You only age once!

Tackling the ethical side of anti-aging research

Live healthier for longer

If you could choose to prolong your lifespan would you do it? As many of you, I would first want to know what are the “conditions of the contract I am signing?”. Aging unhealthily and with a poor quality of life is one thing, but living longer AND healthier is another story. So what if I tell you this is not science fiction, but a reality towards which our society approaches closer every day? As you read this, a growing number of dedicated scientists in the anti-aging research field are working on developing drugs capable of slowing down aging. While these drugs could be the solution to one problem (the increasing number of people suffering from age-related disease), it might be the cause of many others. So are there any ethical issues regarding anti-aging medicine? And if so, what are they? In this post, I will provide you with all the facts you need to understand why in recent years this field of science emerged and in the second part, we will discuss the ethical aspect of anti-aging medicine.

How do we define aging?
Aging is a group of functional modifications that progressively decreases the ability of our organism to function properly. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5991498/). This progressive deterioration starts early in life and continues with time. (Image 1)

Image retrieved from https://www.umcg.nl/

The pandemic that has been here way before COVID-19: the aging pandemic

As kids, we think that our parents and grandparents will live forever. When we grow older, we learn that death is an inevitable part of life. Later on,  we understand that death can sometimes be a relief from long years of suffering from one or more age-related diseases. The number of elderly that spend the last decade of their life completely dependent on medical care is rapidly increasing. My grandfather worked very hard all his life as an engineer in the mines of Slovakia. When retirement came and he could finally start enjoying his free time, he slowly but surely started fading. Cognitive impairment and age-related dementia results in decreased quality of life and loss of independence. As reported by the World Health Organisation (WHO), aging is one of the biggest problems of our generation. The average lifespan is constantly increasing as well as the number of people over 65 years and people suffering from age-related diseases.

Is the socioeconomic status playing a role in this “aging pandemic”?
Developing countries have not reached the point on which developed countries are regarding lifespan. Will anti-aging science impact these populations differently? In the Central African Republic, for example, the life expectancy is around 20 years lower than the global average (https://pubmed.ncbi.nlm.nih.gov/30340847/). Here, people have an average annual income of 400 dollars. People in rich countries, on the other hand, have a much higher lifespan. However, even between countries that are considered rich, differences can be observed.  Americans have a lower life expectancy when compared to people in other rich countries. This shows that the economic status of the country isn’t the only player in the “aging pandemic”. Among other factors, one of the most prevalent one is the access and affordability of healthcare that varies between countries.

Why should scientists want to slow down aging?

By 2030, 82 million people (and 152 million by 2050) will be living with dementia. Due to the aging population and based on the estimation that the risk of developing dementia doubles every 5 years, these numbers continue to grow and that is why it is crucial to do something about it! Even though this results in tremendous economic, medical and societal burden, only less than 1% of medical research focuses on slowing down aging. The other 99% focuses on fighting diseases that currently represent the most common causes of death (cardiovascular diseases, stroke, cancer, dementia). Considering that aging is the main and common risk factor of all these diseases, one might hypothesize that identifying the root cause of aging might consequently mean treating what caused all-age related diseases in the first place.

What could aging research lead to?
It may sound like an episode of black mirror or ‘love death and robots’ (https://www.netflix.com/nl-en/title/80174608) but aging research could achieve a point in which humans become virtually immortal”

Prolonging health-span versus prolonging life-span

One of the scientists that made his life’s-long mission to find the root cause of aging is Professor David Sinclair. In his book „Lifespan”, he explains that each cell has a set of genes which can be either ON or OFF. With aging some of the OFF genes switch ON. This switch can be prevented or reversed by other genes called the longevity genes or Sirtuins. The function of longevity genes can be boosted by molecules found in certain food or drinks such as red wine, but also by intermittent fasting and exercise. Based on these molecules anti-aging drugs have been developed, some of which are already available on the market (e.g. resveratrol and metformin). The main purpose of these drugs is to prolong the period of our healthy years by boosting our longevity genes. As these medicines target underlying mechanisms of aging, they not only eliminate age-related diseases and therefore prolong our health-span, but also prolong our life-span. Even though the attractiveness of sirtuins as an anti-aging molecule capable of improving health through the target molecules participating in diverse biological processes is undeniable, the role of Sirtuin on longevity remains controversial.

Is increased life-span a side effect of of anti-aging drugs ? One should keep in mind that prolonging life-span is only a side effect of these drugs and not their main purpose. In the following part of this post, we are going to discuss all the ethical issues that may arise in the field of anti-aging research.

Ethical issues that exist in the field of anti-aging research

Anti-aging drugs have tremendous potential to allow us to live healthier, happier and longer, but what about the other side of the coin? In a previous post written by Alejandro on the “magic pill” being able to mimic exercise an important question was brought up. What could be the side effect of a medicine like this? And is our society prepared to face such responsibility of bringing anti-aging medicine to the market freely available to the general population? Who would get these drugs? How much would they cost? With these and much more unanswered questions we need to consider the ethical side of anti-aging research.

Main arguments against anti-aging research

1.       Overpopulation

It is a fact that our planet is becoming overpopulated and one could think that slowing down
aging could make it even worse. There are two main things that need to be discussed in this regard. Firstly, yes overpopulation is currently our biggest societal issue as it results in increasing pollution and global warming. However, anti-aging research aims not to make people live forever but to make people live healthier for longer. It is estimated that solely in America, annual costs of treating Alzheimer’s diseases in 2050 will exceed 500 billion dollars. Slowing down aging will decrease the economic and social burden which in turn will allow us to redirect financial and human resources to other important issues such as decreasing pollution and fighting global warming.  Secondly, slowing down aging doesn’t necessarily need to result in population growth. In more developed countries, regardless of increasing life-span we observe a rapid declining birth rate. This is mainly caused by the presence of choice to have children later in life or not at all. Therefore, slowing down aging  for the purpose of increasing health-span is unlikely to result in increased interest in having more children.

2.       Denying the immutability of aging

The definition of “normal” changes with time. One of the reasons why anti-aging research  is often depicted as unethical is cultural prejudice. In our society, the majority of people think that aging and death around 80 years is normal and an inevitable part of life. However, if we look back to 19^th century when the general lifespan was less than 40 years, we realize that what was “normal” then, is not normal now and followingly what is “not normal now” might not be “normal” 50 years from now. Simply said, our society evolves and what we can achieve also changes. Improved hygiene, medical advancement and safer living conditions, doubled the life expectancy in past 200 years. Now we know more about aging than ever before, and using this knowledge to fight age-related diseases is nothing less than our scientific duty.

3.       Inequality

Most people in the world live in poverty. 85% of the world live on less than $30 per day, two-thirds live on less than $10 per day, and every tenth person lives on less than $1.90 per day.

The possible limitation of access to anti-aging medicine related to costs, could cause prioritizing the wealthy. While poor people would continue dying in millions, the rich could “refuse to die”. People do not have access to proper health care or cannot afford it, so in the end, it is the rich that will benefit from this; this is also an ethical consideration. While most of us would agree that prioritizing the wealthy is not right, it happens every day in every sphere and field of our life. The question is whether global inequality should present a problem for bioethics and whether it is the responsibility of scientists to prevent the world from becoming even more unjust?  In my opinion, although it should be our common goal to prevent the world from becoming even more unjust, this should not stand in the way of potential progress in the field of biomedicine. As reported previously, scientists cannot decide to deny palpable good to some people because we cannot provide them for all. Even though this might seem unreachable, the main goal should be to make these drugs available to everyone regardless of their nationality or socioeconomic status. 

4.       Modifying ourselves

People against anti-aging research often argue that it is unnatural to modify ourselves by prolonging our life-span. But who decides when it is okay and when it is not okay to intervene in the “natural” line of life? A good example is cancer. Not treating cancer results in death. Cancer is caused by the overaccumulation of damage in our genome. However we treat cancer patients every day without even thinking about whether it is ethical. Recently, the aging phenomenon has been classified in the list of diseases by the WHO. Therefore, there is no reason to consider intervention to aging and to any other disease differently.

5.       If no natural deadline-life outlives its value

Quality over quantity. Many people agree that this statement applies to life. Life filled with meaningful experiences is a life worth living. Prolonging life span will not necessarily result in a better life, I agree. However, as explained above, anti-aging research is about prolonging health-span rather than life-span. Longer periods with uncompromised health in our lifetime will give us more time for meaningful experiences which will indirectly increase our quality of life. In other words, slowing down aging will result in prolonged health span which will allow us to create meaningful relationships and live our life to the fullest. Just imagine a life where you don’t feel in a hurry for the next stage! What a life that would that be…

6.       Ageism in working environment

In today’s workplace, seniors are seen as being set in their ways and young people as inexperienced. Increasing life-span could result in further increase in unemployment and lack of job opportunities. On the other hand, slowing aging down could result in diminishing the age gap by prolonging the period of productivity in one’s career. Slowing down aging could mean more time to put experience into practice for the old and more time for acquiring experiences for the “young”. 

If we slow down aging, how would people die?

The intrinsic side effect of biochemical processes that sustain life is the generation of toxins. These toxins cause damage, of which a small proportion cannot be removed by any endogenous repair process and thus accumulates. This accumulating damage ultimately drives age-related degeneration. This is aging. Even if we slow down aging, ultimately, our body will start to deteriorate. With increasing age our cells will still suffer from accumulation of metabolic stress, dysfunctional mitochondria, shortening of telomeres and lower protein quality. Ironically enough, if we slow down aging, old age would become the major cause of death. However, eliminating age-related diseases would allow us to live our last years more independently and in improved mental, physical and psychological conditions.

Conclusion

In conclusion, we must make sure that anti-aging drugs are available for everyone and that the freedom of choice is respected. Under these conditions, anti-aging medicine has a tremendous potential to positively affect the world we live in on an economic, medical and societal level. In addition, aiming to have a healthy body for longer would only make sense if we are able to have at the same time a healthy mind. From this perspective, solving the mental health crisis would become more crucial than ever. Regardless of the many ethical points that we need to bear in mind, the anti-aging research should continue to be supported in order for us to one day live happier, healthier and longer lives!