The mainstream of the scientific community has for decade after decade followed an entirely incorrect strategy in the matter of aging, and it was only comparatively recently that this state of affairs was changed for the better by the advocacy of groups like the SENS Research Foundation, Methuselah Foundation, and their allies, alongside advances in the science of slowing and reversing aging that couldn't be easily dismissed, much of that funded by philanthropy rather than established institutions. Given a poor strategy, in which age-related diseases were studied separately from aging, and in their end stages, and without considering their root causes, it isn't all that surprising to find that treating age-related disease progressed poorly and incrementally. The only way to effectively treat age-related conditions is to address their deeper causes, which is to say the mechanisms of damage that lie at the root of aging, such as accumulation of senescent cells.
The commentary I'll point out today has its origin in the National Institute on Aging hierarchy. While reading, it is worth bearing in mind that there is often a great deal of hindsight and positioning in any one individual's explanations for why aging was largely ignored as a cause of disease, and why efforts to treat aging as a medical condition were actively discouraged for decades. The existence of the anti-aging marketplace - a noisy pit of fraud, lies, and false hope - had as much to do with the reluctance of the academic community to engage meaningfully with the treatment of aging as any ivory tower miscategorizations that placed aging and age-related disease in different buckets. Regardless of cause, it is a tragedy that so much time was lost and wasted in the matter of aging, with a cost in tens of millions of lives for every year of delay in the arrival of meaningfully effective rejuvenation therapies.
Sixty years ago, Nathan Shock created the Baltimore Longitudinal Study of Aging, and his idea was that we needed to dissociate aging from disease, because only at that point would we know what disease is and how to treat patients. There was an interest in trying to understand aging so that we could ignore it, because there was nothing that we could do about it. And then, as researchers started to look at aging and began searching for the point of dissociation between aging and disease, they found that it was much more difficult than expected. As our technologies became more developed and sophisticated, the boundaries between aging and diseases continued to blur.
The risk factor paradigm started with cardiovascular and cancer epidemiology; the basic idea is that if you wait a certain amount of time, risk factors will trigger a disease. People initially thought that there was some specificity between risk factors and diseases, but over time we have discovered that this specificity was not really there. Exercise and physical activity can reduce the risk of developing cardiovascular diseases, cancers, pulmonary diseases, sarcopenia, and so on. Smoking increases the risk of developing these diseases, too. You can say the same thing for many different risk factors that are being considered. Cancer and cardiovascular disease, the two major causes of mortality, share many of the same risk factors. Think about obesity: it's associated with most chronic diseases that you can think of. And so there has been a shift in how we have considered aging, from something that we needed to account for and eliminate by statistical adjustment to a causal factor in disease. And I think that it makes a lot of sense.
This explains why aging is a much stronger risk factor for dementia than carrying an APOE4 allele. This shift in thinking is important because it places aging at the forefront of medicine. Now, if this is true, understanding aging provides the strongest chance to prevent chronic diseases and expand healthspan. This shift creates incredible opportunities, and even private companies have started to become interested in studying aging.