole has already delivered.

Clinical trials underway does not equal delivered. In the 3 years since your review article talking about future applications none of these hypothetical applications have been delivered yet.

We are always "close" to a breakthrough. This is exactly what happens with every advancement in science and technology.

I imagine that in the future what will happen is that when a child is born, their stem cells (possibly from the umbilical cord) will be cryogenetically preserved and will form a reservoir from which medical interventions can be prepared as much as 50 years later.

Of course, this assumes we will put a new premium on human life not just limited to the children of the privileged few, which in turn presumes some kind of limitation on human reproduction (steady state population in which births == deaths). Implies a high degree of rationality - who gets to reproduce, and who doesn't? It would take a lot of energy to preserve all those stem cells, after all, and energy supplies really are limited.

That future was the same one advertised 13 years ago when I started medical school. We were already storing cord blood back then.

I’m not saying it will never happen, but this is a really challenging treatment paradigm to get right and I don’t believe it’s “around the corner”. I don’t doubt we’ll have something in 50 years, it’s like battery tech.

I lost my mother a couple weeks back, to two type 2 myocardial infarction about a week apart. Getting cancer and dying a couple months later certainly beats dying a week later.

Don't think it'd have helped much in her case (a massive aortic stenosis, hard to fix at 87), but there are others who would love to have the chance to choose the lesser of two evils.

I know she would.

The last thing we need right now is people living longer.

That's very easy to say until it's your partner, mother/father, or child on the other side of that assertion.

If you're curious and have time, I'd suggest the following excellent exploration of the idea of extinguishing natural death by CGP Grey. He uses an interesting analogy to help challenge the ingrained belief that natural death is just https://youtu.be/cZYNADOHhVY?si=oCqVGD5RX9Q0Cnrk

We only need to look at nature to see that everything dies. It is natural, and necessary.

I am not in any way saying that people should be euthanized or disease not treated or that people not live out their natural lives. But artificial extension of life will only result in those who can afford it staying in power forever.

We only need to look to nature to find the immortal jellyfish.

Much of medical science is "artificial" extension of life. Natural would be you dying of Smallpox at a young age. Instead you've artificially extended your life with a vaccine.

https://en.m.wikipedia.org/wiki/Turritopsis_dohrnii

https://effectiviology.com/appeal-to-nature-fallacy/#:~:text....

That's a logical fallacy. The argument you are responding to is not logical, but rhetorical (argument by analogy, based on the premise that analogous systems behave in similar ways). Logical fallacies don't apply to rhetorical arguments in a logical way.

We can all do better than pedantically pointing out logical fallacies, as no argument outside of mathematics is completely logical.

To hell with nature! I have never understood this argument even a little bit.

> That's very easy to say until it's your partner, mother/father, or child on the other side of that assertion.

There is a difference between living longer/forever and giving a child with terminal cancer a normal full life

What is that difference?

Living forever and living longer shouldn't be grouped together; living forever means unbounded existence and unbounded consumption over time. That's a fundamental paradigm shift for our entire system of being human.

Saving extending the lives of more children is unfortunately, a statistics change for our current world. Unlimited life means all models of economics, morality generally, class, etc will be affected.

But no one is truely going to live forever. They'll die from disease or accident or murder.

Everyone dies man.

Our cells live forever, despite the support "clumps" they create in the process eventually die off.

> Unlimited life means all models of economics, morality generally, class, etc will be affected.

That's also going to happen with automation — and I don't just mean AI, as it has been happening continuously since the power loom led to Karl Marx inventing Communism, or possibly even earlier with the social and technological changes of Adam Smith's era and the end of feudalism.

> That's very easy to say until it's your partner, mother/father, or child on the other side of that assertion.

The idea isn't that poor people will get life extension, it's that families of billionaires will get it. And no it won't "trickle down" life expectancy is actually decreasing in USA despite tech gains.

EDIT: downvote me if you want, you know it's true

Didn't most of the additional deaths come from COVID, drug overdoses and suicides? While those are terrible and need to be addressed, those don't seem to be related to availability of medical treatment.

Deaths of despair are linked to economic system configuration, pushed by the wealthy to remain static. Similar story with US healthcare.

https://www.npr.org/sections/health-shots/2023/03/25/1164819...

https://www.hsph.harvard.edu/news/hsph-in-the-news/whats-beh...

>Deaths of despair are linked to economic system configuration,[..]

Sure there is a correlation between deaths of despair and poverty. However, the argument here was that healthcare advances won't tickle down with the evidence being declining life expectancy. That's a totally different claim. As of 2021 over 90% of Americans had health insurance coverage and AFAIK the vast majority of proven, legitimate treatments are available to those insured people. (sauce: https://www.census.gov/library/publications/2022/demo/p60-27...).

>pushed by the wealthy to remain static

What class war, conspiracy nonsense is this? Do you think "the rich" get together once a year, smoke cigars and discuss what policies to convince everyone of in order to keep the poors down because they are idiots who believe the world is a zero-sum-game?

If each person would be better off if there were fewer people, then you're looking at a zero sum game.

If some groups have outsized resources to play that game, it wouldn't be surprising if they found themselves playing it. There doesn't have to be any conspiracy. Unless they take steps to interrupt the process, people's behavior naturally aligns with whatever is best for the group they feel they're part of.

It's how we got racism and lots of other toxic garbage. To pretend it doesn't exist is to give it a place to hide.

> Do you think "the rich" get together once a year, smoke cigars and discuss what policies to convince everyone of in order to keep the poors down because they are idiots who believe the world is a zero-sum-game?

Sort of. No cigars though, just "how can we solve the poors without giving up what we have?" Notice no public policy or tax increases to actually solve the problems.

https://www.nbcnews.com/id/wbna30851839

https://www.nytimes.com/2022/04/06/us/politics/republican-do...

https://www.independent.co.uk/news/world/bilderberg-group-me...

https://www.vox.com/future-perfect/2019/1/30/18203911/davos-...

https://newrepublic.com/post/175199/ceo-worker-gap-stock-buy...

The rich and powerful need everyone to use any such tech, even if only to find the edge cases where it doesn't work right.

That the USA has a seriously messed up healthcare system and declining life expectancy is a problem for the USA, and part of the reason I didn't move there.

"in USA"

Because the rest of the world does not matter?

If there is a working longevity treatment, do you think that other nations will tolerate it being used for US billionaires and no one else?

Literally everyone ages. 8 billion potential patients on the planet, with the population still growing. If you sell the cure for USD 100 to half of them, you make a lot more money (real money, not just market value) than Elon Musk.

CGP Grey doesn't explore what happens after death is defeated. I can't imagine how it can lead to anything but a stagnated society, with prejudices and inequalities enshrined forever.

Wouldn’t it be the other way around? Now, since the effects of our prejudice, inequality etc, are usually borne way after we die, we don’t get to see the effects of our decisions. If we get to live a lot longer, we’ll be wiser in making better, more balanced decisions.

As for stagnation, sure earth itself is quite overpopulated, but there is nothing technologically stopping humanity from colonizing the solar system.

If humanity gets it shit together and becomes slightly more organized, those experiments in society will just happen in geographically different places.

The “red mars, blue mars, green mars” trilogy explores this quite well, even if the science is a bit dated, the politics aspects of the books are quite interesting, tackling future colonization and longevity’s political pressures and opportunities.

That's a very rosy view of humans. The average person gets older, not wiser; they see the consequences of their actions and find someone else to blame. Real social and cultural change comes from new generations.

This is not backed by evidence or statistics. The earth is not overpopulated nor in danger of being so.

I’ve read a bit on the topic too and I think I agree? One of the other obvious occurrences we’re living through is some form of population collapse. Although it’s termed “collapse” I think it’s better conveyed as “global population shrink”. As far as sustainability, I think we can all wait for generational turn over and see what shakes out. But that brings with it other problems like not having enough younger people to care for the elderly or meaningfully contribute to a tax revenue. Anyway, glad you pointed that out. In a cacophony of doom from main stream media (news, social, political, celebrities) maybe this isn’t one of the very big problems that needs global attention right now.

Not just tax and elder care. If you have fewer young people than old then when those young people take the place of their older colleagues in their various professions you wind up losing a lot of tacit knowledge. If there are 1.5 olds for every young then that young one needs to learn 150% of the skills and knowledge that they did before. In such cases the extra information often gets lost. This is how population collapse leads to civilizational collapse.

Climate impact is roughly O(N) for the number of humans. Sure, some have more impact than others but reduce humans and reduce impact.

This is kind of defeats the point of environmentalism. The point is for humans to live on a sustainable planet, not for us to accept artificial death.

> The earth is not overpopulated nor in danger of being so.

Depends how you look at it; from a "how much food can we grow" perspective, it's possible to put up hydroponics etc. everywhere (with enough effort) and feed a trillion.

Conversely, if you want to "solve" climate change with a reduced population (rather than rolling out new tech) the maximum sustainable number of humans is about 8 million at today's per-capita average emissions level.

"Maximum" is all about the tech and what it can let us do.

The more a society develops the lower its birth rate. Most of the developed world is well below replacement rate, and the rest of the world will be there soon too.

To be fair I personally believe this is not a case of “rich/educated people have fewer children”, more the case that the way society is structured in those rich/educated places, having children is a bad deal.

It used to be if you had some kids, it was a huuge investment, but you got a lot out of the deal after about 13 years.

But right now, children are still a huge investment, but the parents hardly get any economic incentive for it, the country has “captured” that for its own end.

If governments took this into account and “repaid” this back to the parents, I’m sure people will have way more children.

If societies were structured in such a way that children made economic sense to their parents, I’m sure shrinking population would not be a thing.

Now if something like this has moral problems in and off itself is a different question. I just want to point out that “developed countries are have fewer children” shouldn’t be taken as an absolute truth. It just developed countries as currently structured do not incentivize parents enough. Just look at Israel for example.

It is indeed literally a case of rich/educated people have fewer children. It’s called the demographic-economic paradox. [1]

There’s been a lot of research on this because the effect is so pronounced.

> In decreasing order of strength, fertility (TFR) correlates negatively with education, [contraceptive prevalence], and GDP per capita, and positively with religiosity. [2]

If you’re educated, rich, non-religious and can bone with impunity you have somewhere between 1 and 2 kids on average, well below the replacement rate of 2.1

It is absolutely a fantastic deal to have kids in Finland where you get months and months of mat and pat leave, etc, and their birth rate is 1.37

Israel is only high because they’re a religious ethnostate and religiosity as the studies show is positively correlated with fertility.

Respectfully I do think the data shows we should take this for granted.

[1] https://en.m.wikipedia.org/wiki/Income_and_fertility

[2] https://bmcpublichealth.biomedcentral.com/articles/10.1186/s...

Just a smaller comment to a part of yours. Getting maternity/paternity leave of months is peanuts compared to 2 decades of rearing, and I don't think we can use that as "proof". Parenting is hard and we absolutely should be incentivizing it way more, not with leave, but with more financial subsidies and rewards.

Yeah I mean having kids sucks period, that’s why people who can afford to, don’t. Haha, at least that’s my read.

I thought we wanted billionaires to be immortal!

Somehow, the people who always bitch about there being too many people never volunteer themselves to help reduce the problem.

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