Humanity Getting Better, Faster

"Superconvergence

By Jamie Metzl

Timber, 432 pages, $34

It is said that triumphant Roman generals, to ensure that the rapture of victory didn't go to their heads, would require a companion to whisper in their ear: "Remember, you are only a man." Jamie Metzl worries that we may have learned all too well such lessons in humility. Given remarkable recent advances in technology -- and the promise of more to come -- we need to lean into our emerging godlike powers, he believes, and embrace the opportunity to shape the world into a better place. In "Superconvergence," he sets out to show us how, after first helping us overcome our hesitations.

"Our world today is more livable for more of us than at any point in human history," Mr. Metzl asserts. In the words of a 2013 Oxford report that he cites: "Now is the best time in history to be alive." What's more, humanity is just getting going. Revolutions in genetics, biotechnology and artificial intelligence are amplifying one another -- and converging. Some may worry about the dangers of interfering with nature, but Mr. Metzl, a former White House fellow and science autodidact, thinks that such worry is misplaced. We've been "meddling with living systems over tens of thousands of years," he writes, and the effort has worked out pretty well for our species. Now he foresees exponential progress. It is possible, he says, to imagine scientists "unleashing the miracle of human innovation on a planetary level," giving us the capacity to "redirect evolution and recast life in all its dimensions."

Propelling Mr. Metzl's breathless narrative is the conviction (shared by many "exponential" thinkers in Silicon Valley) that we're not just getting better but getting better faster, in part because of global interconnectivity. The people of Mesopotamia learned how to smelt copper 7,000 years ago, Mr. Metzl observes, but it took another 4,000 years before the process was independently discovered in the Americas. Today word of discoveries spreads almost instantaneously, and we benefit from a far greater body of accrued knowledge than our forebears did. The current pace of change will itself be superseded, he says, as "more connected and better-educated people apply ever-more powerful tools to do ever-more radical things."

Mr. Metzl is especially taken by the prospects of biology, which he sees as the breakout science of the 21st century -- what chemistry was to the 19th and physics to the 20th. Bioengineering, in the near future, may make plants more environmentally friendly by, for example, restructuring their metabolism to absorb more carbon dioxide. And genetics may reduce the environmental impact of animal husbandry. Already there are attempts to create "Enviropigs" -- swine that can synthesize a critical digestive enzyme so that it doesn't have to be put into their feed, from which it now leads to harmful runoff.

But the big advances will be in medicine -- and indeed are already in evidence. Mr. Metzl points to the blisteringly fast development of the Covid-19 mRNA vaccine, from digital file to widespread immunization in less than a year; and to gene-editing technologies like Crispr. He cites the experience of Victoria Gray, a young woman from Mississippi who was suffering from sickle-cell disease until, in 2019, researchers in Nashville, Tenn., reinfused her with her own cells, which had been Crispr-edited; the treatment worked, liberating her from the disease's tormenting pain and crippling fatigue. For Mr. Metzl, these are just the first intimations of a revolution to come. AI tools like DeepMind's Alphafold, he says, will help scientists design therapies faster and better.

To get smarter about human health, though, AI will need more information, and here Mr. Metzl's ebullience edges toward the willful suspension of disbelief. His imagined future of healthcare will require "collecting huge amounts of genetic and systems biology data in massive and searchable databases." The details will include not only medical records and the results of laboratory tests but data from the sensors he anticipates will be everywhere -- "bathrooms, bedrooms, and offices" -- as information is hoovered up from "toilets, mirrors, computers, phones and other devices without the people even noticing." While acknowledging that such a scenario sounds like "an authoritarian's dream and a free person's nightmare," he suggests that the chance to catch disease early may offset the risks. This trade-off promises to be a tough sell.

More than many techno-optimists, Mr. Metzl seems to grasp the intricacy of biological systems; he notes that they are beyond our full understanding right now. Even so, a time will come when "the sophistication of our tools and understanding meets and then exceeds the complexity of biology." He is also keenly aware that technology can go wrong. An early advocate of the Covid-19 lab-leak theory (the idea that the virus escaped from a research facility in Wuhan, China), he is sharply critical of China for its initial coverup. He concedes that even in the most reliable hands, godlike technologies can be "extremely dangerous."

To ward off the most dire possibilities, Mr. Metzl offers a series of recommendations. These include initiating forums to catalyze "meaningful, multidirectional public engagement." He envisions coordinators in every country serving a new international body -- under the auspices of the United Nations -- focusing on a "common response to shared existential challenges." "Imagine," he writes, ". . . if we'd had an international health organization . . . with the power to overrule the Chinese government's cover-up." He may have to keep imagining.

Beneath the gauzy futurism and anodyne policy proposals, Mr. Metzl has identified an important truth: that the convergence of new technologies is galvanizing us to reimagine how to meet urgent challenges in medicine and the environment. It's a compelling opportunity -- provided we manage to sidestep self-induced catastrophes along the way.

---

Dr. Shaywitz is a physician-scientist and board adviser, a lecturer at Harvard Medical School and an adjunct fellow at the American Enterprise Institute." [1]

1. Getting Better, Faster. Shaywitz, David A.  Wall Street Journal, Eastern edition; New York, N.Y.. 11 July 2024: A.13.

Kaip atrodo normalus senėjimas?

 „Šis klausimas buvo karšto nacionalinio pokalbio centre nuo praėjusį mėnesį vykusių debatų dėl prezidento posto, kai 81 metų Joe Bideno kovos su 78 metų Donaldu Trumpu sukėlė plačiai paplitusias spėliones apie prezidento nuosmukį.

 

 Abu vyrai, kurie, jei būtų išrinkti, būtų vyriausias kada nors prisaikdintas JAV prezidento asmuo, viešai paskleidė faktus ar klaidingas pastabas, pakurstydami abiejų pusių atakas dėl jų tinkamumo. Bidenas ir Trumpas teigia, kad jų sveikata yra tvirta.

 

 Stebėti, kaip vyresnio amžiaus suaugusieji rodo senėjimo požymius, daugeliui šeimų yra per daug pažįstama, kaip ir klausimai apie tai, ką reiškia sulėtėjusi eisena ar sutrikusi kalba ir ar senstantis žmogus vis dar gali, tarkime, vairuoti automobilį ar gyventi savarankiškai. Kartais senėjimas yra nuolatinis sugebėjimų mažėjimas; kitais atvejais tai gali įvykti greičiau.

 

 Kadangi vyresnio amžiaus žmonės sudaro vis didesnę JAV gyventojų dalį, didėja susidomėjimas atpažinti sveiko ar nenormalaus su amžiumi susijusio nuosmukio požymius. 65 metų ir vyresnių suaugusiųjų skaičius nuo 2020 iki 2023 m. išaugo 9,4 proc., iki beveik 60 mln.

 

 Senstant didėja rizika susirgti ligomis, kurios gali trukdyti fizinei ir psichinei sveikatai. Dauguma vyresnio amžiaus žmonių turi bent vieną lėtinę sveikatos ligą, o daugelis turi keletą. Gerontologai ir geriatrai teigia, kad senėjimo požymiai kiekvienam gali pasirodyti skirtingai, todėl gali būti sunku nustatyti, kas yra normalu.

 

 "Žmonės skiriasi. Kai kurie žmonės šiose srityse atsisako šiek tiek daugiau, šiek tiek greičiau. Kai kurie žmonės tai išlaiko ir niekada nenusileidžia", - sako dr. Mary Tinetti, geriatrė ir Jeilio medicinos mokyklos medicinos profesorė.

 

 Smegenys ir atmintis

 

 Kolumbijos universiteto sveikatos politikos ir senėjimo profesorius daktaras Johnas Rowe'as teigia, kad yra skirtumas tarp įprasto psichikos nuosmukio, kurį lydi senėjimas, ir lengvo pažinimo sutrikimo, kuris gali išsivystyti į demenciją.

 

 Alzheimerio asociacijos duomenimis, lengvas pažinimo sutrikimas paveikia maždaug 12–18% 60 metų ir vyresnių žmonių.

 

 Senėjimo specialistai teigia, kad dėl trumpalaikės atminties trūkumo, pavyzdžiui, pametami raktai ar dažnesnis žmonių vardų pamiršimas, apskritai nėra ko jaudintis.

 

 Atminties sutrikimai, turintys įtakos kasdieniam gyvenimui, pavyzdžiui, pamiršus apmokėti sąskaitas, praleisti susitikimus ar pasiklysti pažįstamose vietose, gali reikšti kažką rimtesnio.

 

 Kognityvinės funkcijos pokyčiai paprastai vyksta per mėnesius ar metus, sako Rowe. Staigų sumažėjimą per kelias savaites gali sukelti liga, vaistų sąveika ar smegenų sužalojimas.

 

 Dezorientacija, socialinio įsitraukimo stoka ir apatija gali būti ankstyvieji demencijos požymiai, sako daktaras Davidas Reubenas, vadovaujantis Kalifornijos universiteto Los Andželo Alzheimerio ir demencijos priežiūros programai ir geriatrijos skyriui.

 

 Norėdami diagnozuoti pažinimo sutrikimus, gydytojai naudoja naujausios ir ilgalaikės atminties, prisiminimo, regėjimo ir erdvės trūkumų bei vykdomosios veiklos vertinimus. Reguliarūs tyrimai leidžia gydytojams stebėti tendencijas, laikui bėgant, o tai yra galingiau, nei žiūrėti į bet kurį vieną duomenų tašką, sako geriatrai.

 

 „Labai viliojanti galimybė žmones vertinti pagal jų fizinį silpnumą ar pažintinius gebėjimus remiantis žvilgsniais“, – sako Reubenas. "Tačiau vertinimas reikalauja daugiau, nei tai."

 

 Gydytojai pažymi, kad tai ne viskas žemyn. Senėjimas gali turėti naudos, pavyzdžiui, geresnių problemų sprendimo, empatijos ir žodyno įgūdžių.

 

 Fizinė jėga

 

 Su amžiumi žmonės linkę prarasti jėgą, ištvermę, lankstumą ir organų funkcijas. Šie pokyčiai dažnai paveikia pusiausvyrą ir eiseną, todėl gali padidėti pavojingų kritimų rizika. Rūkymas, nutukimas ir diabetas padidina tam tikrų su amžiumi susijusių problemų atsiradimo riziką.

 

 Geriatrai teigia, kad reguliarūs suklupimai, sunkumai išlipant iš kėdžių arba sustingus judesiai su ribotu rankų siūbavimu einant gali reikšti pagrindinę ligą, pvz., artritą ar neurologines ligas, tokias kaip Parkinsono liga.

 

 Silpnumas, su amžiumi susijęs sindromas, kuriam būdingi tokie simptomai kaip silpnumas, bloga pusiausvyra ir netyčinis svorio kritimas, pasireiškia nuo 5 % iki 17 % vyresnio amžiaus žmonių. Asmenims, turintiems silpnumą, kurį galima diagnozuoti, naudojant specialias vertinimo priemones, gresia didesnė kritimo, negalios ir mirties rizika.

 

 Kita vertus, fiziniai pokyčiai, tokie, kaip lėtesnis vaikščiojimas, susilpnėjusi klausa ir poreikis dažniau šlapintis, paprastai yra standartinio su amžiumi susijusio nuosmukio požymiai ir nekelia nerimo, sako gydytojai.

 

 „Jei jūs ne taip gerai žaidžiate tenisą, kaip pernai, tikriausiai, to pervertinti nereikia“, – sako Reubenas.

 

 Geros dienos ir blogos dienos

 

 Bet kokio amžiaus žmonėms pasitaiko dienų, kai jie nesijaučia geriausiai. „Gerų“ ir „blogų“ dienų kintamumas greičiausiai bus ryškesnis tarp vyresnio amžiaus žmonių, teigia geriatrai.

 

 Kūno ir smegenų atsparumas arba rezervas mažėja žmonėms senstant, todėl prastas miegas, lengvas liga ar vaistų keitimas gali priversti nukentėti sunkiau. Pavyzdžiui, koledžo amžiaus studentas gali būti ne itin sutrikdytas, visą naktį studijuojant.

 

 „Tačiau jei esate vyresnio amžiaus suaugęs žmogus, turintis šiek tiek mažiau atsargų, o naktis buvo sunki, vartojate vaistus, kurių nesate susipažinę, arba sergate virusine infekcija, kognityvinės ir fizinės problemos aštrėja“, – sako daktaras Richardas Stefanacci, Filadelfijos Džefersono gyventojų sveikatos koledžo docentas [1].

 

1. An Age-Old Question: What Constitutes Normal Aging? --- Short-term memory loss is often not a worry; getting lost in familiar places could be more serious. Janin, Alex.  Wall Street Journal, Eastern edition; New York, N.Y.. 11 July 2024: A.10.

What Constitutes Normal Aging?

"What does normal aging look like?

That question has been at the center of a fervid national conversation since last month's presidential debate, when 81-year-old Joe Biden's struggles against Donald Trump, 78, set off widespread speculation about the president's seeming decline.

Both men, who if elected would each be the oldest person ever sworn-in as U.S. president, have slipped up facts or botched remarks in public, fueling attacks about their fitness from both sides. Biden and Trump both maintain they are in robust health.

Watching an older adult display signs of aging is all too familiar within many families, as are questions about what a slowed gait or confused speech signals, and whether an aging person can still, say, drive a car or live independently. Sometimes, aging is a steady decline; other times, it can appear to happen more rapidly.

As older adults make up a growing share of the U.S. population, there is heightened interest in recognizing signs of healthy or abnormal age-related decline. The number of adults age 65 and older increased by 9.4% between 2020 and 2023, to nearly 60 million.

Aging carries an increased risk of developing conditions that can interfere with physical and mental health. Most older people have at least one chronic health condition, and many have multiple. Signs of aging can appear differently for everyone, gerontologists and geriatricians say, so it can be hard to determine what is normal.

"People vary. Some people decline a little bit more in these areas, a little quicker. Some people maintain it and never decline," says Dr. Mary Tinetti, a geriatrician and professor of medicine at the Yale School of Medicine.

The brain and memory

There's a distinction between the usual mental decline that accompanies aging and mild cognitive impairment, which can progress to dementia, says Dr. John Rowe, a professor of health policy and aging at Columbia University.

Mild cognitive impairment affects roughly 12% to 18% of people age 60 and older, according to the Alzheimer's Association.

Short-term memory deficits, such as misplacing keys or forgetting people's names more often, is generally nothing to worry about, aging specialists say. 

Memory lapses that affect daily life, like forgetting to pay the bills, missing appointments or getting lost in familiar places could signal something more serious.

Changes in cognitive function tend to happen over months or years, says Rowe. Sudden decline, over a period of weeks, could be caused by illness, medication interactions, or a brain injury.

Disorientation, lack of social engagement and apathy can be early signs of dementia, says Dr. David Reuben, who directs the University of California, Los Angeles Alzheimer's and Dementia Care Program and geriatrics division.

Doctors use assessments of recent and long-term memory, recall, visual and spatial deficits and executive functioning to diagnose cognitive impairment. Regular testing allows doctors to track trends over time, which is more powerful than looking at any one data point, geriatricians say.

"It's very tempting to judge people in terms of their physical frailty or cognitive capabilities based on glimpses," says Reuben. "But an evaluation takes more than that."

Doctors note it's not all downhill. Aging can come with benefits, such as improved problem-solving, empathy and vocabulary skills.

Physical strength

People tend to lose strength, endurance, flexibility and organ function as they age. Balance and gait are often affected by these changes, which can increase the risk of dangerous falls. Smoking, obesity and diabetes raise the risk of earlier onset of certain age-related problems.

Regular stumbles, trouble getting out of chairs, or stiff movement with limited arm swinging while walking could signal an underlying condition, such as arthritis or neurological conditions like Parkinson's, geriatricians say.

Frailty, an age-related syndrome characterized by symptoms such as weakness, poor balance and unintentional weight loss, affects between 5% and 17% of older adults. Those with frailty, which can be diagnosed with the help of specific assessment tools, are at higher risk of falls, disability and death.

On the other hand, physical changes like walking more slowly, diminished hearing and needing to urinate more frequently are generally signs of standard age-related decline and not cause for worry, doctors say.

"If you're not as good at pickleball as you were last year, that probably doesn't need an evaluation," says Reuben.

Good days and bad days

People at any age have days when they don't feel their best or sharpest. The variability of "good" and "bad" days is likely to be more pronounced among older people, geriatricians say.

The body and brain's resilience, or reserve, declines as people age, so a poor night of sleep, mild illness or medication change can hit harder. A college-aged student might not be thrown off much by an all-nighter of studying, for example.

"But if you're an older adult with a little bit less reserve and you've had a tough night, you're on a medication that you're not familiar with, or you've got a viral infection, you could have cognitive and physical issues as a result," says Dr. Richard Stefanacci, a geriatrician and adjunct assistant professor at Jefferson College of Population Health in Philadelphia." [1]

1. An Age-Old Question: What Constitutes Normal Aging? --- Short-term memory loss is often not a worry; getting lost in familiar places could be more serious. Janin, Alex.  Wall Street Journal, Eastern edition; New York, N.Y.. 11 July 2024: A.10.