Cover of Being Mortal by Atul Gawande - Business and Economics Book

From "Being Mortal"

Author: Atul Gawande
Publisher: Profile Books
Year: 2014
Category: Science

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Chapter 2: Things Fall Apart
Key Insight 3 from this chapter

Debating the Causes and Influences on Aging

Key Insight

The fundamental reasons for aging remain a subject of intense debate, oscillating between two main perspectives. The classical view posits that aging is a result of random wear and tear on the body's systems over time. In contrast, a newer theory suggests aging is a more orderly, genetically programmed process, similar to the predetermined life cycles observed in some plants, like bamboo that grows for a century, flowers, and then dies. Support for this programmed view comes from research on organisms like the C. elegans worm, where altering a single gene has successfully doubled lifespan and slowed aging, with similar genetic manipulations extending lives in fruit flies, mice, and yeast.

Despite findings supporting genetic influence, the majority of evidence contradicts the idea of a strictly programmed human lifespan. For the vast majority of human existence, spanning hundreds of thousands of years until the last couple of centuries, the average human lifespan was thirty years or less; for instance, Roman Empire subjects had an average life expectancy of twenty-eight years. Dying before reaching old age was the natural course, with death historically having no obvious connection to aging itself. Thus, modern average lifespans, now climbing past eighty years in much of the world, represent an 'unnatural process' rather than an inherent biological program.

Inheritance, surprisingly, plays a minimal role in human longevity, explaining only 3% of an individual's lifespan compared to the average, far less than its 90% influence on height. Even genetically identical twins often exhibit lifespan differences exceeding fifteen years. This limited genetic determinism reinforces the classical wear-and-tear model, reinterpreted through the lens of complex systems. Human bodies are akin to robust, complex machines like power plants, designed with multiple layers of redundancy – such as extra organs, DNA repair systems, and backup gene copies – to function despite accumulating damage. This redundancy allows the system to continue until an accumulation of defects reaches a critical point, leading to 'frailty' and ultimate system failure, a gradual and unrelenting process observed in specific cellular breakdowns like hair graying due to depleted pigment stem cells, or age spots from lipofuscin accumulation, and eye lens changes. Felix Silverstone, a geriatrician, affirmed there is 'no single, common cellular mechanism to the aging process,' concluding that 'we just fall apart.'

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