Aging

A disease?

Is aging a disease? Finally people are asking a better question.

Google the question “Is aging a disease?” and you will get a bewildering number of hits, with a depressing lack of consensus as to the answer. Why is that?

Of course, the problem is with the question. Our answer to any question depends on the definitions of the words in it, and in this case we have a double whammy: neither the word “aging” nor the word “disease” has an agreed meaning, but both are replete with connotations. Thus, for example, an age-old (excuse the pun) argument for aging not being a disease is that aging is universal whereas diseases affect some people and not others — but this conflicts with the concept of a “disease of aging” which denotes a medical condition that people are more and more likely to get as they get older.

A lot of the problem is that some people like to think of aging as the set of age-related health problems that are not diseases (which begs the question of which ones ARE diseases), whereas others like to think of it as the precursor to those diseases, i.e. the lifelong process that eventually predisposes people to them. It is much more productive to think of aging as the combination of these — the lifelong process creates accumulating damage, and then the health problems emerge when there’s more damage than the body can handle. With that perspective, the distinction between “diseases of aging” and “aging itself” is revealed as a purely semantic one: both categories of health issues are side-effects of having been alive a long time and having accumulated a lot of damage.

In an ideal world, that would be enough. Either we could narrow our definition of “disease” to encompass only the health problems that affect young people too, such as infections and congenital conditions, or we could go the other way and define the word “disease” to encompass all health problems, and thereby include all the aspects of age-related ill-health, such as frailty. But in the real world, definitions have inertia, so by far the best approach is to sidestep the question entirely and focus on the thing that actually matters, which is that older people are less healthy than the young and we’d like to find ways to help them not to be. And that, at last, is what’s happening.

First let’s consider clinical trials. For the longest time, big pharma has faced a massive disincentive to invest in the development of therapies against aging, because there was no way to secure their regulatory approval. And that wasn’t the fault of the FDA and its counterparts worldwide — it was simply because the FDA can’t approve a therapy unless it has passed a clinical trial, and a clinical trial needs an endpoint that each patient unambiguously either does or does not meet. Which is just a little bit tricky when there isn’t even an agreed definition of “aging”. But finally, a few years ago, a few senior gerontologists tackled this issue head-on, and after extremely arduous discussions with the FDA they came up with a criterion that was, to their satisfaction, equivalent to aging in all but name and was also, to the FDA’s satisfaction, sufficiently concrete to constitute a bona fide clinical endpoint. The trial for which this was done is called the TAME trial, and it will test metformin, a drug that has been off patent for decades and is thus never going to make anyone much money — but that’s not the point. The point is that, broadly speaking anyway, this clinical endpoint can now be copied and pasted into any future clinical trial design for a candidate therapy against aging — which means that big pharma suddenly has that disincentive removed.

Just as significant is an advance that happened at the World Health Organization. The WHO maintains a catalog named the International Classification of Diseases, or ICD, which is updated every so often — and, again after a great deal of discussion, the most recent version has aging in it. This is huge for investors and companies, because the ICD codes are used by physicians worldwide to describe and justify their choices for what to prescribe. And what is absolutely pivotal is the way in which aging has been added: not as a specific disease, alongside all the other diseases (age-related or otherwise), but as what they call an extension code — a kind of qualifier that can optionally be attached to a disease code. The extension code is “aging-related”, and it has already been approved as a qualifier for many disease codes. In practice, what this means is that if drug X is approved for treatment of disease Y with the “aging-related” extension, physicians are required to prescribe it to people over 65 in preference to drugs that have been approved for that same disease without the extension. The impact on incentive structures needs no further explanation.

As every concept/idea has proponents and opponents, the concept of longevity and aging as a disease does as well. Let’s look at some of the arguments put forth by those that oppose. Some base their criticism on the economic implications, such as — if aging is classified as a disease, how will insurers provide insurance to the older population? If aging is designated as a disease and we find medications that extend longevity, where would we put all the people? And so on…History is replete with such trepidations … will machines take away jobs? And it is also replete with how science has overcome such challenges.

So when someone tells you that aging is a disease, or that it isn’t a disease, the correct response is “So what?”. And when someone asks you whether aging is or is not a disease, the correct response is “Who cares?” What matters is that, finally, the people who determine whether medicines against aging will ever make money are getting the message that aging is a bona fide medical problem, and thus that the quest for medicines that address aging is one that they must facilitate, not hinder.

There is a lot of legitimate R&D that is redefining the longevity landscape (no longer a field of snake oil) with an ever-growing body of intellectual property. The mere appearance of the word “aging” in pitch decks would repel investors and make projects uninvestable in the past, but has now changed to investors actively looking at how interventions can impact multiple age-associated diseases and how in due course aging will increasingly be brought under medical control. The future of medicine is proactive rather than reactive as exemplified by the longevity field.

More and more VCs are funding longevity ventures and doing so with vigor. Five years ago, the field of longevity VC did not exist. Today, many VCs have either invested in or are showing interest in longevity. Prime Movers Lab invests in breakthrough science that impacts billions of lives and we are strongly focused on longevity.

Prime Movers Lab invests in breakthrough scientific startups founded by Prime Movers, the inventors who transform billions of lives. We invest in companies reinventing energy, transportation, infrastructure, manufacturing, human augmentation, and agriculture.

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