by Patrick Cox
March 26, 2018
I had planned this week to write more about the surprising role that mitochondria play in aging. Recent discoveries in this area have convinced me that aging is not only a treatable and reversible disease, but that treatment and reversal is simpler to accomplish than anyone dared imagine.
However, a couple of recent conversations convinced me that I should write instead about the economics of anti-aging medicine.
Two different people, one a reader of this digest and the other a nationally known economist, said essentially the same thing to me. It was, “Won’t anti-aging technologies just increase Social Security and healthcare costs by keeping people alive even longer?”
I find this somewhat disturbing.
A combination of consciously directed research and completely accidental discoveries is revealing that biological age can be rolled back to keep people alive and healthy significantly longer. These discoveries will prevent suffering and frailty while delaying mortality. They will also dramatically increase GDP and fix our failing healthcare systems and fiscal health.
Because I write so much about this topic, I tend to assume that people understand these issues.
Clearly, I’m wrong.
If people with diverse backgrounds fear that new anti-aging biotechnologies are going to make our financial problems worse, I need to spend more time explaining this.
The Basic Economics of Aging
It’s not surprising that many people fear that spectacular breakthroughs in medicine will further complicate our individual and government budgetary issues. After all, this has been the case for over a century.
Until the last century, people who got serious illnesses tended to die relatively quickly. My grandfather, for example, died of a cancer that is now easily treatable. This was typical. Most cancer patients faced certain death sentences—little could be done for them but try to keep them comfortable. The same was true for many other diseases.
Before modern science developed strategies for treating age-related pathologies, a person’s first major disease was usually their last, and healthcare costs were low compared to today’s levels. Incidentally, Social Security was established under those conditions.
Today, we can prolong the lives of people with formerly terminal illnesses for many years. The problem, of course, is that doing so is extremely expensive. As more therapies come online, lifespans are extended and costs increase. So it’s no surprise that programs for the aged—such as Social Security, Medicare, and pension plans—had to substantially increase payments.
Right now, our biggest fiscal problems are directly related to this problem. As the Congressional Budget Office (CBO) keeps pointing out, the only part of the US budget that is increasing in proportion to the total is transfer payments for the aged and the debt service.
The cause, according to the CBO, is higher rates of age-related disease in a growing aged population. This is complicated by the fact that the number of workers (aka taxpayers) is shrinking.
It’s simple math, but still not generally understood. The proof: rising healthcare costs are blamed on everything but societal aging.
You may remember the statement by a prominent politician who said rising costs are driven by greedy drug companies and doctors who routinely perform unnecessary procedures, including amputations. People believe these myths despite evidence that drug costs are only 10% to 15% of total medical costs. Moreover, better diagnostic tools and shared medical records have reduced unnecessary procedures.
In fact, healthcare costs have increased because medical science is getting better at treating specific diseases. On top of that, the population of older people constantly grows, adding to the demand for disease therapies.
The Current Vicious Cycle of Aging—But It Doesn’t Have to Be Like That
Modern medicine keeps patients alive longer, creating an older population. And because the rate of disease goes up with age, the cost of healthcare goes up as well—as does the demand for more effective and expensive therapies.
In fact, the odds of getting another disease rise when a person has been successfully treated for one serious ailment.
If you’re of a certain age, you’ve seen this progression in friends or family. Once someone has had a serious disease, a cascade of complications and other diseases follow. Doctors struggle to keep aged patients alive, so medical bills go up and up. As the average age of the population increases, medical costs rise exponentially.
But that’s the way it’s always been; so that’s the way it will always be, right?
Traditional medicine has focused on minimizing the symptoms of diseases after they appear. This disease-based approach is also shared by our regulatory systems. Operating in this paradigm, the cost of healthcare will explode until our entire budget is consumed by the diseases of aging.
Fortunately, we are in the midst of a scientific revolution that can break this vicious cycle. Leading biogerontologists believe all age-related diseases are only different symptoms of one single disease: aging itself.
When these scientists use the word “aging,” they’re not talking about the candles on your birthday cake. Rather, they’re talking about the processes that destroy health, leading to a cascade of expensive diseases.
At the highest levels of biogerontology, a new consensus has emerged: the underlying conditions that lead to most age-related diseases are treatable.
This is obviously a radical departure from the conventional, disease-based medical model. Unfortunately, this new view of aging hasn’t yet filtered down to the public, healthcare practitioners, policy makers, or regulators.
We know a lot about what the world would look like if medicine addressed the processes that accelerate aging and lead to disease. This is because there are rare individuals who never experience the downward spiral of deteriorating health and rising healthcare costs. They are called super-agers, and they are intensely studied by biogerontologists.
The Goal: Make Everyone a Super-Ager
You may know people in their 90s, but they are not super-agers if they have any age-related disease. Super-agers remain vigorous and disease-free right until the very end, which usually comes at about 100 years old.
The photo below is of a 106-year-old Chinese woman.
My grandmother was a super-ager due to a variation of the cholesteryl ester transfer protein (CETP) gene, but there are many other characteristics that imbue the same benefits. She never had a serious disease until she was almost 100 years old. Then, everything seemed to wear out at once, and she passed quickly and peacefully.
Her lifetime medical costs were a tiny fraction of the average person’s because she never had serious medical problems until the very end of her life. Gerontologists refer to this phenomenon as morbidity compression.
Morbidity is the medical term for having a disease, and most people spend their last decades suffering multiple morbidities. Morbidity compression occurs when the time spent suffering from disease (and the associated medical costs) is significantly reduced.
Another way to describe morbidity compression is healthspan extension. It is critical that we understand the difference between healthspans and lifespans.
A long lifespan probably includes a productive working career that lasts 40 or 50 years. Generally, people retire around the age of 65, and it’s no coincidence that around the same time, the incidence of age-related diseases rises dramatically.
Then, thanks to disease-based therapies, people may spend two, three, or four decades suffering from arthritis, hypertension, dementia, and other diseases. So people may have long lifespans, but they spend half of their adult lives sick and unable to work.
On the other hand, super-agers like my grandmother spend only a small percentage of their lives sick. Many work until the very end of their lives. If everybody were a super-ager, Social Security, Medicare, and pension programs would all be fully funded. Enough people would choose to continue working for decades longer that it would significantly expand the labor force and create economic growth. We could pay off the federal budget, and additional capital formation would create new jobs for younger people.
It is a myth that older people who don’t retire take jobs away from younger people. There is no pipeline of jobs that promotes a younger person when an older person retires. This is primarily because all established companies go into efficiency mode and reduce employment as soon as they have achieved stable success. All net job creation comes from startups and newer companies that hire younger, more energetic workers.
When older people continue to work, they create capital and increase tax revenues. This creates, rather than destroys, jobs. It follows, therefore, that the economy would boom if we could turn everybody into a super-ager.
And in fact, we can.
It’s Not as Far Off as You Think
Though it has been largely unnoticed by the public and policy makers, there has been a revolution in medical science over the last decade or so. Leading biogerontologists are more and more convinced that aging itself is a treatable medical condition. Even very old people can be rejuvenated and given much longer, healthier lives.
The following graphic is from the article, “The aging-disease false dichotomy: understanding senescence as pathology” in the journal Frontiers in Genetics. For a more technical discussion of this subject, read the entire article. At least, however, seriously consider the title, which refutes the notion that age must lead to disease. In fact, it asserts that aging itself is a treatable pathology.
In this chart, the black triangle represents the time in a person’s life that is afflicted by disease. It also correlates to high healthcare costs. Example B represents life extension due to improvements in disease treatments. It represents what everybody is afraid of—a prolonged period in which people are sick and incurring high medical costs. This is the healthcare model that currently pushes the US government into mounting debt.
In contrast, example C shows increased healthspan, that means a longer life along with good health and productivity. That alone would solve the healthcare cost crisis by raising savings and tax revenues.
But frankly, this isn’t the optimal solution, because it shows no decrease in morbidity. That’s what we really want and what biogerontologists believe possible. If everybody’s lives looked like my grandmother’s, total healthcare costs would be much lower while savings and tax revenues would be much higher. That solves what demographers call the Old-Age Dependency Ratio (OADR) problem: not enough young people to pay the bills of an expanding older population.
This is the 800-pound gorilla in the room nobody wants to talk about. Yet we must talk about it because there are biotechnologies in labs right now that could quickly increase healthspans. In fact, several known compounds have the ability to reverse aging even in older mammals and give humans lives that more closely resemble those of super-agers.
These technologies exist. They’re not hypothetical, and they can fix the financial crisis all developed Western (and some Eastern) countries are facing. So I find it distressing when I encounter people who oppose advances in medical science because they believe new biotechnologies will be just more of the old technologies.
They are wrong. Aging can be treated, which will reduce healthcare costs, increase tax revenues, and create both capital and new jobs. There’s a rapidly growing body of research that proves this, but the big breakthrough in biogerontology came from research into the gene pathway called the mammalian target of rapamycin (mTOR).
Scientists experimenting with the natural compound rapamycin found that animals given the compound experienced longer healthspans and compressed morbidity. More importantly, very old animals saw significant rejuvenation and enjoyed nearly the same benefits as animals that received the drug throughout their lives.
This may be the most important scientific breakthrough in medicine to date. It means that geroprotectors—compounds that address the underlying processes of aging to delay and prevent disease—can produce immediate benefits even in the very aged.
Mice on the verge of death have been restored to middle age and gone on to live longer and healthier lives than untreated animals. The economic-policy implications of this discovery are enormous.
It means that health and productivity could be restored to many millions of older Americans. Globally, geroprotectors could add billions of people to the global work force and create trillions of dollars in wealth.
Gary Becker received the 1992 Nobel Prize in Economics in part for proving that increases in health translate directly into increased GDP. It is inevitable that the products of the revolution in biogerontology will eventually reach the public.
My fear is that due to political inertia, it won’t happen soon enough to prevent a global economic meltdown as the needs of the aged overwhelm national budgets. The problem is not scientific, because there are at least a half dozen therapeutics with remarkable geroprotective benefits that could be deployed in just a few years if the government allowed it.
It’s not happening now, though. Some of the companies that own these compounds don’t even want the public to know that their drug candidates are capable of addressing diseases other than the target of their clinical trials.
That’s understandable because so many people believe that aging is not a treatable disease. Biogerontologists, however, know that it is. They also know that we must treat aging to prevent a meltdown of our existing societal structures.
This has been an extremely long article, so I’ll end here. Below, you’ll find links to two articles that tell you more about the benefits of shifting from a disease-focused model to an age-focused medical model.
One seminal article, “The Longevity Dividend,” was published in The Scientist in 2006. This is a very accessible if somewhat dated explanation of geroprotective medicine.
I’ve already linked a more recent David Gems article published in 2015 in Frontiers in Genetics, “The aging-disease false dichotomy: understanding senescence as pathology.” My only problem with the piece is that it is excessively conservative in describing the benefits of anti-aging medicine.
We’re much closer to a true medical revolution than almost anybody understands. Younger people will enjoy the benefits of that revolution, though they may have to endure a demographic crisis before it happens. If you’re older, the only way to ensure that you live long enough to have your healthspan significantly extended is to start pushing for a major societal change in the way aging is viewed.