The Long Con of Aging

“Seventy-five. That’s how long I want to live: 75 years.”

That’s the opening to an article in The Atlantic explaining the position of Dr. Ezekiel Emanuel, an oncologist, bioethicist, and vice provost of the University of Pennsylvania.

Dr. Emanual’s position may be provocative, salacious, and divisive but his point is rather clear: the current version of old age isn’t all sunshine and rainbows.

For literally every single person who has ever lived on this planet, aging is a burden. We are biological machines stuck with a sporadic maintenance regimen of various pills, supplements, dietary, and exercise plans as a way of extending our healthspans.¹

Longevity biotech research - that is: the scientific study of aging - is now on the verge of obliterating this paradigm. Instead of treating symptoms with various indirect methods that often have limited or even harmful results, anti-aging medication addresses the root causes of these diseases, preventing them from developing in the first place.

Take the example of the cholesterol medication Lipitor, the most prescribed medicine in the US. Lipitor is used to reduce cholesterol (specifically LDL² ) in the blood. This is important because cholesterol can cause arteries to harden (atherosclerosis, if you need a big word to throw around at a party) and restrict blood flow to organs. This can cause all types of issues, including heart attacks.

Yet what causes this buildup of cholesterol? Genetic factors certainly play a major role. Yet the primary risk factor is age. So, prescribing a drug to lower the amount of a substance in the blood doesn’t actually address the root cause of the disease (ie already hardened arteries).

Right now, one of the best ways to target the root cause of this stiffening is diet and exercise. We really don’t have anything much better than that.

Yet.

We’re getting incredibly close to unlocking longer, healthier lifespans through the use of therapeutics, diagnostics, and personalized medicine. This will change the game in a number of ways. Here are some ways that might play out.

Capital

This shift in medicine will trigger a huge transfer of capital from traditional pharmaceuticals, geriatric care (like nursing homes - watch out private equity), diagnostic platforms, devices, supplements, and other tangential markets into the companies developing the root-level therapies for aging. Longevity therapeutics will be the new banana stand of pharma.

Healthcare

If pharma is going to endure a shock, healthcare is in for somewhat of an electrocution. The current model of healthcare is to treat people once they become sick. Relative to total healthcare expenditure, almost none is spent on preventative care. In one study, only 8% of American adults over 35 received all high priority preventive services (things like blood pressure screening [87%], cholesterol screening [82%], and osteoporosis screening [63%]).

My favorite part of the study is the one where they surveyed a single preventive medication, which was aspirin.³ I think this proves there’s plenty of room for growth.

Diagnostics

An interesting diagnostics dynamic emerges in a world with effective therapeutics. Most diagnostic platforms today are marketed for longevity. Yet scans and monitoring are less necessary (for longevity) when the the things they are targeting become nonexistent.

This pushes diagnostics into more of a “performance” category. Instead of being used as primary drivers of health, these platforms will become supplemental. This doesn’t make them any less important - performance (i.e. energy, strength, mental clarity, etc.) is not only critical but desirable. The market will still exist in a big way, just not the way it might be marketed now.

The Environment

Like dressing for a summer day in San Francisco, this category encompasses many layers. The environment serves as the foundation for any meaningful longevity initiatives; without a stable and sustainable environment, the pursuit of long-term health becomes rather futile. As environment becomes increasingly to be seen as a prerequisite for health, we can expect a significant shift in capital allocation towards companies tackling everything from agriculture to industrial solvents. We’ll need to solve problems like food security for segments of the population who might not have previously anticipated it.

We must layer our strategies for a sustainable future to make living longer the desirable outcome.

At its core, the notion of aging has been a long con, a drawn-out scheme of nature. But that’s about to change. In the upcoming decade, the landscape of medicine is poised for a remarkable transformation.

Adding to our arsenal of knowledge, we wield groundbreaking tools like CRISPR and AI. We've merely scratched the surface of their potential. With each passing day, we inch closer to fully understanding the secrets of aging and harnessing the tools we already have to do something about it. The possibilities are boundless.

The future of health is going to be fun.

Cheers,

[1] “Healthspan” is a term that combines lifespan + health. Someone who lives 80 incredibly healthy years may be considered to have a longer healthspan than someone who lives to 85 but has 10 years of terrible health.
[2] If you’re interested in an incredibly comprehensive overview of cholesterol, check out this guide.
[3] Aspirin acts as a blood thinner, reducing the risk of heart attacks.