Will Eighty Be the New Fifty by 2076?

(5 minute read)

As part of this series looking from America’s founding in 1776 toward its 300th birthday in 2076, I want to turn this week to health, ageing and longevity.

What might medicine achieve during the next fifty years? Before looking forward, however, it is worth remembering how extraordinary the journey has already been.

What would you rather be: wealthy and powerful in Revolutionary America, or an ordinary person living today?

At first, the answer may appear obvious. Imagine owning a fine house in 1776, with servants, land and enough money to purchase almost anything available.

Yet your wealth couldn’t buy antibiotics, vaccines, modern surgery, reliable anesthesia, blood transfusions or most of the medicines now sitting behind the counter of an ordinary pharmacy.

Nor could it protect your family from one of the greatest tragedies of the age: the death of children. Thomas Jefferson and his wife Martha had six children, but only two daughters survived to adulthood.

Cotton Mather, one of the best-known figures in colonial New England, had fifteen children. Only six reached adulthood, and just two outlived him.

These were prominent families with access to the best care their world could provide. Wealth helped, but it could not purchase treatments that had not yet been invented.

A simple toothache could become an ordeal lasting weeks or months. Eighteenth-century dentistry included fillings, artificial teeth and other surprisingly sophisticated techniques, but for most people the principal answer to a badly diseased tooth remained extraction.

The tooth key, a device that gripped and twisted the tooth from its socket, could break teeth, damage gums and even splinter jaws. George Washington began losing teeth in his twenties and had only one natural tooth remaining when he became president.

Even eyesight depended heavily upon circumstance. We now treat glasses as entirely ordinary. Yet age-related difficulty focusing on nearby objects affects an estimated 86% of modern Americans aged forty-five and over.

A simple pair of spectacles allows hundreds of millions of people to continue reading, working, driving and recognizing faces clearly. Even our ancestors ten generations back would have regarded that as a miracle.

Modern medicine is far from perfect. People still wait too long for treatment. Diseases remain incurable. Healthcare can be expensive, unequal and frustrating. But perhaps we should occasionally pause to be thankful for what we already possess.

A surgeon can replace the cloudy lens of an eye and restore sight in an operation that often takes less than half an hour. Artificial hips and knees allow people who might once have become housebound to walk, travel and exercise again. Imagine what miracles those achievements would have seemed to people living in 1776.

A pacemaker can correct a failing heartbeat. Antibiotics can defeat infections that once killed indiscriminately. Hearing aids can reconnect people with conversations they were slowly losing. We are already living inside a medical revolution.

The more fascinating question is what that revolution may achieve by 2076.

The objective should not simply be to extend lifespan. Keeping people alive for longer while they remain frail, confused or dependent would be a very limited victory. The greater prize is healthspan: extending the years during which people can walk, think clearly, travel, work, laugh and remain independent.

Medicine appears to be moving through three great stages.

Repairing Disease After Damage Occurs

This is the kind of medicine we understand best.

A joint wears out, so surgeons replace it. A heart artery becomes blocked, so doctors open it or bypass it. A kidney fails, so the patient receives dialysis or a transplant. Something breaks, and medicine tries to repair the damage.

The results are already extraordinary. Millions of people remain active because of artificial joints, implanted lenses, insulin pumps, pacemakers and transplanted organs. Conditions that would once have ended a career, destroyed independence or caused death can now be treated routinely.

The next step may be to make those repairs far more complete.

Scientists are developing tissues grown from human cells, while genetically modified animal organs may eventually help address the severe shortage of donor organs. The United States already has a regulatory framework for xenotransplantation, the transfer of animal organs or tissues into humans.

The eventual goal is remarkable: a future in which someone whose kidney, heart or liver is failing does not have to wait for another human being to die.

By 2076, doctors may routinely repair organs using a patient’s own cells, replace damaged tissue before the entire organ fails, or install an engineered replacement designed specifically for that person. Organ failure may no longer mean waiting anxiously for a suitable donor.

Repairing a failing organ would be an extraordinary achievement. Detecting that failure years before it happens would be better still.

Detecting Disease Before Symptoms Appear

Most medicine still begins when the patient notices that something is wrong. There is pain, breathlessness, weakness, bleeding or a change in memory. By then, the disease may have been developing silently for years.

Future medicine may reverse that sequence.

Researchers can already examine proteins in the blood and estimate the biological age of individual organs. In one major study, scientists developed measures for eleven parts of the body, including the heart, brain, kidneys, lungs and immune system. Nearly one person in five showed accelerated ageing in at least one organ, even though the rest of the body might be ageing normally.

Imagine the practical consequences.

A fifty-five-year-old woman might discover that her heart is biologically sixty-eight while her brain and kidneys remain younger than her chronological age. Instead of waiting for heart disease to appear, her doctor could intervene years earlier through medication, diet, exercise or treatments that have not yet been invented.

Your annual health check might eventually become an inspection of every major system in your body. Artificial intelligence could compare blood tests, scans, genetic information, sleep patterns, movement and heart rhythms against data from millions of other people. It might notice a subtle combination that no human doctor could recognize alone.

Medicine would begin to resemble maintenance rather than rescue.

We don’t wait for an aircraft engine to explode before inspecting it. By 2076, future generations may wonder why we once waited for the human body to become seriously ill before acting.

Finding disease earlier may save millions of lives. Preventing the underlying damage from developing at all would transform the meaning of ageing.

Preventing or Reversing the Underlying Damage

The third stage is the most ambitious.

Instead of repairing the consequences of ageing or detecting disease sooner, scientists are beginning to investigate whether some of the biological processes that cause deterioration can themselves be slowed, prevented or partially reversed.

One area involves senescent cells, sometimes nicknamed “zombie cells.” These are damaged cells that have stopped dividing but remain alive, releasing inflammatory signals that can harm surrounding tissue. Researchers are testing senolytic drugs intended to remove them and senomorphic treatments designed to suppress their damaging behaviour.

Other scientists are exploring whether cells can be partially reprogrammed, restoring some youthful patterns of activity without erasing their identity. The idea would have sounded impossible not long ago: instead of merely treating an ageing cell, reset part of its biological machinery.

Much of this remains experimental, and some approaches will fail. But scientists are no longer asking only how to treat the diseases associated with ageing. They are beginning to ask whether parts of the ageing process itself can be altered.

Not every advance will involve rewriting genes or growing replacement organs. Some may come from recognizing that apparently separate problems are connected.

In a major study of older adults at increased risk of dementia, those given hearing aids experienced almost 50% less cognitive decline over three years than the comparison group. The result does not mean hearing aids prevent every case of dementia, but it suggests that maintaining our connection with conversation, sound and other people may help protect the brain.

A reduction of almost 50% in cognitive decline among those at greatest risk would be a substantial medical achievement.

The medicine of the future will include gene therapies and replacement organs, but it will also involve acting earlier upon things we already understand: hearing loss, blood pressure, obesity, inactivity, poor sleep and social isolation.

By 2076, an eighty-year-old may not be regarded as elderly in the way we understand the word today. They may have replacement joints, restored hearing, continuously monitored organs and treatments that remove some of the cellular damage accumulated over a lifetime. They may still work, explore the world and embarrass their grandchildren at the gym.

Not every prediction will come true. Some treatments will fail, others will arrive later than enthusiasts expect, and difficult questions will remain about affordability and access. Yet the direction of travel is unmistakable.

In 1776, even wealthy families buried children they couldn’t save. George Washington could lead a revolution but couldn’t preserve his own teeth. Millions gradually lost the ability to read as their eyesight deteriorated. When that happened, their life closed down around them.

Today, we complain when our new glasses take a week to arrive.

Perhaps that is understandable. Miracles stop feeling miraculous when they happen every day.

But as America heads toward its 300th birthday, we should remember how far medicine has already carried the world and look forward with hope to where it may take us next.

The greatest achievement of the next fifty years may not be immortality.

It may be something more valuable: allowing far more people to remain fully alive for almost all the years they are given.

Till next time,

Brian

BA Gillies

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