Verified by 
One of the distinctions between us and other species is self-consciousness, and knowing we are going to die. But knowing that we are going to die is old hat for humans, knowing when we are going to die is the new trick. But is it anything more than a trick?
For centuries, insurance company actuaries have been in this longevity prediction game, which for them is not a game but important for their bottom line. The goal for a life insurance company is to set its premiums so that as its customers die, they continue to take in more than they are paying out. So if you are a healthy 25-year-old, on average it will be at least a half-century before you die, and your premium will be relatively low. You will be paying in for many years, and the company will be earning interest on your payments, and turn a profit well before they have to pay your heirs. If you are 45, overweight, and have high blood pressure, your premium is much higher, so they still take in more than they will have to pay out.
Or as my old high school math teacher told us: "Life insurance is a bet where if you win, you lose, and if you lose, you win."
All that actuarial work has produced various questionnaires you can find on-line that enable a rough calculation of your life expectancy at any given age. Fill in your date of birth, your gender, your health factors, your habits, and they estimate about how much time you have left.
Insurance companies don't make billions each year being wrong about life expectancy, and the on-line tests based on insurance data aren't statistically far off either.
Factors such as family health history, your own health history, current health status, behavior, and occupational hazards are quite accurate in predicting that that 45-year-old overweight male smoker with a history of heart disease in his family will live ten years less that someone who has none of those factors.
Soon, a biological test looks to endanger the job security of actuaries. It claims to tell us directly how much time we've got. Telomeres are bits of DNA at the ends of chromosomes. They get shorter as we age. In the UK, and probably coming to a drug store near you, customers will be able to plunk down the equivalent of $700, and find out-based on the length of their telomeres-how much time they have left in the comfort of their own homes.
Leaving aside the science and accuracy of this particular test--and there is some controversy--it's highly likely that biological science will become at least as accurate as actuarial math nerds with regression analysis.
The telomeres test from the Spanish company, Life Length (how else would you brand it?), is only the latest iteration of tests that may detect your fatal flaw. The telomeres measure is a general test, but for years we have been able to test in utero for Downs Syndrome, Tay-Sachs disease, and many other medical conditions. Before child birth if you as a potential parent have Huntington's disease-a degenerative neurological disorder with symptoms like involuntary muscle writhing and dementia as well as a significantly shortened lifespan-you procreate with the knowledge that your children have a 50 percent chance of inheriting the condition. There is no cure and only meager symptom relief for Huntington's.
There is also a test for the BRCA1 and BRCA2 gene mutations, which are reliable predictors for breast cancer in both men and women, and ovarian cancers for women. Some women, given this knowledge elect to have bilateral mastectomies and ovary removals, difficult choices that may not always be effective.
Coming up will be tests for Alzheimer's, for which there is no cure, and will be epidemic among the baby boomers.
One bioethicist, George Annas, looked at the BRCA1/BRCA2 tests, and asked, "Since there is no way to prevent this disease, what good is knowing you will probably get it in the future?"
But is this condescension? Aside from an arguably basic right to know, knowledge provides the power to plan for your and your family's future, and participate in research that might help you or others.
Ask people whether they would rather die from a lingering cancer or a sudden heart attack, and the knee-jerk response is a wish to keel over and be gone.
But a group of oncology nurses--people who live with cancer everyday--was asked this question and they all said they would opt for the cancer. With cancer, they agreed, pain relief is quite effective, and it does allow you get your affairs in order and say your goodbyes. When you keel over, you leave a mess behind.
Other research shows that even if we know we have an increased risk of disease or death, it has unremarkable effects on our behavior or emotional well being, perhaps in counter to Samuel Johnson's dictum, "When a man knows he is to be hanged, it concentrates his mind wonderfully."
A recent study, "Effect of Direct-to-Consumer Genomewide Profiling to Assess Disease Risk," (Cinnamon S. Bloss, Ph.D., Nicholas J. Schork, Ph.D., and Eric J. Topol, M.D.N Engl J Med 2011) concluded that subjects who received commercially available genetic screenings showed no "significant differences between baseline and follow-up in anxiety symptoms, dietary fat intake, or exercise behavior." In other words, people did not let themselves go, just because they knew they were going to die sooner rather than later.
Results, however, were mixed on psychological effects, although 90.3 percent show no test-related distress, psychological distress was positively correlated with estimated life time risk.
Bioethicists may be advised to be more worried about scammers who will peddle anti-aging nostrums for people with bad telomeres test results, and insurance companies that may push to require such tests before issuing policies.
This study may have limited relevance for the population at large. The subjects were somewhat self-selected. They elected to take the test. They may behave differently from the random person who experiences headaches and then is told the CAT-scan has detected brain tumors.
There may be differences between how people respond to an indeterminate sentence of death, and an immediate one. Elisabeth Kubler-Ross famously argued that for a dying person, denial, anger, bargaining, and depression inevitably precede acceptance. Against her, George Bonnano argues for the resiliency of the human when faced with disease and death.
Personally, I never underestimate the strength of denial, especially with respect to probable indeterminate events.
One of the reasons it's so hard to quit smoking is that the positive effects of smoking are immediate, and the negative effects are far off in the future. What's true about smoking is also true about unhealthy diets and a sedentary lifestyle.
Even if you knew you had only twenty rather than thirty years to live, how would that change you?
You know that smoking, fast food, and passively watching hours of TV are all bad for you, but what are you doing about it. The recidivism back to an unhealthy weight post-dieting is well over 90 percent. This is not encouraging for those who believe that knowledge is power.
Would you work on your bucket list, or just show up for work?
------------------------------------------------------------
My book, Nasty, Brutish, and Long: Adventures In Eldercare (Avery/Penguin, 2009), was a Finalist for the 2010 Connecticut Book Award. Click here to read the first chapter It provides a unique, insider's perspective on aging in America. It is an account of my work as a psychologist in nursing homes, the story of caregiving to my frail, elderly parents--all to the accompaniment of ruminations on my own mortality. Thomas Lynch, author of The Undertaking, calls it "A book for policy makers, caregivers, the halt and lame, the upright and unemcumbered: anyone who ever intends to get old."
