Our best bet for healthy aging is to escape the flawed health care system. It makes disease treatment more profitable than prevention. It neglects aging as a treatable cause of diseases. And it denies access to personalized lifestyle medicine. This blog is about how you can overcome these limitations. It is about challenging half-truths and outdated ideas. It is focused on evidence-based, personalized lifestyle medicine for lifelong health. Delivered by a feisty public health scientist.
Today, the German media are treating us to science-gate. A story about pseudoscientific studies, predatory journals and their publishers. With the typical subliminal insinuations of an entire science community being untrustworthy. Do they have a point? Or don’t they? I believe they don’t. But I am biased. "Biased" is something I shouldn’t be as a scientist. But remaining unbiased is so damned difficult when some media hacks and talking heads rehash an old, well-known and controlled phenomenon to taint an entire profession’s credibility. Had those hacks just searched google for “predatory publishing” or “predatory journals” they could have discovered that phenomenon 8 years ago. Wikipedia has devoted an article on the matter. But claiming “investigative journalism” is a lot cooler than reading Wikipedia. And English is also not part of every German journalist’s toolbox. Otherwise, they would have discovered Jeffrey Beall’s list of predatory journals and publishers. Already in 2010. Since then, the University of Colorado Denver librarian and researcher keeps his list of questionable journals painstakingly up to date. No scientist who takes his research work and academic career serious will publish his manuscripts in any of those journals. Every one of my colleagues would rather not publish at all than work with any of those journals. Not as an author and not as an editor. But I also know why predatory publishing thrives. Part of the blame falls on the reputable publishers and their business model. It is insanely attractive to anyone who is after profit margins that exceed even those of Google. That’s what the media monkeys either don’t get, or don’t tell their consumers. You’ll immediately see it when you compare the science publishers’ business model to that of a regular newspaper publisher. The latter employs and (hopefully) pays its writers. The publisher also needs to employ the editors. And he has to do the selling and marketing. None of that burdens the science publisher. His authors are the ones who hand in their manuscripts. His editors are the authors’ peers who review the manuscripts, and who help improve them before these manuscripts will be published. If they get published at all. It’s called peer review. And nobody gets paid for it. Neither the authors nor the editors. How many weekends do we spend reviewing papers. Voluntarily, of course. Because the publishers flatter us about our competencies. And because we feel that we have to give back to the science community on whose members’ reviews of our own manuscripts we depend. Until this point, the science publisher has zero costs. Other than what is necessary to manage the flood of manuscripts vying to be published. And here comes the real genial part of this business model. The research work that is the subject of a manuscript has typically been paid for by some public institution. These institutions are mostly the same that finance our universities and their libraries which have to pay the subscription fees for these journals.
In other words: those who pay for the research, have to pay for the right to read the papers that describe and present the research results. No wonder the business model “scientific publishing” churns out better profits than even Google. And we scientists are doing all the work. That there is no shortage of willing authors is due to academia’s career model. Publish or perish is what describes it in three words. And mind you, getting a manuscript to be published is not a walk in the park. Even in low-impact-factor journals the majority of manuscripts received will not make it from the assistant editor’s desk though the peer review and to publishing.
That’s why we often need to submit our manuscripts to several journals. Not at the same time, mind you. Because journals frown on parallel submissions, and sanction it heavily if we dare to do it. Despite all these obstacles, publishing in predatory journals is not an option for the overwhelming majority of us. Not least because of pride. Nobody wants to refer to a paper that has been published in a journal that colleagues immediately recognize as a pseudo-journal. Only journalists don’t know that. Which bespeaks deviant journalism rather than deviant science.
Mit sogenannten Recherchen und Reportagen über pseudowissenschaftliche Studien und scheinwissenschaftliche Verlage ziehen schadenfreudige Journalisten heute den deutschen Wissenschaftsbetrieb in ein schlechtes Licht. Zu Recht oder zu Unrecht? Ich behaupte, zu Unrecht, aber ich bin voreingenommen. Als Wissenschaftler sollte man das zwar nicht sein. Aber Unvoreingenommenheit fällt schwer, wenn Zeitungsschreiber und Fernsehschwätzer ein altes, längst bekanntes und gut kontrolliertes Phänomen sensationalisieren, um damit einen ganzen Berufsstand dem Generalverdacht der Unglaubwürdigkeit auszusetzen. Hätten sie nur mal nach dem Stichwort "predatory publishing" oder "predatory journals" gegoogelt, hätten sie sich schon vor 8 Jahren mit dem Phänomen der "Raubverlage" vertraut machen können. Sogar auf Wikipedia. Aber Enthüllungsjournalismus ist eben cooler als Wikipedia zitieren. Und Englisch ist halt auch nicht Jedermann's Ding. Sonst wären sie nämlich schon 2010 auf der Jeffrey Beall's Webseite gelandet, der in akribischer Kleinarbeit seine Liste der Raubverlage und ihrer "Fachzeitschriften" bis heute aktuell hält. Kein Wissenschaftler, der seine Forschungsarbeit und seine akademische Karriere ernst nimmt, veröffentlicht in solchen Verlagen. Ich kenne in meinem Kollegenkreis niemanden, der diese Raubverlage nicht meidet, wie der Teufel das Weihwasser. Weder eine Publikation noch eine Rolle als Editor in einem dieser Verlage würden wir auch nur einen Moment lang erwägen. Ich weiss, dass ich hier für die deutliche Mehrheit meiner naturwissenschaftlichen Kollegen spreche. Ich weiss aber auch, warum dieses Phänomen der Raubverlage entstand, und warum sie gedeihen wie das Unkraut im Garten. Nicht zuletzt tragen die wissenschaftlichen Verlage selbst zum Florieren ihrer räuberischen Kollegen bei. Was dem Medienkonsumenten nämlich verschwiegen wird, ist das Geschäftsmodell der Wissenschaftsverlage, das man entweder als genial oder als ausbeuterisch bezeichnen kann. Oder als beides. Anschaulich wird das im Vergleich mit einem "normalen" Zeitungsverlag. Der muss seine Autoren beschäftigen (und bezahlen). Der beschäftigt auch die Editoren, die die Autorenarbeiten querlesen und korrigieren. Der Zeitungsverlag muss sich auch um den Verkauf seiner Zeitungen kümmern. Beim Wissenschaftsverlag läuft das alles ganz anders. Die Autoren muss der nicht bezahlen, denn das sind ja die Wissenschaftler, die die Artikel schreiben. Seine Editoren muss er auch nicht bezahlen, denn das sind wiederum Wissenschaftler, die die Arbeiten ihrer Kollegen querlesen und kommentieren. Freiwillig und unbezahlt natürlich. Peer review nennt sich dieser Prozess, den jede wissenschaftliche Arbeit durchlaufen muss. Wie viele Wochenenden verbringen wir mit freiwilliger und unbezahlter Peer Review, zu der wir von den Verlagen natürlich "eingeladen" werden, weil die uns mit der Wertschätzung unserer Kompetenz bauchpinseln. Und weil wir natürlich auch was zurückgeben wollen an den Wissenschaftsbetrieb, dessen Mitglieder unsere Arbeiten querlesen und kommentieren. Bis dahin also hat der Wissenschaftsverlag null Ausgaben. Und hier beginnt das wirklich Geniale: die Forschungsarbeiten, die Gegenstand der Manuskripte der Autoren sind, werden mehrheitlich von öffentlichen Forschungsgeldern finanziert. Forschungsgelder, die von Einrichtungen des Bundes oder der Länder kommen, jener Einrichtungen, die auch die Hochschulen finanzieren, deren Bibliotheken die Abonnements der Fachzeitschriften bezahlen müssen. Mit anderen Worten, diejenigen die die Forschungsarbeiten bezahlen, müssen dann auch noch dafür bezahlen die Arbeiten lesen zu dürfen. Kein Wunder also, dass das Geschäftsmodell "wissenschaftlicher Fachverlag" noch bessere Gewinnspannen hat als Google. Und wir Wissenschaftler machen die ganze Arbeit. Dass die Verlage keinen Mangel an willigen Autoren haben ist dem akademischen Karrierebetrieb zu verdanken. Publish or perish ist dessen Motto, was soviel heißt wie "wenn du keine veröffentlichten Manuskripte vorweisen kannst, wird's auch nix mit der Karriere in Akademia". Selbst bei Fachzeitschriften mit relativ niedrigem Impact Factor schafft es nur ein Bruchteil der eingereichten Manuskripte vom Tisch des Redakteurs durch das Peer Review und in die Veröffentlichung. Deshalb müssen wir für unsere Manuskripte häufig bei mehreren Verlegern anklopfen, natürlich nie zur gleichen Zeit, denn das verbitten die sich und sanktionieren es auch heftig, sollte man es trotzdem tun. Dennoch ist für die allermeisten wissenschaftlichen Kollegen die Veröffentlichung in Raubverlagen keine Option. Alleine schon aus Stolz. Keiner von uns will auf eine Veröffentlichung in einem Verlag verweisen, den alle Kollegen sofort als Raubverlag erkennen. Nur die Journalisten kennen sich da natürlich nicht so aus, was aber eher für Journalismus auf Abwegen spricht als für Wissenschaft auf Abwegen.
The first person to live up to 150 years has already been born.
That's what Steven Austad, David Sinclair and Stuart Kim think. All three are Professors: Of Biology, of Genetics and of Developmental Biology respectively. Sinclair at Harvard Medical School and Kim at Stanford University. Just in case you thought I quote some nutcase science colleagues. Now, imagine, you being that person living to 150. You'd only enjoy the privilege if you could live fully functional 150 years. That's quite the opposite of how we experience aging today: a gradual loss of function. It typically leads to dementia, heart disease, cancer, diabetes, frailty, you name it. Treat that loss of function before it has deteriorated into any of those chronic diseases, and you not only prevent the diseases but you also extend your fully functional lifespan. Treatment of function means an extension of lifespan and freedom from disease. No need to be a professor to get that point. But you apparently need to be in medicine to NOT GET IT. With its refusal to acknowledge aging as a medical condition, medicine is guilty of causing bodily harm: By withholding the treatment for functional decline until this treatable condition has deteriorated into one or several incurable diseases. These diseases are not called chronic for nothing. That's why I am an advocate for treating aging like a disease. That's why our professors are big fans of two cool strategies: Strengthening the innate repair mechanisms and bio-engineering the necessary repair or replacement technologies. Back to the question whether you will make it to 150. Probably not. Because by the time these new strategies will have found their way into the clinic, you'll be dead. I am pretty sure I will be.
Initial exuberance about any new biomedical insight is rarely justified. Just check back at the decoding of the human genome.
Genomics was then hyped as THE hack for personalized disease prediction and prevention. Ten years later the sobering realization: "The numerous genetic variants that mediate disease risk … are thus meager in their predictive power. " [1].
So, don't bet on getting any lifespan extension treatments within your lifetime. UNLESS… … you start with a third strategy. It's called robustification against aging. It simply means to slow down, stop or even reverse the functional decline that comes with age. Now imagine, if we could quantify and measure your organism's robustness against all the things that can go wrong under the hood we can keep it robust. The best part is, we do not need to know the myriad of things that eventually will go wrong under the hood. Surprisingly, measuring function is something sorely neglected in medical science. That's where functionomics enters the stage. Let's take the cardiovascular system as an illustrative example. This system's failure is the cause of roughly half of all deaths (which is one reason why I have made it my priority). Its purpose is to deliver oxygen and nutrients to each and every cell of all organs. And then to carry away all the cells' waste products that come from metabolizing these nutrients and oxygen. It has a second purpose: to unburden the heart, by actively pumping the blood through its conduits (the arteries). The cardiovascular system does its job as a purely hydraulic system. Therefore cardiovascular function can be fully described by the same physical parameters that engineers use to build hydraulic systems. The tool to describe and quantify the cardiovascular hydraulics is cardiovascularfunctionomics. It's a profile of all the functional parameters that together determine your system's functional capacity. Much like your genomic profile determines your inheritance. Translate that functionomic profile into a correction factor of your calendar age, and we have two vital things. First, we know how robust you are against threats to this system. Second, we have a benchmark that can tell us how good we are in robustifying you, say, with a drug or exercise or diet. We do not need to know what exactly it is that might be threatening YOUR system, as long as we know that YOU are robust enough to withstand anything that CAN happen. What is the net effect of 'robustification the functionomics way'? It buys you time. It may be only a couple of years, say, a decade. But 10 years of staying functionally fit may make a sizable difference, between on the one hand living long enough and in good enough health to benefit from future technologies of rejuvenation, and on the other hand missing that boat. Because, even if our professors' exuberance may be a bit overboard, we are pretty close to some exciting new life and health extension technologies. And if it wasn't for medicine, we would be much further ahead on that path by now. That's why I conceived of functionomics. It may make you, and me, the first ones to make it to a healthy 150 after all.
Bibliography
[1]J. P. Evans, E. M. Meslin, T. M. Marteau, and T. Caulfield, “Deflating the Genomic Bubble,” Science (80-. )., vol. 331, no. 6019, pp. 861–862, Feb. 2011.
