The rationale

There are clear advantages to tackling ageing.
Reduced suffering from chronic age-related degenerative conditions will lead to better individual prosperity and wellbeing in later life as well as significant economic benefits at a national and global level.

It is extremely concerning that the dramatic improvements we have seen in life expectancy have not translated into a better quality of life in those extra years.
The gap between healthspan: the proportion of our life we enjoy in good health, and lifespan is growing. And it is particularly marked in the West.

According to research conducted in the US, there is an increase in the absolute number of years lost to mental or physical disability as life expectancy rises. i.e. US citizens may live longer than their parents, but chances are their parents enjoyed more healthy years.

Figures in the UK show a similar pattern.
In 2020–22, average male life expectancy was 78.8 years, compared to a healthy male life expectancy of only 62.4 years, which means 16.4 of those years (21%) were spent in poor health.
Average female life expectancy was 82.8 years, of which 20.1 years (24%) were spent in poor health.

This not only affects families and their loved ones, it creates a global burden on healthcare and social care systems, and negatively impacts productivity levels due to sickness and absence from work. The incidence of long term sickness and people leaving their jobs due to ill health is increasing. The NHS is close to breaking point, and the UK’s social care system has long been in turmoil.
If we were able to intervene earlier with preventative therapies, and ward off age-related conditions, it could break the cycle of health budgets being dominated by the treatment of long term chronic disease.

A study published in Nature magazine estimated that if the global age of death was reduced by one year it would add 38 trillion dollars to the global economy. It claims this uplift would arise from a combination of reduced health and benefits costs incurred by people suffering from age-related conditions, and higher tax revenues generated by a higher proportion of people in active employment.

The business case for intervention is strong.

“The science is now moving as rapidly as the AI revolution and will be similarly if not more impactful.” Lord Lebedev.

The science

The science of longevity aims to unlock the triggers of human ageing and ultimately reset our biological clocks, improving healthspan as well as lifespan. There are a huge array of research projects and trials in progress. From drugs that kill off damaged cells that accumulate during the ageing process and promote cellular repair to advanced gene therapies similar to the fictional ReJuve I use in The Cure.
These gene therapies reprogramme cells to a more youthful state, halting and reversing the ageing process. Effectively turning back time.

Some projects have already seen remarkable results in rodents and primates. The US FDA recently approved clinical trials for a drug that would extend lifespan in dogs.
But none of these improvements, as yet, have translated to humans.

David Sinclair, a professor in the department of genetics at Harvard Medical School and a famous advocate for longevity, believes the answer lies in the epigenome: the regulator of our genes which responds to environmental factors, by controlling the chemical modifications to our DNA and which genes are switched on or off as we age.

Through epigenetic reprogramming using specific ‘rejuvenation genes’, Sinclair has managed to accelerate and reverse ageing in mice, cure blindness by reprogramming retinal cells, and treat dementia, by reversing the age of rodent brain cells.
Sinclair has embarked on further studies in monkeys and has even reversed the age of cultured human brain cells (organoids). He claims that clinical trials in humans are only a matter of months away.

But Sinclair has further ambitions. He believes the next stage of research is to investigate which molecules could imitate the results of these rejuvenation genes. If a molecular solution was found, it could mean a simple course of anti-ageing pills could be developed: a much cheaper solution than gene therapies.
This could open up access to the many rather than the wealthy few, and combat concerns over the equitable availability of anti-ageing treatments.
But this is still very much at the conceptual stage.

There is a theory that humans have a maximum life potential of around 120. Dave Sinclair doesn’t agree. When he was asked if he thinks there’s an upper limit to human ageing, he replied:

‘Well, I know there’s not. That’s not even a question.’

“I’m no longer talking about slowing ageing. I’m talking about true age reversal, multiple times… There is no law that says we must age. Remember that.” David Sinclair

The dangers

It’s hard not to get caught up in the excitement about potential cures for ageing, and closing the gap between healthspan and lifespan.
But there is a cost to such endeavours. And some fundamental ethical considerations that need to be addressed.

Given the dramatic rise in our global population, projected to exceed 10 billion this century, can the world cope with that many people living twice as long?
How will this play out when natural resources are already under threat, and living space at a premium, on a planet increasingly ravaged by climate change? When we are facing extreme weather events that impact lives and food production, with mass migration, starvation and poverty?

Is it fair that humans continue monopolising this planet at the expense of other species and habitats, when biodiversity is already plummeting?

Should medical funding be focused on age reversal when many long-standing preventable diseases are still prevalent in lower income nations such as TB, HIV and malaria, and infant, adolescent and maternal mortality rates are still way too high?

Statistics show that those in lower income brackets have a much higher prevalence of age-related disorders, feeding a vicious cycle of higher unemployment and dependence on benefits.
Who will ensure that everyone gets access to anti-ageing treatments which are likely to be very expensive at the outset, meaning only wealthy individuals or countries can afford them?
Will global regulatory consensus be possible to prevent a deepening of the chasm between rich and poor?

And should medicine be intervening where lifestyle and behaviour changes could avert many age-related conditions?
Is it right to medicalise solutions that could be corrected without expensive new therapies and which might carry with them unknown adverse effects if we ate better, drank and smoked less, and exercised and slept more?

Lastly, what about the impact on society as the old start to vastly outnumber the young? How will it affect youth employment and housing prospects? Families and relationships? Pensions?
Our mental wellbeing: can we cope with living and loving that long?

“I’m an optimist. Anyone who believes in manipulating the human aging process is a terrible pessimist.
I don’t want to be alive when that’s possible. I don’t want to give another Adolf Hitler, a Saddam Hussein, another 50 years of life.
Every time someone like that dies a natural death, people should thank their God, whoever that might be, for the phenomenon of aging.”
Leonard Hayflick, biomedical researcher