Daniel Perry, Gregory Fahy and Michael West at Aging 2008 in Los Angeles
Daniel Perry, Executive Director of the Alliance for Aging Research in Washington, D.C. heads the leading citizen advocacy organization in the nation, promoting a broad spectrum of research focused on improving the health and quality of life of the aging population. Mr. Perry’s diversity of health policy, government, political and journalistic experiences make him an expert in his field. He frequently is called upon as a speaker on aging research and policy before a myriad of audiences. As a journalist, he has been widely published and was the recipient of numerous awards and citations, including a nomination for the Pulitzer Prize.
The following transcript of Daniel Perry’s presentation at the free symposium entitled Aging: The Disease, The Cure, The Implications has not been approved by the speaker. Video is also available.
The Novel Paradigm of Longevity Science
Not long ago the editors of the journal Science put out a very special issue. They wanted to commemorate 125 years of the magazine being in publication, so the editors polled themselves and listed 125 really big questions that we do not yet have the answer to, but which are now reachable by today’s scientists. A normal issue of Science Magazine, for those of you who subscribe, report on small things that scientists are learning about how the world works. In the case of this special commemorative issue, they wanted to list 125 things that we don’t know, but we will know or will be very close to knowing in the next 25 years.
Because 125 is still a big number and they were conscious of readers’ attention spans, they published all 125 but listed an elite 25 questions as well. These are questions like: “What is the universe made of?” and “Can the laws of physics be unified?” and “What will we find to run the world in place of cheap oil?” Big questions.
Very high up in that list of 25, big question number six that the editors of Science Magazine believe we will learn or be very close to learning in the next 25 years is the following. “How much can human lifespan be extended?” The answer to that question, as you have heard tonight and which I know is on your minds in any case, will be utterly profound.
For the past two decades I have headed the Alliance for Aging Research in Washington. We are a non-profit organization. We do engage in very spirited advocacy in the nation’s capital. We do it well in both the spirit and the letter of the law regarding the tax code. We have been called on numerous occasions to testify on Capital Hill before House and Senate committees. We maintain close ties to the executive branch, science agencies and many Capital Hill agencies. We keep busy feeding information to the authorizing, appropriating and budget committees about the value of medical research on the diseases that mostly manifest themselves after middle age.
However, I must tell you, I am constantly dogged by the question that comes from so many people: “What do we mean by ‘aging research’?” I will tell you what I tell them. First of all, I assure you that the Alliance for Aging Research is not an advocacy group for research that is getting really old and out of date. When I explain to them that we are advocates for science with the potential to improve and add years of health and vitality for millions, there is still another set of questions. Are we talking about research into specific diseases of aging? Cancer, Parkinson’s, cardiovascular disease? Are we talking about getting the nation’s health professional workforce ready to meet the coming silver tsunami of chronic age-related diseases? Are we talking about general wellbeing and nutrition, psychological adjustment and wellness for people at later life?
In some sense the answer is: “All of the above.” What I want to focus on in the time that remains is the question that for many of us now seems to be the most intriguing of all — the one question with the potential to change everything we think we know about aging and longevity. What can our very best scientists learn about the fundamental biological mechanisms that we call the aging process? What are the chances that we will use that knowledge of the underlying process to our own benefit?
This is the dominion that we call biogerontology. Success in this realm would be the most consequential and indeed the most disruptive technology we can imagine. Success could redefine the length and quality of human life beyond anything we know. The greatest value of all that might come from biogerontology is that it might provide us with a strategy for preventing, postponing, or even eliminating many current diseases of aging.
Scientists have shown in many experiments that aging can be slowed, put on hold, even in some cases reversed in laboratory animals. Here is the best part — those interventions in aging with test animals act as a powerful means to put off, prevent, or at least postpone a large number of health catastrophes that can accompany aging: everything from cognition and organ failure to blindness and cancer. Many of you have read about caloric restriction. There are also hormonal manipulation and genetic interventions in test animals. The way age delay works is by putting all of those diseases much later in life and closer to death — the compression of morbidity that Dr. Stock mentioned.
Ironically, for all of the potential good that could come from biogerontology, here is the bad news. It has been examined and analyzed less than almost any other field of medicine by policymakers and by the media. It has received less support from government, industry or private philanthropy. Even if we were to be successful, modifications in aging could so challenge fundamental beliefs of people so as to incite irrational fears and resistance from the very people it would help.
A couple of years ago, Dr. Huber Warner, who spent 21 years heading the smallish biology of aging program at the National Institute on Aging went back to academia, and he wrote “Compared to other medical disciplines, the work on biomedical gerontology has been poorly regarded and under-funded during the last half of the 20th century.” That is true enough.
Now, consider this statement from a forthcoming paper that will be published in the next few weeks by the British Medical Journal. It is authored by a dozen leading American and British scientists, including two former directors of the National Institute on Aging. Here is a statement from that article. “There is now reason to believe a new paradigm of health promotion and disease prevention for the 21st century is plausible and will include as its central theme a concerted effort to slow aging in people. Such an effort, if successful, will serve as a new broad spectrum strategy of primary prevention that would significantly enhance and accelerate improvements in health at all ages.”
That is what is coming out from very highly regarded and mainstream scientists on two continents. It is pretty expansive and forward thinking. What can each of us do to advance a new paradigm for health promotion and disease prevention in the 21st century that makes as its central tenet the slowing of aging? Recently, the board of directors of my own organization, which includes Bill Haseltine, committed to an aggressive effort to speak out for longevity science, which I think is a more elegant way of saying biogerontology, in order to hasten the social benefits extending healthy aging, a goal that we have referred to as “pursuing the longevity dividend.”
Now, the members of my board are not naïve. They know very well that longevity science continues to be a tough sell. Let’s face it, call it by any name, the quest for significantly extended lifespan has an image problem, as Dr. Stock mentioned. For well over the past millennium of human history, we have heard plenty about searches after the philosopher’s stone, or the fountain of youth, or the elixir of life. People know that such quests have been notoriously unsuccessful in the past.
By now perceptions of those quixotic journeys are so deeply engrained in our cultural consciousness. Then again, the medieval alchemists and Ponce de León did not have the tools of nanotechnology or the knowledge of the insulin signaling pathway to guide them. They did not have proteomics or the human genome to work on. In the 21st century, we either do have or soon will have a much stronger grasp on all of those technologies.
Ultimately, success against the pathologies of aging will come from the applications of really, truly big science. This will be a combination of biological insights, incredibly high speed information systems, statistical modeling and systems engineering. Here in California, we keep coming back to this, also in the United Kingdom, Singapore, Israel and Japan, these technologies are already being put to use to unlock the potential of regenerative medicine. Indeed, regenerative medicine, stem cell research, and related technologies might very well be the critical enabling platform for an early stage of longevity science.
Large sums from private philanthropy certainly have an opportunity to lead the way, especially in the early stages, to overcome the disbelief and the inertia found at the governmental level. Ultimately, big science on this scale will require the resources, leadership and commitment of national policymakers. I must tell you, tonight we are not there.
Most politicians are not biologists. They are not biotech entrepreneurs. Most of them are lawyers, and unlike Bernie Siegel, they are insecure when it comes to talking about science and medical matters. Sure, they will launch a war on cancer or a war on AIDS, but they will only do that when their insecurities are first overcome by established medical figures. They are not going to stick their necks out into something that does not already have luminaries from Harvard and MIT paving the way for them. Unfortunately, most of these established medical research authorities have made their careers pursuing medical goals not globally aimed at aging, but one disease at a time. That is how we award Nobel Prizes, by following a particular pathway. Going after aging, and the complexity of that, is not the way the medical authorities earn their stripes.
Most established scientific leaders have been brought up to believe that aging is not only unchangeable, but not even very interesting. Now let’s move to lay people. Most of them think there is not anything you can do about aging. Go out to West Covina and ask people if there is anything you can do about it. They believe that even if you could, it would be a social and an economic catastrophe. Too many sick, old people sitting around, not pulling their weight. Even if people believed there could be some scientific breakthrough that would make it possible to extend the healthy years of life, many will set themselves up in opposition because it sounds unnatural or upsetting to social norms or religious beliefs.
Then there are those who believe there is something that you can do about aging, and in fact, it is already possible by way of the nutritional supplements you order online or buy at the GNC stores. They say, “Who needs further research?”
What will it take to overcome negative assumptions among the public? What will it take to convince cautious public officials to set up the kind of major scientific effort to crack the biology of aging. US health expenditures will be three trillion dollars before even the oldest Baby Boomer turns 65 and joins Medicare in less than three years. Three quarters of this national health bill goes to treat chronic diseases, most of which are driven by the underlying processes of aging–cardiovascular disease and stroke, Type II diabetes, neurodegenerative diseases, cancer, loss of vision and hearing… the list goes on and on. Just four diseases alone already account for nearly one trillion dollars in health expenditures in the United States each year.
By 2030, Alzheimer’s disease alone will cost one trillion dollars a year. That is the equivalent of the entire Medicare budget, Medicaid, and veteran’s benefits going toward one disease by 2030.
If you want to get the attention of national policymakers, you want to remind them of this rolling horror show of chronic diseases, disability, lost human potential and the almost unimaginable costs to budgets at the federal, state and county level. Next, we need to drive home the message of biogerontology and bring the authorities together to make it stick. Some control over the processes of human aging may be the only way to blunt the impact of the multiple diseases of aging, that we call the silver tsunami, headed our way.
Compelling scientific evidence that it is indeed plausible to delay, postpone or modify diseases of aging in our species—that point has to be made beyond doubt or dispute. To prove our case, we are going to need credible and statistically validated measures that track the slowing of the aging process. In drug development, these are called biomarkers. Today the FDA does not recognize that there is anything that will change these variables of aging. Until there is some level of scientific consensus to convince the FDA that a drug that comes into the pipeline will get an approval because it is retarding a multiple number of measures of aging, this will be an underfunded area in terms of industrial investment.
Imagine what would happen if there was some level of recognition that if you hit these fifteen different data points in a clinical trial, you get a label that says you are an age-retarding medication. It may be that the first one that comes through that pipeline will be aimed at a specific disease like diabetes or metabolic syndrome, but it is working because it is affecting the underlying biological mechanisms of aging. After a few years there are more scientific papers saying the people on this diabetes medication are getting fewer heart attacks, strokes or cataracts, pretty soon there is off-label prescribing of this drug. That may be another way in which the first anti-aging therapies make it.
It also might be a huge psychological breakthrough if an animal study such as the Methuselah Mouse Prize shows that instead of dying at three or four years, somebody has engineered the same species of mouse to live six or seven years. There are a number of ways we might be able to make that kind of breakthrough. One thing that I know we can do right now to try to prepare policymakers, and indeed the entire public, to accept, anticipate and yearn for an advance is to explode the myth that success in longevity science is going to mean more sick old people and a drag on the economy.
We are looking for ways to fund a series of high level papers from the world’s most prominent health economists to show that all things considered, extending the healthy years of life, even with higher costs in some areas, will be a boost to our economy that will be beyond what anyone can imagine. That is something that we can do, and we are hoping to do it very soon.
Finally, policymakers need to see that we are already spending tens of billions of dollars every year on the National Institutes on Aging on a limited and possibly flawed strategy of going after one disease at a time. Because in old age there is so much co-morbidity, even if you were able to nail stroke or even some cancers, there is so much co-morbidity that you never get out of the box. In fact, trying to fund medical research in the diseases of aging one at a time is a little bit like carrying water in a paper bag that is leaking in many different slits. The longevity science answer is to preserve the overall integrity of the paper bag, despite time, wear and tear. In the aging analogy, the key to that stronger bag is understanding the underlying mechanisms of aging and pursuing that knowledge to its ultimate goal, which would be a broad and beneficial longevity dividend for our entire society.