Abstract
“Politics is not a science, as many of the professors imagine, but an art”
—Otto von Bismarck
I do not remotely claim originality for the view that research into the biology of aging receives far less public funding than is merited by its potential to alleviate suffering and to contribute to prosperity. That was already a perennial vocal assertion of the biogerontology community decades ago. But that raises a rather obvious question: why has that message fallen on such deaf ears among political decision-makers, and what can we do today to make it be better heard?
A few days ago, I had the privilege to meet for over 2 hours with Congresswoman Rosa DeLauro, whose roles include chairing the extravagantly named Labor, Health and Human Services, Education, and Related Agencies Appropriations Subcommittee. Long story short, she is a very influential politician. It, therefore, says a lot that she found such a meeting worth her time. While I cannot at this point declare that she went away imbued with a fervent passion to drive rejuvenation biotechnology forward within the corridors of power, I can certainly say that a channel for future communication has been created.
At such a juncture, it is valuable to look back at the field's past efforts to influence political sentiment and to ask why they did not fare better than they did. By examining that history, we may be able to maximize the chances of doing better this time. Here I will highlight three such efforts: the creation of the National Institute on Aging (NIA), the Longevity Dividend initiative, and the Geroscience Interest Group (GSIG).
The NIA was, ostensibly, a huge step forward for the medical defeat of aging—but only ostensibly. Those who inspired it, such as the legendary gerontologist Bernard Strehler, had very much the right intentions, but in the end they were forced to compromise massively during the process, with the result that only a minuscule proportion of the NIA's activities can genuinely be classed as biomedical gerontology. This neutering ultimately arose, I believe, from the consensus that aging was actually never going to be amenable to serious medical intervention, and thus that it would be quixotic to spend taxpayers' money trying to develop such medicines. Where did that consensus come from? Simply from the dogma that there is a thing called “aging itself” that is in some profound sense distinct from the so-called diseases of old age that are amenable (in principle) to medicine. More on that below.
Decades of frustration later, in 2006, a quartet of luminaries in the gerontology world (including, indeed, the founding head of the NIA) came together to articulate the economic case for investing more seriously in research to keep the elderly healthy. Maybe the name “Longevity Dividend” was not ideal, in view of society's Pavlovian tendency to assume that long life means long decrepitude, and “Healthspan Dividend” might have been more powerful. But, to be honest, I do not think that was the key reason why the effort was so spectacularly unspectacular in its impact on public policy. The main reason, I'm sure, was that the argument that investing a certain sum in this research in order to save a certain sum later on relied on the assumption of, at least, a lower bound on the probability that the sum invested would deliver the desired results in the desired timeframe. And whaddya know, not a peep was uttered by these authors, nor by anyone else, in terms of explicit statements of such a bound. The utterly predictable result was that the audience, that is, policy-makers, continued in the conviction that the chance of such research delivering results was in fact zero—which, obviously, rendered the entire effort pointless. It does not matter how many times an investment will pay for itself in the event that the investment achieves such-and-such a goal, if there is perceived to be zero chance that it will in fact achieve that goal: any number times zero is still zero.
So to the GSIG. This was the brainchild of Felipe Sierra, who heads the NIA's Division of Aging Biology, and he first floated it at a meeting of a couple of dozen biogerontologists hosted by the inestimable Dan Perry, who had for many years led the Alliance for Aging Research (the leading gerontology lobbying organization in Washington) and who was another of the Longevity Dividend quartet. The essence of Felipe's proposal was that the artificial divide between age-related “diseases” and “aging itself” could be bridged, in terms of research funding, by promoting cross-institute requests for applications (RFAs)—effectively creating a division of preventative medicine within each of the institutes whose focus is one or another age-related disease (which, let us be clear, means the largest institutes). It took a little while for the less imaginative members of the biogerontology community to see what Felipe was getting at, but eventually they supported it with great enthusiasm. Er, but where is it now? I am afraid to say that it remains little more than its name implies—an interest group, a talking shop. Virtually no RFAs of the imagined form have materialized. And in this case we cannot even blame the name: “geroscience” is the mot du jour within biogerontology, largely because it is totally new and thus devoid of baggage.
What was the problem? Unfortunately, it was the same one as before: no one in a decision-making capacity believed that there would be any actual result. Sierra's boss's boss (i.e., the head of the entire NIH), Francis Collins, has worked on aging for decades and was verbally very supportive of the GSIG when it began—but be has totally failed to fight for money for it, evidently reasoning that that would be a futile expenditure of political capital.
The pattern that I hope you have discerned in the above tales of woe is one of self-inflicted rejection. The basis for ignoring the protestations of gerontologists that hiking their funding would have a massive bang for the buck is that those gerontolgists will not, in fact, significantly succeed any time soon in their goals to postpone the health problems of old age as a result of receiving the requested funding. And the basis for that pessimistic conviction is, plain and simple, that gerontologists refuse to dispel it. The idea of making a timeframe prediction, however speculative, for how soon a given amount of progress can be made is so utterly anathema to those in this field that they recoil from doing so even though the result is so massively prejudicial to their ability to get their work done.
Is this just the way that science is? Is it truly better to underpromise and overdeliver, even to this plainly foot-shooting extent? Well, let us ask the oncology community. Around the same time that the NIA's creation was first being mooted, cancer biologists started to feel pretty optimistic (albeit wrongly) about the prospects of bringing cancer to its knees, and—critically—they started to say so publicly. We all know the result: the War on Cancer, implemented as a massive hike in funding for the National Cancer Institute. Decades later, progress has been far slower than experts were predicting back then. But so what? Progress has for sure been far faster than it would have been had funding remained stagnant—and moreover, funding has not at any point been cut as a result of failure to meet milestones on time.
The message is clear. It is time for biogerontologists to abandon the cowardice and shortsightedness that has for so long led them to deny their advocates the ammunition with which to secure them the public funding that they truly deserve. Providing that ammunition—the explicit, albeit highly hedged, prediction of timeframes for given amounts of progress—is not a crime against science. Rather, failing to provide it—and thus not only harming one's own funding but also delaying the ultimate medical defeat of aging—is, and I know what I am saying here, a crime against humanity.