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The future of medicine and ageing
15 June 2017

Before the 1990’s old age was seen as an unavoidable fact of life; like an old car we just wear out.

Since then we’ve addressed ageing like a set of fixable parts. When an organ breaks down, we medicate it or replace it. When cancer appears we seek to eradicate it.

David Sinclair doesn’t want you to think that way. Speaking at Amplify, David described ageing as something we can prevent, and in doing so, avoid the diseases that we become more vulnerable to. According to David, when we successfully eradicate cancer, we only extend someone’s lifespan by 2.3 years, because in an ageing body, another organ is nearing expiry.

David sat down to answer some pressing questions following his talk.

You spoke in depth about the health impacts of ageing longer and the aim of ‘squaring the curve’; avoiding a slow decline into ill health. The aim is to spend longer in good health, with a rapid descent close to the end. What collective social impact do you see this having?

It’s going to be a radical change; as radical as going from 1900 until now. In 1900 you had one career and you were lucky to enjoy life after you retired. Now we can have multiple careers. In the future when people live longer and healthier into their nineties and hundreds, they can have twenty different careers in their lifetime. You could, if you don’t like one career, go back to uni a second, third time. It’s almost as though, compared to 1900 you have three different lifetimes.

Does that mean that you need to be the type of person who is predisposed to learning and to being flexible? Is that going to place a demand on us becoming more flexible, agile workers?

For sure. For now we see the most successful people in our society are those that can adapt and be flexible. Very few people stay in the same career and those that do often don’t do as well.

If you began as a lawyer you may end up as a surgeon. You may begin as a carpenter and end up as a writer. There’s no reason you can’t change that radically. But those that cannot change and aren’t willing to change will not reap the benefits of the 21st century.

Over the past few days of Amplify we’ve heard about the impact of artificial intelligence on people whose jobs entail manual labour. Is this going to put even more pressure on those people who may not have experience even being a knowledge worker?

Yes, the 21st century is going to belong to those who have flexible, agile, curious minds. We already see that today, the billionaires of the world haven’t gotten there through hard work, they’ve had to have imagination which is only going to get even more important.  

It’s just a fact that not wanting to learn will be a problem even more so than it is now. That said it’s more important to have grit and determination and resilience than to be smart.

If you’re not endowed with a brilliant mind, and I wasn’t the top of the class by any means, if like me you want to do something and you stick to it you can be even more successful than someone with just brain power.

ABC’s You Can’t Ask That recently interviewed centenarians where many reported overall levels of unhappiness. Their friends were dying around them and they felt like they were existing for the sake of existing. Is it possible that we also must address mental health as people age better? Are we going to see a new field of mental health?

My research keeps the brain as healthy and the rest of the body. I’m optimistic that we’re not heading into a world we already exist in, in that a healthy body does not equal a healthy mind which is a dystopian nightmare!

What I’m aiming for is a world where people in their nineties and all their friends are still alive; they go and play tennis or climb a mountain on the weekend. So people won’t be in nursing homes or lonely. 

In fact, we want to keep people out of nursing homes never needing to go to one – perhaps spending the last couple of years of life in a hospital bed dying quickly and painlessly.

With those people not in nursing homes, with healthier active minds, what value can they bring to society – not necessarily in the workforce but outside of it?

Well there’s interesting work for people who have ‘retired’. The idea of retiring at 65 is already an old one. I’ll give the example of my father. He retired at 68 as a data manager for the pathology firm Sonic Healthcare - he was one of the first employees there - where he worked for all his life.

He thought that would be the end; he’d spend five years travelling the world and then he’d die. But now he’s 78, he feels fitter than when he was in his fifties and he’s started a new career. It’s unpaid work but it’s very rewarding; he sits on an ethics panel for research studies.

I couldn’t help but think about the idea that we can create a pill for anti-ageing and yet in the developing world we have people who should have access to anti-malaria pills but don’t. So are we going to see further inequality or a new division among people who can afford to take anti-ageing pills and those that can’t? What can we do to democratise healthcare?

All new technologies are first adopted by the wealthier nations and the wealthy individuals in those nations – that’s been true for 100 years. What we see time and time again is that these technologies become cheaper and cheaper. It’s true for mobile phones, but it’s also true for drugs. Eventually these drugs go off patent and they become in some cases a few cents a day – affordable for people in developing nations. Anti-ageing drugs may start out less affordable but there’s no reason they can’t eventually become a few cents a day.

It’s not rocket science; these are just chemicals to be made. Finding the right chemical and getting it to be approved costs a couple of hundred dollars.

Therefore, could these drugs make people less susceptible to preventable diseases in those countries?

Yes, the interesting thing about the animal studies is that the animals aren’t just longer lived but they’re more resilient. Resilient to age related diseases but also infectious diseases. So I can see a world where you could give a pill to someone who has been infected with malaria so they can fight off the disease, or an ebola patient who doesn’t die because their body now has the strength to survive.

You showed the average lifespan in 1900 was 45; nearly half what it is now. But then you also mentioned that if someone successfully staves off cancer their lifespan only improves by about 2.3 years. So what is it that we did right between 1900 and now? Have we prevented ageing with some of those habits or have we successfully ‘knocked off’ those diseases that we no longer need to cure?

It’s a combination of much better healthcare in general, so sanitation, antibiotics. Those early discoveries got us to where we are now. Medicines such as heart disease medicines, cancer therapies helped us somewhat, but not a lot. We really owe it to those early discoveries 100 years ago.

We’re now coming to a second medical revolution where we’re not just preventing and treating one disease with a pill but 50. That will get us past a point where we seem stuck. Instead of improving incrementally – I think at the rate we’re currently going at we get an extra 3 months of life every year. These new medicines could form one day to the next, giving you an extra five or 10 years.

Could this help address the global health issue we’re facing in that we’re becoming too dependent, or too resistant, to antibiotics? Could we use anti-ageing drugs to help contain the spread of contagious diseases? Am I getting too far ahead of myself?

The molecules could help the frail and the elderly survive pneumonia for example by boosting their immune system. It’s not crazy to think that you could give better resilience to the elderly if they get an infection.

We also need new and better antibiotics which we’re also working on.