Medicine for aging itself could rejuvenate aged vessels and restore blood pressure to safe, youthful levels for the long term—and those same medicines would improve other aspects of our aging physiology, too. The same biological processes which cause our blood vessels to stiffen are behind other problems, from arthritis to wrinkles; fixing root causes helps with many problems at once. Not only that, but truly controlling high blood pressure would go on to reduce the odds of further problems, from kidney disease to dementia, which are caused when blood pressure is high for prolonged periods. The changes which happen in our molecules, cells, organs and bodies as a whole as we age are why we are so susceptible to disability and disease—identify and learn to treat them, and the ill health of later life can be postponed.
Though we've enjoyed significant success by treating diseases separately, this approach can't add much more to life expectancy: even a hypothetical complete success at curing a single disease has a counterintuitively small effect on health. Demographers can use mathematical models to simulate the total eradication of particular diseases and see what happens to life expectancy and disease burden overall. These calculations show that a complete cure for cancer—currently the leading cause of death—would add less than three years to life expectancy. The numbers for runner-up heart disease are similarly slight: two years at best. The reason for this is simple: if cancer or heart disease don't get you, there are plenty of other diseases waiting in the wings to end your life a few months or years later. And curing cancer, heart disease and all the other diseases which are consequences of aging wouldn't address consequences that we don't currently label as diseases—the frailty, the forgetfulness, the loss of independence and so on. Medicine which tackles the underlying causes of aging would lessen both the risk of disease and the other symptoms of growing old.
This will be the greatest revolution in medical care since antibiotics. Penicillin is a single drug, and yet it can be used to treat a wide range of diseases. The same will be true of treatments for aging—but instead of warding off external threats like bacteria, medicine for aging will target our bodies' own internal degeneration with time.
Even if we can't cure aging in time for ourselves, investing in aging research is an investment in future generations. You only have to invent a new drug or treatment once, and then everyone on the planet, and everyone yet to be born, can go on to benefit from it. Cancer, heart disease, stroke, Alzheimer's, infectious diseases, frailty, incontinence and many, many more—progress on any one of which would be a cause for celebration—could be delayed and maybe defeated together. The legacy of our generation could be treatments for aging which will benefit every generation to come. Initiating the scientific and cultural shift necessary to acknowledge that aging as an entity should be treated could well be the single most consequential thing we do.
The consequences will be profound and wide-ranging, for all of us personally, for our friends and families, and for society and humanity as a whole, and the benefits will far outweigh the costs. Many people's initial reaction to the idea of treating aging is cautious, or even hostile: we wonder what the consequences of longer lifespans will be for population growth or the environment; if treatments for aging would primarily benefit the rich and powerful; or whether dictators could live forever, imposing endless totalitarianism. However, almost any objection can be answered by turning the question around and replacing it with a simple hypothetical alternative: if we lived in a society where there was no aging, would you invent aging to solve one of these problems?
Would creating aging and condemning billions to suffering and death be a viable answer to climate change, or global overuse of resources? Surely we'd find other ways to reduce our collective footprint on the planet before resorting to such barbarism. Similarly, invoking aging to limit the reign of even a particularly despotic ruler is a plan which goes far beyond the craziest CIA assassination plots. Looking at things this way around, the answer is clear: aging isn't a morally acceptable solution to any serious problem. This means that the converse is also true: arguing to leave aging intact in an attempt to avoid other problems is misguided when aging itself carries a huge human cost.
If the conclusion that we should try to defeat aging seems strange, I think that's in large part because of our understandable comfort and familiarity with how things are. We literally get a lifetime to come to terms with growing old, and the place we most often imagine longer lifespans is dystopian science fiction. Our sympathy for the status quo blinds us to how powerful the case for curing aging is—as strong as the case against creating it would be if it didn't already exist.
The moral case for treating aging is underlined by a family of conditions known as progerias, from the Greek for "prematurely old." Sufferers experience symptoms of aging at an accelerated pace: patients look old way before their time, with thinning skin and gray hair manifesting as early as childhood in the most severe forms. People born with Hutchinson-Gilford progeria have a life expectancy of 13 years, and usually die of heart disease—a problem which is otherwise unheard of in teenagers. Another related disease, Werner syndrome, sees patients get cataracts and osteoporosis in their twenties and thirties, before dying of a heart attack or cancer at an average age of 54. These conditions are perhaps the best argument for calling aging a disease, and treating it like one—if this collection of problems is labeled a disease when it appears early, how is it different when it happens at what's currently the "normal" time?
I want to convince you that we should unashamedly aim to cure aging. I'm not saying "cure" because I necessarily think it will happen soon, or all at once, but because I want to normalize an idea which can at first sound jarring. The first treatments for aging will slightly increase our healthspans and maybe our lifespans, too, and that's great. But we shouldn't stop there—what we should aim for is negligible senescence: a risk of death, disability, frailty and illness which doesn't depend on how long ago you were born. Our chronological age would no longer be the defining number by which we live our lives—we would, as individuals and as a civilization, be ageless. That is what a real cure for aging would look like, and it's something we could and should aim for as a species.
This excerpt ends on page 13 of the hardcover edition.
Monday we begin the book Three Dreamers: A Memoir of Family by Lorenzo Carcaterra.