The scientific community does in fact engage in advocacy to attempt to generate more interest and funding for specific initiatives in research and development, particularly where public understanding is lagging far behind scientific understanding in a given field. This is very much the case in the matter of treating aging as a medical condition. The scientific establishment is united in the desire to move forward towards therapies that treat aging, albeit quite divided on the topic of what exactly the form those therapies should be. The world at large has yet to catch up to the idea that aging can be slowed or reversed, never mind the very important point that the first rejuvenation therapies already exist, in the form of senolytic drugs that can clear a sizable fraction of senescent cells in old tissues.
The latest issue of the Public Policy and Aging Report journal is an example of scientific advocacy for the treatment of aging. It is undoubtedly the case that the future of medicine will become largely a matter of treating aging, targeting the numerous underlying mechanisms that cause aging. Most diseases are suffered by only a small fraction of the population at any given time, but everyone suffers from aging. The target market for therapies is more or less half of the human race at any given moment in time, everyone much past the age of 40. The vast majority of medical costs are related to aging. The overwhelming majority of deaths in the wealthier parts of the world result from aging. The next few decades will see a transition from a world in which only palliative approaches or small gains are possible in the treatment of age-related disease, to a world in which these diseases will be cured and prevented, as the healthy human life span lengthens dramatically.
Human life expectancy worldwide rose dramatically over the past century, but people's health spans - the period of life spent free from chronic, age-related disease or disability - have not increased accordingly. "Twenty-first century medicine should adopt the strategy of directly targeting the molecular mechanisms that cause biological aging. Only in this way will it be possible to slow the onset and progression of multiple age-related diseases simultaneously, in order to extend the health span proportionately with the life span." The authors write that aging itself is not a disease, but rather is the biggest risk factor for a wide range of chronic diseases. This is a central tenet of the emerging field of geroscience, which seeks to define the biological mechanisms that underly the diseases of aging - with the goal of slowing human aging to delay or prevent many diseases simultaneously.
Biomedical research and clinical practice have traditionally been focused on disease rather than health. We typically wait until people are sick before trying to cure their disease or alleviate their symptoms, rather than actively supporting health and wellbeing in the absence of disease. Current demographic trends toward older populations make this approach problematic. Instead of improving the quality of life, we may be extending the period of morbidity and frailty for millions of people. Twenty-first century medicine should adopt the strategy of directly targeting the molecular mechanisms that cause biological aging. Only in this way will it be possible to slow the onset and progression of multiple age-related diseases simultaneously, in order to extend the healthspan proportionately with the lifespan.
The language of the longevity dividend as we know it today originated in 2006, but its intellectual origins are not new. in 1956 Clive McKay suggested the successful life extension that had already been achieved in laboratory animals by then (without knowing whether changes in the healthspan also occurred in these animals) justified the experimental manipulation of the lifespan in humans. A lot has happened in the past 65 years since this idea first appeared and in the 13 years since the term was first used. Just recognizing that aging itself is inherently modifiable, and that interventions derived from aging biology represent a new, more promising form of primary prevention than the usual approach to treating one disease at a time, is sufficient reason to see the value of the modern rise of geroscience and the longevity dividend initiative. The language of these initiatives has now made its way into mainstream medicine, in the form of a preference for "healthspan" over "lifespan", representing a new meme that should permanently change the way in which humanity thinks about what it means to age.
Alzheimer's disease is a growing threat to the economic and social well-being of developed countries around the globe, but efforts to delay, prevent, or cure this disorder have yet to yield success. I believe the lack of progress largely results from approaches that ignore the most important component of Alzheimer's disease: biological aging. Major advances have been made in understanding the molecular mechanisms that link biological aging to disease. These mechanisms have been formalized as nine hallmarks, or pillars, of aging. Here, I discuss the barriers that have impaired progress and propose specific steps that can be taken to overcome these barriers. The time has come to adopt bold new strategies that tackle biological aging as the root cause of Alzheimer's disease.