Notes on the 2018 Longevity Forum in London

The Longevity Forum, hosted by investor Jim Mellon and company yesterday in London, was a reminder that we still have a way to go when it comes to guiding the conversation on longevity and rejuvenation in a useful direction. On the one hand, most people give medicine and aging little serious thought until it is too late, and if we want large-scale funding for the goal of human rejuvenation through realization of the SENS research agenda, then the public at large really has to be on board in the same way that they are reflexively in favor of doing something about cancer and Alzheimer's disease. On the other hand, the first reaction of many people when presented with the concept of enhanced human longevity is to fixate on line items that really do not matter in the grand scheme of things: whether retirement will still exist; will life insurance companies have to change their ways; will some particular demographic gain slightly more or slightly less than another as a result of progress in medicine. None of these points matter anywhere near as much as does the act of building the therapies that will save lives and improve lives.

I should probably disclose that I am a technological determinist, in the sense that it is technology that determines society. People will adapt to new capabilities quite rapidly, as illustrated by any number of world-changing advances in communications, transport, and medicine introduced and enthusiastically embraced over the past few centuries. The shape of society will shift in response to those new capabilities. Building the technology is the first, foremost, and only goal: let the rejuvenation therapies be built and distributed, and let the world adapt to the wonders of a longer, healthier life. Insofar as we have to talk about it ahead of time, that talking should focus on whatever is needed in order to direct resources to the appropriate tasks of research and development.

But clearly others feel differently, in that broader discussions should take place, or that there is a process of awareness and coming to terms that must be undertaken. Expectations must be managed, and perhaps that is really all this comes down to at the end of the day. People don't want to be surprised, whether they are managing billions of dollars of life insurance liabilities, or managing their own career and little else. If the status quo today was that we all knew that rejuvenation was arriving soon, then that would be the status quo and everyone would be fine with it. Our job as advocates is, in some sense, to make this the status quo.

The Longevity Forum brought together scientists, insurance and medical industry functionaries, biotechnology investors, former politicians, people with interests in philosophy and self-empowerment, and a variety of less easily described types. There was a row of journalists in the back of the auditorium, heads down and taking notes. The scientific content was kept deliberately lightweight, and the focus was more on what this business of longer healthy lives means for people who live in the mundane world of pensions, life insurance, planning for retirement, and coping with the ugly realities of late life disability. I will say that these are all earnest folk in their own ways and their own bailiwicks, but their day to day concerns are about to be upended in the deluge. The technology has arrived, senolytic therapies to clear senescent cells exist, now, today, and there is no time to be concerned with what will be. By the time any bureaucracy has fully engaged with the question, we will be looking at the dawn of the age of rejuvenation in the rear view mirror.

Large financial institutions are not well positioned for any sort of upward leap in life expectancy in old age, of the sort that will take place the moment that widespread use of senolytic drugs occurs. They can cope with a slightly more aggressive upward trend, and indeed have been gearing up for that for quite some time. But a sudden leap? The result will make the bailouts of other industries in the past few decades look anemic. That is of course no reason to stop. Life for everyone is more important than the financial health of any given group of businesses earnestly engaged in making a severe strategic error. Those that serve poorly should become bankrupt and go under, though sadly the costs are all too often socialized these days. Nothing that was said by the representatives of these industries at the Longevity Forum gives me any hope that it will happen differently; those present either understood but were in no position to make changes, or did not give much weight to the possibility of large upward leaps in life expectancy.

I think one of the reasons that this decimation of the pensions and life insurance industries will happen is because many of the figureheads of the research community are very conservative in their view of timelines and potential. Eric Verdin is an interesting case in point; he was presenting at the Longevity Forum to give an overview of work at the Buck Institute. Verdin makes the case that we are not all that far in to the standard 50 year cycle for longevity-related technologies, and it takes at least 20 years to get anything moving in earnest, pointing to stem cell therapies as an example. On that basis he, like a number of others, sees only incremental advances ahead in human longevity. At the very same time, however, he is quite aware of senolytics, given that it arose in part at the Buck Institute, and touts that work as important. But I have to think that he doesn't see it as any being different than, say, calorie restriction mimetics, in terms of how one can talk about the prospects for human health and longevity. This seems like a deep and important error to me. These two classes of therapy are a world apart. One repairs a form of damage that causes aging, the other adjusts metabolism to slightly slow the onset of further damage. The size of effect and reliability of results are night and day.

In any case, to return to the original point, if one wants to swing society into line with the goal of building an industry whose products will enable people to live much longer in good health, then the established way of going about doing so involves efforts that look a lot like the Longevity Forum. Thus I expect to see more of this sort of thing in the years ahead, and not just in London. The goal of building an industry is far greater than just succeeding with a couple of startup biotechnology companies, and will, even initially, require billions in investment in new medical and research infrastructure. While the core technology demonstrations of the SENS rejuvenation research programs, to produce an old mouse that exhibits comprehensive rejuvenation and a doubling of remaining life span, could be achieved now for something less than a billion dollars spent over a decade, it is vastly more expensive to translate that work into human medicine and then provide it to the world. That requires very large, very conservative organizations to play their part, and they tend to follow public opinion, not lead it.

At one point near the end of the event I found myself advocating senolytics to one of the non-scientists present, a noted figure who runs a charity to help old people with their physical limitations - and is thus in a position to do a great deal of good as rejuvenation therapies emerge. I was forcefully reminded by the resulting polite rejection that people outside our community really cannot tell the difference between snake oil and real rejuvenation therapies. To them a suggestion to look into senolytics, because amazing things are happening in the laboratory and among self-experimenters, sounds no different from a pitch for supplements made by any random fraud in the anti-aging marketplace. Those on the outside are wary, or disinterested, and will be slow to come around. The need for patient advocacy doesn't end just because a treatment exists, and that includes the persuasion of existing patient advocates who work with old people. It seems a terrible thing to me that so many millions are suffering right now, and could make an educated choice on the risks and the rewards to seek benefit from any of the easily available senolytics, if they only knew what we know.

The Longevity Forum is a charitable concern, and part of its remit is not just to bring together the insiders and the outsiders in the matter of longevity science, but also to bring together public, private, and charitable concerns in order to advance their agendas. Charities for scleroderma and premature ovarian insufficiency presented at the event. Both conditions are more subtly age-related than the most common age-related conditions that we are all more familiar with. The latter of the two looks a lot like a very selective progeria in many ways, both superficially and in its biochemistry. There was some discussion of ways in which those present might help. Among those who could offer assistance on the technical front was Alex Zhavoronkov of In Silico Medicine. He presented on some of the capabilities of his company, using deep learning techniques with genetic and epigenetic data sets to find small molecule drug candidates and biomarkers that might accelerate research and development. This is particularly applicable to medical conditions wherein the research community has struggled to gain a good understanding of the underlying mechanisms and causes. It is true, however, that pharmaceutical development in general is one of the least efficient processes in medicine, regardless of the target condition. It is an area ripe for disruption, even if that disruption is limited to creating a very cheap, efficient source of candidate compounds for arbitrary medical conditions.

The formal event ended with a panel discussion on "life well lived." Do people really need to be told how to live? Will the applicability of the wisdom of the ancients really change in the slightest given another few decades of life? One day in the next few years doctors will start prescribing senolytics. Life spans will increase. A lot of ink will be spilled on viewpoints that are ultimately pointless and that will vanish from memory near immediately. Society will continue. But we still, it seems, need to be in the business of managing expectations as well as building new biotechnology.