“Aging is a disease”: A deep dive into one of the most controversial statements in the field of longevity.

First, let’s take a look at the story.

In January 2021, the 11th version of the International Classification of Diseases (ICD) was launched by the World Health Organization (WHO). ICD is a multilingual catalog of known human diseases, medical conditions, and mental health disorders, to standardize disease diagnosis. The diagnostic codes within the ICD are used to record statistics on diseases, health data, and causes of death on death certificates. In other words, ICD has a very important influence on the global healthcare system. It influences resource allocations, health-care services, and insurance coverage.

However, this new version, among other changes, held the term “old age” under general symptoms (code MG2A) and in the causality section of XT9T. This was proposed to replace the R54 code of “senility”, therefore classifying “old age” or “aging” as a disease. Considering the importance of the ICD and its global influence, this change, naturally, received considerable attention (good and bad). This marked the start of a global movement against this classification.  For instance, in Brazil, as a result of several campaigns such as the #VelhiceNãoÉDoença (Old Age is Not a Disease) campaign, a large wave of national debates started.

Let’s get the basics right.

To understand these arguments, we first need to land on some common definitions for certain words used in this debate. Essentially, we need to develop a common language. “Aging is a disease”. Let’s break it down: We already explained the definition of aging in our previous post [link previous post]. To land on a definition for “disease” we should first define “health”. WHO describes health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”. Therefore, to define disease it is not enough to say it is the opposite of “health”. The medical definition of disease is any abnormality of bodily structure or function, other than those arising directly from physical injury; the latter, however, may open the way for disease. [3] But, practically, to define what is a disease we could simply compare it to what is already known to be a pathology and see if it fits the description or not. Ultimately why does it matter if something is a disease or not? Because it helps us classify the medically treatable conditions and group them to more easily approach their treatment! [4]

What are the arguments for and against this statement?

Traditionally, aging has been viewed as a natural process and consequently not a disease. [5] Then why some are trying to change that now? One of the main reasons is to establish aging as an independent discipline of research. This will in turn drive a lot of attention towards the field whether it's about resource distribution or public and scientific attention. This is not to say there aren’t any investments being made now in the field of longevity. Saudi Arabia plans to invest $1 billion a year in research to extend health span. [7] Meanwhile, the US National Institutes of Health is actively asking scientists to apply for funding for their longevity research and is spending $325 million a year on their research. [8] Simon Melov, a professor at the Buck Institute for Research on Aging also pointed this out: “Research, along with the budget, has been steadily increasing over the last 20 years, it’s not a lack of money or a semantic thing of aging as a disease or not a disease that’s holding the field back. Rather, what the field needs to move forward, are investigators who ask “sharp, hard questions” and can investigate topics when the tech they need is still in development”. To this end, this labeling might cause anti-aging drugs and therapies to shift from the Federal Drug Administration’s (FDA) regulations for cosmetic medicine to the more rigorous regulations for disease treatment and prevention. [9]

Another argument is that this labeling will influence the medical attention aging-associated conditions will get. Take progeria as an example, this rare genetic disorder is an “accelerated aging disease” worthy of medical attention. However, when the same conditions happen in people of a certain age, they are dismissed as being “natural”. [6] This in turn communicates a certain fatalism that may lead to inaction from the medical community but also the scientific community. This label, however, suggests that there are things we can do to change our fate. A good example is the labeling of obesity as a disease. Obesity, just like aging doesn’t really fit the description of disease we mentioned earlier; however, this labeling served to drive a lot of attention toward its research and treatment. Labeling aging as a disease will also influence health coverage policies concerning the conditions associated with aging.  So, it seems like there are many solid arguments for the ICD change, then why not do it? Why did WHO back down (sort of)? Well, a major argument against classifying aging as a disease is simply a question of terminology. As mentioned in the previous section, disease is seen as a state of deviation from the norm. But aging is normal and universal. It happens not only in humans but in nearly all animal species. Or medically speaking, a disease is defined as deviating from the normal range within that age and sex. And therefore, certain deviations from the youthful physical and mental state do not constitute a disease in the older generation, and classifying them as such might be considered ageist. Here we come to another argument against classifying age as a disease. It's ageist. According to WHO’s report on ageism, published in March 2021, globally one in two people are ageist. [10] the COVID-19 pandemic was also a clear manifestation of global ageism and therefore the sensitivity to this terminology seems to be justified. Lastly, the term chosen by WHO was “old age”. However, biological aging and chronological aging are not synonymous. As published in the Lancet: “erroneous and arbitrary use of the “old age” code, based on chronological age alone, would compromise safety and quality of health care for older people. Furthermore, clinical decision-making based on ageism would lead to failure in identifying modifiable risk factors and treatment options, resulting in poorer health care and quality of life outcomes.”

So… is aging a disease?

The answer is, we can’t say. However, we have provided the facts and the conclusion isn’t really up to us to make. Additionally, there really isn’t a global consensus to report on this matter. The fact of the matter simply is that aging is the main risk factor for many chronic illnesses and that’s not all. Therefore, whether you classify old age itself as a disease or you choose to concentrate, as WHO has done, on the age-associated decline in intrinsic capacities, is a technicality and should not diminish the importance of the longevity science.

Therefore, addressing this issue now is essential for the long-term global economy. As the population ages, we risk reaching a point where the younger generation will no longer be able to support the care and medical needs of the elderly. This can ultimately lead to an economic crisis as well as a social safety collapse.

Should it matter to people practicing longevity?

In Zova we believe each person is different and needs a tailored treatment that fits them. Therefore, the answer to this question may be different for each person as well. But why did we choose to take you step by step through these debates? Well as mentioned at the start of the article, this debate, we believe, is a great case study to practice scientific thinking and demonstrates the importance of consulting reputable and trustworthy sources. However, even though it matters on a global scale under which category aging falls; as someone practicing longevity it really doesn’t matter if you view aging as a disease or not. At the end of the day the years go by and we just want to be as healthy as possible for as long as possible. Ultimately, we are trying to practice healthy aging, or as Ashley Montagu puts it: “the idea is to die young as late as possible”.