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Is aging a disease?

95 pointsby kenhtyabout 13 years ago

18 comments

reasonattlmabout 13 years ago
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.<p>(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).<p>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.<p>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:<p><a href="http://sens.org/sens-research/research-themes" rel="nofollow">http://sens.org/sens-research/research-themes</a><p>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.<p>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.<p><a href="http://www.fightaging.org/archives/2012/04/the-fda-is-a-destructive-force.php" rel="nofollow">http://www.fightaging.org/archives/2012/04/the-fda-is-a-dest...</a><p>For more reading on the "is aging a disease" thing, you might look at:<p><a href="http://www.fightaging.org/archives/2010/05/talking-point-is-aging-a-disease.php" rel="nofollow">http://www.fightaging.org/archives/2010/05/talking-point-is-...</a><p>"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.<p><a href="http://www.fightaging.org/archives/2009/07/sage-crossroads-podcasts-on-the-pharmaceutical-industry-and-aging.php" rel="nofollow">http://www.fightaging.org/archives/2009/07/sage-crossroads-p...</a><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."<p>...<p>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.
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AngryParsleyabout 13 years ago
Let's use some criteria from <i>Diseased thinking: dissolving questions about disease</i> (<a href="http://lesswrong.com/lw/2as/real_diseases_unasking_the_question/" rel="nofollow">http://lesswrong.com/lw/2as/real_diseases_unasking_the_quest...</a>).<p>1. Biological? Yes<p>2. Involuntary? Yes<p>3. Rare? No<p>4. Unpleasant? Yes<p>5. Discrete? No<p>6. Medicable? Yes<p>So aging has many aspects of what we call disease. Of course, the implied question that everyone cares about is is, "Will humanity be better off if we devote more resources to curing aging?" The answer to that brings much more baggage, and depends on your moral and religious views.
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evo_9about 13 years ago
Reminds me of this excellent read about how our perception of age and dying taints our ability to even consider it a problem we can work on and correct:<p><a href="http://www.nickbostrom.com/fable/dragon.html" rel="nofollow">http://www.nickbostrom.com/fable/dragon.html</a>
fossuserabout 13 years ago
The following is more tangentially related to the article then a direct comment about the interesting points it makes.<p>An interesting hypothesis I read about aging was that it's an anticancer mechanism necessary to become old enough to reproduce.<p>The cellular metabolic process creates a lot free radicals that cause damage, while the body has built in mechanisms to repair the damage at high rates of replication the chance of damage resulting in turning on an oncogene increases.<p>In order to combat this the body slows down its division process to prevent the likelihood of cancer but as a side effect we experiencing the symptoms of aging and inevitable death (usually by cancer if you live long enough to get it).<p>Not sure if any of this is accurate, but the idea is interesting and something I hadn't thought of. It also introduces problems since if at all accurate trying to prevent aging may result in higher cancer risk.<p>Talk of this also reminds me of a quote I like (from <a href="http://hplusmagazine.com/2011/07/13/longevity-science-needs-documentation/" rel="nofollow">http://hplusmagazine.com/2011/07/13/longevity-science-needs-...</a>):<p>"We all express the symptoms of a fatal, inherited degenerative condition called aging - or so the joke goes. It's a dark joke, but there's truth to be found in it, as is often the case in black humor. Unfortunately, all too few people think of themselves as patients suffering aging, and fewer still would call themselves patient advocates, agitating for research leading towards therapies and cures for aging. This is a sorry state of affairs: given that our time is limited and ticking away, the tasks upon the table should always include some consideration of aging.<p>What can we do about it? How can we engineer a research community, funding and support to make real progress within our lifetimes? If you don't spend at least some of your time on this issue, then you're fiddling while Rome burns. Time is the most precious thing we have, and we live on the cusp of technologies that will allow us to gain more of it - but those advances in medicine won't happen soon enough unless we work at it."
tokenadultabout 13 years ago
Thanks for submitting the interesting article, and thanks for the interesting comments already posted by various HN participants. I'll respond generally to those in this comment.<p>From the article: "A study published last year by Danish researchers estimated that more than half of all babies born in wealthy nations since the year 2000 will live to see their 100th birthdays."<p>I had the privilege of reading that study, "Ageing populations: the challenges ahead," Lancet. 2009 October 3; 374(9696): 1196–1208. doi: 10.1016/S0140-6736(09)61460-4<p><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2810516/" rel="nofollow">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2810516/</a><p>and then discussing it with one of the collaborators of a study author in a "journal club" at my alma mater university. Detailed studies of life expectancy at advanced age in a variety of countries show that various lifestyle changes and other changes result in a worldwide trend of increasing lifespan, such that "Very long lives are not the distant privilege of remote future generations—very long lives are the probable destiny of most people alive now in developed countries."<p>The top-ranked HN comment as I post my comment here says, "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." The comment has already been challenged by a knowledgeable participant here as not fully accurate,<p><a href="http://news.ycombinator.com/item?id=3968515" rel="nofollow">http://news.ycombinator.com/item?id=3968515</a><p>and in any event is not relevant to the worldwide research effort (exemplified by the study I have linked here) into the worldwide trend of longer lifespans in the developed world, because the FDA regulates medical treatments only in the United States. (I have lived in a developed country other than the United States, and am well aware that many treatments that are not approved in the United States are prescribed by physicians in other countries and researched by researchers in other countries.) The FDA is not shortening lifespans in the United States, despite what some advocacy organizations say to the contrary.<p>I have had multiple ancestors who were born in the 1800s live into their nineties. And my wife's ancestors, born in a poor country then in the undeveloped world, managed to have quite long lifespans. So we are accustomed in our family to thinking about the implications of long lifespans. Oddly, heritability of longevity is actually LOWER than the heritability of most measurable human characteristics.<p><a href="http://www.nytimes.com/2006/08/31/health/31age.html?_r=1&#38;pagewanted=print" rel="nofollow">http://www.nytimes.com/2006/08/31/health/31age.html?_r=1&#38...</a><p>It could be that anyone, even someone without much of a family history of long life span, might meet the prediction of the study linked above that a young person born after the year 2000 in a developed country is as likely as not to live to the age of 100.<p>Thus far we are making incremental progress, all over the world in a variety of human societies, increasing human lifespan and life expectancy at most ages. Meanwhile a number of forms of fundamental biological research are still just in their beginning stages. In particular, the issue of "missing heritability" in disease research<p><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2831613/" rel="nofollow">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2831613/</a><p><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3059431/" rel="nofollow">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3059431/</a><p>suggests that we have a long way to go to identify biological pathways in living human beings that make a difference in how long individual human beings live. The ongoing progress of science-based medicine<p><a href="http://www.sciencebasedmedicine.org/index.php/category/science-and-medicine/" rel="nofollow">http://www.sciencebasedmedicine.org/index.php/category/scien...</a><p>is slower than desirable partly because all human researchers, in whatever regulatory environment, struggle to overcome their own cognitive biases as they attempt to determine what treatments work in reducing all-cause mortality and morbidity. And the huge role of lifestyle factors in mortality and morbidity<p><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658866/" rel="nofollow">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658866/</a><p><a href="http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000058" rel="nofollow">http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fj...</a><p>suggests that as causation of disease and early death becomes more clear, we will not necessarily find that all human beings choose to reduce their risk of early death to the same degree.<p>To sum up, the submitted article was quite interesting. It reports, "There is now a "groundswell" of specialists in aging, says Dillin, who are lobbying the world's biggest drug regulator, the U.S. Food and Drug Administration, to consider redefining aging as a disease in its own right." If by "aging" those lobbying scientists mean "all-cause morbidity and mortality," that could be a good reality check on outcome studies of treatments for specific diseases. As it is now, people are living longer, year after year after year, and in some places they seem to be living to a healthier old age than ever before. Continuing that trend is a likely outcome of ongoing efforts both to evaluate disease treatments more scientifically and to understand better at a fundamental level how human physiology works.
mlinksvaabout 13 years ago
Story is 2 years old. <a href="http://www.americanscientist.org/issues/id.12809,y.2011,no.4,content.true,page.1,css.print/issue.aspx" rel="nofollow">http://www.americanscientist.org/issues/id.12809,y.2011,no.4...</a> is slightly newer more in depth treatment by David Gems, the person quoted.<p>More similar via <a href="https://encrypted.google.com/search?q=site%3Afightaging.org+%22david%20gems%22" rel="nofollow">https://encrypted.google.com/search?q=site%3Afightaging.org+...</a>
TazeTSchnitzelabout 13 years ago
Betteridge's Law of Headlines - <a href="http://en.wikipedia.org/wiki/Betteridge%27s_Law_of_Headlines" rel="nofollow">http://en.wikipedia.org/wiki/Betteridge%27s_Law_of_Headlines</a><p>"Any headline which ends in a question mark can be answered by the word 'no'".
espeedabout 13 years ago
Something I noticed the other day: Genesis 6:3 says, "My Spirit will not contend with humans forever, for they are mortal; their days will be a hundred and twenty years" (<a href="http://www.biblegateway.com/passage/?search=Genesis+6%3A1-4&#38;version=NIV" rel="nofollow">http://www.biblegateway.com/passage/?search=Genesis+6%3A1-4&...</a>).<p>Interestingly, if you look at the list of the verified oldest people, only one is over 120 years (<a href="http://en.wikipedia.org/wiki/List_of_the_verified_oldest_people" rel="nofollow">http://en.wikipedia.org/wiki/List_of_the_verified_oldest_peo...</a>).
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delinkaabout 13 years ago
There was some research headlined on HN within the last year that suggested aging was nature's response to cancer. Something like: if our cells replicated at a "young rate" for all our lives, replication mistakes would have us dying of cancer at a higher rate. So nature slows down cell replication to prevent cancer growth.<p>I'll try to find the link. Feel free to reply with such if you find it before I do.
lsparrishabout 13 years ago
I think that if a cure for aging is invented tomorrow, I won't be able to benefit from it. Why? Because it will <i>still</i> be in clinical trials by the time I die.<p>The simple solution is to pour money (and lots of it) into the goal of clinically reversible cryonics. At low temperatures, aging vanishes along with all other metabolic activity -- cancer, viral infection, and so forth would all be stopped in their tracks. This buys precious time that can be used to develop a cure for pretty much <i>any</i> condition whatsoever.<p>Cryonics could also be cheap. The energy costs for a large scale cryonics facility are much lower than for small-scale due to the square-cube law. (Square the surface area and you get a cube of the volume, for any shape of container.) So the more the merrier.
SonicSoulabout 13 years ago
isn't it necessary for evolution? Also to keep a balanced variety of species in a self sustaining system such as earth. I suppose without aging, population control would fall squarely on parasites (such as viruses), plagues, natural disasters, and wars over domination of limited resources. Actually i suppose we could be wired differently where organisms don't feel a need to have as much offspring.. But that reinforces the evolution problem.
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MikeCaponeabout 13 years ago
Whatever you call it, it's terrible and it's fixable (like other diseases), so we should work on it.
jakeonthemoveabout 13 years ago
I never understood why the FDA won't approve drugs that improve an aspect of our body, but only those that treat something.
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diminishabout 13 years ago
Yet another title with question mark. Aging appears to be more of a feature and not a bug of organic life.
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kibaabout 13 years ago
Aging also kills. So we'll be living longer life and healthier life if we find a cure for aging.
dacilseligabout 13 years ago
Am I to assume that since the title ends with a question mark that the answer is no?
jackhoyabout 13 years ago
You can help raise awareness of this issue here: <a href="http://questions.sciencedebate.org/forums/149344-the-top-science-questions-facing-america-2012-edi/suggestions/2693427-should-the-united-states-fund-a-war-on-aging-" rel="nofollow">http://questions.sciencedebate.org/forums/149344-the-top-sci...</a>
orthecreedenceabout 13 years ago
It really makes me <i>sick</i> to my stomach that so many people spend the time and resources on "figuring out" aging and how to stop it. Humanity's #1 problem is overpopulation. So let's...make everyone...live longer??<p>We don't need to stop or slow down aging. We need to accept the fact that everything that's alive eventually dies. "When" is arbitrary (with the exception of people under 30 dying). Prolonging the inevitable is a waste of resources, and an enormous burden on society.<p>All these horrible diseases we get when we get older are a product of the fact that our bodies exist for so long. Normally, we'd just die, but modern medicine keeps the body alive so the mind can rot instead. <i>But at least you're alive!!!</i> Also, if people are retiring at 65 and living to be 120, then everyone who is <i>actually productive</i> has to support all these bags of living organic tissue hooked up to machines for another 60 years. For what purpose?<p>You're born. You grow up. You have children. You retire. Then you die, and you make room for everyone else. This is one thing we don't have to sit around questioning. Nobody deserves to live forever. This whole "I have to live longer!!" ego trip is sickening.
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