Should ageing be a disease?

“The creator intended for mankind to develop these technologies that would result in humans living for indefinite time period. We fight against involuntary death and view immortality as the ultimatesolution to every problem mankind faces”

says Bill Faloon1Forever Young: The Church of Perpetual Life, who is the co-founder of the Church of Perpetual Life in Florida2, the first transhumanist church in the world. During a service at the Church, one of the parishioners will say that it is not natural to die. The immortalists believe that science and technology provide the necessary tools to extend human life with the goal of physical immortality.

Quite often the Church would host events where scientists working on the topic of immortality can speak about their work. It is important to note that the Church combines together not only the belief and admiration of science but also important business interests. Bill Faloon is an entrepreneur who built up a company that sells, among other things, anti-aging vitamins and supplements3 Some of the immortalists are members of this company and receive discounts when purchasing products. The Church of Perpetual Life is just one example of the economic interests behind the idea of classifying aging as a disease that this article will examine in depth together with some other issues related to the main theme/question.

What is aging : the first ambiguous question?

The word “disease” has a specific meaning. Presuming that a certain state of impairment is a disease entails that this interruption of normal state has distinguishable signs and symptoms. Furthermore, a disease is considered to be a response to certain factors4 What are these factors that cause aging? Scientists from around the world have been conducted research in order to find the causes of aging. For instance, a team of researchers at Houston Methodist Research Institute in Texas has been working on finding a cure to a very rare genetic disease called progeria5FTelomerase mRNA Reverses Senescence in Progeria Cells (syndrome Hutchinson-Gilford) which causes premature aging among children starting at neonatal period6Causes, symptoms, and treatment of progeria They base their work on previous research conducted by other American institutions according to which “telomere loss and uncapping provokes progressive tissue atrophy, stem cell depletion, organ system failure and impaired tissue injury response” 7Belfer Institute for Applied Cancer Science and Departments of Medical Oncology, Medicine and Genetics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts 02115, USA. Based on this information, the scientific team in Texas focuses on finding a cure to the progeria which consists of restoring the telomere length by means of a technology called RNA therapeutics that gets the cells to produce a protein, called telomerase, which lengthens the telomeres8Telomerase reactivation reverses tissue degeneration in aged telomerase-deficient mice, on

However, this viewpoint about the nature and cure of the disease is not unanimously accepted in the scientific field. To give an example, scientists from the Northwestern University in the USA9Together with the Center for Human Development and Aging in New Jersey, University of British Columbia in Vancouver, Indiana Hemophilia and Thrombosis Center in Indianapolis as well as Tohoku University Graduate School of Medicine in Japan have published a joint research paper which indicates that there is a causal effect of PAI-1 (Plasminogen activator inhibitor–1, a protein) on human longevity. Therefore, they concluded that humans could be protected against biological aging by controlling the mutation of PAI-1. The results of their research is considered to have shed a light on new therapeutic target regarding aging10A null mutation in SERPINE1 protects against biological aging in humans

Other researchers have arrived to different conclusions, namely that the factor causing aging are senescent cells which are senile cells whose number increases with aging. Researchers believe that these cells cause age-related illnesses such as diabetes, heart disease as well as arthritis. So, in order to reverse the effects of aging, researchers from the Erasmus University Medical Center in Rotterdam find a new mechanism to attack these cells and see the results of it by conducting tests on mice11Molecule kills elderly cells, reduces signs of aging in mice

All these are the latest results of scientific research relative to anti-aging therapies. They, as well as many other that are not quoted here, illustrate the variety of viewpoints among researchers. In other words, there is no unanimously accepted theory as to what aging is. Adding the fact that the cure for aging has not yet been found, one could suggest that there are not enough scientific evidence to say that aging is curable and, therefore, that it could be classified as a disease.

The usage of anti-aging cure and the methodological problem concerning its scope

There is ambiguity as to what scientists are trying to find: factors causing aging or factors causing age-related diseases. Yet, this is quite important for the current debate. If they target age-related diseases, for instance heart disease and cancer, then the ultimate goal of their researches is a healthy lifestyle. On the other side, if we consider that scientists seek a cure for aging itself, then we could agree that they target longevity. Looking for a panacea to heal age-related illnesses is similar to curing, whereas extend human life throughout science and technologies is similar to enhancement of human life. In that sense, Michael Sandel says that moral dilemmas emerge when people use gene editing therapies not to cure illnesses but to “reach beyond health, to enhance their physical or cognitive capacities, to lift themselves above the norm12SANDEL, Michael J. The Case Against Perfection, Copyright Atlantic Monthly Company, Apr 2004. But classifying aging as a disease could have positive implications since it would define the extent of scientific research in order to prevent going beyond the scope of healing.

Notwithstanding the initial goal, what would be an attempt to treat a disease could transform into an instrument of improvement and a consumer choice. Here is an illustration of all that. Lee Sweeney from the University of Pennsylvania has been conducting research in order to find a cure for muscular dystrophy that comes with old age and, therefore, cure the immobility that elderly people suffer from13Department of Pharmacology and Therapeutics, college of Medicine The experiments with mice have shown that this therapy not only repairs and reverses the muscle loss but also has the ability to strengthen healthy muscles. The treatment has not yet been offered on the market but has attracted the attention of sportsmen who see in Sweeney’s discovery a tool to increase their competitiveness14SWEENEY, Lee. Le dopage génétique, Pour la Science Other cases where a treatment for age-related diseases is used for nonmedical purposes are likely to occur, for instance to improve memory in order to learn foreign languages or memorize important facts.

All these examples show that a genetic enhancement is different from curing diseases. Is it a question of regulation, then? Appropriate legal and regulatory framework could provide a solution to the ethical quandaries associated with the usage of a cure. Such structure would facilitate the governance and avoid a situation where the treatment is used for prohibited purposes. In addition, the law would allow for a precise differentiation between curing and enhancement and their respective scopes. Given the diversity of scientific methods that researchers use to approach the issue of aging, it should also be possible to have a bottom-up soft-law approach regarding governance of anti-aging cure or age-related diseases. This would conciliate the interests of all stakeholders such as small and big companies, universities and research centres. In this way, we would have a global approach regarding the governance of new technologies and scientific progress, following the model of the Human gene editing summit that took place in 2015 after which participants came out with concrete resolutions regarding policy related issues15International Summit on Human Gene Editing, A Global Discussion (2015) Thus, global soft-law approach could possibly allow people to go beyond their national rules and regulations and adopt a transnational and cross-border system.

The market targeted for anti-aging cure: too big is too small

Living longer does not make much sense if it would just prolong people’s suffering during this time. On the contrary, living longer in good health would make life much easier. Presently the pharmaceutical business is not able to provide drugs that could heal the conditions that elderly people suffer from mainly because today’s sector is in crisis. This could be seen in the attempt of several hospitals in the US to go into the pharmaceutical business in order to fight the deficit of drugs that they face16Fed Up With Drug Companies, Hospitals Decide to Start Their Own This deficit could be explained by the difficulty that pharmaceutical companies face trying to meet the market demand. Firstly, this is because of a lack of resources needed to produce the drugs in sufficient quantities which comes naturally as a result of a monopolised market where only few big companies operate. Furthermore, pharmaceutical companies fail to provide the necessary drugs to heal diseases that people suffer from. In other words, there is a shortage of quantity and quality on the market. Finding a cure for aging or age-related diseases would bring a solution to these business problems, especially in the US where the above-described picture is most relevant.

For instance, a cure for memory loss associated with illnesses such as Alzheimer’s would boost up the drug business: according to latest Alzheimer’s Disease International World Report, in 2016 there were 47 million people worldwide suffering from some type of dementia and is expected that by 2050 their number will increase to more than 131 million17World Alzheimer Report 2016 Another example for this is diabetes. According to the Centers for Disease Control and Prevention in the USA, in 2016 there were 12 million seniors diagnosed with the disease in the country18National Diabetes Statistics Report, 2017 Estimates of Diabetes and Its Burden in the United States Diabetes is considered to be an age-related disease but it is also found among a younger demographic. According to the Media centre of the World Health Organisation, in 2014 the number of people with diabetes is 422 million which shows a considerable increase compared to 1980 when their number was 108 million19World Health Organisation, Media Center These two examples illustrate that there is a huge need for a cure which has only increased over time. Also, the ever-growing need for adequate drugs reveals the considerable gap in the market that could be filled by successful anti-aging therapy/cure.

Curable, cure, cured or the way towards successful manipulation of consumers

“My grandmothers had died of Alzheimer’s, and my grandfather died of heart disease. I thought, if I don’t do something, I know what I’m likely to die of”20A cure for ageing is near but you probably can’t afford it says Liz Parrish in an interview after having tested a new anti-aging treatment on herself. People that are interested in a cure for Alzheimer’s are not only those who suffer from it but also people who want to avoid developing the same condition. The fear of falling sick with a disease that is not curable and die as a result of it gives consumers a strong incentive to purchase such a treatment. The fear of dying is the reason why some parishioners go to the sessions conducted by the Church of Perpetual Life.

Many are those who try to identify the factors causing aging. Normally, accepting that a specific state of disorder is a disease would entail that it might be cured. Considering that aging is curable would give further incentive to work on a treatment. However, the opposite is also likely to occur: creating a cure could create the illness. Promoting aging as being curable serves also for obtaining public approval where the ultimate goal of science in the context of anti-aging treatments is commercialization of the product created by the companies.

As a result of this, the claim that aging is curable becomes a reality because truth is what people believe it is true in spite of the state of the scientific progression on the matter.

Accordingly, we face the danger where aging will be considered as a disease without any real scientific evidence or proof. The Church of Perpetual Life illustrates how business concept uses people belief to promote certain ideas in order to influence social behaviour. Creating and marketing cure for aging or age-related diseases would influence what choices people make regarding drugs. Therefore, classifying aging as a disease could possibly lead to marketing easier treatments developed by researchers among consumers whose potential number is already significant.

Geography of a mind-set and the Silk Road of the age-related industry

The sellers’ actions are motivated by the same psychology as the described above attitude specific to consumers: we observe the same behaviour features but from a different perspective. A demonstration of this mindset is the significant financial support provided by many entrepreneurs and investors to the scientific sector with the focus of understanding the biology of aging and finding a cure for it. To them there is no question that aging is a disease. These investors and entrepreneurs contribute a serious amount of money to develop their age-related businesses and to promote their point view on aging among consumers and, therefore, to commercialise the products their businesses generate. To some extent their actions facilitate the impregnation in the society of the idea that aging is a curable problem because when they sell an anti-age treatment or medicine they promote their viewpoint about aging among people, as it was explained earlier. The process is similar to a vicious spiral and like the chicken and the egg dilemma it is difficult to say which of the two things caused the other one.

Moreover, this particular way of thinking has an abundant scope. To illustrate that, one should study the way money is allocated on the market. For instance, Google founded a R&D biotechnological company called Calico in 201321Google announces Calico, a new company focused on health and well-being, whose purpose is to use advanced technologies to understand “the biology that controls lifespan” in order to create methods enabling people to live longer and healthier lives22AbbVie and Calico Announce a Novel Collaboration to Accelerate the Discovery, Development, and Commercialization of New Therapies The company has established far-reaching partnerships with other stakeholders around different projects which also allows to trace the global scope of the mindset depicted earlier. One of the most important partnerships is with AncestryDNA from 2015 which is the largest genealogy company in the world that manages genealogical and historical records as well as a network of genetic genealogical websites that allow people to receive information regarding their genetic heritage23AncestryDNA’s website By using AncestryDNA’s databases and algorithms, the partnership aims at analyzing the role of genetics and its influences on families that experience unusual longevity 24AncestryDNA and Calico to Research the Genetics of Human Lifespan Consequently, Calico could create, develop and commercialize treatments and therapies 25See n. 23.

Another outstanding partnership was signed in 2016 between Calico and Jackson Laboratory, a nonprofit biomedical research institution26Jackson Laboratory’s website that includes a network of research centres dedicated to genetic studies. The idea behind this partnership is to lead and fund research projects with view to explore the genetics of longevi ty and health with the ultimate goal to identifying genes associated with healthy aging27The Jackson Laboratory and Calico to Investigate Basic Biology of Aging There are other projects that give more explicit information as to the financial scope of the transactions and the respective global scope of this trend. For instance, in 2014 Calico entered into a partnership with the French biopharmaceutical company Abbvie according to which the two companies shall pool together up to $250 million each in order to fund the collaboration with the potential for both of them to provide an additional $500 million
28AbbVie and Calico Announce a Novel Collaboration to Accelerate the Discovery, Development, and Commercialization of New Therapies The purpose of their cooperation is to develop and commercialize on the market new treatments for people suffering from age-related diseases, such as cancer and neurodegenerative diseases29See n. 28. Such active enterprise as well as the considerable resources that Calico benefits from both Alphabet and Abbvie (initial investment of 1.5 billion dollars30Quand Google s’attaque au vieillissement from both companies) places the company among the biggest players in the field of developing treatments for age-related diseases. “One day you may be able to buy a pill that extends your life, dreamed up in a lab funded by a search engine”31What’s He Building in There? The Stealth Attempt to Defeat Aging at Google’s Calico. could that be the ultimate goal of Google when the internet giant launched its biotech company as well as the multiple partnerships that Calico has entered into so far?

Calico is not the only one operating in this field. Another major actor is Human Longevity LLC (“HLI”) which was founded in 2013 and is currently led by one of its cofounders, Craig Venter32Human Longevity’s Management team Human Longevity creates a database combining phenotype, genotype and clinical data that is analyzed in order to understand the biology of health 33Human longevity, inc. And amra partner to provide advanced body composition profiling to hli’s health nucleus clients Similarly to Calico, HLI leads co-projects with different institutions focused on diseases associated with aging, i.e. the partnership with AMRA, which is a leader in body composition analysis on international level34AMRA’s website 35See n. 33. Also, likewise Calico, the company has benefited from important financial investments in the course of recent years: in 2014 HLI raised $80 million in Series A offering and $220 million of Series B Preferred Stock36Human longevity, inc. Completes $220 million series B financing Another company that has a similar finality to HLI and Calico, but is less big37Crunchbase, is Insilico Medicine which combines artificial intelligence and biotechnologies in its work38Insilico Medicine website These examples seek to illustrate the considerable efforts and resources pooled into finding a cure against aging as well as the diversity of business models and economic interests involved in it.

Despite the fact that the cure is not yet found the number of the actors on the market is gradually increasing and this leaves less and less room for new actors to step in.

Equilibrium or evolution/ normal or abnormal/ mortal or immortal… a game with words or a moral dilemma ?

Is there something other than business interest and social practices entangled in the question of antiaging cure? In his article39See n. 11, Michael Sandel talks about the moral status of nature and proper stance of human being toward the given world. Does science and technology go against the natural order by questioning the moral status of nature or is Bill Faloon right when he says that “the creator intended for mankind to develop these technologies that would result in humans living for indefinite time period”40See n.1? Each and every person goes through the same stages of life and aging is one of them. When questioning the inevitable nature of aging, humans challenge nature itself by requalifying a natural biological state into an abnormal one.

Aging is a predecessor of death and it is accepted as a natural phenomenon. This is a fundamental belief whose purpose is to explain the unknown and to confront human fears. In this regard, according to the Christianity and Islam, man is created from clay and, therefore, he is meant to transform into clay again – this is considered to be the equilibrium that exists in our world. Both religions argue that, unlike the body, human spirit is immortal and that there is an afterlife. Other religions, such as buddhism, promote that people are reincarnated after death according to their actions during their lifetime. These three religions are among the most widespread in the world and their doctrines are defended by many. Moreover, they have been foundation for moral principles and other beliefs over time that have shaped numerous cultures and nations.

One could argue another viewpoint. Undoubtedly we are surrounded by nature where everything happens according to a natural order – an organised system consisted of the physical universe and functioning according to natural laws41According to Merriam-Webster dictionary available online Logically, it follows that there is an enormous amount of information circulating around us and, thus, limitless knowledge waiting to be acquired. At the same time, the primary purpose of scientific effort is to gather knowledge about the living world to be used for subsequent objectives. Therefore, everything around us is science. If this is so, then science cannot go against natural order because it is part of the latter. In other words, science cannot cancel natural order. Nevertheless, science can explore the nature and provide the necessary tools to modify it in order to achieve longevity as part of the evolution.

If such means are being found, it would be curious to see how they will be used by humanity. When Freddie Mercury sings “there is no time for us […] who wants to live forever?” we think about spiritual immortality rather than physical one. Long before the group Queen was formed, Oscar Wilde wrote in his novel The Picture of Dorian Gray about a physically perfect but morally corrupted man with the gift of immortality who in the end kills himself. The sharp contradiction between the two ideas of immortality strikes the reader and raises the question as to who is right?

If the members of Queen are right, it is pointless to seek an anti-aging cure because immortality has already been achieved in the face of multiple accomplishments of different men and women whose names have stayed in history. However, if we consider Wilde’s version of immortality, then one should ask the question if the price of scientific progress is the self-destruction of humankind? In that sense, it is relevant to mention another adage written by Oscar Wilde which says “Nowadays people know the price of everything and the value of nothing.” His brilliant words imply a simple truth: people tend to ignore the difference between the value and the price, where the value of something in our possession is the price to pay in order to obtain something else and it is often more than we think it is.

Michael Sandel says in his article “Medical intervention to cure or prevent illness or restore the injured to health does not desecrate nature but honors it”42See n. 11. Yet, the line between enhancement and healing is thin which makes it hard for people to make informed decisions. Being blind as to the consequences of our choices questions our free will expressed behind our decisions. Or maybe, not knowing the value of anything is part of the price to pay for our choices?

Laisser un commentaire

Votre adresse mail ne sera pas publiée. Tous les champs sont obligatoires.