The average child born in the United Kingdom today can expect to live to ninety-two. Fifty years ago, this figure was eighty-four, while it has been predicted that in fifty years time, almost half of newborns can hope to make it to make it to triple digits. This staggering increase is the product of society’s many developments over the last two hundred years, though few factors have had a bigger impact on the extension of our lifespans than the advances of medical science. With decades of biochemical and medical research, we have a better understanding of many of our most grievous diseases and disorders, allowing us to develop healthcare to a level unimaginable even a century ago.
It may be, however, that this development still has a long way to go. The technological revolution of the last three decades has started to filter through to the healthcare industry, and has brought some incredible innovations. In the last year alone, we have seen: the creation of prosthetic limbs capable of generating tactile sensation and responding to motor commands; the development of techniques that treat Alzheimer’s disease with ultrasonic sound waves; and it has even become possible to introduce virtual reality technology into the surgeon’s theatre for treatment of blocked blood vessels. Every year, new treatments and technologies are developed to combat the many ailments we face, be they viral or congenital, gun shot or blood clot—one could be forgiven for supposing that the phrase ‘incurable condition’ may eventually fade from our lexicon. Despite this, there is one affliction that one might consider beyond the reach of medicine: senescence, the decline into old age.
Historically, the development of this weakness, this degeneration, has never been a great burden. One would often succumb to infection or disease before the destructive effects of age took place. Now, thanks to vaccines, antibiotics and pharmaceuticals, we live on even as our minds and bodies degenerate. It is becoming apparent that old age is not too dissimilar to the countless diseases for which we now have cures. Despite the superstition and spiritualism that have always surrounded death and old age, we now know that there is nothing transcendental about ageing: it isn’t the slow approach of a scythe-clutching hooded figure, but a collection of macroscopic symptoms with causes rooted in the molecular biology of human cells. Even those who do not give credence to these supernatural ideas might consider ageing to be an unavoidable and necessary part of life. Evidence to the contrary is mounting: species of turtle, jellyfish and lobster, among others, have been found that display no significant ageing. These animals appear to live in a state of continued youthfulness until injury, disease or predation gets the better of them. Perhaps, then, it is not inconceivable that, with our ever expanding understanding of the body’s cellular intricacies, we can imitate these species’ evolutionary achievements by pharmaceutically inducing increased longevity.
The chance of such an imitation has gained promise in recent months, as interest has been generated around the putative age-arresting qualities of the drug metformin. This chemical is the first choice treatment for type-two diabetes, with around fifty million prescriptions being filled every year in the United States alone. It acts by blocking the production of glucose in the liver and reducing the absorption of sugars by the digestive system. Metformin’s mollifying effect on high blood sugar makes it a very effective antidiabetic, though it seems that its beneficial effects might extend beyond disease prevention. A study of thousands of subjects carried out by Cardiff University last year, found that diabetic patients treated with metformin actually outlived healthy, untreated subjects by a small but statistically significant amount. This defied the expectation that they would die on average eight years earlier. This study suggests that beneficial effects of metformin treatment are of a greater magnitude than the deleterious effects of diabetes mellitus, and that metformin may interact with the body in such as way as to somehow slow the effects of ageing.
This may seem to be a surprising result, but it is not an isolated event. The basic principle underlying metformin’s effect on lifespan has been known for some time. Seventy years ago, the American biochemist C.M. McCay showed that reducing calorific intake almost to the point of malnutrition can nearly double the lifespan of rodents. Initially, the exact reason for this was not clear; it now appears that reducing the amount of energy one consumes stimulates tissue in the body to reduce cellular growth and increase the breakdown of proteins, reducing the aggregation of misfolded proteins that are commonly associated with age-related conditions. This change in activity lessens the chance of cellular death and dysfunction—effectively, it puts the body’s cells on the slow burner, allowing them to survive longer. What metformin may be is a calorific restriction mimetic; a drug that mimics the beneficial effects of a reduced calorie intake without the need to alter diet. Other such drugs have been identified, but metformin appears to be the most effective in humans so far, and in November 2015, America’s Food and Drug Administration announced that a large-scale clinical trial is to be carried out on metformin as an age-arresting treatment.
It will be some time before the results of the trial are known. But once released, they could have a considerable effect on the healthcare industry and wider society. Metformin as an approved longevity promoting treatment could have societal implications as vast as the first contraceptive pills, though it is worth noting that whether or not this trial passes, our long term landscape is unlikely to be considerably different. Metformin is not a one off wonder drug. If approved, it could well increase life expectancy by decades; if not, then it is likely that a chemical with a more potent action will soon be discovered that will. It can also be said that this drug is not a fountain-of-youth pill, with which we can achieve immortality. It simply represents one of the first major steps in the development of longevity-promoting treatments, which may not be as far off as we might have thought. Certainly, pharmaceutical companies would be eager to begin the production and distribution of a longevity-promoting drug. Most drugs available today are targeted either towards the small minority of us who are unwell or diseased, or towards to the particular requirements of healthy individuals, such as with sleeping pills or smart drugs. Few currently available treatments can be said to be as universally applicative or highly demanded as any age-arresting treatment would be.
Unfortunately, where there is high demand, there can also be high prices. The ability and willingness of pharmaceutical companies to charge exorbitant fees has drawn widespread outrage in the past. In 2014, the first pill only cure for hepatitis C was introduced at an eye watering cost of $1,100 per pill. Whilst the price of an age-arresting drug might be unlikely to reach anywhere near the level of this four figure extortion, the inevitable high demand for the drug adds plausibility to the idea that the treatments would not be cheap. They could become solely the preserve of those who are able to afford it, leading to an even more starkly apparent inequality between the rich and the poor. Life for those unable to afford any treatment would remain shorter, whilst the wealthy could anticipate extending the longevity of their privilege.
Alternatively, the NHS could subsidise anti-ageing treatments in the interest of the nation’s inhabitants. The cost of doing so could be enormous, and there would be even more issues facing the country’s health service. Our growing, ageing population is already a strain on the state, and it is only predicted to get worse. We are currently preparing for a huge rise in the population of pensioners, following the nearing retirement of the post war ‘baby boomer’ generation. Parliament has predicted that, over the next five years, the proportion of the population aged sixty-five or over will increase by 12%, whilst welfare expenditure on pensioners in expected to increase by £2.8 billion per year. Consequently, we can see that the expansion of the ageing population is leading to growing pressure on both the NHS and the welfare state. Whilst much of the immediacy of this demographic shift can be attributed to the age structure of Britain, it surely also comes as a result of the matter of increasing life expectancies. An age-arresting treatment that adds even a decade to one’s life expectancy would not only serve to exacerbate these issues, but may act to introduce even more.
The problem faced here applies globally, beyond the scope of just the United Kingdom. The UN has indicated that around 850 million people across the world are malnourished or starving, and over one billion people do not have access to safe drinking water. By 2025, it is predicted that up to two thirds of the world will be struggling with water scarcity. By 2050, when the world’s population is predicted to reach nearly ten billion, it is estimated that half of the world’s population will be malnourished. The resources available to us are currently spread thinly and unevenly amongst us, and a widely available longevity-promoting treatment would likely do nothing but worsen this issue.
This danger is not likely to dissuade many researchers from their pursuits; undeniably, longevity has always been one of society’s abiding dreams. Yet, if care is not taken, our search for life extension may turn out to be a nightmarish Faustian pact: a deal with the devil that turns our dreams against us, causing significantly more harm than good. Rather than a portent to the end, this issue may serve to act as a clear reminder of society’s limitations: a world with a balanced measure of equality, longevity and prosperity is beyond our reach. We cannot have it all, and somewhere a trade-off must be made. With regards to the progress in research towards age-arresting treatments, perhaps this means we should focus on the quality, rather than quantity, of our years on this planet.
Image by Derek Midgley