Fight Aging!

Is aging a disease? The answer to that question really only matters to the degree that it can be used to bring funding into the better portions of aging research, those focused on treating aging as a medical condition. All age-related disease is caused by aging. If we want longer lives that are less troubled by disability and frailty, then aging itself, its causes, must be the target for therapies, not its results. It is a very real problem that this is still a radical statement for much of the research and funding communities. It is a very real problem that the research community is still fighting regulators to have the treatment of aging acknowledged as a legitimate, permitted goal.

Then, on top of this, as is pointed out in the article below, aging research remains the poor relative within the broader medical research community. Efforts to treat specific age-related diseases receive near all of the attention and funding, and this almost always means tinkering with proximate causes and disease state mechanisms with very little in the way of efforts to address root causes. This is why such work rarely produces more than incremental improvements: keeping a damaged machine running without actually repairing the damage is a very challenging proposition. Researchers focused on the biochemistry of aging, and on ways to address damage and change, receive little funding and attention in comparison to the mainstream focus on specific diseases. This is the case even as years of small-scale philanthropic efforts have managed to both raise the profile of aging research, and push a few lines of research to the point at which meaningful results in the treatment of aging can be demonstrated in animal studies.

Should we treat aging as a disease?

"The fundamental questions of whether aging can and should be classified as a disease are not new, but today they are more pressing than ever for many reasons." Gerontology, the study of old age, spans multiple academic fields from economics to social sciences. Biogerontology specifically focuses on those biological process that contribute to aging, as well as the ultimate effects of aging on our health. Insights from biogerontology studies will contribute to public and private medical research, influencing our societal values, and guide policy makers in their decisions. "The main problems in biogerontology are similar to those in drug discovery for most human diseases, but with fewer resources, less visibility and less of a sense of urgency".

To bring into focus aging as a disease, researchers are looking to the future, and the 2018 release of the WHO-curated ICD-11. The ICD (International Classification of Diseases) is an extensive piece of work used at all levels of healthcare management: from physicians to patient organizations, from insurers to policy makers. Via the assignment of codes to disease, it helps countries to direct and reimburse research efforts. "There is an urgent need to proactively develop actionable codes for age-related muscle wasting, many conditions related to cognitive decline, decline of the metabolic system, loss of regenerative capacity and even skin and hair pathologies."

The fundamental questions of whether aging can and should be classified as a disease are not new, but today they are more pressing than ever for many reasons. Recent technological advances in many areas of technology allow for detailed analyses of the progression of aging and the development of epigenetic, transcriptomic, biochemical and imaging biomarkers. Both animal and human data suggest that effective interventions can be developed to extend longevity and prevent the onset of various age-related diseases. There is a clear business case to be made to healthcare providers, pharmaceutical and insurance companies and, most importantly, policy makers, funding bodies and scientists. Research into aging processes and related diseases to identify specific and actionable markers and targets is scarce.

It isn't just a matter of throwing money at the problem and making regulators acknowledge aging as a legitimate therapeutic target. Funding has to go to the right programs. The bulk of aging research programs can easily absorb decades and billions, but will achieve nothing but additions to the knowledge of human cellular metabolism. New sources of funding have a way of being sidetracked into these programs when they enter the field, and so wind up achieving little of practical use. Their funds go towards expanding the grand map of metabolism, and little else. This was the fate of Larry Ellison's funding, of much of Paul Glenn's funding, of the hundreds of millions in for-profit funding provided to Sirtris Pharmaceuticals and related sirtuin research, and so far looks likely to be the way that Google's Calico venture will ultimately go.

Meaningful progress towards the treatment of aging as a medical condition will not come from traditional approaches to drug development that focus on alter the operation of metabolism to as to modestly slow aging. Yet this is the vast majority of the field in a nutshell. There is overall little funding and attention, and the work that does take place is mostly futile: expensive ways to produce at best minuscule outcomes. Scientists who are working on more useful lines of research that involve repair and reversal of the root causes of aging, such as senescent cell clearance, will eventually win out as their low levels of funding produce results in animal studies and then human trials that are better and more robust than those of the current and future slow-aging drug candidates. But, my, it is a slow and painful process to watch in action. Disruption in the sciences requires philanthropy, and when regulation and the mainstream are determinedly focused on other goals for medicine, it is taking quite some time to get the job done.

This is why it is important for us to help, and why it is possible for people of average means to make a real difference when we act together. We can fund the research that lights the way, that will prove that the best paths forward towards treatments for aging are in fact the best paths, beyond argument. Then the rest of the world will, finally, follow the signs we hold up and take over the rest of the work.