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Do you want to become immortal? Me neither. Silicon Valley titans who crave the “escape velocity of death” leave me cold. But most of us would love to stay young longer, preferably without Botox. A series of advances suggests that the science of aging is now at a turning point.
Our perceptions about old age are already changing. People who filled concert halls in their youth to hear the Beatles sing “Will You Still Need Me?” . . When I’m 64 years old? Now we think that old age begins at 74 years old. According to a large German study, middle-aged and older people today have a higher idea of “old” compared to previous generations.
This reflects increases in life expectancy, especially for the wealthiest half of the population in rich countries. The big prize now is to improve the last decade for everyone: rich and poor. Few of us want to live forever, even if it were offered to us; but we would give a lot to avoid a grim descent into the twilight zone of paralyzing fragility.
Since I interviewed scientists for a book on aging, I am regularly asked for advice on what substances to take, including “off-label” ones. Everyone wants a shortcut to longevity. American men in high-level jobs are especially interested in experimenting with products, including supplements, that are available in the United States, not Europe. I am taking one of them myself, with no visible results, but then they would not be visible. Given the amount of snake oil on this market, it is safer to wait for formally licensed products to appear. But that is now the big question: will regulators agree to consider aging a “treatable” condition?
While conventional medicine treats one disease at a time, scientists since the 1990s have been making discoveries that suggest we might be able to address the biology underlying aging itself. They have created worms and mice that live longer and stay vibrant longer by targeting specific genes. Cynthia Kenyon, the biologist who discovered that partially disabling a single gene could double the lifespan of roundworms, described to me the amazement she felt as she watched the modified worms move almost to death, skipping the prolonged stage of instability she observed in their normal worm friends.
A steady stream of discoveries is driving the emerging field of geroscience. Many focus on slowing the decline in the body’s ability to repair DNA. Some molecular biologists are working on NAD (nicotinamide adenine dinucleotide), an enzyme critical to metabolism that declines as we age. Others, like Australian-American David Sinclair, believe that epigenetic noise is a major cause of aging and confusing signals in the body. Sinclair and his colleagues at Life Biosciences have partially restored sight to mice and monkeys.
Some teams are experimenting with drugs that are already prescribed to humans. Rapamycin, an immunosuppressant used in human transplant operations, has been shown to significantly prolong the life of mice, including very old ones. It appears to work by suppressing the mTOR complex, a set of genes that regulate metabolism. Meanwhile, a trial is looking at whether metformin, commonly prescribed for type 2 diabetes, could delay the development of other chronic diseases. Studies have found a correlation between metformin and delayed cancer, for example, but causality has not yet been proven nor has metformin been tested in healthy, non-diabetic older people.
Along with the mentality of treating one disease at a time comes a licensing process for new drugs and therapies that approves them only for specific conditions. Statins are prescribed, for example, for heart diseases; insulin for diabetes. But even if we managed to eliminate one of the major causes of death (cancer, heart disease and stroke), that would only give us a few more years of life, because something else would take them away. Plummeting death rates from heart attacks, while a huge success, offers more future victims of dementia, because aging makes us vulnerable.
Part of the goal of the metformin trial is to persuade the U.S. Food and Drug Administration to approve aging as an “indication,” to indicate that it can be “treated.” It is struggling to raise enough funds for clinical trials, because metformin is a generic drug, so it does not offer enough profits to pharmaceutical companies.
The tipping point may come through dogs, not humans. The wonderfully named Dog Aging Project, which has sequenced the genomes of more than 7,000 pets provided by enthusiastic owners, is conducting a clinical trial to see whether rapamycin can extend the longevity and health of our furry friends. Last year, Loyal, a veterinary medicine company, announced that it had met the FDA’s “reasonable expectation of effectiveness” test for a drug it is developing to extend the life of canines.
While these ideas advance through clinical trials, protocols and safety tests, there is a long-proven and reliable way to reduce the risk of contracting certain age-related diseases: exercise. Apart from the occasional injury, it has no serious side effects. Every scientist I’ve ever interviewed says that aerobic exercise and weight training are prerequisites for staying healthy, no matter what additional medications we take.
It may seem selfish for the West to seek to extend life expectancy, especially of pets, when tuberculosis and malaria continue to run rampant in much of the world. But if we could compress morbidity, we could also change the way we think. We fear old age long before we enter it. The possibility of healthier, more active later decades is a liberating thought in itself.