This page contains the current draft of the full text of Chapter 1 of RAFT 2035. All content is subject to change.
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1. Physical wellbeing
Goal 1 of RAFT 2035 is that the average healthspan in the UK will be at least 90 years (up from 63 as at present).
The rationale for this goal is that good bodily health is the starting point for all other activities. Declining health diminishes human opportunities and curtails human freedoms, as bodies and minds become enfeebled. Declining health can also impose huge social and healthcare costs. Sadly, the healthcare budgets in countries all around the world are already creaking under severe stress.
However, there will be significant benefits, both socially and economically, to delaying the onset of chronic diseases of aging and thereby extending healthspan. These benefits are known as the “longevity dividend”. Happily, these benefits now lie within our grasp.
Healthspan has been defined as the amount of time an individual can live independently, without being hospitalised or requiring regular support from healthcare assistants or family or friends. It can also be measured as the amount of time that someone would assess their own health as being “good” or “very good”.
The latest figures from the UK’s Office of National Statistics for expected lifespan in the UK are 82.9 years for women and 79.3 for men. The same data source states that “healthy life expectancy” is 63.6 years for females and 63.1 years for males. In other words, these figures predict that someone will, on average, be fully healthy for only 77 to 80% of their lifespan.
Unfortunately, the figures for expected healthspan are actually declining. For example, the expected healthspan for women has decreased by three months over a six year period (from 2009-11 to 2015-17).
But things don’t need to be this way. We can look forward to three overlapping waves of improvements in how people age:
- Technology that helps people to “age in place” better, so that, despite aging, people can lead fuller lives. This includes better monitoring systems to give early warnings of impending ill-health, better mobility solutions to reduce the need for people to rely on assistance, and better networking systems so that, despite diminished mobility, the elderly remain connected to their family and friends and have a rich social life.
- Technology that enables more people to live like the “superagers” who age more slowly than the average person. A superager might live like they’re 75, despite being 95 or older.
- Technology that enables people to be “forever young” (if they choose it): they could live like they’re 35, despite being 125 or older.
Learning from superagers
Superagers are defined as people who reach the age of 95 without being impacted by cardiovascular disease, cancer, diabetes, cognitive decline. It’s notable that superagers are often siblings or cousins of each other.
As well as aging more slowly, superagers tend to require less healthcare, even in the twilight years of their lives. They typically experience what is known as “compressed morbidity”. A superager can utilise less medical budget throughout their long lives, in total, than a shorter lived neighbour who spends many more years in declining health.
A number of researchers are avidly studying superagers, to understand how they differ from the rest of the population, in terms of lifestyle, but also in terms of genetics and other biological features. The goal of this research is to understand what treatments and medical interventions might be made available to the rest of the population, so that superaging becomes the norm, rather than (as present) the exception.
As well as learning from human superagers, it is possible to learn from a number of animal species that manifest various kinds of superaging, and even, in some cases, negligible senescence. Senescence refers to the trait, observed in humans and in most other species, that as we become older, we become more likely to die:
- After the age of 35, for each additional eight years that we live, we become roughly twice as likely to die in the next 12 months.
- Stated otherwise, for every extra twenty five years that we live, we become roughly ten times as likely to die in the next 12 months.
However, there are some animal species that appear to demonstrate negligible senescence. In other words, animals in these species do not age. Their biology supports mechanisms that undo the wear-and-tear damage that normally accumulates as the years pass. Applying these mechanisms within humans is a key quest of the emerging field of rejuvenation biotechnology.
The root cause of age-related ill health is a set of different types of damage that accumulates over time at the cellular and molecular levels inside the body. By systematically repairing or reversing this damage, a substantial reduction should be possible in the prevalence of chronic diseases such as heart disease, cancer, dementia, stroke, and diabetes.
This is no idle theory. It is important to draw attention to the remarkable progress being made in the fields of regenerative medicine and rejuvenation biotechnology, and to the prospects for even faster progress in the years ahead. Thanks to a forthcoming suite of new biomedical interventions, the restorative biological properties that we presently experience in our youth, which generally enable us to bounce back quickly from injury or illness, will no longer lose their power as decades pass. Instead, it will become possible in the not-so-distant future to extend these restorative self-healing powers indefinitely, by taking advantage of biochemical and nanotech innovations such as nanosurgery, 3D bioprinting, genomic engineering, and stem cell therapies, in combination with personalised medical treatments enabled by machine learning of huge sets of medical data.
These restorative processes will not only be extended in their duration, but they will also grow in their scope and effectiveness. Diseases which formerly threatened even the most robust physical constitution will be cured more quickly. The destructive power of new pathogens will meet their match in the constructive restorative power of highly intelligent, swiftly adapting, personalised suites of biomedical therapies. And due to continuous monitoring of all our vital statistics, and of threats in our environment, corrective interventions can be triggered at much earlier stages in any downward spiral of bodily dysfunction.
These interventions will be an extension of the important principles of preventive and proactive healthcare – addressing issues at an early stage, before they become more complicated and expensive to treat.
The result will be like the regular visits we make to the dental hygienist that reduce the risk of gum and tooth disease – except that the set of diseases prevented by the periodic low-level bodily cleansing and repair will be much wider.
Progressing rejuvenation therapies
Examples of rejuvenation interventions already under investigation include:
- Senolytics, a new class of compounds that selectively remove from the body old and dysfunctional senescent cells (commonly described as “zombie cells”)
- Treatments to selectively boost the natural autophagy (“self-eating”) repair mechanisms that operate inside cells throughout the body
- Modifications to the microbiome – the set of microscopic bacteria, fungi, protozoa, and viruses that live in the human gut, on the human skin, and elsewhere inside the human body
- Infusions of stem cells
- The selective application of the enzyme telomerase to extend the telomeres at the ends of chromosomes, effectively “resetting the clock” of the cells involved
- CRISPR reprogramming of cellular systems at both the genetic and epigenetic levels
- The use of specific hormones, including HGH (human growth hormone) and DHEA, to regenerate the thymus, thereby countering the age-related decline of the immune system (also known as immunosenescence)
- Mitoprotectants, including various antioxidant biomolecules such as NR/NMN and MITOQ, which can help to protect the mitochondria “power plants” of our cells.
What’s more, a very useful role can be played by automation, machine learning, and testing within increasingly accurate computer simulations of biological systems. This means that existing natural and pharmaceutical compounds can be screened and evaluated for activity that may target key molecular processes involved in the repair of cellular and molecular damage.
To proceed more quickly, these initiatives deserve a greater share of society’s resources to be applied to them.
It is encouraging to see the emergence of new investment mechanisms such as the Juvenescence portfolio of companies developing treatments to extend healthspan. The founder of Juvenescence, Jim Mellon, comments as follows:
We aim to have about 20 shots on this goal – longevity science – and if we get two or three of them right, there will be a very good return to shareholders.
However, progress will be even faster with coordinated public action, such as advocated by the “Party for Health Research” (Partei für Gesundheitsforschung) political party in Germany:
The Party for Health Research would like to invest an additional one percent of the government’s budget in the development of effective medicine against the diseases of old age. Because everyone is affected directly or indirectly by age-related diseases, everyone would benefit from this. To pay for this, one percent would be subtracted from each of the other budgetary items.
Half of this additional money would go towards the construction and operation of new research facilities and the other half would be invested in training more scientists in the relevant fields. For this, the respective university departments would be extended.
However, the faster development of effective medicine against age-related diseases is not only a question of solidarity and ethics. [Society] would also enjoy large economic benefits. Today’s medical costs are already huge and will continue to grow with the upcoming demographic change. A reduction of age-related diseases would lead to an enormous economic benefit. Furthermore, this medicine against the diseases of old age will become the biggest industry ever as everybody needs it…
Quantifying the longevity dividend
If health systems in countries like the UK continue on their current trajectory, they’re likely to bankrupt the whole country before long. It is not sustainable to continue to spend more money on existing treatment methods. Instead, a switch in focus, as recommended in this RAFT goal, is vital:
- A switch away from treating diseases after they have already progressed to a serious extent
- A switch to early intervention and (even better) prevention.
What makes this switch possible is the paradigm change of targeting and treating metabolic aging as the common aggravating cause of multiple chronic diseases.
In broad terms, a contrast is clear between the economic and social consequences of two models of aging:
People in an unhealthy elderly state:
- Consume significant healthcare resources
- Contribute less to industry and community
- Impose a care-giving burden on family and friends.
People in a healthy elderly state:
- Don’t consume so much healthcare resources
- Contribute more to industry and community
- Support and enrich their family and friends.
One attempt to quantify the economic size of the longevity dividend was made in 2013 by professors Dana Goldman, David Cutler, and collaborators, in an article entitled Substantial Health And Economic Returns From Delayed Aging May Warrant A New Focus For Medical Research. The increases in life expectancy considered in this analysis are modest – only 2.2 years in a “delayed aging” scenario. However, what is striking is the financial consequence of this delay in aging. Aggregating expected costs from public programmes such as Medicare, Medicaid, Disability Insurance, Supplementary Security Premium, and so on, and including estimates for the productivity benefits from increased quality of life, the authors estimate the economic value of the delayed aging scenario to be 7.1 trillion US dollars, over the period up to 2060.
This benefit arises from two sources:
- A reduced number of disabled elderly people – up to five million fewer, in the USA, for each of the years 2030-2060
- An increased number of non-disabled elderly people – up to ten million more, in the USA, over the same time period – resulting in greater contributions (both production and consumption) to the economy.
Inevitably, there’s a great deal of uncertainty in the numbers quoted. However, even if the headline figure of $7.1 trillion is wrong by an order of magnitude, the upside remains compelling. And what’s particularly interesting is that these benefits arise from such a small increment in life expectancy – just 2.2 years. Imagine how much larger the benefits could be from a more sizeable increment.
To accelerate progress towards Goal 1, two interim targets for 2025 are proposed.
- A clear demonstration of mid-age rejuvenation of animals with much smaller lifespans than humans – animals such as mice in the first instance, and then pet dogs. Since these animals have short life spans, experiments will take less time to show results. These demonstrations will change the public mood concerning the development of similar treatments for humans.
- To establish a society-wide understanding of the principles of the longevity dividend, and of the measures that can be taken to quickly reduce the costs of rejuvenation therapies so that everyone can benefit from them. This understanding will defuse the fears that are sometimes expressed, that longer healthspans will result in significant problems for society or for the environment. This understanding will show that, on the contrary, longer human healthspans can have very good effects for both society and the environment.
The first interim target will help convince more people that extending healthspan is possible; the second interim target will help convince more people that extending healthspan is desirable.
One of the fears that is sometimes expressed, regarding people having longer healthspans, is that increased physical robustness might be accompanied by decreased mental capability. In other words, individuals and, in their turn, social structures, might become forgetful, entrenched, and resistant to change. Human experience would be diminished, even though lifespans were extended.
However, RAFT 2035 envisions not only physical rejuvenation but also mental and spiritual rejuvenation. That’s the subject of the next chapter.
For more information
- The annual conference Undoing Aging
- The online community Lifespan.io
- The SENS Research Foundation
- The German “Party for Health Research”
- The Longevity International social enterprise
- The 2019 book by David Sinclair, Lifespan: Why we age – and why we don’t have to
- The 2019 book by Sonia Contera, Nano Comes to Life: How Nanotechnology Is Transforming Medicine and the Future of Biology
- The 2019 book by James Clement, The Switch: Ignite Your Metabolism with Intermittent Fasting, Protein Cycling, and Keto
- The 2019 update by S. Jay Olshansky, The Longevity Dividend: A Brief Update
- The 2018 book by Kris Verburg, The Longevity Code: The New Science of Aging
- The 2017 book by Jim Mellon, Juvenescence: Investing in the Age of Longevity
- The 2016 book by David Wood, The Abolition of Aging: The forthcoming radical extension of healthy human longevity
- The 2015 book by Anca Ioviţă, The Aging Gap Between Species
- The 2007 book by SENS founder Aubrey de Grey, Ending Aging: The rejuvenation breakthroughs that could reverse human aging in our lifetime
- Definitions of healthspan