Authors: Dr Chih Wei Teng and Rupal Pichholiya
The introduction of novel medicines or medical procedures is never without controversy. History is littered with examples of humans attempting to ‘play God or against nature’. Some modern cases include in vitro fertilisation, CRISPR Cas9 genetic manipulation and many others that sound more science fiction to the layperson, such as synthetic biology. However, perhaps the single oldest ambition of humanity in the research of medicine or human health is to cheat death from aging.
Anti-aging research from Professor David Sinclair of Harvard Medical School reopened the age-old (pardon the pun) debate on whether aging is a disease. Some of the best arguments are the opposing views of Bulterijs et al. (2015) and Gavrilova & Gavrilova (2017). The former made a compelling case of mislabelling a medical phenomenon because humanity lacked the understanding. When we better understand the phenomena due to improved diagnostics, instrumentation and knowledge, we are better at treating the effects of aging as if they are a disease. On the other hand, the later authors of Gavrilova & Gavrilova (2017) counterargued that age represents a maturation of age-related diseases as the body deteriorates, and not possible to establish a cause and effect relationship between age and the condition. Interestingly, the synthesis of the differing views is that advancements in diagnostics, instrumentation and knowledge can lead us to understand and identify the age-related effects or how the forces of natural selection increase the presentations of disease. Furthermore, knowing what inhibits or protects us from age-related diseases that govern our mortality allows us to target our therapies to extend or restore their functions, realising a fate that is free of age-related diseases that bring about an abrupt end to our natural lifespan.
If we view the statement from Professor Sinclair about ‘aging is far more reversible than we thought’ through the above lens, it might more be about extending the strength of a person’s youth such that it continues to suppress the onslaught of age-related diseases. However, an internet search revealed results that describes Professor Sinclair’s work as ‘age reversal’, ‘getting younger, ‘anti-ageing and ‘fountain of youth’. This begs the question, are these discoveries medicine, nutraceutical or cosmeceutical?
While we should not seek to suppress innovation in health and medicine, there are concerns about nutraceuticals and cosmeceuticals having less scrutiny or being evaluated with less rigour than traditional drugs. Some proponents view a designation as a nutraceutical or a cosmeceutical as a fast track to market or as a means to exploring new business models and shunning the conventional chemists or pharmacies in favour of online selling or multi-level marketing arrangements. Chemists and pharmacists play an essential role at the grassroots level to safeguard against the abuse of medicines. More vigilance and scrutiny are needed as novel therapies entering the nutraceuticals and cosmeceuticals space are utilising processes and tools commonly found in advanced therapeutics medicinal products (ATMPs). A good example is Professor Sinclair’s cell reprogramming experiments, which showed axon regeneration in glaucoma mouse models when injected with vectors loaded with genes from a cocktail of reprogramming factors.
The risk lies not so much with the claims but in the inherent processes within the production and formulation of ATMPs and the ability to sell ATMPs through non-traditional means that are difficult to trace and recall. To that end, it might be pertinent that we begin to recognise aging as a disease, not because of philosophical reasons but simply that anti-aging has evolved away from merely treating ‘skin deep’ conditions to actual therapies that treat age-related diseases such as Parkinson’s or prevent cancer.
My blog is just one of many covering this topic as part of Signal’s sixth annual blog carnival. Please click here to read what other bloggers think about this.
Bulterijs S, Hull RS, Björk VC, Roy AG. It is time to classify biological aging as a disease. Front Genet. 2015 Jun 18;6:205.
Gavrilov LA, Gavrilova NS. Is aging a disease? Biodemographers’ point of view. Adv Gerontol. 2017;30(6):841-842.
Lu, Y., Brommer, B., Tian, X., Krishnan, A., Meer, M., Wang, C., Vera, D. L., Zeng, Q., Yu, D., Bonkowski, M. S., Yang, J. H., Zhou, S., Hoffmann, E. M., Karg, M. M., Schultz, M. B., Kane, A. E., Davidsohn, N., Korobkina, E., Chwalek, K., Rajman, L. A., … Sinclair, D. A. (2020). Reprogramming to recover youthful epigenetic information and restore vision. Nature, 588(7836), 124–129.