The present approach to aging in the healthcare community is uncomfortably close to being a matter of Cnut the Great on the beach telling the tide to go back. In clinical practice most of the major diseases of aging remain irreversible for the average individual, a progression that can only be modestly slowed. The only way to achieve the possibility of turning back these conditions is to repair the forms of accumulated cell and tissue damage that maintain the body and brain in a diseased state - to use rejuvenation therapies. The development of these therapies is painfully slow. It has been clear that clearance of senescent cells is very promising for a decade now, but it will be years yet before any large scale human data emerges for senolytic approaches that work well.
The point of today's open access commentary is that the establishment of even crude and limited capabilities for rejuvenation will necessarily require a major upheaval in the way the clinical community engages with aging and age-related disease. The heroic model of coping with the inevitable must be abandoned. Something more useful must take its place. The author here argues that the medical community must shift its primary focus away from end stage disease towards earlier intervention to prevent that disease. This already exists as a major focus of the cardiovascular disease community, even if the preventative technologies used there are not all that great in the grand scheme of things. But for much of the rest of the medical community enacting such a change will be a sizable upheaval.
Rethinking healthcare through aging biology
Modern medicine has revolutionized the way we diagnose and treat diseases, achieving remarkable success in extending life expectancy. Yet, despite these advances, the traditional disease-centric healthcare model has significant limitations. This approach typically kicks in only after pathology has manifested-when patients exhibit symptoms, seek treatment, receive a diagnosis, and begin therapy. While reactive care has its merits, it increasingly falls short in addressing the needs of aging populations. As people age, they often develop a constellation of chronic conditions - multimorbidity - that strains the healthcare system and diminishes quality of life. Conditions such as cardiovascular disease, type 2 diabetes, osteoarthritis, neurodegeneration, and cancer frequently coexist, leading to complex and often ineffective treatments. Polypharmacy - the use of multiple medications to treat co-existing diseases - introduces further complications, including drug interactions, side effects, reduced adherence to treatment regimens, and increased hospitalizations.
Moreover, this disease-specific focus neglects the underlying causes of age-related decline - the very mechanisms that fuel the development of these diseases. However, recent breakthroughs in aging research have unveiled an exciting opportunity: the shared biological roots of many age-related diseases. These mechanisms, known as the hallmarks of aging, often precede the onset of disease by decades. Targeting these aging processes before diseases fully develop offers a bold new approach: not just treating diseases, but preventing them in the first place.
This shift in focus from reactive disease management to proactive healthspan extension is transformative. By intervening early in the aging process, we could delay or even prevent multiple diseases, addressing not just the symptoms, but the biological declines that underlie them. In this context, cutting-edge interventions such as senolytics and rapalogs exemplify the promising potential of targeting aging itself. Senolytics, which selectively eliminate senescent cells that accumulate with age and contribute to chronic inflammation and tissue dysfunction, have shown promise in extending healthspan and alleviating a range of age-related conditions. Likewise, rapalogs - drugs that target the mTOR pathway, a central regulator of cell growth and metabolism - have demonstrated the ability to extend lifespan and improve healthspan by promoting autophagy, enhancing immune function, and reducing inflammation. As clinical trials continue, these interventions are poised to transform aging medicine, but the road to widespread clinical application remains challenging.
View the full article at FightAging
