Aging. Antiaging research and the need for public dialogue

Life Extension Should Come with Wisdom: Reflections and Questions for the Geroscience and Longevity Community

Geroscience, or longevity biotechnology, has made impressive advances in recent years that have led to the founding of dozens of start-ups, nonprofits and advocacy organizations, and the formation of a global movement to defeat aging. The community envisions changes at the regulatory and policy levels and calls for increased funding for research. Nevertheless, progress in the field has not been matched by discussions about ethical, legal, and social implications, as longevity advocates assume that seeking to expand lifespan or health span is inherently desirable and permissible. In this article, I make the case for the importance of putting ethics and society back into geroscience, along with three considerations for the longevity community. First, it should seek to understand the needs and attitudes of the public. Second, the community needs to define whether the field is primarily striving for healthy aging (increasing health span) or for extending years of life (lifespan). Third, it needs to define the role of investors and tech millionaires in shaping the field's priorities and direction. This last point raises the question of who is setting the direction of a field that can reshape the meaning of being human.

Spontaneous Reproductive Tract Lesions in Aged Captive Chimpanzees

Chimpanzees (Pan troglodytes) have served as an important model for studies of reproductive diseases and aging-related disorders in humans. However, limited information is available about spontaneously occurring reproductive tract lesions in aging chimpanzees. In this article, the authors present histopathologic descriptions of lesions identified in the reproductive tract, including the mammary gland, of 33 female and 34 male aged chimpanzees from 3 captive populations. The most common findings in female chimpanzees were ovarian atrophy, uterine leiomyoma, adenomyosis, and endometrial atrophy. The most common findings in male chimpanzees were seminiferous tubule degeneration and lymphocytic infiltrates in the prostate gland. Other less common lesions included an ovarian granulosa cell tumor, cystic endometrial hyperplasia, an endometrial polyp, uterine artery hypertrophy and mineralization, atrophic vaginitis, mammary gland inflammation, prostatic epithelial hyperplasia, dilated seminal vesicles, a sperm granuloma, and lymphocytic infiltrates in the epididymis. The findings in this study closely mimic changes described in the reproductive tract of aged humans, with the exception of a lack of malignant changes observed in the mammary gland and prostate gland.

[Is there any scientific evidence supporting antiaging medicine?]

The objective of antiaging medicine is to interfere in the normal human biological aging process. Is there any scientific basis to justify classifying antiaging medicine as a medical specialty and not a branch of basic biological science? This review evaluated 110 papers, nine of which (8.2% of the total) reported studies involving human subjects. Only one of these studies was randomized and double-blinded (Jadad 2). In accordance with their classification of recommendations and level of evidence, these studies were considered CII. Three of the nine articles were published in journals with an impact factor over 1.110. Therefore, there does not appear to be any solid scientific and/or clinical evidence that would justify the application of antiaging medicine in current medical practice.

Ethical, social, and personal implications of extended human lifespan identified by members of the public

There are a number of ethical, social, and personal implications generated by the potential development and use of technologies that may extend human longevity by intervening in aging. Despite speculations about likely public attitudes toward life extension, to date there have been few attempts to empirically examine the public's perspective of these issues. Using open-ended survey questions via telephone interviews, this study explored the attitudes of 605 members of the Australian public toward the implications of life extension. Participants were asked to briefly describe in their own words what they believed would be the beneficial, as well as negative, implications arising from life extension (if there were any), both for themselves personally and for society as a whole. Participants were also asked to describe any ethical concerns they had about life extension, if they had any at all. All open-ended responses were collated and then underwent a thematic analysis to uncover commonly cited issues regarding personal benefits/negatives, societal benefits/negatives, and ethical concerns. A considerable number of participants envisioned at least some beneficial as well as negative implications for themselves and for society, and many claimed to have at least some ethical concerns. Some novel issues were raised as well as a number of those discussed within the bioethical literature. The results should encourage researchers, bioethicists, and policy makers to engage with members of the public about the goals of research surrounding life extension, the expected outcomes of such research, and the likely implications for individuals and society.

Ethical concerns in the community about technologies to extend human life span

Debates about the ethical and social implications of research that aims to extend human longevity by intervening in the ageing process have paid little attention to the attitudes of members of the general public. In the absence of empirical evidence, conflicting assumptions have been made about likely public attitudes towards life-extension. In light of recent calls for greater public involvement in such discussions, this target article presents findings from focus groups and individual interviews which investigated whether members of the general public identify ethical issues surrounding life-extension, and if so, what these ethical issues are? In this study, while some participants were concerned primarily with the likely personal consequences of life-extension, for others the question of whether or not to pursue interventions to extend longevity, and how they should be implemented, clearly raised important ethical issues, many of which have been prominent in debates among bioethicists.

Living longer: age retardation and autonomy

Research into human ageing is a growing field of research with two central foci: geriatric medicine works to reduce the incidence and severity of age-related diseases and disabilities by devising adequate therapeutic and preventive strategies. A second focus, this time in the emerging field of biogerontology, is to bring about a general retardation of the ageing process and by this increase the average and maximum human lifespan. This contribution looks into the second focus, i.e. the possibility of age retardation which, for the time being, is merely hypothetical. After outlining research strategies studying age retardation in animal experiments, it will ask how extending human life by technological interventions might play out on the individual, familial and social level. The central concern here will be autonomy-linked issues, seeing that in debates concerning the ethical implications of age-retarding techniques the argument from autonomy is one of the main arguments in favour of the prolongation of human life. In particular, this contribution will assess whether the argument from autonomy does, in fact, unequivocally support the recourse to age-retarding techniques.

From the Lab to the Front Line: How Individual Biogerontologists Navigate their Contested Field

This paper infuses a new perspective into scholarship on anti-aging science: the experiences of individual scientists as they entered and navigate this controversial field. We draw on in-depth interviews with 43 prominent biogerontologists to accomplish three objectives. First, we highlight key factors that draw scientists into biogerontology-especially the unique and complex puzzles posed by aging. Second, we examine how biogerontologists define themselves and their research in relation to "anti-aging" science-particularly how scientists distance themselves from the tarnished history of the field and employ powerful language to distinguish legitimate from illegitimate scholarship, and science from industry. Finally, we explore how individual scientists manage any social, religious, and ethical objections to conducting "anti-aging" research-and the repertoire of responses they use to simultaneously dismantle objections and reinforce the legitimacy of their science. The analyses reveal how much is ultimately at stake for these individual scientists on the front line.

Anti-aging science: The emergence, maintenance, and enhancement of a discipline

Through archival analysis this article traces the emergence, maintenance, and enhancement of biogerontology as a scientific discipline in the United States. At first, biogerontologists' attempts to control human aging were regarded as a questionable pursuit due to: perceptions that their efforts were associated with the long history of charlatanic, anti-aging medical practices; the idea that anti-aging is a "forbidden science" ethically and scientifically; and the perception that the field was scientifically bereft of rigor and scientific innovation. The hard-fought establishment of the National Institute on Aging, scientific advancements in genetics and biotechnology, and consistent "boundary work" by scientists, have allowed biogerontology to flourish and gain substantial legitimacy with other scientists and funding agencies, and in the public imagination. In particular, research on genetics and aging has enhanced the stature and promise of the discipline by setting it on a research trajectory in which explanations of the aging process, rather than mere descriptions, have become a central focus. Moreover, if biogerontologists' efforts to control the processes of human aging are successful, this trajectory has profound implications for how we conceive of aging, and for the future of many of our social institutions.

Ethical and legal issues in antiaging medicine

The development of specific antiaging treatments and the emergence of the practice of antiaging medicine have created new ethical and legal issues. The ultimate desirability of treatments designed to alter human aging is currently an actively debated issue that needs to emerge as an issue of public dialogue, given the potentially dramatic effect these therapies could have on both individual health and societal structure. Current therapies carry many doubts about their safety and effectiveness, which makes the practice of antiaging medicine with the prescription of these therapies a challenging issue from both a legal and ethical perspective. Finally, although the practice of antiaging medicine is not directly recognized and regulated by legislation, both anti-aging treatments and practice are regulated by emerging state and federal legislation that is evolving to address the emerging area of complementary and alternative medicine.

Life extension research: health, illness, and death

Scientists, bioethicists, and policy makers are currently engaged in a contentious debate about the scientific prospects and morality of efforts to increase human longevity. Some demographers and geneticists suggest that there is little reason to think that it will be possible to significantly extend the human lifespan. Other biodemographers and geneticists argue that there might well be increases in both life expectancy and lifespan. Bioethicists and policy makers are currently addressing many of the ethical, social, and economic issues raised by life extension research. However, the emphasis on philosophical argument supporting or condemning efforts to increase human longevity means that much less attention is currently being given to the factors that might play a role in generating interest in efforts to increase human longevity. This analysis considers three factors that might play a role in heightening public interest in efforts to develop biomedical technologies capable of retarding or reversing aging processes. While discussions of life extension research can seem quite futuristic and impractical, there are some powerful existential factors that might well generate considerable public support for life extension strategies if effective biomedical interventions emerge. Rather than providing philosophical justifications supporting or condemning efforts to increase human longevity, this essay seeks to promote a better understanding of the factors generating contemporary interest in prolonging life and postponing death.

Anti-Aging Medicine: The History: Establishing an Appropriate Ethical Framework: The Moral Conversation Around the Goal of Prolongevity

This article presents a triadic framework for ethical discourse around the biogerontological goal of prolongevity, which might someday become achievable through the deceleration of aging. The methods are those of the humanities and philosophical analysis. The perspectives of natural law, equalitarian justice, and beneficence are presented in a balanced manner, although the conclusion reached is that the goal of prolongevity through decelerated aging is ethically valid as a potential means to the beneficent amelioration of the many diseases for which old age is the major susceptibility factor.

Aging: The Reality: "Anti-Aging" Is an Oxymoron

No intervention will slow, stop, or reverse the aging process in humans. Whether anti-aging medicine is, or is not, a legitimate science is completely dependent upon the definition of key terms that define the finitude of life: longevity determination, aging, and age-associated diseases. Only intervention in the latter by humans has been shown to affect life expectancy. When it becomes possible to slow, stop, or reverse the aging process in the simpler molecules that compose inanimate objects, such as machines, then that prospect may become tenable for the complex molecules that compose life forms. Most of the resources available under the rubric "aging research" are not used for that purpose at all, thus making the likelihood of intervention in the process even more remote. If age changes are the greatest risk factor for age-associated diseases (an almost universal belief), then why is the study of aging virtually neglected?

Anti-Aging Medicine: The History: The Three Avenues of Gerontology: From Basic Research to Clinical Gerontology and Anti-Aging Medicine. Another French Paradox

This is a contribution to the debate raised by the position statement on aging ( 1) and comments ( 2) concerning the rapid increase of anti-aging medicine. After a short summary of the history of social attitude to aging and the emergence of experimental gerontology, the French situation is described, emphasizing the economic basis of this phenomenon: increasing insurance fees and tightly controlled honoraria push an increasing number of physicians to this new discipline. No lack of communication seems to be involved between basic gerontologists and physicians ( 2). Anti-aging medicine profits of the increasing population of seniors who want to remain healthy, look young and dislike to consult geriatricians. And also of the fact that no over-the-counter delivery of drugs is available in France. For these reasons there is no serious hope to stop it otherwise than by state legislation.

An ethical assessment of anti-aging medicine

This assessment presents and evaluates various ethical arguments for and against anti-aging medicine. After briefly defining human aging and how it could be viewed as a medical problem, the paper reviews scientific evidence that indicates that medical intervention could substantially change the rate of human aging in the foreseeable future. This evidence includes research in biochemistry, cell, and molecular biology (including research on mitochondrial DNA and oxidative stress as well as research on cellular and molecular replacement interventions), non-human animal studies, and human studies. The following six ethical arguments against anti-aging medicine are presented and evaluated: 1) inequity: the poor die young by the millions, while the rich refuse to age; 2) denying aging's immutability; 3) dominating nature, altering and commodifying ourselves; 4) overpopulation: carrying capacity concerns and the rights of future people to be born; 5) ennui: with no natural deadline, life itself outlives its value; 6) ageism: prejudice against the old and the young. The paper then evaluates four ethical arguments in favor of anti-aging medicine: 1) beneficence: duties to maintain health and prevent disease and death; 2) efficiency: slowing down aging would reduce the rates for all of the most common causes of death in developed societies; 3) limited autonomy: freedom to purchase anti-aging medicines that may or may not work, so long as they are not harmful; 4) improved quality of life: more active, healthier, and wiser (two propositions supporting this argument - that anti-aging medicine would allow for a longer, more active, healthier, and fuller life and that wisdom comes from experience, not senescence - are also presented and evaluated). The arguments in favor of anti-aging medicine are found to be more compelling than the arguments against it. The paper concludes with the recommendation that anti-aging medicine should be funded and regulated in ways that facilitate its potential both to reduce the incidence and prevalence of many diseases and to allow for longer, fuller, and more meaningful lives.