Successful Treatment of Aging is a Goal of Great Importance to Public Health
Why has the tone of writing by ethicists on the topic of treating aging as a medical condition, with consequent extension of health human life span, shifted from from hostility to endorsement over the last twenty years? One possibility is that while a technological capability is thought to be a far future possibility, or unattainable, only those with an ax to grind will talk about it. The years since the turn of the century have seen tremendous progress towards implementing therapies capable of addressing mechanisms of aging, and in lockstep with that the scientific community, and a small but sizable fraction of the public at large, have come to understand that rejuvenation and slowing of aging are viable near future goals. Some of those people are ethicists lacking an ax to grind, and some of those ethicists write on the topic.
Another possibility is that we now know a great deal more about what the first age-slowing and rejuvenating therapies will look like, and many of them are cheap small molecule drugs. Many of those are repurposed from the existing spectrum of approved therapies, not new molecules, and so out of patent and cheap. Not all of the options on the table will eventually manufactured for cents per dose, given a world in which near everyone uses that treatment. Enough of the first generation interventions are in that category, however, to make it challenging for ethicists to view the treatment of aging as something that will be deployed only for the elites, or to employ the usual arguments made against progress: that it will cost too much; be too challenging to implement broadly; that only the wealthy will have access to these options.
Aging, Equality and the Human Healthspan
John Davis (New Methuselahs: The Ethics of Life Extension) advances a novel ethical analysis of longevity science that employs a three-fold methodology of examining the impact of life extension technologies on three distinct groups: the "Haves", the "Have-nots" and the "Will-nots". In this essay, I critically examine the egalitarian analysis Davis deploys with respect to its ability to help us theorize about the moral significance of an applied gerontological intervention.
Rather than characterizing, as Davis does, an aging intervention as a form of "life extension", in this article, I argue that an ethical analysis of an aging intervention should focus on what the primary health impact of such an intervention would likely have on population health - namely, increasing the human healthspan so that the risks of disease, frailty, and disability would be reduced in late life. A by-product of such an intervention is that it may increase the number of years people also live.
Rather than deploying an egalitarian analysis into the far future of a potential new longevity-caste society, I believe it is more prudent and practical to deploy such an ethical analysis to the intrinsic health inequalities that exist between persons at different stages of the human lifespan, e.g., between young adults (age 20-30) and older persons (age 85+), as well as the health inequalities that already exist with respect to variations in the rate of biological aging.
In this essay, I will deploy a comprehensive "present-day" (vs. futuristic) egalitarian analysis that highlights the health consequences of the "status quo" of biological aging, including the health inequalities that exist between persons with "accelerated" aging (e.g., progeria), "normal" aging, and "retarded" aging (e.g., centenarians and supercentenarians). Doing so can help re-frame the ethical arguments concerning intervening in aging, so that an applied gerontological intervention is recognized as a significant form of preventative medicine, rather than a technology that raises serious concerns about radical life extension, boredom, or the creation of a new caste system between the "longevity-haves" and "have-nots".
Like Davis, I believe "that developing life extension is, on balance, a good thing and that we should fund life extension research aggressively". But unlike Davis, I do not believe the best way to promote societal discussion about, or the policy regulation of, an applied gerontological intervention should begin by contemplating the potential future inequalities radical life extension might potentially create. Instead, I believe an ethical analysis should begin from (1) the existing health vulnerabilities of today's aging populations, (2) the existing inequalities of the "aging status quo", and (3) address the most likely aging technology to be developed in the immediate future and reasonable empirical assumptions concerning its fair diffusion.
Aspiring to increase the healthspan, vs. merely delaying death, could constitute an innovative approach to human health and help us realize the noble aspiration of "adding life to years" vs. "adding years to life". Given where the science is today, the goal of a century of disease-free life is a realistic and compelling aspiration. The priority should be on making an applied gerontological intervention a top public health priority for the world's aging populations. If we do this, then the 2 billion persons over age 60 by the year 2050 could enjoy more health and a compression of disease, frailty, and disability.
''Aspiring to increase the healthspan, vs. merely delaying death, could constitute an innovative approach to human health and help us realize the noble aspiration of "adding life to years" vs. "adding years to life". Given where the science is today, the goal of a century of disease-free life is a realistic and compelling aspiration. The priority should be on making an applied gerontological intervention a top public health priority for the world's aging populations. If we do this, then the 2 billion persons over age 60 by the year 2050 could enjoy more health and a compression of disease, frailty, and disability.''
'' ...noble aspiration of "adding life to years" vs. "adding years to life"...''
Hey there! Just a 2 cents.
I know most people think like that, but this, is what enrages me; because, this ethical ''don't aim too high, don't delay aging, delay health degradation..'' is the real crux/problem.
I mean No one wants to Suffer, and live an ultra-long life...suffering. They would prefer being dead soon and be spared the pain. ..I mean, that much is obvious, people want/will choose
a Quality Life (albeit Shorter) - instead of a Very Longer Life, but in Pain.
Quality of Life = Painless Life = Healthy Life.
If Painful Life = Extremely Long Life = Bad Health = Bad Quality of Life (even if much longer).
The thing is, in general, as I said previously, you Must maintain a 'minimum' threshold to Even have the Chance of Reaching Extremely Old Age;
Meaning, you won'T even reach it, if you don't keep some health; this is shown in people with immune problem; they die young...and don't Even reach long life. So you must have health;
but health is just one layer; the Other layer (before) is the Aging (as I explained in large in other comment).
The Aging is the Limiting - element - Longevity/How Long...it *Can* Last - If Health threshold is Maintained* - For Entire Life. That means the Maximum Lifespan Potential MLSP for Human Specie. And that Max; is 120-130 years for humans.
So when I read stuff like:
'' ...noble aspiration of "adding life to years" vs. "adding years to life"...''
I mean, I feel a mixture of understanding, and rage - at the same time.
Like...it's almost someone saying:
''It'S noble to die...becayse...we die anyway, you me and eevrybody else...so why don't you concentrate on being healthy and feeling healthy...for your WHOLE life.''
That's what it amounts to; improving your health and 'adding life to years'...but don't talk about adding YEARS to your life; because, that means you are basically saying: ''why do you care about the Maximum you could EVER reach as human???...don't you know, that ethicists, WANT you to die..because you'Re expensive..to keep alive''.
Uh...maybe, just a thought...because we die? death..you know dying...of Aging?...
Just a 2 cents.
PS: THat'S the problem today, is that people just cannot Fathom it and think it's ven aa joke or absurd to Even think about living 150 yaers...like, 'focus on adding health to your years...the rest...fck..it ...we die. one day, at around 120. Accept it. can't do anything about it.''.
I'm sorry but that is defeatist and just 'abandonning life'...they will start with their 'too expensive, overpopulation 'no one dies of aging anymore', only rich people can 'live like selfish immortals...', do we want to 'live forever?', and more ethical stuff...THIS is what destroys the chances of ever defeating aging; to them, it's not about defeating aging...it's about 'improving health'...cause that's all that makes sense; F....CURING AGING, AND DEATH (...of aging) doesn't. That's why I feel understanding And Misunderstand/rage..because you, me and all the people reading here...have just 1 Life to live. But, seem that does not compute in some people ''it's impossible to fathom..''. IT is, you must start wrapping your head around it...because one day you will die.
I usually don't read these kind of papers. When they start talking about equality and other woke nonsense, I stop reading. From false premises nothing useful can be derived. Garbage in, garbage out.
Btw, do we have a widely agreed on definition of aging ? We all kinda know that it is correlated with decline and morbidity, but it is very hard to set a goal without a definition.
On the other hand we have a whole set of "age-associated syndromes". And each of them migh be worth its own disease code /designation.
For example Senescent Cells and SASP induced pathology. It is extremely strongly associated with aging but could be caused by other factors too.
Hi Filip! Just a 2 cents.
Aging and health (and unhealth/diseases), are quite nebulous/ambigous; they are inter-related, but differentiable. I like to think it as 'layers' or 'co-depedent/co-interdependent', - and -, 'co-independent/co-inter-independent'...sort of like 'Roomates - that could be in a relationship - or not - and be in a sort of open relationship..'free flowing and all understood/accepted - polyamorous (not exclusive nor monogamous)''..thus, not so rigid in their (inter/mutual) linkage/coupling. Coupable, and, decouplable; also. 2 things, and not (necessarily) 1 thing, (1 and) the same.
Yes, they do reach each other and depend of each other; but like a good employee reporting/and depending of the others or his/her supervisor, 'team player/great in a team'..this good employee - is also good - Alone, at it, alone/Lone Wolf, you have nothing to worry abuot this employee because when left alone, he/she does the work- perfectly -- all alone, 'is resourceful - when alone'; (and) , they gel well 'in couple/in group/inthe team'..,too. Thus, they are well-adapting to the situation, either alone/decoupled or in group/coupled. Aging -with- Health; or Aging, separate, from Health.
Aging-related sydromes/diseases that happen, with age, are a manifestation that you cannot maintain that minimum health threshhold; that aging - is contributing - to your Likeliness of getting a disease because you are 'aged' --- aged = propensity for failure of systems...because they are failing/dysfunctional with age...these systems are Important to keep your health; but like anything they become rusted and dysfunctional --- they will incur these diseases to happen; but it's not so much your Age the problem; is that you become weaker/frailer/more fragile/prone to diseases by metabolic and biological dysfunction. You may think that - aging - itself is the cause, but it's not that, it's the effect/consequence of gaining years -- the passage of biological time (in cells its the Hayflick...replicative senescence happening at one time..); when systems work wrong, this can cause disarray/inflammation and just make 'spontaneous diseases happen'...
The question that begs (and helps to answer/differentiate/split this) is Why do we see centenarians that are Healthy -- Much Healthier than younger people who have Diseases..and succomb of them?...Why does a 89 year old dies of alzheimer'S and a centenarian lives on to 115 with Almost No Dementian and 0 Azlheimer's....and worse, my uncle, died of alzheimer's at 74...only..
That's because, Aging and Health - are 2 things - related, but uncouplable also. not Rigidly Coupled/Linked, can be unbound/unlinked/differentiated...as 2 things, instead of a link-one-rigid-same-thing'-Block.
Aging = / = Health
Aging = Health
Health = / = Aging
Health = Aging.
Both, At the same time. Thus, it can mean free 'co-inter-Dependence-&-co-inter-Independence'.
It will be dependence OR independence, depending on the situation, if health threshold is maintained or not; for the - total - extent possible (longevity/maximum possible).
Or, as said, 'layers', in Order
Aging, is Upstream, of health; health is downstream of aging. Health is the 'byproduct' of the aging/metabolism/functions maintenance...for life to happen/continue.
Until, one day, you reach a Stocastic Maximum...this is the 'cumul of damage, residue and epigenetic expiry (methylome emptying/telomeric DNA emptied/hayflick reached in all cells)'...
that...is about the MLSP, 120..130...some people age slower than others...they have Perfect Health and never have any disease..are healthy - maintain- their health threshold to Keep on Living...
They reach..about 120-130;; supercentenarians, that age slower and have about 8 years less on their epigenetic clock. They age slower, and thus, live longer, and do not succomb of diseases..
adn this is the Kicker...some centenarians Have Diseases and are called 'Survivors'...they have a higher diseases burdern - YET - they reach 110+...years old.
so it means what?
It means that Aging and Health - are 2 things...obviously, if you can'T keep your health, as you age, you won't reach old age;
you may think but if i ahve Perfect Health -- I will Will Forever/1000 years...
That's Huge error (my 2 cents...); why? because, as said, the centanarian example, yuo have the Champions - they live 100 years/burdern-free/no-diseases whasotever/'pristine health lucky''..
and Then you have the Survivors...they face diseases in their life - They Survive Them - yet - reach *100+ years, Too.
So, health, is a 'layer' an 'added bonus/layer/underlayer'...beneath..on 'on top' of the 'Aging Pile'...
the aging is the intrinsic aspect/the max possible as specie..while the health is the extrinsic (2nd 'layer as said) element; you can't live 100 if you die of some fatal disease - ''before your time''...you know that saying : ''before the max you Could reach if you Did Not die of some disease as you got older and got sick/unhealthy..''.
I have no problem that people would use the : 'treating aging as a cureable disease/medical condition to cure'...heck, all the better.even if it is techniocally not accurate...
as said, they are 2 things, classifiable/subclassifiable (as, yes, separate/subspecified/subcladed/subgrouped) and thus distinguishable/distinct, yet, verymuch inter-related in the 'genus/large umbrella group', also. Like, family people...you can tell them apart yet are related '(it's) 'in the family'..
Even if we remove all the senescent cells...aging Continues even so -- unabated...
senescent cells are that 'extra layer' (as said with aging); I mean, they could do a study in mouse...that removed ALL the p16 senescent cells..and would make almsot no difference; the mouse would age...would acucmulate more of them and would die Even So.
So, it means, that the senescence burden is highly contributory to inflammation and causing teh Exit from maintainingg you health threshold...
I mean some studies ahve said ''we are erring...aging and health are NOT (exactly) the same thing...ok...they are 2 THINGs...not (necessarily) the same and 1 tthing...they are related Absolutely...but we can see differences and interelating...interelational/interelationships'...intercausal/interconsequential things...of eaach other...but Remain two things that We Can differentiate..''.
There is so much ambiguity, nebulous, confusion about aging and health;so people lump them together, as one and same. When...you realize, at the deeper level, it's more nuanced and thus very full of conundrums and paradoxs....(as explained why some people live long life yet do have diseases -- maintain some kind of health -- yet, one day, they die too...again)...
I think it is a layers...and you Add layers to your biogerontological/biology...as you age...like you coul die in the next minutes...because you Added More Layers 'Inhibiting/Limiting' Layers..to your life...that stops from Ever reaching 120 years old...that is what we call the 'health'...but that'S the thing, these layers (of inflammation/dysfunction) can happen at ANY age...old or young...
one more paradox.
Why a child dies so yuong of some disease -- that child could live 120 if he/she did -not die of some disease -so young...
Just a 2 cents.
PS: I should add, if we say ''but aging - IS - THE - disease...IS - a disease....it'S a disease - in ITSELF''...
A 'disease' that makes you succom ('die') at 120-130...if you don't die of OTHER diseases - before 'that 'aging disease''...
In that sense, I mean, I could agree in that sense; in the sense, that aging, is a disease, like Any Other diseases....that needs curing.
But, there is Nuance to make, it is Not like the other diseases, it is Different - but relatable/relating;
I.e. : The RESULT of this 'disease'....is the same...the 'final Consequence' of Whatever diseases (Whehter 'aging' or 'other diseases') ---> is that you Die.
That much is true and I agree with that. In that sense, that aging 'kills you/makes you die'...like -other diseases...yes, very much so.
But, there is Difference, between a Child dying at 12 years old of a disease and a Centenarian dying at 122 years old 'of old age/aging'...
THAT difference is there, the child that dies so early, dies too, like the centenarian at 122; but the Process/Processus is Different between them; otherwise, that child Would reach 122 - Too.
but he/she doesn't they die at 12...
Thus, we can say, that there Is a difference and thus, we can distinguish them, as 2 things; or let's say, a same thing, but that Acts Differently Depending on the Age of the Person/their point in life and if they are keeping their 'life' 'healthy enough' - to Continue to Exist/Live/Breathe (not die prematurely, of whatever disease (we can call aging a disease...like all the other diseases).
In my case, I realized there is a difference and that you can see that, though aging could be a disease too, is does not Act the same way or Affects you/your life, in the same way...as another disease; the result is the same (yes);...you die....but the Means/Process/to getting there is Not Exactly the same --hence, the difference, as 2 things, instead of same 1.
A child dying at 12 years old ....is not Really dying of age 'of aging'...they are Prematurely Entering the Exit of Life/you could say there are hit by a 'fatal disease - in young age'...but it'S hard to say; someone could say: 'No...they died young because 'aged at the speed of light'..and that disease they got...it'S because they are aging Way Too Fast...and so they die at 12''
I could agree with that because it would be saying : ''health complications manifest when aging is accelerated''...if a child dies at 12...they are accelerated aging -- like Progeria / HGPS kids...Hutchison Gilford Progeria Syndrome...they experience extreme aging, they die at 15 years old...and this 'disease' -- is Akin to 'regular aging' --- this has been proven, regular people accumulate progerin . just like HGPS people; but slower..and it'S why they can live 100 years...while HGPS people can't...and other studies said: ''No, HGPS is Specific and Differentiable - NOT - the same as a healthy child dying of astham attack or of COVID 19..not the same at all; that healthy child dying 'one day to the next' may experience Extreme Inflammation that is Separate from 'aging with time/passing' (spontaenous sensecence (exit from cell cycle) vs replicative senescence (hayflick/reached max possible doublings/division/mitosis)'; that child is Different (per the epigenetic Clock than a HGPS child..they are Not the same); yet, they Both die at 15 years old...); and that child is Younger - per the clock - than that Centenarian - and Younger - than that HGPS child - also.
so this is why it'S so complicated, nebulous and ambiguous...it's a Tangled web; to untangle aging - of health,.. health - of aging. Seems, you can't really untangle them, they are tangled and only they, untangled themselves, depending the situation; for us, it's a tangled mess.