We Have to Have More Courage to Insist Aging is Accepted as a Disease

The recent Nature journal special edition is dedicated completely to the problem of aging. Among various articles covering topics from demographics to comparative biology and robots, there’s one about the interventions in the aging processes. It is a nice overview about the current successes in slowing down aging in mammals, however I found the last paragraph rather disappointing. It says:

Ageing isn’t a disease, and lifespan extension will be almost impossible to prove in humans.

These are the words of the NIA officials and some of the scientists. Aging is not considered to be a disease at the moment. There is no such indication as aging, therefore one can’t register a geroprotector drug, the one that slows down aging. This is one of the major hurdles in aging research. Even though there are some substances that are proven to slow down aging and protect from diseases, researchers can’t make drugs from these substances. This has to be changed if we want to live longer and healthier. I think it’s horrible that the NIA people are propagating this idea that aging is not a disease. They are rejecting the opportunity with their own hands. If they fought for persuading the healthcare officials to accept aging as a disease, a lot of problems would be gone instantly.

Firstly, it would be much easier to get grants for aging research. Now everyone has to come up with the potential impact on treating the pathologies like cancer and diabetes, but once aging is recognized to be a disease, it would be much easier to apply to funding.

Secondly, research would be more effective, all the scientists now working on separate age-related diseases wouldn’t need to shift their attention from the actual cause, they would be able to focus on the aging processes with no harm to the future funding opportunities.

Lastly, there will be aging doctors in the clinic. Right now one can’t come to the hospital and  say, “doctor, I’ve got a problem, I am aging.” People would laugh at such a patient, however this is the best kind of patient, the smartest one, one who cares about his future and wants to prevent the upcoming illnesses and frailty. Most importantly, there is a way to help patients like that. the article says “lifespan extension will be almost impossible to prove in humans.” I believe this is wrong. The right panel of aging biomarkers will do the trick. Yes, the panel will be huge, we would need to monitor a lot of parameters (proteomic, transcriptomic, metabolomic data, etc.), watch the dynamics, but after some time of monitoring, we’ll be able to prevent diseases and make truthful predictions regarding the rate of aging of a particular person. It has already been shown. Read the story of Michael Snyder from Stanford University who was able to track the onset of his type 2 diabetes and treat it, way before the traditional diagnostics could detect the illness.

Glass, Sierra and others hope that research on ageing interventions will change the way we think about disease and drug development, and lead to treatments that tackle multiple age-related diseases at once. Major causes of death worldwide, including cancer and cardiovascular disease, share a common risk factor: age. Tackling one disease at a time isn’t working, says the NIA’s de Cabo. “Ageing is the leading risk factor for all chronic diseases,” he says. “Postpone ageing, and you postpone these diseases.”

Dr. de Cabo is right, however it is absolutely not clear to me how these researchers are going to change the existing attitude without making aging recognized as a disease. I believe it’s NIA that has to be the leader in persuading the government to change the nomenclature and include aging in the list of diseases. Instead, they are hiding their heads in the sand. And in the meantime we are not getting any younger.


Filed under Policy

10 responses to “We Have to Have More Courage to Insist Aging is Accepted as a Disease

  1. David Lefkowitz

    I’m not as discouraged by that Nature article as you, in particular the last paragraph that states “Ageing isn’t a disease…”. More encouraging is the later sentiment that, “ageing interventions will change the way we think about disease and drug development, and lead to treatments that tackle multiple age-related diseases at once. Major causes of death worldwide…share a common risk factor: age. Tackling one disease at a time isn’t working…Ageing is the leading risk factor for all chronic diseases…Postpone ageing, and you postpone these diseases.” I think the authors’ philosophy is consistent with SENS and similar anti-aging advocates, and that the issue of defining aging as a disease as opposed to a concomitant process is largely semantic. Where I would agree with you is the difference it would make from the perspective of the FDA and new drug approvals. But the FDA process has way more issues that are detrimental to the cause than simply the categorization of aging. What ultimately matters is the willingness of governments and private contributors to fund rejuvenation research, regardless of whether it is classified as a “disease”.

  2. David, you are right in your conclusion. My point is that defining aging as a disease will make a huge difference. Leaving things the way they are now will make the statement “ageing interventions will change the way we think about disease and drug development” impossible to bring to reality.

  3. Maria,

    Two points, if I may;

    First being that redefining “aging” as a disease developmental pre-cursor condition might avoid much of the objection to research funding. The research isn’t into “aging” per se, but into the links between aging and disease development and progression. Same result (disease therapies based upon multiple-disease commonalities vs the present “stove pipe” research funding model, aging as a legitimate object of independent therapy development applicable to several disease processes), without the competition for exclusive research funding so much a feature of the prersent model.

    Secondly, the US NIA is an agency of government; as such its research direction and emphasis is subject to political (ie: non-medical) criteria. I have argued against the current government-based model of medical research in your comments prior to this. I hope you can see at least some of the basis for my position as a result of your latest post. Relying for research (or any other, really) funds from people who are themselves reliant upon the common perception that their opponents can create about them to portray them in a negative light will always result in a tightly constrained and medically questionable (at best) research and development (or pretty much any other, I suggest) environment. Much better, I think, to develop a different model of research funding that minimizes individual influence and maximizes transparency of research process. Government would still have a desirable role in the production and distribution process of medical treatment after all.

    • Will, a question. How do you think it will be possible to register a drug against a non-recognized disease? What you are proposing still won’t make drug registration possible. At least I don’t see how this could happen.

      It would be very nice not to depend on the government funding, but only on the private money. The only problem is that at the moment there is no private money. The amounts of funding that comes to the field from private sources in not more that couple dozen millions of dollars per year (SENS gets 1 million from Peter Thiel, Buck Institute gets about 10 millions, other institutes even less, AFAR raises like 10 millions a year, that’s it) as opposed to 1 billion that goes to NIA.

      My point is how can we convince private donors? We haven’t been that effective, maybe we tried false strategies, but I think it is largely due to the fact that rich people rely upon the public opinion. They buy yachts and diamond because it is considered to be cool among the general public. The same thing has to happen with aging. Right now the topic of aging is a taboo. It’s our job to change this attitude. I believe officially recognizing aging as a disease may help.

      • Hi Maria. I thought this a good topic for a post on my own blog as I have an interest in life extension myself. I outline the example of Salman Khan’s experience with his Khan Academy non-profit in education and suggest this as a potential model for you to consider in the life extension/anti-aging effort. I am not the one to answer specific questions as to how to go about registering drugs, but do think that a large organisation that people can contribute/invest/participate in is a viable venue to learn that answer.

        The thing about any government budget is, much of it goes toward things other than research grants and is often subject to other considerations than an agency mission statement. Some of the same would be true of a non-profit, but such organisations have much smaller bureaucratic infrastructure burdens as well as a much more focused compliance with the mission statement than any possible government agency could have.

        My over-riding point is that research of this nature is in need of a mechanism in the fashion of Khan Academy, one that creates a forum for the disperate research efforts and provides an opportunity for people of ordinary means to participate directly too (Peter Thiel’s $1m is very nice of him, but 100 million people like you and me contributing $2 every week for a year is 100 times that amount) (as Glen points out in his comment below). Making that into a functioning process will, more than anything else, create the political environment within which your objections can be positively mooted.

        Sal Khan is in the so-far successful process of convincing school teachers that his way of teaching is better than theirs is, better for them and the students. You are in a position to do the same thing for aging/life extension research contributors and researchers – to give them a voice and a stake in research efforts and outcomes. It won’t happen fast or easy necessarily, but a confident and positive message of the facts, transparently presented in non-technical and straight-forward language seems like an affordable and achievable beginning.

  4. Glen

    All this talk could be circumvented if the right number of people just donated to SENS foundation. I think if about a million people gave 100 US dollars then that would be that. It might seem absurd but I would certainly pay 100 dollars to not suffer from age related diseases (in fact I have). In the scheme of things it’s not that much. Apparently youth is desirable for most people on Earth yet that small number can not be found to try to achieve it. I would say the most concerning part of the article is the talk of slowing metabolism. This is intuiative if we think aging is unavoidable and not an accumulation of damage that occurs throughout our lifetime. It’s typical of the mentality that has dominated the Scientific community for some time. It exists on the premise that we could treat “aging” with a single drug and that we could successfully intervene in metabolism. We can not treat aging with a single drug, human aging/metabolism is too complex and it does not stop the damage from accumulating. This is why some scientists have worked on the problem for 40 years and come up with absolutely nothing. I like Aubrey de Grey’s plan because it is clearly defined and has a lot of detail in how to implement the fixes. Ideas like caloric restrcition or rapamycin on the other hand are based on extemely tennative and non-specific observations.

  5. I would like to cite just one longevity project: The Max Life Foundation. It would be inappropriate for me to endorse it (but I do) here, but I am citing it by quoting a passage in the book “Smart, Strong, and Sexy at 100” because it pertains to the cost to benefit ratio:

    Page 244

    “1. This is not a trillion dollar plus project. In fact, it’s not even a $100 billion project, even though that would be one of the most incredible bargains of all time. (We spend that much on health care in the United States every sixteen days.) We came to the astonishing conclusion that we could accomplish enough to cure aging for the ridiculously low sum of 1.9 to under $5 billion, plus $900 million more for SENS (as described in Chapter Four). Total as little as $2.8 billion.

    2. We can do this over an eighteen-year span, starting from the time the first part of the funding is in place.

    3. About $150 million a year may be all that is standing in the way of youthful open-ended lifespans.

    4. This assumes no reinvested profits will be generated from any of the companies and technologies that would receive funding. If some of these were moderately successful, profits could be reinvested, which would reduce the overall cash outlay.”

    Let me add, that the talk isn’t only about SENS (strategies for engineered negligible senescence), but about reversal of aging (i.e. going from a 90 year old feeble prune to a 20 plus year old person at the top of their game).

    BTW, did you know that the FDA does not allow longevity science product’s direct application? Until this policy changes, no serious investment will be made in the U.S. to bring longevity science to the clinic.

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