Attitudes Toward "Treating" Aging

SamBlake

Somewhat understandably, the FDA requires that treatments target a specific malady to be considered for approval. This presents obstacles for "treating" aging in otherwise healthy individuals. Among other challenges, the burden of proof is exceedingly high -- since there's no sickness or aberration to counteract, such interventions must essentially be shown to be no more dangerous than drinking clean water.

While there is some reason for optimism -- the FDA is apparently taking a look at the TAME trial, which is aiming to re-purpose the diabetes drug Metformin to treat aging -- the underlying attitudes in play here are deeply embedded and may take a long time to change.

What do you all think? Will we witness substantive changes to the attitude that we shouldn't "treat" healthy individuals? Is there a good reason to retain that attitude? If nothing changes, what alternatives exist for demonstrating the efficacy and safety of interventions?

NickOttens

This may be one of the biggest obstacles to overcome -- if we want to overcome it at all. We think of aging as a normal, natural part of life. But isn't it?

Roey

I think we're making good leeway in breaking through that obstacle. As a matter of fact, the WHO recognized some aspects of old age as a disorder in 2018. Check out this fascinating Lancet editorial on the subject.

LisaCovington

Health & wellness institutions are slow to engage in "mindset" change at times, often sticking with outdated ideas and beliefs long after new trends have already begun. Institutional bias is indeed a risk and potential hindrance when attempting to shift the paradigm of thinking around aging. How can they be engaged proactively and thoughtfully?

Roey

By inviting them to the XPRIZE community and workshop, of course

But seriously - what are the options?

SamBlake

I just read an article that, among other things, considers whether governments and policymakers should shift their priorities from reducing mortality to preventing age-related degeneration. (The latter, in my view, essentially equals "treating the healthy.") Somewhat surprisingly, the author rejects the premise on the grounds that [1] it is questionable whether such a distinction would work in practice, and [2] governments ought to be committed to reducing inequality, which necessitates considering both objectives.

Not sure that I agree! Seems like committing to preventing age-related degeneration would reduce the likelihood of an undesirable form of longevity but not necessarily at the expense of ensuring equitable access. Or maybe I am seeing this through rosy shades...

Anyway, here's the article: https://www.sciencedirect.com/science/article/pii/S2352552515000651

Roey

I really don't understand the argument that equality would be reduced by caring for the healthy and preventing health degeneration.

LisaCovington

Maybe health care providers such as Kaiser, that have already made the proactive shift towards a focus on preventative care, would be powerful political advocates for real change in how society & government think about preventing age-related degeneration.

NickOttens

@Roey, did you see Altered Carbon? It's a cyberpunk future where the wealthy clone their bodies and regularly transfer their minds into ageless versions of themselves to live forever. The poor are not so lucky. At best, they're able to transfer their souls into somebody else's discarded body.

Roey

@NickOttens ,
Not only have I watched the series, I'm actually reading the book right now. It's pretty good, even though some parts of it read like a sex story.
But in any case, the author makes clear in the book that even the ordinary people (i.e. you and me) can easily get the money to move from one body to another for at least two lifetimes. It's just that most don't want to do it, after the second transfer, since life becomes too much of a hassle at some point. The ones who can bear the weight of centuries, are the ones who also 'rise through the ranks' and garner enough money to last them several generations.

So yes, there's inequality in that society (in the 25th century, by the way). But the water still rises for everyone.

NickOttens

Sure, but people compare their own situation against those of people around them, and especially people who have it better than them.

Low-income Westerners today are far better off than they would be 50 or a 100 years ago, but when the super-rich are far, far better off, people care about that gap.

I think that's relevant to this discussion. If we enable a future where a longer and healthy life becomes possible only for the wealthy, then even if some of those advancements trickle down and the whole of the society benefits, people who benefits the least might still rebel against it if they perceive an unfairness in the system.

Roey

That's true. Can't argue with that.

nlc

I'm interested in a longer life only if there is quality; longevity unto itself should not be the goal. I also object to 'treating' healthy individuals and turning everyone into patients. I'd much prefer an approach that facilitates the empowerment of individuals to choose healthy lifestyles, which of course, presumes healthy options are available. I would suggest that feeling and being empowered is one of the keys to a healthy long life.

LisaCovington

@nlc Do you have any examples of what those empowered choices would look like that might differ from the choices people have today?

NickOttens

@Jay, you might have thoughts on this discussion as well. Please let us know!

Roey

@nlc - Please allow me to challenge your thinking on this issue.
While I agree that we certainly want to empower everyone, there are some physiological aspects of aging which can only be mitigated (or, hopefully, will be mitigated) by therapeutics and medical treatments. While it can certainly turn everyone into "potential patients", this approach may also be the only one to postpone aging-related symptoms and diseases by decades.

nlc

To respond to Lisa first, we know many f the things that empower older adults. They include communities that are walkable - designed to facilitate interaction, architectural design of houses/apartments/etc that are designed with the same purpose in mind, eliminating ageist attitudes, social support, purposeful involvement, etc. All easier said than done. When we look at quality of life and not just quantity, it goes far beyond the physiological aspects of our being.
To respond to Roey, I am not opposed to medical treatments per se, clearly medicine can do alot of good. Medicine alone and indeed physiological health alone does not assure quality of life.

nlc

ps - for a concrete example look at the Age-Friendly Communities initiative, now well-established in many places in Europe and North America

LisaCovington

@nlc I can see how these types of communities can work well, even when (vs if! ;-)) we discover new ways to extend healthspan.

Roey

@LisaCovington - in the end, this is what many researchers and entrepreneurs in this field are trying to do: to give people the choice. If you want to live in a certain community, go straight ahead! But don't be forced into it because of your failing body.

@nlc - Thanks for making it clear. I would like to reiterate that I certainly agree with your thinking that quality is just as important as length of life.

nlc

@Roey To clarify, the Age-Friendly communities initiative is directed at 'regular' or 'normal' communities; it doe snot refer to gated or specialized communities. Think of universal design of furniture as for everyday types of homes. This is targetted to all communities so they are more age-friendly.

Jun Suto

everyone is getting older but past some point of time, society label them "old". I love DJ Sumirock.
https://www.huffingtonpost.com/entry/this-82-year-old-woman-is-a-dj-in-tokyos-red-light-district_us_58ee5c08e4b08c15f0dbbd10

need more of her.

NickOttens

Video from the FT on gene editing and the possible impact on inequality:

https://www.youtube.com/watch?v=GrCWelaIdl0

abhikgupta

Life expectancy is also increasing in the developing countries, more so in the urban areas. At the same time, the traditional joint families are breaking into nuclear units, and the young members are moving to other cities on jobs or are going abroad. As a result, the aged people are facing problems of loneliness, various inconveniences and insecurity. They are also frequently becoming the ' soft targets' of criminals. The problem is more acute when either the husband or the wife dies, leaving the other all alone. Rising incidences of dementia are further worsening the situation. Societal attitudes and government policies need to undergo a paradigm shift to tackle this problem.

ymedan

[I apologize for the long post]

In 11th century Islamic medicine (Ibn Sina, Maimonides and others), the individual assumed responsibility for his/her well-being. Somewhere along the way (around 100 years ago), western "culture" (read - interests) made it the state/nation responsibility, "freeing" people from caring, delegating their health to an institution that will "fix" them.

Change will come only when this mindset is changed via education and self-empowerment. One such example is CliniCrowd, crowd-initiated clinical studies for common diseases associaed with aging such as Parkinson.

In this discussion thread I have found only one instance of the term "preventative care". The Healthcare establishment prefers to call it "Preventive Medicine". I suspect that this is done in purpose to keep the control and sustain the paradigm of using synthetically derived compounds for interventions. I therefore would like like to propose the term Wellcare for highlighting a caring paradigm along the lines of prevention.

In contrast to Healthcare, Wellcare may involve not just adopting life style habits that promote well-being but perhaps use not just "molecule compounds" but also "energy" interventions. We must recognize that our body would not function without electricity (e.g. heart, muscles, brain) and therefore interventions based on energy may prove much more effective. My best example is MR-guided-Focused Ultrasound.

Controlling tissue regeneration and empowring the immune system are the two technology areas that hold the promise. Their success hinge on understanding the root cause of disease states, coupled with controlling external stress factors (social, environmental) that lead to disease onset.

Enough said

Roey

@ymedan -

I generally agree that we need to focus on preventative treatments - though the exact name ("care" or "medicine") is less important in my opinion. I fail to see, however, how an individual's choice of lifestyle can compete with the powerful treatments of the future. In a way, we've already tried explaining to people that physical exercise and dieting is good for them... and not much changed. So why not go with the medical treatment route instead?

As for the "energy based interventions" - you lost me completely there. Can you explain what you mean by that?

ymedan

By "Energy" I mean Electrical Fields (e.g. Novocure.com) or Mechanical (e,g, INSIGHTEC.com).

The reason I don't want to use the term Medicine but Care is because it is associated with prescribed drugs that have both short- and long-term toxicity.

As for returning the responsibility to individuals, there are effective policies that are capable of making such shift. ACOs (Accountable Care Organizations), Self Insured enterprises and Value-based care are all encouraging staying healthy. See the latest "Food Pharmacy" service by Geisinger.

I would like to see a society with a prospering economy because of a growing healthy population, as opposed to the current situation where the prosperity is linked to the growing "market" of chronically-ill citizens. Longevity with chronic illness from cradle to grave is the ideal scenario for Pharma. Let's be honest.

Roey

@ymedan
You say that -
"Longevity with chronic illness from cradle to grave is the ideal scenario for Pharma. Let's be honest."


But that's only the case until society basically crumbles under the accumulated weight of healthcare debts. And I'm assuming (quite possibly naively) that the regulator won't let that happen.