So a few days ago I'm standing in front of my TV, surfing the channels while waiting for Bab5 to come down the cable, and I catch the tail end of an interview on the News Hour on PBS. David Gergen, editor-at-large of U.S. News & World Report, spoke with Daniel Callahan, author of "False Hopes: Why America's Quest for Perfect Health is a Recipe for Failure." I've since downloaded the transcript of this remarkable conversation from the PBS website. It's extraordinary to see how these two, a journalist and a philosopher, approach topics that both of them are, clearly, unqualified to discuss.

Mr. Callahan begins by singing the now familiar refrain of rising costs for health care, and offers up a solution: simply spend less money on research and hi-tech therapy. His position seems to be that the efforts of scientific medicine are some sort of well-disguised con game or hustle:

"I believe that modern medicine has really kind of led us down a kind of garden path by really suggesting that we simply spend enough money, if we do enough research, if we organize well enough, we'll one day conquer most diseases and maybe death, itself--not quite say death itself--but at least we'll someday conquer cancer, heart disease, stroke, all the things that cause death."

Implicit in all this is that these things represent a sort of pipe dream or fantasy. They haven't been cracked yet, after all, so there's really no reason to keep trying, now is there? I can easily picture Mr. Callahan with a top hat and a snuffbox, pontificating in a nineteenth century salon: "Why do the Universities waste their time and money with the likes of Lister and Pasteur? It's not as if a reasonable man could believe that we'll someday be able to fight back suppuration with a pill, or treat epilepsy, or eradicate polio, or transplant organs."

Of course, all these things have been done. And with the current explosion in the biological sciences, the future of medicine is on the verge of entering "blue skies" territory. Molecular biology has built up a critical mass, as our understanding of gene regulation and our map of the human genome grow and grow. Cancer is now understood at the molecular and biochemical levels, while at the same time new techniques to work at these levels are constantly coming into use. Antiviral drugs like AZT, DDI and the new class of protease inhibitors are helping HIV patients live longer, healthier lives--the dividends of fantastic growth in our understanding of how viruses interact with human cells.

But it's not Mr. Callahan's apparent ignorance or disregard of the revolution in the biomedical sciences that's got me pounding the keyboard. It's this:

"I believe that it's a mistake just to sort of endlessly try to increase average longevity. I mean, I sort of feel that somebody of my highest white middle class male, sixties--I don't think I need an awful lot more life. I've had a pretty good life, and most people in our society by the time they reach my age, they've had a pretty good life, or if they haven't, they're not likely to get much--likely to get it after age seventy. So I think at that point I could say, look, enough is enough. We've done a terrific job. But let's see if we can improve the quality of life within a kind of finite life span."

Baloney. Speak for yourself, pal.

Now let me be up front about this: at the current stage of medical and social development, the "life at any cost" issue has the potential to get really monstrous. A walk through any inner-city nursing home will give you the story: dementia, bedsores, feeding tubes, contractures. I daresay we treat our livestock better. The great physician William Osler once said: "Pneumonia is the old man's friend." Unfortunately, these days, when a demented old man gets pneumonia we put him in the House of God and give him antibiotics and oxygen and a few days later send him back to the hellish existence of the nursing home. Life is over, we refuse to accept, and the patient pays.

It is from this horror, and the horrible expense of American Medicine, that Mr. Callahan makes his remarkable assertion: Immortality, or at least the extension of the human lifespan by orders of magnitude, is a pipe dream, and a bad one at that. Once you've had your three score years and ten, you've had enough. He says so.

Well, I don't buy it. For one thing, if you're eighty-nine years old, with your wits about you, reasonably strong, and occasionally horny, you might feel like you've still got some things to do. Maybe a lot of things to do. And Mr. Callahan sort of allows for that--he intimates that hyper-longevity might be an individual goal, but not a worthy societal goal:

"I know many people that would love to live--if not forever--they would like to be a hundred or a hundred and twenty, but I don't--I can understand that maybe individually but I don't think we, as a society, need to push for that kind of a goal."

And again I say: Baloney. If society doesn't search for immortality, who will? If there's one thing the explosion in biomedicine has taught us, it's that progress is multidisciplinary, the work of thousands of investigators in hundreds of laboratories and hospitals. But it's a much deeper issue. What's at stake may not be the destiny of an individual, but of the human species.

Humans who live for centuries can conquer the stars.

And who knows what else? What happens to men and women when they live to be 200? A thousand? Five thousand? What kind of cognitive powers do such people develop? What kind of art and music do they produce? What kind of poetry comes out of the head of a 5000-year-old Emily Dickinson?

So enough about Mr. Callahan. Let's get to nuts and bolts. How do you do it? How do you make human beings live--and I mean live, not just survive--for a very long time?

We can already speculate as to how it might be done. The New Medicine will work not at the level of organs and limbs, hacking at meat like a butcher. No, the New Medicine will rest on an awesome command of living matter, of the very dance of energy and information within living systems. Let's take a look at the history of medicine, as recounted in a twenty-second century textbook....

"...By the late 21st century, medicine had succeeded in conquering almost every form of known disease and prolonging the human life span to such a degree that it was anybody's guess how long people might ultimately be able to live. The key to this extraordinary success lay in the explosive growth of biomedical knowledge and technology, fueled by coincident revolutions in biomolecular engineering, nanotechnology, and biocybernetics. These disciplines underwent extensive cross-fertilization, yielding the pillars of the temple of the New Medicine.

Molecular Medicine was to be the keystone of this new edifice. The completion of the Genomic Map, and the harnessing of viral vectors and eukaryotic transcription factors heralded the conquest of some of humanity's most horrible diseases. Diabetes, cancer, cystic fibrosis, most birth defects, autoimmune diseases like rheumatoid and lupus, hemoglobinopathies like sickle cell, all the hemophilias and a host of other afflictions could be eradicated by the simple cut-and-paste of nucleotide sequences...

Antiapoptotic therapy had its roots in the late twentieth century, but reached a high level of sophistication with the advent of molecular engineering and nanotechnology. These techniques prevented apoptosis, also known as programmed cell death or "cell suicide." Such treatments helped prevent extensive brain damage after cardiac arrest, stroke and head trauma, improved outcome after heart attack, and proved essentially curative for neurodegenerative disorders like Alzheimer's and Lou Gehrig's disease....

Antibiotic therapy underwent a revolution, discarding the old "drugs against bugs" paradigm to embrace immunotherapy, antimicrobial nanobots, and engineered bacteriophages to wipe out tuberculosis, leprosy, multidrug-resistant gram positive infections, suppurative venereal diseases, and a host of others. Death from gram-negative sepsis became almost unheard-of--although this was also due in part to molecular medicine and new treatments for shock. Protease inhibitors, combined with nanobot-aided cellular surgery techniques, eradicated AIDS, the great pandemic of the 20th century, and hepatitis G, the great pandemic of the 21st....

Medical imaging transformed the art of diagnosis and the ease of medical monitoring. The single most important development in this arena was the appearance of portable nuclear magnetic resonance imagers and microscopes, made possible by advances in superconductivity and information processing. Hand-held MRI scanners became as ubiquitous as stethoscopes, giving physicians the power to look into the patient's body as they never had before. The development of NMR microscopy, and its subsequent incorporation into hand-held scanners, initiated another sea change in diagnostics, enabling physicians to resolve cellular details at the bedside. Other developments included nanobot probes, which could not only burrow deep into the organism to relay images of disease processes, but could also, in some circumstances, be used to repair lesions on the spot. Neural mapping, made possible by NMR microscopes and the vast data storage capabilities of optical computers, allowed physicians and surgeons to characterize neurological disorders and injuries at cellular and dendritic levels, permitting the rational utilization of molecular therapy or nanosurgical repair.

Nanotechnology was as essential to 21st century medicine as antisepsis and the x-ray had been the century before. Once machines could be built on a molecular scale, atom by atom, humanity took its first step toward an almost godlike command of matter--including biological matter. Molecular machines could be designed to attack viruses and bacteria, identify and destroy cancer cells, patrol blood vessels and eradicate deadly plaques, form the boundary between hardware and tissue, or prune and train neural processes like a gardener prunes and trains a vine. Prostheses "grown" out of nanoassemblers, made atom by atom, rendered those hewn from chunks of metal or plastic crude by comparison. Nanobots transformed surgery from a highly disciplined and aseptic form of butchery to a truly elegant manipulation of biological matter--physicians could close wounds by spraying them with a mist, and remove or repair damaged or diseased tissue with a single subcutaneous injection.

Artificial organs remained a necessary component of medical therapy for the most devastating diseases and injuries, but materials science, molecular medicine and nanotechnology enabled prosthetics to achieve a fantastic level of sophistication. A fully functional artificial liver, composed of cultured liver cells on a synthetic scaffold, was introduced in 2010, and served as a major paradigm for the construction of artificial organs and limbs. In 2015, Jeffrey Hurt, at the University of Texarkansas, constructed a human forearm and hand, composed of a biodegradable plastic scaffold cultured with embryonic bone, muscle, nerve and skin cells. He transplanted it onto the stump of a 50-year-old woman whose arm had been crushed by a train. The cultured tissues took over the scaffold and degraded it; one year after implantation the patient had a fully functional, biological arm. Carver developed an artificial muscle tissue in 2020; hearts made from his breakthrough material could deliver the cardiac output of a normal heart with a 12-volt battery. Cloning eventually made the development of artificial pancreas, adrenal and kidney unnecessary, but extremity and sensory organ prostheses remained far superior to anything that could be grown from embryonic tissue, and had the added advantage of being immediately available at the time of injury.

With time, medicine's mastery over living matter culminated in the development of the complex geriatric compounds that came to be known as the Plasm. Very nearly a form of living matter itself, the Plasm was an intelligent cocktail of programmed DNA plasmids, cellular repair enzymes, chromosome-preserving telomerases, nanobots capable of diagnosing and repairing cellular and molecular damage, vitamins, growth factors and stimulants. It became universally available, packaged in foodstuffs, tablets, sports drinks and cosmetics, and appeared to have the power to stretch the human lifespan well beyond a century. But the true power to cheat death would fall to a different type of technology.

Biocybernetics had been ushered in by pacemakers and the like; but reached its full flowering with the development of highly reliable and sophisticated neural implants. The implantation of an electrode into the thalamus for the treatment of essential tremor was reported in 1995; a similar device for the suppression of seizures became available soon after. A primitive video system was implanted into the visual cortex of a blind teenager in 2010 and worked better than anticipated. From then on it was blue skies. Spinal cord injury, nerve damage, deafness, parkinsonism, and stroke paralysis all fell before the progress of neural interface technology. By 2040 human beings could, as a matter of routine, interface computer systems directly via "wetjacks," and the boundary between human and computer began to blur. By the middle of the 21st century this had culminated in the development of the Personality Autostimulating Repository and Datastream Integration System, or PARADIS. When the ministrations of scientific medicine finally failed the biological being, an alternative vehicle for consciousness was now available. Death, the most inevitable and universal of all human afflictions, had been vanquished at last.

Let none of this speculation lead you to believe that your old Quantum Butcher thinks Scientific Medicine is the be-all and end-all. Far from it. The alternative health revolution is fascinating, informative, terrifying, and above all, funky. But that's another column...

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Jonathon Sullivan MD, PhD, is Assistant Professor of Emergency Medicine at Wayne State University/Detroit Receiving Hospital. He is the recipient of an NIH research grant, to investigate molecular mechanisms of brain death after cardiac arrest. Dr. Sullivan lives in Farmington Hills, MI.