Why Seek to Classify Aging as a Disease?

There is a growing determination in some portions of the aging research community to obtain a formal classification of aging as a disease. This means different things to different people, and there are numerous independent regulatory or classification bodies involved in defining and declaring disease. It is a highly politicized process in wealthier regions of the world, tending to involve lining the pockets of politicians and, indirectly, their appointees and allies in regulatory agencies. It takes years to make any sort of progress - just look at ongoing efforts to have the age-related muscle loss known as sarcopenia defined as a disease rather than normal aging in the US regulatory system. That has been underway for nearly as long as I've been an advocate for this cause, with no end in sight, and at a cost of untold millions and wasted years that could have been spent on getting a treatment working and out there in the clinics.

The incentive is there for scientists and research institutions to have aging declared a disease because that opens doors to funding sources, and permits treatments aimed at controlling aging to run through the regulatory process at all. The FDA does not consider aging to be a medical condition at this time, and this position must change in order to allow any sort of meaningful development pipeline to form: everything that happens in cutting edge aging research today happens despite the fact that no-one is permitted to go out there and directly commercialize a treatment. As you might imagine that has a considerable damping effect on funding. I'd prefer change to involve tearing down the FDA and all similar bodies, but most people just want to see a little adjustment: to petition the powers that be until they grudging allow you just that little extra degree of freedom within the straitjacket.

Whether or not aging is a disease from the point of medical philosophy or dictionary definition is somewhat beside the point in comparison to issues of money and issues of freedom to act within the regulatory system. Not that this stops people from pouring on the philosophy, and any other argument to hand, in service of trying to change present regulation:

It is time to classify biological aging as a disease

Is aging a disease? Traditionally, aging has been viewed as a natural process and consequently not a disease. This division may have, in part, originated as a way of establishing aging as an independent discipline of research. Some authors go as far as to create a division between intrinsic aging processes (termed primary aging) and diseases of old age (termed secondary aging). For example, photoaging, the accelerated deterioration of skin as a result of UV rays during one's lifetime, is considered by dermatologists as a condition leading to pathology. In contrast, chronological skin aging is accepted as the norm. As well as being seen as separate from disease, aging is looked at as a risk factor for developing disease. Interestingly, the so-called "accelerated aging diseases" such as Hutchinson-Gilford Progeria Syndrome, Werner syndrome and Dyskeratosis Congenita are considered diseases. Progeria is considered a disease but yet when the same changes happen to an individual 80 years older they are considered normal and unworthy of medical attention.

Additionally, normal in a medical context is generally defined as no deviation outside of the normal reference range for that age and sex, whilst diseases are seen as deviation from this normal condition for that age and sex. Thus someone with a blood pressure of below 120/80 is seen as normal while a blood pressure above 140/90 or below 85/55 is abnormal and a sign of disease. The stratification of reference ranges for age is needed to distinguish fully developed adults from still developing children. Aging as the passage of time and the accumulation of wisdom is not undesirable; the physiological decline that accompanies the process, however, most certainly is.

Whilst aging is a nearly universal occurrence, it should be noted that other medical problems such as muscle wastage leading to sarcopenia, reduction in bone mass and density leading to osteoporosis, increased arterial hardening resulting in hypertension, atherosclerosis, and brain tissue atrophy resulting in dementia, all of which are nearly universal in humans, are classified as diseases in need of medical interventions. Also, autopsy studies indicate that amyloidosis may be almost universal in elderly people and, in autopsies performed by the Supercentenarian Research Foundation (SRF), amyloidosis has been identified as the cause of death in about 70% of people over 110 years of age. Should we remove amyloidosis from medical textbooks as an age-related disease just because it happens to occur in almost every elderly subject?

While most still seem to consider aging not to be a disease others have started to question this position. Some have argued that aging should be considered a disease, a syndrome or a 'disease complex'. Whilst many aging researchers have openly declared that the universality of the aging process means it is not a disease, aging fits the given medical definition of a disease. There is no disputing the fact that aging is a 'harmful abnormality of bodily structure and function'. What is becoming increasingly clear is that aging also has specific causes, each of which can be reduced to a cellular and molecular level, and recognisable signs and symptoms.

Researchers write: "In short, not only does aging lend itself to be characterised as a disease, but the advantage of doing so is that, by rejecting the seeming fatalism of the label 'natural', it better legitimises medical efforts to either eliminate it or get rid of those undesirable conditions associated with it". The goal of biomedical research is to allow people to be "as healthy as possible for as long as possible". Having aging recognized as a disease would stimulate grant-awarding bodies to increase funding for aging research and develop biomedical procedures to slow the aging process. Indeed, others have stated that calling something a disease involves the commitment to medical intervention. Furthermore, having a condition recognized as a disease is important to have treatment refunded by health insurance providers.

We believe that aging should be seen as a disease, albeit as a disease that is a universal and multisystemic process. Our current healthcare system doesn't recognize the aging process as the underlying cause for the chronic diseases affecting the elderly. As such, the system is setup to be reactionary and therefore about 32% of total Medicare spending in the Unites States goes to the last two years of life of patients with chronic illnesses, without any significant improvement to their quality of life. Our current healthcare system is untenable both from a financial and health and well-being prospective. Even minimal attenuation of the aging process by accelerating research on aging, and development of geroprotective drugs and regenerative medicines, can greatly improve the health and wellbeing of older individuals, and rescue our failing healthcare system.

Comments

Hopefully it gets classified as a disease soon but looking how it's going with Sarcopenia, I'm not too hopeful. So what happens if it isn't classified as a disease as far as treatments? Medical tourism? Is that really going to be the only way to get treatments? Or will treatments be almost considered side effects of other drugs?

Posted by: Ham at May 27th, 2015 7:28 PM

It doesn't matter if it's classified because every SENS target has an ageing disease associated with it. Nothing is missed except non-pathogenic changes.

Posted by: Michael-2 at May 28th, 2015 12:50 AM

They do, but wouldn't people want to get these therapies before developing cancer or Alzheimer's?

Posted by: Ham at May 28th, 2015 3:35 AM

I think it doesn't matter so much in terms of being able to run clinical trials because already named diseases cover the hoped for technologies of SENS. However it probably does matter in terms of public understanding and resultant funding.

On the other hand funding for stem cell research has broad public support, even though it is not targeting a disease, probably because it is conceptually simple as a idea of creating replacement body parts.

It is an interesting topic in that although aging is clearly something going wrong with our bodies we don't tend to think of it as a disease as long as it happens to everyone and happens at an average rate.

Posted by: Jim at May 28th, 2015 4:04 AM

I would counter that by saying it is actually a pretty big problem if it cannot be classed as a disease or at the very least allowed to be treated as a recognized target for rejuvenation. The problem in the main means Government funding will not go towards it nor will the FDA pass a therapy that isn't a named disease. Yes arguably you could use off label drugs or therapy to create a rejuvenation package but you would have to jump through hoops to do so and it would soon be locked down I am certain if those who oppose such technology saw this happening.

I also think saying aging is a disease often provokes a knee jerk reaction from the public and summons up images of foil hat wearing crack pots rather than legitimate scientists trying to improve health and longevity. YMMV but I do find this is the kind of reaction I get from a significant number of people, its all in the wording.

Aubrey is correct about using the Immortality word being not just wrong but is in fact damaging. I think saying things like curing aging, defeating death and aging is a disease also provoke similar reactions from the public. It is frankly quite mad we need to present the work in more comfortable ways but if we want public acceptance of the science we have no choice.

ADG gets around it by saying he works on health (which he does) its just that the technology may have the side effect of allowing you to live a lot longer. I think that is certainly the path of least resistance and the way to pitch such things.

Posted by: Steve H at May 28th, 2015 6:48 AM

I tend to use the phrase "Aging is not a disease but it is the root of Pathology" in other words the dysregulation and consequences of aging are not in of themselves a disease per se but they led to disease.

Honestly I might be pessimistic here but I do see medical tourism being the only way to get therapies in the near future and certainly the case for "first pass" therapies. The FDA? sure you can get a gene therapy eg, Miyostatin Inhibtor that helps combat muscle wastage and possibly ablates plaque as a side effect but ONLY if you have Beckers MD. Good luck getting that off label especially in a country that has medical insurance and not a state system.

Medical tourism is the way unless there is radical change in how the medical paradigm works in the US and EU.

Posted by: Steve H at May 28th, 2015 6:56 AM

I also share Reasons desire to tear it all down and start again with the FDA and get more funding to the NIH to tackle aging. The same applies to the NHS and EU systems as well which are equally as restrictive.

Posted by: Steve H at May 28th, 2015 6:59 AM

Unfortunately the FDA isn't going anywhere. And even though all the major diseases like cancer and Alzheimer's have a potential proposed SENS treatment, our current system probably wouldn't allow it to be used until you actually develop one of the diseases. In my opinion, our medical system needs to switch to a preventative system, so people don't develop these diseases in the first place... Or at least greatly delay them. At this point, most people recognize that aging is a major risk factor for all of these diseases, so the fact that this is even an issue is mind boggling.

What if a potential sens treatment provides marginal results in fighting or preventing Alzheimer's, but provides significant rejuvenation or neuroplasticity. Will the FDA approve it, or allow it for preventative use ? What if calico figures out something to greatly slow aging? Will they have to move operations off shore in order to provide treatments? The system needs some kind of reform, and I'd like to think all the bodies working in this field are trying to make that happen(especially given how much money could be at stake for big pharma). I just get an uneasy feeling that medical tourism is going to become huge if breakthroughs are made and the FDA and other similar bodies drag their feet. And let's be honest... They're going to drag their feet.

Posted by: Ham at May 28th, 2015 7:13 AM

I lean toward the opinion that it does not matter if 'aging' as such is labeled as a disease. As Reason quotes:

"What is becoming increasingly clear is that aging also has specific causes, each of which can be reduced to a cellular and molecular level, and recognisable signs and symptoms."

Treat the causes of the pathology. There are multiple ones for an aged body. We already know that, and I believe the FDA and others are on a path to allow for more and more work that directly addresses the diseases of old-age.

I think the FDA does incredible and difficult work. I believe they are very cautious. But I understand, peripherally, the need for someone who is in a life-threatening situation, to experiment.

Evidence that public-funding is taking notice of preventative medicine:
Just take a look at the A4 study, partly funded by the NIA/NIH. http://www.a4study.org. It addresses Alzheimer's Disease. Last I checked, that's a disease of old-age. [Tau and] amyloid targeted. It has "preventative" and "pre-symptomatic" all over the place...just what you want to hear from a Publicly-funded trial, if you're a longevity-fan.

Eugene

Posted by: Eugene at May 28th, 2015 7:56 AM

The system of government must change before these things happen,there are billions to be made from deaths wars and bad and sad things,unless the system of government changes nothing change,it will eventually leads to s total wipe out of life on this planet without such chsnge.

Posted by: Victor at April 24th, 2016 12:33 PM

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