{"id":4279,"date":"2022-04-28T00:19:02","date_gmt":"2022-04-27T23:19:02","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=4279"},"modified":"2022-04-28T00:20:26","modified_gmt":"2022-04-27T23:20:26","slug":"imagination-and-idealism-beyond-the-disease-control-paradigm","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2022\/04\/28\/imagination-and-idealism-beyond-the-disease-control-paradigm\/","title":{"rendered":"Imagination and idealism beyond the disease-control paradigm"},"content":{"rendered":"<p>By Colin Farrelly<\/p>\n<p>The World Health Organization has designated the decade 2021-2030 as the \u201c<a href=\"https:\/\/www.who.int\/initiatives\/decade-of-healthy-ageing\">Decade of Healthy Ageing<\/a>\u201d. \u00a0\u00a0And the <a href=\"https:\/\/www.un.org\/en\/development\/desa\/population\/publications\/pdf\/ageing\/WorldPopulationAgeing2019-Highlights.pdf\">United Nations<\/a> estimates that the 703 million persons aged 65\u00a0years or over in 2019 will double by 2050. \u00a0<a href=\"https:\/\/www.ted.com\/talks\/colin_farrelly_global_aging_and_longevity_science\">I believe<\/a> the aging of humanity is one of the most significant developments of the 21<sup>st<\/sup> century.\u00a0 Population aging is both a success story- one made possible only because of our success with reducing the historically high rates of early and mid-life mortality- but also an unprecedented and pressing public health predicament.\u00a0 Aging is a significant risk factor for disease, frailty and disability.\u00a0 To meet the challenges of population aging the medical sciences must exercise and celebrate the creative epistemic virtues of imagination and idealism.\u00a0 This is the focus of my latest JME article.<\/p>\n<p>The inspiration for writing this JME paper was pure happenstance.\u00a0 When doing research on another project I happened to come across the physician and pathologist Christian Herter\u2019s 1910 Presidential address to the American Medical Association entitled \u201c<a href=\"https:\/\/jamanetwork.com\/journals\/jama\/article-abstract\/431232\">Imagination and Idealism in the Medical Sciences<\/a>\u201d.\u00a0 It is a neglected masterpiece!\u00a0 It is just as relevant today as it was in 1910.\u00a0 Progress is possible in the medical sciences, Herter argued, because science is <em>plastic<\/em>, with new discoveries being made and new interpretations of old facts.\u00a0 And yet, lamented Herter, our lectures and textbooks are conservative and make our minds static by reinforcing the fixity of facts.<\/p>\n<p>Perhaps the most profound insight in Herter\u2019s essay was his observation that the most importance advances in the medical sciences are often made by <em>indirect methods<\/em>, when researchers were not intentionally looking to treat or cure a disease.\u00a0 In the 100+ years since Herter\u2019s essay the medical sciences\u2019 preoccupation with the study of pathology has only intensified.\u00a0 But I believe this century\u2019s most important advance in public health will likely come from an indirect method- an intervention that modulates the inborn aging process itself, thus increasing the human <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6136295\/\"><em>healthspan<\/em><\/a> vs simply increasing survival by forestalling death.<\/p>\n<p>For the past 15 years I have been following the fascinating field of scientific research known as biogerontology or \u201cgeroscience\u201d.\u00a0 This area of research applies insights from evolutionary biology to understand why humans, and other sexually reproducing species, have the lifespan, age of sex maturity, fertility, risks of chronic disease, frailty and disability, etc. that we have.\u00a0 It also studies ways to modulate the aging process in laboratory species such as worms, mice and fruit flies, through interventions like caloric restriction and genetic manipulation.\u00a0 Over the past two decades the prospect of intentionally manipulating the rate of biological aging in humans has gone from realm of science fiction to actual clinical trails, such as the <a href=\"https:\/\/www.afar.org\/tame-trial\">TAME (The Targeting Aging with Metformin)<\/a> clinical trial in humans.\u00a0 Geroscience inspires us to imagine \u201cadding more life to years\u201d vs just \u201cadding more years to life\u201d.\u00a0 But geroscience remains a somewhat marginal and often misunderstood field within the medical sciences, in part because <a href=\"https:\/\/www.thelancet.com\/journals\/lanhl\/article\/PIIS2666-7568(21)00201-4\/fulltext\">many<\/a> do not consider <a href=\"https:\/\/slate.com\/technology\/2020\/03\/aging-disease-classification.html\">aging to be a disease.<\/a><\/p>\n<p>Historically, our imagination fixated, understandably, on ascertaining the causation of pathology, especially those infectious diseases that kept human life expectancy at birth below what we now consider to be \u201cmiddle age\u201d.\u00a0 Discovering what caused particular infectious diseases, like cholera, helped lead to the sanitation revolution.\u00a0 An understanding of the proximate causes of small pox, polio, diphtheria, tetanus, pertussis, measles, mumps and rubella, etc. helped inspire the imagination needed to develop vaccines to enhance the human immune system beyond what evolution had given us.\u00a0 The idealism of safer environments for humans to live, work and play in, helped make a reality safer food to consume, cleaner water to drink and swim in, safer working conditions, safer vehicles for driving, etc.<\/p>\n<p>When we think of ideals for the medical sciences, our minds turn to cures and treatments for specific diseases.\u00a0 The ideal of a \u201ccancer-free world\u201d, or eradicating HIV\/AIDS or COVID-19.\u00a0 In my JME essay I note the successes, but also limitations, of the idealism of <em>disease-control<\/em>.\u00a0 Unfortunately our fixation on the paradigm of <em>disease control<\/em> has marginalized what many scientists now believe may prove to be among one the most significant advances in public health this century- an applied gerontological intervention that slows the rate of molecular and cellular decline, thus extending the human <em>healthspan<\/em>.\u00a0 \u00a0Using our imagination to target the inborn aging process itself, vs any specific disease of aging, may help us realize the ideal of healthy aging.<\/p>\n<p>Paper title:\u00a0 <a href=\"https:\/\/jme.bmj.com\/content\/early\/2022\/04\/20\/medethics-2022-108129\">Imagination and Idealism in the Medical Sciences of an Aging World<\/a><\/p>\n<p>Author:\u00a0 Colin Farrelly<\/p>\n<p>Affiliations: Queen\u2019s University<\/p>\n<p>Competing interests: NA<\/p>\n<p>Social media: <a href=\"https:\/\/colinfarrelly.com\/\">https:\/\/colinfarrelly.com\/<\/a><\/p>\n<p>&nbsp;<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Colin Farrelly The World Health Organization has designated the decade 2021-2030 as the \u201cDecade of Healthy Ageing\u201d. \u00a0\u00a0And the United Nations estimates that the 703 million persons aged 65\u00a0years or over in 2019 will double by 2050. \u00a0I believe the aging of humanity is one of the most significant developments of the 21st century.\u00a0 [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2022\/04\/28\/imagination-and-idealism-beyond-the-disease-control-paradigm\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":353,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8047,328],"tags":[],"class_list":["post-4279","post","type-post","status-publish","format-standard","hentry","category-aging","category-philosophy"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - 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