Chapter 164
Changing Aging — 1
Have you visited the longevity lifespan circus lately? There are eight hundred longevity clinics in the United States—even at the prestigious Mayo Clinic—so they are hard to miss. Some charge up to $50,000 per week. There are longevity vacations with intravenous drips; “Rejuvenation Olympics”; a Fountain Life “country club for precision diagnostics”; fitness centers with intravenous antiaging drips; an X-Prize awarding over $100 million to restore at least a decade’s worth of muscle, brain, and immune function in older adults; and stem cell clinics for longevity. There are carnival barker scientists making false claims and hawking supplements as well as longevity leader lists for what dose of rapamycin they are taking to extend their lifespan. There’s an outspoken forty-seven-year-old centimillionaire taking over 110 supplement pills a day, monitoring his organs (which includes a penile-ring erection sensor) with a staff of thirty medical specialists, spending more than $2 million for food each year for a precise daily intake of 1,977 calories, who has received plasma infusions from his teenage son, along with gene therapy.
Then there are the many hundreds of companies developing drugs or interventions to promote lifespan or selling biomarkers to track one’s biological age. Many high-profile billionaires, such as Jeff Bezos, Sam Altman, Yuri Milner, and Peter Thiel, are betting big on some of these companies. I don’t claim to have any special access to the motivations of these successful businesspeople, but I am reminded of a line from Venki Ramakrishnan in Why We Die: “When they were young they wanted to be rich, and now that they’re rich they want to be young.” These entrepreneurial investments aren’t likely to settle down anytime soon because we’re seeing some real progress in understanding the science of the aging process. Unfortunately, that has led to irrational exuberance in many dimensions. In this chapter, I’m hoping to set the record straight on what we know, what we don’t know, and how likely it is we’ll be able to modulate the aging process to some extent one day. Not yet.
It is true that we are in the midst of changing our perception of what “old age” means. For a start, there are simply more centenarians around. There were 120,000 people aged one hundred and older in the United States in 2024, and that number is expected to rise to about 600,000 by 2060. Unlike our healthy aged exemplar, Mrs. L. R., there’s little evidence we’ve conquered frailty—we seem to be as vulnerable to age-associated decline as ever. In fact, more so. The result of more people getting older with multiple chronic conditions.
According to the World Health Organization, the average American celebrates just one healthy birthday after the age of sixty-five. That seems bleak, but another way to express this acceleration of morbidity with older age is by the number of chronic conditions. For Americans aged sixty years and above, 95 percent have at least one chronic disease, such as heart disease or diabetes, and 79 percent have at least two chronic conditions. Life expectancy in the United States is starting to come back with a small increase after the COVID pandemic but is still below its peak a decade ago, and well below many peer countries in western Europe and Asia.