Science says we could “cure” ageing. But should we?

Sci­en­tists study­ing the biol­o­gy of why we age have made some incred­i­ble dis­cov­er­ies in the last few decades: the age­ing process is not inevitable and, by under­stand­ing the mol­e­c­u­lar and cel­lu­lar mech­a­nisms that give rise to it they are devel­op­ing treat­ments that could slow or even reverse the process. Can we learn enough that humans could live 400 years, like the Green­land shark? It’s a beguil­ing ques­tion, and one which is often fol­lowed equal­ly swift­ly by anoth­er: would we want to? The idea that we could treat age­ing like any oth­er med­ical con­di­tion rais­es some big eth­i­cal ques­tions. Let’s exam­ine a few of the most important.

The most com­mon objec­tion to treat­ing age­ing is often summed up with one word: ‘over­pop­u­la­tion’. The cli­mate is already strain­ing with our col­lec­tive car­bon diox­ide emis­sions, and we’re also pol­lut­ing the plan­et in a myr­i­ad of oth­er ways, from farm­ing and over­fish­ing to microplas­tics and tox­ic waste. If peo­ple live longer, there will be more of us, and won’t that be even worse for the planet?

The first prob­lem with this con­cern is the way it’s posed: ‘over­pop­u­la­tion’ implies that it’s peo­ple who are the prob­lem, rather than the resources we use. It also unfair­ly demonis­es the parts of the world whose pop­u­la­tion is grow­ing the most rapid­ly – pre­cise­ly the poor coun­tries whose pop­u­la­tions use the fewest resources per head. But sure­ly hav­ing more peo­ple nonethe­less makes our var­i­ous envi­ron­men­tal chal­lenges hard­er to solve, even if it’s not the peo­ple per se who are to blame?

The sur­pris­ing fact is that even a com­plete cure for age­ing — a hypo­thet­i­cal pill that would dra­mat­i­cal­ly reduce the risk of can­cer, heart dis­ease, demen­tia and more — would have a fair­ly mod­est impact on glob­al pop­u­la­tion. Tak­ing the pop­u­lar Unit­ed Nations pop­u­la­tion pro­jec­tions and entire­ly remov­ing age­ing as a cause of death by 2025 (a slight­ly ridicu­lous sce­nario beyond even the most opti­mistic pre­dic­tions for anti-age­ing med­i­cine) results in just a 16% increase in pop­u­la­tion by 2050¹. A far more fea­si­ble slow­er devel­op­ment and roll-out of such treat­ments would, of course, result in a small­er increase still.Then it becomes impor­tant to remem­ber what’s on the oth­er side of the bal­ance sheet here: age­ing is the cause of most can­cer, most heart attacks and most demen­tia, as well as frailty, incon­ti­nence, hear­ing and sight loss, and much more besides. It is respon­si­ble for about two thirds of deaths glob­al­ly². I’d hap­pi­ly work 16% hard­er to cut my car­bon foot­print if it meant dra­mat­i­cal­ly reduced death and suf­fer­ing from dozens of caus­es, all around the world.

Viewed like this, pop­u­la­tion is cer­tain­ly some­thing to be aware of (and bod­ies like the UN would do well to pay this sci­ence a lit­tle more attention—none of their pre­dic­tions explore life expectan­cies climb­ing sig­nif­i­cant­ly above 80 any­where in the world), but it’s not the inevitable envi­ron­men­tal cat­a­stro­phe it sounds like it could be at first.

With Ama­zon founder Jeff Bezos being just the lat­est (and rich­est) bil­lion­aire to invest in anti-age­ing research, there’s clear­ly inter­est from the ultra-rich in slow­ing the age­ing process. But, if they suc­ceed, are the rest of us going to be able to afford the treat­ments that result? The good news is, there are three impor­tant rea­sons to hope so.

First­ly, some of these treat­ments might be very cheap: ear­ly con­tenders for anti-age­ing med­i­cines like met­formin and rapamycin are exist­ing drugs whose patents have expired and cost pen­nies per pill³, and even more advanced ther­a­pies are like­ly to cost thou­sands rather than mil­lions, due to automa­tion and economies of scale when treat­ments are applic­a­ble to lit­er­al­ly every human on the plan­et, not just the sub­set with a par­tic­u­lar form of can­cer, for exam­ple⁴.

Med­i­cines would save gov­ern­ments and health­care sys­tems a huge amount of mon­ey, off­set­ting the cost of the treat­ments themselves.

Sec­ond­ly, there will be a large eco­nom­ic imper­a­tive to pro­vide even fair­ly expen­sive treat­ments, pre­cise­ly because age­ing itself is so expen­sive. Dementia—which is, of course, just one of many dis­eases of ageing—is esti­mat­ed to cost over $1 tril­lion world­wide, ris­ing to $2 tril­lion by 2030⁵. Med­i­cines that could alle­vi­ate the enor­mous bur­den of these dis­eases would save gov­ern­ments and health­care sys­tems a huge amount of mon­ey, off­set­ting the cost of the treat­ments themselves.

And final­ly, even if you think the bil­lion­aires are entire­ly out for them­selves, hoard­ing the pills doesn’t even make sense from a self­ish per­spec­tive. Imag­ine you’re Jeff Bezos: do you want to be the first per­son to take an exper­i­men­tal anti-age­ing med­i­cine, or the 100,000th, after exten­sive safe­ty and effi­ca­cy test­ing? The best out­come for the bil­lion­aires is the same as for the rest of us: a thriv­ing longevi­ty indus­try, with treat­ments cheap enough for large-scale clin­i­cal tri­als, and there­fore wide­spread usage.

As long as there have been humans, there has been death. There’s evi­dence that funer­al rit­u­als may date back hun­dreds of thou­sands of years⁶, so it’s like­ly our species has grap­pled with its fini­tude for at least tens of mil­len­nia. Is know­ing it will end what moti­vates us to suc­ceed, or pro­vides mean­ing at all?

The first thing to say is that this is one of many objec­tions that demon­strate how we put age­ing research into its own eth­i­cal category—no-one would ask a can­cer researcher whether they’re con­cerned that a reduc­tion in death aris­ing from their research might neg­a­tive­ly affect the human con­di­tion, and yet, for age­ing biol­o­gists, this is a com­mon query.The sec­ond is that, even if we were to com­plete­ly cure age­ing, peo­ple would still die. There would still be bus­es to be hit by, infec­tious dis­eases to catch, and can­cer, heart dis­ease and more all afflict bio­log­i­cal­ly young peo­ple too, if at a far low­er rate than the elder­ly. How­ev­er, a world where our bio­log­i­cal youth was extend­ed, per­haps indef­i­nite­ly, would cer­tain­ly be a world with less death—and I’m not so sure that would be a bad thing.

Much of the mean­ing in our lives comes from the peo­ple that fill it, our fam­i­lies and friends. And much of the pain, both emo­tion­al and phys­i­cal, results from ill health, either theirs or our own. If we were all liv­ing longer lives in good health, as med­i­cines against age­ing promise, why wouldn’t we want to con­tin­ue liv­ing? And as art, music, sci­ence, tech­nol­o­gy and more con­tin­ue to advance (per­haps to new places only pos­si­ble thanks to cre­ators or researchers with extend­ed careers, able to make dis­cov­er­ies only pos­si­ble with extra decades of expe­ri­ence), it seems incred­i­bly unlike­ly that we’d get bored.

And, even if we do tire of life itself aged 250, wouldn’t you rather go in a short, pain­less man­ner at a time of your own choos­ing, rather than hav­ing life slow­ly and painful­ly tak­en from you over decades by the age­ing process?

The key point is that med­i­cines for age­ing are just that—medicine. They’re no stranger than a heart dis­ease researcher try­ing to pro­long healthy life by cre­at­ing a drug to low­er cho­les­terol. There’s no real evi­dence that the extra years bought by pre­vent­ing heart attacks have stripped mod­ern life of its meaning—so why would adding a few more years free from heart attacks and can­cer and frailty do so?

And all drugs come with side-effects. For med­i­cines with a large enough reach, these can be soci­o­log­i­cal, eco­nom­ic and eth­i­cal. The con­tra­cep­tive pill trans­formed soci­ety, espe­cial­ly for women; antibi­otics and vac­cines haven’t just saved mil­lions of lives, but fun­da­men­tal­ly realigned our mil­len­nia-old rela­tion­ship with infec­tious dis­ease; the first tru­ly safe and effec­tive weight loss med­ica­tions are already foment­ing anoth­er social and med­ical rev­o­lu­tion. We should dis­cuss the eth­i­cal impli­ca­tions of all new treatments—but, though there will always be side-effects to con­tend with, I’d argue that the world would be a far bet­ter place with real anti-age­ing med­i­cines added to that list.

There’s obvi­ous­ly far more to say on the ethics of age­ing biol­o­gy, and you can find a free chap­ter of Andrew Steele’s book, Age­less, at age​less​.link/​e​thics