Tackle aging, not cancer and heart disease, for 'better returns'
Medical research that brings about a delay to the aging process would represent a "better investment" than tackling specific diseases, such as cancer and heart disease, an economic analysis claims.
In terms of its impact on longevity, disability and major entitlement program costs, finding a way to delay aging makes better sense than targeting specific conditions, say the researchers publishing in the journal Health Affairs.
Recent scientific advances suggest that slowing senescence - the aging process - "is now a realistic goal" with benefits that "warrant a new focus" for medical research.
The authors point out that most medical research remains focused on combating individual diseases, but in their micro-simulation of the future health and spending of older Americans, this produces poorer returns than adding healthy years to lifespans.
"Delayed aging could increase life-expectancy by an additional 2.2 years, most of which would be spent in good health," they say.
The authors add:
"The economic value of delayed aging is estimated to be $7.1 trillion over 50 years. In contrast, addressing heart disease and cancer separately would yield diminishing improvements in health and longevity by 2060."
Professor Dana Goldman, the Norman Topping chair in medicine and public policy at the University of Southern California in Los Angeles, led the research using a micro-simulation called the Future Elderly Model. This compared optimistic disease-specific scenarios with a hypothetical picture of delayed aging.
The model found that, even with modest gains in the scientific understanding of slowed aging, an additional 5% of adults over the age of 65 in the US would be healthy, rather than disabled, every year from 2030 to 2060.
This would produce a figure of 11.7 million more healthy US people aged over 65 in the year 2060.
Such improvements in healthy life-expectancy would come at a cost, however: "greatly" increasing entitlement spending, especially for social security. This could be offset, the authors suggest, "by increasing the Medicare eligibility age and the normal retirement age for social security."
Challenged on whether delaying aging would simply put off the onset of diseases and contribute to population growth, Prof. Goldman looked to history.
He told Medical News Today: "Suppose we went back to the way medicine was practiced in the 1970s. This would take 2.5 years off life-expectancy, and would cost us less. Would that world be preferred? The answer is obviously 'no.'"
Prof. Goldman also told MNT:
"People value longer lives, especially when they are healthy lives.
We just need to find a way to get there in a manner that doesn't break the bank, and doesn't lead to inequitable health outcomes in society.
The bottom line is that the risks are manageable and the returns are worth pursuing."
An extra year of life in good health
Prof. Goldman worked with colleagues at Harvard University, Columbia University, the University of Illinois and other institutions. The study assumes a research investment that brings about a 1.25% reduced likelihood of age-related diseases.
The analysis suggests that major advances in cancer treatment or heart disease would give a 51-year-old about 1 more year of life. But this could be doubled to 2 additional years by the modest improvement in delayed aging, with the extra time more likely to be in good health.
"This is a fundamentally new approach to public health that would attack the underlying risk factors for all fatal and disabling diseases," says co-author Professor S. Jay Olshansky, from the School of Public Health at the University of Illinois at Chicago and an expert in aging.
Prof. Olshansky adds that switching the research focus to slowing down aging is worth doing now:
"We need to begin the research now. We don't know which mechanisms are going to work to actually delay aging, and there are probably a variety of ways this could be accomplished, but we need to decide now that this is worth pursuing."
The authors conclude their analysis by saying that, overall, "greater investment in research to delay aging appears to be a highly efficient way to forestall disease, extend healthy life and improve public health."
'Paradigm shift' needed toward behavioral change
On the matter of tackling specific disease, there has been a call for a change in focus here, too. The American Heart Association wants to move away from treating specific biomarkers of heart disease and focus on improving lifestyle behaviors instead.
In a science advisory statement published in the association's journal Circulation, healthcare providers are asked to treat unhealthy behaviors as aggressively as they treat high blood pressure, cholesterol and other heart disease risk factors.
Dr. Bonnie Spring, lead author of the statement and a professor of preventive medicine and psychiatry and behavioral sciences at Northwestern University in Chicago, says:
"We're talking about a paradigm shift from only treating biomarkers - physical indicators of a person's risk for heart disease - to helping people change unhealthy behaviors, such as smoking, unhealthy body weight, poor diet quality and lack of physical activity."
The American Heart Association's statement concludes its "call to action" for doctors with the following key points:
- Implement individual patient strategies and support population strategies to improve cardiovascular outcomes
- Electronically assess and track health behaviors, including smoking, weight, diet and activity
- Collaborate with an inter-professional healthcare team to help patients adopt healthier lifestyles through delivery of behavior-change counseling
- Engage community resources and technologies to support health behavior change
- Support reimbursement of intensive behavioral counseling for patients whose poor health habits put them at cardiovascular risk
- Advocate for healthcare systems and public health policies that prevent the loss of healthful behaviors over the lifespan and that address the behavior-change needs of the entire population.
Written by Markus MacGill
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