The idea of people living hundreds of years has about as much credibility today as the idea of the world not being at the center of the universe had in 1540. Intellectually and in terms of our laws, institutions and actions, we are just not ready for radical life extension. I will illustrate this point with a short piece of fiction.
The story of the X pill
A team of distinguished university researchers uses molecular engineering to create a substance X that appears to activate an evolutionary genetic pathway affecting the expression of hundreds of aging-related genes. When tested, the substance doubles the life of laboratory mice and rats. Based on solid theoretical considerations, it appears that X could be the basis for making an anti-aging pill for humans. Extrapolating up from the mice and rats, it appears in theory that people who start taking the X pill on a daily basis in their 40s will double their average life spans. They will, the reasoning goes, continue to age but at a much slower rate. They will still get the diseases and problems of old age but, on the average, much later. At age 110 they should be about as healthy as people are today at 55.
So, the researchers raised venture capital to start up a biotech company to manufacture X pills and sell them to the public. What happened?
1. Everybody including the researchers recognized that the anti-aging effectiveness of the X pill can’t be established for a long-long time. There is no guarantee that X will work in humans as it does in mice and rats. Taking the X pills seems to result in healthier biomarkers and possibly longer telomeres, but this can’t be confirmed until there are 10 years or more of history. And, those factors by themselves do not guarantee longer lives. The new X biotech company is trying the pills on large monkeys, but it will also take 30-40 years to establish that the pills double the average monkey life spans. In 15-20 years it might be noticed that people taking the X pills continue to look younger or have less deadly diseases. But it will take 150 – 200 years to unambiguously establish that most people taking the X pills live twice as long. And this can only happen if data is gathered on the pill-taking cohort for all that time.
2. For the same reason, for a long time it will be impossible to know for sure that taking the pills is safe. How could anybody be sure that some deadly side effect won’t kick in after 5-10 years?
3. The realization soon dawned that the X pills cannot be developed, tested, approved, and sold as a drug. Drugs are approved by the FDA for disease indications and aging is not a disease. The X substance will not cure diseases. Instead, its action is to prevent many diseases from occurring in the first place, and there is no drug category for that. Once this was realized, it became very difficult for the X biotech company to raise additional development capital.
4. The managers of the X biotech company came to realize a horrible truth: because X is a new and strange synthetic chemical, it is possible that the X pills cannot be legally sold for human consumption in the US and most other advanced countries. Fortunately, a graduate school assistant working for X discovered in the literature that members of a rare species of deep-sea urchin have tiny trace amounts of X in them. This fact allows selling X pills as a “natural substance” dietary supplement. Whew! That was a close one!
5. A clinical trial of the X pill is out of the question. If there were such a trial, it would have to last 30 years just to get early indications. Nobody is prepared to pay the hundreds of millions of dollars required for such a trial, particularly the new X biotech company which is running on a shoestring.
6. For the first two reasons listed above, the majority of doctors recommend their patients not to take X pills. They rightfully say that substance X is unproven, unapproved by the FDA and potentially dangerous. They think they are following the basic medical precept “First, do no harm.” For patients who have had an episode of cancer or heart disease, the warnings from the doctors are particularly stern and ominous.
7. Some prominent religious figures start a crusade against taking the X pills. Their point is that “extending human life would go against God’s natural order.” This is a mixed blessing for the X biotech company. On the one hand it gives them press exposure. On the other hand it leads many pious followers to eschew the X pill
8. Big pharmaceutical companies mount a well-funded PR campaign warning people against taking the X pill. They do not want to see large numbers of people taking x pills for good business reasons. They are not afraid that it won’t work; they are afraid that it will work. The ideal pharmaceutical drug from a commercial viewpoint is not a cure for a serious disease, but is a drug that must be taken continuously to prevent or blunt the symptoms or ravages of such a disease, year after year. That is a prerequisite for a blockbuster drug that rakes in $10 billion or more a year. An X pill that results in many fewer cases of disease happening could be commercially disastrous to many big pharma companies. So, they subsidize doctors to write articles and go on TV opposing the X pills.
9. The big hospital centers that mass-process patients with life-threatening cardiovascular and cancer problems also see their businesses threatened, including cardio surgeons, chemotherapists, radiation therapists, hospital administrators and insurance company executives, people who depend on a steady stream of diseased patients in order to earn from a half-million to more than a million dollars a year. They join the big pharma companies in the anti X pill chorus.
10. The big research-sponsoring establishments like the National Cancer Institute and those who feed in their troughs also have a vested interest in fighting the availability of such a pill. The War on Cancer going back to 1971 has produced marginal results for the hundreds of billions of dollars spent on research. In 2008 the NCI spent $4.83 billion on 5,380 research grants. Until genomics came along, the required basic science platform for discovering what really goes on in cancers was simply not there. Although cancer deaths are down, much of the progress has been due to public health measures like decline in cigarette smoking. Yet, the cancer research establishment is not only going on but is growing. If an X anti-aging pill came along that postpones when most cancers happen by 70 years, imagine what an embarrassment that would be for everyone in the cancer research establishment. Thousands of researchers with their own pet theories about cancer and more thousands working in the cardiovascular, diabetes and neurological disease areas start throwing Olympic-sized swimming pools full of ice water on the X pill idea.
11. As sales of the X-pill increase, the anti X-pill factions decide they have to do something to stop it. They join together in a successful lobbying effort to “regulate” the X pill which means halting its sale and handing rights to future anti-aging drugs to big pharma. People who want to continue taking X pills will have to smuggle them in from Bulgaria. And then they will for-sure not know what they are getting.
This little story brings out several important points about the current reality. Several dietary supplements in the anti-aging firewalls Supplement Regimen are similar to the X-pill in that they theoretically produce healthful and life-extending results, they can demonstrably extend the lives of small animals by 20% to 40%, but what they will do for humans is not yet very clear. Telomerase-activators like cycloastragenol or TA-65 have a significant life-extending potential but what they actually do for humans remains under a cloud of uncertainty. Companies like TA Sciences and Sirtris Pharmaceuticals are facing many of the same problems faced by the fictional X pill company.
There is a major need to prepare the society for the possibility of radical life extension:
1. There is a clear need for educating medical professionals as to progress in developing anti-aging strategies and therapies, and for getting them used to the possibility of radical life extension. The same is true for all concerned parties: lawmakers, institutional administrators, and the public at large.
2. There is a need for a massive shift in government health research funding, away from simply finding chemical and surgical cures for diseases, towards promotion of longevity and disease prevention via public health measures and epigenomic and genomic enhancements of individuals. Public money spent over the years on longevity research is a tiny drop in the bucket compared to money spent of cancer and other disease research, despite the incredible leverage on incidences of the same diseases increased longevity would provide. And significant sums of money need to be set aside for long clinical trials and population studies to help evaluate the effectiveness of emerging anti-aging therapies.
3. Above all, there is a need for a major shift in general perspective regarding life extension FROM more and more doddering, sick, non-functional, non-contributing individuals drawing social security, filling nursing homes, having automobile accidents and driving health care costs ever-higher, TO more and more healthy, creative, fully-functional working individuals in their 70s, 80s, 90s and beyond who are not getting the diseases of old age, and who are more than doing their part to contributing to our society in every way.