Slowing Down Time: The Promise and Perils of Anti-Ageing Medicine
It has long been known that the NHS was founded on a fallacy. Based on the premise that there was a finite amount of ill-health, the NHS in theory would have sustained adequate resources to aid those in need. With year-on-year patient waiting lists becoming exhaustively elongated, however, some argue that its own demand is the source of its downfall. Despite many population-level surveys establishing a widespread desire to live longer, currently 80% of the world's adults aged 65 or over suffer from at least one chronic disease, necessitating even more resources. As medicine thrives and the population ages, the prospect is only likely to become more bleak.
Gerotherapeutics - an emerging field that seeks to slow down or reverse the ageing process in humans - has recently attracted the attention of Silicon Valley, with Jeff Bezos and Peter Thiel pouring investment into the field of anti-ageing medicine. The UK could expect these pills to arrive to market within 5 years time. Anti-ageing medicine encompasses a variety of medical disciplines, from dermatology to genetics, and aims to extend the healthy lifespan of humans extending their youthful vivacity.
Drugs known as senolytics are currently at the forefront of anti-ageing advancements. Senescent cells are those which have stopped dividing, and they accumulate with age. Implicated in a variety of age-related diseases, such as arthritis, Alzheimer’s disease, and cancer, senolytic drugs selectively target and eliminate these cells. This has enabled improved cellular function and tissue repair to be produced clinically. One study found that a cocktail of two senolytic drugs, dasatinib and quercetin, saw mice live 36% longer on average. In addition, they were no frailer near their delayed time of death than controls. The same researchers tested the drug on humans and found that it was safe and improved several age-related conditions (Xu et al., 2018). The good news is there is no difficulty in procuring senolytics. Drugs such as Metformin, a first line agent taken by millions every day against diabetes, have been studied intensely for their senolytic actions at the cellular and organismal levels. Metformin has been proven to favourably influence metabolic and cellular processes strongly linked with ageing processes such as autophagy (the destruction of damaged body cells), inflammation, and DNA damage (Barzilai et al., 2016, Couteur and Barzilai, 2022).
While the use of senolytics is a promising avenue for anti-ageing medicine, there are several ethical issues that arise. One of the main concerns is that anti-ageing treatments could exacerbate existing health inequalities. As anti-ageing treatments become more advanced, they are likely to become more expensive, making them inaccessible to those who cannot afford them. This could lead to a two-tiered society in which only the wealthy are able to access life-extending treatments (Mackey, 2003). Extrapolating this, there is the issue of whether it is ethical to extend life indefinitely. While many people may want to live longer, there are concerns that many individuals conflate the essence of life and its meaningful relations with the preservation of their self or “ego”(Pijnenburg and Leget, 2007). Additionally, it is unclear how anti-ageing treatments would affect the human psyche and whether people would be able to cope with an extended lifespan.
Senolytics are a promising field of medicine that could have far-reaching benefits for human health and longevity, but the ethical issues that arise must not be understated. As researchers continue to develop new treatments, it is important that deliberation of their potential impact on society go hand in hand. With the rush to produce results, most current research has been done in animal models such as dogs and mice that age faster than humans, so the prospect of results should still be taken with a grain of salt. Another roadblock lies within a drug to counter ageing ever being approved by medical regulators, such as the US FDA, as this requires the world recognising ageing to be a preventable condition. The reluctance to call ageing a disease, then, may rightly be one mankind never overcomes.
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Barzilai, N., Crandall, J. P., Kritchevsky, S. B. and Espeland, M. A. (2016) 'Metformin as a Tool to Target Aging', Cell Metab, 23(6), pp. 1060-1065. DOI: 10.1016/j.cmet.2016.05.011.
Couteur, D. G. L. and Barzilai, N. (2022) 'New horizons in life extension, healthspan extension and exceptional longevity', Age and Ageing, 51(8). DOI: 10.1093/ageing/afac156.
Mackey, T. (2003) 'An ethical assessment of anti-aging medicine', J Anti Aging Med, 6(3), pp. 187-204. DOI: 10.1089/109454503322733045.
Xu, M., Pirtskhalava, T., Farr, J. N., Weigand, B. M., Palmer, A. K., Weivoda, M. M., Inman, C. L., Ogrodnik, M. B., Hachfeld, C. M., Fraser, D. G., Onken, J. L., Johnson, K. O., Verzosa, G. C., Langhi, L. G. P., Weigl, M., Giorgadze, N., LeBrasseur, N. K., Miller, J. D., Jurk, D., Singh, R. J., Allison, D. B., Ejima, K., Hubbard, G. B., Ikeno, Y., Cubro, H., Garovic, V. D., Hou, X., Weroha, S. J., Robbins, P. D., Niedernhofer, L. J., Khosla, S., Tchkonia, T. and Kirkland, J. L. (2018) 'Senolytics improve physical function and increase lifespan in old age', Nat Med, 24(8), pp. 1246-1256. DOI: 10.1038/s41591-018-0092-9.
Pijnenburg, M. A. and Leget, C. (2007) 'Who wants to live forever? Three arguments against extending the human lifespan', J Med Ethics, 33(10), pp. 585-7. DOI: 10.1136/jme.2006.017822.
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