Exploring the Ethics of Research into Healthy Ageing @babrahaminst

Learning Outcomes All students will: Describe the difference between health-span and life-span. Most students will: Engage in group discussion about some positives and negatives of research altering how healthy we are when we’re older. Some students will: Be able to explain, using healthy ageing as an example, how the advancement of science can result broad changes outside of just medicine. Key word/s Health-span, healthy ageing, lifespan, group discussion, opinion

Healthy Ageing Research Babraham Institute scientists study immunology, epigenetics, and cell signalling. Our aim is to understand how changes in our body as we age affect our health. This fits with the Biotechnology and Biological Sciences Research Council (BBSRC) remit to support research which will lead to strategies for improving lifelong health and wellbeing, and thus reduce pressure on the health and social care systems.

Babraham Institute research themes Epigenetics – How reversible modifications to DNA can control access to genetic information. Epigenetic changes can be linked to ageing and the effects of our environment. Signalling – How chemical pathways inside cells allow them to adapt their function and behavior in response to changes in their surroundings. Control of these pathways can change with age and contribute to illnesses. For more information - https://www.babraham.ac.uk/our-research Immunology – How cells in the immune system develop, specialise and are regulated to respond to infections. The strength of the immune response declines sharply with advancing age.

Ice Breaker: Do you agree with aspects of ageing research? Ice breaker activity Read statements around ageing, and ask students to arrange themselves on a scale across the room by how much they agree or disagree with the statement (1 minute per statement). Following this, we will discuss why people agree/disagree with each statement (up to 4 minutes per statement).

‘We should raise the retirement age from 67’ Chris Seekings, The Actuary, March 2018 ‘We should raise the retirement age from 67’ Ice breaker activity Read statements around ageing, and ask students to arrange themselves on a scale across the room by how much they agree or disagree with the statement (1 minute per statement). Following this, we will discuss why people agree/disagree with each statement (up to 4 minutes per statement). Article: http://www.theactuary.com/news/2018/03/ageing-population-driving-workforce-crisis-for-uk-businesses/

William Haseltine, Forbes, April 2018 ‘If we can understand how we age and can use that to prevent disease, then we have a duty to do so’ Ice breaker activity Read statements around ageing, and ask students to arrange themselves on a scale across the room by how much they agree or disagree with the statement (1 minute per statement). Following this, we will discuss why people agree/disagree with each statement (up to 4 minutes per statement). Article: https://www.forbes.com/sites/williamhaseltine/2018/04/02/aging-populations-will-challenge-healthcare-systems-all-over-the-world/

‘Should we be able to change the DNA of a human embryo?’ Ian Sample, The Guardian, July 2018 ‘Should we be able to change the DNA of a human embryo?’ Ice breaker activity Read statements around ageing, and ask students to arrange themselves on a scale across the room by how much they agree or disagree with the statement (1 minute per statement). Following this, we will discuss why people agree/disagree with each statement (up to 4 minutes per statement). Article: https://www.theguardian.com/science/2018/jul/17/genetically-modified-babies-given-go-ahead-by-uk-ethics-body

What happens when we age? What are some features of ageing? Wrinkled skin Spine curvature Muscle wastage Increased risk of infection Cataracts Sleeping problems Alzheimer’s Frailty See fact sheet for more information CC images: Dog w/ cataracts: https://www.flickr.com/photos/carbonnyc/6252864832 Lady: https://www.pexels.com/photo/adult-elder-elderly-enjoyment-432722/

What is healthy ageing research? Lifespan or healthspan? Ask – can anyone tell me the difference between healthspan & lifespan? Improving lifespan – living for longer Improving healthspan – reducing amount of time with disease CC images: Athlete - https://www.flickr.com/photos/amrufm/480653897 Wheelchair - https://www.flickr.com/photos/140068985@N08/28207069111 Researchers are trying to understand: Why is it that some people remain healthy with age? How can we help keep more people healthier for longer?

Why is healthy ageing important? Source – https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukpopulation/mar2017

Why is healthy ageing important? What does it mean if our life expectancy is increasing but our healthy life expectancy isn’t? Years with disease 75% over 65s suffer from at least two age-related diseases (1 in 5 of us) Time requiring ‘substantial care needs’ has doubled between 1991 and 2011 References: Graph adapted from House of Lords Report: Ageing: Scientific Aspects: July, 2005 75% over 65s suffer from at least two diseases (Goldman et al., 2013) The number of years spent with ‘substantial care needs’ as doubled between 1991 and 2011 (May Bulman, The Independent, 2017) Adapted from House of Lords Report: Ageing: Scientific Aspects. July, 2005

Healthy ageing research at Babraham Institute Michelle Linterman’s group are researching how the immune system declines with age: These images show that 2-month old mice (pictured left) are better able to respond to immunisation compared to 22-month old mice (picture right), as detected by the increased green staining for T helper immune cells in their lymph nodes. This provides evidence to suggest that vaccinations are less effective in the elderly. More information on this work can be found here: https://www.babraham.ac.uk/our-research/lymphocyte/michelle-linterman/research

Healthy ageing research at Babraham Institute Myriam Hemberger’s group are researching changes in fertility with age: This image shows the womb of an elderly mouse. As a mouse ages, the womb becomes less sensitive to hormones, as shown by the uneven, patchy areas of green. This is reflected in the developmental problems seen in the offspring from these older mothers. This provides evidence for how the risks of complications increase with age, and could allow us to reduce the likelihood of problems occurring in the future. More information on this work can be found here: https://www.babraham.ac.uk/news/2017/09/older-wombs-linked-to-complications-in-pregnant-mice

Healthy ageing research at Babraham Institute Oliver Florey’s group are researching a process called entosis or cell cannibalism, when one cell surrounds, kills and digests another: This image shows an example of the process, and their work identified an unknown mechanism of entosis that might help to protect us from harmful damaged cells and could slow cancer growth More information on this work can be found here: https://www.babraham.ac.uk/news/2017/07/cannibal-cells-may-limit-cancer-growth

Activity: What could be the next breakthrough in healthy ageing research?

What could be the next breakthrough in healthy ageing research? Split into four groups Read through your ‘future scenario’ Discuss the following: Who would this affect? What impacts would there be on their quality of life? What are some potential issues with this? 4 scenarios, one for each group Facilitators: examples of potential problems for them to think about: Population size Availability – will it be expensive? For the rich only? Retirement age Health insurance – how would the information be protected so insurance doesn’t unfairly charge people with specific genetic makeup Food availability CC images Health insurance (piggy bank): https://www.flickr.com/photos/68751915@N05/6793821977 Crowding: https://www.geograph.org.uk/photo/4969740 Aerobics: https://commons.wikimedia.org/wiki/File:Aerobics_class.jpg

What could be the next breakthrough in healthy ageing research? What are three key points from your scenario? Who would this affect? What impacts would there be on their quality of life? Would this be available to everyone? Why? How would this effect our population size? What effect could this have on health & social care services? How might this affect insurance policies? Anything else?

Summary Babraham Institute & BBSRC aims are based on important predictions on our futures, but we need to be aware and appreciate the related ethical issues. Social & economic implications of research need to be considered in Government, and the ethical issues need to be thought of by scientists

Recap What are some signs of ageing? What is the difference between lifespan and health-span? Why is it important, particularly now, that the Government wants to promote healthy ageing? What are some potential impacts of future advancements of healthy ageing research?