This popular science article on efforts to treat aging as a medical condition is a particularly good example of the type that fail to mention SENS rejuvenation research and any related efforts that involve repair of the cell and tissue damage that causes aging. This one even omits any mention of senolytics, the rapidly broadening efforts to clear senescent cells that are supported by increasingly robust evidence, which has to be a deliberate omission in any overview of the current state of the field. The rise of senolytics and the current enthusiasm for study of senescent cells is very hard to miss. Why do authors do this? What is the prejudice that leads them to focus on marginal, challenging efforts that haven't made significant progress towards practical therapies, such as work on calorie restriction and calorie restriction mimetics? This author is clearly capable of finding sensible things to say about many of the topics that are covered, which makes it more of a mystery.
As researchers work to develop and test ways to slow aging, they will first look to create treatments intended for people in their 50s and 60s, when chronic diseases often start to set in. Studies evaluating those treatments, some of which are already planned (most notably the trial for metformin), should only take a few months or years, measuring secondary indicators like frailty instead of death itself to ensure their efficacy. Eventually, there might be drugs for people to start taking when they're even younger. But giving pharmaceuticals to healthy people is a hard sell. Without extensive long-term clinical trials, it's impossible to anticipate how the decades-long use of an anti-aging drug will affect other aspects of long-term health. There will almost inevitably be some side effects, and the public will have to wade through discussions of whether or not it's worth it. There are people who question whether the clinical trials needed to prove the safety and efficacy of such therapies are even ethical.
These issues hint at a deeper ideological hurdle stopping anti-aging treatments from becoming commonplace. For now, our medical system is designed to address medical conditions as they arise. Putting interventions to treat aging on the market would mean a fundamental shift in our medical system, towards preventative medicine. "We've been trained in biomedicine to focus on sickness rather than health, so that paradigm shift will take time." And to move from success in the lab to having an actual impact on human wellbeing, you need to have public opinion on your side. Social acceptance of aging interventions could pave the way for the medical shift. The field of anti-aging research suffers from a reputation problem. For decades, products running the gamut from skin creams to herbal supplements have claimed to have "anti-aging" properties, with virtually no science to back them up. "People associate our field with snake oil. That only adds to that perception that it's not rigorous." What's more, people in general are reluctant to talk about getting old and dying.
For now, researchers are still trying to get the U.S. Food and Drug Administration (FDA) onboard. As it stands now, the FDA only approves treatments for a specific medical condition. Now researchers in the field of aging are trying to convince the agency to make a separate designation for preventative medicine. From the FDA's perspective, the field of medicine built around combating aging is still in its infancy. "A question not yet answered is how many aging-related but otherwise independent diseases (coronary artery disease, dementia, sarcopenia, etc.) would need to be improved for us to consider the therapeutic effect an 'anti-aging' effect, rather than an effect on specific diseases. It is worth noting again that a drug that improved any of these conditions would be very valuable," an FDA spokesperson said. It's also still a challenge to figure out how to measure whether or not these interventions are effective.
"If the field of aging is going to move forward in having drugs to treat aging in humans, we're going to have to have an FDA-approved pipeline to do so." Having that framework in place will drive innovation, researchers claim - more research money can be allocated towards prevention, and pharmaceutical companies will work to develop new drugs that could potentially be used by the entire adult population. Though researchers don't believe there will be a special designation for anti-aging interventions anytime soon, a clear FDA pathway, plus more frank public discourse, could give the field a reputation to match the rigorous science already underway. And it seems increasingly likely that some intervention or another will emerge to keep people healthy for longer. "20 years ago, I would have said finding a way to extend the health span had a .5 percent chance of working. It's up to a 25 percent chance now, and every year it's going up."