Ageing has been considered a natural and inevitable process for most of human history. However, the idea of redefining it as a disease has gained traction in recent years. The most notable example of this occurred in 2021 when the WHO almost suggested that old age was a disease in its new edition of the International Classification of Diseases (ICD). It retracted this decision after backlash from researchers and gerontologists, but the debate raged on.
As counterintuitive as it may sound, there is solid ground to justify the redefinition. Studies have found that ageing is one of the most significant risk factors in most chronic illnesses. Given that it causes conditions such as frailty and inflammation, while also being diagnosable/measurable and influenced by genetic and environmental factors, it wasn’t a stretch to argue that ageing meets the WHO definitional criteria for a disease. Furthermore, the biological mechanisms associated with geriatric syndromes are the same as those associated with the ageing process itself. According to this perspective, the two phenomena aren’t separate but are actually part of the same thing. This means that geriatric syndromes could be reconceptualised as conditions caused by accelerated ageing. As a result, it could be argued that ageing is not only a disease but an unusually lethal one with a 100% fatality rate.
Of course, not everyone agrees with this point of view. Growing old is a natural and universal process, while diseases are disorders of bodily structure and function. Equating the two is therefore problematic at best. This is the case not only from a definitional standpoint but from a socio-cultural one as well. According to surveys, 82% of older Americans have experienced ageism, with 65% having been exposed to negative stereotypes about the elderly through the media, while 45% had experienced interpersonal ageism. Being discriminated against or infantilised can cause unnecessary psychological distress. In some cases, the negative messages can even be internalised by the recipients, potentially leading to lower self-worth and worse health outcomes. Over a third of respondents to the survey clearly had internalised ageism. Categorising ageing as a disease would likely increase the stigma faced by the elderly and increase the psychological distress they suffer from it as a result.
Even more worryingly, ageism can be institutional and is prevalent in most healthcare systems around the world. Elderly people are more likely to have their complaints and symptoms dismissed by healthcare professionals, leading to them being under-diagnosed and under-treated. One of the primary reasons for this dismissal appears to be that health complaints are perceived as part of the natural ageing process, and hence not something worth addressing medically. Academics worry that if old age was treated as a disease, some healthcare professionals would use it as a catch-all diagnosis for any health complaint made by older people, worsening institutional discrimination.
However, it could be argued that categorising ageing as a disease could also lead to positive social outcomes. Classifying something as a disease leads to more attention, not only from the general public but also from the pharmaceutical industry, policymakers and other funding bodies. This could incentivize more research into the field, leading not only to a better understanding of relevant biomechanisms but also of potential treatment methods.
As previously mentioned, scientists have found that the same biological processes cause both ageing and age-related diseases. Instead of treating age-related diseases separately after they’ve emerged, anti-ageing treatments could reduce the risk of developing any of them in the first place. This could lead to significant improvements in health span and geriatric health, while also potentially reducing the burdens on the healthcare system. At first glance, this dream sounds far-fetched or even impossible. Currently, no drug to slow or stop ageing has been developed and approved.
Research into the field has sometimes been difficult due to a scarcity of academic grants and regulatory challenges. For example, the FDA normally takes one disease – one target – one drug approach to clinical trial approval, as do many regulatory bodies. As ageing itself is not considered a disease, approval is difficult. Luckily, things seem to be changing. The FDA approved the TAME trial in 2015, despite it aiming to see how effective a drug was at treating ageing, and the paradigm in the drug discovery field is slowly shifting away from the one disease – one drug approach. Additionally, billionaires such as Thiel and Musk have been investing millions in anti-ageing start-ups. As a result of these efforts, there are now several possible candidates for anti-ageing drugs currently in clinical trials. Other newer methods have seen significant success in animal studies. In a few decades, we may have the technical capacity and knowledge to slow down human ageing significantly.
Of course, this doesn’t mean that we should. Massive social changes would be needed if the human lifespan increased significantly. Many European countries have already seen an increase in life expectancy and a decrease in fertility rates in recent years. The result has been an increasingly overburdened pension system. Of course, people pursuing medical solutions to ageing hope it will increase their health span as well as lifespan. Social and legal changes like pushing back the retirement age would therefore be viable if effective anti-ageing drugs were to become available. However, this change would not only be politically controversial, but also inequitable, given the huge disparities in life expectancy between different groups within the same country. Furthermore, if ageing was ever stopped, demographic problems such as overpopulation would probably arise.
In conclusion, there are two main aspects to consider in this debate. We must decide whether or not we want ageing to be medically treated as though it were a disease, and also whether or not to define it as such. Although some alarmists state that curing ageing would lead to unprecedented problems such as changing demographic structures and severe overpopulation, these concerns are overblown. We are still many decades away from reversing, stopping or even significantly slowing ageing. Focusing on the problems that this would result in is not only premature but could set back research aimed at making smaller lifespan/healthspan gains in the near future.
There is therefore no compelling reason not to research potential treatments for ageing in the present. At first glance, this suggests that ageing should be defined as a disease so that it can be studied as such. After all, this would make more money available and remove regulatory barriers. However, it could be argued that formally defining it as a medical condition isn’t necessary to achieve this. Paradigm shifts in the pharmaceutical industry and an influx of money from billionaires could solve the financial and regulatory barriers to investigating new anti-ageing techniques. Given this context, there’s no need to increase stigma against old people by defining ageing as a disease.
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