Commenting on "Not a Pill"

I mention some of my thoughts on priorities, supplements, and the likely nature of meaningful future anti-aging technologies in the latest Longevity Meme newsletter. As we all know, I'm not that hot on the amount of (media and community) attention lavished on supplements and pills when serious anti-aging science is languishing for lack of support.

I was planning on posting a followup here today regarding balance in our approach to the future and health, but Ian Clements beat me to the punch in an e-mail communication. So I'll let him to do the talking:

You keep saying that a pill is not the answer - how do you know (as distinct from believe)? Whilst I share your scepticism about a pill being the answer, I'm sufficient of a scientist not to be certain about anything about the future - empiricists use evidence, not belief, as their criterion.

More importantly, taking pills is not mutually exclusive to doing all the other things to extend life and improve health (we both seem to agree on that).

The problem I, and, I suspect, most others face, is attempting to keep fit and healthy whilst staying cautious - waiting too long until all the evidence is in is to maybe delay too long the benefits. This necessarily applies when the science is moving only as fast as I am ageing! It is a balance of risk - hoping that the risk is minimal or non-existent for adopting what turns out to be false ideas and possible major advantages if they are right. We've all seen this for vitamins; smoking; diet and exercise. Sure there's been blind alleys, wrong turns even (avoiding all fat as much as possible being a recent example), but I suspect that those of us who've attempted to follow the best science at the time have stayed ahead of the curve despite these errors (all too-often pointed out by dubious relatives and friends).

So I see nothing wrong in chasing supplements at the same time as calling for progress for cures for ageing - they are not mutually exclusive.

Comments

I guess it depends on how you look at the issue. I for one am holding out great hope that pharmacological "life extension" technologies will become available sooner than a lot of other technologies. Drugs, like Metformin, can have an impact on gene expression profiles, and can mimic the benefits of Calorie Restriction. I expect drugs (single chemicals or cocktails) will be available in the next 5-10 years that will be much more effective than Metformin, bordering on the effectiveness of CR.

Depending on who you ask, CR should extend life by anywhere from 3 to 50 years. I personally think 10-15 years is reasonable, if started mildly just after puberty, and then aggressively by age 20 or so. However, for the purposes of helping people reach Actuarial Escape Velocity, we need to worry about people in their 40's and older. CR started this late will probably only bring about 60%-70% of maximum extension, so anywhere from 2 to 35 years, depending on who you believe.

Anyway, I think that a pill that can increase remaining life expectancy by 3-10 years when started at age 50 is something that could help millions more people last long enough for stem cell therapies, somatic gene therapies, and nanomedicine to be developed in the following years and decades. In effect, it helps bring AEV within reach of more people. From that view, I think that pills definitely have their place. I seriously doubt, however, that they will be any more effective than CR.

On the other hand, the whole concept of developing a cure in a pill detracts from the "real" anti-aging research projects out there: SENS, nanomedicine, etc. It casts a negative image on these projects in two ways: first, most of these pills will provide modest if any benefit, so people will continue to doubt that science can make any real impact on aging, and second, people will associate the whole idea of a cure in a pill with the metaphorical snake oil salesmen. And if the general public thinks that anti-aging medicine isn't effective, they won't pump their dollars or their votes into the real solutions. People won't be willing to commit to a war on aging if they think that the bulk of anti-aging research can't do any better than what one can accomplish by living a healthy lifestyle.

So, from the research community's point of view, I think that pills should still be pursued (as long as they don't take serious funds away from the better alternatives), and from the general public's point of view, I think that pills are definitely a problem.

Posted by: Jay Fox at July 26th, 2004 5:52 PM

I think Jay is bang on when he says:

"the whole concept of developing a cure in a pill detracts from the "real" anti-aging research projects out there: SENS, nanomedicine, etc. It casts a negative image on these projects in two ways: first, most of these pills will provide modest if any benefit, so people will continue to doubt that science can make any real impact on aging, and second, people will associate the whole idea of a cure in a pill with the metaphorical snake oil salesmen. And if the general public thinks that anti-aging medicine isn't effective, they won't pump their dollars or their votes into the real solutions."

This is especially so, since I'm at the conservative side on the continuum of CR's likely effects in adult humans (an extra ~10 years on top of maximal "healthy lifestyle" curve-squaring).

But I think there's another point that deserves to be emphasized: there is so little private or public capital available to work on anti-aging therapies that a pill which will take so long to develop (and longer to prove safe enough and promising enough to legitimate being administered to otherwise healthy people) is ultimately taking precious dollars away from research which could lead to viable SENS therapies on a comparable time scale with much more important results.

When you consider that the few companies working on CR mimetics are abandoning work on genuine anti-aging drugs under the baleful influence of the priorities of venture capital (Elixir going off on obesity, Sirtris on diabetes), it becomes all the more important to make sure that funding goes to other strategies.

On top of this, I suspect that, despite all the "have your cake and eat it, too" headlines, a CR mimetic may not escape many of the symptoms of CR. It might, in particular, make one ravenously hungry (turning on 'famine mode,') or kill one's libido (shifting resources from reproduction to maintenance), or whatever. I'd take it if the effects
were no worse than CR -- it'd still save me weighing my #$#(*!! food! -- but such side effects might either keep the pill off of the market on the basis that the public wouldn't accept it & thus it wouldn't be profitable, OR it migt just keep people from taking it -- which might let us save ourselves, but still leave a lot of people shuffling into old age and death.

Venture capital can only be redirected to interventive biogerontology when an extra bone is headed their way, such as when the Methuselah Mouse Prize finally gets big enough to meaningfully supplement venture capital dollars, leading to a "good money after good" effect. Public funding -- which in my view is the more likely route for getting successful anti-aging therapies off the ground, if not necessarily into the clinic -- can only be mobilized by each of us talking to our friends and family, spreading the "Longevity Meme," and shouting louder at the politicians.

-Michael

Posted by: Michael at August 15th, 2004 7:27 AM

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