Chapter 190
The Path Forward — 2
One of the other obstacles that holds back a drug or intervention to promote lifespan is that aging is not considered a disease by regulatory agencies. You will recall that obesity was not considered a disease until the GLP-1 drugs emerged, which radically altered our perception of this condition. The same might eventually occur with aging, but it’s different because aging is universal, whereas obesity is not. Both are linked with a wide range of diseases. We’ll have to see what effect that evidence, while currently lacking, has in the future. It is likely that preventing a specific age-related disease will comprise the evidence someday, even though that does not equate with body-wide slowing of aging.
We have little data to support that slowing the aging process leads to a “compression of morbidity,” the concept initially proposed by James Fries in the early 1980s. It can be likened to the 1858 poem by Oliver Wendell Holmes about the horse carriage, “The Deacon’s Masterpiece or the Wonderful One-Hoss Shay”:
Have you heard of the wonderful one-hoss shay,
That was built in such a logical way
It ran a hundred years to a day,
And then, all of a sudden it
..........
How it went to pieces all at once,
All at once, and nothing first,
Just as bubbles do when they burst.
Fries proposed that over time we are moving toward an “ideal survivorship curve,” meaning that we extend healthy aging and there’s minimal time for chronic illness (fig. 13.1, left panel), as if a person suddenly falls off the cliff or dies with intact health in their sleep. This same concept was also popularized by Peter Attia in his book Outlive as “Medicine 3.0” (fig. 13.1, right panel).
Ray Kurzweil, who believes that the first person who will live to one thousand years has been born, is a big proponent of “longevity escape velocity,” as he wrote about in the Economist and his book The Singularity Is Nearer. The idea, introduced a couple of decades ago, is that eventually medical advances will outpace life expectancy. Kurzweil believes that annual increases in life expectancy will reach twelve months between 2029 and 2035, “at which point ageing [for people] will not increase their annual chance of dying.” Things just don’t move at such velocity in medicine. But, again, expanding longevity does not equate to living longer with fewer years of chronic illness.
Figure 13.1. Theoretical compression of aging. Ideal survivorship curve proposed by James Fries (left panel) and Medicine 3.0 curve proposed by Peter Attia (right panel). Adapted from James Fries, “The compression of morbidity,” Annals of the Academy of Medicine of Singapore 12, no. 3 (July 1983): 358–67 (left panel); and Peter Attia, Outlive: The Science and Art of Longevity (New York: Harmony, 2024) (right panel).