The recent furore over the horror film The Substance has left critics divided. The depiction of an ageing Hollywood aerobics instructor who injects an unlicensed, distinctly dodgy-looking serum in order to unleash a younger version of herself has been both slated and adored. Described by one critic as ‘a body horror, female-centric spin on The Portrait Of Dorian Gray’ the film was a surprise winner at The Golden Globes, and nominated for several Academy Awards although Demi Moore didn’t manage to clinch the coveted Oscar.
It paints a savage view of a misogynistic Hollywood that fosters impossible expectations of female beauty.

I have to say, I enjoyed it. Uncomfortable viewing without doubt, Moore gives a fabulous no-holds-barred performance which illustrates just how much people are prepared to risk to defy ageing and cling onto their youth.
These themes are not new.
History shows we have always nurtured a fascination with the idea of eternal youth. From Herodotus, and Alexander the Great’s fabled search for the Fountain of Youth, to legendary quests for the Holy Grail and the philosopher’s Stone: the desire to find a cure for ageing, whether that be elixirs, crystals, supplements or injections has obsessed scientists, artists and kings. And entrepreneurs.

An ever-expanding longevity industry is invested in fanning those flames, whether that be big pharma, the beauty industry or a profusion of biotech start-ups who want to tantalise us with technological solutions to old age. Because they know we are willing to pay for them. Which provides the perfect backdrop for my latest speculative thriller, The Cure.

The Cure tells the story of a scientist, Ruth, who discovers a cure for ageing whilst researching the disease that killed her young daughter. Just one injection a year reverses your biological clock, guaranteeing a long, healthy life.
The novel explores the consequences of this discovery on society, relationships and the planet, and what might happen if we do indeed find that Holy Grail and drive human lifespan to a new high.

My fictional therapies in The Cure are based on scientific research that is happening now.
Huge sums are being invested in a diverse array of projects: 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 therapies reprogramme cells to a more youthful state, halting and reversing the ageing process. The vision is to turn back the clock and cheat death by staving off age-related degenerative disease.

The pace and quantity of ageing research is accelerating, enabled by genetics, big data and AI and it is probable that we will see some variation of these treatments moving beyond clinical trials to market within the next few decades: sooner, if some advocates are to be believed.

Some research projects have already produced 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 and more accessible solution than gene therapies.
It’s hard not to get caught up in the excitement about these potential cures. But there remains an important if unpalatable question.
Just because we could do it, does that mean we should?

“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

The reality is that there is a social and environmental 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?

Who will ensure that everyone gets access to anti-ageing treatments which are likely to be very expensive at the outset? 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 which might carry with them unknown adverse effects when we could stave off degenerative conditions if we ate better, drank and smoked less, and exercised and slept more?

I don’t have the answers to these questions. But they need to be aired.
Otherwise we delegate our collective fate to the companies and individuals racing full pelt to secure that Holy Grail.

THE CURE is published on April 10th and is available to preorder from all good bookshops.
It will also be available as an ebook and audiobook. You can preorder here.

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