Raiany Romanni is a Harvard Kennedy Fellow in Effective Altruism, an A360 Scholar, a Stanford Existential Risk Fellow, and a bioethicist. She is currently working on a non-fiction book aimed at catalyzing the ethics of longevity research, while suggesting that aging is the costliest of all human diseases.
You are a bioethicist. Could you explain to our readers what this is, how did you become one, and why we need bioethicists around?
The easy answer would be to point at my degree in bioethics, from Harvard Medical School. The more accurate answer, however, would be to say that I became a bioethicist because I’ve always been obsessed with life. What does it mean to be alive, or dead? How have the meanings we ascribe to life evolved over the centuries? My training in philosophy seemed insufficient to address these questions. Theory is only useful if we can translate it to the suffering of real persons, and to the emerging world of converging technologies which will transfigure “the” meaning of life.
We need bioethicists around because what is right isn’t always intuitive, and it takes rigorous work to understand how best to augment human flourishing. As a bioethicist, I try to occupy myself with what is quantifiably good for human societies. I recently became a Harvard Kennedy Fellow in Effective Altruism (EA) and believe EA supplements the work of bioethics by encouraging counterintuitive questions like “What if we treated the fundamental processes of aging, instead of Alzheimer’s? Would that — objectively — be a better use of our limited resources towards our existing goal of extending human healthspan?”
We currently spend a little over 1% of all National Institutes of Health funding on the fundamental processes of aging. Meanwhile, some 80% of an average individual’s medical expenses occur past the age of forty. There’s a significant mismatch here.
Our society spends billions of dollars on fighting diseases and keeping people alive for as long as possible, sometimes to the point of absurdity. Yet, there is a lot of resistance when we dare to talk about solving aging or extending lifespan. Why do you think this happens, and how do you deal with it?
For all our medical breakthroughs, two things have remained rather constant throughout history: human lifespan and human healthspan. For every human life, we have consistently recorded one death, at a maximum age of 122. At around 25, we begin to decay. These two facts often overshadow the remarkable fact that we’ve engineered a doubling in average life expectancy over the past century.
The eradication of smallpox and polio — and the relative control of nearly all infectious diseases — was hardly insignificant. But the fact that we haven’t doubled the number of years a human can live — let alone in good health — legitimately contributes to the public’s disbelief that scientists may be able to achieve this.
We’re wired to appreciate the world through an availability heuristic: the examples we can most readily recall often guide our moral reasoning. So, it’s not altogether irrational that people should question our ability to reverse aging. Only a small fraction of the world’s population devotes their time to reading dense, scientific papers, which indeed prove that several mechanisms of aging can be quite easily manipulated. And only a small fraction of the world’s population wants to deal with the ethical challenges that accompany this fast-arriving revolution.
We’ve built so much of our infrastructure around the idea of death and gradual decay that most of us would rather just reject the messy possibility of a longer, healthy life. It seems like too much work. With radical health extension, what do we do about incarceration or monogamy? These are difficult questions—but certainly worth answering.
As a myth, the notion that death is a progress-furthering entity, and aging a necessary parcel of life, made sense. For millennia, it was a helpful narrative, needed to cope with the gruesomeness of bodily decay, when we could do nothing about it. We certainly didn’t have the converging technologies, when the Black Plague killed a good half of the European population, to hope otherwise. In that context, religion, too, was a rational choice.
Responding from a place of recognition of the public’s rationality, rather than the (misguided) assumption that people reject longevity research because they are irrational, is helpful, I think. People rely on heuristics to do their own scanning of the world, and those can be misleading at times, but I like to believe that if offered a full picture of the problem of aging, a good portion of us would be convinced it must be solved.
Do you think that ethical and economic arguments in favor of life extension work in synergy, or maybe invoking economy and profit devalues the moral foundations of our cause?
The ethics, in my view, can’t be considered without consideration of the economic, downstream effects. If you think ethics ought to be addressed without regard to economic impact, then you can’t talk about equitable distribution, affordability, or even the creation of these therapies in the first place (which, whether theorists like it or not, requires money).
We can’t reduce the ethics to just economics: a mistake often made when bioethicists assume that biotechnologies should only be pursued if they can be made immediately affordable. But we also can’t undermine the fact that increased capital can translate directly into increased human flourishing.
To be relevant (i.e., not constantly outpaced by the science), I think bioethicists must learn to consider technologies in principle: to assume that they could work, could be quite equitably distributed (not in ideal, Rawlsian worlds, but in the flawed societies we’ve got), and could go through all phases of a clinical trial. Then, we get to truly interesting questions.
If we could engineer ourselves out of aging, would we risk engineering ourselves, too, out of the meaning of human life? The answer, I think, is yes: but only as much as we engineered ourselves out of the meaning of life in the Stone Age, when to be human meant to hunt and gather for one’s every meal—until it didn’t.
Recently, I read an op-ed in The Guardian, where the author was attacking the longevity field because he sees it as “billionaires trying to reach immortality by spending tons of money.” This is ridiculous, of course, but how do you think the growing involvement of personalities like Jeff Bezos in our field affects its moral landscape?
First, I think the wealthy should be rewarded for funding these life-saving technologies towards clinical safety, and — eventually — towards governmental adoption. If there is no reward, there are no therapies, no trickle-down effect, no decreased human suffering.
The sad part, for me, is that venture capital alone, absent governmental funding, is going to take decades, if not centuries, longer to deliver commercial-grade aging therapies. Imagine, for a minute, that for some odd reason governments decided during the COVID-19 pandemic that they would leave it all to private capital. We’d probably get to a vaccine, and to some level of social relief, but not within the span of several months.
Again, only about 1% of all National Institutes of Health funding goes to fundamental aging research. So, at least we have people like Bezos and Thiel and Zuckerberg interested in disrupting the healthcare system. I hope they do: we’d all benefit from it.
Are you interested in the ethics of extreme life extension? Have you ever thought about what an ageless society might look like? I personally think so much in our civilization depends on aging and mortality that it’s hard to imagine a world without them.
I’m interested in increased human flourishing, and diminished suffering. Whether a civilization that could repeatedly reset its biological clock could achieve both is a question at least worth pursuing.
We’ve built our entire infrastructure to sustain—not solve—the problem of aging. Nick Bostrom’s “The Fable of the Dragon Tyrant” is a brilliant caricature of this problem. If we could always return to a more youthful state — say, like Turritopsis dohrnii — I think we’d be incredibly productive. The US currently spends nearly half its federal budget every year on the effects of aging. Imagine the problems we could solve—and there will be no shortage of problems—if that funding were freed up.
But then, would innovation take place at a similar rate? Some studies show that people are most productive in their forties—when they’ve lived enough years to know what they are doing, but not enough that their cells can’t remember what they used to be. If the same person were in charge of innovation, say, through a two-hundred-year health-span, would they be prone to founding startups, and coming up with fresh solutions to old problems? I think we’d need to actively train this new civilization on the importance of remaining nimble, and not carrying biases. This may not be so easily achieved, but if the alternative is murdering these people, or burdening our healthcare systems, I think we all agree it would be well worth the effort.
So, yes, if we engineer ourselves out of aging, we will most likely engineer ourselves, too, out of “the” meaning of life. This would be neither the first nor the last time in history this happened. We’re the storytellers. The difference, in this century, is that the story is going to evolve at an unprecedented pace.
We are all ambassadors. I know I get to explain the idea of life extension quite often. Can you give our audience a piece of advice on how best to promote our cause?
The cause isn’t ours: it’s humanity’s. Health extension is a more effective way of doing what we’ve been doing all along: namely, extending life and health, and delaying death and decay.
Soon, our populations will begin to shrink—Japan, for example, is set to lose 21 million people by 2050. And, as Peter Diamandis writes, in technologically advanced societies—where misdistribution and not scarcity of resources is the issue—large populations are an asset. The more minds working towards human and planetary flourishing, the better.