Home / Columns / Science says we could “cure” ageing. But should we?
Andrew Steele
π Health and biotech π Society

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

Andrew Steele
Andrew Steele
PhD in physics from the University of Oxford, Science Writer and Columnist at Polytechnique Insights
Key takeaways
  • The possibility of designing treatments for ageing raises a number of ethical questions.
  • Looking at demographic studies, eliminating old age as a potential cause of death, shows that the population would increase by about 16% by 2050, if old age is eradicated by 2025.
  • In terms of access to treatment, affordability is more than feasible in the face of the colossal costs of old age on the global economy. A "cure" for ageing would mean billions saved.
  • The ethical implications of new treatments should be discussed, including for real anti-ageing drugs.

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.

What would we do with all the people?

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.

Would treatments only be available to the rich?

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.

But doesn’t death give life meaning?

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

1Would cur­ing age­ing cause over­pop­u­la­tion?Cal­cu­la­tions based on UN pop­u­la­tion pro­jec­tions
2Cal­cu­la­tions based on IHME Glob­al Bur­den of Dis­ease data
3Nation­al Insti­tute for Health and Care Excel­lence, retrieved Decem­ber 2021 age​less​.link/​s​s973t
4More detail can be found in A world with­out age­ing
5Mar­tin J. Prince et al., World Alzheimer report 2015: The glob­al impact of demen­tia, Alzheimer’s Dis­ease Inter­na­tion­al 2015. age​less​.link/​u​csaf9
6P. Pet­titt, J. R. Ander­son, Pri­mate thana­tol­ogy and homi­noid mor­tu­ary arche­ol­o­gy. Pri­mates (2019), DOI: 10.1007/s10329-019–00769‑2