The Longevity Revolution The Benefits and Challenges of Living a Long Life by Robert N. Butler, M.D.
Public Affairs, 608 pp., $30 If, for many in modern society, the fear of death may be considered to be among the most deep-seated and universal of emotions, fear of growing old may be catching right up to it. Few look forward to finding themselves weak or wrinkled, as happens to those who live long enough, and perhaps destitute and alone, as happens to many.
For some, growing old may seem almost as bad, or worse, than the alternative; but throughout the developed world, it's an increasingly likely possibility. Life expectancy in the United States increased more than 30 years between 1900 and 2000. Individuals of all ages must become accustomed to living in a world where an ever-expanding segment of the populace is of advanced age. Here, Dr. Robert Butler explores this demographic transformation and its effect on the economy, politics, medicine, and our way of life. There is hardly anyone more qualified to do so: Dr. Butler, a gerontologist and psychiatrist by training, is the founding director of the National Institute on Aging, part of the National Institutes of Health, and coined the term "ageism." His Pulitzer Prize-winning Why Survive? (1975) brought needed attention to the challenges then faced by older people.
With his additional 30 years' perspective, you might expect that Butler's first-hand experience of having himself aged, combined with his professional accomplishments, would yield some profound insights on a subject that has only grown in importance. Unfortunately for readers, he squanders his authority by lapsing into a recap of standard left-of-center talking points.
The demographic challenges described here--inadequacy of medical care, especially for the socio-economically disadvantaged; the difficulties faced by older people who want to work; the need for more research on age-related diseases such as Alzheimer's and other dementias--are real enough. But Butler's work is ultimately depressing not for its enumeration of the actual problems but for the impractical, not to say utopian, nature of his solutions. They almost invariably boil down to more money for government agencies, more bureaucrats, and lots more funding for well-intentioned international organizations. Reviewing his proposals is a bit like reading a travel brochure for a lovely destination one couldn't possibly afford: You are at once titillated by the possibilities, but grimly resigned to reality.
Prime example: Butler advocates a version of nationalized health care that would be accomplished by gradually reducing the qualifying age of Medicare (65) until it encompassed everybody. Never mind that Medicare is fraught with waste, fraud, and abuse. (Here in South Florida a married couple just pled guilty to submitting $420 million in false claims for medical equipment; they'll get time behind bars, but the vast majority of the money is unrecoverable and the damage done by this mom-and-pop operation is puny compared to the feats of more sophisticated swindlers.) Butler offers no tangible advice on how to clean up the existing mess of this entitlement before advocating a massive expansion. His views on Social Security are a bit more realistic, with an acknowledgment that generations who expect to live longer have no choice but to work longer and assume more personal responsibility for their health and finances. But once again, he lapses into his refrain about the superiority of government programs to privatization.
Butler is a leading expert on aging, so why is he writing about day care and deforestation? He glosses over euthanasia--a longevity and age discrimination issue if ever there was one!--and writes more about the greenhouse effect and the ozone layer. Moreover, according to Butler, "The economic foundation for the modern Western welfare state was laid, and it, in turn, contributed to longevity. It is sheer foolishness to imagine that we can extend life or sustain complex modern societies without substantial government participation."
But by interpreting the theme of longevity as anything tangentially having to do with being alive, as Butler apparently does, he strays into issues where the extent of his knowledge seems to be standard leftwing boilerplate. He lays out a neo-Malthusian worldview that advocates voluntary population reduction, and in some sort of exchange, longer life-years per person. He argues that such depopulation would bring about "a better balance between humanity and nature" and "make way for the new age wave and enhance the quality and length of life." It is more than a little troubling to imagine a perspective that favors the extension of life on the condition that there be fewer individuals around to enjoy it!
These shortcomings perform a serious disservice to the bulk of the book. Butler's unparalleled expertise yields some ingenious ideas and, occasionally, provocative solutions for dealing with the inexorable passage of time. The Longevity Revolution is at its best when it explores tough scientific questions dealing with the life span--whether humans have a built-in expiration date, and if so, how it can be surmounted--and his explanation of humanity's history, in terms of longevity, as well as his discussion of the potential for extending human life spans, are as compelling as any work of science fiction.
When Butler actually describes specific uses for funds--as opposed to simply advocating blank checks directed to the coffers of pet institutions--some proposals are worth contemplating. For example, he offers a thoughtful discussion of the need to support older persons in their quest to be productive members of society, whether for pay or as volunteers, and explicit policy shifts for the Food and Drug Administration--such as cracking down on unregulated "dietary supplements" and conducting additional post-marketing research on approved drugs--are eminently reasonable. Butler also takes on the obesity crisis--20 percent of health dollars now go to diabetes--and warns that, if current trends are not reversed, American life expectancy will actually decrease--and for the first time in American history, children may not live as long as their parents.
Alas, such gems are too often diluted in the text, or hiding among the proposals for handouts. (Did he really just suggest a tax on international plane fares to support the United Nations?) If only Butler had put aside his fantasies of importing the European welfare state--"at its finest, it has the taxing and spending power to look after the welfare of both the nation and its citizens"--and shared his expertise on what it means to grow old--physically, emotionally, and yes, economically--without reflexively promoting the creation of yet another federal agency, this could have been a fascinating book.
Lila de Tantillo is a writer in Florida.