Rejuvenative medicine - how far off are we?

Truth be told his posts can generally be ignored anyways. He rarely contributes anything worth reading

Your bad, or is that you're bad?

No I mean Sandy

Like Cold Fusion, or perpetual motion, some dreamer will change the rules.

Government will do anything to take control.  Case in point.  The Food and Drug Administration wants the authority to regulate supplements.  This authority will expanded the agency's political power.  Additionally, the agency acts to protect pharmaceutical companies, preserving the status quo.  The companies do not want to compete with products of  proven effectiveness, fewer or no side effects and lower costs.

Personally, I'm extremely sceptical of perpetual motion, highly sceptical of cold fusion, and pretty sceptical of the claims made by the supplements industry (although some supplements are plainly a good idea, there's just too little evidence for most of them, and far too many touted on the basis of reasoning like the "it's natural so it's good" fallacy or anecdote).

As for practical immortality.  I doubt it happens.  The mature technology may permit a person to live forever, but they won't.  Life will see to it.  People won't die in bed, except in rare circumstances.  If I'm remembering correctly, some genius at an insurance company figured out a actuary table for an "immortal".  I think the average was about 350 years, with a maximum life expectancy about 1000 years. 

Now there's a fun appliance of stats.  Even if you take out ageing, we do indeed remain very mortal indeed.

Various studies show that, when technologies make cars "safer", people tend to push the envelope further. (example: German taxis and antilock brakes) Might this principle apply if we push the boundaries of human longevity?

True that.  My favourite example was the effect of making seatbelts in cars mandatory in the UK in the 80s.  Deaths and injuries among drivers went down, even though people started driving a little faster; but deaths and injuries among pedestrians and cyclists went up, because the cars were moving faster.

Would more people engage in skydiving, racing powered vehicles ( including spaceships ), and other risky endeavors?

Tricky one, there.  You aren't taking the risks out of those activities; if anything, you'd have more to lose if, say, you've got a couple hundred years of healthy life ahead of you than a few decades of physical decline.  On the other hand, more people would be physically and mentally capable of various risky physical activities if we could eliminate osteoporosis, arthritis, Alzheimers etc.; so you might well have more 90-year-olds skiing, mountain climbing and so forth than we do today.

It would not surprise me to see many complex changes as a result of increased longevity. Over long periods of time, I suspect that many people would become fiercely resistant to tyranny. When you have the prospects of hundreds of years ahead of you, do you want your future to be limited by corrupt governments?

It'd be interesting to see just what might happen with immortality.  There's a strong association between age and right wing economic views today, but also one between age and "don't rock the boat" political views.  Also, continuing to hold views prevalent among the youth might last longer if physical youth is itself maintained longer, and the old are just that much older. 

Truth be told his posts can generally be ignored anyways. He rarely contributes anything worth reading

. . . says a man who does not have a forum full of people discussing his works, about a man who does.

Truth be told his posts can generally be ignored anyways. He rarely contributes anything worth reading

Your bad, or is that you're bad?

No I mean Sandy

I know you did.  You are still a bad man.  Shame on you.  Why can't you be more like me.  Always kind and considerate.

Governments are clearly run by people who want power irrespective of what they claim.

I agree.

and pretty sceptical of the claims made by the supplements industry (although some supplements are plainly a good idea, there's just too little evidence for most of them,

Are you equally skeptical of the claims made by the pharmaceutical industry?  Consider:

http://www.ncbi.nlm.nih.gov/pubmed/9555760?dopt=Abstract  A finding by the JAMA that properly-prescribed and -administered (i.e., not overdoses, not wrong) drugs are around the 5th leading cause of death in the US;

and that there has never been a truly blind test of any drug.  Anyone who gets the side effects knows they received the real thing, which is an opening for the placebo effect to kick in; in a truly blind test, the recipient would not be told what the drug is supposed to do at all.

far too many touted on the basis of reasoning like the "it's natural so it's good" fallacy or anecdote).

Quite so.  I like pointing out that arsenic is all-natural. . . .

And as far as I can find, "anecdote" is the only evidence for the effectiveness of vaccination.  I have seen no rigorous scientific test of the vaccination theory, and I have some theoretical grounds for doubting its efficacy -- as in, a disease agent naturally encounters multiple bodily systems:  skin, mouth, eyes, nasal & sinus linings, lungs, stomach & intestines; rarely does it go straight to the bloodstream, but vaccinations bypass all those other tissues, and it seems evolutionarily improbable that those normally-involved tissues don't have a role in creating immunity.

You are seriously debating vaccines? Why is it you fringe folk always descend on vaccines?
The overall principle on widespread vaccination is about herd immunity. You make enough people resistant or immune to the disease to prevent it spreading. Results will always vary per individual on how well the vaccine works. Plus your understanding of the immune system is non-existent or even how vaccines work on the individual. It's about your immune system not the rest of your body. Your immune system is the part of you that fights disease, hence why it is called that. The vaccine is a weakened version of whatever you want to try and vaccinate against or something similar that is safe (enough) to administer in comparison to what you're trying to protect them against. The immune system responds as normal to the infection, fights it, creates antibodies designed to fight it and then deals with it leaving the antibodies with you which means in future your immune system can crank out more of them if a similar disease is detected.

And as far as I can find, "anecdote" is the only evidence for the effectiveness of vaccination.

You disbelieve in statistical trials? I'm real unclear how to respond to this.

I have seen no rigorous scientific test of the vaccination theory, and I have some theoretical grounds for doubting its efficacy -- as in, a disease agent naturally encounters multiple bodily systems:  skin, mouth, eyes, nasal & sinus linings, lungs, stomach & intestines; rarely does it go straight to the bloodstream, but vaccinations bypass all those other tissues, and it seems evolutionarily improbable that those normally-involved tissues don't have a role in creating immunity.

It seems sensible to me that other tissues could be useful for developing immune system responses, and that tissues which do not receive antigens from blood with immunization might be somehow deficient as a result. Perhaps better vaccines could be devised which get past that potential limitation. But vaccines which provide partial immunity could still be good enough to much reduce the risk of serious disease, or the spread of infection. That's the important thing.

I dislike the tone of Holt's response but he has a point. Some vaccines get testably better results than others, and some are probably not worth using. (We aren't very good at predicting virus epidemics and we can vaccinate a lot of people at big expense and a few of them get serious bad effects, when the disease they are being vaccinated for probably would not have happened anyway. Better to get a series of correct predictions first.)

But I find the idea -- that in general vaccines are not effective -- is hard to grasp.

You know what all those vaccine naysayers? I have one thing for you.

Smallpox.

Hows that smallpox? You been dying of it lately? Has anyone in the civilised world? Sorry has ANYONE?
It works. Vaccination works. Any who say otherwise are simply spoiled brats who have never experienced the world without it. Are all vaccines flawless? Of course not. Is the general concept and methodology flawless? Most likely not. Is it good enough and been proven to work? Guess what? Reality disagrees with the screams of those who claim it does not.

and pretty sceptical of the claims made by the supplements industry (although some supplements are plainly a good idea, there's just too little evidence for most of them,

Are you equally skeptical of the claims made by the pharmaceutical industry?  Consider:

http://www.ncbi.nlm.nih.gov/pubmed/9555760?dopt=Abstract  A finding by the JAMA that properly-prescribed and -administered (i.e., not overdoses, not wrong) drugs are around the 5th leading cause of death in the US;

and that there has never been a truly blind test of any drug.  Anyone who gets the side effects knows they received the real thing, which is an opening for the placebo effect to kick in; in a truly blind test, the recipient would not be told what the drug is supposed to do at all.

I am equally sceptical of the motives of the pharmaceutical industry.  Their claims, however, are held up to a higher standard of evidence; they have to demonstrate that their products work in well-designed double-blind randomised controlled trials, or their products won't be licensed.  There are still issues, in this regard; there's continual examples of people trying to cheat the system, sometimes by engaging in one or another form of statistical skullduggery.  But a lot of said issues have been addressed, and being held to account to demonstrate efficacy is all you can do.

Also, have you ever heard of the "nocebo" effect?  (Give people sugar pills, and a certain proportion will still report side effects - to a certain extent, even when you tell them they're receiving a placebo).

far too many touted on the basis of reasoning like the "it's natural so it's good" fallacy or anecdote).

Quite so.  I like pointing out that arsenic is all-natural. . . .

And as far as I can find, "anecdote" is the only evidence for the effectiveness of vaccination.  I have seen no rigorous scientific test of the vaccination theory, and I have some theoretical grounds for doubting its efficacy -- as in, a disease agent naturally encounters multiple bodily systems:  skin, mouth, eyes, nasal & sinus linings, lungs, stomach & intestines; rarely does it go straight to the bloodstream, but vaccinations bypass all those other tissues, and it seems evolutionarily improbable that those normally-involved tissues don't have a role in creating immunity.

The crucial test required for any new vaccine is a randomised controlled trial, after the vaccine has been shown to be safe and to induce an effect that's likely to be immunising against the target pathogen in smaller trials.  .  When people get fancy, the trial may be cluster-randomised in such a way that you can see the herd immunity effects within an area as well as the individual effects.  If the people you've vaccinated don't get the disease, or get it much less often, you know it's worked for them and how well.  Furthermore, if you randomise 80% of the people in some randomly selected areas to be vaccinated and the other 20% are less likely to get the disease than people living in unvaccinated areas, you know there's a herd immunity effect.  Here's one recent individually randomised trial, and another recent cluster-randomised trial.

Are you equally skeptical of the claims made by the pharmaceutical industry?  Consider:

http://www.ncbi.nlm.nih.gov/pubmed/9555760?dopt=Abstract  A finding by the JAMA that properly-prescribed and -administered (i.e., not overdoses, not wrong) drugs are around the 5th leading cause of death in the US;

and that there has never been a truly blind test of any drug.  Anyone who gets the side effects knows they received the real thing, which is an opening for the placebo effect to kick in; in a truly blind test, the recipient would not be told what the drug is supposed to do at all.

I am equally sceptical of the motives of the pharmaceutical industry.  Their claims, however, are held up to a higher standard of evidence; they have to demonstrate that their products work in well-designed double-blind randomised controlled trials, or their products won't be licensed.  There are still issues, in this regard; there's continual examples of people trying to cheat the system, sometimes by engaging in one or another form of statistical skullduggery.  But a lot of said issues have been addressed, and being held to account to demonstrate efficacy is all you can do.

Also, have you ever heard of the "nocebo" effect?  (Give people sugar pills, and a certain proportion will still report side effects - to a certain extent, even when you tell them they're receiving a placebo).

Pharmaceutical testing costs way too much. And it's an excuse for pricing too high also.

I say, elminate the large testing done by pharmaceutical companies and have the FDA do those tests. Do them on random Medicaid patients. You don't have to tell the Medicaid patients that they're part of an experiment.

So when you join Medicaid you agree to take part in medical experiments, and from that you will sometimes get treatment which there is good reason to believe is better than the usual, but sometimes you will get standard treatment. You agree to some minor relaxation on medical privacy to make it easier to discover treatment effects. You perform a service to society by being on Medicaid.

And after a new drug has been tried on, say, 40,000 Medicaid patients and the results compared to other treatments, then it can be released for anybody. The results would be public and as more Medicaid patients are prescribed the drug the results would get routinely updated.

Results: Drug testing becomes considerably cheaper for pharma companies. WIth final testing out of their hands the incentive to cheat becomes much less, and the incentive to cheat at earlier stages is somewhat less -- what good is it to continue work on something that final tests will probably show is no improvement? Testing could be faster for effective drugs -- as early results come out positive the number of Medicaid patients getting it can be increased -- and slower for ineffective drugs. Testing can also be much more thorough, without increasing costs a whole lot. After all, those Medicaid patients would be getting some sort of treatment anyway, so the main increased cost comes from providing the new medication and tracking the results.

This is something that might be approved even by Congressmen who don't like Medicaid. Treating Medicaid patients as lab rats would be a step in the right direction, wouldn't it?

Just this.

About half a century ago Thalidamide, however you spell the damned thing, caused birth defects in Europe. So the US FDA over reacted, in my opinion, testing things to death. All well and good but how many people have died from delayed drugs since?

Seatbelt anecdote, My brother was trapped in a wrecked car with gasoline leaking and running over his body. So his next car was a diesel and even today, 30 years later, he refuses to wear a seatbelt. Personal choice, personal responsibility, personal safety.

Problem with your proposed random testing of medicaid patients. Firstly it'll already have to have undergone human trials before its close to ready for clinical testing. Prior to human trials there will have been animal testing and prior to that years of research.
Doesn't solve much and doesn't alleviate much of the cost.

I don't really want to really join in the piling on of people disagreeing with mellyrn on this - pharmaceutical testing is what pays my princely salary, so my views are probably suspect.

This, however, I felt unable to let pass:

Anyone who gets the side effects knows they received the real thing, which is an opening for the placebo effect to kick in

As it is utterly without basis in fact. "Side effects" (we call them Adverse Events, or AEs, in the trade) do occur in patients in the placebo arms of trials, often at a rate similar to that of the active treatments. So the assumption that "side effect" = "real thing" is simply incorrect.

@ J Thomas,

Costs are an issue, and yes, big clinical trials are a substantial chunk of the costs.  Your proposed solution, however, would be rejected on ethical grounds.  The principle of autonomy is one of the main ethical foundations of modern medicine; and to make access to medical care contingent on willingness to participate in clinical trials would violate the patient's autonomy.

A further practical objection would be that a voluntary trial participant is more likely to actually take the pills, to be easy to follow-up, and generally to cooperate with the trial than a coerced participant.

@Holt,

See above.