Research institutions are willing to pour comparatively large sums into the pursuit of existing already developed and approved drugs that might, possibly, have some marginal, tiny effect on the course of degenerative aging. This is one manifestation of a large and harmful issue that plagues medical research as a whole, which is that there is very little interest in pursuing radical new improvements to the state of therapies. Rather the larger investments nowadays often go towards mining the existing catalog of approved drugs in search of different uses and slight gains that might have been overlooked in the past. Other groups delve into supplements to evade the FDA, with the similar goal of slight gains and overlooked substances. These are no paths to rapid progress or a future of greatly improved medicine.
Why is this the present state of affairs? I blame regulation. It is so enormously costly to obtain approval for any new drug, let alone a new technology that doesn't quite fall into any of the existing categories that regulators understand, that developers and researchers are steered at every step of the way towards reuse of existing drugs and other technologies. This is what you get when government influence over a field of human endeavor has risen to the point at which all that is not explicitly permitted is forbidden. Progress is greatly slowed and stifled.
Of course everyone puts on the best face for this. Look at these new and bold things we are doing, they say. They are neither new nor bold, however. Nor are they the road to greatly extended healthy lives or the defeat of aging, and those claims should be laughed out of the room when made. No existing drug such as those mentioned below can do more than slightly slow the accumulation of damage that causes aging. They don't repair that damage, they thus won't add significant numbers of years to life, and they are unlikely to even do as much good as calorie restriction or regular moderate exercise. In the case of the various drug candidates noted in the articles linked below, the evidence isn't even all that robust when it comes to extending healthy life in animal studies. This is marginal activity that will most likely do very little for the bottom line of healthy years lived. It is the business as usual of the research establishment of the yesterday, and something that must be disrupted and driven out by new and better approaches to the treatment of aging.
This is all made doubly frustrating by the fact that now, as a result of more than a decade of hard work and advocacy for aging research, many more researchers are willing to speak openly about treating aging as a medical condition. Yet they focus on strategic options for research and development that haven't much of a hope of producing meaningful gains in healthy life span. We are in the midst of a revolution in the capabilities of medical biotechnology: this is not a time to cling to past incrementalism, but rather a time to embrace new approaches and new strategies that could achieve rejuvenation and radical life extension.
Some of the top researchers on aging in the country are trying to get an unusual clinical trial up and running. They want to test a pill that could prevent or delay some of the most debilitating diseases of old age, including Alzheimer's and cardiovascular disease. The focus of the project isn't to prolong life, although that could occur, but to make the last years or decades of people's lives more fulfilling by postponing the onset of many chronic diseases until closer to death.
Researchers expect to enroll more than 1,000 elderly participants in the randomized, controlled clinical trial to be conducted at multiple research centers and take five to seven years. The trial aims to test the drug metformin, a common medication often used to treat Type 2 diabetes, and see if it can delay or prevent other chronic diseases. (The project is being called Targeting/Taming Aging With Metformin, or TAME.) Metformin isn't necessarily more promising than other drugs that have shown signs of extending life and reducing age-related chronic diseases. But metformin has been widely and safely used for more than 60 years, has very few side effects and is inexpensive.
The scientists say that if TAME is a well-designed, large-scale study, the Food and Drug Administration might be persuaded to consider aging as an indication, or preventable condition, a move that could spur drug makers to target factors that contribute to aging. Fighting each major disease of old age separately isn't winnable. "We lower the risk of heart disease, somebody lives long enough to get cancer. If we reduce the risk of cancer, somebody lives long enough to get Alzheimer's disease." "We are suggesting that the time has arrived to attack them all by going after the biological process of aging."
An FDA spokeswoman, said the agency's perspective has long been that "aging" isn't a disease. "We clearly have approved drugs that treat consequences of aging," she said. Although the FDA currently is inclined to treat diseases prevalent in older people as separate medical conditions, "if someone in the drug-development industry found something that treated all of these, we might revisit our thinking."
NAD is a linchpin of energy metabolism, among other roles, and its diminishing level with age has been implicated in mitochondrial deterioration. Supplements containing nicotinamide riboside, or NR, a precursor to NAD that's found in trace amounts in milk, might be able to boost NAD levels. In support of that idea, half a dozen Nobel laureates and other prominent scientists are working with two small companies offering NR supplements.
The NAD story took off toward the end of 2013 with a high-profile paper by Harvard's David Sinclair and colleagues. Sinclair, recall, achieved fame in the mid-2000s for research on yeast and mice that suggested the red wine ingredient resveratrol mimics anti-aging effects of calorie restriction. This time his lab made headlines by reporting that the mitochondria in muscles of elderly mice were restored to a youthful state after just a week of injections with NMN (nicotinamide mononucleotide), a molecule that naturally occurs in cells and, like NR, boosts levels of NAD.
NMN isn't available as a consumer product. But Sinclair's report sparked excitement about NR, which was already on the market as a supplement called Niagen. In early February, Elysium Health, a startup cofounded by Sinclair's former mentor, MIT biologist Lenny Guarente, jumped into the NAD game by unveiling another supplement with NR.
This intersection of the supplement marketplace and scientific research is a sideshow and has little to do with any serious efforts that might produce treatments for the causes of aging. It will no doubt be successful in parting fools and their money, however. This sort of thing usually is, even absent a bevy of scientists willing to put their reputations on the line. Remember than nothing of any practical use came of resveratrol and sirtuin research, though it certainly generated a lot of data and new understanding of that small slice of human metabolism. Similarly nothing of practical use will emerge here. Don't fall for the hype, and don't spend time and effort advocating for or supporting efforts that cannot possibly produce meaningful gains in human life span.