{"id":26828,"date":"2013-06-03T15:03:09","date_gmt":"2013-06-03T14:03:09","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmj\/?p=26828"},"modified":"2013-06-03T15:05:40","modified_gmt":"2013-06-03T14:05:40","slug":"richard-smith-longevity-is-one-of-the-greatest-curses-introduced-by-the-scientists","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmj\/2013\/06\/03\/richard-smith-longevity-is-one-of-the-greatest-curses-introduced-by-the-scientists\/","title":{"rendered":"Richard Smith: \u201cLongevity is one of the greatest curses introduced by the scientists\u201d"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" alt=\"Richard Smith\" src=\"http:\/\/www.bmj.com\/site\/blog\/icons\/bmjh7648e.jpg\" width=\"160\" height=\"110\" align=\"left\" \/>\u201cLongevity is one of the greatest curses introduced by the scientists,\u201d wrote Evelyn Waugh in a letter to Harold Action in 1961, a few days after his 58th birthday. I read this a few days after I had given a talk on the pandemic of NCD (non-communicable disease) where I emphasised that the pandemic was the result of \u201csuccess\u201d in extending life expectancy. But could Waugh be right?<\/p>\n<p>Minutes after reading Waugh\u2019s statement I read Matthew Arnold\u2019s bleak poem on growing old, written in 1867, when he was 45.<!--more--><\/p>\n<p><strong>Growing Old<\/strong><\/p>\n<p>What is it to grow old?<br \/>\nIs it to lose the glory of the form,<br \/>\nThe lustre of the eye?<br \/>\nIs it for beauty to forego her wreath?<br \/>\nYes, but not for this alone.<\/p>\n<p>Is it to feel our strength &#8211;<br \/>\nNot our bloom only, but our strength -decay?<br \/>\nIs it to feel each limb<br \/>\nGrow stiffer, every function less exact,<br \/>\nEach nerve more weakly strung?<\/p>\n<p>Yes, this, and more! but not,<br \/>\nAh, &#8217;tis not what in youth we dreamed &#8216;twould be!<br \/>\n&#8216;Tis not to have our life<br \/>\nMellowed and softened as with sunset-glow,<br \/>\nA golden day&#8217;s decline!<\/p>\n<p>&#8216;Tis not to see the world<br \/>\nAs from a height, with rapt prophetic eyes,<br \/>\nAnd heart profoundly stirred;<br \/>\nAnd weep, and feel the fulness of the past,<br \/>\nThe years that are no more!<\/p>\n<p>It is to spend long days<br \/>\nAnd not once feel that we were ever young.<br \/>\nIt is to add, immured<br \/>\nIn the hot prison of the present, month<br \/>\nTo month with weary pain.<\/p>\n<p>It is to suffer this,<br \/>\nAnd feel but half, and feebly, what we feel:<br \/>\nDeep in our hidden heart<br \/>\nFesters the dull remembrance of a change,<br \/>\nBut no emotion -none.<\/p>\n<p>It is -last stage of all &#8211;<br \/>\nWhen we are frozen up within, and quite<br \/>\nThe phantom of ourselves,<br \/>\nTo hear the world applaud the hollow ghost<br \/>\nWhich blamed the living man.<\/p>\n<p>Why, I wonder, did Arnold have such a bleak view of old age at 45? But as a poet he\u2019s by no means alone in his view. Philip Larkin expresses similar thoughts in <em>The Old Fools<\/em>, referring to old age as \u201cThe whole hideous inverted childhood.\u201d<\/p>\n<p>What do they think has happened, the old fools,<br \/>\nTo make them like this? Do they somehow suppose<br \/>\nIt&#8217;s more grown-up when your mouth hangs open and drools,<br \/>\nAnd you keep on pissing yourself, and can&#8217;t remember<br \/>\nWho called this morning?<\/p>\n<p>Larkin was 46 when he wrote that poem. Arnold died aged 66, Larkin at 63, and Waugh at 62. Waugh was a devout Catholic and may have been looking forward enthusiastically to the afterlife. In a letter written in 1962 he objects to a \u201cturncoat\u201d being elected to parliament and writes:\u00a0 \u201cIt shows there is no justice in this world and that one must look to a life beyond the grave to regulate the accounts.\u201d Lady Marchmain in Waugh\u2019s <em>Brideshead Revisited<\/em> makes clear that what happens in this life matters little, it is the next life that matters.<\/p>\n<p>I don\u2019t believe in an afterlife, and I\u2019m 61, close to the age at which all three writers died. Two weeks ago I walked a hundred miles along the Devon coast with others in their 60s, and none of us found it much of a difficulty. I can\u2019t say that I feel old, so far I\u2019ve been remarkably lucky with my health\u2014my greatest <a href=\"https:\/\/stg-blogs.bmj.com\/bmj\/2012\/07\/16\/richard-smith-homesickness-my-most-serious-disease\/\">suffering being homesickness<\/a> when I was 10.<\/p>\n<p>But I have a profound respect for poets, perhaps too profound, and I thought of Waugh\u2019s statement on longevity as yesterday I visited a residential home that might take my mother. She is 83 with no short term memory, but remarkably jolly. I think I know that my 45 year old mother, who at that age used to visit her demented mother in a home, would not have wanted to be as she is now. But is that relevant now she\u2019s 83? She is as she is, but does anybody enjoy being in a residential home? There is singing, painting, eating, and disjointed conversation, but the main occupation is waiting for death, a wait that can seem long. \u201cWho benefits,\u201d asks Lewis Lapham, another great writer, \u201cfrom the inventory of suffering gathered in the Florida storage facilities?\u201d<\/p>\n<p>Anthony Trollope, one of my favourite writers, wrote in <em>The Fixed Period<\/em> about an imagined new colony that recognised the uselessness of the old, how they cost much, but contributed little. So at age 67 they were \u201cdeposited\u201d in a college where they reflected on their life for a year before being compulsory euthanased and then cremated, itself controversial in 1862 when Trollope published his book. The debate in the book is that the first person to enter the college, he who proposed the system, has second thoughts. Trollope was himself 67 when the book was published, and he died while still 67.<\/p>\n<p>The great doctor William Osler referred to Trollope\u2019s book in his farewell speech at Johns Hopkins, was misunderstood as having advocated euthanasia (at 60), and received worldwide condemnation.<\/p>\n<p>What is the \u201cright\u201d age at which to die? WHO agreed with the Bible last week at the World Health Assembly when it defined premature death as death under 70, but some militants, like Iona Heath, former president of the Royal College of General Practitioners, have suggested 60. (She is, I guess, at least as old as me and possibly older.)<\/p>\n<p>Perhaps even Waugh might agree that what matters is healthy life expectancy, which is unfortunately and unsurprisingly not as easy to measure as total life expectancy. At the moment, according to the Office of National Statistics, healthy life expectancy for men in England is 64, meaning that a fifth of life is spent in ill health. At the last count the proportion of life spent in good health was rising in England and Wales but falling in Scotland and Northern Ireland. The pandemic of obesity and diabetes could well mean that the proportion of healthy life will fall.<\/p>\n<p>So perhaps Waugh is more right than wrong, but, as a Mexican friend reminded me while I was writing this blog, Susan Ertz noted that \u201cmillions long for immortality who don&#8217;t know what to do with themselves on a rainy Sunday afternoon.&#8221;<\/p>\n<p><em><strong>Richard Smith<\/strong> was the editor of the BMJ until 2004 and is director of the United Health Group&#8217;s chronic disease initiative.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u201cLongevity is one of the greatest curses introduced by the scientists,\u201d wrote Evelyn Waugh in a letter to Harold Action in 1961, a few days after his 58th birthday. I read this a few days after I had given a talk on the pandemic of NCD (non-communicable disease) where I emphasised that the pandemic was [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bmj\/2013\/06\/03\/richard-smith-longevity-is-one-of-the-greatest-curses-introduced-by-the-scientists\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":38364,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[955,447],"tags":[],"class_list":["post-26828","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-richard-smith","category-india"],"jetpack_featured_media_url":"https:\/\/stg-blogs.bmj.com\/bmj\/files\/2017\/02\/Richard-Smith.jpg","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/26828","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/comments?post=26828"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/26828\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media\/38364"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media?parent=26828"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/categories?post=26828"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/tags?post=26828"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}