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Are we really doomed to grow old and die?

Andrew Steele
Andrew Steele
PhD in physics from the University of Oxford, Science Writer and Presenter

#1 DO WE HAVE TO GROW OLD?

True: Ageing is responsible for more than 100,000 deaths every day

Of the 150,000 deaths that occur on Earth every day, over two thirds of them are due to age­ing1. This is because, bio­log­i­cal­ly, the age­ing process is the cause of our biggest killers, like can­cer, heart dis­ease and demen­tia2. Though diet, lifestyle and oth­er fac­tors can make these more or less like­ly, their effect is dwarfed by the bio­log­i­cal con­se­quences of get­ting old­er: hav­ing high blood pres­sure can dou­ble your risk of a heart attack, but being 80 rather than 40 mul­ti­plies it by ten 3. As a result, age­ing is the sin­gle largest cause of death and suf­fer­ing, globally.

False: The ageing process is inevitable

Though we think of get­ting old­er as a nat­ur­al fact of life, this isn’t the case for all species. Biol­o­gists have a sim­ple def­i­n­i­tion of age­ing: an increase in risk of death with time. Humans have a risk of death that dou­bles every eight years4. How­ev­er, some species, includ­ing some tor­tois­es, fish and sala­man­ders, are ‘neg­li­gi­bly senescent’—more plain­ly, they don’t age5. Along with their unchang­ing risk of death, these ani­mals don’t become frail or less fer­tile with time. This means that their ‘healthspan’ is increased, along with their lifespan.

Uncertain: How long we can hope to live

Every so often, a study pro­pos­es a ‘lim­it’ on human lifes­pan, either by look­ing at demo­graph­ic trends, or analysing aspects of human biol­o­gy. How­ev­er, these ‘lim­its’ have repeat­ed­ly been smashed his­tor­i­cal­ly, as life expectan­cy in the lead­ing coun­try has increased by three months per year, every year for almost two cen­turies6. Are we approach­ing a real bio­log­i­cal lim­it now? Or can med­i­cines that tar­get the age­ing process help us side­step the con­straints that evo­lu­tion has placed on us, and help humans become more like neg­li­gi­bly senes­cent tortoises?

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#2 CAN SCIENCE EXPAND LIFESPAN?

True: We can slow down and even reverse the ageing process in the lab

Sci­en­tists have found dozens of ways to inter­vene in the age­ing process in the lab. The first indi­ca­tion came in the 1930s, when sci­en­tists study­ing diet in rats noticed that those eat­ing less lived sub­stan­tial­ly longer than their peers allowed to eat what they liked—and they did so in good health, stay­ing fit and with less dis­ease7. We’ve since repli­cat­ed this feat by find­ing genes that can slow age­ing, and using drugs and oth­er treat­ments that alter aspects of the age­ing process, slow­ing the decline in lab ani­mals. The first of these are already being tri­alled in humans.

False: Living longer would mean extra years in a nursing home

A lot of peo­ple imag­ine that liv­ing longer would mean extend­ing the frail years at the end of life, drag­ging out our decrepi­tude. But this under­stand­able wor­ry gets things back­wards from a bio­log­i­cal per­spec­tive: as we treat age­ing, we’d increase healthspan by defer­ring the age-relat­ed changes that cause dis­ease, and this would cause peo­ple would live longer, rather than the oth­er way around. This makes sense in theory—because you have to die of some­thing, so not being ill means you’re much less like­ly to die—and also in prac­tice, where both slow-age­ing lab ani­mals and excep­tion­al­ly long-lived humans don’t just live longer, but spend a greater frac­tion of their lives in good health.

Uncertain: How medical practice and regulation will adapt to these new, preventative treatments

The dream of real anti-age­ing med­i­cine is pre­ven­ta­tive treat­ments that would slow down our decline as we age, and pre­vent many or even all of the age-relat­ed killers. How­ev­er, this approach is very dif­fer­ent to cur­rent med­i­cine, which usu­al­ly waits for dis­eases to arise before inter­ven­ing, and then treats them indi­vid­u­al­ly. This means that reg­u­la­tors, like the FDA in the US or EMA in Europe won’t approve a drug unless it’s effec­tive against a spe­cif­ic dis­ease. We need a soci­etal debate about how we should go about approv­ing pre­ven­ta­tive treat­ments for ageing—and the poten­tial ben­e­fits are so large it’s crit­i­cal­ly impor­tant that we get this right.

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#3 WILL WE BE ABLE TO BUY IMMORTAILITY?

True: Billionaires and private companies are trying to slow the ageing process

In 2013, Google launched a spin-out called Cal­i­co aim­ing to under­stand and inter­vene in the age­ing process. This year, Ama­zon founder Jeff Bezos sunk some of his bil­lions into a com­pa­ny called Altos Labs, work­ing on an age-revers­ing tech­nol­o­gy called ‘cel­lu­lar repro­gram­ming’. After decades as a niche sci­en­tif­ic pur­suit, age­ing biol­o­gy final­ly has enough con­crete results that big investors are get­ting inter­est­ed. How­ev­er, there’s still lots of work to do, includ­ing fun­da­men­tal biol­o­gy typ­i­cal­ly stud­ied in uni­ver­si­ties and research insti­tutes, and more fund­ing is des­per­ate­ly need­ed: in the US, only about a dol­lar of gov­ern­ment fund­ing per Amer­i­can is specif­i­cal­ly ear­marked for research to under­stand the age­ing process—compared to more than $10,000 per per­son spent on health­care, a num­ber which age­ing research could sub­stan­tial­ly reduce8.

False: We’re on the brink of immortality!

The press loves to run with head­lines about liv­ing for­ev­er, par­tic­u­lar­ly in the con­text of bil­lion­aires invest­ing in age­ing research to give them a bit longer to spend their unimag­in­able wealth. How­ev­er, immor­tal­i­ty isn’t on the cards even in the best-case sce­nario: even neg­li­gi­bly senes­cent ani­mals still die (the old­est record­ed Galá­pa­gos tor­toise, Har­ri­et, died of a heart attack—the dif­fer­ence between her and a human was that she lived 175 healthy years first!)9.  Even if the out­come isn’t immor­tal­i­ty, it could still be huge­ly sig­nif­i­cant: a recent paper esti­mat­ed that delay­ing age­ing by just one year would be worth $37 tril­lion to the US econ­o­my alone, and larg­er gains would be worth pro­por­tion­ate­ly more10.

Uncertain: When these medicines might arrive

In spite of big-mon­ey bets from bil­lion­aires, it’s not clear how long it will be before we can expect to see the first anti-age­ing med­i­cines in hos­pi­tals, or the local phar­ma­cy. Mov­ing from an idea that works in mice in the lab to human treat­ments is a noto­ri­ous­ly dif­fi­cult process. How­ev­er, it seems like­ly that they will arrive in time for most peo­ple alive today. Some pro­posed treat­ments are drugs that we already use for spe­cif­ic con­di­tions, such as dia­betes drug met­formin and, if that works against age­ing, there’s no rea­son we couldn’t roll it out glob­al­ly with imme­di­ate effect (it helps that it’s a well-under­stood med­i­cine that costs cents per pill). Oth­er front-run­ners, like ‘senolyt­ic’ drugs that remove aged, senes­cent cells from the body have proved their met­tle in mice and are already under­go­ing human tri­als, so it’s quite pos­si­ble they could be in use before the decade is out. More spec­u­la­tive ideas, like the cel­lu­lar repro­gram­ming being explored by Altos Labs, might be decades away—but, if you’re mid­dle-aged or younger today, or a lit­tle old­er but live longer thanks to the first gen­er­a­tion of anti-age­ing drugs, a few decades is still soon enough to mat­ter. This means, while we can’t be sure, I think it’s well worth get­ting excit­ed about age­ing biology—and doing more research to make unlock­ing the enor­mous poten­tial eco­nom­ic, social and health gains more likely.

1https://​andrew​steele​.co​.uk/​a​g​e​l​e​s​s​/​r​e​f​e​r​e​n​c​e​s​/​d​e​a​t​h​s​-​c​a​u​s​e​d​-​b​y​-​a​g​eing/
2https://​andrew​steele​.co​.uk/​a​g​e​l​e​s​s​/​r​e​f​e​r​e​n​c​e​s​/​c​a​u​s​e​s​-​d​e​a​t​h​-​d​i​s​a​b​i​l​i​t​y​-​w​i​t​h​-age/
3https://​www​.aha​jour​nals​.org/​d​o​i​/​1​0​.​1​1​6​1​/​c​i​r​.​0​0​0​0​0​0​0​0​0​0​0​00485
4https://​andrew​steele​.co​.uk/​a​g​e​l​e​s​s​/​r​e​f​e​r​e​n​c​e​s​/​m​o​r​t​a​l​i​t​y​-​w​i​t​h​-​a​g​e​-​mrdt/
5https://​genomics​.senes​cence​.info/​s​p​e​c​i​e​s​/​e​n​t​r​y​.​p​h​p​?​s​p​e​c​i​e​s​=​C​h​e​l​o​n​o​i​d​i​s​_​nigra
6https://​www​.sci​ence​.org/​d​o​i​/​1​0​.​1​1​2​6​/​s​c​i​e​n​c​e​.​1​0​69675
7https://​aca​d​e​m​ic​.oup​.com/​j​n​/​a​r​t​i​c​l​e​-​a​b​s​t​r​a​c​t​/​1​0​/​1​/​6​3​/​4​7​25662
8https:// age​less​.link/​7​679wa
9https://​www​.smh​.com​.au/​n​a​t​i​o​n​a​l​/​h​a​r​r​i​e​t​-​f​i​n​a​l​l​y​-​w​i​t​h​d​r​a​w​s​-​a​f​t​e​r​-​1​7​6​-​y​e​a​r​s​-​2​0​0​6​0​6​2​4​-​g​d​n​t​n​q​.html
10https://www.nature.com/articles/s43587-021–00080‑0

Contributors

Andrew Steele

Andrew Steele

PhD in physics from the University of Oxford, Science Writer and Presenter

After a PhD in physics from the University of Oxford, Andrew Stelle decided that ageing was the single most important scientific challenge of our time, and switched fields to computational biology. After five years using machine learning to investigate DNA and NHS medical records, he is now a full-time writer, author of Ageless: The new science of getting older without getting old, presenter and campaigner.