SPECIAL EDITION
Overcoming the Top 10 Wicked Issues in Healthy Longevity: A Top-Down Perspective
It’s exciting to see a whole range of new technologies in the healthy longevity space, and I’m the last person to want to ‘rain on the parade’. However, my long experience in the biopharma world alerts me to the need to anticipate and address a range of issues that may stand in the way of these technologies reaching those who could benefit from them.
I call these healthy longevity’s ‘Ten Wicked Issues’. They are wicked in the sense that—as Wikipedia (no pun intended) puts it—they are “difficult to solve because of incomplete, contradictory, and changing requirements that are often difficult to recognize.”
Over many decades, the route to successful development and commercialization of biopharma solutions has become well-established: clear definitions of the disease being treated, the mechanism of action of the drug, well-constructed clinical trials conducted under very carefully controlled conditions with clear endpoints, yes/no regulatory approvals, etc. There’s room for variation, as in the “adaptive development” I pioneered some years ago and which was used during the pandemic. But typically, the formula and criteria are clear.
In addressing healthy longevity, though, much is not so well-defined. What mechanisms hold the most promise among the many ‘hallmarks of aging’? How should efficacy be measured if we can’t wait for everyone to die, or not? How best to test potential therapies when most of the clients interested are being treated by a wide range of differently managed clinics? How do we demonstrate effectiveness to payers if not everything is self-paid? The table below lists my top 10 of these issues:
Finding and filling the gaps in the science base
Deciding which mechanisms of aging to prioritize
Converging on the best biomarkers of aging to measure impact
Constructing rigorous clinical trials to demonstrate what works and for whom
Developing networks of professionally managed, protocol-driven clinics to conduct trials
Shaping regulatory attitudes, policies, and practices for the timely approval of healthy longevity innovations
Designing reimbursement systems to support the adoption of approved innovations
Reducing the costs of effective innovations to serve billions, not just billionaires
Applying data science, AI, and diagnostic tools to mine past medical practice and personalize healthspan strategies
Creating a compelling public and political narrative to support the shift to prevention and healthspan maximization
You may have your own list, but I challenge all my readers to say they know the answers to all (or even most of) these wicked issues. I’m an optimist, or I wouldn’t be involved in this field. What I believe we need is focused analysis and dialogue around each issue—work that needs funding as well as enthusiasts to drive it forward.
We are putting together a program to establish goals and targets in these areas for discussion with funding agencies and philanthropists. I invite you to get involved by reaching out or casting your vote on the key issues that matter most to you by clicking the link below. This is your chance to make an impact on the future health of millions—perhaps even billions—of people.
