Nobel Laureate Aaron Ciechanover is talking about medical progress and its implications. What was your dream job when you were a kid? Aaron Ciechanover: I wanted to be a physician. And I am a physician, so I fulfilled that dream. I did not know anything about science. I did not know what one was supposed to do in science. I wanted to be a doctor, and I became indeed a doctor. But then, sometimes into my practice in medicine I realised that the job was not going to fully satisfied my curiosity and take me for a long time because I was more interested in the mechanisms of diseases that in curing patients. And then I decided to go to science. You have been one of the keynote speakers at the Nobel Week Dialogue meeting on ‘the ages to come’: what are the principal issues about ageing? AC: We are paying a price. If you think about living in the nineteenth century, people died at the age of fifty. They died of infectious diseases, or in war, the woman died in delivery, and in big family, five children out of ten died. Science and technology, in the twentieth century mostly, extended life span of about thirty to fourty years, which is amazing. During the Egyptian time, or even the Greek or Roman time, people lived for twenty-five or thirty years. Then the life span was extended of twenty more years in 400 years, and then further more years were gained in another century. And it is science and technology, but also vaccination, medicine and antibiotics, sanitation, diet understanding and so on. But it came with a price: degenerative diseases. Basically, these are not diseases of ageing: these are degenerative diseases. The world ‘ageing’ itself is an issue: we do not know what it means. Can eighty years be defined as ageing and sixty years as not ageing? I do not know what it means. The system probably has the capacity to maintain and sustain itself for so long, but then the system breaks down. All the brain diseases, all the cardiovascular diseases and malignancies are breakdowns in quality control system, in many ways. Think about it. In the brain, it is about some proteins; in the cancer, it is cell cycle divisions, whereas in cardiovascular diseases it is accumulation of lipids and rigidity in the system. It is all about degenerative system, time-dependent diseases that are chronic and accumulated for long time. They started early on, but they get to show their symptoms at a certain age. Science is now directed to fit them. The question is: what is next? Exactly. Are we going to fit these diseases? AC: And then: are there diseases behind the corner? At the turn of the century we did not know about cancer. People died from cancer, but we did not know it was such a big issue because very few people lived long enough to get it or Alzheimer. Now it is an issue. Should we fit them? I think we may, partially at least. There are many diseases behind, and there may be other diseases still waiting for us. The question is also the following: theoretically, if we should fit them all, we are going to live hundred and fifty and two hundred years, and then what about retirement, sustainability of earth, as well as other practical and philosophical questions? I think that living older organisms have a limit. And I think there is a threshold we should not be able to go over. What about the social implications? AC: There are already huge social implications, and there will be even more in the future. In modern countries, like yours or mine, the investments in health is dramatically increasing with age: people say that for people at the age of eighty or ninety that are chronically ill, the investments in health in the last part of their life equals to the third of what invested during the entire life. Think also about chronically ill patients hospitalized and in intensive care units, those who cannot take care of themselves. So the end of life has become an ethical question and we should afford it. There are many, many issues linked to it. And it will be crucial to tackle them in the coming years. AC: Exactly. You have to die of something. Let’s say we would be able to cure cancer, or Alzheimer, or cardiovascular diseases. And then what? Should we be young forever or healthy forever? Ageing is a phenomenon with different factors involved. Everything ages. Even in infectious diseases, people died also because the immune system is compromised. Your chances of dying of influenza are much higher when you are eighty than when you are fourty. Even infections, which are not degenerative and do not belong to this class, affect more this group of people than the others. There is multi-system collapse. There will be a limit. Ten years ago you won the Nobel Prize. How did your life change? AC: Exactly ten years ago. Well, I will tell you. I became busier, but I got it at a relatively young age, at the peak of my career. Initially you are happy at the first day, the second day, the third day, the fourth day. But then you go back to work. I have a very active laboratory, and we recently took a different angle of research for the ubiquitin system, which is exciting. I am a regular scientist. I am doing more public issues now, I am more involved in the education in my country and in other public things, but I am remaining an active scientist dedicated to big lab. Science is a big fun. When I first met you a couple of years ago, I remember I was told that you are also actively engaged in teaching science to young children. AC: Right. I think it is important. Many people tell me that they believe in God but not in science, and I tell them that science is not a religion: science does not ask us to believe in it, it exists anyway. People are afraid of it because of its complexity. Scientists are always trying to find and explain things, but many people think that scientists just work in the basements. I think that it is necessary to implant in children the love for science from the very beginning, and mostly the love for asking questions about the universe, for example why does the sun rise in the morning? Or what allows life on earth? Why earth is so unique compared to the moon? Or about our own body and evolution: what happened to us? The problem with science is that it collides, unfortunately, with religion. And especially when you are coming to a sensitive issue like evolution, who is in charge: God or Darwin? I do not think that they are not mutually exclusive, absolutely not. I think that the religion is a matter of culture, is morality, principles, behaviour. And you can wrap it up with catholic, jewish, protestant wrap: it does not matter. God is above everything else: He is in our hearts. And unfortunately because of the interference of religion -as the leadership of every religion, Judaism as well, what the controls of people- there is an enforcement of ignorance, of lack of knowledge, of investigation, of inquiring and asking questions. And this is bad. Because if you take a child and you try to educate him to understand nature, but on the other hand he is told that he should forget about this because there is a God sitting on somewhere, then we are in a big danger. And we need to find a way to have the two aspects in the same room, in a not-mutually exclusive manner. And if you ask me about religion today, any religion, I think it is the most dangerous element. Education to science and progress in society are crucial. And remember: this is not religion, this is interpretation of religion by people who designed themselves as ambassadors of God. I have never seen any certificates that God sent to them as ambassadors. It is all about power and control of people, and keeping them uneducated. What are your expectations for the 2015 interdisciplinary Lindau Nobel Laureate Meetings? AC: I do not expect much, but all I can tell you is that the Lindau Meeting is fantastic.I know! AC: If people ask me what is the message of Lindau, I would say: ‘that it is possible’. Not to get the Nobel Prize, because you must be crazy to think about the Nobel Prize: there are many talented people that are not getting it, even more talented than Nobel Laureates. I have never meant to get a Nobel Prize, I was driven by curiosity. But it is possible doing something meaningful. Even for those who are growing in small countries with no resources: you need to be driven by yourself. If this message goes through, this is great. Because when I was growing up, I thought Nobel Laureates where like Spielberg’s E.T. But they are not like E.T.: they are human beings. Like us. Like everybody else. Like you. AC: And I am not different from people walking in the street. And this message should pass through. You can influence society, and it is not necessary to be a Nobel Laureate: you can be a teacher, and your students will grow up to be leaders. You can be an architect, a sculptor, a musician, a painter, you can be anything. Living for seventy or eighty years just driving the car and going to the grocery is like…boring. Why should we do it? It is a waste of time. It is like spending eighty years of life by doing nothing. You never thought about winning the Nobel Prize, right? AC: It is too big. I have never lived in my life to win a prize. And it must be crazy to do so: if you drive yourself to win prizes, I think you will never get it, as you are busy thinking about it. And secondly, this is a bad way of living life. Can we say that the best accolade are the results itself, what you get in the laboratory and satisfy the curiosity (and then the Prize, of course)? AC: It is the secret of nature: it is fantastic. We discovered a system that nobody knew before, a major, big system. Now people applied this knowledge to medicine, and see patients and physician doing so: this is wonderful. I walked out from medicine and then if I see myself back in the back door. It is really fantastic. The dream of the young Ciechanover actually came true. AC: Yes, then I became a physician from the back door! I am not treating patients, but I am certainly into diseases. All this came via the science. It is not the Nobel: the Nobel is the culmination of an effort. Because the achievement was the reward, and the Nobel was given for the achievement. The achievement is not the Nobel, the achievement is the science. It is fun to be a Nobel Prize, I am not sorry for it. But it is recognition by society, it is not an achievement in science, it is not a discovery. Again, it is nice to be a Nobel Laureates, a kind of so-called celebrities, but that is not the issue. I have been living many years before winning the Nobel Prize and doing science and nobody really cared about me, but I tremendously enjoyed doing this. And I still enjoy it! Because this is what I do everyday, at the end of the day, or when I get up in the morning. Yesterday morning, for example, I went to the lab, not to celebrate the Nobel Laureates. And this is what really matters: enjoying what you do. AC: No doubt at all.