The debate over whether aging should be formally declared a disease is entirely driven by the structure of medical regulation. The flow of funding through the medical system is shaped by lists of defined and allowed medical conditions derived from the International Statistical Classification of Diseases and Related Health Problems, and everything not explicitly allowed by regulators is either outright forbidden or a great deal more challenging to bring to the clinic than would otherwise be the case. The people who want aging to be defined as a disease are demanding a less costly, more rapid path of development for therapies to treat aging. It is as simple as that. Here, it is argued that perhaps advocating more directly for that goal of a faster, cheaper development process would be a better idea than focusing on definitions of aging.
Is aging a disease? Debate continues, with both good and flawed arguments, but progress is needed, so here are three ways to move discussions forward. First, this is the wrong question. The right question is what regulatory framework optimizes long term health. Second, aging isn’t one thing, but multiple distinct pathological processes. Third, there were analogous debates on obesity – it wasn’t a disease but now is. A new proposal to distinguish clinical obesity could be copied.
Advocates rightly see disease status as a path towards clinical trials for aging interventions using aging itself as primary endpoint instead of an individual chronic disease. Opponents rightly worry that labeling everyone past a certain age as ‘diseased’ loses a meaningful distinction versus current clinical illness thresholds. The real question is whether aging should be a clinical indication for trials. All aged adults are meaningfully biologically less robust when compared with young adults; age is by far the top risk factor for all age-related diseases, and intervening to mitigate this difference is a valid medical goal.
Obesity went through analogous debates for years. Like aging, obesity is a risk factor for and plays a direct causal role in many diseases. Over many years, more and more important organizations classified obesity as a disease – but this remains controversial. The history of arguments on both sides are worth reading and mirror much of the aging-as-disease debate. Recently, the Lancet Commission published a consensus proposal to distinguish more severely pathological obesity, labeled clinical obesity, from less significant pre-clinical obesity. They propose that clinical obesity is a disease, and while they admit obesity and its consequent increased disease risk exist on a continuum, they consider illness to be a meaningful binary state.
Aging is analogous, both overall and its subpathologies. There’s a clear continuum with a severe region that even without clinically diagnosable chronic diseases is clinically significant enough based on dysfunction of organs or tissues or functional decline to warrant treatment, before progression to outright age-related diseases. An analogous esteemed commission of aging experts should define criteria for this.
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