A Certain Irrationality Still Pervades Much of the Aging Research Community

Imagine for a moment that the inhabitants of a town beside a river are hampered by their inability to get across the river. They have been talking about getting across the river for so long, and without any meaningful progress towards that goal, that it has become a polarized topic by now. Most people won't mention crossing the river these days because it has become the subject of tall tales and ridicule. The town is growing, however, and now it has a concrete works and enough revenue to order all the rest of the materials needed for a bridge. Accordingly, a bridge faction arises, but is almost immediately set upon by another, larger faction who think that a better use for the concrete and the funding would be a nice viewing platform overlooking the river, and a road leading up to it. Wouldn't that be a benefit to the town, and safely certain in comparison to actually having to set up pilings and cranes and all the rest of what might be needed to build a bridge? Both of these factions amount to only a handful of people in total, however, and are largely ignored by the rest of the town, whose support they need in order to move ahead.

This sketch is somewhat akin to the situation we find ourselves in when it comes to biotechnology and aging. The people who want to take credible paths to human rejuvenation, bringing aging under medical control, now that such a goal is possible given the technology to hand, are a minority in comparison to the people who want to do no more than slightly slow down aging. The difference in the potential benefits produced by these two courses of action is night and day: one does very little, the other is a road to agelessness and an end to all age-related disease. The difference in cost is likely minimal in the grand scheme of things. Yet the majority of that part of the aging research community interested treating aging as a medical condition are following the objectively far worse path, rather than the objectively far better path. Meanwhile, the majority of the public pays no attention and has little to no interest in the topic - despite the fact that this is, quite literally, a matter of life and death.

Thus, there are two battles of importance when it comes to advocacy for the treatment of aging. The first is to create widespread public support for longer, healthier lives and the research needed to achieve that goal. We currently live in a world in which most people are all for cancer research and heart disease therapies, but opposed to or disinterested in research that targets aging, the root cause of those conditions. Progress at the large scale requires greater public support for this cause than presently exists. The second battle is to ensure that the right projects are funded: comprehensive rejuvenation, not a slight slowing of aging. Bringing an end to aging, not just tweaking it a little. Both goals are equally possible, but at present the better of the two has far less support and funding. That this second battle is still being fought, and needs to be fought if we are going to see significant progress in our lifetimes, is why articles like the one quoted below appear every so often - though not as often as they should.

Fear of Life Extension

In about the year 2000, a commandment came down from the very heights of the Geriatric Olympus: "Thou Shalt Not Study Life Extension. Nay, nor shall thou speak wistfully of such a prospect. For it is written that life extension scares the bejesus out of the gods of policy." The fear haunting policy makers is that medical progress will result in longer lives without better health - the specter of millions of empty shells in wheelchairs populating ever-expanding nursing homes. Ever since this commandment, the ruling concept has been "quality, not quantity." We don't want to live longer - just better.

This concept ignores two realities: firstly, that we do want to live longer; secondly, that at a population level, it is impossible to live longer without living better. Conversely, living better means living longer. At one level, these realities are too obvious to require explanation. However, policy gods work at the level of abstract concepts, and strange things can happen when abstractions are substituted for actual experience.

We do want to live longer. As any clinician knows, those with serious chronic illnesses not only cling to life but for the most part enjoy it and are grateful for the opportunity. Even in places with easy access to un-messy and legally sanctioned suicide, there are not that many takers. And it is virtually impossible to separate quality from quantity in human life. Measures that reduce disease also increase longevity, and vice versa. There are rare examples where quality and quantity might diverge - perhaps chemotherapy and radiation for glioblastoma multiforme is one - but I challenge clinicians to come up with common examples. Aggressive end of life care does not increase quantity. Palliative care does not shorten life and in some trials even extends it.

Thirty years ago, there were serious articles by various experts about how the (then) continued increase in life expectancy would lead to an epidemic of Alzheimer's and thence to a need for more nursing homes, more wheelchairs, more of everything unpleasant and costly. But that was silly. People live longer because they are healthier, not because some magic pill or machine keeps decrepit, barely functioning organisms alive. Yet the commandment outlawing enthusiasm for life extension requires researchers to start their publications with statements about wanting only to improve quality, not quantity of life.

Comments

With respect to what the public thinks, I think that you are overlooking the fact that a huge percentage of the public is religious, and believe in a supernatural explanation for aging.

Posted by: NY2LA at April 11th, 2017 6:38 PM

@NY2LA: The situation on the ground looks pretty similar to me in both comparatively religious and comparatively secular regions of the world.

Posted by: Reason at April 11th, 2017 8:04 PM

I am curious to know why you think the majority view is healthspan? People like Nir and others advocate healthspan like a relgious mantra but I am seeing increasing numbers of researchers interested in going beyond that. Loved the intro story here about the village too most amusing as is the paper :)

Posted by: Steve Hill at April 12th, 2017 2:30 AM

In my experience opposition to life extension on religious grounds is largely non existent. And there are even Pew Research papers to back this up.
On the other hand I've seen more than one well known and outspoken atheist pose deathist views with proud fatalism.

Posted by: Anonymoose at April 12th, 2017 2:41 AM

Most people in the town would be opposed to building the bridge because they know they would not be able to afford the toll. Even if the bridge did not cost them anything they would still oppose its construction because it would disproportionately benefit those that could afford the toll. Class warfare.

Posted by: JohnD at April 12th, 2017 12:45 PM

@JohnD The people are already paying for a long daily bumpy boat ride to the other side of the river. The bridge is a superior alternative and even if some are not capable of paying the toll most would elect to have the alternative regardless - but they will grumble about the construction for years on end.

Class war is a luxury of the middle class. The poor quite honestly, don't care. Unfortunately as it happens most of the 1st and 2nd world is populated by middle class whiners - the haves who want to have more - as opposed to legitimate have nots.

I'm not saying you're wrong. In fact I fully agree most people will moan - heck they mostly already are - even though the therapies are barely starting to be developed. Why wouldn't they, it's just another thing added to the super cars and luxury yachts they dream about on the daily.

It it is wrong though - from a purely historical perspective - technology always trickles down to the masses and trying to stop technology will only stop it from reaching the middle class faster, rather than to be developed in general. It is a reality the ones worried about equity will have to reconcile in their minds for their own good.

Posted by: Anonymoose at April 12th, 2017 3:15 PM

I'd say my fear is that life extension gets handled by Big Pharma - which is the Royal Route to Nowhere. Take the TV ads for "Opdivo" as an example - 90 days more life with horrible side effects possible at maybe 150K initially and 14K per month. In other words, I fully expect drug companies to pursue extremely expensive treatments that are merely marginal to prevent any real 'cure' for aging.

Posted by: chriszell at April 12th, 2017 3:33 PM

Chriszell: Cancer treatments aren't expensive and inefficient because they are developed by big pharma, they are so because researchers try to fight each type of cancer one at a time, and cancer evolves and changes its type. That will not happen with for example WILT, because it attacks every type of cancer at the same time, and cancers can't evolve to strike back.

Posted by: Antonio at April 13th, 2017 3:05 AM

I don't think life extension therapies can become extremely expensive.

Some people in the forums at longecity.org already tried senescent cell clearance with dasatinib & quercetin. Normally dasatinib would cost a fortune and is on prescription only but they got it for cheap through some not so official source. Using patented stuff without licensing for private or scientific purposes is completely legal.

So the amount of money you can milk out of this market is proportional to the trust in your product as it should be. If you want to get excessively greedy you just break the very same market you want to feed on. Regulations don't help much either as they can be circumvented.

Posted by: Matthias F at April 13th, 2017 6:12 AM

Last week, a new drug to fight MS was announced. Once again, fairly marginal results and a 60K price tag. It isn't just cancer drugs - it's anything the drug companies can get away with. As when they jacked up prices on Naloxone - for fighting opioids. Or the Epi pen, because they could.
Teva dropped manufacture of Vermox after it became obvious that it might halt tumor growth for pennies a tablet.

The internet and brave independent researchers may be our only hope. I do hope that excess greed will break the markets but we aren't fully there yet - and the FDA is hot to stop progress - as with attacking cheaper internet drugs.

Posted by: chriszell at April 13th, 2017 9:49 AM

> Teva dropped manufacture of Vermox after it became obvious that it might halt tumor growth for pennies a tablet.

Mebendazole is still available for pennies a tablet under different brand names all around the world. It's more expensive in the US as Amedra bought the US marketing rigths and now has a monopoly on anti-parasitic medication there. IMO Teva dropping it has nothing to do with it's antitumor properties. They discontinued a product that had too much competition to make any money and sold the rights to the competitor with the better product. That's it.

And yes, the other three are expensive. You can do that in niche markets because nobody will step up for competition as the market just isn't big enough for two companies. But it's still better to pay high prices for a special product than having no product at all, right?

I don't think you can compare that to life extension therapies, though. That market is much bigger and such a policy doesn't work any more if the market is big enough to support more than one supplier or even a black market.

Posted by: Matthias F at April 13th, 2017 12:28 PM

As I understand it, Teva dropped it without providing an explanation and just as the Pub Med studies were drifting towards showing success in humans. In the nick of time, coincidence...

So, Epi pens and Naloxone are niche markets? By that definition, every drug feeds a niche market. And given the frequently marginal nature of these side effect laden, extremely expensive products, are they better than no product at all? Can we even be sure they do anything useful, given the sort of manipulations that drug companies are guilty of?

Posted by: chriszell at April 14th, 2017 11:20 AM

> As I understand it, Teva dropped it without providing an explanation

Sure. And you can still see it on the shelves, years after it has been discontinued. While other brands sell significantly cheaper. Draw you own conclusions.

> So, Epi pens and Naloxone are niche markets? By that definition, every drug feeds a niche market.

Then what should be the definition of a niche market if not the criterion that there are very few buyers? I'll give Aspirin as a counterexample.

> are they better than no product at all?

I guess so, if they can save a life like Naloxone can. Yet still overdosed drug addicts are too rare to make a real market. If Naloxone sold for 20$/dose that turnover would hardly be enough to pay a single employee.

Posted by: Matthias F at April 14th, 2017 10:06 PM

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