Depending on who you ask, we may be on the cusp of a great leap forward in longevity medicine. “In probably the next three to four years, you will have this pill basket” of anti-aging drugs, says Dr. Vijay Yadav, an assistant professor of genetics and development at Columbia University. Based on the patient’s health profile, he says a clinician could tap into the basket’s selections and prescribe something to improve health during their final decades: “Let us see whether we can add 10 more years of a healthy life to you.”
You’d have to be remarkably bullish to believe those drugs will prove to greatly boost the quality and length of late life in the imminent future. Even Dr. Yadav doubts that the potential of these therapies will be fully understood—and thus implemented most effectively—in his lifetime. After all, proper testing would take decades. Yet some experts in the burgeoning field of geroscience—the study of aging—are increasingly confident that a batch of different molecules undergoing analysis for anti-aging properties contains game-changers. “It is similar to running horses in a race,” says Dr. Yadav. Among the potential prize ponies are prescription drugs like rapamycin, metformin, and senolytics, alongside supplements like alpha-ketoglutarate and taurine. The aim is to perfect an array of molecules that not only extend the life expectancy of users, but also boost overall health during their final years.
But despite the potentially transformative nature of these molecules, some spectators have found progress to be needlessly slow. “The way our system is structured, there’s just no incentive to do those trials,” says Dr. Matt Kaeberlein, a biologist and pathology professor at the University of Washington and a prominent figure in the world of gerontology. Because many of the promising candidates are already generic drugs, the rate of research has been gradual. Without serious money to make, even the prospect of a non-metaphorical Holy Grail can’t motivate the pharmaceutical industry.
The structure of FDA trials are also an awkward fit with geroscience: When testing the efficacy of an anti-aging therapy, what do you measure? There’s not a catch-all biomarker. “That’s still a significant hurdle,” says Dr. Ben Miller, chair of the Aging and Metabolism Research Program at the Oklahoma Medical Research Foundation. “If we go to the FDA with a blood pressure medication, we measure blood pressure to know if the drug is working or not. With aging, it’s really hard to go with what marker you’re going to use.”
Nonetheless, progress has continued. Closely watching the advance are so-called biohacker communities, online groups that digest any new data to guide their own regimens of potential longevity drugs—typically therapies for other illnesses taken off-label—hoping for a headstart on treatments whose effectiveness will later be fully proven. There’s no way to pin down exact numbers, but approximately 20,000 people visit rapamycin.news each month, home to a clique of people taking the drug for its purported anti-aging properties, according to its founder.