Editor’s note: Dr. Steven Austad is scientific director of the American Federation for Aging Research, a national nonprofit organization, and chairman of the University of Alabama at Birmingham Department of Biology. The views expressed are his own.
The No. 1 threat to global health is not what you think. It is not pollution, climate change, poor diets or smoking. It is not cancer, Alzheimer’s or heart disease. No, the biggest threat to global health is aging.
The degenerative processes of aging underlie all the “celebrity” diseases like cancer, stroke and Alzheimer’s as well as most causes of chronic pain and disability, like falls and fractures, arthritis, vision and hearing loss. We will all suffer from it eventually, and it is the aging process itself, rather than individual diseases, that threatens to overwhelm our health care infrastructure and cripple our economy.
That is the bad news.
The good news is that researchers over the past several decades have discovered that basic aging processes can be treated. Just as the death rates for heart disease and stroke plummeted once we discovered how to treat high blood pressure and high cholesterol, similarly by treating basic aging processes, it will apply the brakes to aging, delaying the many maladies of later life as a group, keeping people healthy for years longer. As some have put it, in the future it could take a century to reach age 75.
Our successes in treating aging — and there are dozens of them, with more emerging all the time — are at present largely confined to laboratory animals. But medications have been discovered that can delay mouse versions of cardiovascular disease, numerous cancers and Alzheimer’s disease.
These medications have also preserved muscle strength, delayed arthritis, rejuvenated stem cells and boosted vaccine response among other things. It is time to evaluate the effectiveness of these drugs in people, which is why the American Federation for Aging Research has proposed the first such study.
It is called TAME (Targeting Aging with Metformin). Metformin is currently prescribed as the first line of defense against Type II (adult onset) diabetes, and is taken by millions of people. It has been proven to be safe and inexpensive. Provocative — although slender — evidence links metformin use to protection against heart disease, cancer, and dementia in addition to its anti-diabetic effects.
So we propose a controlled experiment — called a clinical trial when done with people — that would monitor the comprehensive health status of people randomly selected to get either metformin or a placebo. Such controlled experiments are the gold standard of scientific evidence, and would provide valuable insights.
Of course, this raises some understandable questions:
Wouldn’t such a study take decades and be cripplingly expensive? No. If you start a study with people of a certain age, they are likely to contract one or more of the diseases of aging within the next five years. So it is straightforward to see whether a group taking the drug develops fewer new diseases of aging over five years compared to a group not taking the drug. Numerous similar studies of drugs to treat individual diseases are done all the time.
Why go to the time and expense of doing a clinical trial? If metformin has all these beneficial effects and millions of people are taking it, won’t we eventually detect these effects without an official experiment? The reason for doing a clinical trial is because the Food and Drug Administration (FDA) requires the type of evidence to approve any drug for human use. This is a new type of trial, though. We are asking whether a single drug can treat or prevent multiple diseases and conditions. Getting FDA approval for such a drug (and they have already indicated they would consider it) gives its use legitimacy. In addition, the prospect of FDA approval for aging-retarding drugs would attract new excitement and new funding for this type of research.
What if it doesn’t work? We acknowledge that it may not. Most drug trials fail. But a better question might be “what if it does work?” It would mean more years of healthy life for millions of people, and could be the biggest health breakthrough since antibiotics.
Even if it doesn’t work, we would have established a path-to-approval for potential aging-retarding medications. There are a number of other drugs that show equal promise in animal studies. If even one of those works in people, it is a game changer. One recent economic analysis concluded that slowing the human aging rate by 20% would save more than $7 trillion — that’s trillion with a “T” — over the next 50 years in the United States alone.
Given that the economy of every developed country is bending under the weight of its health-care costs, and given that a medication that treated aging could dramatically reduce the global burden of misery, it would seem reckless not to begin this trial — and sooner rather than later.