Fight Aging!

Ethicists seem a little stuck on the idea that treatments to slow and potentially reverse aspects of aging are only available to the wealthy, or will only be available to the wealthy. Today's open access complaint about making the world a better place at least manages to also touch on what I think is the more pertinent issue, which is knowledge. One can't try interventions that seem plausibly likely to produce benefits in the matter of degenerative aging without knowing that the option is there. One can't make an assessment of the odds of benefit versus harm without knowing a fair amount about biology, mechanisms of action, and the state of the field. One can't accumulate that knowledge without understanding which of the many sources of information are lying through their teeth in order to make money. One can't substitute wealth for knowledge and pay middlemen to point in the right direction without knowing which of those middlemen are corrupt and selling a bill of goods. It's a knowledge problem all the way down.

The most plausible, well-studied initial approaches to treat aging are also readily available at generic drug prices. Rapamycin. Senolytic compounds like the dasatinib and quercetin combination. Or they are free if we're also counting exercise and calorie restriction. The next step up, exosome therapies and stem cell therapies, can be obtained for a few thousand dollars per treatment given a lot of legwork and cost comparison on the part of the patient. The futuristic approaches like partial epigenetic reprogramming? At some point there will be versions that cost little. Just wait.

I suspect that ethicists and journalists and others who like to grind axes on the activities of the wealthy are deceiving themselves. They look at a few exceptional and vocal wealthy people who are spending a great deal on personal health as a hobby and see that as broader reality, rather than a tiny minority engaged in doing unusual things with their time and funding. The reality is that most wealthy people do little that is out of the ordinary when it comes to their health, and have little to no knowledge regarding potential advances in the treatment of aging. Meanwhile, a relatively small number of interested non-wealthy people quietly put in the time to learn the bounds of the possible and undertake self-experiments by trying rapamyin or senolytics, or saving up for exosome treatments. The mainstream pays very little attention to that contingent, and perhaps justifiably so - as for the vocal wealthy self-experimenters, they are a tiny minority of the population.

Meanwhile, most people have no idea. Medicine and biology are not in their wheelhouse, why would they have any idea as to what is in process and speculative and potentially useful? The knowledge problem is the hard problem here, not the finance. Given something that may be useful, and costs little, how does one cut through the background noise of nonsense and self-interest to produce and present clinical proof and induce widespread use? It is a collective action puzzle, and our species does not have a good track record when it comes to solving those.

The Ethics of Extending Life: Longevity Medicine and Health Inequity

In one survey, nearly 80% of 1000 US respondents said they'd like to live to be 120 years old, but only if they remained mentally and physically healthy. Without that hypothetical guarantee, far fewer people wished to live such a long life. We not only want to live longer, we want to live longer and better. From stem cell therapy to biomarker tracking, from genomics to AI algorithms that support early disease detection, medicine has entered a new era in which some view aging as a condition that can be managed and mitigated, provided the right tools are used.

Due to limited accessibility and high costs, those in economically and socially privileged positions have been the first to benefit from these advancements. As life-lengthening medical interventions continue to develop, health span extension may become stratified along socioeconomic lines, concentrating its benefits among the already privileged. Without intentional policy and ethical frameworks, these innovations may deepen population health inequities.

There is another, more subtle accessibility challenge facing longevity medicine: "Even if you made every longevity medicine intervention free, you still need to interpret all that information." That requires the consumer to possess a high degree of health literacy, which is typically higher in well-educated, high-income individuals. "Wealthy patients walking into longevity clinics aren't just buying the intervention, they're buying someone to do that cognitive work and navigation for them, to be the quarterback of their health, or the CEO of their health, which is a service that's almost completely absent from primary care for most other people." Without someone to provide context and guidance, the large amount of data that longevity medicine testing reveals may simply be disregarded, or worse, widen disparities.

Longevity medicine offers fantastic potential for increasing health span - a hope that many of us dream of - but the future of longevity medicine will be defined by not just how long we can live, but by who gets the opportunity to do so.