“Terminal Lucidity” Is “the Light Before the End of the Tunnel”

(p. D6) . . . “terminal lucidity,” [is] a term coined by the biologist Michael Nahm in 2009 to describe the brief state of clarity and energy that sometimes precedes death. Alexander Batthyány, another contemporary expert on dying, calls it “the light before the end of the tunnel.”

A 5-year-old boy in a coma for three weeks suddenly regains consciousness. He thanks his family for letting him go and tells them he’ll be dying soon. The next day, he does.

A 26-year-old woman with severe mental disabilities hasn’t spoken a word for years. Suddenly, she sings, “Where does the soul find its home, its peace? Peace, peace, heavenly peace!” The year is 1922. She sings for half an hour and then she passes away. The episode is witnessed by two prominent physicians and later recounted by them separately, at least five times, with identical descriptions.

Early reports of terminal lucidity date back to Hippocrates, Plutarch and Galen. Dr. Nahm collected 83 accounts of terminal lucidity written over 250 years, most of which were witnessed by medical professionals. Nearly 90 percent of cases happened within a week of death and almost half occurred on the final day of life.

Terminal lucidity occurred irrespective of ailment, in patients with tumors, strokes, dementia and psychiatric disorders. Dr. Nahm suggested the mechanism of terminal lucidity may differ from one disease to another. For example, severe weight loss in patients with brain tumors could cause the brain to shrink, yielding fleeting relief of pressure on the brain that might allow for clearer thinking. Yet this theory doesn’t explain terminal lucidity in people dying from dementia, kidney failure or other diseases. Like death itself, terminal lucidity retains a screen of mystery.

My grandfather talked to us for 10 minutes the day before he died. He hadn’t spoken coherently in days. His hands had become baby-like, grasping our fingers or the bed railing reflexively. The weight of his eyelids had become too heavy to lift.

Suddenly, he was back. “What’s the good word?” he asked, as if that day was the same as all the days before. He marched down the line of grandchildren at his bedside, asking for the latest news in our lives. He asked if they ever finished building the Waldorf Astoria in Jerusalem. He made a joke, one I can’t remember except for the way he smiled out of the right side of his mouth, tilted his head from side to side, and held up his hands in jest.

And then, again, he was gone.

For the full commentary see:

Sara Manning Peskin, M.D. “The Gentler Symptoms of Dying.” The New York Times (Tuesday, July 18, 2017 [sic]): D6.

(Note: ellipsis and bracketed word added.)

(Note: the online version of the commentary has the date July 11, 2017 [sic], and the same title as the print version.)

“Terminal Rage” May Be “Rage Against the Dying of the Light”

The quotation below from Dylan Thomas is his first line and title for one of my favorite, albeit sad, poems. It is the first line, but my favorite line is: “Rage, rage against the dying of the light.”

(p. D4) Terminal Agitation

“Do not go gentle into that good night” (Dylan Thomas)

My grandfather screamed two days before he died. “Open that door and let me out! Right now! It’s a travesty! Open that door!”

It was the scream of a lost child. My grandfather’s eyebrows, which had been lost over the years from the outside inward so that only a centimeter of long gray hairs near the middle remained, tilted toward each other.

Until then, we were preparing for missing and absence. Not for an agitated delirium. Not for rage.

. . .

Instead of peacefully floating off, the dying person may cry out and try to get out of bed. Their muscles might twitch or spasm. The body can appear tormented.

. . .

People who witness terminal agitation often believe it is the dying person’s existential response to death’s approach. Intense agitation may be the most visceral way that the human body can react to the shattering of inertia. We squirm and cry out coming into the world, and sometimes we do the same leaving it.

For the full commentary see:

Sara Manning Peskin, M.D. “The Symptoms of Dying.” The New York Times (Tuesday, June 20, 2017 [sic]): D4.

(Note: ellipses added. In the original, the line of Dylan Thomas’s poem, and his name, appear in italics.)

(Note: the online version of the commentary has the same date and title as the print version.)

Elephants Have Backup or “Resurrected” Copies of Cancer-Killing Genes

(p. D3) Elephants ought to get a lot of cancer. They’re huge animals, weighing as much as eight tons. It takes a lot of cells to make up that much elephant.

All of those cells arose from a single fertilized egg, and each time a cell divides, there’s a chance that it will gain a mutation — one that may lead to cancer.

Strangely, however, elephants aren’t more prone to cancer than smaller animals. Some research even suggests they get less cancer than humans do.

On Tuesday [Aug. 14, 2018 [sic]], a team of researchers reported what may be a partial solution to that mystery: Elephants protect themselves with a unique gene that aggressively kills off cells whose DNA has been damaged.

Somewhere in the course of evolution, the gene had become dormant. But somehow it was resurrected, a bit of zombie DNA that has proved particularly useful.

Vincent J. Lynch, an evolutionary biologist at the University of Chicago and a co-author of the paper, published in Cell Reports, said that understanding how elephants fight cancer may provide inspiration for developing new drugs.

. . .

In 2015, Dr. Lynch and his colleagues discovered that elephants have evolved unusual p53 genes. While we only have one copy of the gene, elephants have 20 copies. Researchers at the University of Utah independently made the same discovery.

. . .

Dr. Lynch and his colleagues continued their search for cancer-fighting genes, and they soon encountered another one, called LIF6, that only elephants seem to possess.

In response to DNA damage, p53 proteins in elephants switch on LIF6. The cell makes LIF6 proteins, which then wreak havoc.

Dr. Lynch’s experiments indicate that LIF6 proteins make their way to the cell’s tiny fuel-generating factories, called mitochondria.

The proteins pry open holes in the mitochondria, allowing molecules to pour out. The molecules from mitochondria are toxic, causing the cell to die.

. . .

After the ancestors of elephants evolved ten LIF genes, however, something remarkable happened: One of these dead genes came back to life. That gene is LIF6.

Somewhere in the course of elephant evolution, a cellular mutation inserted a genetic switch next to LIF6, enabling the gene to be activated by p53. The resurrected gene now made a protein that could do something new: attack mitochondria and kill damaged cells.

For the full commentary see:

Carl Zimmer. “MATTER; A Resurrected Cancer Fighter.” The New York Times (Tuesday, August 21, 2018 [sic]): D3.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the commentary has the date Aug. 14, 2018 [sic], and has the title “MATTER; The ‘Zombie Gene’ That May Protect Elephants From Cancer.” Where there is a small difference in wording between the versions, the passages quoted above follow the online version.)

The paper published in Cell Reports and mentioned above is:

Vazquez, Juan Manuel, Michael Sulak, Sravanthi Chigurupati, and Vincent J. Lynch. “A Zombie LIF Gene in Elephants Is Upregulated by TP53 to Induce Apoptosis in Response to DNA Damage.” Cell Reports 24 (2018): 1765–76.

The “Rules of Desperation Oncology” Allow Oncologists to Throw Dying Patients a Hail Mary Immunotherapy Drug

(p. D1) Dr. Oliver Sartor has a provocative question for patients who are running out of time.

Most are dying of prostate cancer. They have tried every standard treatment, to no avail. New immunotherapy drugs, which can work miracles against a few types of cancer, are not known to work for this kind.

Still, Dr. Sartor, assistant dean for oncology at Tulane Medical School, asks a diplomatic version of this: Do you want to try an immunotherapy drug before you die?

The chance such a drug will help is vanishingly small — but not zero. “Under rules of desperation oncology, you engage in a different kind of oncology than the rational guideline thought,” Dr. Sartor said.

The promise of immunotherapy has drawn cancer specialists into a conundrum. When the drugs work, a cancer may seem to melt away overnight. But little is known about which patients might benefit, and from which drugs.

Some oncologists choose not to mention immunotherapy to dying patients, arguing that scientists first must gather rigorous evidence about the benefits and pitfalls, and that treating patients experimentally outside a clinical trial is perilous business.

But others, like Dr. Sartor, are offering the drugs to some terminal patients as a roll of the dice. If the patient is dying and there’s a remote chance the drug will help, then why not?

. . .

(p. D6) . . . there is Clark Gordin, 67, who lives in Ocean Springs, Miss. He had metastatic prostate cancer, “a bad deck of cards,” he said in an interview.

Dr. Sartor tried conventional treatments, but they didn’t work for Mr. Gordin. Finally, the doctor suggested immunotherapy.

Mr. Gordin’s insurer refused. But then the lab that had analyzed his tumor discovered it had made a mistake.

There was a chance Mr. Gordin might respond to immunotherapy, because he had a rare mutation. So his insurer agreed to pay.

Immediately after taking the drugs, Mr. Gordin’s PSA level — an indicator of the cancer’s presence — went down to nearly zero.

“Makes my heart nearly stop every time I think about it,” Dr. Sartor said. “Life sometimes hangs on a thin thread.”

For the full story see:

Gina Kolata. “A Life’s One Last Chance.” The New York Times (Tuesday, May 1, 2018 [sic]): D1 & D6.

(Note: ellipses added.)

(Note: the online version of the story has the date April 26, 2018 [sic], and has the title “‘Desperation Oncology’: When Patients Are Dying, Some Cancer Doctors Turn to Immunotherapy.”)

Social Security Administration Is Lax in Stopping Fraud and Slow in Aiding Fraud Victims

(p. A1) For the past two decades, Liz Birenbaum’s 88-year-old mother, Marge, has received her Social Security check on the second Wednesday of each month. It’s her sole source of income, which pays for her room at a long-term care center, where she landed last October after having a stroke.

When the deposit didn’t arrive in January [2024], they logged into Marge’s Social Security account, where they found some startling clues: the last four digits of a bank account number that didn’t match her own, at a bank they didn’t recognize.

“Someone had gotten in,” said Ms. Birenbaum, of Chappaqua, N.Y. “Then I hit a panic button.”

It quickly became evident that a fraudster had redirected the $2,452 benefit to an unknown Citibank account. Marge, who lives in Minnesota, had never banked there. (Ms. Birenbaum requested to refer to her mother by her first name only to protect her from future fraud.)

Ms. Birenbaum immediately started making calls to set things right. When she finally connected with a Social Security representative from a local office in a Bloomington, Minn., the rep casually mentioned that this happens “all the time.”

“I was stunned,” Ms. Birenbaum said.

. . .

(p. A18) It can be a lucrative fraud, and a devastating benefit to lose. An estimated $33.5 million in benefits — intended for nearly 21,000 beneficiaries — were redirected in a five-year period ending in May 2018, according to the most recent audit from the Office of the Inspector General, an independent group responsible for overseeing investigations and audits at the agency. Another $23.9 million in fraudulent redirects were prevented before they happened over the same time period.

“Fraudsters were able to obtain sufficient information about a true beneficiary to convince the Social Security Administration that they were that beneficiary,” said Jeffrey Brown, a deputy assistant inspector general at the Office of the Inspector General, who analyzed the issue in 2019. “Once they were in the front door, they were able to change their direct deposits.”

. . .

Just months before Marge’s benefits were redirected, the O.I.G. issued a report that said the administration’s portal, called my Social Security, did not fully comply with federal requirements for identity verification: It said it didn’t go far enough to verify and validate new registrants’ identities, in all cases.

. . .

The issue would have been impossible for someone like Marge to rectify on her own. It was challenging enough for Ms. Birenbaum, a marketing consultant, and her brother, based near their mother in a Minneapolis suburb, who worked together to recover the benefits and secure Marge’s account.

Ms. Birenbaum — who reported the crime to the O.I.G. and the F.B.I. and alerted her state and federal representatives — once spent two and a half hours on hold with the Social Security Administration before connecting with a regional case worker. The rep was able to see that her mother’s direct deposit information had been altered in early December, the month before the benefits vanished.

Ms. Birenbaum’s brother visited their mother’s local Social Security office and became Marge’s “representative payee,” which allows him to handle her affairs (Social Security does not accept powers of attorney). They had to find ways to make the correction without bringing Marge to the office, which Ms. Birenbaum said would have been a “herculean task.”

Marge received the missing money on March 1, [2024] about a month and a half after they discovered the problem.

For the full story, see:

Tara Siegel Bernard. “Internet Thieves Drain Social Security Accounts.” The New York Times (Saturday, March 9, 2024): A1 & A18.

(Note: ellipses, and bracketed years, added.)

(Note: the online version of the story has the same date as the print version, and has the title “How Fraudsters Break Into Social Security Accounts and Steal Benefits.”)

“If You Burn Out, Relight the Fire”

(p. A11) Dr. Gladys McGarey, 103, continues to consult, give talks and podcast interviews after nearly eight decades in the medical field. She started an Instagram account that has nearly 47,000 followers.

“If you burn out, relight the fire,” says McGarey. She ran a clinic while raising six children and had to start a new one when her husband and clinic partner left her when she was 69 and married one of their colleagues.

. . .

Not everyone wants to work in their later years, says Dr. Robert Waldinger, a professor of psychiatry at Harvard Medical School.

“It’s not burnout. It’s just ‘I don’t want to do this anymore,’ ” says Waldinger, director of the Harvard Study of Adult Development, a longitudinal study on how people thrive.

As people get older, they are better at discerning what really matters, he says, and what they can let go of. The goal isn’t necessarily an 80-year career, but finding purpose in whatever we chose to do in our 80s and beyond, whether that is taking care of a grandchild, playing the piano, or joining a community theater.

For many, there is passion, purpose and love in the work.

. . .

Like others who have remained engaged in their careers in their later years, she says the secret is to find things that make life important and our “hearts sing.”

For the full commentary, see:

Clare Ansberry. “At 103, Work Still Makes Heart Sing.” The Wall Street Journal (Wednesday, Jan. 3, 2024): A11.

(Note: ellipses added.)

(Note: the online version of the commentary has the date December 29, 2023, and has the title “TURNING POINTS; How to Work—and Love It—Into Your 80s and Beyond.”)

The memoir by McGarey mentioned above is:

McGarey, Gladys. The Well-Lived Life: A 102-Year-Old Doctor’s Six Secrets to Health and Happiness at Every Age. New York: Atria Books, 2023.

Super Agers “Have a Purpose”

I have personally benefitted from Vernon Smith’s longevity, since he graciously wrote two drafts of a positive blurb for my Openness to Creative Destruction book.

(p. A5) Vernon L. Smith, 97, is a very busy man.

The economist at Chapman University just finished writing a book about Adam Smith and works about eight hours a day, seven days a week in his home office in Colorado Springs, Colo. He enjoys chatting with friends on Facebook and attending concerts with his daughter.

“I still have a lot of stuff to do. I want to keep at it,” said Smith, who won the Nobel Prize in economics in 2002.

. . .

(p. A10) Researchers studying “super agers,” people over 80 who have mental faculties of people decades younger, said strong social relationships are important for keeping brains sharp.

The same is true for people who live beyond 100, said Stacy Andersen, a behavioral neuroscientist at Boston University and co-director of the New England Centenarian Study.

“They have a purpose. They have things they want to go out and do every day,” Andersen said.

Smith says his work and his family keep him motivated and driven.

“I want to go to at least 106,” he said.

For the full story, see:

Dominique Mosbergen. “Several Factors Help Ward Off Mental Decline.” The Wall Street Journal (Friday, Feb. 16, 2024): A5.

(Note: ellipsis and bracketed year added.)

(Note: the online version of the story was updated Feb. 15, 2024, and has the title “How to Stay Mentally Sharp Into Your 80s and Beyond.” The last sentence quoted above appears in the online, but not in the print, version of the article.)

My book mentioned above is:

Diamond, Arthur M., Jr. Openness to Creative Destruction: Sustaining Innovative Dynamism. New York: Oxford University Press, 2019.

New Longevity Drugs for Dogs Can Be Proof-of-Concept for Longevity Drugs for People

(p. A1) “When you adopt a dog, you’re adopting future heartbreak,” said Emilie Adams, a New Yorker who owns three Rhodesian Ridgebacks. “It’s worth it over time because you just have so much love between now and when they go. But their life spans are shorter than ours.”

In recent years, scientists have been chasing after drugs that might stave off this heartbreak by extending the lives of our canine companions. On Tuesday, the biotech company Loyal announced that it had moved one step closer to bringing one such drug to market. “The data you provided are sufficient to show that there is a reasonable expectation of effectiveness,” an official at the U.S. Food and Drug Administration informed the company in a recent letter. (Loyal provided a copy of the letter to The Times.)

That means that the drug, which Loyal declined to identify for proprietary reasons, has met one of the requirements for “expanded conditional approval,” a fast-tracked authorization for ani-(p. A19)mal drugs that fulfill unmet health needs and require difficult clinical trials. The drug is not available to pet owners yet, and the F.D.A. must still review the company’s safety and manufacturing data. But conditional approval, which Loyal hopes to receive in 2026, would allow the company to begin marketing the drug for canine life extension, even before a large clinical trial is complete.

. . .

. . . the letter, which came after years of discussion between Loyal and the F.D.A., suggests that the agency is open to canine longevity drugs, Ms. Halioua said.

. . .

Aging may be an inevitability, but it is not an unyielding one. Scientists have created longer-lived worms, flies and mice by tweaking key aging-related genes.

These findings have raised the tantalizing possibility that scientists might be able to find drugs that had the same life-extending effects in people. That remains an active area of research, but canine longevity has recently started to attract more attention, in part because dogs are good models for human aging and in part because many pet owners would love more time with their furry family members.

“There’s not a lot you wouldn’t do if you could stack the deck in your favor to preserve the life of your hairy, four-legged child,” said Ms. Adams, the Rhodesian Ridgeback owner.

For the full story, see:

Emily Anthes. “A Drug Aims to Extend Dogs’ Lives, Yes It Does.” The New York Times (Saturday, November 29, 2023): A1 & A19.

(Note: ellipses, and bracketed year, added.)

(Note: the online version of the story was updated Nov. 29, 2023, and has the title “Could a Drug Give Your Pet More Dog Years?”)

Alleged Upper Bounds to Lifespans Continue to Be Surpassed

(p. A2) In a 2002 paper, “Broken Limits to Life Expectancy” the demographers Jim Oeppen and James Vaupel showed that for nearly 100 years, estimates of when life expectancy would hit its limit were proven wrong, often in just a few years. In 2020, Max Roser of the University of Oxford noted that this trend was still intact.

There is no guarantee, of course, that this trend will continue over time or everywhere. Perhaps pandemics, weather disasters or fentanyl deaths will become widespread enough to outweigh improvements in cancer treatment and so on. But I wouldn’t bet on it.

The better bet, according to demographers, is that children born this year will live longer than children born in any previous year.

For the full commentary, see:

Josh Zumbrun. “THE NUMBERS; The Good News About Life Expectancy.” The Wall Street Journal (Saturday, December 16, 2023): A2.

(Note: the online version of the commentary has the date December 15, 2023, and has the title “THE NUMBERS; The (Surprisingly) Good News on Life Expectancy: It’s Still Going Up.”)

The Oeppen and Vaupel article mentioned above is:

Oeppen, Jim, and James W. Vaupel. “Broken Limits to Life Expectancy.” Science 296, no. 5570 (May 10, 2002): 1029-31.

The 2020 article by Roser, updating the Oeppen and Vaupel paper, is:

Roser, Max. “The Rise of Maximum Life Expectancy: Predictions of a Maximum Limit of Life Expectancy Have Been Broken Again and Again.” Last updated March 1, 2020 [cited Sat., Dec. 16, 2023]. Available from https://ourworldindata.org/the-rise-of-maximum-life-expectancy.

Many Long-Lived Ashkenazi Jews Did NOT Follow Usual Advice on Exercise, Diet, Sleep, and Social Connectivity

(p. B10) Louise Levy, who along with hundreds of others 95 and older was part of a study to understand how their genetic makeup led to their good physical and cognitive health during extremely long lives, died on July 17 [2023] in Greenwich, Conn. She was 112.

. . .

Mrs. Levy was one of more than 700 people, all 95 or older, recruited since 1998 to participate in a study by the Institute for Aging Research at the Albert Einstein School of Medicine in the Bronx to learn the genetic reasons for their unusually long, healthy lives.

“It’s not luck,” Dr. Nir Barzilai, an endocrinologist who directs the institute, said by phone. “They exceeded luck. The biggest answer is genetics.”

Using the blood and plasma of the test group, all Ashkenazi Jews — a comparatively homogeneous population whose genetic variations are easier to spot — the institute’s Longevity Genes Project has discovered gene mutations that are believed to be responsible for slowing the impact of aging on people like Mrs. Levy and protecting them against high cholesterol, heart disease, diabetes and Alzheimer’s disease.

“The most striking thing about them is they had a contraction of morbidity,” Dr. Barzilai said. “They are sick, as a group, for very little time at the end of their lives.”

He added, “Did they do what we know we should do — exercise, diet and sleep and have social connectivity? The answer is mostly no. Sixty percent were smoking. Less than 50 percent did much household activity or biking. Fifty percent were overweight or obese. Less than three percent were vegetarians. So they weren’t special in that sense.”

The goal of the research is the development of drugs that would imitate what the centenarians’ genes do to protect their health.

For the full obituary, see:

Richard Sandomir. “Louise Levy, 112, Longtime Subject in a Genetic Study of Human Longevity.” The New York Times (Saturday, July 29, 2023): B10.

(Note: ellipsis, and bracketed year, added.)

(Note: the online version of the obituary was updated July 31, 2023, and has the title “Louise Levy, Who Was Studied for Her Very Long Life, Is Dead at 112.”)

“If You Work Forever, You Can Live Forever”

(p. B12) At age 80, Byron Wien compiled “20 Life Lessons” from a long career as a Wall Street soothsayer. “Never retire” was No. 20. “If you work forever, you can live forever,’’ he explained. “I know there is an abundance of biological evidence against this theory, but I’m going with it anyway.”

Mr. Wien (pronounced ween) didn’t outrun biology. But when he died on Oct. 25 [2023], at 90, he was still engrossed daily in reading the economic tea leaves for his most recent employer, the private equity firm Blackstone. He continued to call politicians, central bankers and financial titans around the world for intelligence to help shape his strategic reports for his firm. And if he felt that his own colleagues weren’t picking his brain enough or adding him to enough meetings, he would tell them he had plenty of bandwidth.

“He was thirsty for knowledge and probably the most curious individual I have ever come across,” said Joan Solotar, the global head of the private wealth division at Blackstone, who was Mr. Wien’s boss.

“I had the pleasure of giving Byron his annual review,” she added, in an interview, “and he would sit down and every year ask the same question: ‘Tell me what I can do better.’”

For the full obituary, see:

Trip Gabriel. “Byron Wien, 90, Wall Street Seer of the Unexpected.” The New York Times (Saturday, November 11, 2023): B12.

(Note: bracketed year added.)

(Note: the online version of the obituary has the date Nov. 9, 2023, and has the title “Byron Wien, Wall Street Seer of the Unexpected, Dies at 90.”)