Assessing The Promises And Perils Of Longevity Medicine

Who wants to be a centenarian?

Not too long ago, I expect only a few hands would be raised in response, as longevity was often equated with decline and diminished activity, inspiring the old joke, “When my doctor told me healthy habits could extend my life by ten years, he didn’t say they would be these ten years.”

All of that has changed as medical breakthroughs are enabling growing numbers of people to live longer, healthier lives. In 1980, there were just 15,000 centenarians in the U.S.; now there are more than 100,000, according to the Census Bureau, which predicts that number will quadruple by 2050. Polls show a significant proportion of Gen Z and Generation Alpha (people born after 1996) expect to live to 100.

Their ranks may swell even more as billionaires such as Jeff Bezos, Peter Diamandis, and—perhaps most famously—Bryan Johnson are investing in longevity research, studying everything from cellular health to epigenetic reprogramming medicines, often using themselves as test cases for exploratory treatments and protocols. At the recent Milken Institute Global Conference held in Los Angeles, more than 4,000 of the world’s wealthiest business leaders and dealmakers supplemented their discussions of finance with talks by top longevity experts, including Dan Buettner (Blue Zones founder), Richard Isaacson (Director of the Atria Precision Prevention Program), and Eric Verdin (CEO of the Buck Institute for Research on Aging).

These conversations focused not simply on surviving to 100, but on experiencing a healthy and active life to 100—and beyond.

As a medical doctor—and a human being who loves life—I am fascinated by the medical research that is unlocking the mechanisms of aging and delighted that it is already helping us improve patient care. As a hospital administrator, I am also aware that the growing ability of science to impact and even transform life is triggering a wide range of political, social, and economic issues.

If medical and societal interventions can meaningfully slow cognitive and physical decline, the ripple effects extend far beyond individual patients. What will it mean for the workforce, safety net programs, and society at large when older generations remain healthy, active, and intellectually sharp well into their later years? Could this fundamentally alter the social and economic fabric of our world? What if the breakthroughs prove to be terribly expensive? Do we risk deepening class divides between those who can afford miracle treatments and those who cannot?

As we marvel at the latest breakthroughs and anticipate the bigger and better interventions to come, wide-ranging modeling is needed, focused on questions such as, “What would the economic implications be for our healthcare system if all age-related diseases could be delayed by a year or more? What would the impact be if we could extend our healthy working lives by five years?”

These questions become increasingly urgent as the search accelerates for a single drug or treatment that can delay the onset—or even cure—all deadly age-related diseases. I’ve seen discussion about the potential epigenetic effects of existing drugs, including the possibility that the diabetes medication metformin might have a positive effect on longevity by protecting chromosomes from degrading and reversing the chemical tags on DNA that are associated with aging.

I’ve deliberately stressed the “might” in that claim since the research linking metformin and longevity is incomplete. But there is significant money behind longevity research, and I think we need to begin to determine how we will view aging in the very near future.

If there’s a medication to effectively “cure” aging (or age-related illnesses), if everyone can choose to live to 100 or beyond, we all need to consider what a meaningful life truly looks like in the shadow of immortality.