Skip to main content
  • Fall 2022 Editorial - How Do We Fight Aging?

    You’ve seen the TV ads: You should buy the clinically proven memory molecule that has been extracted from the unusual animal that has defeated aging. They claim it will “boost your memory and cognitive ability.” They refer to Turritopsis dohrnii, the so-called "immortal jellyfish."

    The claim is that it can hit the reset button and revert to an earlier developmental stage, and thus the jellyfish will never die. That claim amazed me.

    The truth is, of course, more complicated. When the jellyfish Turritopsis dohrnii dies it sinks to the ocean floor and falls apart. Then, some of its cells reaggregate into polyps, and some of these polyps emerge to become new jellyfish. That’s not so different from how the birds and the bees do it. In going back to a gamete form, there is some type of reset and refreshment that lets the progeny recapitulate the cycle of life. So, this jellyfish has two ways of reverting to an earlier life stage to begin anew. One is sexual and the other asexual. This ambiguously begs the question of whether the parent is the child or achieves immortality through children.

    Turritopsis Dohrnii, also known as the immortal jellyfish, is a species of small, biologically immortal jellyfish found worldwide in temperate to tropic waters.

    The agent they are selling is Prevagen that contains apoaequorin, a protein found in many types of jellyfish and not shown to either: 1) have any benefit to preserving jellyfish or human brain function, or 2) even being absorbed and then getting into brain tissues. Because Prevagen is an unprescribed food supplement, testing is not required.

    Common sense tells you that proteins get digested by stomach acids and gut enzymes. But the advertisers are counting on the public’s concerns with Alzheimer’s disease and the brain fog from long COVID-19 added to the old basic fear of aging. It’s no wonder that the public is interested in a cure. Prevagen is not an approved medication by the Food and Drug Administration for any form of dementia. Let me say that again more tersely. This is a scam.

    It’s disappointing that taking Prevagen isn’t the answer to our problems with aging and death. The senior ophthalmologists of the Academy, as well as many others, would love a simple solution to ageing.  Most of us find the issues of aging and death daunting and discouraging, if not depressing. Or not. Not everyone is as obsessed or bothered by these fears.

    Psychologists tell us that many children start obsessing about dying about age 4 or 5. Kids may be clued in on this by the rude reality of the death of a pet, a story line on TV or by news accounts of a tragedy. Their parents will likely help them comprehend death and dying. Children tend to work through four levels of understanding:

    1) When you die, your body doesn’t work anymore.

    2) All living things die.

    3) Once you die, you can’t come back.

    4) No one can avoid death.

    When my firstborn was four, she had processed through these FOUR levels and showed discomfort while asking us, her parents, “What will I do when you die?” My gimmick was to tell her not to worry because I probably wouldn’t die until about age 90 and that 90 years was a very long time. To make the point, I would ask her to count to 90 knowing full well that she’d be bored long before she got there. It worked. But now, 90 doesn’t seem like such a long count anymore.

    I think that Woody Allen was onto something when he said, “I'm not afraid of death; I just don't want to be there when it happens.” Studies show that elderly patients in nursing homes did not fear death itself but rather worried about the process of dying. Perhaps their lack of fear of death was also a product of the ascertainment bias of these studies that only questioned elderly persons who lived in nursing homes. Invariably, these surveys also found that life at the nursing home was boring as the elderly lacked family around them to give them meaning. Indeed, other studies have shown that many cultures that don’t institutionalize the old do much better than ours at supporting the elderly, filling their lives with a sense of meaning, and mitigating these types of fears.

    Author and geography professor Jared Diamond gives a TED talk: “How Societies Can Grow Old Better."

    In it, he demonstrates how the process of growing old and dying varies a great deal in different parts of the world. And attitudes towards death and dying vary dramatically by culture. Fundamentally, in tribal societies (ancient and current), the elderly live out their last years surrounded by their children and grandchildren. In some tribal societies that we would deem as primitive, the elderly are sometimes disposed of by neglect, encouraged to commit suicide or even killed.

    In primitive nomadic societies, when you can’t keep up by walking long distances, you are literally left behind. As my walking range is limited, I have no doubt that I would have been left behind (in fact, I often am during family shopping trips). But in sedentary tribal societies, such as the New Guinea Highlands, the elderly are regarded as useful, at least by providing childcare, and valued for their knowledge and wisdom (in a world where books and Google aren’t available, old people rock). I might have done better there.

    Additionally, there are several sophisticated societies that particularly value the old. Confucius taught that filial piety was paramount, and so East Asians are more apt to revere the elderly. But in Western Europe and even more in the U.S. things are very different. The elderly are considered the least valuable in the prioritization of resources, such as healthcare. One reason for this is our cultural heritage. The Protestant work ethic implies that after an older person stops working, that person’s value diminishes sharply. In the U.S., a demographic shift is coming towards fewer young and more elderly, and this will make things even worse. The elderly will, at best, be marginalized, and at worst, culturally discriminated against.

    Some national differences, even within Western Europe, are interesting. In Germany, there are laws requiring that everyone who dies must receive a respectful burial or cremation. In Italy, the practice of Catholicism requires caskets, but such caskets are typically stacked in mausoleums as the ground space is limited. In Albania, although most funerals are secular and held at home, cremation is not practiced, and caskets are buried. In Ireland, wakes often go on for long periods as family, friends and neighbors share stories, sing and party. But even bigger differences between countries are seen in other parts of the world.

    Most Asian cultures believe in the afterlife. Japanese rituals often combine both Buddhist and Shinto traditions and include washing the deceased individual's body and the cleansing of the burial ground as part of the funeral. In China, the rituals focus on honoring elders. The deceased’s social standing makes a big difference and if not correctly privileged it will bring bad luck upon the family. In India, death rituals are strongly influenced by Hinduism and focus on helping the deceased achieve a good reincarnation. In West Papua, New Guinea, the Dani relatives of the deceased may amputate their own finger as a personal show of sacrifice and shared pain.

    There are also some modern versions of death rituals as well.  For example, there are now drive-through funerals found in both Japan and the U.S. And there are sky funerals, popular in several Buddhist cultures, that entail leaving the body to be consumed by vultures as some believe this helps to transition the soul for a favorable reincarnation.

    In the U.S., we not only tend to marginalize the elderly, but even marginalize discussions about aging and death. It is an uncommon subject for situation comedies on TV. On the other hand, several movies have taken on this serious subject. There are, for example, three Clint Eastwood movies: “Grand Torino,” “Mule” and “Trouble with the Curve.” Also good were, “The Best Exotic Marigold Hotel” and “The Leisure Seeker.” Most of these films have common themes. There was a longstanding love; then there was a loss of and a betrayal by an aging body and/or mind. Finally, the protagonists are left with only gossamer memories of the love.

    In the Fall edition of Scope, I have already reviewed an excellent book that grapples with death and aging. I highly recommend “Being Mortal: Medicine and What Matters in the End” by Atul Gawande. However, most popular books on aging purport to tell you how to extend your lifespan. These are rather trite as they give the same sort of advice that your mother already gave you (don’t smoke or drink, eat green things, exercise, and do things in moderation). I do research in Alzheimer’s disease and my standard answer to what is the best way to try and prevent Alzheimer’s is, “What’s good for the brain is what we know is good for the heart.” Which is true and also likely to be your mother’s advice. Little else is apt to make much of a difference. There are, of course, lots of studies that associate mental stimulation with preserved mental function.

    There are claims that people who do Sudoku or crossword puzzles or learn new languages develop symptoms of Alzheimer’s at a later age. I hate to be a “Debbie Downer,” but all of these studies are retrospective and confuse causation for association. The obvious ascertainment bias is that those who are more intelligent and educated are more likely to do these sorts of things and also less likely to be initially diagnosed with Alzheimer’s. Which is altogether different than saying you actually are delaying the pathology of Alzheimer’s. It is well known that very accomplished and intelligent people can fool those around them, and this even includes their neurologists, when the symptoms of dementia are mild. These very talented people seem to also have an accelerated course later in the disease process of Alzheimer’s. That’s because they were actually more advanced with Alzheimer’s when finally diagnosed. Being brilliant and with great vocabularies, they found work arounds to pass all the cognitive screening tests, but eventually they ran out of compensatory strategies in the late stages and then crashed quickly.

    Every age and society have had examples of desperate strategies for those who are unwilling to accept aging and death. About 40 years ago, there was a great interest in cryonics, the cryopreservation of the recently dead. The rich would preserve their entire dead bodies into liquid nitrogen (at a cost of up to $200,000). The middle class could get a big discount by having only their heads put into liquid nitrogen vats ($50,000). If you choose to do either, be aware of two caveats: 1) even if the medical scientists of the future learn how to cure the disease that killed you, would they want to when there are plenty of people who are probably suffering from these diseases in their time and who haven’t undergone the postmortem changes that add insult to injury; 2) who pays for the storage and liquid nitrogen refreshment a century after you and your family aren’t around?

    Already, several cryonics companies have gone bankrupt and failed to keep their bodies/heads preserved in cold. But newer strategies always come along and sometimes supported by rich and famous institutions. Have you heard of Google’s project to solve aging and death? $1.5 billion has already been committed to what Google calls a “singularity research project.” Singularity is Google’s promise that it will be a complete game changer.

    Personally, I am inclined to try and acquire acceptance of death through experience and conversations with wise old people and to read philosophy. Cicero and Michel Montaigne are particularly helpful here. Montaigne claims that “to study philosophy is to learn to die.” He goes further and says that the understanding of death is a prerequisite for the understanding of life and the art of living. In his three-volume collection of essays (1580), the French thinker gives us several excellent compositions on aging and death.

    Or we could go more simply with Ashley Montagu who says much in his pithy phrase, “The idea is to die young, as late as possible.” I’m down with that.