THE MIXED BLESSINGS OF TURNING 83

I enjoyed turning 83 on July 15, 2014.  Nedra and I celebrated with a dinner out (including a margarita with two straws) and she baked my favorite cake – an almond cake with a crispy icing and studded with raspberries.  That takes the edge off the reality of old age with its multiple insults of a less effective body; a feeling of being marginalized by the rush of the present and the recession of the past into history; and a foreboding of a truncated future.  That marginalization came to me when I learned my Life Lines column would shift from every other week to once a month.  I can’t complain because I have done that column for 17 years (over 400 articles) and I am grateful it will continue in its monthly schedule.  But what it tells me is that nothing lasts. Culture constantly changes.  It would be delusional to think of writing a column in the style of Montaigne, or Francis Bacon, or Addison and Steele, or Thomas Paine or T H Huxley. A new generation seeks a new way of saying things as it proves with introducing jazz then swing, then rock and roll, then rap.  In my life time I wrote letters avidly in my youth, did not use a telephone until I was in my 30s, wrote my first books with a fountain pen, shifted to a typewriter, and did not use a computer until the late 1980s.  Now I look at the doings of my relatives, friends, and former students on Facebook.  I regularly use email. But I do not Text or Tweet and I have resisted getting a cell phone so I can enjoy privacy while walking or visiting. I have experienced at least four generations so I have seen lots of changes in culture.  The experience is like driving an old car.  It eventually becomes elevated in status as an antique car (especially if lovingly restored) instead of being seen as a tin lizzy.  

I enjoyed reading The 100 Year Old Man Who Crawled out the Window and Disappeared  by Jonas Jonasson.  It makes sport of history and politics and its hero, Alan Karlsson, is like Inspector Clouzot in the Pink Panther films. I wish aging were as  humorous or as free of decrepitude as the novel portrays it. But wouldn’t it be a dreary world to live without some illusions?

WHAT WILL LIFE BE LIKE FOR YOU IF YOU REACH 82?

 

Younger people do not think much beyond a few years ahead.  Yet we all see people who are much older when we are in the prime of our careers or lives.  I remember the first time I visited a nursing home for the elderly to visit one of Nedra’s relatives.  This was about 1970.  I was young (at least I think being 39 is young to me now).  The first response was the odor of urine that permeated the place.  The thought of incontinent old people horrified me and I can see why younger people blot out the thought of that future.  The second was the feeling of helplessness as I watched some people scooting about in wheel chairs, many leaning on canes, and lots walking corridors holding onto railing along the walls.  The thought crossed my mind that I would rather die a quick death from a heart attack than melt away cell by cell as I aged into oblivion. Today I am in the early phase of my 82^rd year.  I use a cane occasionally to avoid falling if the weather is bad or if it is dark or I feel I will tire from walking too much.  I take tai chi classes with Nedra so we can exercise our arthritic joints. My brain feels like it is 30 years old and I can do lots of mental skills.  I can do Sudukos (even the hard ones and sometimes I use a pen instead of a pencil).  I still write books and have had five books published in the past ten years, the latest this year (2013).  These are not vanity press books.  They are scholarly books that must pass critical review by internal and outside referees of the publisher. I also have at least five books I wrote during the same time that have not been published.  I am a realist.  If I don’t get a book published, I try writing another book.  To me that is easier than to market myself.  That’s the same attitude I have for Sudukos.  Solve it and get an endorphin rush.  Goof it up and abandon it by trying another.  If I run out of puzzles to do, then I will erase and try again (and often succeed). So far I have not tried that with my rejected manuscripts. But unlike puzzles, writing books and articles is more fun.  I learn something every time I do the research for a book.  I still have the curiosity of a child and want to learn something new every day I waken.  I understand why many elderly people are depressed.  They have lost the capacity to do the physical things they loved. They may never have had an opportunity to develop their mental skills.  If they do not have dementia, they will see their lives fading away and lack the knowledge of how to cultivate their skills. For me retirement was never going to be shuffleboard, playing cards, and watching vintage movies.  It is the last phase of my life cycle, and as a biologist, I want to extract every moment of creativity I can summon and savor what I have wrought.

ON TURNING 82

 

 

On July 15, 1931, I was born in Brooklyn, New York.  I am now 82 years old living in Bloomington, Indiana.  My life has taken me from New York City (22 years) to Bloomington, Indiana (5 years) to Kingston Ontario (2 years), to Los Angeles (8 years) , to Setauket, New York (42 years), and back to Bloomington (3 years so far). I have enjoyed a life as a scholar, a professor, a geneticist, a historian of science, and a writer.  I have enjoyed being the father of five children and seeing them launch their own careers and families.  I learned my own (and Helen’s) inadequacies in a first marriage that failed after four years.  I have enjoyed 54 years of a happy marriage with Nedra and we have never failed to encourage each other through our relatively rare moments of self-doubts. I was not fully on my own with a permanent job until I was 27 as a freshly minted PhD.  During those two years in Canada I learned how to publish my research, how to get grants to support it, and how to teach.  For the scholar the process of becoming independent takes time. At UCLA I became recognized as a geneticist, a scholar, and a teacher.  I enjoyed a busy laboratory with six students obtaining their PhDs.  It was also the 1960s, an era that was searing in its social turmoil on campuses.  It profoundly changed what I taught and shifted me away from the laboratory and into teaching non-science majors as my response to the needs of the 1960s.  It also shifted me to Stony Brook University where I could develop my Biology 101-102 course using a “humanities approach.”  When I turned 65 I did not feel old but I gave myself five years to explore what I wanted to do when I retired.  My Lifelines column was a result of that effort and I continue to enjoy bringing the life sciences to an adult public that prefers the “humanities approach” to what is called popularized science. I see the former as stimulating our world view and the latter as adding to our factual understanding.  Both are needed but I find the humanities approach relatively uncommon. 

I did not begin to feel old until I was in my mid seventies. Aging is like walking through a mine field and you never quite know what is ahead. I have been fortunate that no major surgeries have come my way and my mind is still alive, curious, eager to learn, and eager to share what I have learned.  I can’t count on that luck to accompany me for what my physician desires “of seeing you through to your 90th year and after that, we’ll see.” I have a modest arthritis compared to my father whose gnarled fingers and frozen joints still haunt my memory.  The greatest gift of retiring at 70 was the freedom it gave me to write as much as I wanted and at my own pace, subsidizing my own scholarship and not having to worry about earning a paycheck or honorarium. For this I give thanks to Andrew Carnegie who introduced the TIAA retirement program for professors.  Without his foresight I would have had to subtract five books from my publishing record, wondering when, if at all, I could find time to write them.    

Blog March 19 2011 Is there a social contract for our health?

We believe that a government is a social contract between those who are governed and those who govern us with our consent. It is the basis of our own American government which is part democracy and part republic with lots of checks and balances and a Constitution to prevent tyranny. It is an imperfect system but it works reasonably well and we voters have the power to throw out administrations that fail us and we can shift to a new direction. We reject anarchy or extreme libertarianism (a sort of “devil get the hindmost” social Darwinian system) in which the government plays such a minimal role that each person is at the mercy of the good will of the rest of humanity. Herbert Spencer preached that extreme libertarianism some 150 years ago in his book Social Statics and he believed that everything should be privatized, except for the military. We should pay for our police protection, fire protection, health, testing of safety, and education. He opposed public schools because they preached loyalty to the state and he felt the individual should always be an enemy of the state, criticizing it for its encroachments on individual freedom. He also opposed colonialism, the institution of a Royal family, and discrimination against women. He felt all education should be autodidactic with the library (private , of course) as the source of knowledge instead of the classroom.
Unfortunately people are complex and do not work as ideal components of utopian dreams. Those utopian schemes often end up in totalitarian thinking, with conformity rather than cantankerous diversity as the favored state of society. If we are to live in a “real world” we have to recognize the following. Humans are mortal. They are genetically diverse. They are raised in diverse households with diverse idiosyncratic parenting. They are grossly varied in opportunities and the circumstances of their birth. Some will have birth defects (about 3 to 5 percent). Some will have infectious diseases and they vary in their immune systems. Some will have physical impairments of their senses and require eyeglasses or hearing aids. Some will have organ failures. Some will have autoimmune diseases. Some will get cancers. It may not be possible to tell who will be at risk for such disorders. To address our health problems we either have to be lucky and our families have the wealth to pay for needed surgery or medication or we have to have an affordable health insurance that provides most of our basic health needs. If we are born poor then the costs of such health care are beyond what our incomes can provide. If we have a government universal health insurance then the costs are spread across all citizens just as we pay for our military through taxation.
I have yet to hear a proposal from critics of Medicare and Medicaid of a private health insurance program that can exist for the poor. I can only assume that premature death and illness of the less fortunate are tolerable for those who are fortunate enough to buy their own very effective private health insurance plans. That is not just selfish it is morally disturbing. What it tells me is that it all right to ignore the needs of others as long as you yourself are OK. Is this what our religions have taught us? Is this the message of the “good Samaritan?” Is this compatible with the “ Golden rule?”

What surprises me is how we respond with haste to new epidemics but ignore chronic and “familiar” diseases that saturate a good portion of humanity. Here is the reality for the coming decades. We will have more old people who will have lots of chronic illnesses. We have shifted away from employer provided health insurance to individual provided health insurance but for most Americans they cannot afford the costs of private insurance. Private insurance, like fee for service medicine, is wildly expensive and has far outpaced inflation. Most individuals have no factual basis for making informed decisions on what type of health care to buy or what to do if they are not covered. We need to rethink how to provide care with numerous “triage type” health centers instead of hospital emergency rooms so less expensive physician assistants and RNs can assess minor health emergencies (e.g., colds, upset stomachs, sprains, minor cuts) and distinguish those from patients with profound or more complex medical needs. We also have to think about what type of health care should be available to the very old, especially those requiring assisted living. For those who can trade in the equity of their homes for such care this is usually not a problem. For the working class who live in apartments or homes which have more modest equity, this is a very serious problem. For legislators I have a prediction for them to consider. In a few years the very old will be such a significant portion of the population that they will have the votes to favor their own interests.

Life Lines 73

WHAT DOES IT MEAN TO SAY THAT WE ARE MORTAL?

When we are very young we have limited experience of death, and for most children it hits home when a grandparent dies and they sudden realize they are mortal. For household pets like cats or dogs that recognition of death may never occur and in all likelihood they live their lives without a sense of being mortal. If small animals had a sense of mortality it would be very depressing. Imagine being a mouse and knowing that your mean life expectancy is two years. Of course, length of life is relative. We don’t feel like mice because Sequoia trees live, on average, two or three thousand years. Even a 250-year-old Galapagos tortoise does not shake our sense of fulfillment in a life expectancy of 80 to 90 years. Many insects live only a matter of days or weeks and it takes a stretch of our imaginations to imagine being fulfilled in such a short life cycle. As humans we can cope with our death by assuming (as most of humanity does) that there is a life after death either in the form of a resurrected body and mind or a disembodied mind existing out there (again, for most of humanity, in some sort of heaven or hell). There is an alternative way of looking at mortality and that is stoicism. That is a philosophy I learned about reading the Enchiridion aloud to a blind high school teacher who became, without my knowing it, a private tutor. I read classical literature and “great books” to him, an hour before classes began, for several years. The Enchiridion was written by Epictetus, a handicapped Roman slave, born with a deformed leg. He taught that our life could be shaped by those events we had little or no control over (our heredity, our status at birth, wars and other calamities, or even good fortune) and those that we did have control over (our moods, how we behave toward others, and the ideals we set for ourselves). I liked that attitude and it has served me well over some 60 years of life after learning it.

Biologically, death is essential for life to evolve or even continue. If we did not die the world would be unable to provide food, room, or even oxygen for us to exist unless we gave up our desire to reproduce. Death trims the population to a sustainable size. It also fosters variations to come into being that might otherwise be repressed. Younger generations of humans do things differently than their ancestors. Their values change, their knowledge changes, their priorities differ. Older people are stuck with their habits and traditions. They often stand in the way of a youthful generation that rejects the values of the old. This is why conservative thinking tends to go with older age. Ironically the radicalism of a youthful generation is often perceived as the conservative past for the next generation. But death does not visit the old alone. It also sifts through our genetic compositions and those with inefficient immune systems or those with genetic disorders or conditions that limit their survival may fall short of our species’ life expectancy. Biologically this may make sense, but emotionally it is difficult to accept the mortality of those we love, revere, or consider models for our lives. In a way it is good that most plants and animals are unaware of death. Nature plays out its vicissitudes, as lawyers liked to note in the wills they prepared for us, and harvests through death the failures who leave fewer offspring behind. Fortunately, for humanity, we have learned to extend our life expectancy and patch up our failing organ systems, but sooner or later death wins. The machinery of life sooner or later wears out. My stoicism, so far, keeps my ideals alive.

Life lines 17

BONES, FAT, AGING, AND VIBRATION

Dr. Clinton Rubin is the Chair of the Biomedical Engineering Department at Stony Brook University. His research is on the relation of stem cells to the formation of fat cells and bone cells and how these two types of cells respond to mechanical stimulation. For most people mechanical stimulation means exercise. And for most people exercise, unless they like it, means running, bending, squatting, pushing, or engaging in games that require such effort. For those who live a sedentary life and exercise is at best walking from a parking lot to a store, a consequence of the lack of mechanical stimulation is an increase in the size and number of fat cells and a decrease in the number and size of bone cells. That means as we age we get fatter and as we age we get more brittle bones that break when we fall. In fact, Rubin claims after age 35 we lose about 2 percent of our bone cells per decade (in my case an 8 percent loss of bone cells). About 35 percent of adults in the United States are obese. I guess I would belong to that category because when my wife looks at my buttoned shirt as I sit, she calls me Wimpy, Popeye’s friend (for those whose memories go back to Smilin’ Jack, think, too, of his sidekick, Fat Stuff).

A few years ago, a thought occurred to Dr. Rubin. If both fat cells and bone cells have a common cell origin from mesenchymal stem cells, would there be a similar response in these two cells to mechanical stimulation? Instead of exercise he tried something different. He used a very mild vibration (the sort of pleasant thrumming in a vibrator chair) and found that it isn’t how hard you exercise but how much total vibration you get that gives you a maximum effect of mechanical stimulation. This is a couch potato’s dream – press the vibrator, munch the chips, and watch football or other diversions and slim down. Before you fellow fatties get too carried away, Rubin suggests some common sense. It isn’t so much what you eat; it is how much you eat that counts for making the fat that goes into your fat cells. Few people stop at one pretzel or one fistful of potato chips. Few people push away the plate after a sliver of pie. Few people allow one glass of beer as the day’s limit.

The surprise to Dr. Rubin was the beneficial effect vibration had on bone. In mice he studied, it prevented loss of bone cells and that means it could reduce the risk of osteoporosis. The story, as usual in science, is more complex than our desire to make it simple. In a high fat (or high calorie) diet, mice suppress mesenchymal stem cell formation. This not only leads to obesity and bone loss, it also diminishes the immune system and it diminishes muscle cells. While “buzz your bones,” as Rubin calls it, in moderation is a good idea, excess buzzing is damaging. In moderation Rubin finds his buzzed mice (90 cycles per second) cannot feel the buzz but their fat diminished 25-30 percent compared to non-buzzed mice. Dr. Rubin’s work is on going and he intends to use human volunteers to test out his buzzing therapy as an approach to regulating fat, bone and muscle growth. Lots of problems remain. A tennis player’s racket arm has 30 percent more muscle than his or her throwing arm. This implies that vibration in one part of the body may not do the job for the rest of the body.

Life Lines 15

AGING IS A MATTER OF HOW MANY MITOCHONDRIA YOU HAVE LEFT

Way back in high school you learned that the mitochondrion was “the powerhouse of the cell.” If you took a college biology course as an undergraduate you probably learned that the mitochondria in your cells are bacteria-like in size and have their own DNA and that their major function was to take small carbon-bearing molecules from your digested foods and burn them with the oxygen you breathe to produce chemically stored molecules, chiefly ATP. The mitochondria power the metabolic activities of the cell, tearing molecules apart and synthesizing more complex molecules from simpler ones. Each of your cells has about 1000 mitochondria and each mitochondrion has several dozen copies of its small circular DNA. There are about 60 genes in a mitochondrial chromosome. Most of those genes are involved in production of chemical energy and thus the “powerhouse” reputation that you may remember. If you multiply the number of your cells by the number of mitochondria per cell you get a staggering 100 quadrillion of them in your body (that’s a one followed by 17 zeroes). When they act collectively making ATP they produce heat. The warmth of your body reflects the activity of your mitochondria. That’s why you get hotter in the summer when you exercise and why you shiver and jump around in the cold to warm your body.

Unlike the genes in the nuclei of your cells that produce 99.99 percent of your body, the mitochondrial genes only function is this one essential function of producing the bulk of the energy you need to stay alive. They do so at a price. They lack repair enzymes so mutations accumulate faster in mitochondria than in your nuclear chromosomes. When you are young this is less of a problem because your cells are still dividing but when you are an adult most of your cells slow down and rarely divide. So the mutations accumulate and your cells do not replace worn out mitochondria. The business of making energy by burning small carbon-bearing molecules with oxygen also produces a lot of chemicals that damage DNA. Your mitochondria make hydrogen peroxide. Have you ever seen it bubble when you daub it on a sore? These reactive oxygens readily damage DNA. So here’s the problem. You begin to lose mitochondria as your cells age. That means less energy per cell. When the energy is too low the cell dies. So if I look at the 76 year old skin on the back of my hands I see wrinkles, as you do if you are also old like me, but because I am a biologist, I also see in my mind’s eye, the cells that have winked out on me like so many dead light bulbs over the years and those cells have not been replaced (because I am no longer a child or teenager). The dead cells in the lower layers of my skin reduce the mass of my hands and the covering skin wrinkles as it collapses into those numerous cavities. So now you know why you wrinkle when you get old. Dead mitochondria lead to dead cells that lead to wrinkles. But, alas, there is more. Because we get old eventually, our mitochondria are fewer in number per cell and thus we produce less heat for our body. So now you know why your grandparents need a warmer temperature in their apartments or homes and why they heap blankets on themselves or wear clothes around the house that younger people would take off or feel stifled. I think of my interview with Sir Julian Huxley in his home in London, and he sat with gloves on (the fingers cut off) and a shawl around his shoulders and a small blanket over his lap. His mitochondria were fading in his memory too and his wife had to keep correcting him. Those who long for extending their lives have a tough job when they begin to shift their attention from our nuclear genes and chromosomal telomeres and start looking at our disappearing