Aging drugs should be boring
1 November 2021
Context: Aging drugs are defined here as drugs that are explicitly intended to extend broad healthspan (quality of life) and lifespan (years of life) by targeting the aging process.
Many of the narratives that dominate the aging discourse today - thousand-year lifespans, immortality itself, obsession with specific drugs - are scientifically misleading and harmful to the full realization of the field.[1] This is how I think about the problem of aging and the opportunity of treating it.
Aging drugs mean enabling greater human accomplishment.
Health is fundamental to all other human pursuits. Declining health and our inability to meaningfully affect this process deprives people of the ability and dignity to pursue their life dreams. Aging drugs are a way to decrease our frailty and increase our resiliency to the whims of biological randomness and misfortune.
Aging drugs are simply a facilitator of other, greater, human accomplishments.
Aging drugs are not about immortality or radically extended lifespan.
While humanity will likely learn how to radically extend lifespan one day, that future is still far away. Aging drugs in development today are not necessarily direct precursors or paths to radical lifespan extension.
Intertwining these narratives makes a good objective - more healthier years - controversial. Controversy isn’t bad on its own, but being controversial and misleading makes these narratives unacceptable.
The dominance of the immortality narrative also masks a compelling - and much more intellectually honest! - narrative: a future where we don’t all know someone who has painfully succumbed to cancer, where children do not have to watch their parents slowly forget who they are, where children can know their grandparents’ full selves.[2]
Aging drugs are a societal equalizer.
A common pushback to aging drugs is - won’t they further exacerbate societal inequality?
First: we shouldn’t conflate the problem of aging drugs with the problems of our healthcare system, which already better serves the needs of the wealthy.[3]
A broadly adopted aging drug that keeps people healthier longer will help alleviate the disproportionate burden illness has on those with less financial resources, such as the extreme monetary, opportunity, and time cost of caring for aging parents and the inaccessibility of expensive acute medicines and preventative care. Prevention is almost always cheaper and more accessible than acute treatment, and a good aging drug can be thought of as pan-preventative medicine.
To maximize benefit, aging drugs need to become boring.
By continuing to pursue the narrative of aging being radical, contrarian, controversial, we slow progress towards boring, broad adoption.[4]
Medically boring —> to maximize social benefit, aging drugs should be as broadly utilized in medical practice as NSAIDs and cholesterol-lowering drugs are today. The first aging drugs will likely also be mechanistically boring (safe, well understood, cheap, small molecule generics)
Socially boring —> the development of aging drugs is commonplace and expected, just as cancer drug development is today
Commercially boring —> every Pharma should (and I believe will) have an aging division, just as they have neuroscience, cancer, etc divisions today.
[1] Unfortunately, many of these narratives make for great stories and garner lots of attention (and sometimes funding) for those declaring them, so they persist.
Thousand-year lifespans - the idea that the first person to live to 1,000 years has already been born.
Immortality - self evident.
Obsession with specific drugs - that metformin, rapamycin, sirtuins, or any other one specific pathway are aging panaceas.
[2] I recently learned more of the life story of my grandma, who was lost to dementia long before I became aware. She grew up in the Third Reich, had a family during the rebuilding of Germany, witnessed the transition from few cars to the modern world. I wish I could have asked her about it.
[3] Like most things. This is a common bias - that the current bad is better than potential future bad.
[4] Although I do enjoy working on something contrarian - much more fun at parties :)
Thank you to Tevon Strand-Brown, Laura Deming, Chris Power, John Forstmeier, and Scott Barclay for reading iterations of this post!