Let us never know what old age is. Let us know the happiness time brings, not count the years.

Ausonius. (310–395 CE). Roman poet, born in Bordeaux, France. Fig. 1.

Fig. 1: Ausonius.
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Ausonius a Roman poet, born in France.

Many things are associated with old age in humans; illness, wisdom, dementia but as I always say: there is one good thing about getting old, no more exams!! The other thing I have noticed is that wine bottles seem to have shrunk in size. In youth sharing a bottle of wine with another could sometimes be problematical but with advancing age it becomes less of a problem and sometimes a second bottle is opened, although not fully consumed (usually). I recently overheard a conversation between 4 men (of a certain age) in a restaurant when one of them called the waiter to their table and proclaimed: This bottle seems to have shrunk! One way around this is to only buy magnums (they hold the equivalent of two bottles; 54 fl oz). Magnums may also be a better storage vessel than the common 75 cl bottle and magnums are generally regarded as the ideal size for bottle ageing, as purportedly wine ages more slowly in magnums compared with the standard 75 cl bottle. If you are worried about finishing it at one sitting, simply re-cork the magnum with a wine stopper. If you don’t or can’t use the cork then insert one of the many commercially available wine stoppers. Hugh Johnson (the well-known wine writer) maintains that many bottles of red wine taste better the following day.

One of the more desirable effects of climate change is the ability of grapes to ripen in areas in which this was unlikely to happen. Jancis Robinson, writing in the FT Magazine [1] points out that Britain is a good example of the positive effects of climate change. Apparently, Tim Wildman, MW (master of wine) is making excellent wine from grape varieties that hitherto were associated with uninspiring wines. He says his wines are ‘heritage varieties’ and are made from Richensteiner, Schönburger and Madeleine Angevine, early-ripening crosses and hybrids from Germany. I haven’t tasted any of these wines but look forward to in the future.

Of course, climate change may be associated with extreme weather conditions from heat waves and drought to flooding. What was news to me and, probably many of you, is that Germany is the third largest producer of wines from the Pinot Noir grape (Spätburgunder in Germany) after France and the USA. Not many of these wines are sold outside Germany. It is possible that Spätburguder may become the flagship of German red wines as Riesling is for white wines, according to Romana Echenspenger MW [2]. She also claims that climate change has benefited Germany in making wines from Pinot Noir and that clonal selection is very important [3]. To underline this change Stuart Pigott, a British wine expert said recently: Two decades ago, a high-end Pinot Noir selling for at least €100s a bottle could be made three or four times a decade, whereas now they can be produced every year, [4].

On the one hand, in humans, advancing age may accentuate unpleasant characteristics which were present in more youthful times. On the other, advancing age may bring with it wisdom which can soften the exuberance of youth and lead to more balanced opinions. Whatever your view there is no doubt that the toxicity of many medical procedures and pharmacological agents increases with age. Thus, such patients may be excluded from clinical drug trials and drug dosage may need to be adjusted to avoid toxicity Initially, (1970s/80 s) allogeneic bone marrow transplantation (as it was known) was limited to recipients below 55 years because of the toxicity of conditioning therapy. This consisted of total body irradiation (TBI) and high dose cyclophosphamide. With the introduction of reduced intensity transplantation (RIC) some centres have increased the age where allogeneic transplantation is offered to patients up to the age of 70 years.

One of the problems with the term ‘old vines’ is the definition of old. Most people take 50 years as the cut-off for old vines. It is difficult for most of us to estimate the age of a vine but many believe that ‘old vines’ produce better wines. Recently Jancis Robinson [1] has extolled the superiority of old vines without defining their age so the situation remains fluid! However, without sounding too cynical, the words ‘old vines’ on a wine label may, in some cases, be a marketing ploy. In an attempt to protect the veracity of the term ‘old vines’ the Historic Vineyard Society was formed in California in 2010 and has assembled a registry of vines planted before 1960 [5]. The society was also anxious about the speed of ripping up of ‘old vines’ to make way for Pinot Noir in Sonoma.

Whatever about old vines or re-constructed grape varieties, what about old drugs with a second life. Although we are now entering the era of immunotherapy for malignant diseases let’s not forget some of the tried and tested drugs. The alkylating agent Bendamustine is probably the best-known Fig. 2. Bendamustine was developed in the early 1960s and used in East Germany for the treatment of CLL, NHL, Multiple Myeloma, Hodgkin Lymphoma and Lung Cancer. However, because of Cold War prejudice it was only studied in clinical trials after the unification of Germany in the 1990s and approved for the treatment of CLL in 2008 and later that year for NHL. The latter was often combined with Rituximab, a chimaeric antibody developed after the discovery of CD20 in 1980 by Lee Nadler. It received European approval in 1992. Initially given as a 30–60-minute intravenous infusion it was approved for sub-cutaneous use in 2014 Fig 2. The other drug that has been around for a long time is methotrexate (MTX) Fig. 2. Since Denis Burkitt Fig. 3 used the drug in the 1950s, with the help of Joseph Burchenal [6], for the treatment of what we now call Burkitt’s Lymphoma, the drug has been used to treat childhood ALL, prophylaxis against Graft versus Host disease (GvHD) and many benign diseases.

Fig. 2: Bendamustine.
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Bendamustine hydrochloride a recently ‘re-discovered’ alkylating drug.

Fig. 3: Methotrexate.
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Methotrexate a drug used for >50 years.

The good news for patients is that immunotherapy for malignant disease is making progress and is less toxic than chemotherapy. Some ‘old’ drugs are proving useful and we are still using drugs that have been in use since the 1950s. For wine drinkers, climate change may offer a larger selection of wines for consumption and the debate about ‘old’ vines continues.