Aging may be due to an accumulation of error of mistakes in DNA with each generation or with each cell division of cells. DNA replicates itself. It makes an identical image of itself that is transmitted to the next generation of cells it reproduces itself. And that's what's responsible for reproduction of cells and for living things. It's very efficient. Every time that there is a new generation of cells the DNA makes an identical image of itself, which is transmitted to the Next Generation. However, there are occasionally errors in the reproduction or in the replication and organelle postulated that aging may be due to an accumulation of the era from one generation of cells to the next in other words. If there was a 1% error in the reproduction of DNA with each generation of cells, the arrow would be cumulative so that by ten generations of cells by the 10th Generation you might have almost 10% error in the DNA because the arrow would be transmitted to each generation of cells and that that 10% error might be enough to interfere with further reproduction of cells. And thereby not allow continued life or living of the organism where the cells resided. The era theory is a very attractive one because there has been experimental evidence found out error in the DNA certain chemical and physical tests have shown that some of the molecules of DNA do reproducing era from time to time. They make mistakes and don't replicate truthfully or with good fidelity. However, a recent discovery in the last few years has shed some doubt on the quantitative importance of the era Theory and that information is the fact that there are endonuclease enzymes enzymes within the nucleus of the cell called endonuclease is that are incredible as it may sound capable of recognizing the error in the DNA and correcting it. The enzymes the endonuclease enzymes are capable of sniffing out the error portion of the DNA and allowing for insertion of the correct sequence of molecules. So even if there was a 1% error with each generation in the DNA The end of nuclease enzyme would probably correct about 99% of it. So that instead of having one percent error passed on to each generation. You only have a 100 of a percent error. However, since nobody knows what the critical amount of era is the discovery of the end of nuclease does not throw out the error Theory it just produces its quantitative importance, but one of the other fascinating things is that if there is era that is responsible for aging and a limited lifespan in living things one could ask Will why not put in more endonuclease or if certain types of animals are cells have deficiencies and endonuclease. Why can't we correct the error by artificially adding two cells endonuclease? In fact, maybe endonuclease is can correct some of the inborn errors. I've metabolism. The inborn disease is the hereditary diseases where there are deficiencies in certain genes or mistakes and certain genes. And in fact, this is being done in lower forms of life is called DNA recombination or DNA manipulation and is very possible and probable that in the future. One of the methods that we will have to correct certain hereditary illnesses is the application of endonuclease to the fetus or to the newborn child to correct the errors in the genetic information in the cells of an individual. A second Theory of Aging is the so-called free radical Theory. Has no political connotations. Some of you may know that free radicals are terms that refer to very active molecules highly charged molecules that are highly reactive chemically. Free radicals are formed by number of things including radiation if molecules and chemicals are exposed to radiation the high-energy radiation will cause some of the molecules to become free radicals by knocking off some electrons from the molecules or raising some of the electrons to a higher energy State and making a molecules very reactive at about 15 years ago. The denim Harmon who is Professor of medicine and biochemistry at the University of Nebraska College of Medicine postulated that aging may be due in part to an accumulation of free radicals in tissues of living things and he didn't just pull this idea out of a hat. He postulated it on the basis of certain experimental evidence. That was known. And some of that evidence was that when lower forms of life specifically drosophila flies fruit flies were irradiated with x-rays that were sublethal in their dosage. It wasn't the lethal dosage. There was a general shortening of the lifespan of the entire population by as much as 30 to 40% There was some other evidence that Harmon had in a related back to the nuclear bomb explosions in 1945. As you know in August of 1945 the u.s. Exploded to fission Bombs Over Hiroshima and Nagasaki. Since that time the United States has studied very carefully the effect of the explosion on the survivors all those several hundred thousand people were killed outright. A large number of the population survived in the u.s. Set up the atomic bomb casualty commission to study the effects of the radiation on the survivors those people who had received sublethal radiation Doses. And now for over three decades this commission has been studying the biology and health and medical condition of the survivors. And there appears to be suggestive evidence that some of the parameters of Aging some of the signs of aging seem to be accelerated in the survivors of the bombings of Hiroshima and Nagasaki most of the population with civilian and there was no Central repository of Records, like the military might have stored away someplace so that all the information on what the health and biology of these people would have been if they hadn't been exposed to the radiation has been lost. Most of the records were in the doctors offices and the hospitals and they were all destroyed in the bombing. So we have no way to know what the life and health and medical condition of these people would have been if I hadn't been exposed to the radiation in a sense. There were no controls. However, some years later the United States did have the opportunity to study the effect of radiation on a group of people on whom we had good Baseline medical information. In 1952 the United States exploded the first Fusion bombs the first hydrogen bombs, the explosions were carried out at the enewetak atoll in the South Pacific and these explosions and experiments were under the control of the u.s. Navy would set up what they called a Fail-Safe experiment. It was said there was absolutely no chance of danger to human life established all the safeguards and they had double checks and triple checked and then we were sure that there was no chance of danger to human life. the winds in the upper atmosphere began to change and the radioactive fallout which consisted largely of radioactive strontium-90 and radioactive iodine-131 began to be carried much more than 50 miles absolute safe limit, which the Navy had declared was the farthest the radiation could go what they had done was they had evacuated all the islands to a radius of 50 miles from the epicenter of the explosion. And before the Navy realized it this cloud of radioactive fallout began to be carried much more than the 50-mile absolute safe limit and was carried over 80 miles and began to fall on the island of run Jewel app, which was inhabited by South Sea natives. The Navy quickly evacuated ronja lab, but not before the radioactive Cloud at fallen and every Islander on rhonj lap was exposed to over 200 rankings in air radiation of this fine. Ash that's settled over the entire Island. It was a totally uniform dosage and every Islander was exposed. It was a sub lethal dose, but it was a significant radiation dose. Unfortunately, these Islanders had had very careful medical and biological examinations before the exposure ronja lamp was a protectorate of the United States having been given to it by the United Nations after World War II and because of that the US government had done very careful health studies on the Islanders because they were responsible for the health of the Islanders. They had also done ecologic studies on the island starting the Flora and Fauna of the island. The Navy quickly evacuated all the inhabitants and have been following them very carefully ever since because here we had a population where a good Baseline information was prevalent and present and we had an access to study these people over the next 20 years or more. It's been almost 25 years now and although it's too early to be certain at this time. Not enough time has elapsed there appears to be suggestive evidence that some of the parameters of Aging in these Islanders may also be accelerated and with this group it's going to be much more meaningful because we have the Baseline information. All the children on the island incidentally have had to undergo total surgical removal of the thyroid glands to prevent the development of thyroid cancer from the radioactive iodine 131. As you know, iodine is soaked up by the thyroid gland to make thyroid hormone and the groin glands of growing children soak up a lot of iodine. So to prevent the cancer developing from the radioactivity and their glands it was easy enough to do surgical removal of the glands. Unfortunately strontium-90. Is it chemical that very much resemble calcium? And calcium as you know goes into the bones of growing children and the strontium-90 also goes into the bones. That's where it's mainly sequestered and unfortunately strontium is even more tightly bound to Bone than calcium and there is no good way to remove it. You can't remove all the bones from children like you can the thyroid gland and how many of these children are going to develop osteogenic sarcoma cancer of the bone in later years. We won't know it will probably be another decade or two before we have the final results in on the effect of that radiation on the population. However, it is expected that within the next decade or two. We will have information on this so-called human experiment the effect of a given and calculated dose of radiation on a human group whose biology and medical status were well-known and well study prior to the exposure. Well, this is very interesting and why have I spent so much time on the free radical Theory? The reason is is that there are ways that are being worked on to reduce the number and amount of free radicals in living tissue. Dr. Denim Harmon who is Professor of medicine and biochemistry at the University of Nebraska and Omaha has been for the last two decades studying the effects of giving simple chemicals in the food of animals that will reduce the free radicals and he has been able to lengthen the healthy life span of experimental animals. He's used rats initially by 30% More recently he's going to do the experiment on pigs. The reason he's use pigs is because pigs are very close to humans from Viola logical point of view their immunology and biochemistry is very similar to human beings and in pigs he has been able to increase the healthy lifespan of Pigs by 25% How people will say one my God, why don't we start taking this material and food right now? Well, the reason is as close as pigs are to humans humans aren't pigs and you can take the information from one species and apply to another safely. Although there has been no evidence of toxicity or damage to the animals that he's used one cannot be certain that this would not be harmful to humans. There's another reason why the experiment hasn't been done in humans and probably won't be done for some time. There has been very little support of Aging research of gerontological research in the United States. It's been considered a very low priority area, unfortunately. But even if there was funding to do an experiment would take 70 years it would take more than 70 years. It would take a full lifetime. If we were to start children now on these chemicals which inactivate and bind up free radicals and reduce their amounts in the body. We wouldn't know the answers until the year 2050 or pass then there's another reason it would be difficult. Think of the logistics are doing experiments starting on children and following them throughout their entire lives keeping them on a diet while you can't even do it now for a year or two not only on children adults. It becomes a very very difficult problem and then addition there are ethical aspects of allowing parents to volunteer their children for such a study and then continuing the study even when the children become adults and then there's a practical problem how many scientists and doctors and people would be willing to start an experiment the answer to which they wouldn't have for over 70 years long after they're dead. I'd like to go on to another Theory of Aging the so-called hayflick phenomenon spelled like it sounds after Doctor Leonard hayflick who was professor of medical microbiology at Stanford University School of Medicine. About 15 years ago doctor hayflick became very interested in cell culture. And the reason he became interested in tissue culture was because this was the. Of time when people are talking about organ transplants. And hayflick correctly recognized that in our society in our culture there would never be enough organs to transplant. It would never be enough hearts and kidneys and livers and other organs, which the surgeons were thinking of transplanting and he was correct in this you found that about half the time the cultures seem to grow indefinitely, but the other half of the time they died out after about fifty cell divisions after about fifty generations of cells He went a little further though, then Corral did and he examined the cells that kept growing the ones that kept growing more than the fifty generations and he found that the cells began to look a little peculiar. Instead of the normal diploid or double number of chromosomes that youman cells have 23 * 2 or 46. He found some of the cells had triploid e triple number of chromosome 69 multiple bizarre numbers of chromosomes called polyploidy a hundred a hundred and twenty hundred and thirty he found that some of the cells have more than one nuclei. More than one nucleus. They had multiple nuclei. He found that some of the cells begin to look at you. You're they began to grow very widely. They became very large and as some of you may recognize what he was describing was that the cells that kept growing more than fifty Generations had undergone malignant transformation into cancer. In other words, he showed that normal human cells are capable of a finite number of cell divisions or Generations about 50 after which they die out or they turn into cancer. When he published his results people got very excited. They said well Dr. Hatef, like you have discover the cause of our limited longevity why we only live to be three score and ten or for school a year we run out of cells and he thought that was correct. And so did everybody else until he calculated the amount of tissue that could be produced if our cells were capable of 50 replications from the time. We were born from the time we were fetus. And it turns out that enough tissue would be produced to last a hundred and fifty to a hundred and seventy-five years. Are the implications of this a staggering it says yes, there is a cellular limitation to our life span, but we never near approaches. We never even usually live to be more than half of what are cellular potential might be. So the question comes up while what are the things the other things and they're shortening lifespan. This brings me to another Theory of Aging which is related to some of the day that we just talked about. It's the so-called immunocompetence Theory immuno confidence immunocompetence refers to the confidence of the immune system the functioning of the immune system of our body the immune system is that system which is responsible for fighting Invasion from foreign organisms or bacterial or fighting off cancer. The immune system of the body is capable of recognizing self from non-self is capable of recognizing foreign cells from healthy cells. The immune system consists predominantly of certain types of white blood cells called lymphocytes. There are two types of lymphocytes the B cells because they reside in the bone marrow and the T cells because they derive from the thymus gland. The B cells are capable of making antibodies certain chemicals which help fight infection. When you get an immunization shot, what happens is the immunization material you're getting the vaccine stimulates your B cells to produce antibodies chemicals which in activate the vaccine which in activate the bacteria from which the vaccine was made so that you can fight infection with the antibodies. The T cells on the other hand are cells that are capable of recognizing foreign invading organisms. By certain receptors on their membranes and they destroy them. They're called killer cells. They actually can recognize bacteria invading organisms and cancer cells and Destroy them. It has been found that with age there is a decline both quantitatively and qualitatively in the functioning of the immune system predominantly the T cells there are fewer of them and they have trouble recognizing self from non-self and they have trouble destroying invading organisms in a sense the T-cell function declines along with these other organ systems. The immune system as I mentioned is what is responsible for helping us fight cancer and infection Invasion by Foreign bacteria and microorganisms. There is evidence that all of us at many times during our lives are forming cancer cells in our bodies, but we don't get cancer because our T cells recognize the cells as being foreign and they destroy them. The reason we don't get clinical cancer is because the few cancer cells that are formed or destroyed immediately and don't get a chance to form tumors that can then spread to other parts of the body. However, if the immune system isn't functioning well then perhaps the invading cells won't be recognized the cancer cells. They won't be destroyed and they can get a foothold and start growing and cause then metastatic and fatal cancer. Well, this is very interesting. But what good is it do well some of the good that it does is that there are ways being worked on now to enhance the functioning of the immune system to improve it. In fact, we already have some methodologies that are still partially experimental but have even been applied to certain humans. One of the ways in which the immune system could be rejuvenated in a sense would be if you when you were younger had some of your T-cells taken out of your body from your blood in your bone marrow and put into tissue culture and grown. and then when a sufficient store of them was available to freeze them to put them in deep freeze and to hold them and then 30 40 50 years later when you were ready and you needed them when your own immune system wasn't working well to have reinjection of your own T cells in fact Dr. Heflick has been storing and growing T-cells now. There have been ways in which some fortunate people who had cancer as an example have been able to have been saved by T Cell injection. There are ways now in which we can cure cancer. Take as an example leukemia. If you had leukemia right now we could cure you. The way that we would cure you what could cure you of the cancer would be to give you total body radiation to knock out. All you are cancer cells completely destroy them by radiation. The only problem is even though we cure the leukemia. We cure the cancer the cure would kill you because the radiation would knock out all your own bone marrow and your healthy cells in the bone marrow that you need and you wouldn't have enough to continue living. However, if you had an identical twin from whom you could receive a transplant of bone marrow, then we could give you radiation and knock out all your cancer cells and then give you a bone marrow transfusion. And in fact, those few fortunate people who had leukemia who happen to have identical twins. Some of them have been saved and are cured of cancer and are still living. however, if we were able to have stored Merrill that would not be rejected if it were drafted from every person in a frozen Bank like we just talked about before we might be able to rejuvenate the immune systems of all people when they develop diseases where they needed more immune functioning but there's another approach and that is that ways are being worked on now to give chemicals and medications which can stimulate your own immune system. Even if it's been suppressed. And although this is still experimental. We predict that within the next decade sometime in the 1980s. There will be ways of stimulating the immune system by giving certain medications simple medications and chemicals that will enable us to withstand infection and cancer as we grow older. One of the most fascinating things that has been discovered about the immune system that has great therapeutic importance and may be extremely significant in determining how long and how healthy you may live is recent evidence that the immune system is capable of being psychologically conditioned. I'll explain. They took rats this work was done at the University of Rochester Medical School in New York. They took rats and tested the T-cell function. There are ways of testing immune system functioning and they found it to be normal. Then they gave the rat saccharine a harmless sweetening agent that has no physiological effect. And they found the T cell function where main normal as was expected. Then they gave the rats an immunosuppressant drug the kind of drug that is used in humans who are receiving transplants of organs. When we want to suppress the immune system a little bit to prevent rejection of the transplant was otherwise a transplant will be looked on as far and cells which they are and be rejected. So doctors give a drug which suppresses T cell function not completely but just enough to prevent rejection of The graft. They had done a pavlovian conditioning experiment on the rats to condition their immune system to respond to saccharin which should have been a physical physiologically inert material, but upon conditioning. They conditioned the rats immune systems to be suppressed by the sacrament. More recently. It's been shown that in Youmans psychological depression and withdrawal from activity in activity. Is capable of causing immune system suppression. So what we've shown is number one that the immune system is capable of being psychologically conditioned and number two. We've shown that depression and withdrawal from activity is capable of suppressing the immune system. When depressed people are treated for their depression the immune system function returns to normal. Well, this is very interesting. But what good does it do what role does the immune system play in our longevity in our healthy longevity turns out of very important one. One has to ask what are the causes of disease and death in old people if we think that the immune system decrease functioning is limiting our lifespan. We know a lot about the cause of death of younger people. It turns out that I'm careful study. There is practically no reliable valid information on the cause of death of very old people and I mean old people I mean above 80 and even that shouldn't be a definition of old in fact as we'll see later. If I would have dropped dead right here while I was speaking. Everybody would want to know what happened. At least. I hope you want to know what happened. And a post-mortem examination would be performed. And the most common causes of death in younger people in people under 70 or under 80. We know very well that are heart attacks and strokes their due to arteriosclerosis. There's good data and evidence on it because when young people die frequently post-mortem are done autopsies are done to find out the cause. We have good reliable data on cause of morbidity illness and mortality death in young people. But if I were 85 or 90 and I drop dead while speaking or doing anything else not only my family but even the doctors would say, well he died of old age. Well people don't die of old age. They dive specific mechanisms and causes and unless one investigate the causes of illness and disease in the very old. We won't know what's causing it and we won't know what to do to prevent it. I look on the final rejection of the older person in our society is when we're not even interested enough in them to know why they died. We've been very interested in this and in Baltimore before we came to North Dakota and now at the University of North Dakota, we have been doing a pilot study on cause of morbidity and mortality and very old people with permission of the next of kin of the families. We have been attempting to obtain autopsy information and it's revealing some very interesting data. The causes of death in the very old are quite different than in the younger. Remember the leading cause of death in the younger people arteriosclerosis heart attacks Strokes. In the very old the leading cause of death appear to be number one infection number two cancer and number three pulmonary emboli blood clots breaking off from thrombosis in veins in the legs traveling to the lungs. Now the first two of these that we've discussed already infection and cancer are very much related to the decreased immunocompetence in old age. And the third one pulmonary emboli from thrombophlebitis or phlebothrombosis from clots in the veins in the legs is very much a preventable condition and is very much related to inactivity. Inactivity will cause a stasis the stagnation of blood flow in the lower extremities. One of the things that helps return blood to the heart from the lower extremities is the pumping action of the muscles of the leg. That's why when a soldier stands at attention for an hour or two. He Keels over and faints because his leg muscles aren't working and aren't returning enough blood to his heart to maintain enough blood to his brain and the upper part of his body. So he kills over and faints and then the blood can get back to the heart when he's in dependent position because it's not stagnating down in the gravitationally dependent part of the body. So the faint is an important therapeutic maneuver when somebody faints standing on Parade don't stand back up again and hold them up or try to support them. Let him faint if you keep him up as a matter of fact it may kill him. So in activity is one of the things that's responsible for the pooling of blood in the veins of the legs. When we walking exercise our muscles the muscles push on the veins the veins have valves in them which prevent backflow of blood so the blood can only flow in One Direction that back to the heart if we sit around on a chair. or lie around and we don't exercise those leg muscles the blood pools in the veins and become stagnant and stagnant blood is much more susceptible and prone to getting clots in it to undergo thrombosis in activity of older people will induce phlebo thrombosis or blood clots in the veins sitting in a chair for 5 or 6 hours without exercising the legs can induce thrombosis crossing your legs. Like most of us do all the time end of fears. Interferes with drainage of blood from the veins in the legs because we compress the veins underneath the knee and that can also lead to phlebothrombosis. Will the important thing about this is that what we found is that the major causes of illness and death in the very old appear to be due to conditions which are preventable and reversible or maybe preventable and reversible number one if we can prevent the decreasing immunocompetence. We may reduce the incidence of infection and cancer which leads to so Much Death in the very old and if we keep exercising an active, we will reduce the incidence of phlebothrombosis in the veins of the lower extremities, which cause clots that break off and go to the longest fatal pulmonary emboli. this brings me up to 2 Words which are very important. Which will give us information. Which we think can be used to increase the healthy longevity of human beings and these words are atrophy and hypertrophy atrophy atrophy is a term that refers to the decrease in function and size of an organ with disuse with lack of proper stimulus. If you sit around on your butt all day and don't exercise your muscles are going to get weak. If you don't walk and exert forces across your bones, the bones are going to get week and they're going to fracture easily. They're going to break easily when you fall. This condition in fact is called osteoporosis. It's a weakening of bone. The opposite of atrophy is hypertrophy hypertrophy. It is the increase in function and size of an organ with proper use and proper stimulus. If you want to make your muscles strong, you do exercises. If you want to make your bones strong you do exercise is isometric exercises where one muscle is pitted against the other is a very effective form of exercise. In fact with hypertrophy there is not only an increasing function and size of the organ but there's an actual increase in the size of the cell the cells actually get bigger. They produce more protein. They synthesize more chemicals. They can do more work with atrophy. There is a decrease in the actual size as well as the function of the cell itself in the organ. That is undergoing atrophy. What I'd like to do is spend a little time now. Talking about something that we used to think had very little to do with medicine. It has to do with sociology. If you were to ask me, what is the most important thing that one could do to ensure a healthy human lifespan. I would have to say it has nothing to do with medicine or drugs or the medical profession. It pains me to say it, but I have to admit it's true. It has to do with sociology. And I'd like to introduce this by telling you a little travel log. It's a true one. Bring out the point. In 1972 the 9th International Congress of gerontology was held in Kiev in the Ukraine in the USSR and scientists from all over the world attended. There were over four thousand scientists in gerontologist. After the meetings were over after we had done all our work attended. Our meetings given our papers. We all came home with one exception one of our colleagues. Dr. Alexander leaf leaf, who is Professor of medicine at Harvard Medical School and director of the medical service at the Massachusetts General Hospital. Had heard stories emanating from Russia and Georgia from an area of Russia near the Black Sea of people living to be 120 and 130 years and even older. Most American gerontologists and gerontologists from all over the world had poo-pooed the stories. They said it's a lot of Russian propaganda to encourage tourism. It's quackery. It's not so at least didn't believe it either and he said that somebody got to go there and show this up as a hoax as a fake. So with funding from the National Geographic Society after we all had come home from Kiev Leaf went to Russia and Georgia to a community where these old people have been reported called up Kezia and he was going to go and interview them to show it all up as a fake and a hoax. He was going to interview them and compare the ages. They told him that they were with the recorded documents and birth and marriage certificate and everything else that they had. So he went to have caused you and the Russians were very Cooperative all these old people were very proud to see a distinguished visitor from the United States and they cooperated very nicely any interview them all. And he checked out what they told him against their documents and he studied very carefully and to his surprise the age of scene to check out to about 95% accuracy. So that the man who said he was a hundred and thirty-five may have been lying. He may have only been $129 or the one who was a hundred and said he was under 20 may have only been a hundred and fifteen but just to is surprised they just checked out to about 95% accuracy. So he said well that just very clever. They've doctor their documents. They fudge things up. They've got a nice little thing going here and he didn't put too much stock on it. So he thought that he would check the ages by another independent method and he would catch them on this. He interviewed all their descendants because they all lived in the same general community. The interview the children and the grandchildren and the great grandchildren and the great great grandchildren and the great great great grandchildren all the way back for over a century. Any checked out their rages against what they told him and then he added up all the ages of the descendants and compared those with what the old people the very old people told them and much to my surprise. They checked out to about 95% accuracy. He said I'm not that clever than I thought they've gotten their family into the conspiracy. So he checked it out by a third independent method he compared what these people in their descendants told him with with what was known in recorded documents, which these people had no access to he compared what they told him with the old archives an ancient Imperial Russia of czarist, Russia. He went to St. Petersburg now Leningrad where Russian archives are stored. He went to France were left. A lot of the czarist archives were taken by the White Russians After the Revolution and time. After time these stories checked out and leaf was met with the astounding conclusion that these people really were very very old. So he thought well, what are the reasons for it? It must be because they're different biologically. So he examined them he checked them out and he found out that they had two kidneys and they had two lungs and our hearts were in the middle of their chest a little more in the left side. They weren't any different biologically, except we would long since been dead and they were still living and healthy. So then he thought it must be the diet because he noticed when he got there that they had a very good diet. They had plenty of fruits and vegetables and good amount of protein. They didn't eat all the fat and carbohydrate junk that were used to eating but then he realized that what they were eating was just a good agrarian diet and there are many peoples in the world of weed agrarian diets, and they don't live to be a hundred + 20 + 130 And then he went back to something that he had noticed when he first got there but which he had dismissed and not paid much attention to because after all he was a scientist in a physician and he wasn't interested in the softer sciences and sociology. What are you noticed when he got there was at the culture of this group was very different than anything he had ever seen before. These people had a very important role in their society. They were needed. They were turn to as being important in the decision-making process of the community. They kept functioning. They kept working. There was no such thing as mandatory retirement at age 65, maybe when somebody was 75 they cut back from working 12 hours a day to a 10 hour a day work day. And maybe when they were 90 they cut back to an 8 hour a day work. And maybe when they were a hundred and ten they cut back to working 6 hours a day and 120 maybe to four hours a day, but they kept working. They were needed for their work. They did important work. They were look to for advice and for Council when important decisions the community had to be made the younger people turn to the town Elders for advice. These people had lived for over a century and head over A Century of accumulated wisdom and knowledge. When they were important celebrations the old people were given the primary place of importance at the head table. In fact, they were great Banquets and honored dinners when somebody who turned a hundred it was a great thing to be a hundred and they look forward to the hundred and tenth birthday because there was even a bigger bank with at that time and it after the hundred and tenth. They look forward to being a hundred and twenty. Lee tells the story of 100 year old fellow who wanted to get married You wanted to marry a 90 year old young girl in the village. Any turn to his 125 year old father because they had to ask her parents for permission for things like this. And the father wouldn't give his permission. So the townspeople went to the father and they said why don't you let your youngster get married to this nice young girl. And the father said I want to marry her myself. These people were vigorous. These people were interested in their lives and other people were interested in their lives. And we thought this was very interesting. And Wally was there. He thought maybe he better go and look at two other places in the world where very old people have been reported and there are only two other places where it has been reported that people are living to be these kinds of Ages. So he went to the second place in the world. In a place called hunza which is between Afghanistan and Pakistan in the Himalayas. At least went to hunza and he found the same thing. So he thought he better visit the third and last place in the world where very old people have been reported and with funding from the National Geographic Society. He went to South America to Ecuador where in the Andes there is an Indian village called vilcabamba. Inhabited by South American Indians who are in no way biologically or culture related to the people in hunza and abkhazia. And in vilcabamba, he found the same thing the people there didn't live to be quite as old as those in Windsor and Anacostia. They only lived in to their hundred and teams their diets weren't quite as good. They had a little bit less protein and less calories. but it was largely vegetables and fruits and not all the fat and carbohydrate junk that we're used to in vilcabamba a community that in no way could be culturally or biologically related to a kazio hunza these people really live to be very old. Now Leaf is too much of a scientist to say ah, ha we found the answer but I must admit that after reading his reports after speaking with Alex leave one has to ask the inevitable question are these people living longer because it's worth living longer. Not 10 years ago. I would have said that's preposterous. That's black magic as a physician and scientist. I know that you can't live longer just by wanting to live longer, but I'm a little wiser these days and I've learned a lot from my patients and from older persons and I've gotten rid of I hope some of the blinders that I've had. I still have a few but not as many And I think that in fact not only is that the case that people are living longer because it's worth living longer but the answer is been staring physicians in the rest of us in the face for many years, but we haven't been seeing it. The evidence is already here. We've talked about atrophy and hypertrophy what happens to people when they don't exercise their facilities their facilities waste and undergo atrophy. We have now evidence that the immune system is capable of being psychologically conditioned and plays a major role in morbidity and mortality in very old people. People themselves patients have been telling us this for years, but the medical profession in the rest of society. Haven't been wanting to believe it. We have other evidence. We've known for many years that morbidity and mortality in the military who frequently retire in their forties increases astronomically right after retirement process the morbidity mortality curve to take a sharp climb upwards. After retirement in the military in the 40s and plateaus off again in humans after 65 mandatory retirement in our culture, there is again a sharp increase in morbidity and mortality which again plateaus off. With institutionalization of older people in their 70s and 80s and 90s, which force has a lower level of activity and increases dependency level especially if it's inappropriate institutionalization which often it is. There is a sharp increase in morbidity and mortality. The data the evidence has been with us all along. We haven't been looking at it. There is one other piece of information that I'd like to mention because it relates to this. And we have called it for want of a better term and hypothesis of an organizational hierarchical. aspect of longevity and organizational hierarchical determinant of longevity and by that we mean that in humans the determinant of the human healthy life span is a function of increasing levels of hierarchical organization of human being and human life. We've talked about cellular limitations which are dependent on molecular aspect of DNA the genes of our cells. We've talked about the cellular limitation to longevity which might limit us to 150 or more years. We've talked about the organ system level of organization where the physiologic decline an organ system functioning declines at a rate that might limit our life span and 130 to 140 years. What we really been talkin now about is the total organism level the total integrated organism that is influenced by its central nervous system in brain. We're the way that it lives will limited its life span too much less than a hundred and twenty years through the processes of use out of atrophy. We also have to talk about higher levels of organization namely psychological organization and then interaction with the community and environment in which we live is sociological and ecologic level of organization the higher organizational level. The more limiting it seems to be to our life span to our healthy life span. Well, this is a very encouraging story if it's true because we are capable of altering the way in which we live the sociology and environment in which we live perhaps more easily and with less manipulation, then manipulating the genes and the molecules within our cells and the cells themselves before I came to North Dakota to University of North Dakota highways in Baltimore. I was doing research at Johns Hopkins Medical School, and I was medical director of a Geriatric Center and Hospital in Baltimore. At the center we were very much concerned with inappropriate institutionalization of older people. National figures indicate that up to 40% of people in nursing homes are there in appropriately that they are without sufficient medical or nursing indication that there by default of society which has not developed the resources. To allow older people to stay in the community the kinds of personal and Healthcare assistants that are required to keep people in the community. So we were very very cautious about admitting people and didn't admit them unless it was absolutely necessary for the medical and surgical point of view because when you admit someone to a dependent level which has a higher level of dependency than they need or I should say increases the level of dependency past that which they need you do the individual just service just as important. If not more important is we are denying them the work that is necessary to prevent physical emotional and mental atrophy. Most of us have not trained ourselves to have other activities after work retirement. We haven't led the kinds of lies that have allowed us to develop ourselves. So that we can engage in other physical mental and emotional activities and our society is denying us the right to continue working in the sentence is denying us the right to continue living. I remember when I was a child we used to be told that the eskimos had a very barbaric way of dealing with their older people. I never knew it was true and frankly. I kind of doubt it but they used to put all the old people out after they didn't work any more out into the snow to freeze to death for the older people with going to walk away. And we said is not terrible but in effect, aren't we doing the same thing except more subtly by denying older people the right to work when they would want by limiting the amount of activities that they can engage in. Aren't we fostering the same problem? I think the answer is yes. Aren't we as a society discriminating against the needs of older people and failing to recognize them. Let me give some other examples. In 1968 when the Medicare law went into effect. It did not cover renal dialysis the use of the artificial kidney for people who own kidneys fail in 1970. The directors of one of the leading dialysis centers in the United States in Baltimore was quoted correctly in a newspaper article describing some of the good work that that's Center at done and they did do good work. He described the rehabilitation of a 20 year old girl who had had renal failure kidney failure and it was on dialysis and was rehabilitated and it was now back to running and jumping horses. That's the work she did and it was a very good Rehabilitation effort. Then the question is asked will what do you do when people are Older and he said well when they're over 65, we wouldn't subject them to dialysis. And everybody passed it off as being reasonable. You wouldn't want to subject older people to dialysis. It actually is not a very painful a traumatic procedure. It's a life support system. That is now accepting Medical Practice. Well in the early 1970s the National Kidney Foundation got wind of the fact that Medicare was not paying for dialysis and they forced to change in the Medicare policy and now Medicare does cover renal dialysis. And now the dialysis centers are dialyzing people 65 and 70 and 75. They are making the decision based upon the medical indication. They had deluded themselves before. Into thinking they had a medical indication. When what they were really using was a fiscal indication the fact that it wasn't being paid for by Medicare or third-party carriers and many older people were dying from kidney failure who might have been saved with renal dialysis. Another example when Medicare first went into effect there was a policy that to be covered under Medicare patient in a nursing home had to be seen at least once a month by a physician provide a bare minimum of physician attendance in review. When physical constraints became the determinants of that policy, which is now administered by Blue Cross Blue Shield in Most states. There was an interesting change in that Medicare policy. You know what it reads now now the policy is that Medicare won't cover more than one visit a month for an old person in a nursing home. What's set out to be an attempt to provide a bare minimum of medical visitation has turned out by policy interpretation by Blue Cross Blue Shield to be a limiting maximum and we know that many older persons in nursing homes require much more than one visit a month to be adequately supervised. haven't we put the older persons in our society on the lowest priority scale and aren't we still doing that for delivery of health services and other services and needs that they have An example I think that typifies in a rather gruesome way what can happen in a supposedly Advanced Society in the way that it treats and handle this older people. I think he's brought out by what happened in a culture and I use the word culture rather advisedly. in Central Europe about 40 years ago. I'm referring of course to Nazi, Germany. before the Nazis started killing Jews and gypsies poles and Russians and anybody that didn't like They tried out the methodology first on their own people on Ariens. And you know who they tried it out on you guessed it on old people. before the Nazis started out on their Mass extermination policies They started experiments. In killing people old people in nursing homes, they call the program euthanasia on direct orders from at off Hitler in 1938. The German started the policy of putting to death old people in nursing homes and convalescent hospitals. They were killed by medical personnel by doctors and nurses with intravenous and intracardiac injections of poisons of gasoline petrol and other things they try out various different methods of killing. The families were told that the patients died of communicable disease and they were incinerated that they were cremated if they wanted some answers they could get them but the German populace didn't really believe this too too. Well because all of a sudden the children of older people who are in certain on only certain nursing homes in East in Germany where these were carried out began to get notices of the deaths and the children of people and other nursing homes never got them. So the Germans actually knew what was happening the acceptance of the practice by the population. However, it was laid very subtly several years before doctor girl. Those who had been minister of propaganda and also in charge of Education very interesting link had made it change in the text books and Nazi Germany in the mid-30s to prepare for this policy the old problem saying the arithmetic books of it costs 200 marks per egg. How many eggs can you buy with 1500 marks was now change to it cost 40,000 marks to keep alive in a nursing home once in awhile non-productive older citizen who was no longer of any use to the right. It cost only 2,000 marks to subsidize a young Aryan couple each year to have another child for the fura question. How many young Aryan couples can be subsidized to have another child for the feura for the amount. It takes to keep a live in a nursing home once and I'll non-productive older person who is no longer contributing to the economy and the students dutifully wrote out their answers. I question in wonder whether or not More subtly, we're doing similar sorts of things in our own Society. I think we should close now perhaps with just one statement that I think Bears thinking about and perhaps discussion. And that is remember that the systems and the organizations. That we develop now the institutions that we develop now. In which older persons live? Will be the institution is in which we ourselves will die.