By Joe DeSantis\u00a0 The United States faces a\u00a0human and financial\u00a0crisis of\u00a0chronic illness.\u00a0\u00a0 Every year, one-fifth of our economy \u2013 about\u00a0$3.7 trillion\u00a0\u2013 is lost to chronic diseases\u00a0such as\u00a0heart disease, dementia, diabetes, and cancer.\u00a0This includes the cost of treating the diseases ($2.1 trillion) and the lost economic output from\u00a0people\u00a0being sick and being caregivers.\u00a0These costs are projected to increase\u00a0even higher as the number of Americans with chronic illness grows from 157 million to\u00a0200 million by 2050.\u00a0\u00a0 In part, these\u00a0daunting\u00a0figures are a\u00a0byproduct of our success\u00a0in treating these diseases. For instance, in 2018, the US experienced the\u00a0largest one year drop in cancer mortality in history. This follows\u00a0the previous largest one year drop in 2017. Overall, since 1991, the cancer death rate has fallen by 31\u00a0percent. Deaths from heart disease have also experienced an extraordinary decline over the past several decades. Roughly one-third the number of Americans die annually from heart disease today than in the 1970s.\u00a0\u00a0 The challenge is that as we\u00a0improve\u00a0survival rates with disease, people\u00a0live longer, which\u00a0increases their risk of developing other diseases.\u00a0In fact, aging is the\u00a0No. 1\u00a0risk factor for\u00a0disease.\u00a0The National Council on Aging\u00a0estimates\u00a0that\u00a0not only do\u00a080\u00a0percent\u00a0of Americans over 65 have one chronic condition, 68\u00a0percent\u00a0have two or more.\u00a0The\u00a0US\u00a0Centers for\u00a0Disease\u00a0Control and Prevention\u00a0has a\u00a0narrower\u00a0definition of chronic disease, but even\u00a0it\u00a0shows\u00a0that\u00a056\u00a0percent\u00a0of all Americans over 65 have two or more chronic conditions.\u00a0\u00a0 This\u00a0whack-a-mole\u00a0challenge in treating\u00a0chronic disease\u00a0as we age, and the increasing expense of doing so,\u00a0has\u00a0led to a\u00a0renewed\u00a0focus on prevention\u00a0in health care.\u00a0Doctors and health plans are paying more attention\u00a0to the lifestyle factors that put us at higher risk of chronic illness\u00a0and seeking to help their patients and customers live healthier lives.\u00a0\u00a0 This is a\u00a0welcome development, but\u00a0we\u00a0should\u00a0be realistic\u00a0about how difficult it will be to make\u00a0significant\u00a0improvements\u00a0in chronic disease\u00a0at a population level\u00a0simply by encouraging healthier lifestyles.\u00a0While we have had success in reducing smoking in America, it was due to a massive, society-wide effort that was given\u00a0unusual\u00a0urgency\u00a0by the fact that one person\u2019s smoking puts others around them at risk.\u00a0The same\u00a0cannot\u00a0be said for lack of exercise.\u00a0In fact, most of the trends of modern life\u00a0make\u00a0healthy living\u00a0harder, not easier.\u00a0Getting people to\u00a0be more active, eat healthier, and sleep better is swimming against the tide.\u00a0\u00a0 Fortunately,\u00a0a new scientific\u00a0field\u00a0has emerged that\u00a0could significantly expand\u00a0our toolbox to prevent\u00a0chronic disease. The key insight of this new science is the close connection\u00a0between\u00a0risk for developing\u00a0chronic illness and aging.\u00a0\u00a0 Geroscience\u00a0asks:\u00a0What if chronic diseases\u00a0are better understood as\u00a0symptoms of\u00a0the\u00a0underlying\u00a0condition\u00a0of\u00a0aging?\u00a0What if by treating aging, we could prevent\u00a0or significantly delay the onset of\u00a0a whole constellation of chronic diseases?\u00a0\u00a0 The idea of treating aging seems confusing until you understand that what these scientists mean by aging is not simply adding years to your life. They are referring to a process of growing dysfunction at the cellular level in organisms that increases the risk of disease. Geroscientists\u00a0have identified nine \u201challmarks of aging\u201d\u00a0in humans\u00a0that negatively reinforce one another, causing a downward spiral in health. Treatments for aging would target\u00a0one or more of these pathways to maintain healthy cell function for longer,\u00a0thus\u00a0preventing disease.\u00a0\u00a0 Geroscience\u00a0is more than a theory. Scientists have\u00a0used a variety of techniques\u00a0from\u00a0small molecules to gene therapies\u00a0to\u00a0target aging pathways in mice. The results\u00a0of those\u00a0experiments\u00a0have\u00a0been mice that\u00a0don\u2019t\u00a0just live longer, but live healthier, with much lower\u00a0incidences of\u00a0age-related\u00a0diseases during their lives.\u00a0\u00a0 As exciting as these developments are, it is always a\u00a0big leap to\u00a0get\u00a0treatments that work in mice to be effective in humans. But this\u00a0challenge is particularly difficult for therapies\u00a0to treat aging.\u00a0Our entire regulatory framework for pharmaceuticals is based on the idea of treating diseases after they occur, not preventing them.\u00a0In order for the\u00a0US Food and Drug Administration\u00a0to approve a treatment, a\u00a0pharmaceutical company must show that it is\u00a0safe\u00a0and\u00a0it achieves a clinically meaningful endpoint in how a patient \u201cfeels, functions, or survives.\u201d\u00a0It is not clear how to apply that standard if a patient starts off healthy. At the least, it would require\u00a0clinical trials that last years and involve thousands of people to show a lower rate of onset of age-related chronic illnesses in\u00a0the treated group compared to controls. These sorts of trials would be expensive.\u00a0\u00a0 For this reason,\u00a0most, if not all, of the\u00a0clinical trials being run\u00a0right now\u00a0in humans\u00a0that\u00a0target aging pathways are\u00a0for the purpose of\u00a0treating\u00a0diseases, not preventing them.\u00a0This is certainly worthwhile, but it is not actually\u00a0harnessing the truly\u00a0revolutionary nature of this approach.\u00a0The\u00a0bet these companies are taking is that if they can show\u00a0that this concept of\u00a0targeting aging\u00a0pathways can help treat disease, then it will create a \u201cfoot in the door\u201d\u00a0to\u00a0using the same treatments to prevent\u00a0them.\u00a0\u00a0 One solution is to allow the use of surrogate biomarkers based on the identified nine hallmarks of aging to be used as endpoints in clinical\u00a0trials.\u00a0Geroscientists\u00a0have created \u201caging clocks\u201d that\u00a0use some of\u00a0these hallmarks to measure your\u00a0\u201creal age.\u201d\u00a0Treatments could be measured effective if they slow, stop, or even reverse patients\u2019 aging clocks.\u00a0(One\u00a0small\u00a0clinical\u00a0study\u00a0attempting to regrow\u00a0the thymus gland with human growth hormone had the unexpected side effect of decreasing\u00a0participants\u2019\u00a0aging clocks by\u00a02.5 years.)\u00a0 There is some precedent for this. For instance, treatments that reduce tumor size are assumed to be making\u00a0an improvement because tumor size is recognized as a marker for cancer progression, and thus survival time.\u00a0As more\u00a0scientists, doctors and regulators are educated about aging biomarkers\u00a0and their relationship to developing chronic diseases, a similar model could be adopted for aging therapies.\u00a0\u00a0 Of course, discussing an idea like treating aging leads one to wonder:\u00a0Could we eventually live forever, and in good health? Maybe, but\u00a0even the most optimistic of scientists in the field say that we are\u00a0far away from that point.\u00a0It\u00a0makes the most sense to focus on the potential\u00a0of what we know now\u00a0\u2013 using\u00a0therapies that prevent chronic disease instead of waiting to treat them once they appear.\u00a0This is\u00a0a\u00a0revolution\u00a0that\u00a0could be\u00a0the\u00a0key to solving\u00a0America\u2019s\u00a0crisis of chronic illness.\u00a0To learn more,\u00a0listen\u00a0to Newt\u2019s interviews with Dr. David Sinclair and\u00a0Dr. Nir Barzilai\u00a0on his podcast and stay tuned for more\u00a0news on how you can get involved in helping this new field of science make the transition from the lab to the clinic. Newt hosts monthly virtual events in which he discusses news of the day and why it matters to you and your community. These Newt Live events are your opportunity to communicate directly with Newt. 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