Why preventative medicine is a must

The population on planet Earth is getting older and this fact is made clear by the aging demographics of both developed and developing countries. Projections estimate that there will be very sharp rises in the numbers of people over the age of 50, and very small increases expected in those under 15. From these facts, we judge that the cost of traditional health care of based upon the current “nationalistic” model will struggle, unless they undergo a radical alteration. A number of possible solutions are debated, ending in a conclusion that a liberal society is likely to choose preventative medicine as the next health care model for the 21st Century.

To this end- the concept of anti-aging/ preventative medicine is tackled, including some of the difficulties involved with bringing this new arm of medicine into the clinical environment.

Also discussed is the challenge of biological age measurement, to assist in the determination of the actual level of health in a “healthy” person, with a view to an optimal health, rather than just normal health.

Antiaging medicine is a new concept, one that enables individuals- working with health care professionals in a different way, to take better care of themselves. It is everyone’s interests to understand that there is a need for preventative medicine in our societies and that this information is conveyed effectively to the public.

It’s generally known that the average life expectancy is getter longer, increasing year on year. FIGURE 1 illustrates the life expectancy for the USA from 1900 to 2050 and similar trends can be presented for all the developed and indeed developing countries.

Presently, the average 65-year old in the developed world can expect to live to be 79 and the average woman can expect to live to be 82. The changes taking place can be exacerbated when you realise that a child born in 1997 can expect to live 29-years longer than one born in 1900, representing a 60% increase.

Yet this could just be a “drop in the bucket” compared to what some scientists believe is already possible. Many believe that today’s existing knowledge about the human biological system and the technology that is already available, will mean that many more people will be able to regularly live beyond 100, perhaps even regularly beyond 120 and who knows where. For the theory is- that the longer you live, the more chance you have to expose yourself to new technologies that can further extend lifespan.

Naturally none of this is worthwhile, unless we are also enhancing or maintaining a good standard of health, thus improving the optimal health span as well as the life span.

Simply extending life span based upon the costs and impracticalities of the current standard healthcare system, is unlikely to be feasible.

The life span of the baby boomers

Not only is the average life-span becoming much longer, (thus increasing the numbers of elderly individuals in the population), but we are also about to see the impact of the baby boomers upon society. The baby boomers are those individuals born between the Second World War and the Korean War and they represent the largest single section of the population and for whom as they age, are now beginning to move into their geriatric period. As they have impacted every single area of commerce and society of their generation because of their sheer numbers, we can now expect this same impact for all their geriatric requirements.

Taking Italy as an example, we can study their current and forecasted populous. FIGURE 2 is for the year 2000, here we can see a typical apple shaped graph with still seemingly reasonable numbers of the working age-group, (i.e. income generating). FIGURE 3 is the graph for 2025 and it changes quite dramatically, it looks more like one of those old-fashioned spinning tops for children. Now there are now many more people in the over 50’s age groups. And when we look at the projections for 2050 in FIGURE 4 we see that the demographics appear to look like an inverted pyramid, with for the first time, massive numbers in their 60’s, 70’s and 80’s. But we don’t have to wait until 2050, as it is estimated that the 65 plus age group will start to experience a surge of growth from 2010.

To see how obvious it is that the elderly population is growing at a far greater rate than any other part of society, look at FIGURE 5. This graph illustrates that individuals over the age of 65 are expected to grow at a rate of 200% between 2000 and 2050. Whilst the growth rate of those between the ages of 15 and 64 will expand at 16% and those under 15 years of age at only 5%. But the single biggest increase is attributable to those over 80, with an expected increase of more than 400%! Indeed, this 80+ age bracket is by far the fastest growing population group. Putting this into perspective; in the year 2000 there were 600 million people in the world aged 60 and over. There will be 1.2 billion by 2025 rising to 2 billion in 2050. And this is not singularly a developed world issue. Today, about two thirds of all older people are living in the developing world; by 2025, it will be 75%.

Aging factors

Whilst it’s common knowledge that the older one is, the more likely we are to be treated for a disease or ailment, FIGURE 6 helps to highlight this. It shows by groups of varying ages, their percentage of the total drug consumption. This particular study looks at the years of 1990, 2000 and 2001 and whilst there are variations between the years, it is clear that the overall trend is up, and that apart from birth and childhood diseases, the older you are, the more likely you are to be prescribed medication. For example, someone who is 75 is likely to use 4-times as many drugs than someone who is 45.

The question we have to ask ourselves is, what does this mean to society if we let these facts meet our previous graph showing the over 65’s increasing by 200%?

Another factor that advances with age is disability, as shown in FIGURE 7. While the graph shows similar results for France, Germany, the Netherlands and the UK, the consensus is that the older we are, the more likely we are to suffer from some form of disability- many of which may need some type of care with its concurrent cost. Indeed, as FIGURE 7 highlights at the age of 55 there is a 1 in 5 chance of having a disability, rising to 1 in 2 at the age of 75 and so on.

Again, let us pose the question, what happens if we let these figures meet those in the aging population demographics already mentioned?

Consider that old-age dependency rates will rise in every major world region over the next 20-years, and that the burden in 2025 is expected to be at least 50% larger than it was in 1998. In just 14-years time society will consider 1 in 5 of its population as elderly. However an aging populous could have benefits; on the up-side, an increase of just 6-years extra life expectancy in the United States, between the years of 1970 and 1990 translated into an additional gross national product of $57 trillion dollars, and those figures were based on a 1992 report.

But for those who say we can’t afford to introduce preventative medicine, consider that in June 2000 the University of Chicago estimated that curing heart disease would be worth $48 trillion Dollars, and curing Cancer would be worth $47 trillion Dollars. Perhaps the question should be, can we afford not to introduce preventative medicine!

Aging’s financial burden

Looking more closely at one example of an aging disease, we can begin to see more clearly the financial costs involved. Alzheimer’s Disease is currently the 12th leading cause of death and it is perhaps an accurate example of an aging disease, because it very rarely affects anyone under the age of 60. At present, there is a 1 in 7 chance of being diagnosed with Alzheimer’s Disease if you are over the age of 65. That figure rises to a massive, and rather alarming 1 in 2 chance if you are over the age of 85. In fact, the risk of Alzheimer’s Disease doubles every 5-years after the age of 65. In the United States alone, $80 to $100 billion Dollars is spent every-year on Alzheimer’s health-care, or lost in earnings, and it has been estimated that curing Alzheimer’s Disease could be worth as much as $1.5 trillion Dollars.

If we take into account all the age-related diseases and disorders, is it possible to get an overall view of the financial costs involved? Essentially all diseases fall into one of four categories, they are either:

1. Inherited or genetic disease.
2. Infectious disease.
3. Trauma.
4. And finally, degenerative diseases- which for argument, we can suggest are attributable to aging- for by literally being older it dramatically increases our chances of acquiring them.

According to the statistics, only 10% of all health-care costs are spent on the first three. In other words, 90% of the total health-care budget is spent on degenerative disease. In the United States alone, that translates into around $700 billion Dollars every year!

Thus, if we really want to make a big impact on health-care in the world, we must focus on this 90%, we must focus on the degenerative diseases of aging. If we can slow or prevent the signs of aging from occurring, we could eliminate overnight the majority of disease and therefore the majority of its cost, both in financial and human terms.

But why are health costs so high? Clearly there are a number of factors here, including the need for highly trained staff, specialist equipment and premises, as well as liability insurance etc. All these factors are clearly present in the treatment of a disease, and obviously it could all be significantly reduced if far fewer people were actually sick in the first place!

Looking more closely at drug development, we see that the pharmaceutical companies are mainstays of the Fortune 500. Indeed, 10 drug companies registered more profits than the 490 remaining Fortune 500 companies combined!

We are reminded that high margins/ profits are required for R&D and the approval process. Naturally, not all drugs become approved and thus the average cost of approving a new drug- just in the United States- was estimated in 2002 to be $800 million.

When going for approval, the most important question is- can the molecule be patented? After all, who is going to risk millions of Dollars to approve a molecule that anyone can sell? But as it is so difficult to patent a natural molecule, it means the accent is upon the artificial. Then once approved, a flood of press releases and marketing follows with the blessing of the authorities, after all they have approved it for use in disease X etc. This then leads to greater public awareness.

This is a reality of the way things work, and as such greatly impedes the small guys and the natural molecule brigade and is one of the major obstacles to be faced. For the commercial reality is, that claims can’t be made about substances that aren’t approved and approval is expensive and requires strong patents.

Problems for the widespread introduction of preventative medicine

There are a number of issues that impede the introduction of preventative/ antiaging medicine, these include:

a) Patents: Which have already been mentioned.

b) Approval: Apart from the prohibitive cost of the approval process, there is also the fact that products have to be tested to correspond to a given disease or disorder. There is no current acceptance of disease prevention, or of aging itself, therefore if the category fails to exist it is clearly difficult to start an approval process! There will have to be a change to the categories to accept perhaps just biochemical changes. For example, rather than treating an end-point disease to accept that hormonal change itself, or reduced inflammatory markers is good enough to prove a substance’s worth, leaving the physician free to use these tools as they see fit. Another issue is the fact that most often substances for approval are tested singularly. Whilst more often than not, a combination of substances work synergistically together, and is especially true of natural molecules and is the foundation of a holistic approach to medicine. Unfortunately, single item substances are tested individually to prove their lo

c) Studies: In preventative medicine, we really need negative studies. By this I mean, we want to keep healthy people healthy. The types of clinical trials that need to be run mean using healthy people, utilizing the substances in question and then showing that over time the people who were in the trial were less prone to disease etc. Again, all to often the trials run are the exact opposite, take a sick person and try to make them healthier. That is not the ultimate goal of preventative medicine and therefore it becomes another hurdle in the battle of the current approval mechanism.

d) Time: As usual it is not on our side. Once again the ultimate goal of antiaging medicine is to extend both the optimal health and the life span. Trials in humans need to be run over decades to prove their worth, although many are willing to accept that when we see positive results in a short to medium period that we can’t afford to wait for the end-point, otherwise the data is of little relevance to today’s generation.

e) Insurance: Very little tends to be reimbursable through insurance at present. Therefore as preventative/ antiaging medicine falls to cash-only patients, the numbers of people engaging in it is restricted.

f) Scope: Asking the question- what do you prevent in your healthy patient? Brings up numerous issues of the vastness of the possible scope. In its widest sense the goals and aims are enormous, obviously because aging is affecting every part and every system of our body’s. Of course, one can concentrate on specific areas, perhaps those that are most likely to be lethal, or even be of the greatest concern to the patient themselves. In its broadest sense, using all the skills and technologies that are available to us, including examination, observation, blood work, scanners and good old-fashioned questions and family background etc., the testing could potentially become enormous and is clearly limited by the issues of cost and convenience.

g) Measurement: Finally on the issue of measurement, we need to develop techniques to measure healthy people, to try to determine just how healthy the healthy patient is! Furthermore, we need to move away from the idea of normal and think more along the lines of optimal. A major criticism of antiaging medicine is that it is suggested that advice and substances are given “ad-hoc”, and that, as by definition, healthy patients don’t feel much difference in some cases, so the advice and recommendations are taken on “faith.” So is there any way that we can show that the use of various protocols or products, such as the bio-identical hormones, are not only impacting the level of that particular hormone, but are also affecting the aging status of the patient as a whole?

Clinical application issues

Looking at the status of the actual measurement of aging and health today, what challenges do clinics face in adopting preventative medicine?

a) Firstly, we can recognise that there is a lack of scientific measurement within the industry, with no clear path to follow.

b) Secondly, any solution requires it to be quantitative, and standardization is lacking within the field.

c) Plus, consider that any measurement that takes place has to be seen to be changeable within a relatively short period of time. From the patient’s perspective, results have to be achievable within a reasonable time frame.

Ward Dean, M.D., noted in his 1988 publication, Biological Aging Measurement: “It is assumed that with increased automation and computerization, that data will be more easily collected and analyzed, to rapidly improve the accuracy and cost effectiveness of aging measurement. I hope this book will be useful in assisting to accomplish this goal.”

What’s the answer to world aging?

In the very near future, the world has to ask itself some basic questions. For example:

1. Can we expect the future working generations to pay 70% or even more tax, to support the same health-care program for a top-heavy society? It is estimated that if the policy of early retirement continues, (i.e. between the age of 55 and 60), that in just 20-years time there will only be 2 people in employment for each retired person! Thus, it appears that older people will be a necessary component of the workplace, continuing to contribute to society, if only in order to support themselves. That’s another reason why we need a fit, lucid and agile older society.
2. Do we continue as we are? Can we allow an ever increasing elderly population to meet an already stretched health-care budget, and simply increase the numbers of people who are ending their lives in suffering? There are already discussions in the UK about whether or not certain drugs, particularly ones that are expensive and perhaps have a small benefit- should be given to the elderly. These questions have currently been raised in regard to certain senile dementia drugs and cancer drugs. They are likely represent the “thin end of the wedge” and that we are all going to hear a lot more debate and indeed decision on such matters.
3. At the end of the day, for those who state; “there are too many people already,” one of the answers is a low birth rate. Are we ready for societies that dictate who, when and indeed if you can have children?
4. The only other answer to population control is a high death rate. Do you wish to live in a society that considers euthanasia necessary, perhaps dependant merely upon chronological age, or maybe a ratio of your health-care cost and age?
5. Or will we introduce antiaging medicine and revolutionise health-care by concentrating on the true prevention of disease? We could reduce the overall cost of health, adopt the holistic use of natural substances and allow our elderly to live in dignity and self reliance, by remaining lucid and useful to the community at large.

Antiaging medicine

Whether or not one likes the terminology, antiaging medicine itself represents the ultimate preventative medicine. The model is based upon the very early detection, prevention and reversal of aging-related disorders.

The science of antiaging medicine is truly multi-disciplinary, for it is represented by advances in the fields of biochemistry, biology and physiology and enhanced by contributions from mind/ body medicine, molecular genetics and the new emerging medical technologies.

Antiaging medicine has its foundation in what Nobel Laurate, Linus Pauling described as orthomolecular.

Furthermore, antiaging medicine accepts that aging diseases and disorders can and should be prevented, rather than simply treated.

Today there are literally thousands of physicians, scientists and researchers around the world involved in the research and treatment of aging. Huge strides are being made in the understanding and control of the aging process.

Our challenge is to bring together the international research, and to utilize whatever molecules and techniques that may be necessary for the long-term health of the patient- according to that science.

Ultimately, that means changing the way the patent system and the approval system operates. Big steps. But if we remember to educate and prove to the public that this is the common sense they have been looking for, then usually no one stands in the way of a ground-up revolution for very long.

Conclusion

We stand at the threshold of a new paradigm, for the first time in history we understand some principles of why we age, how we can measure biological aging and how we can slow and treat its affects. Through the use of lifestyle choices, chelation, nutrition, hormones, drugs and the emerging technologies, we now have the ability to delay, reduce and even prevent the appearance of numerous disorders and diseases.

I envisage in the decade to come that thousands of antiaging clinics will be established. People will attend these clinics for regular checks and through the use of biological aging markers, an individual’s rate of aging and risk from particular degenerative disease will be measured. Steps will then be taken to slow and eradicate these biological aging signs before they become diseases, and therefore difficult and expensive to treat.

In other words, the traditional recognition and diagnosis of disease will change forever. One could consider these aging but otherwise “healthy” individuals attending antiaging clinics, in much the same way as individuals visit the dentist today, for their preventative checks and measures.

However, as is usual with all great advances, mankind will probably experience the vested interests of the establishment and dogma, that together- will attempt to slow down, or perhaps even prevent the wide-scale use of antiaging medicine. After his discovery, Christopher Columbus said: “Human progress has never been achieved with unanimous consent. Those who are enlightened first are compelled to pursue the light in spite of others.”

If we too can grasp the fundamental fact that we need to be pro-active about aging instead of just being tolerant of it, then mankind will be able take into its hands the possibility to radically alter the way we think about and approach “health.”

If we don’t allow dogma, vested interests and other imposed restrictions to stand in our way, then the door is already open to us.

References:

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United States Census Bureau. US Department of Commerce, May 1995.
American Academy of Antiaging Medicine, www.worldhealth.net
De Grey, A. 2004 Journal of Rejuvenation, Mary Ann Liebert Publications.
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World Health Organisation Ageing & Health: www.who.int/hpr/ageing
Lehman Brothers Equity Research.
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United States Census Bureau, May 1995.
United States Department of Commerce, 1992.
The Economist, 3 June, 2000.
National Vital Statistics Reports, Vol. 47, No. 20, June 30, 1999.
United States Health-Care and Finance Administration, 1996.
Physicians for a national health program, June 25, 2003.
Life Extension Magazine, May 6, 2002. Life Extension Foundation,