生物与医学2021nature.com
靶向衰老的经济价值
The economic value of targeting aging
进阶 · 约 45 分钟读完前置知识：健康经济学基础、支付意愿（WTP）、人口寿命指标
导读
这篇发表于 Nature Aging 的论文从经济学角度评估“直接把衰老本身作为干预目标”的价值：它用支付意愿（willingness to pay）估算人们为延长寿命愿意付出多少，从而量化延缓衰老带来的经济收益，并与逐个治疗老年疾病的方式作比较。核心论点是针对衰老本身的干预具有很高的经济价值。
HN 关注点：HN 读者争论的焦点是：用支付意愿估算寿命价值的方法是否站得住脚，以及抗衰老疗法离现实有多远、监管与社会影响如何。
HN 评论精选
这几条评论里：支持 1 质疑 1 补充 2
支持衰老像被正常化的“暴君之龙”，针对它的干预收益巨大；这篇经济分析是说给资金决策者听的。
这让我想起 Nick Bostrom 的《The Dragon Tyrant》和大卫·福斯特·华莱士的《This is Water》。这条“龙”（衰老）已变得如此寻常，我们甚至不再质疑它，就像鱼不质疑水是什么。我们围绕如何应对这种必然性建立了整个社会。但归根结底，如果做得到，杀掉这条龙会带来更大收益、大幅减少伤害。我看到帖子里有人抱怨这里的经济分析，或者说老年人正在搞坏我们的世界、应先解决那些问题。对前者，我认为这项分析是在为这场辩论增加弹药，因为很多决定把钱投到哪里的人是基于经济学做决策的——这篇论文不是写给你看的，是写给他们看的。对后者，我质疑这个前提：文化变迁太快，不能只用年轻世代主导来解释，这也和老年人掌控一切的说法相矛盾。真相是，如果人能活到一千岁，社会将发生根本变化，我们对“儿童”“成人”的定义都会改变；在打开盒子、尘埃落定之前，我们不知道那会是什么样。
godelski查看英文原文
I'm reminded of Nick Bostrom's story called "The Dragon Tyrant"[0][1] and David Foster Wallace's "This is Water"[2]. The dragon became so normal in our lives that we do not even question it, like a fish does not question what water is. That we've created a society around this how to deal with this inevitability. But at the end of the day if we could, killing the dragon would be more beneficial and reduce harm by a significant amount. I see several people in this thread complaining about the economic analysis here or how old people are messing up our world and thus we should fix those things first. For the former question, I see this analysis as adding ammunition to the debate, because many people that determine where we should fund base their decisions on economics. This paper isn't aimed at you, it is aimed at them (speak to your audience). For the latter, I question the premise. Culture has moved too fast that it cannot be purely explained by younger generations dictating the change. This also falls counter to old people controlling everything. So I don't buy the premise. The truth is that if people were living to a thousand years old that society would fundamentally change. Who we consider children and adults would fundamentally change. The truth is that we don't know what this society will look like until we open the box, and until the dust settles. We should be questioning if this is good or bad (we should challenge all ideas) but we need to recognize that this would be such a fundamental change in society that we have no real baseline for determining how we would change. My personal belief is that we do not go quiet into that dark night. There is a lot to fear, but often our fears are irrational. This would save billions of lives, and so I believe it is worth the risk and worth the hardship we will face as society transitions into this new paradigm. [0]https://nickbostrom.com/fable/dragon.html [1](Animated by CGP Grey) https://www.youtube.com/watch?v=cZYNADOHhVY [2] https://www.youtube.com/watch?v=eC7xzavzEKY
补充DIY 长寿疗法（senolytics、雷帕霉素）可能十年内出现明确证据，值得持续关注。
有很多 DIY 爱好者在试验 senolytics（清除衰老细胞）和雷帕霉素等长寿疗法。我预计大约 10 年内就会有明确证据表明其中至少一些疗法有效——等越来越多人健康地活到 80、90 岁甚至更老，这一点将无可否认。我 30 多岁，还用不上，但一直密切关注相关科学。比如这个临床试验在研究雷帕霉素不同给药方案的安全性，后续还计划用最安全剂量做更大规模、更长期的研究。（补充：好吧，也许不止 10 年，但在我有生之年应该能看到。）
deegles查看英文原文
There are a lot of DIYers experimenting with senolytics and Rapamycin therapies for longevity. I expect that in the next 10 years or so evidence will be clear that at least some of these therapies work. It will be undeniable as more and more people start to hit their 80s, 90s, and beyond in very good health. I'm in my 30s so not in need yet but I'm keeping a close eye on the science. For example, this clinical trial [0] is studying the safety of various dosing schedules of Rapamycin, and a planned followup study will use the safest dose with a larger group and longer timeline. [0] https://www.lifespan.io/campaigns/pearl-participatory-evaluation-of-aging-with-rapamycin-for-longevity/ edit: fine, maybe more than 10 years but within my lifetime :)
补充只要针对某一老年病获批，就能靠超适应症处方让抗衰老疗法进入市场，绕开“衰老不是疾病”的监管障碍。
“治愈衰老”只需要在人体临床试验中获批治疗某一种与衰老相关的疾病，比如骨质疏松。一旦拿到该适应症的 FDA 批准，有意愿的医生就可以超适应症开药。如果这种骨质疏松疗法还有“副作用”——让皮肤显得更年轻、改善短期记忆、提高性欲——那么几年后大概会开出大量超适应症处方。所以，如果你有治愈衰老的好办法，却担心 FDA 不承认衰老是一种疾病，这就是把疗法推向市场的路径。
philipkglass查看英文原文
A cure for aging only needs to get through human clinical trials for treating one aging-associated condition like osteoporosis. Once it has FDA approval for treating that one condition it can be prescribed off-label by a willing physician. If the osteoporosis treatment has unusual side effects of also making skin appear more youthful, improving short term memory, and increasing libido, then there will probably be a lot of off-label prescriptions written a few years later. So if you have a great way to cure aging but are worried that the FDA does not recognize aging as a condition, that's how you get the treatment to market.
质疑质疑支付意愿估算：多数人负担不起，且群体指标不宜用来做个体决策。
论文里写：“通过 rectangularization 把剩余预期寿命从 78.9 岁提高到 79.9 岁，出生时对最初这 1 年增量的支付意愿为 118,100 美元；通过延长寿命把 60 岁时的剩余预期寿命从 21.7 岁提高到 22.7 岁，60 岁时对最初这 1 年增量的支付意愿为 257,700 美元。”他们到底找谁来确定这个“支付意愿”？多数人根本没这笔钱。如果要多工作好几年才能换来多活一年，为什么不干脆早几年退休、享受那段时间？毕竟付了这笔钱之后，你仍可能死于意外。用人均预期寿命这种群体指标，让个体决定是否愿意多活一年，似乎很不合适。
giantg2查看英文原文
"the WTP at birth for the initial 1-year increase in remaining LE from 78.9 to 79.9 years via rectangularization is US$118,100, the WTP at age 60 for the first 1-year increase in remaining LE from 21.7 to 22.7 years through lifespan improvement is US$257,700." Who the fuck did they get to determine willingness? Most people don't have the money to spend. If it takes you years of extra work to pay for a one year life extension, why not just retire years earlier and enjoy that time? After all, you could still die from an accident after paying the sum at birth/60. It seems highly inappropriate to use a population based metric like life expectancy to have individuals decide if they want a one year increase (likely the individuals don't understand life expectancy as well as).
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