My Very Own Near Death Experience

Sepsis; with organ failure. That was the diagnosis of my condition shortly after I was wheeled into the emergency room at Kaiser Permanente's brand new San Diego Medical Center by the paramedics on the morning of Monday, 3 July (three weeks ago today). My wife was told by the physicians that it was touch-and-go. One of the many physicians who attended me told me later that 40 years ago it would have simply been game over. I was conscious and not in pain, but it wasn't apparent to me at the time how serious the situation was. It should have been, though, because my wife had found me on the floor of our bedroom, where I had dropped down after realizing that I was very light-headed and might faint. The paramedics who responded to her 911 call thought their blood pressure cuff had broken since they couldn't get a reading. The look on the faces of the ER doctor and nurses suggested that that they were expecting me to be near death--and I was, even if I didn't know it then.

My body had been take over by a massive skin infection (cellulitis) focused in the groin area that stopped my bladder from working, nearly squeezed the life out of my kidneys and liver and had precipitously dropped my blood pressure (to 60/30), and raised my heart rate to 177, with an added irregularity to the heart rate. They pumped me full of saline, antibiotics, probiotics, heart meds and other things, all of which saved my life. It included a bit of midnight surgery to install a "central line" (a tube) into my heart to administer meds directly to the heart.

The U.S. Centers for Disease Control note that sepsis is more common among those under 1 and 65 and older, and more common among those with some kind of preexisting condition. While I am over 65, I do not have any chronic conditions that might predispose me to this. I was asked several times if I might have been bitten by a spider while working in the yard (not that I was aware of), or if I had traveled anywhere (yes, to Los Angeles a couple of weeks prior, but as different as LA may be from San Diego, it doesn't seem too dangerous!). None of the myriad tests/cultures they administered came up with any clue to the source.

NIH says this about the seriousness of sepsis:

Every year, severe sepsis strikes more than a million Americans.1 It’s been estimated that between 28 and 50 percent of these people die—far more than the number of U.S. deaths from prostate cancer, breast cancer and AIDS combined.

The number of sepsis cases per year has been on the rise in the United States. This is likely due to a combination of factors, including increased awareness and tracking of the condition, an aging population, the increased longevity of people with chronic diseases, the spread of antibiotic-resistant organisms, an upsurge in invasive procedures and broader use of immunosuppressive and chemotherapeutic agents.

Or, to quote my wife, Deanna: "it is the most serious cause of death you've never heard of."

I will always be grateful to the many wonderful physicians and nurses at Kaiser Permanente who saved my life. The love of my life, Deanna, kept me going throughout my ten days in the hospital, staying with me in my hospital room all day and night, questioning and advocating on my behalf. She is my strength and I genuinely owe my life to her as much as to the medical staff. Our daughter drove down from Long Beach to help out while I was in the hospital (and later with her whole family), and our younger son, Greg (often mentioned in these blog posts), flew out to from North Carolina to assist--later to be joined by the rest of his family. Indeed, he was there to take me and Deanna to the Emergency Room three times after my discharge. Our older son, John (also often mentioned in these blog posts), flew out twice from Switzerland to help out (the second time with our oldest granddaughter), and we've had visits from our oldest grandson who is currently doing an internship in Santa Monica. The kids and grandkids have been champions through this ordeal.

Will that which didn't kill me make me stronger? I hope so, but it is still too soon to tell.

Birth Rate is Up in Switzerland; Down in the U.S.

It's not every day that the news from Switzerland is that the birth rate is going up. But, thanks to my son, John Weeks, for linking me to a story from there showing that there were more births in Switzerland last year than in any year since 1972!

The FSO said the increase was due to the growing number of babies born to foreign parents. However, it said it would be wrong to speak of a baby boom. Rather it was connected to the increase in the number of women of childbearing age in the country. The average number of children per woman was unchanged at 1.5 while the average age for giving birth for the first time was slightly higher than in 2015, at 30.8 years.

In fact, the total fertility rate in Switzerland has hovered right around 1.5 children per woman since the mid-1970s, according to UN data, so this is interesting news, but not too breathtaking.

Meanwhile, back here in the U.S., Justin Stoler sent me a link to a Washington Post story decrying the decline in the number of births in the U.S. 

According to provisional 2016 population data released by the Centers for Disease Control and Prevention on Friday, the number of births fell 1 percent from a year earlier, bringing the general fertility rate to 62.0 births per 1,000 women ages 15 to 44. The trend is being driven by a decline in birthrates for teens and 20-somethings. The birthrate for women in their 30s and 40s increased — but not enough to make up for the lower numbers in their younger peers.

Now, the headline for this story indicates that "some demographers are freaking out." The reporter interviews only two demographers, however, and neither is freaking out. Donna M. Strobino, a professor of population, family and reproductive health at the Johns Hopkins Bloomberg School of Public Health notes that the drop in births to younger women is a good thing, not a bad thing, as I have noted before.

The other person quoted in the story is William Frey from the Brookings Institution:

William Frey, a demographer and senior fellow at the Brookings Institution, points out that despite the recent decline, the U.S. fertility rate still remains relatively high compared to many other developed countries like Germany and Italy. The United States also still has more births than deaths. And we still have a growing labor force. All these things mean, he said, “I don’t think that’s cause for alarm.” 

Frey attributed the decline in birthrates to a women's “lifestyle” choice as well as the fact the economy has been in a funk. Times of economic downturn or uncertainty tend to cause a drop in birthrates, but when things turn around they tend to bounce back in a kind of catch-up period. 

“Every year I say when the economy is getting better then we’ll start having more children,” he said, “and I'm still expecting that to happen.”

So, the bottom line is that Switzerland's birth rate remains well below replacement level despite this recent rise, and the American birth rate remains just slightly below replacement level despite this recent drop. Everybody take a deep breath...

The Consequences of More People Living Later into Old Age

For the past week there has been an emphasis on aging in this blog--not necessarily related to the fact that I recently had a birthday! The Smithsonian article I mentioned three days ago included results from a Pew Research survey finding that most people are actually a bit cautious about wanting to live too long. We want to be healthy, but living a lot more years beyond 100 isn't necessarily the thing that most people are thinking about. 

When the Pew Research Center asked Americans in 2013 whether they would use technologies that allowed them to live to 120 or beyond, 56 percent said no. Two-thirds of respondents believed that radically longer life spans would strain natural resources, and that these treatments would only ever be available to the wealthy.

But if these treatments were more widely available, there would be severe economic consequences. A recent report from the Social Security Administration suggests that too many people aged 65 and older in the U.S. are too reliant on Social Security for their income.

This note examines reliance on Social Security bene ts among people aged 65 or older as mea- sured by the 2015 CPS and two other major surveys. All three surveys report that roughly half of the aged popu- lation live in households that receive at least 50 percent of total family income from Social Security and about one-quarter of the aged live in households that receive at least 90 percent of family income from Social Security.

The problem, of course, is that many people aren't saving enough for their own retirement (as I discuss periodically), but even if they are, that savings plan is based on an expected number of years lived that is well below even 122, much less something beyond that number. And why aren't we saving enough? There are many answers to this question, but a big one revolves around the fact that we live in a society whose economy is based on consumption, not production. Today's Economist Espresso has a short piece on the American economy with the following comment: "Consumers are responsible for almost 70 cents of every dollar spent in America. So when consumption grew only slowly at the start of 2017, growth sagged to 1.4%."

We consume instead of produce in part because lower wages in developing countries (especially China) have made goods cheaper than they were when we were producing them at a higher cost. That seems like a rise in our standard of living, but that is ephemeral. We can buy more, but since we're not producing like we used to, we go into debt more. This is not a sustainable model. As I discuss in the book, in the long run we need to come to grips with the fact that a planet with finite resources cannot tolerate growth forever. That might have seemed possible when we had many fewer billions of people, but it certainly is not now true. 

So, the consequences of more people living later into old age will almost certainly be economically catastrophic if we don't dramatically change our way of thinking about the economy in general. On that note, have a good weekend...

Update to "What If We Can't Possibly Live Past Age 122"

Two days ago I blogged about the possibility (a distant one, to be sure) that humans might live to be 1,000 years old. Yesterday, I blogged about a study published a few months ago in Nature suggesting that we have hit the limit of human lifespan and it is 122. Eddie Hunsinger quickly emailed me to point out that I had suggested in yesterday's blog that Jim Vaupel and Jay Olshansky both thought that the limit of human lifespan was 122, but in fact only Vaupel had made that assertion. Eddie was absolutely correct and so I am updating my thoughts here to get them in line with what the article in Retraction Watch actually said:

Jim Vaupel, a gerontologist at the Max Planck Institute for Demographic Research in Rostock, Germany and one of the authors of one of the BCAs, was one of the harshest critics. He told Retraction Watch: The “findings” stem from their naive use of inappropriate data…The balance of evidence suggests that if there is a limit, it is above 120, perhaps much above and perhaps there is not a limit at all. Whether or not there is a looming limit is an important scientific question. Because they used weak statistical methods to analyze inappropriate data, they contribute nothing useful to deeper understanding of human life expectancy and human lifespan.

Whereas:

Jay Olshansky, of the University of Illinois at Chicago — who both reviewed the original article and wrote a “News and Views” piece accompanying it, told Retraction Watch that the authors of the rebuttals are “missing the point:” The rebuttals are mostly focused on slightly different ways of looking at the same limited data; basically, if you tilt your head a little to the left or right and look at the same old age mortality/survival statistics for all humans, you might come to slightly different conclusions. They quibble about how to deal with the mathematics of small numbers at extreme old age, and they fail to realize the obvious, staring them right in the face: the number of people surviving to extreme old age is so small because there is a biologically based limit to life operating on our species, and what they’re quibbling about is the byproduct of the very phenomenon they think does not exist.

Olshansky's conclusion is OK if we are seeking evidence only from the past record of ages at death. But, there are two problems with that, one of which was noted by the Retraction Watch article:

Vaupel also...told Retraction Watch that maximum age at death was even the wrong statistic — instead, the authors should have been looking at the oldest person alive in a given year: In many years the maximum lifespan attained in that year is greater than the maximum age at death–because someone is still alive at an age greater than the maximum age at death. An analysis of maximum lifespans should focus on the oldest age attained over time. As the graph we cite in our note shows, maximum lifespans have tended to steadily rise over time with no looming limit in sight.

And that, of course, it exactly the point I was trying to make. If new advances in the science of aging are taking place, people are going to be staying alive longer, rather than dying. Now, to be sure, as Eddie and I discussed, the potentially dramatic changes in old age science could really alter the picture of human lifespan--or they may just make us healthier until we die at an age no older than 122. Only time will tell.

What If We Can't Possibly Live Past Age 122?

Thanks to Rebecca Clark for pointing to a "widely publicized Nature study" that I had admittedly missed last October, but which is now the subject of a lot of controversy, as summarized in Retraction Watch. In their letter (not quite a paper), the authors from the Albert Einstein College of Medicine in New York, argue that ever since Jeanne Calmest died in France in 1997 at age 122, there have been on older ages at death. Therefore, the rise in the oldest age at death (which we define as the human lifespan) appears to have leveled off, and maybe will never go above 122.

Two of the key people arguing that this is an unfounded conclusion are Jim Vaupel of the Max Planck Institute for Demography in Germany and Jay Olshansky of the University of Illinois, Chicago. Both are foremost authorities on the topic of aging and are widely cited in my text. The major point here is that new scientific ways of dealing with aging, including regenerative medicine and other approaches, as I discussed yesterday, offer at least the suggestion that the oldest age at death could be pushed to higher--maybe even a lot higher--ages. To ignore that science seems, well, unscientific...