Time to recognize ageing as a disease (by Piotr Pawlik)

Time to recognize ageing as a disease

Out of 150,000 people who die each day worldwide, roughly two-thirds die of age related causes1. But they do not die due to the ‘old age’ – contrary to the popular belief, there is no such a thing as ‘death of old age’: it is always a failure of this or other organ, often whole systems, and this failure is brought about by some master causes hidden deeply in the chemistry of our bodies. Biogerontology – the science of (anti)ageing – aims to target this master causes and improve our healthspan. Yet, despite the massive death toll and immeasurable suffering connected to the final years of life, ageing is considered a normal process and many of those, who think that cancer or Alzheimer’s should be cured are sceptical of medical control of ageing. But this control is, albeit slowly, coming to the labs worldwide. In order to bridge the gap between laboratories and clinics, we must act: it is the time to recognize ageing as a disease.

Sexually transmitted terminal disease

But why would anybody want to treat ageing in the first place? If this question seems odd to you, then we are getting somewhere. Surprisingly many people need convincing that ageing is no fun. That it brings pain, suffering and ultimately death. That it removes from this world the most valuable, knowledgeable, wise, experienced and accomplished human beings. In those discussion, the same arguments are brought about: overpopulation, immortal dictators, boredom and the most surprisingly, the argument that ageing is natural, and therefore somehow it must be good, or at least desirable and it certainly cannot be classified as a disease.

I will start with the last objection, as it is the most puzzling for me. Let’s first agree, for the sake of the argument, that ageing is indeed natural. What follows from this assumption? Exactly noting. Bacterial infections are also natural, and somehow we do not have problem with promoting antibiotics to fight them. This misunderstanding stems from so called naturalistic fallacy, which Steven Pinker describes as: “…the idea that what is found in nature is good … as in: If birds and beasts engage in adultery, infanticide, cannibalism, it must be OK2.”

But is ageing natural? It certainly occurs in nearly all living creatures, but biologist know of animals who do not age. These animals still die, of course, falling prey to predators, diseases, parasites or accidents, but they do not exhibit any measurable signs of ageing3. But let’s forget for a moment about those exceptions, as most animals do age. So is this natural process? Not if by ‘natural’, we understand ‘evolved functionality’. Ageing has no biological function – it was not ‘designed’ to remove old and make space for young, it was not ‘designed’ to make our life worthwhile by the fear of death – in other words, it was not designed at all, it’s rather an evolutionary neglect than an evolutionary achievement.

Overpopulation – this always pops-out. Yet, according to UN4, the fertility is falling and the population growth rate is slowing down. But let’s suppose that the global population will grow at the constant rate of about 1% per year (as it was in 2015), therefore 83 million new people annually. Is there any risk of running out of space or resources? Well, according to even most optimistic models, the radical life extension would have surprisingly small consequences for demographics: roughly 20% increase by the 100th year5. Is this increase to much to handle? Most likely not. The Earth’s carrying capacity increases as food production improves and renewable energy becomes more prevalent. It is also important to keep a sense of proportions: is it morally acceptable to do nothing about humans dying today only because helping them might spell demographic trouble for future generations?

So maybe the new anti-ageing medicine will be hijacked by the bad people? Dictators, spoiled billionaires and celebrities? People who raise this objection usually have very hollywoodesque vision of medical research. They imagine some obscure laboratory, where a mad scientist concocts a magical elixir and with insane laughter delivers it to his master. However, this is not how the future will look like, and historically we already have a good track of ‘magical elixirs’ that were not monopolised by the powerful and the rich: antibiotics and vaccines. These do extend life. They probably saved my life once or twice, and yours as well. Rejuvenation medicine will be a complex and multi-step treatment, and yes, on the beginning it will be expensive, but that is only temporary.

Ageing should be a disease…
Let’s bring yet another perspective: obesity. Is it a disease? There are no obesity-causing microorganism, it is certainly very natural, and contrary to ageing, tendency to accumulate fat was beneficial to early humans. However, this did not stop American Medical Association from classifying6 it as a disease. This shows that what is considered a disease is somewhat arbitrary and the discussion should be practical, rather than semantical. In medical research, changing the definition has consequences far beyond the dictionaries. In case of obesity, it was argued that medicalisation of the condition will bring more awareness to the problem and in consequence more research and investments. The same could happen with ageing: the biogerontological community struggles with underfunding and little interest from the public. Every now and then an article heralding the imminent advent of immortality appears in the popular press, mostly getting facts and their consequences wrong, but this is enough to appease the conscience the public: ”someone is doing something, so there is no need for my money, engagement or advocacy”.

…because we need (and can) cure it
It is the time for most important question: is all the fuss worth it? Is healthspan extension possible? The short answer is: yes. No laws of physics need to be broken and the example of non-ageing animals show, that the principle was already developed in the natural world. SENS research foundation7 (I encourage you the check their website!) has done incredible job in the last decade promoting healthspan studies and fundraising for the research. In 2015 Elizabeth Parrish, CEO of BioViva, was first person to receive experimental telomere-elongating treatment in hope of rejuvenating the aged cells. In the US, multiple start-ups develop senolytic therapies, aimed at the removal of the senescent cells. In Europe, The Major Mouse Testing Program8 screens libraries of drugs to find new senolytics, and in March 2017 an important breakthrough in design of senolytics has been reached by a team at the Erasmus University9. Other avenues of the research are gaining traction and we can now reasonably hope that in the next decades our healthspan will improve significantly, and the lifespan extension will be a consequence of this change. As Voltaire once said, ”no problem can withstand the assault of sustained thinking”, so sooner or later the problem of ageing will be solved. I, for one, would prefer it to happen sooner than later, and with your engagement we can make it happen. Let’s start with admitting that ageing is a disease, and it is time to cure it.

1 http://www.who.int/mediacentre/factsheets/fs310/en/index1.html 2 http://www.upi.com/Odd_News/2002/10/30/QA-Steven-Pinker-of-Blank-Slate/26021035991232/ 3http://senescence.info/aging_animals.html 4 https://esa.un.org/unpd/wpp/Publications/Files/Key_Findings_WPP_2015.pdf

5 https://www.ncbi.nlm.nih.gov/pubmed/20426616 6 http://www.nytimes.com/2013/06/19/business/ama-recognizes-obesity-as-a-disease.html 7 http://www.sens.org/ 8 http://www.majormouse.org/ 9 http://dx.doi.org/10.1016/j.cell.2017.02.031