As you may know, researchers Michael Rose and John Phelan have joined the ranks of those marshalling scientific arguments against calorie restriction (CR) as a means of significantly extending healthy life span in humans - "significantly" in this case meaning by a few decades. Regardless of the merits of their paper and models - from the discussions on the GRG mailing list, they form a good stab at the topic, but are far from watertight - I think that we should remember that we're talking about something that can, at best, assuming folk like Michael Rose are wrong, slow aging by a handful of years. This is far, far better than nothing - and indeed, I'm very much the calorie restriction advocate - but it pales before what would be possible in the years ahead if sufficient funding were devoted to developing real anti-aging medicine.

I've said before that too much time, attention and money is spent chasing the slowing of aging rather than reversal of aging. I also think that Randall Parker is right on the money with his comments:

We need rejuvenation therapies. The idea of finding a way to slow aging with CR or sirt1 or the latest hope Klotho all seem like misplaced hopes to me. Klotho may eventually deliver the same (limited) benefit as CR but without the perpetual hunger and might be worth taking some day. But we really need gene therapies, cell therapies, immunotherapies that can remove extracellular junk, and other therapies that can do repair.

Calorie restriction is good for you, and is currently the best, most backed method for extending your healthy life span. Yet this is only true because there are no other available methods ... and calorie restriction isn't the starting place for the healthy life extension medicine of the future. That starting place is funding for medical research programs like Aubrey de Grey's SENS - and lots of it.

Posted by Reason at 9:19 PM
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As you may know, I'm a big fan of late adoption and conservatism (in the "marked by caution and moderation" meaning of the word), as well as patience and a wide field of view when looking at science in progress. With that in mind, I thought I'd point you to a very helpful look at why my point of view is a good one.

"There is increasing concern that in modern research, false findings may be the majority or even the vast majority of published research claims," says researcher John Ioannidis in an analysis in the open access international medical journal PLoS Medicine.

This is something that scientists are quite aware of - although you wouldn't find many broadcasting it to the world, for all the obvious social reasons. I think it's a wonderful exercise to point out the systematic causes of this process. When I said the following:

Important questions, especially those related to medicine and statistics, are not answered with a single study. Each study, and the resulting debate, can take years. Building - or changing - even a preliminary scientific consensus on any position is a process that spans decades.

I could - and should - have added that most of what was written on these topics would turn out to be wrong. It might contain useful ideas, or prompt other people into useful directions, but it will be wrong. This is taken for granted by scientists; after all, the scientific method and the community that supports it form a system that makes useful, rapid, solid progress even though the individual components of that progress are largely flawed. Science is built by consensus and aggregation, a form of ongoing, distributed cross-checking of information. Every single collection of data could be 99% wrong, but you'll still get the right answer in the end if you have enough of those collections to compare.

The take away here is not to listen to any single study (and especially if someone is using it to sell you something relating to the anti-aging marketplace). Ten studies or twenty studies pointing to the same conclusion are more interesting.

Posted by Reason at 9:42 PM
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For today, a post wherein I reproduce part of an exchange from the GRG mailing list. Robert Bradbury (who has some interesting ideas on aging that you might want to read) is presently in an optimistic frame of mind based on a look back at the past decade:

Some of you may want to do a PubMed search on: genes AND aging. It now turns up more than 5600 articles. That would have been a *much* smaller number in the mid-to-late '90s.

Of particular interest on the first page are the articles by C. Kenyon reporting on aging genes in C. elegans, S.M. Jazwinski on aging in yeast, J. Campisi on cell senescence and cancer and D.C. Wallace on the involvement of mitochondrial mutations in somatic cell aging.

These are all some of the leading researchers in aging studies.

The article by C. Kenyon is particularly important as they used an RNAi library to identify 23 new longevity genes in C. elegans.

Given the recent transgenic mouse studies extending the lifespan by using retargeted catalase (Rabinovitch) and the Klotho study (Kuro-o) it seems likely that transgenic mouse studies of longevity will increase significantly. But transgenic mouse studies are long and expensive (though there appear to have been tens of thousands of them which have been done). Now that the Zebrafish [genome] map is essentially complete it is possible to use them as a vertebrate model for aging. Though they live longer than mice it is much cheaper to create transgenics in a wide variety of genes (many more eggs at very low cost) and study internal physiological changes that take place with age (they are transparent). There are also very low costs for keeping thousands of them which is something not usually done with transgenic mice.

These things combined lead me to the conclusion that we are entering the "golden age" for understanding aging. By 2010 we should have a fairly good understanding of all of the significant causes of aging and by 2015 have probably developed a number of interventions for human beings to be tested in human beings.

One of the debates will revolve around whether those interventions should be transgenic manipulation of cells (either in vivo or using stem cells) or whether they will be through drug companies providing drugs.

So the chances of anyone aged 55 or younger of having a significantly extended lifespan over the current average lifespan seems quite high in my opinion.

He is right in that the basic research is moving forward very nicely, but I'm a little less optimistic at the moment. This is partially a result of my libertarian concerns regarding regulation and partially a result of where I see the research funding going at the present time:

The thing that bothers me is that I see all the presently engaged money sliding down the slope to the "slow aging" end. The range of plausibles down there - metabolic tinkering, lifelong gene alterations, etc - don't appear to include interventions that will do much good for us folks who used up 2/3 or more of our damage quota by the time they're introduced.

We need, ASAP, significant resources heading upslope to SENS-like strategies aimed at reversing the damage of aging. If by 2020 the best that's available is along the lines of super-[calorie restriction] or super-Klotho in humans that will produce 30% life span extensions for those who benefitted from them for an entire life, I fear we oldtimers will be out of luck.

I make the same cautions a little more clearly in the latest Longevity Meme newsletter:

There is no such thing as useless information in cellular biochemistry, but practical anti-aging medicine for those of us who have burned through two-thirds or more of our life already will probably not come from comparatively modest tweaks - genetic or otherwise - to metabolic processes. All these do is slow the rate at which age-related damage accumulates, something that decreases in utility the later in our lives it starts.

I don't see it as implausible that longevity science could vanish down the rabbit hole of producing a better calorie restriction or a better klotho - something that would be wonderful and effective for people with their whole life ahead of them, but singularly useless for those of us reading this today. It's up to us to ensure that this does not happen: the time to influence the directions and emphasis of longevity research is now, just as it always has been. You can have your say in the matter by donating to the rejuvenation (or late intervention) component of the Mprize, which rewards scientists who work on anti-aging science specifically designed to save the lives of the aged. If we fail, we'll be left looking just like the last generation of healthy life extension supporters and advocates - and that would not be a good thing, not at all.

Posted by Reason at 12:24 AM
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Congratulations are due to members of the Longevity Meme Folding@Home team; they've worked, posted, recruited and donated - and pushed the team rank from 700 to 500 in a mere ten weeks since I last gave an update. As promised, I will be mailing goodies to those participating members who want a memento of the occasion. If you joined the team prior to today (August 28th 2005), send me an email with "Folding@Home 500" in the subject line and containing the following information:

• your mailing address
• your Folding@Home username

Well done! Here's to hitting 300 in another ten weeks.

Readers who are not familiar with the Folding@Home program - in which you donate spare processing cycles from your computer, to be used in investigations of the biochemistry of Alzheimer's and other conditions related to protein folding - may want to start with my introduction at the Longevity Meme.

Posted by Reason at 2:47 PM
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I advocate calorie restriction (CR) as a Good Thing, assuming your physician agrees, as I'm sure regular readers know by now. The health benefits have been more than adequately demonstrated, and there is the strong likelihood of increased longevity based on decades of animal studies and a few tantalizing human results. Of course, you'll also lose weight - but this is something of a side-effect for CR practitioners rather than a goal to be attained for its own sake. Since starting my advocacy of CR, I've heard numerous anecdotes regarding the difficulties that more overweight - or obese - people have with the practice of CR; it seems that different dietary and lifestyle strategies are more effective at weight loss above a certain weight (varying by person). Once you get down to a more reasonable weight, calorie restriction becomes easier. Or so they say.

While wandering the wilds of the web today, I came across a summary of a much more rigorous treatment of this phenomenon and thought it worth sharing.

Without hard data, I've relied on the idea that the Basal Metabolic Rate (BMR) in metabolism may be the trigger for a "conservation of energy" in the human body. That taking daily calories below the BMR triggers what many call "starvation mode" in the metabolism - that is, the body starts to use less energy as it prepares to survive what it perceives as a famine condition.

My recommendation has remained consistent over the years - one must try to determine their BMR and eat enough calories to meet that calorie requirement for basic function so the body will allow for loss of its stored energy - fat on the body. Interestingly, the BMR of most people is much higher than they realize and certainly higher than the often recommended calorie-restriction of 1200-1600 calories per day for weight loss.

The article goes on to discuss and explain the significance of a recent study on some biochemical details of calorie restriction and weight loss. Interesting stuff. The information to take away with you would seem to be that at a given weight, there is an optimal level of caloric intake that will convince your body to process stored fat rather than hoard it or layer on more. The more fat you have, the more calories you need in order to hit this optimal intake. If this level is much higher than the level of caloric intake for an out-of-the-box practice of calorie restriction, then you will likely have difficulty jumping right on in. A more gentle ramping down of calories might be called for, as well as trial and error testing of your metabolic response to different levels of caloric intake - as more experienced calorie restriction practitioners would advise in any case. As with many other things, patience, research and experimentation will win through in the end.

If you're new to calorie restriction, I recommend picking up a copy of The Longevity Diet; I think you'll find it very helpful.

My final, anecdotal, contribution: regular exercise makes all the difference to your efforts, leading to large changes in the response of your body to different levels of caloric intake. Try it and see.

Posted by Reason at 1:07 PM
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The Klotho gene (link to Wikipedia, a stub entry at the time of writing that I expect to see expanded) was under investigation back in 2001 and 2002 for its association with longevity:

Studying more than 2,000 anonymous samples from three ethnically distinct groups of people, the scientists found that having two copies of a less-common version of klotho is twice as prevalent in infants as in people over age 65. These results suggest that people born with the two copies die sooner than others, although the gene's exact influence on health and aging are not known, the scientists say.

...

Previously, Japanese scientists discovered klotho in mice, noticing that without klotho's protein, the mice developed atherosclerosis, osteoporosis, emphysema and other conditions common in elderly humans. Because of their interest in accelerated aging diseases, Dietz and his colleagues began studying klotho in people.

The first thing to do when you discover a mechanism that accelerates age-related degeneration in mice is to turn it around and see if can extend healthy life span - as a general rule, gerontologists are unexcited by processes that reduce life span. There are all too many of those, and most have no association with any way of extending life span - application of blunt force is one example, as a certain wag noted.

The time elapsed between the 2002 work and the present day is just about long enough to set up a decent set of life span experiments with laboratory mice and get a good sense as to how it will all turn out. In the case of the Klotho gene, this indeed came to pass. It is pleasing to see that Klotho has now been welcomed into that small, select circle of known ways to significantly extend healthy life span in mice:

In the new study, a group led by Kuro-o, now an assistant professor of pathology at the University of Texas Southwestern Medical Center at Dallas, created transgenic mice with overactive versions of the Klotho gene. Those mice proved to have life spans 20 percent or more longer than mice with the ordinary version of the gene, Kuro-o said.

"These are still animal experiments, but potentially it might be possible to use the hormone in humans," he said. "But we still don't know if the protein can be used to extend life span in humans."

A lot must still be learned about the Klotho hormone, starting with the way it works, Muro-o said. "We speculate that it blocks insulin action," he said. Specifically, it appears to block the insulin-like growth factor-1 pathway. Studies have shown that blocking that pathway extends the life span of worms, flies and mice, he said, and the same may well be true of humans.

The upper bound of life span extension in the study was 30% or so, in the same ballpark as the results of calorie restriction. The association with insulin suggests that both overexpression of Klotho and the gene expression changes caused by calorie restriction may work on an overlapping set of biochemical mechanisms - which certainly shouldn't prevent industrious researchers from trying both at once to see how that goes. I certainly would if I had the funds and a group of gene engineered Klotho mice.

I predict that this will be grist for the mill for those funded groups and companies - such as Elixir, Sirtris, etc - already working hard on metabolic science resulting from calorie restriction studies. Good news all round for those interested in near term (next five to ten years) results from currently funded longevity research.

UPDATE: I should have mentioned that Kevin Perrott has more on Klotho; I certainly agree that researchers should enter a set of Klotho mice into the Mprize for anti-aging research.

Posted by Reason at 12:42 AM
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I found this HHMI research into brain metabolism and Alzheimer's rather interesting, especially in light of another recent piece on changes in gene expression in the aging brain. Alzheimer's disease appears to be like rust - you can certainly put it off, you may be lucky enough to have moderately rustproof genes, but live long enough and you'll get it eventually ... and it will kill you. All common neurodegenerative conditions are high up on the healthy life extension hit list - we need to have cures or preventions if progress elsewhere in the science of living longer is to benefit us.

Alzheimer's may be a natural consequence of normal ongoing metabolic processes, and we all know by now that neither "natural" nor "normal" necessarily means "good," I trust. Different parts of the brain have different levels of usage, and those areas with greater usage may lapse into Alzheimer's more quickly:

The availability of powerful imaging techniques and the ability to merge different sets of imaging data through new bioinformatics and statistical methods enabled Buckner and his team to construct a picture of Alzheimer's from molecular changes to the structural and functional manifestations of the disease. In the process, the team unexpectedly observed that the regions of the brain that light up when we slip into comfortable patterns of thought are the same as those that, later in life, exhibit the disabling clumps of plaque characteristic of Alzheimer's, a disease that most frequently manifests itself after age 60.

That remarkable correlation, said Buckner, suggests that dementia may be a consequence of the everyday function of the brain.

...

The default state, according to Buckner, is characterized by metabolic activity in specific regions of the brain, notably the posterior and cortical regions. "These regions were active in the default states in young adults and also showed amyloid (plaque) deposition in older adults with Alzheimer's disease," the researchers write in the new Journal of Neuroscience paper.

"The key insight is that brain activity and metabolism are not uniform across the brain," Buckner said. "When we looked at people on the cusp of dementia, we saw a loss of brain tissue in the regions we predicted it would occur," based on our observations of metabolism.

...

Buckner emphasized that the notion of a causative relationship between everyday metabolic functions of the brain and Alzheimer's remains a hypothesis. However, new studies may help "show if amyloid (plaque) deposition is really dependent on metabolism. Can we find a biologically plausible reason for how metabolism causes Alzheimer's disease?"

Food for thought, and possibly groundwork for the second generation of effective therapies. The first generation of effective therapies for Alzheimer's is likely to be based on gene therapy to tailor the immune system into cleaning up the damage - that will work, or so it seems from early stage studies, but prevention is always better than a cure.

Posted by Reason at 12:42 AM
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I don't link to the Speculist as often as I should - falling down on the job, I'm afraid. So without more ado, here is a selection of recent posts from the Speculist on healthy life extension and related medical advances:

They Went So Young:

Ultimately, it's families, loved ones, and friends who will drive the acceptance of life extension technologies. ... Throughout all the generations of humanity, people have watched their loved ones age and die, and deep down wished they could do something about it. When options are available, people will use them. Of course they will.

Future Healing:

It's 2020. You're a doctor presented with a patient suffering from an advanced, untreated neurodegenerative disease. What do you do? Several recent scientific developments give us some idea.

Covering the Spread:

if radical life extension really will be with us soon, people might want to start thinking about very long term investments. I envision bonds with maturation periods in the centuries.

Good News On Stem Cells:

the notion that stem cells will play a major role in soon-to-come life extension efforts is gaining broad acceptance among researchers ... in order to realize this kind of scenario, we have to make substantial progress in our understanding of and ability to manipulate both adult and embryonic stem cells.

Take the time to read; I think you'll find it rewarding.

Posted by Reason at 1:00 AM
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Prevention is cheap, repair is costly. Yet we have a medical establishment that is shackled - by regulation, by its own choice, by other factors - to developing after-the-fact emergency damage repair strategies for age-related disease rather than means of prevention. It is an approach doomed to failure in every way but generating profit - and it won't even be much good at that if socialism and collectivism in the US medical system continue their steady advance. Randall Parker has some thoughts on the matter:

Think of it this way: If potholes in the roads were causing damages to vehicles that far exceeded the cost of fixing the potholes then the political cry would go out to fix the potholes. Well, the cost of diseases and aging - both for expensive treatments and for the costs of disability - run into the trillions of dollars per year. So why do the US National Institutes of Health get less than $30 billion dollars per year while US federal, state, and local governments spend somewhere in the neighborhood of $700 to $800 billion per year for medical care and nursing care? Why does the private sector spend even more while the government also spends money to provide income to old folks who are too aged to work?

While we can not allocate money to repair and rejuvenate bodies as quickly as potholes can get repaired we can allocate money to achieve repairability of human bodies within the lifetimes of most of us.

...

In 2003 health care spending made up 15.3% of the US economy and is projected to rise to 18.4% by 2013 with further increases beyond 2013. Currently US federal biomedical research spending (almost $29 billion out of an almost $11 trillion economy) amounts to less than a third of a percent of GDP. Why spend over 30 dollars delivering care with today's lousy treatments for every dollar spent on research to develop newer, better, and more cost effective treatments? Imagine we spent $30 dollars on car repairs for potholes for every dollar we spent fixing potholes. Our current policies are about that dumb. Effective treatments will be cheaper treatments. Also, effective treatments will boost productivity and economic output by boosting the level of function of the labor force and by allowing people to work more years. Biomedical research will pay back many times over.

I'm not a fan of any sort of government or centrally controlled wealth redistribution, for research or otherwise, but the above suggestion is an iota less terrible than continually funding a failed coping strategy.

This all seems to me like more of the cricket and ant, writ large, tens of millions of people spending vast sums of money in failed attempts to save themselves - often other people's money, through the wonders of coercive wealth transfer - because they failed to invest in medical research for a better future. Because they failed to decentralize the medical establishment, failed to abolish the regulations that increase costs and force most funding and research down less productive paths. Every dollar that is diverted away from healthy life extension research today will lead to many, many dollars in medical costs in the years ahead.

Posted by Reason at 1:30 AM
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You can never have too many beginner's guides; everyone needs one at some point in time. I just noticed an introductory guide to searching for medical information online published at PLoS Medicine earlier this month:

Yet, as many a doctor will point out, the bigger problem with medical knowledge today is not its paucity, but the difficulty of navigating what there is. Finding the right answer quickly for a patient is difficult, and perhaps nothing will replace a good medical librarian in finding that information.

The rise of the search engine Google (www.google.com), along with other freely available search engines, has made it easier to find information, although the clinical uses of Google have not been as well documented as those of PubMed [1]. Google will not point to the answer to every question, and often the articles it finds in response to your question are not freely available. But for many clinical scenarios, Google and other search engines can provide, quickly enough, an answer that is good enough. This article aims to provide tips that will help with these clinical scenarios, saving time that can be used with a medical librarian to answer more difficult problems.

I will be adding this to my list of useful references to point out to those folks who turn up at my virtual doorstep bearing questions.

Posted by Reason at 12:28 AM
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My attention was drawn, via John Hawks, to a review of Ray Kurzweil's Fantastic Voyage by aging researcher Tom Kirkwood that is available - for paying subscribers only, sadly - at Nature. To get an idea of Kirkwood's background and thoughts on the matter of healthy life extension, you might want to read one of his recent EMBO Reports papers. John Hawks, who is more the Nature subscriber than I, notes:

The review is basically supportive of the actual content of the books, but at the same time critical of the hype.

...

We know, for example, that, in model organisms, boosting some of the mechanisms for cellular maintenance and repair can indeed extend life-span. This does not mean that the same techniques will necessarily work in humans, because we know from comparative studies that humans are already endowed, for good evolutionary reasons, with much better maintenance systems than shorter-lived species. By analogy, a design modification that boosts the performance of my own modest car will not necessarily make a Maserati go faster, as the Maserati is engineered for peak performance already. But we can try.

I don't think that the current brace of funded work looking at manipulating our metabolic biochemistry for enhanced health and longevity - largely spreading out from research into the mechanisms of calorie restriction - is a bad thing. But it is a different and most likely less fruitful field of science than any form of directly tackling repair and prevention of age-related damage. It's tuning the engine rather than coming up with a better design for longer-lasting components or better tools for repair.

Posted by Reason at 12:15 AM
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As this press release promoting one of the A4M conferences demonstrates, many in the "anti-aging" marketplace are quite hip to the latest science. They read, they stay abreast, they even advocate - the problem is that this is a post-hoc process that always leads to "and here is something you can buy today that will help slow the aging process." This is either a lie or - at the most generous - willful self-delusion. Even calorie restriction is not proven to extend healthy life span in humans - it's just very likely to do so based on the vast weight of evidence to date acquired over decades of scientific inquiry. This weight of evidence is sorely lacking for every product or methology touted by the "anti-aging" marketeers. To prove a slowing (or reversal) of age-related damage we would need either working biomarkers of aging (which we don't have) or wait until people keel over and count the years (which we don't have the luxury of time to do, since we'd be the ones keeling over).

There are plenty of products, techniques and lifestyle choices out there that can fight or help prevent specific - or even multiple or whole classes of - age-related disease. Selling these things for those purposes is in no way unhelpful or unethical. Do any of them "slow the aging process?" What does that phrase even mean in these days of far greater understanding of age-related damage at the genetic and biomolecular level?

Beyond this, all the definitions get nebulous once you start splitting hairs to put together a good marketing campaign based on this "anti-aging" brand. Can you use the Reliability Theory of aging to justify any healthcare or preventative medicine as "anti-aging?" Which averaged-out gains in individual life span count? Fixing heart disease? Better nursing care for the elderly? At some point it all becomes meaningless - especially if your goal is to sell something you happen to have in stock and that cannot be proven effective.

For the consumers reading this: there aren't any silver bullets out there, and you do yourself a disservice by chasing around looking for one. If you want to live a longer, healthier life, then take care of the health basics (exercise, modest supplementation, weight), practice calorie restriction and support medical research into working anti-aging medicine. Especially the latter. It isn't rocket science, it isn't any different from patient advocacy for other medical conditions - we just aren't there yet, and the only we'll see rejuvenation technologies and greatly extended healthy life spans in our lifetime is through advocacy, public support and major research funding.

Posted by Reason at 11:02 AM
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Here is an interesting post from the sci.life-extension group, late of usenet and now hosted by Google. The gist of it:

An enourmous problem with the life extension movement is that very little movement is taking place! I have read since the days of Durk Pearson and Sandy Shaw the cliche that we are doubling our knowledge every year and that in a few short years we will be so knowledgable that aging will be a thing of the past.

The reality is that in the almost 20 years that I have been involved in the research and practical application of life-extenstion technologies I have seen very slow progress. With the exception of caloric restriction, we have gained few interventions that might (and that is a painfully truthful word) do us some good.

...

As for the readers of this message, if your in your 20's your have hope, if your in your 40's caloric restriction might save you, if your in you 60's and beyond maybe ALCOR will saw off your head and freeze it if your lucky.

This is not a good situation and one that doesn't speak to the doubling of knowledge to brush aside the simple problem of aging.

This is a view from the old school, yet one that accepts that we are close to working anti-aging medicine and radical life extension by steps and advances - and so a critical question is whether we as individuals can live long enough in good health to benefit. Can we beat the curve with the poor tools we have to hand and what looks to be available in the next few years? These are vital, important questions for all of us - and I don't think we can spend our resources any better than by supporting the future of medical research to the hilt. Chasing solutions in the now - being a cricket rather than an ant - isn't going to build the future we would like to see.

It it harsh to say that the past generation of healthy life extension advocacy movements failed? Could they have achieved greater progress, steered greater investment towards meaningful longevity research? Over the same or shorter periods of time, cancer, AIDS, Alzheimer's and diabetes patient advocates and researchers have built empires - vast and diverse research communities poised and funded to drive technological progress and take advantage of new medical technologies as they become available. Over the same period of time, first generation healthy life extension advocates failed to overcome the very same barriers we face today in our attempts to guide funding towards meaningful anti-aging research.

Why did they fail? Why is it that we have the multi-billion dollar old school supplement industry and the dubious "anti-aging" marketplace rather than a funding network - private, public or both - and responsible, directed research into a cure for aging to match cancer institutes dollar for dollar? What can we learn from the history of our distributed advocacy movement and apply to our efforts in the years ahead?

Posted by Reason at 8:07 PM
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