Dying is not a glitch. To the contrary, dying makes you strive. But is it possible we soon lose that certainty? Imagine your time left would be indefinite, why should you bother doing things today?

While, according to Franz Kafka, “The meaning of life is that it stops,” we have started to see the first ideas and concepts that seem to make this quote outdated.

But first things first. How long do you want to live – to 85, 90, 100 or beyond? For most of us, more important than how long we live is the state of our health in old age. Instead of extending lifespan, we should extend health span.

Today, we’re not there yet, at least not in the conventional way.

Since the 19th century, average life expectancy has risen almost continuously, with a baby born today expected to live until 81, compared to just 50 in 1900. This was mainly due to improved hygiene – the common use of soap therefore is to my opinion the biggest invention ever – as with the introduction of vaccines later on.

Much of the future increases in lifespan however will be due to improvements for the over-65s rather than reductions in deaths during childhood. Imperial College London and the World Health Organization analysed lifespans in 35 industrialised countries. It predicted all would see people living longer in 2030 and the gap between men and women would start to close in most countries. South Korean women will be the first in the world to have an average life expectancy above 90, the study suggested.

The march of improvement in longevity led many scientists to speculate that there is no upper limit on how long humans can live for. On the other hand, scientists at the Albert Einstein College of Medicine, in New York, believe that human life expectancy probably peaked in 1997 with the death of the world’s oldest woman Jeanne Calment, who died age 122. The researchers believe that imperfections in the copying of genes will always mean there is finite limit to human life. The claim that 125 years is the limit of human lifespan and the chance of a supercentenarian passing that is just one in 10,000.

Nevertheless, ageing is really plastic in simple lab organisms. In worms for instance we can increase lifespan by 500%. In more complex animals like mice, we’ve been able to increase lifespan by 20-30%. But we don’t know what’s possible in humans.

Two main streams of intervention are being pursued. The first is to understand the root causes of aging and stop them before damage accumulates. Geroprotective drugs are a big topic. Often repurposed from drugs already on the market, these traditional small molecule drugs target a wide variety of metabolic pathways that play a role in aging. Think anti-oxidants (like resveratrol, the natural chemical compound found in grapes, red wine, and other foods), anti-inflammatory, and drugs that mimic caloric restriction, a proven way to extend healthspan in animal models.

The second approach is repair and maintenance. The main example is Stem cell therapy. This type of approach would especially benefit the brain, which harbors small, scattered numbers of stem cells that deplete with age. For neurodegenerative diseases like Alzheimer’s, in which neurons progressively die off, stem cell therapy could in theory replace those lost cells and mend those broken circuits.

The discovery of induced pluripotent stem cells (iPSCs), where scientists can turn skin and other mature cells back into a stem-like state, hugely propelled the field closer to reality. Newer repair systems, like gene-editing technology CRISPR, as well as the printing of organs to replace broken ones are popular alternatives being pursued in many labs now. Techniques for building nanorobots are being developed that should make the repair of our cells possible. For example, as we age, DNA in our cells is damaged by radiation or chemicals in our bodies. Nanorobots would be able to repair the damaged DNA and allow our cells to function correctly.

The latest trend are senolytics, a class of drugs that kill off senescent or “zombie cells.” Over 10 prospective candidates are already in the pipeline, with some expected to enter the market in less than a decade. The idea of innate senescence suggests that we have a master clock inside of us that counts down the hours of our lives. There are indeed clocks like this. The most famous are telomeres—little snippets of DNA which get shortened each time a cell divides. The study of telomeres has been controversial. It is not clear if telomere shortening is a cause or an effect of aging. Telomeres do not shorten in constant amounts—while there is a minimum amount that comes off at each cell division, they will shorten at a faster rate if the cell has been damaged through other means. Many researchers now believe that telomere shortening is more of a symptom of aging than its cause.

A few players to watch are Calico, backed by Google with the goal of combating aging and associated diseases, Unity Biotechnology (which raised over $200M lately), and most recent resTORbio and Spring Discovery. Also, leading startup incubator Y Combinator announced YC Bio to target lifespan extension in its future breed of startups specifically.

One might argue however that our mind could survive without the body. Not surprisingly there are startups to upload your brain so you can keep living digitally. The first startup with a confirmed 100% mortality rate.

Last month, a startup called Nectome, announced its plans, still in their initial phases, to inject the brain with a special formula, in a technique known as aldehyde-stabilized cryopreservation (ACS). This will preserve the neural connections thought by some neuroscientists to encode a person’s mind, potentially for hundreds of years. The hope is that, eventually, it will be feasible to “digitize this information” and use it to “recreate your consciousness,” according to the company’s website. It might provide a glimmer of hope to terminally ill people, for example, who want their consciousness to live on. “We archive your mind” to “Committed to the goal of archiving your mind,” which seemed less like an overpromise. Never has the cryonics movement, with its promise of reviving frozen bodies in the future, seemed so old-school.

Indeed, we have technologically progressed, to envision our avatars, to enable the person they’re copying to live forever. Indeed, as this buddy is one part digital, you will be able to store yourself, who you have been, for future generations, in a kind of historical, digital archive.

New Dimensions in Testimony, for instance, is a new way of preserving history for future generations. The project brings to life the stories of Holocaust survivors with 3D video, revealing raw first-hand accounts that are more interactive than learning through a history book. Holocaust survivor Pinchas Gutter, the first subject of the project, was filmed answering over 1000 questions, generating approximately 25 hours of footage. By incorporating natural language processing, people are able to ask Gutter’s projected image questions that trigger relevant responses.

It will remind you to that Black Mirror episode, a while ago, Be Right Back It first aired on February 11th 2013. This particular episode tells the story of Martha, a young woman whose boyfriend Ash is killed in a car accident. As she mourns him, she discovers that technology now allows her to communicate with an artificial intelligence imitating Ash and reluctantly decides to give it a try. “Be Right Back” had two sources of inspiration: the question of whether to delete a dead friend’s phone number from one’s contacts, and the idea that software could create Twitter posts mimicking dead people.

Google and Facebook have created systems to deal with death, such as suspending inactive accounts and allowing people to bequeath their data to a surviving friend or relative. Some companies offer related services: PasswordBox and Entrustnet allow users to nominate an “executor” who will act out their digital wishes after death, including passing on account information to designated heirs.

An interesting entry in the e-death industry is a small start-up Eterni.me, which is taking end-of-life services to  the next frontier. “We all pass away sooner or later, leaving only a few memories behind for family, friends and humanity—and eventually we are all forgotten,” the Web site reads. “But what if you could be remembered forever?” The company plans to store data from Facebook, Twitter, email, photos, video, location information, but also wearables like Google Glass and Fitbit devices. While you are living, you can curate and add to this material; you can also choose privacy settings and determine what information you want stored and made public.

The service’s defining feature is a 3-D digital avatar, designed to look and sound like you, whose job will be to emulate your personality and dish out bits of information to friends and family taken from a database of stored information. A user will be encouraged to “train” its avatar, through daily interactions, in order to improve its vocabulary and conversational skills. Think of it as a more advanced version of Siri, who will be able to “respond to questions more naturally, and learn from every conversation you have with her.”

Developmental psychologists often talk about the importance of leaving a legacy behind: something tied to who we are that will outlive us. Recently, at a festival called ‘Before you die’, this universal wish became clear again. But this is usually something obvious, like having children or writing a novel. An avatar with an approximation of your voice and bone structure, who can tell your great-grandchildren how many Twitter followers you had, doesn’t feel like the same thing.

And nevertheless, it is enough to start the debate. The debate on the nature of our virtual alter ego, we now call a Digital twin. The human digital twin is also the topic of a bold proposal put forward by the Health EU project, of which the tagline is “Human avatars to prevent and cure diseases.” This international project recently applied to become a FET Flagship (a prestigious multi-disciplinary research program run by the European Union that offers one billion euros in funding over ten years.)

Indeed, we can start to envision our digital guardian angel and permanent personal assistant that automatically crunches vast amounts of biological, behavioral, and environmental (so-called real-world) data to spot and predict personalized health risks, before they cause real harm. One can only imagine the power this would give us in both preventing sickness and proactively pursuing health and well-being. As said, our main goal should be to extend health span, not lifespan.

To be continued at Hack Belgium, April 26-28, 2018, in the health track “Sick no more”. And in my upcoming book, May 2018, on the creation of health by delight.

Ready to hack Health at Hack Belgium 2018?

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