From a distance, thinkers will see an unsustainable pattern. Yet faced with the prospect of immediate extinction, these old people and their loved ones will demand the therapies.
I don't see how this particular issue is different from the standard problem of "fair" allocation of limited resources most people, organizations, companies and governments grapple with every day.
I'm sympathetic to the idea that basic, proven health care (80% of the benefit for 20% of the cost) should be free to all, and that more expensive, less effective health care should be available to people rich enough to buy it. But this is highly problematic politically. If your society supports "(top of the line) health care is a right, not a privilege", then standard models of resource allocation are problematic. Political leaders might give in to the demands, at the cost of health care spending rising to (say) 50% of GDP. We could lose our economic competitiveness in a catastrophic way.
This is an ongoing discussion in every Western country, actually. Privileges tend to become rights when the society can afford giving them to everyone.
Not too long ago smart phones were pretty rare and very expensive. This becomes less true every year. If Apple had waited until iPhones could be delivered to everyone at a low price, it would have taken much, much longer.
Historically, the way you solve the problems of cost is scale/competition/refinement of production mechanisms/research/application/data/competition (especially when IP restrictions go away). The way you get this is by bringing the thing-you-want-to-be-cheap to market quickly.
This applies in some areas, but not others. It might apply in health care if your treatment gives people another 100 years of healthy life all in one fell swoop. But the actual history of medical research is that since the appetite for extra months of life and extra percentage points of cures is unlimited, we see costs rising rather than falling. The cost of a given medication should fall after it goes out of patent protection, for instance, but there is always (so far) some other medication or device that is (at least marginally and allegedly) better. This is the most fundamental problem with the US health care system: patients demand more health care regardless of the price -- a cost they want someone else to bear.
My plea is to keep life-extension therapies far from the market until all the conditions are in place to solve the problems of cost and making sure that the path is clear to extending healthy life, not decrepitude. This should include an enthusiastic, positive attitude towards life instead of weariness and depression.
Can you give more specific examples of what life-extension therapies you would want kept off the market?
As an example, let's say your plea is granted, and you are put in charge of a currently non existent "Longevity International For Eternity" Bureau, and you get to approve, ban, cancel or delay any or all treatments as you see fit. It's a lifetime appointment and you don't have to worry about popularity if you don't want to, but you can if you want. Can you give more information about what you would do?
What I would do is close to what a certain fairly mainstream set of health care reformers would like to do. It would involve reducing much spending in the last three months of life when a terminal condition exists, it would involve taking age into account in allocating donated organs. It would involve drug companies showing that a proposed new drug is more effective (or otherwise significantly superior to) existing medications, not just that it is effective. Although this is not an idea I have seen elsewhere, I might also take an "end-to-end" approach to medical research, wanting to see a sort of "business plan" that shows enough benefit to enough patients to justify costs. Any life extension treatments would be considered using the same set of criteria. Giving frail, confused 85-year-olds another ten years of the same kind of life would not qualify as a positive outcome.
I'd like to add interest into hearing a proposed criteria in how various propositions are assessed.
Thank you very much. I apologize for not looking at the post after posting it (doh). Basic "QA". Was it worth writing this comment, or am I just contributing to data smog? Don't know. Anyway, the thanks are genuine.
But there is one area where progress really seems feasible within a few years: radical life extension. The right combination of drugs affecting gene expression just might do it.
You will probably not get radical life extension by solely altering gene expression. You'll need something more invasive.
and making sure that the path is clear to extending healthy life, not decrepitude.
You know that is in fact the current state of medicine, e.i. extending life a little, but not really increasing healthy years. For example warfarin (commonly subscribed to elderly at greater risk of cardiovascular disease and stroke), do not improve quality of life, more the opposite, since it reduces clothing --> increase bleeding, cause spontaneous bruising. I'm all for healthy lifespan, but that is what I'm hoping initiatives like SENS might deliver as well as increase in lifespan.
Yes, and I think we should stop paying for some current procedures that prolong decrepitude, as well as not funding new ones.
Yes, and I think we should stop paying for some current procedures that prolong decrepitude.
That is highly problematic, since that will result in more strokes and mycardial infractions that - aside from causing death - result in an increase in morbidity.
And what if people want to live longer, even if the extra years added will have more decrepitude. From a paper by Nick Bostrom:
One study assessed the will to live among 414 hospitalized patients aged 80 to 98 years, presumably representing the frailer end of the distribution of the “old old”. 40.8% of respondents were unwilling to exchange any time in their current state of health for a shorter life in excellent health, and 27.8% were willing to give up at most 1 month of 12 in return for excellent health.
My plea is to keep life-extension therapies far from the market until all the conditions are in place to solve the problems of cost and making sure that the path is clear to extending healthy life, not decrepitude.
You realize that this is equivalent to saying you want people to die instead of having a number of shitty years of life (after which they'll get uploaded or have the effects of aging reversed), right?
I estimate the chance of getting uploaded or having the effects of aging reversed before society collapses (at least to the point that such a person would die) is about, oh, one in ten thousand. Given that estimate and my sense of the cost, then that is an implication of what I am saying.
It might be off topic for this thread, but I think a claim like this is worth some sort of separate post. If you truly believe that civilization is that close to the brink, then it seems helpful to display the argument somewhere to inform others of the danger. Even if we can't stop the collapse, we could be prepared. And if your argument doesn't convince us, you'll have tried and have that off your conscience.
It's nothing I have enough detail on to support a separate post. I suspect my phrasing emphasized the wrong part of it (sorry). I have no reason to think our society is due for a catastrophic "dip" in the next few hundred years. I'd even give it a thousand. And after that we might well recover, but preservation of any individual life gets iffy through that period. So I'm giving us one in ten thousand of reversing aging or uploading brains before that collapse (100-1,000 years from now). The chances of developing it when civilizations rise and fall over what could be millions of years might be higher (one in four?) -- but that's of no use to today's frail elderly. Those periodic, "black swan" catastrophes themselves are cause for great concern of those who want to live a very long time.
Maybe I'm missing the context here, but why is the preceding post down voted? As far as I can see he's just reporting his subjective probability of some future events. If you disagree, you could supply links to evidence that might change his opinion, but I don't see why you'd down-vote his honest probability assessment. Maybe it was his rhetorical flourish: "that's of no use"?
My sense of the discussion here is that Bart119's attempting a tricky cost-benefit analysis of life extension and being a bit loose with his arguments. Perhaps he could start over with a defensible smaller argument: "present-day life extension, if extraordinarily successful, will create costs for society as a whole that may be a problem."
Forewarning: this is something of a rant and not carefully argued... Hey, someone with (at least somewhat) similar views. Great to hear from you. I skimmed the other discussion, and regret I didn't see it earlier. I don't worry about an inability to die if you don't like life, and think the population issue isn't so bad by itself (I worry about the disproportionate number of old people (even if healthy) and the rarity of children. But "unknown consequences" weighs very heavily. The status quo bias isn't such a bad thing as a defense against hubris. And while I can't prove it, I think a society where people live to (even) 200 is extreme hubris, playing with fire. Individuals have an incredibly strong motivation to keep themselves alive. If it runs against the common good (which it could in any number of ways) it would be very hard to stop. I'm not sure how LWers got so terribly afraid of death -- usually atheists accept death. And, while I'm at it, I think The Fable of the Dragon Tyrant is one of the most maddening pieces of sophistry around. It could be a textbook case for "kill the enemy" emotional manipulation. I scratch my head at how a group that starts out in search of rationality ended up as starry-eyed transhumanists. But I tend to think that rationality wouldn't really resolve differences related to life extension. It's different probability estimates and different utility curves. So an unpopular view like this gets voted into invisibility, and the community keeps its unanimity. What to do? Probably go off to some other corner of the web of like-minded people, and stop trying to change minds... End of rant.
I haven't voted on this comment yet, but I was very tempted to. While I do disagree with it, I'm more irritated that it makes several unsupported generalizations. You admit that there's a bias involved in the arguments against life extension and then say that it's to stop hubris, then you handwave away any evidence that you could provide to back up your argument. Sure you might not be able to prove that it's hubris, surely something led you to believe that that could also persuade others right?
The rest of my complaints run in a similar vein; average life expectancy has been increasing for at least 50 years now, surely there's evidence showing how people have damaged the common good in the name of life extension (Ballooning healthcare costs comes to mind). You generalize that all LWer's have a fear of death... how? Who have you seen talking about being afraid of death? Why would rationality be insufficient? How do you know your views are getting downvoted on the sole basis of expressing an unpopular opinion?
If your other comments were of similar quality to this one, I wouldn't have a hard time imagining why they were downvoted. They come off more as rants than as carefully measured attempts at argument.
I will say though, that if you do try and provide arguments that I'd be happy to upvote it.
Hey, thanks for the reply. I appreciate it. I'm not upset if people want to downvote the rant -- rants by their nature are not carefully argued. The best spin might be 'brainstorming'. I'll edit it to label it up-front. But I don't see how the original post is poorly argued; that's what matters for visibility. The one thing I'll note is:
average life expectancy has been increasing for at least 50 years now, surely there's evidence showing how people have damaged the common good in the name of life extension
I agree and think that supports the point. The trend has already caused some damage, though we can handle it fairly gracefully. If it accelerates dramatically, then I fear we will be unable to handle it. Maybe I misunderstood you.
Maybe I'll get the energy to make a post on hubris, but not right now.
And while I can't prove it, I think a society where people live to (even) 200 is extreme hubris, playing with fire. Individuals have an incredibly strong motivation to keep themselves alive. If it runs against the common good (which it could in any number of ways) it would be very hard to stop. I'm not sure how LWers got so terribly afraid of death -- usually atheists accept death.
When you accept that "death" is the end of existence, and I mean really the end of it, then you don't accept it. At least, I haven't been presented with a philosophy that would support seeking death if all things were equal. Maybe if your death somehow saved or preserved the lives or happiness of others, but that's not the issue.
So, when you ask why LWers got "terribly afraid" of death, i'd say that this community seems to embrace the truth of death. It's the end. Why would you choose to cease if there was a chance of continuing beyond, and that chance didn't take away anything from anyone?
I know I'm not presenting anything new, but I thought the clarification (of my understanding) might help.
Thank you for clarifying. Sure, if you're enjoying life and there's no cost to going on living, we'll all choose that. The question is how much we'll pay to keep that chance of living a while longer.
In response, I'd say that somehow the focus is too narrowly on any one point in time. At any given moment, it's terrifying to think you'll die and you'll do a great deal to avoid it at that moment. But as we talk of pre-committing in game theory situations, you might want to pre-commit regarding death too. You might say you don't want extraordinary measures taken. (Analogy: I would choose to submit to torture rather than have a thousand others tortured in my place -- but don't give me a panic button to reverse the choice during my actual torture!)
I sometimes sense here people saying, "Well, I'm going to live a very long time and then get my brain uploaded" and I think it's a way of dismissing death -- waving it away to some indefinite future so you don't have to get that sick feeling contemplating it in the present. But it doesn't really help. The computer's going to crash at some point too. You'll get more comfort for no less reality believing Jesus is your savior.
My father was receiving hospice the last few weeks of his life in a nursing home. There was a no-hospitalization understanding, but during a crisis, the duty nurse called an ambulance for him. The hospice nurse said that if she'd been called in a timely fashion, he probably would have died that day. Instead, I got to visit him in the hospital the next day. It was odd thinking in that moment that he was alive right then and could answer my questions, while our agreed plan had been for him to be dead by then. Note, though, that he had not a shred of joy in living and died a few days later anyway. (Yet if given a button to kill himself I doubt he'd have pushed it). Looking back a couple years later, I remember the oddness of that moment, but those few days didn't really matter very much. They mattered less than some other four days of his life spent in a notably non-optimal fashion, and who of us doesn't have oodles of such days?
For fictional support, I'd mention two books. First, in the Earthsea trilogy by Ursula LeGuin, Ged's achievement is being so comfortable with the inevitability of death that he can perform a totally exhausting and painful feat of magic to seal a hole in the world that allows a corrosive form of immortality -- sealing it off for him as well as everyone else. And the world rights itself. The second is the Hyperion/Endymion series by Dan Simmons, where the right action is giving up the 'crucifixes' that bestow immortality. The brave girl enjoys her last few days of life even knowing she's going to volunteer to be roasted alive to make the galaxy a better place. The day is worth enjoying even if it is your last.
I say there's no real way of making sense of death. We're programmed by evolution to work hard to postpone it, which was adaptive in our environment of evolution. As a nasty side effect, we know we'll eventually lose no matter what we do. But few of us kill ourselves in despair at that realization, and we still will risk death saving our children -- both also adaptive.
I'm sure nothing I'm saying is original either, and others have said it better.
There's near thinking and far thinking. While LWers debate far questions, near questions remain. To take a few examples, we in the US still spend large sums on special interests through subsidies and tax breaks, and jockeying for partisan advantage makes pursuit of sound policies very difficult.
Cryonic revival, FAIs, UFAIs colonizing other star systems -- they all seem pretty far out in the future to me and a lot of other people. So a tiny band of LWers and like-minded people work on what they have a passion for, which is as it should be.
But there is one area where progress really seems feasible within a few years: radical life extension. The right combination of drugs affecting gene expression just might do it.
Eliezer, in The Moral Void and elsewhere, makes clear a passionate if not fanatical commitment to longer life, and it seems the common LW view. Yet surely economics must come into play. If we can give a 60-year-old another day of high-quality life for $10, no one would question that we should. But suppose the cost of each extra day doubles. At 20 days the cost is on the order of $10,000,000 a day. Although we might try to couch it in kinder terms, at some point we end up saying to this person, "Sorry, you die today because we can't afford what it costs to keep you alive until tomorrow." Harsh, but inevitable.
I assume exponential costs get through to thinkers even in far mode. I see economics downplayed throughout LW thinking, on the assumption that radical improvements are possible. They might happen in the longer term, but not within the course of a few years. In the next few years, mere linear increases in costs are very relevant.
The LW thinking on life extension assumes that (1) it is vigorous, healthy life we will extend, not decrepit, depressed old age, and (2) it will be affordable to all. When thinking to a far future, it's easy to assume such conditions will be met. But when a technology is right in front of us, timing issues can be extremely important.
It is a good guess that if life-extension technology comes to the market, the demand will be intense and immediate. It's a good guess that it will be expensive (the cheaper it is, the less drug companies will be motivated to develop it). And it's also a good guess that the first people to sign up in the face of risks and side effects will be the old, who have little to lose.
We face the prospect of sucking up larger and larger portions of our economy extending the lives of decrepit, demoralized old people. (We already face this trend, but the life-extension technologies that are in the offing would make it much worse).
From a distance, thinkers will see an unsustainable pattern. Yet faced with the prospect of immediate extinction, these old people and their loved ones will demand the therapies. They would be upset to think that the drugs are in the closet right down the hall but they aren't eligible to get them. They'd be less upset to know that the drugs are not approved yet, and still less upset to know that there is no clear evidence that they work in humans, and so on.
My plea is to keep life-extension therapies far from the market until all the conditions are in place to solve the problems of cost and making sure that the path is clear to extending healthy life, not decrepitude. This should include an enthusiastic, positive attitude towards life instead of weariness and depression.
There are other reasons why we should be wary of such new technologies, but these short-term, practical ones seem like a clear case that is largely independent of one's utility function.