When I was nine, I knew of exactly one person who was rich. It was a farmer from the town next to ours, in the ploughlands of coffee-mantled Brazil, where an unsettling combination of slavery and hard work had made a select few succeed. Still, priests and schoolchildren alike couldn’t help but be at once enchanted and intimidated by this one well-to-do harvester, as if his presence elevated our otherwise destitute region.

He was perhaps the oldest person I had ever seen. But the rumpled skin and oysterish hair appeared to have worked in his favor. Or so it seemed to those of us spectating from the outskirts, as if we could sneak into the tinseled world of Hollywood by studying him. We, the unknowingly destitute schoolchildren, made up elaborate stories that justified the folds and furrows on our unknowing actor’s sun-flecked skin. “They’re cracks from getting bigger,” a six-year-old explained. “It’s a gift, really” the other—twelve—hastily responded, his words betraying the learned confidence of better-trained adults, who’d come to think of aging as a blessing, almost as if it had been engineered by tenderhearted gods to furnish human life with meaning.

We didn’t know that our one storied farmer had cancer, then—melanoma, stage three—and that a vain attempt to treat it would cost him and his family far too much. (He was only Southeastern-Brazil rich.) 

As schoolchildren, our learnings on the blessedness of human aging had begun. Growing weak, sick, and frail seemed like the most dignified future any of us could ever dream of. If sporting the region’s most obvious wrinkles meant we could be welcomed everywhere with goiabada (a Brazilian sweet reserved for older afternoon guests and stowed atop refrigerators by the clever mothers of ever-hungry children) we’d take it in a heartbeat. 

We ignored that aging is a major source of suffering, emotional and physical; and that several species age far more favorably than humans. American lobsters, for instance, become stronger and more fertile with age, and unlike simpler organisms that do not seem to age like we do, lobsters are complex, social creatures, with interests like  redecorating the sea-floor for better feng-shui. 

By our first full decade of life, we’d never think to ask: why did lobsters grow wise and strong, while we grew wise and frail?

The Ceilings of Our Science

Twentieth-century science doubled the life expectancy of Homo sapiens, but our health still declines at nearly the same age today as it did in 300 BC. We’ve learned to keep chronically ill adults alive, and made some welcome progress in maintaining health. But in 2024, we’re about as likely to develop the diseases of aging—like cancers—if we live to age 60 as we were in the Iron Age. We’ve never actually extended the human lifespan. The oldest person to have ever lived (to an alleged 122) was born in 1875 and never saw the 21st century. 

Yet attempts to increase health and lifespan have been successful in nearly every animal studied so far. In a 1993 study, changing just one gene (daf-2, a pathway humans share) in C. Elegans worms doubled their lifespan. Changing one additional gene (rsks-1) resulted in a five-fold lifespan increase—the equivalent of a 400-year-old human. In mammalian models, approaches like inhibiting mTOR activity or eliminating senescent cells often result in increased function and median survival rates.

Technologies like genome engineering for polygenic conditions may be decades away from safety, and a long list of scientific and technological bottlenecks remain underfunded. In addition, because clinical trials for multiple disease indications are also costly, lengthy, and prone to false-fails, the effects of existing therapeutics on human aging remain largely speculative. 

We even lack consensus on what aging means, since it differs both between species and within organisms. The human ovary, for instance, becomes geriatric some forty years before the brain. No animal ages exactly like we do, which means animal-tested therapeutics may end up not translating. We may need to advance new human-relevant methodologies, like organs-on-chips. And we will need validated biomarkers of aging to bypass the length and complexity of healthspan trials. Because aging is the result of molecular damage, intracellular therapeutics may be insufficient. Messier interventions like replacing aged tissues may be needed. 

But difficulty hasn’t stopped us, say, from replacing human hearts—or from allocating public funds to research on Alzheimer’s, though we lack human-relevant results.

The U.S. invests only 0.54% of all National Institutes of Health funds into the biology of aging despite the great expenses incurred by this underlying cause. An underlying cause that is becoming much more pressing with the growing gap between health and life expectancy. Government funds often precede scientific results. 

Our failure to achieve better results in aging science may have as much to do with moral bottlenecks as with scientific ones. Maybe aging, like Elon Musk put it, “could obviously be fixed. The real question”—the one we haven’t answered yet—“is whether it should be.” 

The Quirks of Gene-passing Machines

I must have been eleven when I learned that to understand aging as the stuff of biology was unseemly, if not downright heretical. I thought that if we could grow wise without oysterish hairs, we’d be none the worse for it as a species. We are, after all, such stuff as roundworms and fruit flies are made of—and we’ve improved the aging profile of both. 

I recall the quiet on my mother’s face when we buried her grandmother. Once mother’s caretaker and best friend, she’d been the one in need of care for the last fifteen years. I asked if vovó wouldn’t fear the dark, since we’d left her alone, untended, blanketed only by some heaps of earth and a drab moon. I asked if the ants wouldn’t eat her; if that had not been a horrible day and life, really, her last decade or so; and if she might not awake in the middle of the night, afraid. 

Mother couldn’t think, but didn’t have to: she had near-automatic answers to all of these questions, unusual as they might have been: vovó is in a better place now. Those last years she shared with us were a gift, God’s grace and plan. It’s a beautiful thing to age, to die, to make room for the young—it’s what is natural, what makes us human, what makes life worth living.

But, I asked, wouldn’t life have been more worth living if vovó didn’t have to suffer so much before passing? Isn’t it human to treat wounds and pains, and isn’t it the stuff of medicine to postpone death? Wouldn’t it be prettier if vovó could have taught me to be kind and patient (I never learned patience), and  if she could have shared all the wonderful things she’d learned with my kids? Wouldn’t, I asked, all that make life even more meaningful if her giving heart and failing brain wouldn’t be nibbled by those ants; if she didn’t have to sleep there alone today, and every day forever now? 

Mother never answered, but in the corner of her eyes I spotted tears that told me I had been speaking the unspeakable. I swallowed my many more questions, and in their place there grew a quiet shame. 

Since my grandmother’s funeral and the poor explanations I was offered for her pain, my envy for older adults gradually waned. Would I want to live to be 100? In good health, yes. In good health—though I have learned not to say this out loud, since it is heresy to the schooled ears of adults—I’d live to see the heat death of the universe. But no one lives to be 100 in good health. Not humans, anyway. Jellyfish, bowhead whales, Greenland sharks, red sea urchins; they do. Breeding at two hundred isn’t uncommon for some species; and for a rare few biologically immortal ones, death isn’t a necessary counterpart to life.

As Steven Pinker suggests in The Language Instinct, we don’t grow weak and frail because evolution actively roots for our decline. We do because unaided evolutionary pressures can’t attain their all-things-being-equal goal of unfailing health. 

Aging isn’t an elixir devised to do away with ill-conceived ideas. Modern regimes don’t typically end with the passing of heads of state—but actions taken by living humans can end them. If we didn’t have to spend nearly half the U.S. federal budget on older adults, a new kind of reverse ageism might emerge. If medicine succeeds in living up to its centuries-old objective of extending health at the pace it extends life, the average age for presidents might one day be 100. This shouldn’t obviate our imperative to achieve a more humane health system.

Today, some 40 million Americans—predominantly women—are unpaid caretakers of millions of older adults in declining physical and mental health. Aging is not a magic formula designed to increase resource availability for younger humans. If such a formula existed, it might have conspired for the existence of more working-age adults. For every 1% increase in population growth, a 3-4% increase in personal abundance can be tracked. Counterintuitively, the ideal recipe for economic growth and innovation may be more births as well as more long-lived adults with younger brains and sprightlier limbs.

Neither a Blessing Nor a Must 

I write this from secular Boston, where schoolchildren are taught that reason ought to be applied to solve humanity’s most pressing problems. Yet it was here, in 1861, that poet Henry Longfellow wrote, “The young may die / but the old must.” If we believed him, we’d not support the treatment of most diseases or pandemics which disproportionately affect older adults. If we were serious in our argument that what is natural is superior, we’d fund neither vaccines nor pacemakers; neither sunscreen nor Medicare. 

Not long ago, we did think this way about smallpox and heart transplants. Hearts were thought to be the linchpin of humanity, and smallpox was seen—in the eyes of Bostonians who in 1721 arrested a physician who inoculated his son—as “God’s way to punish sinful people… trying to prevent [it] was to interfere in God’s plans.” 

Our values changed, and these changed our biology. It won’t be the last time this happens. We can either leave these outcomes to chance or guide them. We can wait for a spontaneous breakthrough in aging science—or we can actively recruit the talent, capital, stories, and regulations needed to improve aging and delay most human deaths.

Stories have the overlooked power to engineer the limits of our science. The prevailing story outside bubbles like Boston and San Francisco is that aging is good, and that attempts to treat it are arrogant. But those very bubbles have time and again been at the forefront of other value changes  in the United States. 

Today’s contrarian thinkers are likely to again catalyze the value changes needed for aging research to succeed — yet without public funds, we may not live to see it.

Pharmaceutical giants are already profiting from repurposing drugs for multiple disease indications, as with the recent weight-loss drugs designed for diabetes and now being tested for healthspan. But if aging science remains an after-thought, our odds of developing safe and effective drugs for aging will be low.

The wealthy farmer from my childhood? He didn’t have to die a painful and socially costly death so that slavery did not live on. To believe this would be to undermine the agency of brave and breathing thinkers who engineered and fought for new ideals with their own sweat and tears. Progress doesn’t magically unfold when funerals take place. It is architected by the still-living. 

Vovó didn’t have to suffer to spare the living from developing new political institutions more apt at passing on power. Neither do the billions of people whose health and productivity are affected by some form of grief. Our culture hasn’t remained static over the centuries, and to assume we cannot solve the new hurdles created by a more humane health system would be to undermine the so far fruitful ingenuity of our species. 

In the future, older adults able to hold on to positions of power without frailty or cognitive decline may flip the current demographic structure on its head. In 2024, young adults largely subsidize the biological decline of their elders. By the end of this century, older adults may come to subsidize the development of young, disadvantaged workers.

With enough public funding by agencies like ARPA-H and investment from philanthropic organizations like the Amaranth Foundation (where I’m a researcher), we can bypass the tragedy that it’s been more profitable for pharmaceutical companies to extend the unhealthy lifespan of a cancer patient by 3 months than to improve a non-patient’s healthspan by 3 years. And once our incentives are better aligned—as investor Alex Colville tells me—we may just have built the most profitable life sciences companies of all time. 

Aging is not a blessing. Not for the tycoons of Boston, and not for the schoolchildren from rural Brazil. But if we can unlearn our moral biases, we may finally build a health system that lives up to its name—and to the age-old goal of extending health at the same pace we extend life.