Science says we could “cure” ageing. But should we?

Sci­ent­ists study­ing the bio­logy of why we age have made some incred­ible dis­cov­er­ies in the last few dec­ades: the age­ing pro­cess is not inev­it­able and, by under­stand­ing the molecu­lar and cel­lu­lar mech­an­isms that give rise to it they are devel­op­ing treat­ments that could slow or even reverse the pro­cess. Can we learn enough that humans could live 400 years, like the Green­land shark? It’s a beguil­ing ques­tion, and one which is often fol­lowed equally swiftly by anoth­er: would we want to? The idea that we could treat age­ing like any oth­er med­ic­al con­di­tion raises some big eth­ic­al ques­tions. Let’s exam­ine a few of the most important.

The most com­mon objec­tion to treat­ing age­ing is often summed up with one word: ‘over­pop­u­la­tion’. The cli­mate is already strain­ing with our col­lect­ive car­bon diox­ide emis­sions, and we’re also pol­lut­ing the plan­et in a myri­ad of oth­er ways, from farm­ing and over­fish­ing to micro­plastics and tox­ic waste. If people live longer, there will be more of us, and won’t that be even worse for the planet?

The first prob­lem with this con­cern is the way it’s posed: ‘over­pop­u­la­tion’ implies that it’s people who are the prob­lem, rather than the resources we use. It also unfairly demon­ises the parts of the world whose pop­u­la­tion is grow­ing the most rap­idly – pre­cisely the poor coun­tries whose pop­u­la­tions use the few­est resources per head. But surely hav­ing more people non­ethe­less makes our vari­ous envir­on­ment­al chal­lenges harder to solve, even if it’s not the people per se who are to blame?

The sur­pris­ing fact is that even a com­plete cure for age­ing — a hypo­thet­ic­al pill that would dra­mat­ic­ally reduce the risk of can­cer, heart dis­ease, demen­tia and more — would have a fairly mod­est impact on glob­al pop­u­la­tion. Tak­ing the pop­u­lar United Nations pop­u­la­tion pro­jec­tions and entirely remov­ing age­ing as a cause of death by 2025 (a slightly ridicu­lous scen­ario bey­ond even the most optim­ist­ic pre­dic­tions for anti-age­ing medi­cine) res­ults in just a 16% increase in pop­u­la­tion by 2050¹. A far more feas­ible slower devel­op­ment and roll-out of such treat­ments would, of course, res­ult in a smal­ler increase still.Then it becomes import­ant to remem­ber what’s on the oth­er side of the bal­ance sheet here: age­ing is the cause of most can­cer, most heart attacks and most demen­tia, as well as frailty, incon­tin­ence, hear­ing and sight loss, and much more besides. It is respons­ible for about two thirds of deaths glob­ally². I’d hap­pily work 16% harder to cut my car­bon foot­print if it meant dra­mat­ic­ally reduced death and suf­fer­ing from dozens of causes, all around the world.

Viewed like this, pop­u­la­tion is cer­tainly some­thing to be aware of (and bod­ies like the UN would do well to pay this sci­ence a little more attention—none of their pre­dic­tions explore life expect­an­cies climb­ing sig­ni­fic­antly above 80 any­where in the world), but it’s not the inev­it­able envir­on­ment­al cata­strophe it sounds like it could be at first.

With Amazon founder Jeff Bezos being just the latest (and richest) bil­lion­aire to invest in anti-age­ing research, there’s clearly interest from the ultra-rich in slow­ing the age­ing pro­cess. But, if they suc­ceed, are the rest of us going to be able to afford the treat­ments that res­ult? The good news is, there are three import­ant reas­ons to hope so.

Firstly, some of these treat­ments might be very cheap: early con­tenders for anti-age­ing medi­cines like met­form­in and rapa­my­cin are exist­ing drugs whose pat­ents have expired and cost pen­nies per pill³, and even more advanced ther­apies are likely to cost thou­sands rather than mil­lions, due to auto­ma­tion and eco­nom­ies of scale when treat­ments are applic­able to lit­er­ally every human on the plan­et, not just the sub­set with a par­tic­u­lar form of can­cer, for example⁴.

Medi­cines would save gov­ern­ments and health­care sys­tems a huge amount of money, off­set­ting the cost of the treat­ments themselves.

Secondly, there will be a large eco­nom­ic imper­at­ive to provide even fairly expens­ive treat­ments, pre­cisely because age­ing itself is so expens­ive. Dementia—which is, of course, just one of many dis­eases of ageing—is estim­ated to cost over $1 tril­lion world­wide, rising to $2 tril­lion by 2030⁵. Medi­cines that could alle­vi­ate the enorm­ous bur­den of these dis­eases would save gov­ern­ments and health­care sys­tems a huge amount of money, off­set­ting the cost of the treat­ments themselves.

And finally, even if you think the bil­lion­aires are entirely out for them­selves, hoard­ing the pills doesn’t even make sense from a selfish per­spect­ive. Ima­gine you’re Jeff Bezos: do you want to be the first per­son to take an exper­i­ment­al anti-age­ing medi­cine, or the 100,000th, after extens­ive safety and effic­acy test­ing? The best out­come for the bil­lion­aires is the same as for the rest of us: a thriv­ing longev­ity industry, with treat­ments cheap enough for large-scale clin­ic­al tri­als, and there­fore wide­spread usage.

As long as there have been humans, there has been death. There’s evid­ence that funer­al rituals may date back hun­dreds of thou­sands of years⁶, so it’s likely our spe­cies has grappled with its finitude for at least tens of mil­len­nia. Is know­ing it will end what motiv­ates us to suc­ceed, or provides mean­ing at all?

The first thing to say is that this is one of many objec­tions that demon­strate how we put age­ing research into its own eth­ic­al category—no-one would ask a can­cer research­er wheth­er they’re con­cerned that a reduc­tion in death arising from their research might neg­at­ively affect the human con­di­tion, and yet, for age­ing bio­lo­gists, this is a com­mon query.The second is that, even if we were to com­pletely cure age­ing, people would still die. There would still be buses to be hit by, infec­tious dis­eases to catch, and can­cer, heart dis­ease and more all afflict bio­lo­gic­ally young people too, if at a far lower rate than the eld­erly. How­ever, a world where our bio­lo­gic­al youth was exten­ded, per­haps indef­in­itely, would cer­tainly be a world with less death—and I’m not so sure that would be a bad thing.

Much of the mean­ing in our lives comes from the people that fill it, our fam­il­ies and friends. And much of the pain, both emo­tion­al and phys­ic­al, res­ults from ill health, either theirs or our own. If we were all liv­ing longer lives in good health, as medi­cines against age­ing prom­ise, why wouldn’t we want to con­tin­ue liv­ing? And as art, music, sci­ence, tech­no­logy and more con­tin­ue to advance (per­haps to new places only pos­sible thanks to cre­at­ors or research­ers with exten­ded careers, able to make dis­cov­er­ies only pos­sible with extra dec­ades of exper­i­ence), it seems incred­ibly unlikely that we’d get bored.

And, even if we do tire of life itself aged 250, wouldn’t you rather go in a short, pain­less man­ner at a time of your own choos­ing, rather than hav­ing life slowly and pain­fully taken from you over dec­ades by the age­ing process?

The key point is that medi­cines for age­ing are just that—medicine. They’re no stranger than a heart dis­ease research­er try­ing to pro­long healthy life by cre­at­ing a drug to lower cho­les­ter­ol. There’s no real evid­ence that the extra years bought by pre­vent­ing heart attacks have stripped mod­ern life of its meaning—so why would adding a few more years free from heart attacks and can­cer and frailty do so?

And all drugs come with side-effects. For medi­cines with a large enough reach, these can be soci­olo­gic­al, eco­nom­ic and eth­ic­al. The con­tra­cept­ive pill trans­formed soci­ety, espe­cially for women; anti­bi­ot­ics and vac­cines haven’t just saved mil­lions of lives, but fun­da­ment­ally realigned our mil­len­nia-old rela­tion­ship with infec­tious dis­ease; the first truly safe and effect­ive weight loss med­ic­a­tions are already foment­ing anoth­er social and med­ic­al revolu­tion. We should dis­cuss the eth­ic­al implic­a­tions of all new treatments—but, though there will always be side-effects to con­tend with, I’d argue that the world would be a far bet­ter place with real anti-age­ing medi­cines added to that list.

There’s obvi­ously far more to say on the eth­ics of age­ing bio­logy, and you can find a free chapter of Andrew Steele’s book, Age­less, at age​less​.link/​e​thics