Longer, Better, Faster, Stronger?
The past, present and future of living longer
Hi, it's Ben from the Tony Blair Institute. To coincide with the launch of our new paper on the biology of ageing, this week we look at how we might take another giant leap forward for humanity and extend the quality and quantity of life.
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In the 1660s, polymath and scientist Robert Boyle played a key role in establishing Britain’s Royal Society, the world’s first government-sponsored scientific society. As part of his work, he created a desiderata - a list of things wanted or needed - as a guide or prediction for future scientists. Emulating fish without engines, potent drugs to “alter or Exalt Imagination” and perpetual light were among them. So too were others that continues to capture attention today: namely, “the prolongation of life” and “the recovery of youth.”
Little more than 50 years later, the UK was beginning to inoculate its first citizens against smallpox. Otherwise known as the “speckled monster,” it was one of the ages most lethal diseases and accounted for around 10% of deaths. But the introduction of Edward Jenner’s pioneering attempts to control infectious marked the “first upward spike in life expectancy,” which at the time was around 35 years old.
Smallpox as % of all burials (five-year moving means)
A few centuries on and advanced economies have experienced broad increases in life expectancy. But as we understand more and more about biology and have increasingly sophisticated tools through AI and ML to accelerate discovery further, some are beginning to ask whether we can take another giant leap forward. That is, can we improve the quality of our life and live to old age in fine fettle i.e. our healthspan, but also can we begin to push new frontiers of humanity and extend the quantity of life i.e. our lifespan?
In its simplest proposition, today we know that ageing is the biggest risk factor for chronic disease. Our chances of developing multiple illnesses – from cancer to heart disease to dementia – increases significantly as we age. Even our pandemics are largely diseases of the aged, with 6 out of every 7 COVID deaths in the US occurring in those over the age of 65.
Source: Laura Deming
As populations in many advanced economies therefore live longer – but not healthier – we risk facing an avalanche of illness. This challenge of ageing populations, when combined with decreasing birth rates, has been described by demographers and economists as an existential issue for our economies.
Yet there are signs of progress. The field of longevity has taken significant strides over the past two decades, offering the hope of living healthier for longer. There have been major breakthroughs in our basic understanding of the biology of ageing, and the market is aligning too. The Bank of America Merrill Lynch estimates the market for tech focused on the human lifespan will grow to $610bn by 2024.
Some of this requires deep caution: the elixir of youth is an enticing proposition and – as with any industry – will have a fair number of actors making false promises about our future. Added to this is the often superficial narrative put forward in the public debate on Silicon Valley’s quest for immortality that strips out the necessary nuance.
But digging under the surface, there are a few aspects where this developing field that should require further attention.
First is the basic research question and how we deepen our understanding of the biology of ageing. Researchers have already begun to identify key hallmarks of ageing. While there is not yet consensus around the number, hierarchy and order of importance of these hallmarks, there is general agreement that certain processes – such as cellular senescence, stem-cell exhaustion and macromolecular dysfunction (telomere shortening and damage to DNA and proteins) – are important components of the overall ageing process.
These promising insights have already helped identify molecular targets and exploring new frontiers of knowledge should be a foremost priority.
Second is about measurement. What gets measured gets managed, and as well as unravelling the biological mechanisms of ageing, we also need to be able to accurately measure its progression. Reliable markers of biological age (ageing biomarkers) are needed to more rapidly deliver new therapies, and to help understand and address the differences in variability in ageing between individuals.
Progress is being made. Most significantly, researchers have uncovered an array of epigenetic markers that strongly correlate with biological age. While these so-called epigenetic clocks give a relatively immediate and accurate approximation of ageing, there is still a critical need for a more diverse range of ageing biomarkers to provide flexible and robust estimations of biological age.
Third is how it fits into wider advances in Genomics, AI and Gene Editing. Along with the development of AI, we have opened up profound possibilities for drug discovery. In a world where medicine is becoming increasingly personalised, we need to understand how ageing may manifest differently across various subpopulations and even at the individual level. Researchers are already beginning to investigate this and have recently used deep, long-term, multi-omic profiling to begin to define “ageotypes” (subpopulations that exhibit different mechanisms of ageing) and personal markers of ageing.
One of the foremost proponents of this field, the Harvard geneticist David Sinclair has said that:
“The field of aging and longevity research has reached a point of maturity where the leaders in the field believe that we can have — or will have — a big impact on the planet. That impact will be in medicine, in health span, and in its knock-on effect on [everything from] human productivity to Social Security… It’s not a question of if there’s going to be an impact, it’s really a question of what kind of a future we want to build when this happens.”
However, it remains that broad public conversation regarding the transformative impact of extending longevity has been limited, with only a handful of public leaders peering into the box. In a recent report we set out a range of recommendations for policy makers who recognise the scale of the challenge and opportunity around longevity.
This includes modelling the economic value of targeting ageing to extend life and healthspans (something few countries do today), smoothing the pipeline for clinical trials, and the development of innovative funding models like Fast Grants to accelerate research.
While our politics focus on the immediate, extending longevity offers an opportunity to address part of the demographic crisis and stimulate an emerging – and potentially huge – field of innovation and investment. Doing so will require concerted effort, but it is within reach. If we were to write a new 21st C desiderata today, many things will have changed. But the prolongation of healthy life is a pursuit that we should always strive for. It should still be top of the list.