 Okay, if we could take our seats for one last time. Once again, the ushers are going down the aisles if you have questions. And I think we're ready to go. Who would like to start on the panel? Dr. Haifle? Yes, I was intrigued by your observation, and I think you said it was supported by Dr. Selko, that if we all lived long enough, we would probably or possibly all acquire Alzheimer's disease. Well, by the same line of reasoning, if we lived long enough, we also would acquire cardiovascular disease, stroke, and cancer. And the good news is that by having Alzheimer's disease, you wouldn't know it. I think the authority that I mentioned in that case was Ron Peterson at the Mayo. I actually think Dennis would have a different view of that. I think the point I was trying to make was building on the point that Jay was making in response to his questions to Cynthia. Language is important, and whether we label something a disease or not has tremendous ramifications as to how you approach it. So I am just trying to ask us to keep an open mind about what I can engage in is the continuum of brain aging and the challenges of labeling parts of that continuum. So that was just a reflection on what you said. Not an answer to your question, but continue the dialogue with Dennis. I think he has a comment, too. Sure. Dr. Selco. Thank you. Well, as an aside, I personally don't think that everyone would develop the condition we call Alzheimer's if they lived long enough. So that would be my position. But some feel differently. I think what Peter did so beautifully is what apparently from my experience at the Nobel conference, it's an end of one you love to do around here, which is to make people think. And he clearly made me think, and he made a number of points, great many points in a short time, that are provocative and many of which I would agree with. One of the things we academics do is to do what everyone in the population does and that is create some controversies or some arguments come to loggerheads. And humans love to do that. We love to do sports, we love to compete, and academics no less and perhaps more than others. But I want the general audience to recognize that while there are competing ideas about how to both think of the term Alzheimer's and the entity and how to treat it and solve it, there's enough brain power and person power to do all of this. Probably there aren't quite enough dollars and we do compete over dollars on occasion, that is all of us. But my point is this, that the emphasis that Peter put on the importance of the humanistic impulse in us all to help our fellow man and woman with Alzheimer's disease is enormously important. And people like myself who are steeped in the biology recognize, even though we sometimes don't come across as recognizing, that it is hard and long-winded for us to develop and offer true treatments and cures. What drives us on in the biological model while our colleagues emphasize humanistic and social and emotional and spiritual ways of handling the problem are facts such as the notion that the most common cause of dementia at the Boston City Hospital in 1900 was not Alzheimer's disease, it was not even hardening of the arteries in the true sense, that is, multiple small strokes, but it was neurocyphalus. And many people had and died of neurocyphalus. We hardly ever, if ever in our careers, see a case of dementia due to that. And that gives me hope as a biologist because we know the folks who are behind getting rid of neurocyphalus, the folks who invented and developed antibiotics. So my point is this, that there very much is room, even though sometimes in academic circles we love to put the gloves on, that there's room for multiple approaches at once and happily they are going on at once. Those of us who are convinced that biological treatments, indeed, as Peter pointed out, small molecular structures, pills, very often made in our capitalistic society in the non-profit sector, we believe that the examples of neurocyphalus and an even atherosclerotic dementia which has gone down over time because of treatment with statin drugs and anti-hypertensives, this model is worth pursuing. But it is by no means the only model and we biologists need all the help we can get. Peter? Dennis, I think syphilis is a good example, although it is an example where the etiology is a specific agent. And I think when you come across age-related diseases you run into these complexities of the fact that you're dealing with an organism at a different stage of life and where the overlap and pathology makes the challenge all the greater. We need to take the challenge up at a number at different levels including biological. I think the point I was trying to make too is that this is not just a scientific issue. How we address age-related cognitive challenges, how we think about this is not just a job for the scientists. You really can't wait for us to come up with the labels. You need to think about how we label illnesses in our society. I just give the example, since you gave an example, homosexuality. That's a label that we've changed our attitude about psychiatrists used to try to cure homosexuality and now our attitudes are quite different. So you're part of this process, not just the scientists and the doctors. Laura? You're a paradigm buster, I guess, and really are shaking up my view of how I thought about aging and cognitive aging and disease. And it reminded me of a couple that I met years ago when I had done a neuropsychological workup on a husband and then met with him and his wife. And it was clear to me that this man was demented and I was giving them feedback about the test and largely talking to the wife. And she... This was a couple that was very poor, not a lot of education, and she listened to me for a minute and then she got quite angry that I was insulting her husband. And she said, you know, he's worked hard all of his life and if he doesn't want to think anymore, I'm going to take care of him. And it did make me realize, I mean, I really was taken aback because I'm thinking she's going to be devastated and she was just like, hey honey, you got problems, I don't have any problems with this man, you know. And I'm listening to this talk and I was thinking of her again and how much emphasis we put on cognitive functioning and the society in which we live. But then it leads me to, what do we do? I'm really interested and intrigued by the argument, but does it mean we shouldn't try to find a cure? And if you're going to try to find a cure then you have to say what something is and delineate it and operationalize it, so I mean, what's... In your mind, what's the... How do these things get resolved? It's a matter of priorities and approaches. I mean, I think there's a biology, you can imagine and affecting the biology regardless of what we call it. But to have coded Alzheimer's disease clearly has attracted more money and attention and to offer the opportunity for cures, creates hopes and expectations. When I was on the National Alzheimer's Advisory Panel, it was always very easy to attend to the needs of biology because many people don't understand biology and these group of experts would say, sure, half a billion dollars more for research, we never got quite... for research, we never got that much more. But then when it came to kind of improving care and the healthcare system and if you had a billion dollars, which in healthcare is not even that much amount of money, what do you do with that? So I think it does convert to where we spend our dollars, how much money we put into different approaches and frankly in my own view and I'm a geriatrician, I'm a gerontologist, I'm a person who's growing older, I think we run the risk in this society and I'm going to get lynched or thrown off the stage of putting too much resources into older folks and the fact that we are not vaccinating kids and not educating kids and we should attend to everybody in society but there's a big picture out here. Yes, one quick question I really enjoyed the presentation and insightful as always. I want to take off on one very small point that you made in your presentation and I'm just curious, what do you think of scientists who transform themselves into entrepreneurs in order to sell interventions to the public to treat diseases associated with aging or aging itself? I celebrate entrepreneurial behavior. I think that's, you know, one never wants to speak against somebody with what they want to take and help people. I do think that we need to know when people have those kinds of relationships. In the 20 years that I have 25 years I've been in my career we went from you were suspect if you had a relationship with a company to you're kind of not part of the group if you don't have your own company and I look to Dennis as a role model for me in the sense that he did develop his own company and I share this with that and I respect for him for that and if we get a vaccine for Alzheimer's disease out of this Dennis will deserve an enormous amount of credit and in our society will deserve the financial awards that he reaps and I have no problem with that I think the problem and you see it in the anti-aging medicine when the science isn't there and the entrepreneurial behavior is not associated with the closure about relationships and Dennis did exactly that then I am concerned I think that the money in our society in general and I won't share my political persuasions and particularly money in medicine is a really a big problem for us as a profession as I mentioned in terms of conflict of interest the pharmaceutical companies would have you believe that there is a magic bullet for everything and I think we are learning that we don't I just wrote an editorial on the fact that we don't hear about negative studies we only hear about the positive studies that the data is suppressed the language is manipulated so I think our multinational pharmaceutical companies have some work to do to regain our trust Dr. Salko again I do concur with what Peter said and the problem with the biopharmaceutical industry is that they don't always follow the kinds of logic and the kinds of goals that would be most useful for the population and for our patients they follow the bottom line and that's for better or worse the way that our capitalistic system is made up where they are enormously useful if we are on the watch to control their impulses, our impulses because a great many people are investors and are involved in private enterprise for drug discovery they are enormously useful for things that academia will simply not do the alternative to biopharmaceutical companies would be to have more of a national or international institute that would have its concrete responsibility for developing treatments of various sorts of vaccines, medications etc that largely hasn't arisen because the national institutes and our academic institutions are for generating new knowledge the process of making a drug or making a vaccine is partly new knowledge but partly a repetitive process that requires a great deal of iteration and so we need to struggle with how do we get that part of the work done and the way our society has currently solved it is by allowing that in the iterative process of trying to find drugs it's not necessarily the best way to go and I firmly believe that we have to keep controls on that process we can't just let it run by itself and the whole movement to disclose conflicts of interest is a great one it certainly wasn't one when you and I were young neurologists it's become more and more common there are many fora many journals that still don't require it indeed they should there's a question from the audience here you obviously feel that patients with Alzheimer's disease benefit from staying involved in the community is there any data that suggests that this process slows down the development of the disease one of the just build on the comment that we were talking about the pharmaceutical industry there's a lot of money to do studies on pills it's not hard to get a it's really hard to do studies of complex social interventions we hope to do that in the intergenerational school with some of our programs and there is some evidence and Laura might be able to comment more for example Linda Freed who's the head of geriatrics at Hopkins has evidence that volunteering in school helps the physical and cognitive health of older adults but those are not folks that have any memory problems so I would say there is no evidence based health information about that however I would say this also if somebody is actively engaged in the community and if they're doing things that are meaningful to them the chances that they would actually get the label of Alzheimer's disease are probably pretty small so if you want to convince your doctor that you don't have Alzheimer's disease go out there and be functional and be active in the community it's kind of a silly answer to the question but there isn't to be serious a randomized control study that would suggest that this actually helps prevent Alzheimer's disease there's another kind of practical question as a medical caregiver experienced many people being left alone in nursing homes the patient gets no visitors because they can't understand if we visit or not they get abandoned how can we address this I think the first thing I would say is to underestimate that they know of your presence even if they don't seem to recognize you try seeing them a song try playing a piece of music try touch try aroma therapy there's actually some evidence based medicine on aroma therapy that's come out recently so you could be in relationship with people just verbally so try those things but clearly there is a point at which somebody is at a point where they're gone beyond but I'll tell you I sure wouldn't want to make a misjudgment about when that point had occurred keep up that relationship as best you can can I quickly add something to that there is some evidence that even moderately demented people can recognize the emotional faces of others so they may not understand the verbal content but it looks like people can see if someone's angry or sad and I think it's really important to remember that because when somebody doesn't appear to understand you it's easy to then start to look a certain way and it appears that people may well understand and just to elaborate on that the worst thing you hear for people even with mild dementia and Dennis has heard this story as well the doctor from the word go ignores the person with the Alzheimer's disease the doctor mistreats their own patient, addresses all their comments to the caregiver and doesn't recognize the presence of somebody with a label Alzheimer's disease so this issue of distorting relationships can occur very early on even with the person that is responsible for that healing relationship one last question here knowing what you know about aging what is the essence of any of you consciously changed anything in your life based on that knowledge who wants to fess up here well I'll just say quickly I already got my chance my wife and I started I have a buck can I pass it whoever wants to answer against the buck look I think it's what your mother said healthy diet mental and physical exercise clearly my wife and I got involved in the school because we felt that was something that would give us a sense of purpose and who knows maybe it will contribute in a small way so I try to listen to what the experts like my mother say good advice for all of us one comment that is that I often tell folks who come in who have what some of us call Alzheimer's that is they are very concerned that they either have or about to develop Alzheimer's disease and they're often the children of Alzheimer victims so there's good reason for justification for it but often when they're tested carefully there's no objective evidence that they have Alzheimer's or even mild cognitive impairment so I usually tell them if you're worried that your memory is slipping and you just can't keep things going the way you used to just take away about 5% of your memory the course of the day or even 2% to slow down a little bit and when they come back to me some of them tell me 4, 5, 6 months later that seemed to work I don't feel as nervous that I'm developing Alzheimer's the one person I've met who never pays attention to that message is me Jay? Actually I think that question that was asked is a very fair question I mean here we are researchers in the field of aging and somebody wants to know what are you doing or what are you doing any differently than anyone else and actually I think we need to be answering those kinds of questions and I'll tell you my answer I do not take any vitamins I do not take any minerals I know there are plenty of people who pop pills like crazy I don't do any of those things I'll be honest with you I actually didn't personally know how I felt about aging until after I wrote it down in our book and then I discovered the importance of the randomness to the aging process something I really wasn't quite aware of before but once I recognized the randomness to the aging process I suddenly realized how long I lived as much as I would like to live long enough to see my grandchildren contribute to their reproductive success by sending them checks as much as I would like to do that what I realized is that how long I live is not all that important and what's really important is how healthy I am and how good I feel during the time that I'm alive so I do spend a lot of time exercising because it feels good I'm very careful not to overwork my joints a little bit older than my wife but I don't take any vitamins and minerals and I really just exercise and have a diet based on moderation and it's as simple as that Where's that dollar? You get the dollar Well I think the fact that none of us have come up with some kind of formula or lifestyle change or intake of some kind of drug or vitamin the fact that we have none of us have suggested that we're doing that is an answer to your question and that is that and I hope I'm not I hope I'm speaking for everybody here I hope I'll be corrected if I'm not and that is that we we simply don't know of any intervention that will slow, stop and certainly not reverse the aging process but what we do know is that there are many things that you can do and Dr. Olszanski mentioned exercise and diet many things that we can do to delay, postpone or prevent pathology or disease and that's the distinction Can I make one more point? Dr. Olszanski, go ahead Actually I was just reminded of one extremely important point that Dr. Hayflick just reminded me of if Cynthia is right and there's a gene or a gatekeeper gene or a couple of genes I think we're in trouble and the reason is is that we would then have to identify that gene and modify it and in all likelihood if we attempt to modify a single gatekeeper gene that's going to have some cascading effect on something that we call longevity in all likelihood it's going to have an effect on something else that perhaps we may not like the good news is believe it or not I think what many of us have been trying to say and that is that aging is not programmed and in the absence of an aging program interventions that influence the manifestations of aging work that's why we can increase muscle mass at the age of 100 through exercise can help at any age because aging isn't programmed we can intervene at any age to improve quality of life and I think that is the important point to be made Ladies and gentlemen one of the emails I got this summer this was from the people from California who were apologizing for not being able to attend here today said the reason they like to come here their favorite thing is that they like to think that they were sitting in an eavesdropping on intelligent conversation and I think they're absolutely right when we put this conference together what we hope to do is to give the general public an idea of what the field of gerontology is like who's in it how they think and what they do it's a very broad and very field I think you've discovered that I'm always agree either but I think they did a marvelous job of telling us about it