Redesigning Old Age

A friend of mine, regarded as a contemporary but probably only sixty years old, was recently speaking of a club picnic which he would not be able to attend. He was now living with his mother, and since she was 84, obviously neither of them could go to a picnic on a sailing vessel. The club committee, listening to this regret, chuckled that of course we shouldn't expect him. My thoughts were somewhat different. Since I'm 84 myself, I was wondering if she was available for a date. And of course I am going on the picnic, why shouldn't I?

Most of the old fatal diseases have been cured, and guess what --People are living longer.

This little encounter is offered as illustration of how realities change faster than attitudes. But attitudes better start catching up with the times, because some grim financial realities are just as safely predictable as the demographics. Biblical prophets declared mankind was destined to live for 70 years, until threescore and ten. But American life expectancy at birth has been extending by three years every ten years, for nearly a century. At birth, the average American male at birth can now expect to live until he is 80, women a little longer. But that will be eight decades from now, so if life spans extend at present rates, average life expectancy will reach 104 by the time today's newborn reaches 80.

Scientific colleagues feel that is an unrealistic example of the extrapolation fallacy. To them, the human genetic apparatus is programmed to wear out at age 100, so advancing life expectancy will taper off between now and then. There's a concept called apoptosis, stating that cells will only divide a certain number of times before they quit. Human protoplasm seems to be programmed to reach apoptosis around age 100. If the scientific articles start mentioning big advances in staving off apoptosis, then of course much of the rest of this article will need to be modified. In the meantime, when a friend or family member dies at the age of 90, it would be appropriate to deplore a regrettable loss of ten years of potential, before that apoptosis thing would have set in.

Six decades of practicing medicine do confirm these statistical inferences. But experience does not at all confirm the present tendency to predict constantly rising costs of medical care. With no difficulty at all, I can recall several dozen diseases which shortened life expectancy in the past, but which have largely disappeared. Tuberculosis comes first to mind; in my student days we saw several new cases every day, and experienced great difficulty finding vacant beds to house them in the several tuberculosis hospitals of Philadelphia. Every single medical student in my class had a positive test for TB, and almost every class had one or two students who dropped out for a year or two to have it treated. Typhoid fever was a similar example from the generation before me. My teachers often pointed out a forty-bed ward at the Pennsylvania Hospital that had been reserved exclusively for typhoid cases. I had been practicing for fifty years when it suddenly became simple to treat duodenal ulcers. Ten percent of the population had ulcers, and they would bleed, or perforate, or penetrate, or stenose and cause thousands of patients to eat disgusting diets, taking handsful of chaulky pills. Rheumatic fever, and the associated bacterial endocarditis, no longer fill our hospitals. Syphilis is gone, poliomyelitis is gone, small pox, and lots of less common conditions. Pneumonia, with a mortality rate of 10%, is now treated with an office visit or two. The death rate from heart attack and stroke is down 50%, with a vast backlog of presently semi-clogged arteries to mature before mortality finally comes to rest at a very low level. Fifty percent of the drugs in use today were unknown seven years ago, so all that education and re-education is unnecessary. In my medical lifetime, I probably discarded two full medical educations.

Looking ahead, I can only see three or four major diseases that still lack a cure. Cancer is number one, and Alzheimer's Disease is number two. Add to that schizophrenia and manic-depressive disorder, and when those four are cured, it becomes difficult to state what will cost Medicare very much, or shorten life expectancy very much below the promised 100 years. So you can't scare me very much about the frightening impending bankruptcy of Medicare. If the problems of foolish borrowing put it out of business, there still won't be much mortal illness worth treating.

What should appall us is the absolutely predictable cost of paying for the protracted healthy retirement of so many people, and the absolute impossibility of paying for it by continuing on our present path. Maybe that's what all this obesity means. Maybe people are trying to store up enough fat when they are forty, so they can go without eating at all from sixty-five to ninety.

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