People have always said that aging is one of the only two certainties in life, the other being taxes, as far as taxes are concerned proper planning and tax avoidance strategies remove the inevitability of that one and science is still working on number two with surprisingly rapid progress.
In recent years, Gerontologists have begun to overturn much of the conventional wisdom about the inevitability getting old and we are relatively close to a time when it's possible to separate chronological age from physical ability and arrest what is currently still an inevitable decline. Aging is not the simple result of the passage of time but the result of accumulated cellular and molecular damage which builds up over time until it begins to cause serious and ultimately life threatening health issues once we reach a certain age. The exact age when these issues arise will vary from person to person but they are ultimately inevitable, they are what we term comorbidities, we define this as the existence of one or more diseases or conditions from which a person is suffering at the same time. Comorbidities are usually chronic long term conditions which can sometime interact with each other, for example diabetes can cause issues with the heart, kidneys and vision if left untreated plus it can damage the nerves causing diabetic peripheral neuropathy. Where the future will be different to today is that we currently try to treat these conditions with various medication's and other interventions, whereas anti-aging medicine would mean that we would intervene earlier before the condition became difficult to manage, this is vital because as things stand currently the primary shortcoming is that we are intervening too late when the condition has already become very challenging to manage. It is clear that drugs such as senolytics have the potential to delay these comorbidities and increase a persons healthspan but this is only the beginning of a complex journey toward rendering aging a manageable condition but this early type of intervention looks promising based on current research and will have the potential to buy time for people who are currently already in middle age or early old age until further interventions can be developed.
Some of the main conditions which we would classify as potential comorbidities are below.
In my opinion, the turning point regarding the war on aging will be viewed by future generations as having taken place on June 25th 2000 at the Marriott Hotel in Manhattan Beach, California. This was the point when Dr Aubrey de Grey realized that curing aging was likely to be extremely difficult but there might be an alternative route that could still lead us to significant life extension. This alternative is termed by Dr de Grey and many others as the engineering approach. Myself and many others view this approach as holding the greatest promise for combating aging within the next 10/20 years and leading to comprehensive rejuvenative interventions.
Executing this mission to bring aging under decisive medical control requires an unprecedented level of interdisciplinary effort and a long-term focus it might prove to be the case that because pharmaceutical companies had to work together to beat Covid-19 increasing interdisciplinary efforts might well prove to be a game changer.
The key to understanding the engineering approach is to keep in mind that we will probably not develop a true a CURE for aging in the foreseeable future. Whilst it would be ideal if we could we must be realistic and work on the basis that it will probably not happen. In my opinion, we must work from where our knowledge stands currently. Our strongest area of knowledge lies in that, whilst we understand the reasons why the body deteriorates with age, we do not have the requisite knowledge to intervene in a way that influences the actual ongoing metabolic processes.
I am often asked "how long before we can cure aging?" To understand let’s keep in mind that we are already adding two months to life expectancy every year (or 5 hours per day) and this has been consistent for the last 30 years or so. If you then consider that many people including myself see a better than 50% chance of controlling aging within 10/20 years the whole issue starts to become very interesting. As far as the time span for an actual cure, I would hazard a guess that it is at least 100 years away. The alternative approach is to aim at controlling aging and repairing the accumulated damage, this should be our primary goal because we understand the types of damage we need to address as well as how the damage is laid down even though we understand very little about actually slowing aging or influencing metabolism. This is the essence of Aubrey de Grey's theory and most other theories regarding the engineering approach, without doubt route holds the best prospect of success in the first half of this century because we are already making significant progress in all of the vital areas required to make it a reality.
I am pretty confident that taking this route potentially means that we do not have to find a cure for aging itself, therefore, we bypass the problems that our lack of knowledge in the area of metabolism and the aging process creates because what Aubrey terms “engineered negligible senescence" can potentially extend life indefinitely while not actually curing the underlying aging process which is allowed to continue.
The key lies in the fact that we have a sufficient understanding of genetic and biochemical processes that lead to metabolic damage that we can already envision what is termed the engineering approach. Aubrey frequently uses the question "how long will a house last?" Of course, the answer is that, if you look after it, it can last forever! The key here is that Aubrey proposes that we find a method to undo the damage that has accumulated over the first 50 or 60 years of a person’s life. Repairing the damage means we do not need to understand all the processes of aging, only that we need to know enough to extend healthy lifespan by let us say 30 years.
Most people would presume that slowing the aging process might be a great deal easier than reversing it. I tend to agree that at first glance this would seem to be a perfectly logical assumption and, indeed, in all probability the first therapies are likely to be interventions which slow the aging process and increase an individual’s health span. Current indications are that at least 7 or 8 extra years of healthy life are within striking distance and research involving Senolytic drugs and NMD and NR look very positive see this link.
It is actually quite easy to follow, in essence this is how it will work, lets assume you are 60 years old at the time of the first intervention/treatment and that this early and fundamentally imperfect selection of therapies repairs 25 years worth of accumulated damage. Now let's look 10 years ahead when you would reach the chronological age of 70 but would be biologically only 45 years old. We now come to the vital key to the whole theory which is this, let's assume that 20 years after the first treatment, when you are chronologically 80 but biologically 55 years old your doctor and yourself will conclude that the damage that was not repaired in the first treatment combined with further damage accumulated over the last 20 years is again posing a health risk. This is the point when you would require a second intervention/treatment.
The Impact of Intervention Number Two Holds the Key
It is now with this second treatment that the progress in medicine comes into play because, by the time 20 years has gone by, anti-aging medicine will have moved on significantly, whilst the first treatment bought you an extra 20 or 30 years by repairing a fair amount of the damage accumulated over 60 years of living, it did not repair it all. Twenty years later progress will mean that the latest treatment would not only be able repair all of the damage corrected by the first intervention but also some of the damage that was not able to be repaired 20 years earlier, in essence whilst you are now 80 and receiving intervention number 2 this improved bundle of therapies would be able to repair not only all of the types of damage that were repaired by the first intervention along with the 20 years of further damage which have accumulated since your first treatment, it will also repair some (but probably still not all) of the damage that could not be repaired by the first treatment. This means that, whilst you will have aged 20 years, chronologically you will be biologically younger after the second intervention than you were after the first. This is the essence of Aubrey de Grey's theory, essentially, it is a short cut to very significant life and healthspan extension. Whilst it is not a cure for aging it acknowledges that it does not need to be because it simply buys time and leads to a situation where regular interventions (10/20 year intervals) with increasingly effective treatments could potentially extend life virtually indefinitely.