The study of biology has and continues to turn many long held beliefs on their head.
From the time of Hippocrates up to the advent of modern medicine, it was thought the body contained four “humors:” black bile, yellow bile, phlegm, and blood. And that each of these bodily fluids directly influenced our temperament and health.
There’s the more recent narrow example of ulcers. Until the 1980’s it was widely believed that peptic ulcers formed as a result of stress and poor lifestyle habits. Now there is clear evidence that 90% of ulcers are associated with the h pylori bacteria.
However, no scientific challenge to our beliefs about biology, including perhaps Darwin’s Theory of Evolution, is comparable to the one we hear about today, that we can turn back the hands of time and reverse aging.
Yes, average life expectancy has doubled in the last hundred years, mostly because scientists answered the dangers of infectious disease with antibiotics and vaccines. But the bold hypothesis that we can end aging altogether has been gaining ground in the life science industry.
What if getting older does not have to equal aging? If we go after the aging process itself, will we end all disease?
These questions provided the heart and hope of the inaugural Burrill and Buck Aging Conference held earlier this week in Novato, California, a co-production of Burrill and Company and the Buck Institute for Research on Aging.
The Buck Institute for Research on Aging
“Why do we think of aging as normal?” asked Brian Kennedy, CEO of the Buck Institute. This was a conference devoted to increasing our paradigms on the topic, so no one spoke up with the answer running through all of our minds, “uh . . . is it because everyone around us ages?”
Brian exhibited some dramatic graphs in his slides, such as the one where you see average life expectancy over the last 20,000 years. It has that long horizontal line running along the bottom all the way to the end: 10,000 BC, 5,000 BC, 100 AD, 1200 AD, to1900 AD where it begins to shoot straight up.
Brian’s other slides sport terms like “healthspan vs lifespan,” and “compressed morbidity.” And he dived into the latest research at the Buck done on mice with rapamycin which showed some pretty awesome results. This research focuses on "mTORC" pathways which are directly related to driving up the aging process.
The work of Cynthia Kenyon was understandably cited throughout the conference. In 1993, her discovery that a gene mutation (Daf-2) could double the lifespan of C. elegans ignited intensive study into the biology of aging.
Brian acknowledged that going from nematode worms to mice was a big jump, and an even bigger leap of applying the research to humans in clinical trials. Still he sounded terribly convincing. His theory goes like this. Evolution has never been focused on extending our life span. There have been so many environmental factors which have led to aging and death. Before now we didn’t really die of aging.
“Evolution didn’t deal with aging because it didn’t have to. It’s actually pretty easy,” he said casually, his slide pointer nearly outpacing his reasoning.
Will humans now be able to give evolution a hand with aging as we have with GM crops, insulin, and cloning?
The Paradigm Shift
Aubrey de Grey says “absolutely.”
He’s the CSO at the SENS Research Foundation, an organization that funds aging research around the globe, and the poster boy for “radical life extension.” He’s also the co-author of Ending Aging: The Rejuvenation Breakthroughs that Could Reverse Human Aging in Our Lifetime. De Grey has become a lightning rod in the industry for his bullish thoughts about defeating aging in the next few decades.
At a “working lunch” session, I joined the table chaired by Aubrey to hear the radical ideas which have made him such a media darling. In fact, de Grey sounded very straightforward, and downplayed his radical side. He addressed an incentive problem with science funding. Researchers aren’t willing to tackle big problems such as aging, because of the mantra that they must publish often in order to secure continued funding. Aubrey cited a researcher that SENS has been funding who was able to work on one project without publishing for three years.
Aubrey acknowledged that his main job has been to bring about a paradigm shift in the thinking toward aging, and I asked him how he’d characterize that paradigm. Is it a scientific paradigm, a philosophical one?
“In fact, it’s been easy to get scientists on board,” said de Grey, habitually twisting the ends of his ever reaching mustache and stroking his long beard. (Indeed, from his appearance, Aubrey looks as though he’s defied aging himself, coming from the time of Darwin.) He suggested that he encounters more emotional resistance than scientific, or philosophical.
A conference goer at the table spoke up about the economic problems that we are already seeing and would become much worse when we are all staying around longer.
“How will young folks find a job when the older ones aren’t giving their own up?” came the question.
“Thank you for the question,” replied Aubrey, continuing with his more characteristic acerbic style, “but is that your real question, because I can answer that in about ten seconds.”
Most people respond to the idea of radical life extension with all kinds of questions about this or that issue, says de Grey, but mostly it is just to resist opening their minds. They’re masking a deep emotional response.
Both Brian and Aubrey insist that there should be a re-prioritization in the industry toward funding research on aging itself. According to Brian, less than 1% of the NIH budget goes to research on aging. Aubrey says we currently employ a “divide and conquer” strategy with disease, but that our resources would be better spent on the biological causes of aging because aging leads to the many diseases.
Later this week I attended a Big Data conference at Stanford and asked several researchers whether we should reallocate resources toward aging research. I couldn’t get any opinions on NIH funds, but the consensus was that we should try many different approaches.
Mike Snyder, the Director of the Stanford Center for Genomics and Personalized Medicine, and a recent guest at Mendelspod, pointed out that most medical breakthroughs such as that of penicillin came about by chance, even accident.
"There's great value in these more open ended projects," he said.
The Healthcare Burden
In his opening address to the meeting, Steve Burrill covered the broader context around aging and what it means for healthcare around the world. With his carpet bombing of facts and figures, Steve’s talks always build up a terrible impending disaster and end with hope. He’s an investor and wants to spur entrepreneurs to innovate.
Most of the numbers had to do with the growth of the aged population and the enormous burden this is putting on healthcare.
- In the year 2000, there were 605 million people over the age of 60. In 2050, there will be 2 billion.
- The majority of healthcare spending on a person happens in the last year of life.
- In four years the cost of healthcare in the US will almost double.
To help him build his case and pursue ideas for new models, Steve invited Dr. David Lawrence, former CEO at Kaiser Permanente on stage for a discussion.
“Ten years ago, nobody wanted to be Kaiser. Now everyone does,” asserted Steve in his introduction of David. Kaiser has built a successful healthcare business by being both payer and provider, caring for people from the “cradle to the grave.”
“Our current healthcare model is not working,” the former Kaiser CEO asserted immediately. “It was created in the nineteenth century for a different world, a world of infectious disease. And there is too much waste, the most common of which is when patients ping pong through the system. Fifty cents on every dollar is spent on waste.”
Steve then pushed the discussion into new ways to take advantage of technologies such as mobile phones and social media that are connecting people like never before. When asked whether the new “retailization” of healthcare (quick care centers set up at big retail stores such as Walgreens and CVS) would threaten established models such as Kaiser’s, David replied that he didn’t think so.
“Innovation will not happen at Kaiser. It’s just too big. Too many people and levels involved to make any changes,” he said, adding, “and I hope the new retail centers have a chance to innovate before they are eaten up by the big providers.”
It was mentioned that governments are becoming more active in determining the value of healthcare products, such as pharmaceuticals. But just how the new models in healthcare were going to solve the problem of the growing aged population was not that clear. One thing that everyone agreed upon: let’s raise the age of retirement.
It’s a bold move to produce a conference on the topic of aging. While many of the other pioneers of the biotech industry have “cashed in” and get together for “look back” sessions, Steve Burrill is keeping his eye on the future. Steve is sometimes criticized in the industry for being heavy handed. But this a joint effort on a glaring topic, the first industry conference on aging research that I’ve seen.
“This is mankind’s greatest moment,” said Steve with a fire in his eyes. And I think he believes it.
I asked Steve and David to talk about whether healthcare would become increasingly stratified between rich and poor as we solve the science of aging. And what they thought of the mantra that healthcare is a right.
Steve confirmed right away that healthcare would indeed be stratified, but not in ways we’d expect. There will be some “playing God” who will be able to dole out healthcare. But who that will be is not yet known. “And let’s not be naive and think if we get the science right, it’ll just happen,” he cautioned.
David chose to tell his own cautionary story about how we value our health and what science may or may not solve, what money may or may not buy. It was a tale he’d heard from a friend recently about an old fellow who owned an olive farm in Greece. The old guy would sit each day in front of his olive trees in the sun and smoke his cigarettes. One day a younger man came up and asked the older man why he doesn’t sell his orchard to developers and make a fortune. The old man replied, because I’m happy sitting here on this rock smoking in front of my olive farm.
Sure, let's search for the answer to a longer life, the former Kaiser CEO seemed to suggest, and not forget that happiness still trumps all.