23 November 2020

40 Minutes

Last night's '60 Minutes' had two of three segments which gave one pause.

Geezers (aka, 65 and up) -

The report, a return to some 90+ folks first done in 2014, details what has happened to some of those in a study on aging. Much of the report centered on memory deterioration, in particular what is, and is not, Alzheimer's. Turns out that memory loss, aka dementia, may well not be mostly Alzheimer's, but other pathologies. We see bunches of brain sections, some with plaques and tangles and some not. Some with are from people who never demonstrated Alzheimer's symptoms. Some not, did have symptoms. And some reveal other memory deterioration, TDP-43 which looks like Alzheimer's in living patients.

That was all very interesting, but then the segment jumped the shark.

One of the researchers in the study tells Lesley Stahl that of the people born today, half with live past 100. Such bullshit, and from someone who ought to know better.

One need only look at the data. Pick some date in the past, such as 1932 (FDR's socialism begins) or 1900 (an arbitrary, but reasonable demarcation between 'old medicine' and 'new medicine') as your baseline and 2,000 as your endpoint. Now, ask yourself two questions: 1 - what has been the change in life expectancy at birth 2 - what has been the change in life expectancy at 65 (the Right Wingnuts claim that the age was chosen for Social Security because that was average life expectancy)

The answer to 1 is: multiple decades.
The answer to 2 is: a few years.

It's absolutely not that 'people are living longer', it's that if you don't die young, you're just as likely to get really old as you ever were.

What's going on here? Simple: from your baseline date to 2,000, medicine (and some public health programs) drastically reduced the mortality of folks younger than geezerhood. Move the center of mass of a distribution to the right, and you move the mean/average too. You may or may not move the median, depending on lots of things. Childhood mortality, in particular due mostly to vaccines, plummeted. Anti-smoking campaigns reduced the number of smokers, and thus lung cancer. Workplace deaths plummeted as well, Covid in meat plants today notwithstanding. And so on.

Look at life expectancy at 65 for both your baseline date and 2,000 and you'll see a tiny fraction of increase compared to at birth. It's OK for innumerate civilians to be gulled by this, but a professional aging researcher? Boy howdy.

We've made little progress, at the cost of many billions of dollars, in reducing the mortality of age-related disease in the geezer cohort: cancers and cardiovascular. In the main, you'll get a few months more, much of it hooked up to IVs.

Now, there is one way that the assertion might be partially correct: if more folks are healthier as they reach 65, due to ongoing progress with the younger folks, then the 65 and over cohorts will enter healthier and thus more will make it to 100. But that's not the same as prolonging the lives of those who pass 65.

Are there areas of medicine aimed at the younger than 65 cohort which have not yet been solved? It seems, to me, pretty much not. Cancers, modulo those treated with Gleevec, have not been, by any definition, cured. Diabetes is rampant. Cardiovascular therapeutics are not moving very rapidly. And so on.

Long haulers -

The main takeaway, to me, was the possible explanations for why long haulers exist at all. Until they began banging a drum, "hey! we're here, dummies!", the received wisdom was that recovered meant immune and back to normal. Now we know that ain't necessarily so. And those who are long haul tend to be in the 20 to 40 cohort. One unsettling explanation for how long haul comes to be is that the immune system goes berserk.

Which leads me to wonder: these fancy, never before distributed technology, mRNA vaccines have short term 95% efficacy (I don't believe that number is the meaningful one, but that's for another episode). But what if that efficacy is the result of turbo-charging the immune system? Will we be trading some immunity for a swath of the population in long haul? Just askin.

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