Chapter 191
The Path Forward — 3
While it would be ideal for people who made it healthy well into their eighties or nineties not to have to suffer dementia, cancer, cardiovascular disease, or frailty for many years, it’s hard to find any support for this concept. Perhaps the only finding backing this comes from the New England Centenarian Study on the rarefied group of supercentenarians (age 110 and older) who were healthy throughout their lives and did not exhibit disability in their last years. There’s no evidence yet for safely and effectively slowing the aging process in human beings. Until proven otherwise, we should assume that expanding health span or slowing aging simply defers morbidity rather than compresses it.
Notwithstanding these difficulties, I do believe we will ultimately see body-wide modulation of aging. We have many different promising shots on goal, huge resources being expended, and acceleration of drug discovery efforts with AI. We have seen with the GLP-1 drugs how, despite decades of blatant failures, it was ultimately possible to tackle one of the most profound medical challenges of all—obesity. And it would not be at all surprising that a derivative of that drug class pays dividends for extending health span. That’s in the cards for the future, not now.
Here is where the excitement is well founded and near term. We are going to see major progress in prevention of age-related diseases and preserving organ-specific health. We’re now entering a golden time when we’ll be doing that on an ever frequent and impactful basis. That’s because most age-related diseases have a long warm-up period of at least one to two decades before symptoms manifest. With biomarkers, polygenic risk scores, proteins, genome sequencing, imaging, and multimodal AI, we are gaining unprecedented power to identify high-risk status at the individual level. Not just identify high risk but do so early in a person’s life and predict the timing of when the condition may begin to manifest. AI appears to be capable of reliably predicting tipping points before they happen in complex systems, and the human body surely qualifies as a complex system.
This precision medical forecasting allows for intensive lifestyle+ factors to be put in place for the individual, along with tight surveillance with biomarkers such as protein organ clocks, cell-free tumor DNA in the plasma, inflammation, gut microbiome constituents, or appropriate imaging aligned with the condition of concern. This strategy is new and awaits validation, but it is a less ambitious, more realistic and attainable one than changing body-wide aging.
In the meantime, there’s no hard line between modulating whole-body aging and targeting a specific organ’s aging. We know GLP-1 drugs can help prevent diabetes and heart failure in people with obesity, among other organ effects. You could interpret that as having multiorgan benefit. Maybe this family of drugs favorably affects the aging process throughout the body. We’ll eventually find out. Likewise, a potent anti-inflammatory drug or partial epigenetic programming could be used to target an organ but might wind up slowing the aging process throughout the body. On the other hand, a body-wide directed aging intervention may only slow the pace of aging in one organ. For now, organ-specific interventions can be considered as building on what we know, de-risking the safety concerns for being overly aggressive. If we could prevent the major diseases that are age-related, that would be a monumental achievement. I’m convinced that is now possible.