The political establishment is a plague upon the land; this is generally true of any era. We are fortunate to live in an age in which the level of impact is less brutal and more bureacratic than it has been, and in a region in which the level of wealth is high enough to allow most people to live comfortably despite the constant wars and vast waste of the powers that be. There is, importantly, sufficient space in our society left unpillaged and uncontrolled for technological development to take place at a fair pace. Technology determines near everything about our lives, the degree to which they are worth living, the shape of our societies, and the pace at which we age to death. Faster progress is a great and wondrous thing. Yet, sooner or later, new technologies become promising enough to come to the attention of the political establishment, at which point the challenges of development turn into the challenges of fending off various genteel and less genteel forms of banditry and sabotage.
I noticed the article below in the political press today; it is surprisingly informed in its details, if not some of its premises, given the source. Political journalism is just about the worst of the press industry, and "worst" in this context has become a very low bar of late; the stentorian propaganda of the past has given way to a sort of tawdry crab bucket mass hysteria. As to the article here - should we start to see more of this sort of thing, repeated more often, that might mark the beginning of an interventionist establishment in the matter of longevity science. This probably isn't something to be welcomed: the first instinct of that establishment is to put a halt to any form of change, the second is to tax every new thing regardless of the damage done, and the third is to restrict and control access, limiting it to those with connections.
Where the attention of the establishment results in funding wrestled from the pool generated by involuntary taxation and devoted to a specific cause, such funds are invariably largely diverted into useless activities and waste, or used to prop up unrelated activities carried out by the politically connected. Look at just how little the US National Institute on Aging has accomplished over the last twenty years: so much funding, so many studies, so many programs, and yet where are the results in terms of years of human life span gained? Remaining life expectancy at 60 has moved very slowly upward in a trend unrelated to public research expenditure. The future of additional years of healthy life will be enabled by philanthropy, charities, and startup companies using a tiny fraction of the NIA budget, based on science that was sufficiently explored to get started thirty years ago.
Meanwhile, the first instinct of the propagandists of the political press is to ask how any improvement to the suffering of the elderly might affect the balance of votes or entitlement payments or political parties or current regulations. One gains the distinct impression that people, that suffering, that death really don't matter all that much in their eyes, save for how they are seen at a distance from the city on the hill. It is ugly, I think.
We could do worse than to shun all politicians and their creatures, and work on doing the good that we want to see in the world ourselves. The political establishment exploits and thrives by co-opting our worst instincts, however, and as the present state of the world demonstrates, this strategy is highly effective. As a choice in life, I'd advise reading more Thoreau and Spooner and less of the press as it stands today - advice that was no doubt just as relevant a few centuries past as today. Engaging with the political establishment is a poisoned chalice, one that drags down the productive and ensnares them in a system that does little but generate waste and mockery. The real work is done elsewhere.
What if you could live to 85, 90 or even 100 with your mental faculties intact, able to live independently without debilitating conditions until the last year of your life? What if just one medical treatment could stave off a handful of terrifying ailments like heart disease, cancer, and Alzheimer's? The idea of a pill for aging sounds like science fiction or fantasy. But the hunt is increasingly real. The leading approach even has a name: senolytic drugs. The science is still far from proven, but the prospect of a drug for healthier aging has already attracted significant investment from well-known drug companies, and the first human studies of anti-aging drugs are getting underway. If the results pan out, the first drugs could be available in as little as a decade.
As the research moves forward, however, it is raising a series of new questions that both medicine and regulators will need to confront. And the most complex questions arise around exactly the issue that makes the field so exciting: The notion of treating the aging process itself. There's never been a drug for aging in part because "aging" isn't considered a disease by the FDA. Should it be? What signs and symptoms of aging is it OK to medicalize? And if a drug were approved for aging - something that every human experiences - who would bear the costs for a pill that potentially could be prescribed for every person alive? And those aren't the only questions. It turns out that evaluating the science is also complex, partly because it's hard to measure whether a drug is fundamentally changing the course of human aging. It's also ethically fraught: Aging is a normal human process, so testing a drug for "aging" means that otherwise healthy people would be subjected to its inevitable side effects, for unproven benefit. How long a trial would even be needed? Regulators aren't close to answering this kind of question.
So far scientists are tiptoeing around many of these complicated issues by testing these drugs only in very sick people, studying to see if they help treat deadly diseases with few other treatment options. The idea is to get a potential anti-aging drug approved first under more traditional protocols without having to tackle the thornier, longer-term questions raised by the idea of treating "aging." However, doctors are unlikely to wait for answers to the larger questions around these drugs before they begin to prescribe them to patients. As soon as a senolytic or other anti-aging drug is approved for any purpose, physicians are allowed to start prescribing them to their patients for any condition they want, and likely will.
Anti-aging science has long been viewed with skepticism, a "soft" science more often the province of quacks selling dubious potions than serious medical researchers. But senolytic drugs are changing that. The idea behind them is to attack senescent or "zombie" cells - cells that have stopped dividing, but aren't dead. Senescent cells release toxic and inflammatory compounds that impair the function of healthy cells, and scientists believe they help drive the decline of important body tissue, like organs. Scientists have found that the number of senescent cells increases with aging in mice, monkeys and humans; they're associated with chronic conditions like diabetes, heart disease, cancer, arthritis and overall frailty. In small mammals, scientists have found that killing senescent cells delays and prevents many age-related conditions and diseases. In animal testing, senolytic agents have also successfully treated conditions including heart dysfunction, lung diseases, diabetes, osteoporosis, and damage induced by radiation. Clearing senescent cells from adult mice has even been shown to increase median lifespan.
Interpreting results of human anti-aging studies won't be easy. To prove that a drug prevents aging, companies will ultimately have to find changes in people that aren't known to be affected by disease. For example, skin gets lined and wrinkled and loses elasticity over the years - but that doesn't cause illness. Muscle mass also decreases with age. If a company could show that the drug alters these changes, "that's a pretty good argument that you are affecting aging." But the potential for approving anti-aging drugs on the basis of these signposts is already triggering the alarm bells of bioethicists. They fear companies' pressure to approve these medicines quickly could lead to patients being exposed to medicines that offer only superficial benefits - and possibly hidden harm. This concern over "indication creep" - the tendency for drugs to be prescribed for problems they weren't approved to treat - is another trigger for ethicists. Many of the companies testing the first senolytic drugs aren't trying to get them approved for aging but instead are targeting diseases where they believe senescent cells play a role.
Because of the enthusiasm around the drugs, researchers are already concerned about anecdotal stories of people wanting to use the medicines to treat aging before they're ready for prime time. Paul Robbins of the Scripps Institute said some senolytics are natural products or older chemotherapy drugs. He's heard of clinics already being set up overseas to provide drugs like these as anti-aging treatments, even without evidence they work, or data on the right dosage. The hype is dangerous, warns James Kirkland, whose employer, the Mayo Clinic, is investing in senolytics. "Anything can go wrong along the way. If you could caution your readers, tell them absolutely not to take these drugs until trials are done, because this is a new way of doing things. We don't know if they are going to work and we don't know what the side effects are."
"If you demonstrate that these drugs work, probably everybody is going to want to take the drugs. So then the question becomes a question of cost," said Steven Austad, scientific director of the American Federation for Aging Research. A high-priced drug taken by everyone could place a burden on an already strained health care system, which presumably would have to pay for everyone to take the drug for many decades. And the longer people live, the longer they will draw from government benefit programs. "Politically, this is a hot topic," said Laura Niedernhofer of the Scripps Research Institute. "Someone who does not dig in deeply thinks immediately, 'Oh my God, lifespan is going to extend and Social Security is already in bad shape, and so how are we going to handle this'?" Niedernhofer is an optimist, however, arguing that the costs of anti-aging therapies will more than pay for themselves, their costs offset by the fact that healthier people will require less medical care in the final years of their lives.
Another concern, said University of Minnesota bioethicist Leigh Turner, is pushing resources toward an unproven idea, instead of toward tried-and-true public health programs that have already been proven to extend lives and improve health, like providing clean drinking water or better waste management. But "nothing in our world is equitably distributed - not money, not food, not water," counters S. Jay Olshansky, who studies aging at the University of Illinois at Chicago School of Public Health. These inequities aren't an excuse to stop pursuing an idea that could improve health for everyone. And the potential high cost shouldn't stop the research, he says: Richer countries have pursued a lot of expensive health interventions that were at first not affordable, or are still not affordable to parts of the developing world.