James Peyer of Cambrian Biopharma on Defining Aging as a Disease
James Peyer was involved in the aging-focused fund Apollo Ventures before he moved on to the more recent venture industry initiative that evolved into Cambrian Biopharma. Cambrian is arguably even more focused on creating new biotech startups to treat aging, rather than investing in existing companies, than is the case for Apollo. Many venture capitalists are coming to the conclusion that the pace at which new biotech companies in this space are arising is too slow to provide sufficient opportunities for the capital that could be harnessed to produced progress. That pace must thus be accelerated.
Peyer is a regular on the conference circuit, and can be relied upon to give interesting, thoughtful presentations on the state of the science, the state of the funding, and what the venture community should do next in order to best support the growth of the longevity industry. You can find many of his talks on YouTube, and I recommend looking them over if you would like a sense of what the venture side of the longevity industry is thinking.
Q&A with Cambrian Biopharma's CEO - hallmarks of aging and classifying aging as a disease.
We wondered what Dr Peyer's views were on classifying aging itself as a disease? "I have a somewhat controversial view on this amongst folks in our field," says Dr Peyer. "I believe that the entire discussion about whether aging should be considered a disease is actually little more than a distraction from the real, more technical issues standing in the way of getting a medicine that enhances healthspan from being approved for that use. Many of my colleagues advocate in good faith that this would be a key inflection point for the field, and I used to believe the same. However, the more I have come to understand about the way that these drugs would be regulated in the future, the less concerned that I am with worrying about categorizing aging as a disease."
"I do absolutely think that it is appropriate and proper to classify the build-up of damage that accumulates during aging as a disease. There is already a gray area about when other conditions are labeled a pathology vs not a pathology. We have categorizations for pre-diabetes, mild cognitive impairment, benign tumors, and high cholesterol. Are these conditions diseases? I would argue that it's not important what we call it. What is important is the following: (A) Can we run a clinical trial to address the condition and (B) would health insurance companies provide such a medicine to its patients?"
"One of the most valuable learnings from the pioneering work of Nir Barzilai on the TAME trial and other conversations with the FDA has been that building a composite chronic disease endpoint is already acceptable to the FDA. Building a drug that reduces stroke and heart disease risk (what the statins were approved for) has been acceptable to the FDA for ~20 years. Building a drug that reduces heart disease, stroke, Alzheimer's, cancer, and diabetes risk is also acceptable. What would change in this context if the regulators labeled aging a disease? Nothing. We just have to do the trial to show that such a drug is actually working. The path is already there for us. The real challenge is how we design and power these trials and whether we can use biomarker-based endpoints to make the iteration time of testing these medicines shorter."
Some drugs and treatments That don't treat a disease had been approved by governments
In the United States and other countries. Examples: birth control pills in 1960 - it doesn't treat or prevent a disease - pregnancy is not a disease, although it may prevent overpopulation - which is not a disease, but a social problem.
Also vaccines don't treat diseases, only prevent them. Botox and other cosmetic treatments
are used to repair visible aging damage - approved by governments, although there is no government in the world that designates Aging a disease.
So, it is very probable that governments will approve comprehensive rejuvenation therapies, as long as they are safe and effective in humans.
"B) would health insurance companies provided such a medicine to its patients ?"
No, because Aging is a pre-existing condition - every one is born with it and the vast majority of insured patients will require treatments - so the risk is too high and they will not be insured against Aging. Governments that have " universal" health insurance will not cover Aging because the cost will be too high. Many governments are already in deep debt and financial deficit because of corona virus, flue and other pandemics.
This is one important reason why governments don't call Aging a disease - designating it a disease would raise expectation in the population - voters / taxpayers would demand that governments spend more money on research and treatment of Aging - so governments don't want to raise expectations and cause all kinds of troubles.
That means rejuvenation enthusiasts will have to pay for treatments by cash or credit card,
And venture capitalists will have to set the prices not too high and not too low. High enough to make profits and low enough for at least 10% of the population to be able to afford it.( for the rich class and the middle class).
"Governments that have " universal" health insurance will not cover Aging because the cost will be too high."
Nope, the costs of pensions and having a big % of non-working population is much much much higher.
"Many governments are already in deep debt and financial deficit because of corona virus"
Nope, they are in deep debt due to pensions. Their stupid lockdowns (not the coronavirus) were only the nail in the coffin.
No, older people are much more expensive for government as the medical is often paid by government. Its much cheaper to keep them healthy (and productive assuming robots haven't taken over most jobs). Also, rejuvenation treatments should become much cheaper over a 5 year period, IMO.
@Robert: "...and productive assuming robots haven't taken over most jobs."
I see this as an issue more than anything else. Many countries had high unemployment levels and weak economies well before Covid, so governments will want to keep people alive only if they are certain that they won't be a burden.
Example: if we could shave 20 years off most 80 year olds tomorrow (or in the next 10-20 years), what percentage of them will be able to return to work? At the very minimum, many would have to upgrade their skills, and people in manual jobs won't be healthy enough to do what they did when they were truly young.
And even if they could: why would an 80 year old, who suddenly feels young enough to take up a sport or a hobby, want to go back to the grind when he can live off his government pension?
There are so many unexplored unknowns in this whole thing that claiming that governments will automatically shell out billions, as soon as the technology is available, to make people not old (which is not the same as making them psychologically young and with a life expectancy of decades) is incredibly simplistic.
I am assuming that a government paid for rejuvenation therapy would come out of your pension allowance.
Let's jump from that bridge be seen we come there. There could be many solutions to the problems highlight. For one the governments will be all to happy to raise the retirement age. Then the 80 years olds probably have the habit of harder work then the now affluent generations where hard work is a virtue and not a necessity. If all jobs are automated by robots and cloud services then or means that activities that were dwarfed by the regular grunt work well become the primary earners.