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Richard W. Besdine, M.D. Headshot

The Biggest Risk Factor For Top-Killing Diseases

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Today, aging and disease are linked like birthdays and cake. In fact, the greatest risk factor for all the big killers is the number of candles on that cake. But imagine living to 85 or 90, never worrying about getting cancer, diabetes, or Alzheimer's disease. It's not possible now but it could be.

Scientists who study the biology of aging -- the basic mechanisms of how our cells and tissues change with age -- believe the aging process is modifiable. It cannot be stopped, but it can be slowed. Even better, scores of peer-reviewed studies have proven that decelerating the aging process in lab animals also offers huge health benefits, dramatically delaying and lowering their incidence of chronic disease.

If we could achieve the same exciting results in humans, we could transform the lives of older people and achieve what aging researchers call a longer healthspan. As University of Michigan gerontologist Dr. Richard Miller has said, "the goal isn't to prolong the survival of someone who is old and sick, but to postpone the period of being old and sick."

So what's stopping us? Our scientific understanding of the aging process and how it affects our health is still a work in progress. With America's 65-plus population set to double in the next 20 years, and age-related health care costs threatening to bankrupt federal and state governments, it's time to change our approach to research on the biology of aging. Putting a man on the moon was a defining national goal in the 20th century; in the 21st century, it should be decoding the biology of aging to find the fountain of health.

Interventions proven to slow the aging process include genetic manipulation, diet, and drugs. For instance, certain genes found in both animals and humans are known to modulate the rate of aging, including the CETP gene variant (the so-called "longevity gene"), which increases "good cholesterol" and may protect against Alzheimer's disease. Other approaches include caloric restriction (feeding lab animals a nutritious but much lower-calorie diet); use of rapamycin, usually given as an immunosuppressant after organ transplant; and a compound called resveratrol, a derivative of grape skins now being tested as a diabetes treatment.

It is also important to study the molecular processes that go wrong in old age, including the body's response to inflammation, which appears to be an important contributor to bad health events in older adults. A better understanding of the mechanisms underlying inflammation could help defeat or prevent cancer, Alzheimer's disease, osteoporosis, anemia, and even cognitive decline after 70.

All these discoveries have one thing in common: we know they work, but we don't understand enough about why or how. As Roger McCarter, professor of biobehavioral health at Penn State and president of the American Federation for Aging Research, points out, "knowing how they work is important because each has potential downsides. For example, caloric restriction can cause decreased wound healing, feeling cold all the time, and greater susceptibility to infectious disease. These concerns need to be addressed before such techniques can be applied to humans."

Unfortunately, this potentially transformative work is a poor stepchild in the biomedical research enterprise. Older Americans tend to develop multiple chronic diseases (accounting for 95 percent of Medicare and Medicaid spending). But most research funding gets siloed into grants that study individual diseases, produce therapies that treat only one aspect of a patient's complex condition, and may add few, if any, very expensive months to life.

Aging research has far greater potential to repay the public's investment than disease-centric research, because the best defense is a good offense. Getting at the root cause of a range of diseases can ultimately help us keep millions of people from developing those conditions in the first place.

Although the National Institutes of Health budget exceeds $31 billion annually, the vast majority of those funds are allocated to research on specific diseases rather than the basic biology of aging, despite its potential to provide many preventive and curative strategies.

This funding disincentive creates a troubling "brain drain" of promising scientists studying aging who go into other fields. The problem and the missed opportunity will only get worse if the Republicans' proposed across-the-board budget cuts are allowed to gut the NIH just when we need medical and scientific innovation more than ever.

The anthropologist Ashley Montagu said it well, "the idea is to die young, as late as possible." Aging research can show the way. All we need is the political will to try.

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