Should We Consider Aging a Disease?

In 1851, blacks throughout the US were reported to suffer from a disease called “drapetomania.” The symptoms—a white physician argued—were bouts of “sulkiness,” followed by an inexplicable urge to flee plantations. The treatment, he wrote, was to have “the submissive kneebender (which the Almighty declared [‘the negro’] should be)” relatively “well fed and clothed,” occasionally “whipping them,” to “cure them from running away.”

For better or worse, no definition of disease exists independent of historical context. In 2022, an infertile woman may be said to possess a medical condition. In the 1600s, the same woman may have been burned at the stake, or said to bear “a wandering womb” (as medieval concepts of anatomy included “the womb being able to run around inside the body at will”). In 2065, still the same woman may be considered perfectly healthy, if childbearing becomes the job of artificial wombs.

This notion—that the term “disease” is not static—complicates the moral distinction between “therapy” and “enhancement.” Some bioethicists argue that therapies should be pursued which prevent human suffering. Yet human suffering does not fall categorically outside the boundaries of early-21st-century conceptions of health. In 2022, one can both suffer and be considered healthy—or, as one definition of the absence of disease suggests, one can be on “the normal functioning path of the organism.”

If a person lives to be 100 years old, they are almost certain to develop cancer. Indeed, 96 percent of all cancers occur in patients aged 35 and older. This means that cancers are often not a deviation from “the normal functioning path of the organism”—and yet we treat them as abnormal. Human aging is not yet widely considered a disease, but can be perceived as the primary cause of suffering in our century. Scientifically, aging can be understood as the source of all the leading causes of death in 2022, including COVID-19—around 90 percent of all US deaths from the virus were patients over 60.

Economically, the gradual decay of our unprecedentedly long-lived populations costs the US nearly half its federal budget every year. It’s no wonder that the most well-funded pre-seed biotechnology startup in history—Altos Labs, which boasts an impressive list of Nobel laureates and enjoys funding from Jeff Bezos—is committed to the idea that aging, even if normal to our species, is also profoundly harmful. It’s unsurprising, too, that the Saudi royal family is planning to donate a billion dollars a year to aging science.

A growing number of scientists suggest that aging is the (treatable) disease of which most cases of Alzheimer’s, heart disease, and cancer are symptoms. Over the past century, we engineered more than a doubling in average life expectancy, but average health-span has hardly changed throughout the history of humankind.

Aging therapies are often deemed superfluous because, through the myopic lens of early-21st-century morality, they constitute “enhancement”: a deviation from the sick-care model of therapeutics whereby diseases are only named—and treated—retroactively.

Is aging an essential part of our design?

Today, human aging and being human are often conflated as a single process, aging being comprehended as a mystico-teleological phenomenon designed by tenderhearted gods to furnish human life with meaning. When cancers were first documented in ancient Egypt, they were similarly thought to be a product of celestial ingenuity: as the American Cancer Society writes, “Ancient Egyptians blamed cancers on the gods”—but their theology was consistent with this proposition.

In 2022, if we choose to accept post-Enlightenment evolutionism, reality is far more grim: when it comes to longevity, as David A. Sinclair writes in Lifespan, “individuals look out for themselves.” We have been painfully slow to revise Aristotle’s unscientific—and highly influential—theory that older adults die to make way for the young. Now, several biologists dispute the notion that aging and its ailments exist for a reason special to us. They reject the belief that what Yuval Harari has called “the human spark” could ensure biological processes exist to advance human ideals.

Humans, unlike other primates, have a fondness for mythological narratives of grandeur and heroism—often, at the expense of comprehending the more humdrum or capricious reasons for why things happen. Cancers, like the processes of aging, constitute not one, but several diseases. They develop not so civilizations may prosper and flourish, but as happenstance features of haphazardly conceived systems. Biologically immortal species (like the jellyfish Turritopsis dohrnii) offer good evidence that aging is not inevitably beneficial to life, and may well be considered a multifactorial genetic disease, the universality of which in humans makes it more—not less—harmful.

Concerns that this shift may provoke ageism ought to be addressed by preventing older (not younger) individuals from enjoying excessive perks, such as holding onto a job for 80 years. And even if calling aging a disease is a conflation of cause and effect, language only works because it allows for such imperfect generalizations, with far-reaching effects in the real world.

In The Blank Slate, Steven Pinker reminded us that natural selection is "morally indifferent”: no engineer is tasked with guaranteeing that the survival of specific genes aligns with human aspirations. To think, as the philosopher Hans Jonas does, of “the organically programmed dying of parent generations to make room for their offspring” is to subscribe to the gawky mishmash of a creationist-secularist view—accepting the callousness of a godless universe, while hoping, still, for teleological protection from our designer-gods.

Absent effective aging drugs, one of humanity’s most pressing problems by the year 2100 will be the contraction of the global population. Without young immigrants, the United States would already be experiencing negative growth, and Japan is set to lose 21 million people by 2050.

The current global population of nearly eight billion people (better fed and sheltered than at any time in human history) is proof that large populations in themselves are not the problem. Indeed, as Peter Diamandis and Steven Kotler argue in The Future Is Faster Than You Think, an unprecedented number of well-nourished minds working towards human flourishing is what made feats like the Enlightenment possible.

But, to most early-21st-century humans, there remains something deeply unsettling about the treatment of human bodies as high-tech mechanical devices to be tweaked. Should we be striving for this kind of limitless “enhancement”? Could human life be purchased, like silicon devices? What about our very special spark?

When we discard teleological narratives of almighty gods—which in the past (as in 1851) served as heuristics for profoundly irrational and immoral deeds—the facts become clear. If evolution had our flourishing in mind when it produced the processes of aging millions of years ago, this benefit is no longer valid. And if we choose to treat Alzheimer’s or fund retirement programs, then the preventative treatment of the fundamental processes of aging is not simply a pet-project for future, more stable civilizations, but an ethical imperative if civilizations wish to become more stable.

Who will receive treatment?

Today’s aging therapies are far from equitably distributed. Those with some arguable benefits—including NMNs and metformin—even when offered at a low cost, remain unsought by lower-income populations due to systemic barriers. Further, governments rarely fund fundamental aging research (only 0.54 percent of all National Institutes of Health funding is devoted to it), which delays at once the democratization of existing therapies and the advancement of clinical safety studies for more effective ones.

But just as safe and affordable cancer treatments are not yet here, and champions of a cure for cancer are untrained in the science and economics of promising drugs, so too, one need not agree on the nuances of aging therapies to find their potential success—including safety and affordability—ethically permissible.

As Sinclair writes, “effective longevity drugs will cost pennies on the dollar compared to the cost of treating the diseases they will prevent.” If we decide to name the fundamental processes of aging a disease, governments and average individuals would incur fewer costs, freeing up capital for other important human aspirations, such as wider access to medical therapies.

Yes, Jeff Bezos, Mark Zuckerberg, and Peter Thiel stand to make vast profits from the sale of human life and health. And yes, they are sure to benefit from aging therapies far sooner than my family in rural Brazil. But if their funding can advance these therapies towards clinical safety, helping to save billions of lives while unburdening our healthcare systems, this would be a just distribution of capital-for-output.

In the end, it’s up to us whether or not we think of aging as an essential part of the human condition. Science, we must remind ourselves, advances not one funeral, but one hard-working, living human at a time. There is hardly a belief more harmful than that biological decay is a mystical, kind, or dialectical force, guiding humanity towards its predetermined and unalterable telos.

It is human agency—with the sweat, faults, and capriciousness of the living—that engenders progress. It is our own ever-ungainly understanding of terms like “disease” and “health” that designs the future of our species.


This is a companion discussion topic for the original entry at https://quillette.com/2022/07/28/whats-in-a-disease/
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There are only two certainties in life; death and taxes. There is nothing wrong with death. All living things die. So coming to terms with it should not be a problem unless one is a delusional and narcissistic adolescent who thinks that they have a right to live forever.

The question is not death, but how we live our lives, however long they are. That is what most of us are not that good at, and new medical knowledge and technology has merely enabled an awful lot of us in affluent consumer societies to be kept in self-defeatingly miserable health for longer than ever possible before in our history as a species.

And what that draws attention to is how poorly we have negotiated the way affluence has enabled us to live. More than that, that affluence has drawn attention away from the enormously challenging and investment intensive business of creating living value and meaning from our lives. And getting that right is far more important than how often one drew breath, which will not matter at all once one dies anyway.

In a life well lived, death is an apotheosis; our summary full stop. And while we do not always get the chance to reflect on it as we approach it, it should be an exalted moment for which we are not merely prepared but embraced by, like a lover. It likely won’t be a particularly comfortable experience, but then neither is being born.

I do not particularly wish to become a great grandfather, because great grandfathers are out of time in the generational sequencing of human affairs. Three generations are a full house and anyone else is an excrescence, no matter how robustly-healthy-marathon running one is when a fourth generation is born.

No matter how loving and nice the family is about it, great grandparents are surplus to requirement, because all the familial action pivots to the youngest generation, and the very old are therefore inevitably remote figures whose presence is only honored in the breach, with the grandparent children torn between their ancient father, their own children and their commitment to their children’s children.

Great grandparents are awkward and everyone breathes a slight sigh of relief when the old bastard eventually does the right thing, and thankfully dies…or very sensibly departs to Switzerland for some tender and painless termination.

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There is nothing wrong with creamed spinach either, but I wont touch the revolting stuff. Whether something is “wrong” exists independent of whether it is desired.

Yet it is a problem, and seems to have been so for the history of humanity. Entire religions tentpole around this issue. I personally fear death and seek to put it off as long as possible, yet I do not feel I qualify as either delusional or narcissistic. Perhaps you disagree.

Regardless, casually dismissing a very normal human fear as “delusional” seems at odds with your normal thoughtful posting.

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This seems a little out of character. You feeling OK?

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My dear Gamma, I am 75 this year, & while for the moment I am in excellent health, these are my last years. People of my generation are dying off.

For me, death is not only part of life, but something to be embraced rather than feared, in the same way child birth is. A good death & a resolved attitude to it is part of a good life that realises that it is of no importance in the end & that all good things…all things…come to an end.

Those who are left behind maybe grieve for a while, but move on in the way all life does, taking & running with whatever legacy we have left behind for good or ill. Bits of us are still left behind in our children. Only the individual ego fully disappears.into the void. My father & mother still live on in me, even though I am old like they once were.

These days I become very emotional when I think of them, knowing that in some sense I will soon join them in my turn to become a memory in the minds of those who follow after me.

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Ouch.

Am I really so obnoxious? :smiley:

That is a particularly healthy attitude. I hope one day I am able to share it.

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I’ll start by saying, I’m 100% for curing aging, and it’s some kind of flaw - of human imagination, willpower, focus - that this is not a commonplace opinion and a standard social priority. But we can at least say that this idea is now deeply woven into today’s technological culture.

The author is intriguing in that she doesn’t come from a science/technology background. She originally studied Nietzsche, and “the ontology and poetics of death” in the context of “unforeseen extensions in human life and health”. Now, according to her Quillette bio, she’s “a Harvard Kennedy Fellow in Effective Altruism, A360 Scholar, VitaDAO Fellow, ODLB2, and bioethicist”.

So she made the leap from humanism/transhumanism as philosophy (think of de Unamuno, “Tragic Sense of Life”, or Bernard Shaw’s play “Back to Methuselah”), into the alphabet soup world of futurist activism that now stretches as far as the Ivy League (she’s at Harvard, home of the radical bioengineer George Church) and the dubious fast-moving realm of virtual blockchain organizations (a DAO is a “decentralized autonomous organization”). Let’s hope she actually does some good there.

Physical matter, in all of its forms, degenerates, changes, and becomes something completely other than it was in the beginning. Whether one is talking about stars, galaxies, mountains, rivers, life forms, they all change and completely disappear as they were, or they will in the future. Have read, that at one time the Appalachian Mountains were higher than the Himalayans are today. Change is the only constant in not just life, but the Universe in general. To try to step athwart physics, history, science, and life, saying stop, is highly unlikely to work. Merely begetting a new form of problems, which at present we are not even aware of. That is change, but is it
of any use to us at all.

I’d go as far as to say death is an important aspect of human social life and a vital ecosystem as well. The question might be, is there an optimal life span that enhances the human society and the ecosystem.

Recommend search “Paul davies”, cancer, evolution. We got cancer wrong and probably due for a transformation in our treatment modelling. It takes a long time to turn the medical science ship once it’s on a track of proving a particular track’s own worth. What is health, What is disease? As a health professional I note that much perspective in the developed world seems designed as a consumer product, and the consumer sure asks for it. The modern history of health improvements is predicated on better nutrition, water supplies, hygiene, but also the ‘war’ on organisms and their ecosytems e.g mosquitos and other parasites. Cities are destroying their mangrove swamps to build houses near the water and get rid of mosquito and ‘sand flies’. We aren’t really talking about this. Given that there is a lot of evidence that calorie intake levels is critical to life expectancy, technological corrections to ageing are an indulgent furphy. We could raise the world’s life expectancy to an equitable level and around 100 years without breaking a sweat but by creating culturally global discipline around caloric and nutritional intake. Political BS is the biggest killer on the planet.