The future of the long and healthy life
Last Tuesday I joined a thought-provoking webinar by Swiss Re Institute and the Asia Society Switzerland ... my, it's been almost a week - how times flies ... Actually, that's right on topic as the focus was aging, with the title of the event asking, "How long can we live?"
There were answers from the experts on the title's question - more on that later. Life. Long life. Extended life - it's always been considered the holy grail, and it's always been thought of in terms of the mythical fountain of youth. The important element in this myth is this: It was always understood that old age was only worth having while living it in a healthy vessel.
Now then, to the webinar, featuring geroscientist Nir Barzilai, Professor of Medicine and Genetics and the Director of the Institute for Aging Research at the Albert Einstein College of Medicine, as well as John Schoonbee, Swiss Re's Chief Medical Officer. They both began by stating that their research interest isn't in extending life, but in keeping people healthier, longer.
Professor Barzilai said in his introduction that aging can be targeted, delayed, stopped, and, in certain instances, reversed. As appears intuitively obvious, there are two ways of dealing with the aging process - one is by way of a healthy lifestyle (nutrition, exercise, sleep, etc.), the other is by way of drugs. Barzilai shared an initial slide (see below) that, at first glance, simply listed many of the well-known diseases we're all too familiar with. But look at the progression and one thing becomes powerfully clear - the risk of every listed disease increases - quite dramatically - with age. Simply put - aging drives diseases.
The professor said that, effectively, the main risk in all the above are not the various diseases - but the process of aging itself. If that process could be delayed - or even halted - people around the world would live healthier into old age. It is an arresting thought because what happens right now really doesn't do the trick, does it? As we all know only too well, age very much is also a major risk with our current scourge, COVID-19. Around the world there are disproportionate numbers of deaths in older adults. On a depressing note the professor did say he expected that most coming vaccines would not be effective with the elderly.
The professor's research aims at keeping people at their healthier younger-life stage for longer, thus shortening the old age span where the risks of the above diseases await. Barzilai gave the example of an elderly person with a heart disease. They might get a bypass and go on living - but they're still old and thus just waiting for any of the other diseases that are so far more likely to afflict them, the older they get. It is also known that an individual's aging process, after being afflicted with a disease, progresses more rapidly. It is a downward spiral that, according to researchers, can be stopped - by tackling it before old age sets in. The professor highlighted promising research - here two areas they are working on:
A focus on centenarians
The 100+ population is still a rare bunch ... what is it that allows some people to live beyond the age of 100? The Institute for Aging Research has one particular group of roughly 3000 research subjects - among them 750 centenarians and their offspring. The focus is on discovering the secret of what makes them "super agers". It is already known that centenarians are very resilient, they tend to stay healthy into old age (see below slide). Their genetic secret is not yet unlocked - but that's the focus.
A focus on medication
The second research topic was equally fascinating and suggested that, in a way, the holy grail has already been found and has been around for decades (discovered in 1922 according to Wikipedia) in the form of a drug called Metformin. The professor said, straight out, that you can give this medication to any animal and it will live longer. Today Metformin is mainly used with diabetes patients. However, research so far is highly promising and Barzilai pointed out that the those taking Metformin had fewer diseases and less mortality. He also showed, with the results from several studies, that people taking Metformin during COVID have less morbidity and less hospitalization.
To make it very clear - no one was saying that this is the holy grail, the cure-all. But even a cursory glimpse at the web shows that there's a lot of focus on this. The National Center for Biotechnology Information (NCBI) writes that "Metformin is the first drug to be tested for its age-targeting effects in a large clinical trial" (this forms part of the Professor Barzilai's research).
The interconnected healthy lifestyle
Later during the webinar, when one of the participants asked "So, as someone +50 years of age, should I just take Metformin, or rather focus on a healthy lifestyle?" - both speakers, unsurprisingly, gave the lifestyle advice. That is something that is here, now, abundantly studied - and something we all have within our power to do. At Swiss Re, we call this "The Big 6" - by living these in good balance, we do a great deal to minimize health-related risks in older age.
Dr. Schoonbee explained that the research focus at Swiss Re is not on extending life beyond 100 - but on keeping life healthy. There have been massive negative developments in the past decades, leading to millions of obese people and a surge of diabetes cases. By driving awareness and understanding around the Big 6, millions of people can live healthier lives into old age. Schoonbee said that Swiss Re has done a huge amount of research to better understand and thus of course also to better price risks. In essence, our bodies are tremendously interconnected - if you consistently ignore (or actively damage) one element, it'll affect many others. The below example shows that sleep affects a range of things. As laypeople, we may not know most of the scientific details, but the basics should be abundantly obvious to all of us - they are, aren't they? After all, if we just pay a little attention to how we feel, how our minds and our bodies feel, depending on what we do, we know. Our system tells us, gives us hints, impulses, in various ways. Those are always the moments of choice - do we ignore or do we start acting in healthier ways?
Questions about the future
How long can we live? Schoonbee said that we have a natural limit. He expects the average person to live to their mid-nineties with a healthy lifestyle. With genetic advances, there may be an extension beyond that, but he sees the 150-200-year life as science-fiction. Barzilai agreed, saying that there currently is a roof at about 115 (and that only for those special super agers). But he also said that it doesn't have to stay there. He believes that there is a world of healthy aging ready to be unlocked for the time of life between the age of 80 and 115.
Why isn't everyone taking it? There was an interesting conversation around Metformin and its current use. Professor Barzilai explained that aging as such is not recognized as a disease. He smiled when he said that this is not an easy challenge, because geroscientists really don't want to call it a disease. So, currently, most of the focus goes to fighting diseases as they appear - not to the underlying process of aging that accelerates the potential onset of a cluster of diseases. John Schoonbee also explained that, in our society, we don't generally give medication to essentially healthy people.
What's the insurance perspective? The aim is clear - Schoonbee said that the goal is a population of insured people that live well and healthy into old age. A healthier population also means lower premiums for everyone, and thus more and more people able to afford the protection (both in terms of health and life insurance) they'll still want and need. "We make the world more resilient," Schoonbee said, stating Swiss Re's purpose, "and a focus on the Big 6 helps us deliver on that." Beyond the Big 6, however, there absolutely is also a need for medication. After all, as Professor Barzilai highlighted, there are people that are in weakened states already, people that cannot exercise the way healthy people can - such as someone recovering from cancer treatment, or an HIV patient, or someone who's wheelchair-bound. There, medication is essential.
What if everyone lives healthy to 100 and beyond? The demographic shifts around the world are very clear and the topic of aging is vast. Which is why Swiss Re Institute gave it this focus with The "Aging Effect" series. The two speakers talked about society, mindset, usefulness reskilling and purpose. There are no final answers yet - but there are lots of ideas. The older-age human society will happen - and that is nothing that needs to be catastrophic for society and social systems around the world - but it does require rethinking a great deal of how we used to look at old age in the past - and yes, it requires a dramatic effort to fix aging per se - if we can, by way of lifestyle and medication, make society healthy into old age - then there are plenty of positives to look forward to. Without that research focus and the solutions that will follow, systems will eventually collapse and because of that the research around aging must, if anything, see intensified research.