Don't Wait for Aging to be Classified as a Disease

The author of this open access commentary has long been a strong proponent of forms of programmed aging theory, as well as an outspoken advocate for mTOR inhibitors as an approach to treating aging. I don't agree with programmed aging, and I think mTOR inhibition - like all approaches to modestly slowing aging by mimicking calorie restriction - is of too little benefit to merit large-scale expenditure of research and development resources. The scientific and biotechnology communities should be able to do far better via the SENS-style approaches based on damage repair, and indeed that point is already being demonstrated in the case of senolytic therapies. This article, however, is more of a commentary on high level strategy and the effects of regulation, coupled with a desire to forge ahead rather than hold back in the matter of treating aging, thus I concur with much more of what is said than is usually the case.

For decades, one of the most debated questions in gerontology was whether aging is a disease or the norm. At present, excellent reasoning suggests aging should be defined as a disease - indeed, aging has been referred to as "normal disease." Aging is the sum of all age-related diseases and this sum is the best biomarker of aging. Aging and its diseases are inseparable, as these diseases are manifestations of aging.

What then is aging without diseases, so called "healthy" aging. "Healthy" aging has been called subclinical aging, slow aging, or decelerated aging, during which diseases are at the pre-disease or even pre-pre-disease stage. Diseases will spring up eventually. "Healthy" aging is a pre-disease state in which asymptomatic abnormalities have not yet reached the artificial definitions of diseases such as hypertension or diabetes. Instead of healthy aging, we could use the terms pre-disease aging or decelerated aging.

Currently, the term healthspan lacks clarity and precision especially in animals. Although the duration of healthspan depends on arbitrary criteria and subjective self-rating, it is a useful abstraction. In theory, a treatment that slows aging increases both healthspan (subclinical period) and lifespan, whereas a treatment that increases lifespan (e.g., coronary bypass, defibrillation) is not necessarily increase healthspan. The goal of both anti-aging therapies and preventive medicine is to extend healthspan (by preventing diseases), thus extending total lifespan.

The fact that aging is an obligatory part of the life of all organisms is not important. What is important is that aging is deadly and, most importantly, treatable. Consider an analogy. Is facial hair in males a disease? No of course, not. Still most men shave it, effectively "treating" this non-disease, simply because it is easily treatable. Is presbyopia (blurred near vision) a disease? It occurs in everyone by the age of 50 and is a continuation of developmental trends in the eye. It is treated as a disease because it is easily treatable with eye glasses. Unlike presbyopia, menopause in females is not usually treated because it is not easy to treat. Thus, the decision to treat or not to treat is often determined by whether it is possible to treat. It does not matter whether or not the target of treatment is called a disease.

It is commonly argued that aging should be defined as a disease so as to accelerate development of anti-aging therapies. This attitude is self-defeating because it allows us to postpone development of anti-aging therapies until aging is pronounced a disease by regulatory bodies, which will not happen soon. Aging does not need to be defined as a disease to be treated. Anti-aging drugs such as rapamycin delay age-related diseases. If a drug does not delay progression of at least one age-related disease, it cannot possibly be considered as an anti-aging drug, because it will not extend life-span by definition (animals die from age-related diseases).

Link: https://doi.org/10.18632/aging.101647

Comments

Ya changing the regulations and such is hard, and not necessary. Say clearing the senescent cells makes it so people with severe kidney disease live for 7 years on average versus 5 years with no clearing of senescent cells.

That drug can then get regulatory approval for treating severe kidney disease. The company can then work from there with more clinical trials to get approval in additional indications. The market for some of these illnesses is so vast, that great revenues can be achieved from just one indication, let alone several.

Once some of these drugs have been on the market for a few years, and the indications are blossoming, then its from there that the question will inevitably come up, is there a way we could approve these treatments more generally. And some people will begin getting the treatments 'off-label', and if the results are noticeable, millions of other people will want that too.

Its at that point that the public and policy debate can begin for how to define and approve anti-aging medicines more generally. But right now its just not necessary.

Posted by: aa3 at November 26th, 2018 3:51 PM

I can't believe there isn't anything at all about veganism on this site. A plant-based diet has been proven as the optimal one for decades, seemingly reversing many of these age-related illnesses and greatly extending life. Yet I looked through this sites various 'worthy causes' and find only technological solutions to this problem With something as obvious, cheap and easy as veganism, the silence on the subject on this site is deafening.

Posted by: Robert at November 26th, 2018 5:22 PM

@aa3
If the treatment works when slightly, then in a few years there world be a cottage industry of providing it. Look at the plastic surgery, beauty parlors, and the dietary supplement industry. And people very will be gladly lining up :)
No way to stop it. Not for long...

@Robert
Your milage will vary. I would guess that a strict , yet balanced, vegan diet works bring similar benefits so calorie restrictions. And the same difficulties to follow the regiment..

Posted by: Cuberat at November 26th, 2018 6:45 PM

@Robert: I've been a vegetarian for nearly 25 yrs but only followed a vegan diet from 2014 onwards. Those 4 yrs since I eliminated milk/cheese from my diet have seen me make gains in muscle (I workout 3 times a wk) and have more energy when I'm jogging. This site and the work Reason does is amazing; but I agree with you that a plant-based diet is something we can all do today to improve our health. The other animals we share this planet with would appreciate it too!

Posted by: Steven B at November 27th, 2018 8:59 AM

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