How Realistic is Super Aging? Research-Based Answers (Encore)

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Announcer (00:00)
The following is an encore presentation of Conversations on Health Care.

Mark Masselli (00:08):
Our guest is a widely published researcher whose latest findings are attracting attention. He says, new
evidence shows that humans are approaching a biologically-based limit to life. He'll explain why he calls
it a glass ceiling, and not a brick wall.
S. Jay Olshansky (00:23):
We have become so successful in extending life, in allowing people to live out past 60, 70, 80, even 90,
that the majority of the population is going to be exposed to the basic biological process of aging, which
is immutable currently. So if you expose enough people to this immutable force, the gain in life
expectancy must slow down.
Margaret Flinter (00:50):
Jay Olshansky is a professor of epidemiology and biostatistics at the University of Illinois, Chicago. We
are talking to him about his findings, and what they mean for the health care sector, for policymakers,
and for all of us in our personal lives.
S. Jay Olshansky (01:05):
I can tell you that in the world of aging science, there is a tendency to embellish and exaggerate the
effects of one treatment or another. Unfortunately, our field is filled with people that have been selling
longevity for thousands of years. I call anti-aging medicine the second-oldest profession.
Margaret Flinter (01:24):
This is Conversations on Health Care.
Mark Masselli (01:35):
Well, Dr. Olshansky, welcome to Conversations on Health Care.
S. Jay Olshansky (01:39):
Thanks for having me. Delighted to be here.
Mark Masselli (01:41):
Yeah. You conducted this analysis with researchers from the University of Hawaii, Harvard, and UCLA.
We know we've seen dramatic increases in life expectancy, or we think we have, over the 19th and 20th
century. This is a result of healthier diets, medical advances, many other quality of life improvements.
But you looked at life expectancy at birth in the world's longest-living populations since 1990. Maybe
you could share with our listeners, what did you conclude about this being a glass ceiling and not a brick
wall?

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S. Jay Olshansky (02:16):
So look, historically there have been two revolutions. The first revolution was basic public health in the
early part of the 20th century. It brought down early-age mortality. It saved children from dying from
infectious diseases. It was enormously successful. Women stopped dying as frequently as they had
throughout history from maternal mortality. So we witnessed about a 30-year increase in life
expectancy in the 20th century. It was an amazing public health revolution, nothing like we've ever seen
in human history.
(02:50):
There was a second revolution that happened in the latter part of the 20th century, as major chronic
fatal diseases, heart disease, cancer, stroke and so forth began to succumb to advances in medical
technology. We got very good at manufacturing survival time for people. These treatments, these
surgical procedures, these medicines are actually enormously successful at restoring health back to
where it is without these medications. In this latest paper, we took a look at the latest set of reductions
in life expectancy, and demonstrated that something that we predicted in 1990 was going to happen
actually happened.
(03:37):
What we said was, we have become so successful in extending life, in allowing people to live out past
60, 70, 80, even 90, that the majority of the population is going to be exposed to the basic biological
process of aging, which is immutable currently. So if you expose enough people to this immutable force,
the gain in life expectancy must slow down. This slowdown in the rate of improvement is not a
consequence of harmful behavioral risk factors. It's a consequence of success. Of living long enough to
experience something that is currently immutable, which is the aging process. So this is what we
expected about 30 years ago. It's exactly what happened.

Margaret Flinter (04:25):
Well, Jay, I want to sort of level set our conversation, which I think is such a fascinating one. One, I want
you to share with our listeners, what is life expectancy right now in the United States, and how does it
compare to others? But part B of that would be, almost everything that I've been reading has talked
about the deaths of despair, and how the deaths of despair is what is really driving this. I wonder, I know
this is going a couple of levels into this, but is that segregated by social factors and disparities factors,
and are you kind of separating those things out? So start that wherever you like. Thanks. I know it's a
few questions in one.

S. Jay Olshansky (05:08):
Lots of questions in there. So first of all, let me explain what life expectancy is, because I think a lot of
people don't really understand what it is. For a baby born today, how do you figure out how long that
baby's going to live? The way in which this is done is that we use something called a life table. It's
nothing more than an accumulation of all the death rates that exist today for people at all ages. We
assume those remain constant. Under those conditions, we can calculate how long an average baby
today would live. This is not the same as the prevalence of the older population, which will rise pretty
dramatically during the course of the 20th century, due to past trends in birth rates. So right now in the
United States, life expectancy is about 80. It's a little higher for women, a little lower for men.
(06:00):
Where are we relative to the rest of the world? I think we're maybe somewhere around 45. The vast
majority of other developed countries has a higher life expectancy. Now, don't get me wrong. They're

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pretty close to each other, but there are some life expectancies up in the mid-80s for females like in
Japan or Hong Kong, for example. The United States, we're several years behind. So it's a pretty big
difference between us, and virtually all of these countries are experiencing the slowdown that we talked
about in this latest manuscript. Now, you asked about diseases of despair, and there's no question this is
happening. If you go back to an article that my colleagues and I published in 2005 in the New England
Journal of Medicine, we basically said, "This will be the first generation of children to live a shorter
lifespan than their parents."
(07:03):
That was because of the latent effect of the obesity epidemic. Obesity really rose pretty dramatically in
the latter part of the last century and the first two decades of this century. It takes a while for the
negative health and longevity effects to express themselves. It began around 2010 or so here in the US,
and actually in other parts of the world. But there were other causes of death that were also rising as
well, and not just in the United States, but elsewhere. There's no question that there's two Americas. I
mean, this was actually the original title of one of the manuscripts that we worked on for the MacArthur
Foundation.
(07:46):
We were suggesting, there's this one subgroup of the population that's doing really well. They listen to
their doctor. They go to their doctor. They take their medications. They are wealthier, more highly
educated. They have access to health care. That population is indeed experiencing an improvement in
life expectancy that's not that far different from other developed nations. Then there's another part of
the country which is larger and growing more rapidly, which is experiencing these diseases of despair,
diseases associated with obesity, with drug use, the kinds of behavioral risk factors that shorten life. So
we think that that's one of the reasons why the improvement in life expectancy in the United States is
much slower than it is elsewhere in the world. I think I answered all of your questions.

Margaret Flinter (08:38):
Yeah. Yeah.

Mark Masselli (08:39):
Well, that's interesting. We serve, community health centers serve special populations all across the
country where race and economics have an enormous impact. You raised a number of things. I want to
get to them a little later. Certainly GLP-1 drugs, the impact that they have. But I do want for our
audience level set that your analyzed data was up to 2019. So that didn't include the recent COVID
deaths or the impact there. How do you factor in the country's rising suicide rate? Margaret talked a
little bit about that, but I'm really wondering what the impact of COVID is. Obviously, it's not just the
initial wave of COVID, but it's long COVID, and a virus that continues to mutate. We don't really know
where it will end up. We hope it's in our rearview mirror, but it doesn't seem to be going away.

S. Jay Olshansky (09:34):
So we stopped in 2019 for a reason. Had we gone to 2020, the negative effects of changes in behavioral
risk factors and various phenomenon that influenced longevity, it would've looked much worse. We
didn't want to have the influence of COVID influence the results of our analysis, so we stopped in 2019.
Now COVID, I'll be honest with you, I actually drafted a manuscript early on in the summer of 2020 on
COVID. We later discovered that we couldn't really trust the data from the CDC on what was a COVID

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death, what wasn't a COVID death. I'm not entirely trusting COVID mortality statistics, I'll be honest with
you. What I do trust is total mortality.

Mark Masselli (10:24):
Right.

S. Jay Olshansky (10:26):
So the one thing that is stable on a month-to-month basis in the US and other places is the number of
deaths that occur every month, and that pretty much stays level. We know there's some increase in the
winter months in the Northern Hemisphere. But we did experience excess mortality, I'm pretty sure in
excess of 20% in some time periods following the beginning of COVID. So it told you that the negative
effects of COVID were pretty dramatic. And it wasn't just deaths from COVID, it was deaths from the
collateral damage associated with closing down. There were lots of people who ordinarily would've gone
to their doctor to treat medical conditions that they had, that couldn't go to them. Myself, I had to have
my gallbladder removed in the summer of 2020. I had to wait, I think it was six to eight weeks, because
we couldn't get a bed.
(11:24):
Now that's a relatively mild problem, but imagine somebody being treated for cancer or identifying
cardiovascular disease. There were lots of other things going on. Now going forward, I'm going to use
the three word answer that I teach my students, which is the right answer to most things. Which is, I
don't know. We don't really know what the effects of COVID are going to be going forward. Now, rarely
do we have an exposure to an infectious disease that has a positive effect later on. I mean, I had shingles
about 10 years ago, actually. It's actually one of the reasons why I'm wearing these hearing aids,
because I lost hearing in my left ear, in part due to shingles. That was a result of an exposure to
chickenpox that happened when I was 10 years old.
(12:16):
We don't really know what the latent effect of an exposure to COVID is going to be. It could influence
the cognitive functioning of some people. It could influence lung function in others. We just don't know,
and it's going to take a while to figure out if there's any long-term effects of COVID exposure. Keep in
mind, we do have about three pandemics every century. So there will be at least two more in this
century. The good news is that we developed mRNA technology that allows us to deal with these
conditions much more effectively than we have in the past. So there are competing forces at work that
are going to influence COVID mortality going forward.

Margaret Flinter (13:06):
Well, you've been involved in this debate, and clearly one of the strong voices in it over life expectancy
for a long time. We understand you actually have a bet going with a biologist who once wrote that the
first 150-year-old person is probably alive right now. I think you said, "No way. That's not accurate." Tell
us the kind of pushback you received to your latest research, and what's the basis for your colleague's
argument that the first 150-year-old person is probably alive right now? What's the point of
disagreement here?

S. Jay Olshansky (13:38):
So the bet is basically simple. Will anyone alive in the year 2000 be alive in the year 2150? If the answer
is yes, then he wins the bet and actually gets about a billion dollars. If no one is alive in 2150 that was

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alive in the year 2000, then my ancestors will win. The premise of this was actually fairly
straightforward. This is a friend of mine, Steve Austad. Who actually both of us are very much in favor of
work that's going on in the world of geroscience today, this effort to slow the biological process of aging
so that we could extend the period of healthy life, and compress frailty and disability into a shorter time
later in life.
(14:23):
The premise is that some new medical breakthrough in geroscience that slows aging is going to come
online in enough time to influence enough people so that one of them makes it to 150. Now, just so that
people out there know, the world record for human longevity is 122, Jeanne Calment, a woman from
southern France who died in 1997. By the way, she smoked for 100 years. Now, this is not a license to
smoke, as I like to tell my students, because most people that smoke will die earlier than would
otherwise be the case. But it does tell you that smoking is not a risk factor for everyone, just like obesity
is not a risk factor for everyone. I think I got to most of your questions. Did I miss anything?

Margaret Flinter (15:08):
Nope. I think that's good. If I translate it, and Mark may be following up on this, is part of what you're
saying that we may not change overall life expectancy so much, but maybe we can compress the frailty,
diminished vitality years of the life expectancy that we have?

S. Jay Olshansky (15:26):
Yeah, so this is critical. Back in 2018, I published an article in the Journal of the American Medical
Association, where the editors asked me to communicate to physicians this whole concept of
geroscience and why it's relevant and important. I basically said, "Look, we have had enormous success
in extending life. We need to declare victory. We manufactured 30 years of life. We're still
manufacturing survival time." Most of us over the age of 60 are living on what I call manufactured time,
time that has been created for us by the worlds of public health and our physicians. I mean, look, I'm
alive today. I'm 70 years old. And my wife, by the way, also are both alive because of medical
interventions that happened earlier in life, not that long ago.
(16:21):
I would suggest that that's the case for many people over the age of 65. So we're patched together. We
go to our doctor, you fix us up, you patch us up. You push us out the door, repeat until failure. The
problem is that we face a phenomenon in epidemiology called competing risks. Which is another way of
saying, the older you get, the more diseases accumulate in older bodies. It's like a game of whack-a-
mole. If each mole represents a disease, the older you get, the more of them there are, and the faster
they come up. It's not a winning game, but we are playing it right now and we're playing it very
effectively. But we need to play it differently.
(17:04):
The reason is that, because we're being patched together by medicine these days living on
manufactured time, we run the risk of success that may lead to failure. In other words, we may live long
enough to get diseases that we don't want. It's possible that dementia, many forms of dementia
including Alzheimer's, could very well rise in the future as a result of reductions in death rates from
cardiovascular disease and cancer. Now, don't get me wrong. I'm not saying we shouldn't be going after
cardiovascular disease and cancer. It's just that the population level, we need to be cognizant of what
we're doing to ourselves.
(17:46):

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We've been very successful, but the price we have to pay is the rise of diseases and disorders associated
with aging. That's where we are today. That's why we're working so hard to try to change the game of
whack-a-mole. To push it out so that we don't even play the game until much later, and that we can
compress that period of frailty and disability into a shorter time. This work on geroscience that both
Steve Austad and I agree is going to happen is designed to extend healthy life. Lifespan extension may
result. We don't know by how much, but we're fairly certain that it will make us live healthier longer.
The translation is that it may take 70 years to become 60, or 80 years to become 70, but the whole idea
is to be healthier longer.

Mark Masselli (18:37):
So let me talk a little bit about geroscience and the investments that you'd like to see. But before we get
there, GLP drugs, GLP-1 drugs, and the impact that it has on your sort of model. Given that many people
who are listening to the show know somebody or themselves are now taking one of the various brand
names of the GLP drug. Having a profound impact. It also suggests that it may also have some collateral
positive news for us in terms of the health front. How do you factor those types in, and is that a game
changer than the sort of general medical interventions that have happened that make us better? Is it a
leap forward, versus a step forward?

S. Jay Olshansky (19:23):
So I like this question, and let me tell you why. In the world of geroscience, those of us that are trying to
find a way to slow aging, we're trying to get out of this one disease at a time model, where you have one
disease, you have one treatment. What we're talking about in geroscience is one treatment influences
multiple diseases simultaneously. It lowers the risk of all of them all at once. So is it possible that these
new drugs can do that? Maybe. The clinical trials are not in. There's a lot of work that has to be done to
make that determination. We don't know if people have to stay on these drugs the rest of their lives.
We don't know if there's any long-term effects. I don't know much about the side effects. The answer is
the same one that I gave you earlier, which is, I don't know, nor does anyone else.
(20:16):
There seems to be some positive signals indicating that it's lowering the prevalence of diabetes. Well,
obesity and obesity-related conditions like diabetes and cardiovascular disease and some forms of
cancer. So if it actually has a cascading positive effect on multiple disease endpoints, then it's a really
good example of geroscience, of exactly what it is that we're trying to accomplish. Now we would need
to document and demonstrate a compression of morbidity in older individuals taking these drugs, but
it's too early to tell. I mean, they've been on the market for a while. I'm pretty sure the safety protocol
has been established. So it's really efficacy. Does it really do what we think it does? It appears to have
some benefits, but it's too early to tell what the long-term implications are.
(21:11):
So there's no way we can include that in our models. That much I can tell you. It's very, very difficult. I
can tell you that in the world of aging science, there is a tendency to embellish and exaggerate the
effects of one treatment or another. Unfortunately, our field is filled with people that have been selling
longevity for thousands of years. I call anti-aging medicine the second oldest profession. People have
been selling it for a long time with every conceivable pill that you can imagine. We don't need to
exaggerate or embellish to justify why it is that we need to move in this direction of developing
gerotherapeutics that slow aging. We're in desperate need in long-lived populations of drugs or

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interventions or patches, so to speak, that can enable us to live healthier longer. In the end, that's all we
want. I had this-
Mark Masselli (22:10):
Let me get you in a little trouble. What shouldn't we be investing in? Because we've got a lot going into
NIH. Where is it that you'd sort of say, this has not produced the results it should have produced?
S. Jay Olshansky (22:24):
You mean which of the various gerotherapeutics?
Mark Masselli (22:27):
Well, no. I think just the general investments that go into health at NIH and the like. Because at some
point there's a pie. There's only so many slices in it. Geroscience you're suggesting needs more
resources. Is there something that you'd sort of say, "Hey. We've spent this money in this type of
research, and hasn't been productive"?
S. Jay Olshansky (22:52):
Well, so part of the conclusion of our latest manuscript is we will get diminishing returns-
Mark Masselli (23:00):
Right.
S. Jay Olshansky (23:01):
... from these investments. This cancer moonshot, look, when the moonshot idea was developed years
ago, I can tell you that this whole concept of geroscience was considered by President Obama as a
potential moonshot. They went after cancer instead, because the vice president's son had brain cancer.
But I think if you really want to go after cancer, the way you go after it most effectively is to go after
aging. That would be the same answer, by the way, for almost all of the things that go wrong with us,
since aging is the primary risk factor for most things that go wrong in older bodies. So yeah, in the end,
the answer to your question is interventions that modulate the biological process of aging is the way to
go in the future if you want to influence cancer, if you want to influence health and longevity.
(24:02):
It's both mind and body. Keep in mind, if we extend the length of our lives just by extending the
functioning of the body without influencing the aging of the brain, we may create a worse condition that
we don't want. Whenever you get this mismatch of mind and body at older ages, that's when you run
into problems. When you get a healthy mind and body that makes it out to older ages together, it's a
really wonderful thing to see. Numerous publications have come out documenting the economic value
of extending healthy life. I think some researchers from Harvard and the UK estimated about $38 trillion
in added value for one year of healthy life.
Mark Masselli (24:54):
So live long and prosper?
Margaret Flinter (24:58):

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Well live long and enjoy life. Along those lines, you pretty much can't pick up a medical publication or
the newspaper in this most recent month or two, maybe going back several months, about the potential
impact of alcohol, and unsafe at any level, like unsafe at any speed. It kind of ties to both things that
you're talking about, sort of aging, but also the impact potentially on cognition. That one sort of came a
little bit out of left field, in terms of decades of safe in moderation, to saying maybe dead wrong on that.
And that this might be a contributor certainly to morbidity, at least in terms of Alzheimer's, if not
mortality. Do you see any value to factoring in these kind of more recent studies that come out, or are
you really sticking with the longevity tables and using that as your guidepost?

S. Jay Olshansky (25:54):
Well, personally I stick with the longevity tables, but it's funny you should mention this. Because I was at
a conference in Australia two years ago, and I was asked this very question about alcohol, because this
issue of safe levels of alcohol came up. There were, I don't know, 5-600 people in the audience. Almost
everyone had a glass of wine in their hands. Somebody asked me this question, and I said, "Look, I'm
going to be honest with you. You may not like the answer, because you all have a glass of wine in your
hand, but there may not be any safe level of alcohol at all." It reminds me of the old discussion of
hormesis. You may remember this, right?
(26:34):
This was an argument made decades ago that a small amount of radiation was actually thought to be
helpful for you. It juiced up the immune system, so to speak. Until it was eventually discovered that,
yeah, no, sorry. There is no healthy amount of exposure to radiation. So this is a tough one to deal with,
because alcohol is so prevalent in our world and even in small quantities. I'll be honest with you. I don't
drink any alcohol at all, neither does my entire family. But this is a tough one, because alcohol is such a
part of our world, it's going to be hard to break that.

Mark Masselli (27:15):
I really want to go to sort of the economic impact of the work that you're doing. Because we've got a lot
of folks in the marketplace who are telling them that they'll live to 100 and beyond, right? The insurance
companies, the wealth management business. I'm wondering what the implications of your findings for
people who are told, for instance, that they're going to retire for over 30 years, and need to save for
that eventuality. Any thoughts on that?

S. Jay Olshansky (27:44):
Yes. We actually address-

Mark Masselli (27:46):
Their kids are going to invest, have a lot of money.

S. Jay Olshansky (27:50):
Well, so what's going to happen... The reason why this happened, by the way, is that shortly after our
science article came out in 1990 predicting this slowdown, others said, "No, no, no. It's going to
accelerate. Life expectancy will rise pretty dramatically. Half the babies born today will live to 100. Life
expectancy is going to go up to 100 by 2060." There were lots of companies, including insurance
companies and wealth management firms, that completely bought into this hook, line and sinker. So the
insurance companies underwrote business under the assumption that larger and larger segments of the

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population were going to make it to 100. We'll be lucky in the United States if 5% of the birth cohort
makes it to 100. So their entire book of lives in the insurance industry is, if indeed that's the assumption
that they made, may be in trouble.

Mark Masselli (28:46):
Let me get one last thing, of how you relate to the Blue Zone folks. Any relationship there, who are
looking at places around the globe where people are living longer lives?

S. Jay Olshansky (28:57):
Well, there have always been pockets of people that have lived long lives in different places. Blue Zones,
this has been suggested to be around for quite some time, and I know there's been some recent
research suggesting that people at extreme ages may be exaggerating or embellishing their ages. I
wouldn't be surprised by that at all, but it's completely immaterial to these issues of population level life
expectancy. By the way, if you're a wealth manager, it is profoundly bad advice to tell all of your clients
to plan to live to 100, because they're going to be spending a lot of time working when they could be
enjoying their retirement instead of planning for years that they're not likely to live.

Margaret Flinter (29:45):
I have to sort of bring it back to our work in community health centers, which has such a big focus on
trying to reduce or eliminate health disparities. Certainly quality of life is huge, the ability to not be
beset by some of the challenges and chronic illnesses that we see differences by race, ethnicity and
poverty. When you build those tables, it sounds like it's an all in for all the humans that we're looking at
in a country. But are you also separating out and looking for progress by different categories of people,
where we know that there are differences today in life expectancy by race, ethnicity or poverty?

S. Jay Olshansky (30:33):
Yeah, so we've done that already. We published on that years ago through the MacArthur Foundation
Research Network on an Aging Society, where we demonstrated that there are multiple subgroups
certainly within the United States, some of whom are doing very well and some of whom are not. And
the ones that are not doing well are growing faster than those that are doing well, which is one of the
reasons why our life expectancy is so low relative to other countries. I do have one related story. I'll be
real quick.
(31:02):
In Chicago, there's a famous street called the Midway Plaisance that runs right by the University of
Chicago, where I was a student and faculty member for years. On the right side where the university is,
life expectancy is way up in the 80s. On the left side where there's poverty, life expectancy is about 100
years behind. So you can have people living across the street from each other experiencing pretty
dramatic differences in longevity. This is a classic example of the influence of the social determinants of
health and life expectancy.

Mark Masselli (31:40):
Well, Dr. Jay Olshansky, thank you for this fascinating conversation. Thanks for all the great work. We
look forward to seeing, or somebody will see who wins that bet in 2050. Thanks, our audience, for being
here. Don't forget to subscribe to our videos on YouTube, and find us on Facebook and X with our
account name, CHC. As always, you can go to CHCradio.com to sign up for email updates. You can also

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share your thoughts and comments about this program. Thank you for joining us. Jay, thank you so
much. Great conversation.
Margaret Flinter (32:15):
This copyrighted program is produced by Conversations on Health Care, and cannot be reproduced or
retransmitted in whole or in part without the express written consent from Community Health Center,
Inc. The views expressed by guests are their own, and they do not necessarily reflect the opinion of
Conversations on Health Care or its affiliated entities.

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