Is aging a disease?

In Swiss Verbier, those born in 1945 or earlier ski for free. This perk, also offered at other resorts, reflects the reality that few octogenarians are eager to brave the slopes. The risks of age-related injuries, such as fractures or paralysis, are often too high—or are they? Due to lifestyle choices, some people age faster than others. Thanks to a healthy diet, regular exercise, and a bit of genetic luck, some 80-year-olds still take on the steepest descents with confidence. What if we could all live like that?                                                                               

What if the typical limitations of aging could be delayed—or even overcome? What if aging itself is a disease that can be treated? Proponents of classifying aging as a disease point to the biological hallmarks of aging, such as cellular damage, genetic mutations, and reduced regenerative capacity. They argue these processes actively contribute to disease and disability. By recognizing aging as a disease, they believe research funding could increase, potentially leading to interventions that slow or even reverse the aging process. Some supporters compare it to obesity, which the American Medical Association classified as a disease in 2013. While aging may not fit the traditional definition of a disease, they argue that labeling it as such could help drive the development of treatments, similar to how the GLP-1 weight-loss drugs emerged to combat obesity.

There’s no doubt that aging is the single greatest risk factor for nearly every chronic disease. Over time, our cells shift from healthy and resilient to frail and dysfunctional, ultimately paving the way for disease.

 

Breakthrough research by John Gurdon and Shinya Yamanaka Young, for which they were awarded the Nobel Prize in 2012, suggests that it may indeed be possible to reverse or slow aging at the cellular level. The so-called Yamanaka factors can reprogram adult, specialized cells back into an embryonic-like state. By rejuvenating cells, their capacity to buffer damage and respond to stress improves, which could delay the onset of diseases or prevent them altogether. By addressing aging itself, we could target the root cause of many diseases and potentially extend not only lifespan but also healthspan—the number of years we live in good health.

This perspective is gaining traction, though not without controversy. In 2022, the World Health Organization (WHO) proposed including "ageing-related decline" in its International Classification of Diseases (ICD), a global catalogue used to standardize disease diagnoses. However, the WHO ultimately withdrew the proposal due to significant reservations. Critics argue that aging is a natural process, not a pathological one, and fear that medicalizing it could lead to overtreatment, stigmatization of older adults, and a disproportionate focus of healthcare resources on anti-aging interventions.

Critics also highlight that aging is a complex process, interwoven with social and psychological factors, not just biological ones. Classifying it as a disease risks reducing older adults to their biological decline, potentially overlooking the social and environmental factors essential to their well-being.

Despite these concerns, the debate is far from settled. Research into the biology of aging is progressing rapidly, with promising results in animal models. From senolytics that clear aging cells to gene therapies that reprogram cellular function, extending human healthspan is no longer the realm of science fiction. The implications of classifying aging as a disease could be profound, potentially leading to a paradigm shift in healthcare. Instead of a reactive system focused on treating individual diseases, we might adopt a proactive approach aimed at preventing age-related decline altogether.

Market pundits, such as Jim Mellon of Juvenescence, predict a 'stock market mania' fueled by technologies that help extend human life beyond 100 years. With research costs plummeting due to outsourcing and AI, we can expect new therapies to emerge more quickly. However, picking winners among longevity-enhancing biotech stocks remains a challenging endeavor, with few willing to take the risk. Developing a new drug can take up to 15 years and cost $2.5 billion, and even then, FDA approval is far from guaranteed. In fact, about 90% of drugs that make it to clinical trials—a difficult and costly milestone in itself—never receive approval.

A less risky strategy might be to anticipate takeover offers from large pharmaceutical companies targeting biotech firms that show positive clinical trial results or secure FDA approval. Established, profitable large-cap biotech companies like United Therapeutics, Biogen, and Eli Lilly have already proven to be successful investments in the longevity space. Additionally, suppliers—the 'arms dealers' of the industry—who equip laboratories, supply materials, and handle outsourced production, stand to benefit greatly from this emerging wave.

In the meantime, the best investment might be in yourself—regular exercise has been shown to have effects on cells similar to short pulses of Yamanaka factors!