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Diagnosing the Legacy NBA



The disease of colonialism

By Larry Krotz
Originally published: United Church Observer, July 2016

Can a straight line be drawn between rising rates of diabetes among Indigenous peoples and cultural assimilation?



Murdo McDougall has a disease that didn’t exist for his people when he was born 78 years ago. Now diabetes affects one in seven, or nearly 500 people (including youth and children), in his community of Garden Hill, an Oji-Cree First Nation on Island Lake in a remote corner of northeastern Manitoba. Some, like McDougall, manage to live with it successfully. He has kept it at bay for 25 years by sticking to what he calls “a traditional lifestyle,” continuing to fish, which he does commercially, and keeping active in his church, Henry Fiddler Memorial United.

McDougall’s nephew Clarence, the transportation co-ordinator for the Garden Hill nursing station, also has diabetes. Clarence is 54 and thin as a rake. He has established a regimen where he spends every evening at the Wa-Wa-Tay Fitness Centre, two tidy and spotlessly clean rooms in the local high school filled chock-a-block with exercise equipment set up by the local Aboriginal Diabetes Program. Clarence also makes it a point to eat his vegetables, “even if I have to swallow quickly to do so,” he laughs.

But the McDougalls are the exception. “Diabetes is killing us,” is the blunt assertion of Eric Wood, manager of the local community health program. Murdo and Clarence are controlling their diabetes through exercise and nutrition. Failure to control, though, produces devastating consequences. In the nursing station where Wood has his office, an entire wing has, since 2004, been given over to seven dialysis machines.

A lot is known about diabetes at Garden Hill. A decade ago, it was one of five First Nations to be studied intensively by Dr. Stewart Harris of Western University’s Schulich School of Medicine and Dentistry. In Harris’s 2010 report, 323 among the 3,000 people in Garden Hill were listed as having the disease. The average age of diagnosis was 40.6; 34 percent of the diabetics suffered chronic kidney disease; 11 percent had coronary artery disease; eight people were on dialysis; eight had suffered amputations of lower limbs; and four had gone blind.

During my visit this past spring, Larry Wood, the local Aboriginal Diabetes Initiative worker, told me that all the stats have gone up. The number of Garden Hill residents diagnosed with diabetes has now grown to 470; the age of onset has dropped ever younger; and 25 (or 43 if the three neighbouring reserves are included) are now on dialysis.

It is hard to put a positive or even hopeful spin on what diabetes is wreaking among First Nations across Canada. The situation can really only be framed as a scourge comparable to the plethora of other afflictions — medical, social and cultural — that have befallen Indigenous peoples since European contact and colonialism.

About 640 million people have diabetes worldwide, prompting the United Nations to call it “a global threat” and some media outlets to dub it “a tsunami.” Never mind that the disease has been around for a long time. About 3,500 years ago, Egyptian physician Hesy-Ra listed remedies to combat “the passing of too much urine.” For a few millennia, contracting Type 1 diabetes was a death sentence. Then in 1923, Dr. Frederick Banting and three other Canadian medical researchers discovered ways to make extracted insulin available for injection.

A few decades later, scientists distinguished between Type 1 and Type 2 diabetes. In Type 1, the pancreas fails to produce insulin — without injections, the patient would die. In Type 2, often associated with obesity or aging or both, the pancreas either produces insufficient insulin or the body struggles to put it to proper use. Type 2 diabetes can be controlled through strict lifestyle interventions such as exercise, weight loss and nutrition. Failure to control it can result in things like blindness, limb amputations and kidney failure (requiring dialysis or a kidney transplant). People in their 60s and 70s are at greatest risk for contracting the disease, though diabetes diagnoses have been on the rise for children in Canada since the 1980s.

For reasons that specialists are still working to understand, some population groups are at substantially higher risk. A 2014 study by the U.S. Centers for Disease Control and Prevention confirmed what has been common knowledge for about three decades: that Type 2 diabetes is found in much higher concentrations among Native Americans, African Americans and Hispanic Americans. Forty percent of Arizona’s Pima Indians have diabetes — the highest rate in the world.

There are all kinds of surveys and statistics. Among the more jarring facts is that in Canada, seven percent of Indigenous women over the age of 15 have been diagnosed with diabetes, compared to three percent for the rest of the female population, according to Statistics Canada. The rate of diabetes increases with age: 24 percent of Aboriginal women over the age of 65 have diabetes compared to 11 percent for the rest of older women in Canada.

Until about 1950, Type 2 diabetes was rare among Canada’s Indigenous peoples. Since then, it has increased to about double the national rate, and in some communities, it has reached three to five times the average. (Type 1 diabetes remains rare among Canada’s Indigenous peoples.) Winnipeg’s Dr. Michael Moffatt, who began his career in the 1970s among the Cree of northern Quebec and the Dogrib of the Northwest Territories, recalls no cases of diabetes at all when he was a young physician. Later, when he became head of Manitoba’s Northern Medical Unit, supervising hospitals in Churchill, Norway House and Rankin Inlet and overseeing fly-in doctors to isolated First Nations, “I started encountering it everywhere.”

A big question is: why? One theory, widely circulated for a time, had a genetic basis. The hypothesis, called “thrifty gene,” held that over thousands of years living off the land, Indigenous hunters had survived cycles of famine and feast by facilitating efficient fat storage during times of abundant food. In modern times, however, abrupt lifestyle changes and the abundance of food — particularly high-fat, high-sodium processed foods — render that genetic trait a disadvantage. For people already predisposed to relative hyperinsulinemia, upper body obesity, insulin resistance or beta cell exhaustion with impairments in insulin secretion, adding an unhealthy diet and a lack of exercise can pave the way toward diabetes. There is resistance in some quarters to any explanations based on genetics or race. However, most scientists accept that genetics and ethnicity play some role.

Many of these lifestyle changes are the result of colonialism. The report of the Truth and Reconciliation Commission argues that residential schools caused social problems that have led to health disparities. For many First Nations, being sent to residential school marked the first time their diets changed drastically — typically from wild food to meals high in carbohydrates. Murdo McDougall adds that Garden Hill families stopped planting their own crops when the community switched to a cash economy (with family allowances) and children, who would otherwise have helped tend the gardens, were sent off to residential school. The community store, at that time still run by the Hudson’s Bay Company, became the predominant source of food, including junk food.

Where people have stuck to their traditional lifestyles, outcomes have been different. Dr. Jim Carson, another Northern Medical Unit doctor, tells the story of a 40-year-old Inuit man suffering from the disease when he was observed in late summer. “He went off on his trap line, returning in the spring 40 pounds lighter and diabetes-free. The coke, candy bars and chips of his sedentary existence had been replaced by ‘country food’ — wild game and broth soups — and the exercise of his trapping work.” The Pima Indians of Arizona have the highest rates of diabetes, while their cousins across the border in Mexico, who have stuck to a more traditional existence, have numbers that are in line with non-Indigenous populations.

Diabetes in First Nations people has been the concern of Western University’s Dr. Harris since he was a young graduate in the 1980s and based in Sioux Lookout in northwestern Ontario. One of the First Nations in his territory, Sandy Lake, now has a 35 percent prevalence of adult diabetes. Harris points out though that during his working life, not only diabetes but all chronic diseases have shown an up-tic. “Massive change to the lifestyle and environment unmasked or facilitated the emergence of cardiovascular disease. Cancer rates are skyrocketing in First Nations populations.”

Diabetes is an expensive disease. The Lancet and PharmacoEconomics recently estimated its annual cost at $1 trillion. In places like Garden Hill, health care is the biggest industry. So many people required dialysis — and had to go so far to obtain it — that the provincial government paid $5.2 million for its dialysis unit. Patients from neighbouring reserves, St. Theresa Point, Wasagamack and Red Sucker Lake, fly in and out for their sessions by helicopter.

When I visited, I learned that the dialysis unit was mandated to support 18 patients. That turned out to be not enough. Twenty-five are on a wait-list and have had to move to Winnipeg to obtain their treatments there. It costs between $95,000 and $107,000 a year to provide a patient with dialysis, not to mention the costs to treat the many complications of the diabetes — vascular problems leading to amputations, nerve damage, blindness. Though not all of the nearly 500 people with diabetes in Garden Hill are in need of expensive levels of care, ultimately many of them will be. Recruiting and keeping trained staff for the dialysis unit is an ongoing challenge, as is finding a secure system of reliably pure water. The unit is periodically shut down as a result of chronic water quality issues.

Along with the economic costs of diabetes come social and psychological costs. The disease disrupts families, stirs anxiety, causes physical suffering, and shifts a patient’s energy and activity away from family and the community and toward his or her own health.

And diabetes isn’t the only problem facing Garden Hill. The community has all the challenges we’ve become used to hearing about from isolated First Nations. It depends on winter roads to bring in supplies, and warm weather this year rendered the road chancy. The band government is in financial default and under third-party management. Unemployment is high, and disaffected youth have formed at least two gangs.

Frances Desjarlais has been working on diabetes for her entire career. The First Nations woman trained as a nurse 30 years ago in her home community of Swan River, Man. Desjarlais, since 2007, has been regional diabetes co-ordinator for Health Canada’s First Nations and Inuit Health Branch in Winnipeg. Her job is to oversee and support 64 local diabetes workers (like Garden Hill’s Larry Wood) on every Manitoba First Nation, as well as meet regularly and provide encouragement and resources to the diabetes co-ordinators of Manitoba’s seven tribal councils. The objective for the next 10 years, she says, is to “slow down the rate of complications, lower diagnosis rates. It’s going to take a long time, but we need to see those numbers.”

When Desjarlais herself was diagnosed 13 years ago, she recalls, “I was floored.” The shock made her understand the predicament of her patients. “Because of my nursing background, I have more information than the normal person. But when you’re living with diabetes, you have all the same emotions; the fact that I’m a diabetes educator doesn’t mean squat. I knew I was going to have to live with this, adjust my diet, learn moderation — that’s a big word for me now — get past my ‘woe is me.’” She started walking every day as a regimen of exercise.

Many of those living with diabetes in Garden Hill, along with the family members and health workers who support them, are getting past the “woe is me” to find solutions that will improve everyone’s health.

Through the Aboriginal Diabetes Initiative and the efforts of its employee, Larry Wood, the Wa-Wa-Tay Fitness Centre is fully equipped. Provincial government funding was used to erect a barn for the community to raise a thousand chickens and to purchase tillers and seeds to grow community gardens. Grade 10 students have become mentors to Grade 4 kids, working with them to get exercise and prepare healthy snacks. The local Northern Store is in the fourth year of using federal subsidies to lower the prices on perishable foods such as milk and fruit. At neighbouring St. Theresa Point, health workers arrange cooking classes, walkathons, nutritional bingos and initiatives to bring nutrition awareness to the local store. It is all positive and all desperately timely.

Desjarlais, like Murdo McDougall, believes there also needs to be a return to emphasis on the land, Native medicine and cultural wholeness. “Aboriginal people need to look at our teachings and traditions of caring for ourselves, care for our bodies,” she says. “We need to take back our Indigenousness, go back to our gardens, back to the land as when we were healthy. When we worked hard and our kids played outside instead of couch surfing, we were healthier. Processed food, smoking — we need to step back and see what we can do. This isn’t just one thing, diabetes, this is everything. We need to work with families and elders. It’s going to take us a while, but we need to do that.”

Looking into the future, it takes courage to see beyond more expenses, shortened lives and misery. Fighting diabetes among Indigenous people will require constant vigilance along with the sense that victory, though slow, is possible.


Forever


By Larry Krotz
Originally published: United Church Observer, May 2015

How close are scientists to helping us live a great deal longer? Researchers are using cutting-edge science in a quest to defy mortality. How far should they go?


In 1513, when the Spanish explorer Ponce de León was searching for the fabled fountain of youth, he went to Florida. After wading through malarial swamps, the legend goes, he came upon some disease-free spring water around what would become St. Augustine. He declared it the fountain of youth, and it became his fame. Five centuries later, when I am looking for something similar — an explanation for aging and an answer to the question of whether we might do something about it — I get on a plane for California. My destination is the Buck Institute, a stunning building of glass and white travertine stone designed by I.M. Pei and set like a jewel on 200 hectares of wooded hillside in Marin County, north of San Francisco.

In 1900, the average life expectancy for a Canadian was 50. Some, of course, lived much longer, but those who died as infants or in childbirth or of various infections kept down the averages. By 1990, with improved sanitation, antibiotics, vaccines and better practices during childbirth, average life expectancy had risen to 74 for males and 81 for females. By 2012, it was 77 and 82. Could it improve any further? The low-hanging fruit has already been plucked. Further gains would require crossing a new frontier: making old people live even longer — perhaps dramatically longer.

The Buck Institute bills itself as the world’s leading private institution dedicated to the study of aging, and its scientists even coined a term for their investigation — “geroscience.” They dare to ask: Why do we age? And is it possible to slow, stop or even reverse that process? The questions challenge assumptions that hold sacred places in our culture: that aging is a natural and inevitable process, and death is as certain as taxes. How much should we tinker with what most of us believe is a set limit to the human lifespan?

As I started my research, I felt unsettled. Apparently I’m not totally enthralled about the possibilities of science transcending nature. I couldn’t escape a feeling of disloyalty to the proper rhythms of the universe. The Psalmist pegged the ideal human lifespan at threescore years and 10, or even fourscore for the strong (that’s 70 or 80). We are told that Moses lived to 120, Noah to 950 and Methuselah to 969. But I always assumed those numbers were exaggerated — or somehow from a different calendar. The longevity record in modern times is 122, held by a French woman named Jeanne Calment, who died in 1997.

It’s hard to argue that longer life is a negative thing. Yet there have always been opposing camps. Aristotle described the elderly as those whose “passions have slackened, and they are slaves to the love of gain.” The centuries-long quest to turn nature on its head has included some wacky practices, such as implants of goat testicles and ingestion of radium-laced elixirs. In 1934, poet W.B. Yeats emerged from what was in effect a vasectomy at age 68 claiming to be frisky as a colt. Scientific research into aging has roots in the 1960s, but it got going in earnest in the early 1990s with a generation of scientists who remain active today — several of them at the Buck.

The Buck Institute was established by the estate of Marin County philanthropists Beryl and Leonard Buck. Leonard, a pathologist whose family owned an oil company, died in the 1950s. His widow, Beryl, died in 1975 expressing the desire “to extend help towards the problems of the aged.” Twenty-four years and several lawsuits later, the Buck Institute opened its doors, funded by income from the estate. Kris Rebillot, director of communications, explains that 17.5 percent of the institute’s present annual budget of US$32.5 million comes from the Buck Trust. To support the work of the 229 employees, each of the 23 faculty augment this funding through grants.

Rebillot takes me below the gleaming upper floors into an underworld of laboratories chock full of expensive equipment. Microscopes, freezers and cell-sequencing apparatus share space with thousands of research subjects: mice and fruit flies, yeasts and microscopic worms. These tiny specimens are where the strategies that will someday be applied to humans are tested. Institute CEO Brian Kennedy has spent the past 25 years looking through his microscope at yeast. His colleague, Gordon Lithgow, has spent equivalent time with tiny worms called C. elegans. Judith Campisi and her post-doctoral students work with mice, while Pejmun Haghighi spends his days with fruit flies. It’s not that we are reduced to these tiny beings, but the other way round: to understand how the cells in more complex beings function, you need to start with the single-cell organisms and work up.

Geroscience is different from research into the various diseases that hit us when we get old, though Haghighi (who is also on the faculty of McGill University in Montreal) looks for clues to Alzheimer’s in the proteins of his fruit flies, and Campisi (who has a posting at the University of Alberta by virtue of supervising one of its PhD students) hopes to postpone age-related cancer through what she is learning from the cells of her mice. Geroscience also differs from gerontology, the examination of everything to do with aging, including the socio-economics.

Lithgow, a Scot who maintains his soft brogue, explains that the beauty of his worms is their 20-day life cycle. “Things go on in the worm during those 20 days that take 80 years in us.” The highlight of his career came in 2000 when he and a colleague changed a single gene and managed to make one of their worms live not for 20 days, but 40.

Campisi cranks up a PowerPoint presentation to explain what she has learned about how our cells age and the mischief that leads to heart and vascular conditions, neuro-degeneration, diabetes, organ failures, osteoporosis and cancer. “The occurrence of these diseases rises exponentially after age 50 or 60, and the evidence is mounting that there is something about the process of aging itself that is driving them all,” Campisi says. “That is our hypothesis, and if we’re right, we will absolutely revolutionize modern medicine.” What she predicts is that the silo model, where specialists look at one disease at a time, will collapse and geriatricians will instead treat aging itself. The focus will be on avoiding or postponing disease by creating a generally more healthy body that deteriorates more slowly. “It’s still a dream that we will be able to tackle diseases in this way,” Campisi adds, “but it’s no longer science fiction.”

What Campisi, who hails from New York, has figured out over 35 years is that as we get older, multitudes of useless “senescent” cells impede our bodies from attacking all the above-mentioned diseases. In collaboration with colleagues at the Mayo Clinic, she has been able to inject powerful drugs that help mice get rid of senescent cells and, as a result, clear their bodies of cancer tumours. It’s only a matter of time, she believes, until drugs achieve the same for humans.

Integral to many theories of longevity is something called caloric restriction (CR). In the 1930s, scientists at Cornell University observed that severely restricting dietary calories in lab rats — while maintaining micronutrient levels — resulted in life extension. In subsequent decades, experiments have been carried out with dogs and primates, in all cases achieving extended lifespans.

Severe calorie restriction, however, has side effects. No one wants to feel cold and experience slower healing of wounds or reduced sex drive, acknowledges Brian Kennedy. “People don’t want to be malnourished, and few want to put in the effort to gather the knowledge to do it [CR] properly. You can’t eat two Snickers bars and call it a day.”

The trick, then, is finding a drug that will mimic what was achieved in the rat studies while letting humans continue to eat normally — what’s known as a “mimetic.” Writer David Stipp, whose book The Youth Pill details research initiatives into human aging, states that CR mimetics from the early 2000s began “to transform the anti-aging quest from an endless guessing game into a fairly routine exercise in drug development.”

Some initiatives have stumbled after promising debuts. An exciting moment in the early 1990s was identifying the so-called French paradox: despite rich diets loaded with sauces and cheese, the French were discovered to have healthier hearts than Americans. Could it be because of the red wine they consumed?

Researchers soon isolated an ingredient called resveratrol. When tested on yeasts and finally on mice, it extended both lifespan and energy. Then it was acknowledged that the average person would have to drink 300 glasses of wine per day to replicate the dosage and effect.

Something currently considered promising is rapamycin, a member of a class of drugs called mTOR inhibitors, and already shown to be capable of counteracting aging and delaying age-related diseases in mice and other animals. This is where Kennedy is directing much of his research energy. In one trial, mouse lifespan increased by 38 percent. In 2014, the pharmaceutical company Novartis proved rapamycin safe for humans through a six-week trial with older people who were also receiving the influenza vaccine. The drug zeroed in on a genetic signalling pathway associated with immune function and aging, and improved the participants’ immune reaction to a flu vaccine by as much as 20 percent.

The 25 years of Kennedy’s scientific career match the trajectory of modern aging research. Now 51, the Kentucky-born scientist has been, since 2010, CEO of the Buck Institute after stints at MIT in Boston and the University of Washington in Seattle. “Skeptics have always argued that aging is a natural process, and you could never test drugs for aging in humans because you shouldn’t give drugs to healthy humans,” he says. He sees the work of his colleagues, both at the institute and in the increasing number of research programs in universities around the world, as preventative medicine. “We don’t want people living longer if it’s just prolonging their time suffering the diseases of aging. We want to see if we can delay or postpone those. People imagine we’re trying to make rich people live longer. We’re not doing anything different than people targeting one disease at a time. We’re just trying to come up with an intervention that will prevent multiple diseases at one time, something that will prevent cancer that, by the way, might also prevent Alzheimer’s.”

While the Buck Institute scientists seek pharmaceutical keys to extending longevity, that goal has already been achieved elsewhere through more natural means. A decade ago, National Geographic writer Dan Buettner set out to find “blue zones,” places around the globe where people seemed to live extraordinarily long lives — naturally. Buettner identified five: a corner of the Mediterranean island of Sardinia, Okinawa in Japan, Ikaria island in Greece, the Nicoya Peninsula of Costa Rica and — the next stop on my journey — Loma Linda, Calif.

Each blue zone community had its defining characteristic. What distinguishes Loma Linda is the fact that most of the 23,000 people who live there are Seventh-day Adventists — the church founded in the 1860s that, among other things, follows Old Testament rules (no tobacco, alcohol or pork) and observes a strict Saturday Sabbath. Adventists are also deeply committed to health, having established hospitals all over the world. One of their largest health-care facilities is in Loma Linda where, in 1905, Ellen G. White founded a nursing school that became Loma Linda University; a community grew up around it. White’s 1905 book, The Ministry of Healing, became a bible of proper nutrition.

Well before the arrival of Buettner, Adventists realized they had something special going on. In 1960, 23,000 Californian members of the church joined the Adventist Mortality Study. Through it, they discovered that if the death rate from coronary heart disease in non-Adventists is taken as 100 percent, then deaths among Adventist men were only 66 percent of what was expected (and 98 percent for women). Overall cancer deaths, again with the non-Adventist population as the standard, were 60 percent for Adventist men and 76 percent for Adventist women. Mortality was also lower with specific types of cancer: the lung cancer death rate among Adventists was 21 percent; the colo-rectal cancer death rate was 62 percent; the breast cancer death rate for Adventist women was 85 percent; and the prostate cancer death rate for Adventist men was 92 percent.

In 1974, another study of 34,000 California Adventists began, this time to determine what components of their lifestyle contributed to the lower rates of diseases. Yet another study was launched in 2002, with 96,000 Adventists from across the United States and Canada. This one, which is still ongoing, is exploring the links between lifestyle, diet and disease.

Larry Beeson is a cheerfully relaxed professor at Loma Linda University’s School of Public Health. The 68-year-old, who sports steel-framed glasses and mutton-chop whiskers, classifies himself as a “lifer.” Beeson came to the university as a student and was welcomed onto the faculty in 1973. He’s been there ever since, teaching generations of students and joining the research into their one big question: Why do Adventists live to such a ripe old age? Male Adventists outlive other men in California by 7.3 years, and female Adventists outlive other women by 4.4 years. And not, emphasizes Beeson, seven and four dragged-out years but, by and large, vigorous, healthful, productive years. “We die in the end of the same diseases — heart and stroke and cancer — but we do it later and live well up until that end.”

Adventist studies compare the health and longevity effects of various diets. Beeson (who consumes eggs and milk but not meat) notes that vegans have the lowest rates of Alzheimer’s disease and dementia, a number that climbs as more animal products are introduced. A vegetarian diet is recommended for church members but not enforced. The culture of the town supports such a lifestyle with lots of vegetarian options and soy milk on restaurant menus and in grocery aisles. School cafeterias are vegetarian.

The conclusions of the studies reveal no mysteries to someone like Beeson who rhymes off the essentials: “Eat a plant-based diet; maintain normal body weight — avoid being obese; don’t smoke or drink, except lots of water; eat lots of nuts; maintain a faith base — bring God into the picture.” This last point particularly intrigues him. “When Dan Buettner came here,” Beeson observes, “the one thing that separated Loma Linda from the other blue zones was the 24-hour Sabbath. That is, the time to de-stress, put my work aside and replace it with concentrating on my relationship to God, to my family, to my friends.” In the current ongoing health study, a sub-study, designed by psychologists and members of the faculty of religion, will try to quantify the effect of being a religious practitioner on health and longevity.

What is it like to live in a town with a substantial population of seniors? As I drive around the spanking-clean streets, I note that the civic centre is promoting a scrapbooking workshop for seniors. The organic produce supermarket has basket-mounted scooters for mobility-challenged customers, as does the campus food market. But this is not a seniors’ community like you might find in Florida; Loma Linda is definitely mixed. When I peek in the door of the university gym (which is open to the public), I note as many grey-haired persons as students sweating on the machines. While seniors make up 14 percent of Loma Linda’s population (compared to the California average of 11 percent), there are also the 4,500 students at its medical schools (many of whom are Asian), as well as the university’s faculty and staff members and their families. It is not a homogenous place.

Except in the religious sense. Rev. Randy Speyer, one of 17 pastors at the 6,500-member Loma Linda University Church, tells me that there are almost no churches other than Adventist inside the town limits, and 30 more Adventist churches in a 10-mile radius beyond the town. With those kind of numbers, it’s not hard to keep the Sabbath customs. Speyer spent 20 years as a counsellor in northern California before coming to Loma Linda’s church last year. This is the first time he’s been in such a monolithic community, as well as one with such a preponderance of older people. Five of LLUC’s 17 pastors are dedicated to ministries with seniors. But some noteworthy things are observable: the generations mix, and seniors teach children in Sabbath school. Seniors also take leadership roles on committees and are committed to continued education. When people are spry and vigorous in their 80s and 90s, it redefines the term “seniors.” Lots of 65-year-olds, Speyer observes, remain working as teachers and doctors, enjoying their professions and the contributions they make.

As a man of a certain age, I’ve decided to embrace John Burroughs’s dictum that “old age is always 10 years older than I am.” Yet, although I’d be happy to see aging postponed, I also feel I must be prepared to gracefully leave the stage — not hog it at the expense of those coming after me. Nothing in the healthy mix of generations in Loma Linda, nor in the modest and reasonable goals of the Buck Institute scientists, offended that instinct. As Kennedy assured me, they’re not trying to make “rich people live longer.” In fact, they know they have big challenges still ahead.

Lithgow acknowledged that what has most surprised him in the 15 years since the eureka moment when his worm doubled its life is how slowly things have moved. “I guess we thought that would be a watershed moment and the walls would come tumbling down,” he said. “Money would come into the field; pharmaceutical companies would pop up recognizing that aging and disease were going hand in hand. It didn’t happen.” Instead, geroscience remains at the edge of respectability, with the pharmaceutical industry slow to invest because government regulators aren’t yet on board with anti-aging drugs.

“The complexities of humans still encompass huge unknowns,” Lithgow admitted. “There are holes in our understanding. The big challenge remains translating what we know from studying worms into something of import for humans. That is painstaking, time-consuming and expensive.”

Coincidentally, while I was travelling through California last February, Time magazine put human aging in the public eye, featuring a baby on its cover with the provocative headline, “This baby could live to be 142 years old.” The sensational pronouncement played into the hands of enthusiasts, who love to trumpet the possibilities of 90-year-olds who look and feel 45.

We already do take some things for granted. Today’s medicine prolongs life each time it treats or cures an individual’s disease. But will a combination of drugs and geroscience prolong life for the population as a whole? What about the more extreme possibilities of turning back the clock — actually making people younger? This has already been achieved in the labs: blood from young mice has been transfused into old mice, heralding a futuristic horror show where the old, like vampires, might feed on the young. And despite Lithgow’s gloominess about financing, some very big players are showing up. In 2013, the Internet giant Google set up Calico (California Life Company) with an investment reputedly in the range of $1 billion. The specifics of Calico remain secret, but its project is generally to “harness advanced technologies to increase our understanding of the biology that controls lifespan.”

This brought me rudely back to reality. Science will plow forward, but so will the accompanying implications. In her lead essay in Time, Laura Carstensen, founding director of Stanford University’s Center on Longevity, postulates that “our aging society presents challenges every bit as fundamental and pervasive as climate change and globalization.” Carstensen’s centre, established in 2006, has charted how quickly the demographic structure has been reshaped. Once a pyramid, with a small quotient of elderly at the top, it now looks more like a rectangle, with the aged population equal in number to the young. The implications of this shifting demographic are both financial and structural (things like architecture with no stairs or automobiles that drive themselves). But they’re also ethical. How will the changing demographics affect things like global population pressures, demand for resources and political tensions between the young and the old?

The idea of a fountain of youth retains its imaginative power, and the possibilities are more enticing than ever. But the issues at play are not simply scientific. And we’re going to have to start talking about them.



WHO CURATES EVIL?



Originally published: United Church Observer, March 2014

There is something inherently perverse about the as-yet-unfinished and not open until later in 2014 Canadian Museum of Human Rights rising from the flat plain between a parking lot and a baseball stadium at Winnipeg’s Forks. When you get right down to it, the $351 million dream of the late media mogul Izzy Asper, the only national museum outside Ottawa, is being built to celebrate evil. Celebrate is not the right word, of course: itemize, or document, or memorialize, perhaps. There will be celebration, but it will be of survival against horrible odds, endurance against the atrocities that human beings inflict on one another. If you and your people are able to come through the worst of horrors, that in itself is cause for celebration. But (another perversity) is that getting to be part of the museum’s litany of narratives has become, almost naturally, a kind of race to the bottom. Equally bad things happened to me as to you. Or –as the museum’s developers have been dealing with since almost the day they started work- ‘the story you are proposing to tell about me is not nearly so bad as it should be’. Disputes, during the half decade the museum has been taking shape have almost constantly overshadowed what its promoters most wanted to highlight: the symbolism of the building’s stark rugged Tyndall stone, its glass atrium suggestive of the enfolding dove wings of care, the spiral staircases leading up to a light-filled 100 meter-tall Tower of Hope. Possibly, a museum of something as touchy as human rights should expect this. It is a museum of grievances, and it is very hard to make the aggrieved happy.

The contentiousness has all come from groups feeling their particular stories weren’t going to be given sufficient scope and play. The Ukrainian community lamented that Holodomor (the starvation imposed by Stalin) exhibits were going to be too close to the washrooms; Palestinians objected to being left out entirely; even Jews -who Asper envisioned as central to the museum- were reportedly upset that the founding of the state of Israel was not going to be commemorated. But what has turned into the nascent museum’s most heated controversy is the growing insistence that exhibits depicting the story of First Nations peoples need to carry the word ‘genocide’ in their titles. And the museum’s resistance, so far, to doing that.

The government of Canada currently recognizes five genocides: the Holocaust, the Holodomor, the Armenian genocide of 1915, the Rwandan atrocities in 1994, and the Bosnian ethnic cleansing. The aim of activists is to add one more to the list. For them, the museum is a testing ground and when their overtures are resisted, they are angry. The Manitoba Assembly of Chiefs claim that when the Southeast Tribal Council in 2009 made a donation of $1 million, profits from its casino, they did so, “with the understanding that the true history of the treatment of First Nations people would be on exhibit.” When that didn’t happen, Chief Murray Clearsky wrote scathingly to museum CEO Stuart Murray this past summer, “It is now abundantly clear that Canada is choosing to sanitize the true truth and continue with their agenda of minimizing the many attempts of genocide perpetrated against the many peoples of this land.”

The project to delineate much of what happened to First Nations peoples after European contact a ‘genocide’ is, of course, much bigger than the museum. Last July, a potent shot was fired through an op-ed page column in Canada’s largest newspaper. “Canadians need to face the sad truth that the country engaged in a deliberate policy of attempted genocide against First Nations people,” former Assembly of First Nations National Chief Phil Fontaine along with two active members of the Jewish community, Michael Dan and Bernie Farber, wrote in the Toronto Star. Their arguments were built on now-standard history -residential schools and the transporting of prairie peoples onto reserves- along with some recently come-to-light documentations about things like experiments conducted as late as the 1950s where residential school children were veritably starved in the interests of nutritional research. These, said Michael Dan, reminded him chillingly of “Nazi medicine.” The authors consider it self-evident that the many nasty actions perpetrated against native peoples over three centuries since European contact fit inside the definition of genocide as the United Nations constituted it in 1947. Dan, a physician, says that because of being a doctor he is clinical about it. “The UN definition is there, so you look, something either fits the criteria or doesn’t. Many things that happened to native people fit the criteria.”

And while this position is shared by growing groups in academia, the media and elsewhere, it is problematic and carries profound implications. Such a re-assessment of Canada’s history is unsettling not least because if it gets commonly accepted we’ll be acknowledging not far distant Nazis or Stalin or Ottoman Turks as perpetrators, but the Canadian government –and its colonial predecessors. Ourselves and our ancestors. Even our churches that –as in the residential schools- committed evil while believing they were doing good. The most troubling of constructs.

In our world, ‘genocide’ is absolutely the worst thing you can say about an action undertaken by individuals or groups. To have to confront it as something your own government might have participated in or engineered is truly horrible. So horrible, in fact, that many events that carry the characteristics of genocides fail to –or struggle to- get named as such. Behind all this, is a substantial problem with the word itself. The horrific things that happened not to people but to peoples all down through history essentially went without a name until Raphael Lemkin, a Polish-born jurist who lost the whole of his family to the holocaust, grasped onto the Greek geno meaning race or tribe as the root for a new term and declared that ‘Genocide’ occurred when you and your group are targeted not because of what you had done, but because of who you were. Ironically, formalizing genocide as a crime in some ways seemed to augment rather than solve problems. After much lobbying and debate, the newly formed United Nations in 1948 passed resolution 260 that defined genocide as something both to be prevented and punished. But many resisted, including the US whose Senate took nearly four decades to finally ratify it. Possibly this was because also at risk of punishment were those who failed to prevent.

Another problem: which horrific events would be allowed to claim the name? What happened to the Armenians at the hands of the Turks in 1915 was retroactively termed a genocide –though still much protested by Turkey. Meanwhile, whether the violent slaughter that rent Rwanda in 1994 was actually genocidal in nature continues to be disputed in some circles. One issue seems to be that the term itself has been elevated onto such a special tier of evil that its use is both jealously guarded and jealously coveted –franchised out, if you will, to specific victims. Harvard scholar Samantha Power (now US ambassador to the UN) in her 2002 Pulitzer Prize winning book A Problem From Hell, America and the Age of Genocide describes how for almost the entire hundred days it took the Rwandan catastrophe to play itself out, the U.N. Security Council and the various arms of the U.S. government were locked in a semantic debate about whether to use “the G word”.

Genocide is a legal as well as a descriptive term. It is also dueled over between politically motivated activists on one side and, on the other, scholars who need to be rigorous about history. To them, levels of intent are important as is the notion that one size doesn’t necessarily fit all. William Schabas, a Canadian-born international law scholar at Middlesex University in the U.K., told a CBC radio interviewer that the term carries ”a special stigma that distorts a debate.” This is a view shared by the first academic I approached for an interview, an historian who hastened to tell me the topic has become so politicized he didn’t wish to go on record. Like Schabas, he does not deny that awful things happened to native peoples in Canada, but argues that the use of the genocide term makes it difficult to look with any degree of precision at even the awful things. Conventional wisdom and political correctness take over with the resulting chill preventing historians from discussing what they should discuss –and what is useful to the rest of us- that is, the implications of choices that are made in our public discourse.

The application of the term ‘genocide’ to what happened in North America goes back to books in the 1970s (The Genocide Machine in Canada, the pacification of the north, by Robert Davis and Mark Zinnis); the 1990s (The American Holocaust, Columbus and the Conquest of the New World, by David Stannard); and 2004 when Dean Neu and Richard Therrien published Accounting for Genocide, Canada’s bureaucratic assault on Aboriginal People. Andrew Woolford, a professor of criminology at the University of Manitoba specializing in genocide studies, predicts that the term will become ever more central to discussions about Canada. In 2004, he was the only Canadian scholar presenting at a genocide conference; nine years later there were seven papers on Canada at an international conference. “There is a generational shift,” he says, “where younger academics want to look at Canada through the critical genocide studies lens.” Still, he laments that people would fear being labeled ‘denialists’ should they disagree with even a part of the thesis presented. “The role of scholarship should be to complicate rather than simplify things.”

On the positive side, Woolford argues that should it (that acts of genocide were perpetrated again Native People) become a general consensus, the results would in actuality be beneficial. “For the survivors, recognition is important. From a more general perspective, my angle is that thinking about ourselves as a nation born out of genocide gives us a point to reinvent ourselves, to think about how we can de-colonize Canada and be different as a nation.”

For Michael Dan, one the Star editorial’s authors, it should be about healing. “As a Jew,” he says, he has spent a lot of time trying to process ideas of genocide. “In Canada we have trouble processing the idea we are capable of it. It doesn’t go with our being peacekeepers, a nice country that is apologizing all the time. But in order to heal we have to acknowledge that we did this.” Phil Fontaine sees acceptance as closing an as yet still-gaping circle. “Some people say it’s going to be just another money-grab,” he allows. “Not so. It was never intended as something that would extract more money from the government. But there has to be a series of conversations with Canadians so together we can write the missing chapter in Canadian history, one that would have to include this notion of genocide.”

Something else about genocide, is the thorny question of responsibility and guilt. As Hannah Arendt famously wrote of the Second World War Holocaust -quite possibly appropriate for the aboriginal situation in Canada- yes, racist policy, though sometimes couched in the language of good intentions, bears a basic responsibility. But then, along with some unarguably violent assaults, the majority of destructive actions are carried out by people simply doing their jobs (in Canada’s case possibly a lot of church people) blind (sometimes willfully) to the implications of a bigger picture. This, as Arendt termed it, is the banality of evil.

Rt Rev. Stanley McKay says that the idea of there having been genocide is difficult for our society to wrestle with. “We are completely caught up in the Canadian concept that somehow we were doing good; the church in particular, had the interests of the First Nations in our minds and hearts when we did these things.” The first Aboriginal moderator of the United Church, now retired north of Winnipeg, says he feels that though it will encounter strong resistance, the project to identify some actions as genocide is important. “Years ago those of us who lived on reserves and went to residential schools experienced racism without having any idea what to do,” he says. “We had no idea we had rights to have things different.” When asked if the Church has a role in the emerging discussion, he answers quickly: “Yes, a fundamental role. The credibility of the Christian community is on the line as this information becomes more widely available and people can no longer claim ignorance. The future of the church rests on its capacity to engage and develop right relations.”

Rev. James Scott, General Council’s Officer for Residential Schools for the past eleven years, has observed the term ‘genocide’ gain traction over time with “more Aboriginal people now using the word.” In response, he says that in the fall of 2013 his staff flagged the importance of having a conversation about use of the term within the Church. “We need to move as a settler society to grapple with the breadth and depth of what harm we did,” he told me. Still, he pleads for caution. “Genocide is a very incendiary word that sometimes might be a barrier in the way of having people talk about important things that really happened. If you scare people away, they won’t want to hear the truth.”

Says Scott, “There may be graduations of how blunt we can be, but those graduations need to move forward. We need to learn and help others understand the profound brokenness we created.”

Everybody struggles in this manner. In Winnipeg, museum staff wrestle with what they see as their proper responsibility. “If the museum were to use the word genocide, it would make a declaration it has no right to make,” museum spokesperson Maureen Fitzhenry told the Winnipeg Free Press. “We are not a court that adjudicates,” Clint Curle, head of stakeholder relations, told me, “but a place to hold the conversation. We believe this is our proper and also welcome role. Education may be more effective than adjudication in helping Canadians grapple with the human rights issues in our past. That is also more in keeping with the museum’s capacity.”

What should Canadians feel? Should we be appalled by efforts to lump us in with history’s more vile regimes, or should we welcome a more blunt interpretation of our national story? Is it important and necessary that we experience and feel a greater shame than we already carry with regards to the history of relations with native peoples?
Andrew Woolford quotes German philosopher Jurgen Habermas, who acknowledged about his country, “we are participants in a form of life that made genocide possible and this is why we need to critically interrogate the past and our present.” Applying this to our own time and place he adds, “I think we need to interrogate the Canadian past and the Canadian present and work towards social change.”