Saturday, January 29, 2022

I want to live forever - or do I?

Do you remember resveratrol? This was the “magic” antioxidant that supposedly made red wine so healthy, and on which pharmaceutical companies spent a fortune. I always believed that the reason the French smoked more and yet had fewer heart attacks than Americans had little to do with red wine and more to do with their relaxed lifestyle: 2-hour lunch breaks at home with family and the month of August off. In any case, Glaxo Smith Kline spent $720 million on a start-up that was working on a resveratrol-like compound only to shut it down for failure to produce useful results in increasing health and longevity.

Two products that are currently being studied as anti-aging compounds are an old drug used to treat diabetes, metformin, and a newer agent, rapamycin, that is used to prevent transplanted organs being rejected. Both have shown promise in increasing longevity in animal studies.

The average human lifespan has certainly increased dramatically over the past few centuries. World-wide, human life expectancy at birth has risen from about 30 years in the mid-19th century to 73 years in 2020. The reasons for this are the dramatic reduction in infectious disease deaths through immunization and, to a lesser degree, antibiotics, safer food and water, safer work environments and better maternal care. These mean fewer people die young.

What has not changed much is the maximum human lifespan. The oldest old live to be 110 to 120 years, and this has not changed, though we are certainly seeing more centenarians. Most species have an upper limit to their lifespan in the absence of disease or trauma, and for humans, this would appear to be about 120 years.

One impediment to “anti-aging” drug development is that the FDA does not recognize “aging” as a disease to be treated and would thus probably not approve a drug targeted at extending lifespan rather than treating a specific disease. Another is the very high safety threshold such a drug would face if it were to be targeted at everyone.

The other big question is whether many of us would want to live longer if this meant living with a growing array of medical problems and frailties. The ideal drug would not necessarily make us all live to 120 but would let us get into our 80’s, 90’s and beyond with intact joints, brain, and muscle.

Both metformin and low-dose rapamycin are currently in human trials, and other products are in animal studies. No promises, but stay tuned.

Prescription for Bankruptcy. Buy the book on Amazon

Friday, January 7, 2022

Quo vadis, Omicron?

What a difference a day makes. In my December 1 post, I said “While there have been no cases identified yet in the U.S., I would be shocked if there are not already a handful here.” Of course, now 5 weeks later, a local testing center said that 93% of Covid isolates in Massachusetts were Omicron.

Much of the early information about this variant has proved true. The Omicron variant is dramatically more easily transmitted than earlier variants; no disease but measles seems to spread as easily. Fortunately, it also remains true that Omicron is much less lethal than earlier variants. While the daily case counts in the state have increased 20-fold – from 1200 positive samples/day over last summer to 25,000/day this week, hospitalizations have “only” gone up five-fold – from 500 at the summer low to the current 2500 and daily Covid-related deaths have increased 4-fold, from 10/day to 40.

The fact that it is less deadly does not mean it is harmless. A virus that spreads 10 times as easily but kills half as many of those infects will kill 5 times as many people!

The good news for those who have followed the science is that the current serious cases are almost all among the unvaccinated. Hospitalization due to Omicron is 9-10 times greater among the unvaccinated than those who have had the full series (including booster).

A recent study found that prior Covid infection gave good SHORT-TERM (3-4 month) protection against the original virus and the Delta variant, but much less protection against Omicron.

There is also the very real concern that as hospitals are over-run with Covid cases, other treatments, including elective surgeries, have had to be delayed.

What should you be doing? If you are fully vaccinated, I would go about my life using just simple common-sense precautions. Avoid crowded venues when you cannot be sure that other people there are vaccinated and wearing masks. At theatres with good protocols for enforcing mask use and checking vaccination status, I am comfortable attending performances. Wear a mask when you are inside stores, museums, etc. Do what you enjoy outside. Gather with friends and family if you know all are vaccinated.

Nothing is risk-free. Getting in a car involves risk. Without being cavalier, I think those of us who are vaccinated and careful can enjoy getting back to living.

If you have been delaying, PLEASE get vaccinated.

Prescription for Bankruptcy. Buy the book on Amazon