Scientists are demystifying aging — funding could add decades to our lives

The Biden administration deserves accolades for their proposed $6.5 billion Advanced Research Projects Agency for Health, referred to as ARPA-H. ARPA-H would aim to deliver breakthrough treatments for diseases like Alzheimer’s, cancer and diabetes.This is an ambitious goal, but one that is achievable if the administration takes bold action.  

Unfortunately, for now it appears Congress is headed toward a watered down ARPA-H, funded at less than half the requested amount. It also appears the new agency will largely continue the outdated “disease first” culture of most National Institutes of Health-funded research. To me this suggests, at best, incremental advances. What we need is an ARPA aimed toward 21st Century medicine that tackles biological aging: a geroscience moonshot. 

Geroscience is the field of scientific investigation that seeks to understand the biological aging process and how it contributes to all of the various pathologies that come with old age. It’s no secret that nearly every major cause of death in the United States has age as its greatest risk factor. Just going from 40 to 70 increases your risk of dying from cancer by about 40-fold, heart disease 30-fold, and Alzheimer’s disease by a whopping 300-fold. For perspective, high blood pressure and obesity increase your risk by less than threefold. 

Over the past two decades, scientists have learned a great deal about the biology of aging. At the same time, we are also learning how to tweak those processes to slow, or even partially reverse, many of the functional declines that go along with old age. Yet, less than one percent of the NIH budget goes toward studying this. Instead, the vast majority of research funding and, by extension, drug development focuses on individual diseases in isolation. As a consequence, our entire biomedical enterprise is geared toward waiting until people are sick and trying to cure or treat their disease. If our bodies were commercial aircraft, this would be akin to skipping maintenance and waiting until the engine is on fire at 35,000 feet before you take action.  

Geroscience seeks to maintain optimum health — and prevent disease — by attenuating the molecular causes of biological aging directly. Excitingly, there are now several geroscience interventions that increase healthy lifespan by 10 to 30 percent in laboratory mice, with early data indicating at least some work similarly in people. If validated in clinical trials, that could be equivalent to about 20 years of additional health. 

The economic case for a geroscience moonshot is compelling. Healthcare is among the most pressing challenges we face as a nation and, by far, the greatest fraction of healthcare expenditures comes from caring for the sick elderly population. The disease-first approach has been quite successful at keeping sick people alive longer than was possible 50 years ago, which it turns out is really expensive. In contrast, if we keep people alive longer in good health, they can remain productive members of society.  In fact, one recent study estimated the cost savings from a conservative geroscience intervention that increases healthy life expectancy by only one year would reach about $38 trillion annually.  Given the proposed ARPA-H price tag of $6.5 billion, that equates to a 5846-fold return on investment.  

Equally compelling is the social impact of targeting biological aging versus treating individual diseases. While some people maintain relatively high quality-of-life with one or more age-related disorders, for others the consequences of prolonged ill health are an enormous burden. Chronic pain, fatigue, and invasive medical intervention can rapidly lead to depression and serious mental health consequences. All of this takes a heavy toll on patients, caregivers and family members. Wouldn’t it be better for everyone to maximize healthspan and spend those extra years free from disease? This is the promise of a geroscience moonshot. 

As a scientist with more than two decades of experience in aging research, I believe that targeting an Advanced Research Projects Agency toward geroscience would fundamentally change the trajectory of human health. The field is at an inflection point where investment at this scale is likely to yield outsized economic and social benefits. It’s a near certainty that clinical interventions capable of adding much greater than one year of healthy life expectancy would be developed within the next decade, resulting in returns of many trillions of dollars.  

The Biden administration has an opportunity to lead the world into a future where we come to expect our loved ones will maintain good health well into their 80s, 90s and even past the century mark.   

Dr. Matt Kaeberlein is a fellow of the American Association for the Advancement of Science, CEO and chair of the American Aging Association, and a professor of Laboratory Medicine and Pathology at the University of Washington School of Medicine, where he directs the Healthy Aging and Longevity Research Institute, the Biological Mechanisms of Healthy Aging Training Program, and the NIH Nathan Shock Center of Excellence in the Basic Biology of Aging.