Carving Named Diseases From the Concept of Aging

Seen from a considered distance, the culture of aging research - formed of researchers, regulators, and the interested public - operates in strange ways. No-one is permitted to treat aging: by decree of the regulators and complicity of the researchers that is taboo. But slow progress in treating aging is made nonetheless. That technological progress goes hand in hand with an intricate cultural dance that consists of splitting off pieces of the concept of aging and giving each piece a different and distinct name ("Alzheimer's disease," "osteoarthritis," "sarcopenia," and so forth). Once such a sliver of aging is named and fully accepted, it is no longer taboo to work towards treating it.

To a certain degree, culture shapes the progress of medical science. Strategies for repairing aging outright by focusing on common low-level molecular changes - like Engineered Negligible Senescence - don't mesh well with the structure of the mainstream culture of aging research, and so face an uphill battle to win greater adoption. Repair strategies do away with the whole business of parceling up a collection of end-stage symptoms of aging and declaring them a disease, and focus instead on a different vision for aging and the treatment of aging from the bottom up. Long-standing cultures are resistant to change, however, and especially resistant to radical change. That is far from the only hurdle in the way of progress, and the existence of centralized control over medicine and heavy regulation has a lot more to answer for than odd cultural ideas about how things should work, but those odd ideas are still a factor.

You can see some of this business of carving slivers from the concept of aging in a recently published retrospective article on research into the biology of neurodegenerative diseases:

Only 40 years ago it was widely believed that if you lived long enough, you would eventually experience serious cognitive decline, particularly with respect to memory. The implication was that achieving an advanced age was effectively equivalent to becoming senile - a word that implies mental defects or illness. ... Many discoveries made in the years since have given us better tools to study memory storage, resulting in a major shift away from the view of "aging as a disease" and towards the view of "aging as a risk factor" for neurological diseases. So why do some people age gracefully, exhibiting relatively minor - and at worst annoying - cognitive changes, while others manifest significant and disabling memory decline? Answers to these questions are fundamental for understanding both how to prevent disease and how to promote quality of life.

...

Looking back on the rather grim expectations concerning memory and the elderly that were held only a few decades ago, the vision today is very different and much more positive. ... The future holds great promise for the once remote dream of understanding the core biological processes required for optimal cognitive health during aging - and progress in this regard should also provide the needed backdrop for understanding and preventing the complex neurological diseases that can be superimposed on the aging brain.

The culture of the aging and broader life science research community is appropriately intricate: it's a large industry, working on exceedingly complex problems. But don't uncritically accept it for what it is; it never hurts to take a second look from a suitable distance and ask whether what you see is all that is possible, and whether it is good, useful, worse, or better than other plausible options.

Comments

This is an excellent and clarifying point. And progress in the fight against aging couldn't occur in any other way. Consider the related issue of "house maintenance". You might notice that some houses are more run-down than others, and resolve to do something about it. But if your concept of what to do was just to "repair the house", as if that was a single action that was always the same, you wouldn't get very far. You would instead need to get into the fine details of the changes that can occur to a house, how they can be reversed, and maybe you would even need to examine why you regarded such changes as undesirable. The label "aging" subsumes the effects of many diverse processes that happen simultaneously to a human being, and nuanced intellectual clarity about what those processes are and why they happen is essential for anyone who wants to make a difference here.

Posted by: Mitchell Porter at September 7th, 2011 8:29 PM

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