If you had asked me in early September whether I would be invited to testify before the U.S. Congress in mid-September on any topic, I would have laughed it off, but that is exactly what happened.
On the 15th of September I testified before the U.S. Congressional Committee on Science, Space, and Technology on the topic: “The Fountain of Youth? The Quest for Aging Therapies”. This issue has been one of my areas of specialty since 1990.
You can find verbal testimony and answers to questions raised during the hearing here; the full written testimony will become available at a later date and I’ll make that available when allowed to do so.
I was very impressed with the congressional committee’s knowledge on the subject during the hearing, and their aids were extremely thorough during the pre-testimony interview. Their thoughtful questions reflected a deep understanding of the profound influence that advances in aging science are about to have on most aspects of our world. Their interest was genuine and I could tell they had read the articles I sent to them.
Since I’ve written about elements of this work in previous newsletters, I won’t go into detail here. What I will do here is present my answers to just a few of the questions addressed in my written testimony – which no one outside of the Committee has seen yet. The goal was simple – keep it short, easy to understand, and supported by science. Your comments and questions are welcome.
Is Biological Aging the Primary Risk Factor for all Diseases of Aging?
Aging bodies exhibit common attributes associated with using these living machines beyond what I consider their biological warranty period. Even if we adopt what might be thought of as ideal lifestyles, and if all disparities could hypothetically be eliminated, our bodies would still age, we would still grow old, and most deaths would occur between the ages of 65-95 from the same causes of death we see today.
When medical professionals and public health experts inform us, correctly of course, that many diseases are preventable through lifestyle modification, what they don’t tell us is that death is a zero-sum game. Aging related fatal and non-fatal diseases and disorders are not eliminated through primary prevention – they are for the most part postponed and compressed into our remaining years of life.
If we are successful in reducing or eliminating one risk (such as smoking), we will no doubt reduce the risk of multiple diseases related to that risk, but biological aging marches on – uninfluenced by any progress made against specific diseases. Chronic age-related fatal and non-fatal diseases and disorders accumulate the older we get. This phenomenon is known as competing risks, and it is the reason why the life expectancy of national populations will not likely exceed about 85-88 years for men and women combined under present conditions.
Is Aging a Disease?
This is a point of contention in the field of aging. By declaring aging a disease, some believe it will be easier to get the FDA to approve targeted therapeutic interventions. Others, myself included, suggest that aging is no more of a disease than puberty or menopause – it is a natural developmental byproduct of operating our living machines long enough to witness its effects.
Calling aging a disease implies that all older people are, by definition, diseased – which is an example of ageism. We’re not against aging or growing older – which is what the ‘aging disease’ designation implies by default. What we are seeking to achieve is an extension of the period of healthy life. Declaring aging a disease is just not necessary to launch this new movement in public health.
Besides, the FDA has already approved Geroprotectors to target multiple disease endpoints all at once, without declaring aging a disease.
What is The Goal of Geroscience?
To extend healthspan by compressing the frailty and disability that comes with aging, into a shorter duration of time near the end of life. What would a successful Geroscience therapeutic do for us? The life and death of Queen Elizabeth II is an exemplar of what Geroscience is pursuing – a healthy active life with a short period of frailty at life’s end. Conceptually, think of it taking 80 years of clock time to become biologically 60-years-old; or 90 years of clock time to become biologically age 70. Extending healthspan is the primary goal, and the cost savings associated with a successful Geroprotector that yields just a one-year increase in life expectancy would be $38 trillion.
Will Geroscience be the Fountain of Youth?
No. If the concept of a fountain of youth is taken in its literal sense as that presented in the popular literature where we become younger versions of ourselves by using some intervention, this is not going to happen in my view. There are many instances of exaggeration and embellishment among some in the scientific and medical community regarding the use of this phrase – some of which is driven by those seeking to profit from these therapies or research dollars from investors – but most researchers in the field stay away from mentioning “fountain of youth” in the same sentence as Geroscience.
Reversing some of the signs and symptoms of aging and lowering the risk of death and frailty is already possible with the use of diet, exercise, and risk factor modification – but there are limits to how much these kinds of interventions can influence lifespan and healthspan.
If “fountain of youth” is interpreted to mean that we can alter the age trajectory of mortality and disability through scientific means that have been properly tested for safety and efficacy, then under these conditions the phrase may be appropriate.
Those of us involved in Geroscience are acutely aware of a long history of hucksterism that has followed medicine and public health for thousands of years, so most shy away from using this phrase. I personally avoid using this phrase, just as I avoid the phrases “age reversal” and “immortality”.
I view Geroscience as the next logical paradigm in public health that will simultaneously avoid the dangers of life extension brought forth by treating one disease at a time and enhance the probability that healthspan will be extended and morbidity and disability compressed.
Can Geroscience Replace Diet, Exercise, and Risk Factor Control?
No. Taking a Geroprotector is not a license to adopt an unhealthy lifestyle. The same behavioral risk factors that shorten life and increase the risk of disease would be operational when using a Geroprotector.
Geroprotectors would likely enhance and extend to older ages the effectiveness of diet and exercise and risk factor control in extending healthspan and compressing morbidity and disability.
Are There Secondary Benefits Associated with a Successful Geroprotector?
If Geroprotectors had been available at the beginning of the Covid-19 pandemic, it would likely have dramatically reduced death and disability related to this communicable disease? Why? Because Covid-19 and other communicable diseases prey on subgroups of the population that are experiencing multiple health challenges (e.g., pre-existing conditions) – the very phenomenon of competing risks described earlier that explains why this virus tends to kill most effectively at older ages. The declining effectiveness of our immune system is one of the hallmarks of biological aging, so any intervention that delays the process of aging, will have secondary benefits associated with multiple infectious diseases including pneumonia and seasonal influenza, among others.
Geroprotectors will also likely be needed for astronauts that travel for extended periods in space due to high risks associated with exposure to radiation.
It is difficult to determine this far in advance what other attributes of human health might benefit from Geroprotectors, but it is safe to say that any intervention that enables us to slow down biological aging is likely to have as yet unforeseen benefits.
It is difficult to imagine any harm to human health that would follow from interventions that yield more healthy years of life.