The Longevity Pyramid, a Prevention Viewpoint
One prevalent viewpoint in the research and development community is that a great deal of work lies ahead merely to shift the priorities of the medical community towards prevention in the matter of aging, and that the failure of the medical community to be more prevention-focused is wasting most of the potential of existing approaches that can modestly slow aging. Here we are talking about diagnostics for early stage disease, exercise, calorie restriction mimetic supplements, and the like. This is in contrast to those who would rather push forward to more impressive biotechnologies of rejuvenation, assuming that the demonstration of rejuvenation and consequent demand for such therapies will cause the medical community to reorganize its own priorities without the need for outside pressure.
The primary focus of medicine in the late 19th and early 20th centuries was the management of communicable diseases. Today's healthcare systems confront a different landscape: the prevalence of chronic diseases, which often develop over extended periods, with the most critical being the "top four": cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes. Modern medicine has adapted various strategies in response to this shift, yet there is a tendency for chronic disease management to mirror approaches historically used for infectious diseases.
This has sometimes led to interventions being applied in the later stages of chronic diseases as symptom management becomes the predominant focus rather than early prevention. As a result, the healthcare stance today is often reactive, rather than proactive - addressing illness once it has already manifested. Without the adoption of new medical and wellness paradigms, the world is set to face an unsustainable burden of chronic diseases, which is already taking a substantial social and economic toll. To mitigate the age gradient in comorbidities, a health system focused on prevention rather than intervention is imperative. A shift in mindset is therefore needed, necessitating a transition toward long-term prevention strategies that align more appropriately with the gradual progression inherent to chronic diseases.
The present narrative review aims to provide insight into the "longevity pyramid" concept, a structure that effectively describes the various levels of longevity medicine interventions. At the base of the Longevity Pyramid lies the level of prevention, emphasizing early detection strategies and advanced diagnostics or timely identification of potential health issues. Moving upwards, the next step involves lifestyle modifications, health-promoting behaviors, and proactive measures to delay the onset of age-related conditions.
How to face the unsustainable burden of chronic diseases?, A very effective agent that shortens the time people are chronically ill are the so-called aging accelerators. These are substances that health insurance directors are familiar with. So there is no need to invent something that has already been invented.
I think it is a false dichotomy that longevity researchers *either* care about prevention (focusing on modest interventions like CR mimetics) *or* care about rejuvenation (with focus on biotechnologies like cell therapies, in vivo gene therapy, senolytics). I think it is truly a "yes and", that one naturally follows from the other:
- The *focus* of traditional western medicine is largely treating recognizable diseases
- Rejuvenation-oriented therapies work best (and sometimes *only* work at all) in early-stage "pre-disease" AKA "prevention" settings.
As such, in order to most effectively develop biotechnologies of rejuvenation in people:
1) The R&D/medical community needs to care about intervening *before* a traditional disease has been diagnosed (e.g., based on biomarkers and subclinical pathology, AKA "prevention")
2) Credible biomarkers (e.g., inflammatory markers, epigenetic clock(s), senescent cell burden) need be aligned upon by researchers and regulators as surrogate endpoints for classical "clinical" endpoints (e.g., progression free survival, overall survival).
3) Biotechnologies of rejuvenation need to be tested in those "prevention" stages of disease, with early efficacy based on modulation of those biomarkers/subclinical pathological features