Most people, when asked, do not see ageing as a disease. In a , citizens (including doctors) were asked to rank 60 conditions, with only 12 strongly rated as diseases.
Options including insomnia, alcohol-induced liver cirrhosis, infertility and erectile dysfunction failed to make the 12. were at the bottom, along with wrinkles.
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But what we consider a disease can and does change. For example, it was not until 1949 that mental disorders were first classified as diseases, and the American Psychiatric Association .
The first modern disease classification – the International List of Causes of Death – was widely adopted in 1900 and is generally referred to as ICD-1. Since 1948, this master list – now known as the International Classification of Diseases – has been maintained by the , which published ICD-10 in 1992 and is planning to finish the 11th revision, ICD-11, in 2018.
The inclusion of a condition in the ICD greatly impacts on the way it is treated, researched and funded, as medical professionals bring their full attention to bear.
Ageing should be added to the next ICD in a way that firmly positions it as a disease in its own right. Why? First and foremost, because the belief that it is a natural, inevitable process – one that many gerontologists say we should embrace and enjoy – allows it to avoid the intense scrutiny applied to most maladies on the list.
There is, of course, opposition. Critics say that without an immediate treatment and no clear set of biomarkers to measure the transition to pathology, it would make a large chunk of the population uncomfortable. People may be diseased but lack medical options for their condition, or clear means of diagnosis.
Fresh approach
But the need for a new approach is clear. Despite ICD-10 containing more than 14,000 different disease-related codes and the US equivalent, called the ICD-10 Clinical Modification, containing over 68,000 codes, efforts to extend healthy life through medical treatment have not been impressive.
The US Food and Drug Administration since it came into being in the 1930s, with about 30 new drugs now added annually. With the exception of vaccines, antibiotics and a few other drug classes, most of these address disease symptoms rather than providing a cure. They marginally extend human life by suppressing the pathological nature of disease, but often this does not improve the quality of that extra life.
Frustrated by this, many scientists and even large pharmaceutical companies, led by Novartis, are that may slow or even reverse ageing – which could give us many additional years of youthful life.
Unfortunately, their efforts are often restricted by the lack of a clear business plan: because ageing is not classified as a disease, there is no clear way to bring anti-ageing diagnostic tests or treatments to market. Branding it in this way would serve as a focus for both scientists and companies, giving them a viable, measurable and marketable target. This would then help to prevent scores of age-related diseases.
Taking this step would strike at the heart of age-related pathology. We would be left with a quantifiable and vulnerable foe, subject to analysis and treatment like any other, and rendered ripe for research, investment and action.
Image credit: Jim Erickson/plainpicture
