Lucille Tournas, J.D. candidate 2018 AGING AS DISEASE Lucille Tournas, J.D. candidate 2018

Aging and Disease The field of gerontology has long considered aging itself not to be a disease World Heath Organization (WHO) publishes International Classification of Disease (ICD), does not define aging as a disease. Next revision of the manual is due this year, however a strong focus on “healthy aging” has been added to the work program. While FDA does not yet categorize aging as a disease, it responded favorably to the proposed TAME study (Targeting Aging with Metformin)-testing the ability of metformin to reduce or postpone multiple age-related diseases and dysfunctions. Yet, the study does not test the effects of “aging” as such, but on various age related diseases and dysfunctions.

Aging defined as disease Aging happens to all of us, and generally thought of as a natural part of life. However, a shift in defining aging as a disease would change the standard from delaying disease in order to delay aging, to one that delays aging in order to delay further disease.

Arguments for treating aging as a disease Social norms play an important role in determining what is or is not a “disease” We treat other natural conditions as a disease Even if aging is inevitable, the rate of aging is not fixed. Important societal benefits from treating aging as a disease

Disease and Social Norms What is considered normal versus disease is strongly influenced by social norms. Drapetomania, which is the fight of slaves to flee captivity, was once seen as a legitimate medical illness Homosexuality was once in the Diagnostic and Statistical Manual (DSM), but was removed in 1973. Conversely, there have been things we deemed normal, that are now considered disease Osteoporosis, sarcopenia, Isolated Systolic Hypertension, Alzheimer’s were all once labeled normal components to aging.

Other natural processes are treated as diseases Pregnancy is natural, but we approve medications for prevention and complications. Menopause and low testosterone- both are natural declines, but we offer hormone replacement to offset undesirable symptoms. Male hair loss is natural, yet we approve drugs for this condition

While aging may be inevitable, the rate of aging is not and may be manipulated

Naked Mole Rat Naked Mole Rat defy a\the biological law of aging-they rarely get cancer, are resistant to some types of pain, and can survive up to 18 minutes without oxygen, and don’t age, some live over 30 years and females keep their fertility. Gompertz law-risk of dying rises exponentially with age, for example, in humans in doubles every 8 years after 30-applies to all mammals except the naked mole rat. Studies have shown that naked mole rats have very active DNA repair and high levels of chaperones, proteins that help other proteins fold correctly. These mammals naturally don’t accumulate damage the way other mammals do.

Diseases we Associate with Premature Aging Photoaging-Disease vs. Natural Aging Photoaging is the accelerated deterioration of skin as a result of UV exposure-it is seen as a mechanism for skin cancer. However, skin aging associated with age is viewed as a normal process If we acknowledge premature aging, why can’t we slow it down? In this way, perhaps aging is not fixed. Both genetics and environmental factors can play powerful roles.

Hutchinson-Gilford Progeria & Werner Syndrome Both are rare, inherited, premature aging syndromes Hutchinson-Gilford Progeria - typically appear typical during early infancy, but quickly demonstrate growth problems Werner Syndrome - symptoms beings in adolescence/mean age of diagnosis is 24 These same symptoms manifested in the elderly are considered normal and therefore not treated

Important societal benefits from treating aging as a disease

Rationale for Targeting Aging As a treatable disease Position paper by the International Society on Aging and Disease (ISOAD) on the “critical need to promote research of aging and aging- related diseases to improve health and longevity of the elderly population,” describes rationales, technologies, and policies needed. Aging process is the root of most chronic diseases afflicting the world population Degenerative aging processes are the major underlying cause for non- communicable diseases (NCDs), including cancer, heart disease, stroke, type 2 diabetes, Alzheimer’s disease, obstructive lung disease, and others. Current medical research is focused on single diseases

Benefits of Treating aging as a disease Promote medical efforts to work towards minimizing undesirable conditions associated with aging or eliminating it. Increase funding for research on slowing aging Potential treatments more likely to be covered by health insurance providers. Would provide a pathway for drug approvals Lower staggering health care costs for end of life care Change framework and mindset of aging as an unmodifiable inevitability