#333 ‒ Longevity roundtable — the science of aging, geroprotective molecules, lifestyle interventions, challenges in research, and more | Steven Austad, Ph.D., Matt Kaeberlein, Ph.D., Richard Miller, M.D., Ph.D.

The recent rise in public interest in longevity, misconceptions, and the link between healthspan and lifespan [3:45]

The rising interest in longevity, misconceptions, and the link between healthspan and lifespan

• The term longevity is clearly at a peak in terms of public interest
  • The number of times “longevity” is searched on Google is similar to “Bitcoin”
• All of today’s guests have devoted decades to studying longevity

Why are people so interested in longevity? Is there a bubble going on?  

Steve Austad

• It’s a surprise that longevity has become so big, because for a long time we tried to move away from that in the aging field because we were worried that people were thinking of longevity as we’re going to keep frail, feeble old people alive longer
• When really what we were trying to do is extend health
• He thinks it’s because there are certain people of a certain age who’ve started to think about their own longevity
• There’s also a whole new generation of tech entrepreneurs that really feel like this is a problem that will allow them to live healthily for several decades (at least) longer than they are now
• He hasn’t seen this level of interest before
• 30 years ago, he would’ve said, “Let’s not even say the word longevity, let’s say healthspan.”
• That has changed as more and more people have been peeking in at the field from the outside

The field hasn’t changed they way they talk, it’s the people eaves dropping on the field that have changed  

Rich Miller

• People have always been fascinated for millennia on things they could do to stay alive and healthy as long as possible
• But there were actually scientific discoveries in the ’90s that showed that it could be done
• Then in the last 20 years there’s evidence (in mice) that it can be done with pills

So that naturally should lead to speculation that there could be pills you could give to people that would postpone poor health for a substantial amount of time 

⇒ 20-30% [extension of healthspan] is what we’re seeing in mice, and 20-30% would be very important for people

• That is one part of it
• The other part is that there are now people who are making a lot of money by selling stuff that is untested (or useless) to gullible customers

People who want to make a lot of money have finally found that there’s an impetus that will allow them to sell stuff, even if there’s no evidence that it works 

• And they control an enormous amount of advertising dollars, both formal and informal
• That’s a big part of the difference

With regard to something Steve said about the balance between healthspan and lifespan 

• It’s become fashionable, for the last 20 or 30 years, to imagine that you get one or the other, that you have to make a choice
• That it’s a decision, and that if you give up on lifespan that allows you to extend healthspan
• Rich thinks that’s ridiculous and controverted by all the available evidence

⇒ All of the drugs at least that extend lifespan in mice (and could potentially do so in people) do so by postponing diseases 

• Both the diseases that will kill you (that’s why they extend lifespan) and the diseases that won’t kill you, but which will annoy you and make you very unhappy to be old
• Peter points out ‒ that’s also true of exercise and not being insulin resistant

Healthspan and lifespan are linked together, they go up and down together  

⇒ Getting people disabused of that false seesaw metaphor [that for healthspan to go up, lifespan goes down, and visa versa] is an important goal for the public interface between longevity scientists, aging scientists 

15 years ago the first ITP was published showing the overwhelmingly surprising and positive results of rapamycin

• After a decade-long lag, those results were repeated
• Cynthia Kenyon’s work was published in ‘93, and this may have been the thin edge of the wedge into the idea that lifespan was malleable
  • Albeit through a genetic manipulation in a less relevant model

Thinking about this lag, do you buy Steve’s argument that it’s a confluence of technology, tech entrepreneurs? 

Rich answers the first question: why the lag?

• There’s a whole batch of important reasons
• 1 – The prevailing attitude about aging is there’s nothing you can do about it
  • I’m not going to outwit aging, though maybe I can be healthier in my older years

“The notion that aging is not malleable, though wrong and provably wrong, is still the overwhelming opinion even of reasonably educated scientists and certainly of the lay public.” ‒ Richard Miller

• 2 – Commercially, there are companies that make a ton of money selling stuff that doesn’t work by pretending, with a wink and a nod and a lawyer, that it might slow the aging process down
  • And since they can make a lot of money, they don’t actually have to spend valuable marketing dollars on doing research and stuff to prove that it works

The long road to developing a longevity drug

• In the hands of the ITP (Interventions Testing Program), for some of the drugs, the patent is owned by another company
  • Or they’re out of patent
  • Or it’s a natural product
• None of that says take me to whoever owns a big pharmaceutical firm
• Even if you want to do it right and you’ve got a very large budget, it’s not an overnight kind of thing
• For the half a dozen drugs that have been shown to work in the ITP (in mice), finding something in the same family that works really well for people (and is safe) is not trivial

That takes a long time and it takes a commitment of money and time and effort and intellectual resources, and so far it has not been enormously successful (unfortunately)  

Steve Austad, “Can I push back a little on what Rich said about healthspan versus lifespan?”

• Several papers have come out recently showing that the gap between healthspan and lifespan in people is actually increasing
  • It’s increasing the fastest in the United States
  • It’s increasing faster among women than men
• In humans this is a very real gap and it’s a growing gap
• In the area of geroscience (the stuff that we do), Rich is right
  • We don’t see this in our experimental systems

To Steve, this emphasizes the fact that we need to change the focus 

• One of the reasons that the gap exists is we’re getting better and better and better at treating heart disease and cancer and all these things
  • Keeping people alive when they wouldn’t have been alive 10 years ago
• This is a really important factor when thinking of public health globally 

Matt Kaeberlein

• Thinks both Rich and Steve are right, but looking at it from different angles
• Steve pointed out that you can make people live longer when they’re sick
• What Rich is saying (and Matt agrees with) is that if we target the biology of aging, he hasn’t seen anything to make him believe that you can separate healthspan and lifespan
  • Meaning he hasn’t seen things that slow aging/increase lifespan that don’t also increase healthspan

Steve Austad 

That’s an important point: if we target aging, we’re doing something different than the way medicine is operating now, which is targeting individual diseases after they occur 

Redefining healthspan, the US healthcare paradox, and separating longevity science from commercial hype [12:30]

Peter makes the connection to healthcare spending 

• This came up in a recent podcast with Saum Sutaria [episode #327] talking about healthcare costs
• One thing that emerged is the sad statistic that among the OECD nations, the US has the lowest life expectancy 
• Which is ironic given that we are spending, on average, about 80% more, and in some cases double what most other developed nations spend on healthcare

So how do you reconcile this?

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