It is Time to Embrace 21^st-Century Medicine

Extract

Biomedical research and clinical practice have traditionally been focused on disease rather than health. We typically wait until people are sick before trying to cure their disease or alleviate their symptoms, rather than actively supporting health and wellbeing in the absence of disease. Current demographic trends toward older populations make this approach problematic. Instead of improving the quality of life, we may be extending the period of morbidity and frailty for millions of people. Twenty-first century medicine should adopt the strategy of directly targeting the molecular mechanisms that cause biological aging. Only in this way will it be possible to slow the onset and progression of multiple age-related diseases simultaneously, in order to extend the healthspan proportionately with the lifespan.

The world is getting older. Over the past century, life expectancies in developed countries have increased approximately 60% at the same time that birth rates have declined. The net effect of these trends is that nearly every nation is experiencing a dramatic “graying” of the population. Unfortunately, the increase in life expectancy does not appear to have been matched by increasing “health expectancy” (Nikolich-Žugich et al., 2016). The concept of the healthspan refers to the period of life spent free from chronic, age-related disease or disability (Kaeberlein, 2018), but increases in the human lifespan have not been matched by increases in the population healthspan (Olshansky, 2018). Instead, many people are living longer with one or, more often, multiple diseases of aging. In 2017, it was estimated that more than half of the global health burden among adults could be attributed to age-related diseases (Chang, Skirbekk, Tyrovolas, Kassebaum, & Dieleman, 2019), and this number is growing. The consequences of these demographic shifts and increases in comorbid survival are profound, with major economic and social implications.