This is a question that crops up regularly - and it does so entirely because of the regulatory structure that exists in much of the Western world, such as that imposed by the FDA. In essence the FDA only approves medicines for specific, recognized, named diseases. Therefore you cannot legally, commercially treat aging in the US, as aging is not recognized by the FDA as a disease, and there is no path towards reversing that situation.
(Though let us be clear, the idea of a named disease is a nebulous entity: "Alzheimer's" probably covers at least three distinct conditions, for example, and it's much the same for Parkinson's and many other diseases that were named early and only now are being split out into their various etiologies. Ultimately at the level biotech is moving into now, names for collections of symptoms and similar-looking damage go away in favor of treating specific mechanisms that get you there).
To show just how much of a cost the FDA imposes just by this regulatory aspect, you might look at sarcopenia: it has cost millions of dollars and years to date and will cost millions and years more to lobby the FDA (meaning put dollars into the pockets of lawyers and appointees) to recognize sarcopenia as a condition. Until that happens, there will be no serious commercial research into the numerous potential mechanisms and therapies, because you can't sell the results in the US.
Now multiply that by the thousands of potential named conditions you could carve off the bulk of mechanisms that is called aging. Look at the SENS Foundation research pages for a primer on the underpinnings:
So given this ridiculous state of affairs, pretty much par for the course for big government, therapies for aging will never happen in the US for so long as the present regulatory structure exists, and for so long as there is no massive medical tourism and global research and development exchange devoted to circumventing it. That latter community is only just getting started, when considered in the grand scheme of things.
But most people are blind to all of this, and think that the FDA is actually a force for good - because they don't see the opportunity cost and the progress that didn't happen. In fact, the FDA and its equivalents overseas are the biggest obstacle to significant medical progress in this age of revolutionary advances in biotechnology.
"Because aging is not viewed as a disease, the whole process of bringing drugs to market can't be applied to drugs that treat aging. This creates a disincentive to pharmaceutical companies to develop drugs to treat it," said Gems.
Why, despite the great range of potential applicable biotechnology, do we not see hundreds of millions of dollars invested in startups attempting to address the aging process? The answer is buried in this New York Times article on Sirtris: "Dr. Westphal and Mr. Sinclair stress that they are not working to 'cure' aging, a condition that, so far at least, is common to all humanity and that most physicians do not consider a disease. 'Curing aging is not an endpoint the federal drug agency would recognize,' Dr. Westphal says dryly. Instead, both men say, they are working to ameliorate the diseases of aging."
...
LARRY MILLER: [When] I was heading aging at Glaxo Smith Kline, the issues that I faced were that I was very interested in developing medications for frailty and weakness in muscle for when people get old because when people get weak they usually stop eating and then they fall and break a hip and end up in the hospital and die potentially, but the regulatory apparatus isn't there yet. Sarcopenia isn’t recognized as an official disease by the FDA, so the pathway to get drugs approved for frailty and to get more people mobile and into society is just not there.
Sort of connected to this, but from the other end, our requirement to classify everything as a disease has pretty terrible repercussions across society.
As an example, my mum's a doctor and has worked in wards in which old people die. There's a requirement for a "cause of death" for each person to die in a hospital. Often this was given as pneumonia or similar for people who essentially died of old age. Unfortunately, someone looked at the statistics and discovering that lots of people were dying of pneumonia decided that it needed to be treated, and so now with aggressive treatments people who are at the very end of their lives are kept alive until something else comes along and kills them. The reality is, once your body has reached a certain point likelyhood of survival falls very quickly, and treating a single disease is simply a very brief and ineffective way of dealing with that.
Interestingly, although human lifespan has been increasing year on year, it's not an indication that we're actually living longer. What's happened is that things that kill you in early to mid life - heart attacks in 50 year olds, viruses and infections and injuries that 20 years ago would have been deadly - have been reduced. The outlook in terms of years of life for someone that actually manages to reach 80 or 90 has increased very little - perhaps 1 or 2 years over the last 50. (I read this somewhere but I've lost the source - I'll try and find it).
The single thing to treat, the thing that is the precursor to all other things, is ageing.
The single thing to treat, the thing that is the
precursor to all other things, is ageing.
I do not agree. My grandfather died at 99 years old. He was able to work his land until 98, lived a full life and died with no regrets. We were sad of his passing, but we accepted his death and were happy that he died fast, without much struggling.
You know what's really sad? A 22 year old boy dying of an unnoticed heart disease that led to a sudden cardiac arrest. This happened to an acquaintance of mine and it was freaking sad, as this boy was robbed of a chance to live his life.
Ageing is not the problem. The problem is that we are nowhere close to treating chronic diseases like cancer or heart diseases. The problem is that we don't even know for sure the cause of obesity or diabetes, passing baseless assumptions and flawed studies around that cause more harm than good. The problem is that we have no idea how to treat allergies and based on recent trends allergic asthma will soon be considered an epidemy. The problem is that we haven't even cured the freaking common cold.
Medicine, as far as I'm concerned, is still at the stage of alchemy. Dreaming of increasing the maximum lifespan or even of immortality is a romantic notion, but I would be happy if young people had a chance of living their life, instead of dying of diseases that have been around forever.
I think your simple way of looking at this is actually part of the problem.
If you want to get beyond the alchemy stage then more money needs to be put into research. For some people, ageing is a problem and they will spend lots of money to alleviate the symptoms, and to prevent a "premature" death.
There are many companies who will invest lots of money in an effort to capture this segment of the population. By doing the basic research for one segment, you are actually building a foundation of knowledge that will benefit all segments. For example, a device that can monitor the heart of an 80 year old can also be used on a 20 year old.
People had healthier lives even until a while back. I agree life expectancies were less. But that is because of wars and epidemics.
People would live in binary conditions. Healthy or dead. Unlike today people are left hanging in between, without total cure, and at the same time without good quality of life after treatment.
Organ transplants in my country(India) and other fatal diseases are worse than death. In fact death is more preferable than miserable conditions where a person is half cured. Its like the body wants to die, but is just chemically alive. Its expensive too.
This is the biggest failure of current day medicine.
Young people dying is sad, but it's also uncommon in the west. My grandfather died at 85. At that age, death can be in the form of almost anything. Complications from fevers, urine infections, the onset of age related diseases. It's amazing just how quickly someone that age can go from a physically and mentally alert person to death.
The root cause of all that is ageing. Your grandfather is certainly the exception. Ageing weakens the immune system, it leads to cell death, it increases the likelihood of cancer, it increases the likelihood of alzheimers, it leads to brittle bones and muscle wastage.
Chronic diseases like cancer and heart disease are caused by ageing. Yes, sometimes young people suffer from these, but they're exceedingly rare. If you consider it a goal to increase the lifespan of your population as a whole, you change that by targeting the things that affect everyone. 0.6% of all cancers are diagnosed in the 15-24 age group. If that rate was kept up for life to 100, cancer rates would be 6% of what they are now. 55% of people in the same age group are killed in car crashes or by guns (in the US). If you want to save lives, that's where you focus.
The life expectancy increase in old age is actually better than you say, and that may be due to great improvements in treating heart disease and cancer.
It is true, however, that the bulk of historical increases in life span at birth are due to the reduction in infectious disease burden. Infectious disease both kills people young and adds systematic damage to the survivors such that their life expectancy is reduced.
So the progress [in life expectancy prior to 1950] was largely due to saving lives below age sixty-five, especially children.
But after 1950 the improvements to life expectancy have largely been due to saving lives after age sixty-five, to this extension of life, to this giving - adding years to the life of older people.
So it's been a remarkable shift, and the shift has been due to the fact that since 1950 we've had various kinds of interventions that could help save people from heart disease, that could intervene with various infectious diseases that were killing very old people, so the antibiotics and so on helped older people a lot.
> Therefore you cannot legally, commercially treat aging in the US, as aging is not recognized by the FDA as a disease, and there is no path towards reversing that situation.
If the FDA doesn't regard aging as a disease, then any treatments devised to prevent or reverse aging are not treatments for any disease; so wouldn't the FDA, under this policy, have no role whatsoever in regulating aging treatments?
Not considering aging a disease would seem to put anti-aging products entirely outside the FDA's reach.
Nope. Treatments would almost certainly involve synthetic drugs, which are prohibited by the FDA unless approved. But they can't get approved because of some Puritan regulation (thou shalt not use medical science to improve thy life, only to treat diseases). Yaay moralizing bureaucracy!
SENS isn't exactly trying to "cure ageing" they are trying to "make old people healthy". The side effect of that would be that you don't die. All the causes of ageing are things that can be re-framed as diseases of old age, and attacked as such.
The current system is a complete farce. The vast majority of chronic illnesses that western medicine purports to treat don't even exist in any meaningful sense, they're just made up in order to make the medical system seem more 'scientific' in order to make money and justify taking away people's freedom.
In essence the FDA only approves medicines for specific, recognized, named diseases
This reminds me of Melanotan[1], a drug developed by the University of Arizona to boost skin pigmentation in order to reduce the chances of skin cancer. The only way that testing and approval can proceed is for it to be applicable to the treatment of a specific disease, and prevention doesn't count.
The FDA advisory panel recommended last week that Truvada be approved for prevention of HIV[1]. Low molecular weight heparin (enoxaparin) has been approved for the "prevention of deep vein thrombosis" for years.[2]
In other words, the following:
> The only way that testing and approval can proceed is for it to be applicable to the treatment of a specific disease, and prevention doesn't count. (emphasis mine)
Well, they can say that anti-aging treatments are just supplements for "healthy aging", since such treatments don't cure a specific disease and supplements don't have as many regulations as medical drugs. The bonus is that these supplements would actually work as advertised as opposed to vitamin pills.
Good luck trying to convince the FDA that a gene therapy to allotopically express mitochondrial genes throughout the patient's cells and add suitable RNA mechanisms to transport the relevant gene products back to the mitochondria again is a supplement.
The FDA is already trying very hard to regulate the supplement industry in any case - that's a lucrative battle for lobbyists these past few years. The moment that it looks like "real medicine" is being marketed as supplements, the FDA will gain its mandate to regulate supplements and suddenly you won't be able to freely buy them anymore. That is pretty much the endgame anyway, given the rapacious ratcheted growth of government in the US, but there are certainly ways in which it could be accelerated.
(Though let us be clear, the idea of a named disease is a nebulous entity: "Alzheimer's" probably covers at least three distinct conditions, for example, and it's much the same for Parkinson's and many other diseases that were named early and only now are being split out into their various etiologies. Ultimately at the level biotech is moving into now, names for collections of symptoms and similar-looking damage go away in favor of treating specific mechanisms that get you there).
To show just how much of a cost the FDA imposes just by this regulatory aspect, you might look at sarcopenia: it has cost millions of dollars and years to date and will cost millions and years more to lobby the FDA (meaning put dollars into the pockets of lawyers and appointees) to recognize sarcopenia as a condition. Until that happens, there will be no serious commercial research into the numerous potential mechanisms and therapies, because you can't sell the results in the US.
Now multiply that by the thousands of potential named conditions you could carve off the bulk of mechanisms that is called aging. Look at the SENS Foundation research pages for a primer on the underpinnings:
http://sens.org/sens-research/research-themes
So given this ridiculous state of affairs, pretty much par for the course for big government, therapies for aging will never happen in the US for so long as the present regulatory structure exists, and for so long as there is no massive medical tourism and global research and development exchange devoted to circumventing it. That latter community is only just getting started, when considered in the grand scheme of things.
But most people are blind to all of this, and think that the FDA is actually a force for good - because they don't see the opportunity cost and the progress that didn't happen. In fact, the FDA and its equivalents overseas are the biggest obstacle to significant medical progress in this age of revolutionary advances in biotechnology.
http://www.fightaging.org/archives/2012/04/the-fda-is-a-dest...
For more reading on the "is aging a disease" thing, you might look at:
http://www.fightaging.org/archives/2010/05/talking-point-is-...
"Because aging is not viewed as a disease, the whole process of bringing drugs to market can't be applied to drugs that treat aging. This creates a disincentive to pharmaceutical companies to develop drugs to treat it," said Gems.
http://www.fightaging.org/archives/2009/07/sage-crossroads-p...
Why, despite the great range of potential applicable biotechnology, do we not see hundreds of millions of dollars invested in startups attempting to address the aging process? The answer is buried in this New York Times article on Sirtris: "Dr. Westphal and Mr. Sinclair stress that they are not working to 'cure' aging, a condition that, so far at least, is common to all humanity and that most physicians do not consider a disease. 'Curing aging is not an endpoint the federal drug agency would recognize,' Dr. Westphal says dryly. Instead, both men say, they are working to ameliorate the diseases of aging."
...
LARRY MILLER: [When] I was heading aging at Glaxo Smith Kline, the issues that I faced were that I was very interested in developing medications for frailty and weakness in muscle for when people get old because when people get weak they usually stop eating and then they fall and break a hip and end up in the hospital and die potentially, but the regulatory apparatus isn't there yet. Sarcopenia isn’t recognized as an official disease by the FDA, so the pathway to get drugs approved for frailty and to get more people mobile and into society is just not there.