While we are aware that smoking increases the risk of lung cancer and a poor diet can lead to diabetes or heart disease, there is another significant risk factor contributing to nearly every chronic illness. The simple act of getting older elevates our likelihood of developing conditions such as cancer, dementia, heart failure, and numerous others. Aging, defined as the natural, progressive decline in physiological function over time, stands as the primary risk factor for the diseases that tragically claim the lives of our loved ones.
Despite this, the medical field does not approach aging with the necessary urgency. Instead, the area is often overshadowed by the pursuit of miracle cures, exaggerated claims, and confusing messages. This environment allows a culture of “anti-aging” fads, driven more by marketing than by scientific evidence, to thrive.
The human toll is starkly evident; our parents and grandparents frequently experience hospitalizations, receiving reactive treatments that address individual conditions rather than the root cause. This also places an immense financial strain on the economy. In 2024, the U.S. government allocated over $1 trillion to Medicare for the elderly, a figure projected to increase by approximately 5% annually. As the population ages and more Americans reach their 70s and 80s, we face the risk of depleting financial resources and a shortage of caregivers for our elderly population.
The magnitude of this challenge necessitates a fundamentally different strategy. A considerable number of scientists are achieving promising early results that could significantly alleviate the burden of aging. However, a mechanism is needed to deliver these innovations to the public. By addressing regulatory obstacles, establishing clinical infrastructure, and streamlining regulatory processes, we can encourage drug developers, regulatory bodies, and insurance providers to recognize aging as a valid medical target.
The field of aging research is transitioning from hype towards a more rigorous, clinically focused, and impactful future, offering the potential to age without compromising health.
A significant study published in Nature Aging revealed that even a modest one-year increase in life expectancy achieved by slowing the aging process would be worth an estimated $37 trillion, far exceeding the benefits of reducing any single disease. This valuation encompasses not only reduced healthcare expenditures but also extended productivity, increased years of independence, and the cumulative advantages of maintaining biological youthfulness.
These are not mere theoretical projections. They represent a future where your grandmother remains mentally sharp and active at 85, where your father avoids spending his final decade debilitated by illness, and where the individuals who raised us can fully participate in the lives of the next generation.
The question arises: why do we lack medications that can prevent or reverse health deterioration associated with aging? The explanation for this longevity paradox lies less in our understanding of aging biology or our capacity to identify potential therapies, and more in the challenges of safely delivering promising drugs to individuals. Current clinical and regulatory systems are designed around specific diseases, evaluating a drug’s efficacy in improving well-defined outcomes over months or a few years.
Aging does not fit neatly into this framework. To ascertain whether a drug administered to 50-year-olds impacts their function at ages 70 or 80, clinical trials targeting aging biology would need to span decades. Even major pharmaceutical companies are hesitant to undertake such risks when the regulatory pathway remains unclear. In this void, supplements, unproven treatments, and their charismatic proponents flourish.
The Advanced Research Projects Agency for Health (ARPA-H), where I serve as a program manager, employs a fundamentally different approach. ARPA-H was established to tackle high-risk, high-reward health challenges that are too complex or unconventional for traditional methods. We convene experts from various disciplines, make bold investments, and accept that some projects may not succeed in the pursuit of transformative health breakthroughs.
Our dual objectives are to prevent aging and to reverse it. These goals extend beyond scientific inquiry; they also involve the development of the clinical and regulatory frameworks necessary to make aging-focused therapies practical, testable, and accessible.
As a crucial initial step toward prevention, ARPA-H recently launched the Precision (PROSPR) program. Developed in close collaboration with geriatricians, regulators, and pharmaceutical companies, PROSPR is designed to lay the groundwork for a genuine longevity sector by enabling the first generation of aging-targeted drugs within a three-year clinical trial. The program will identify early indicators of future health by analyzing over 20 years of human data and integrating the most predictive biomarkers into a score capable of forecasting 20-year health outcomes.
To validate this score, PROSPR will conduct the first Phase 3 clinical trial targeting aging in individuals not yet diagnosed with a specific disease. This trial will evaluate three drug targets already approved by the FDA for other conditions: metformin, which influences cellular pathways linked to aging; newer compounds known as senolytics; and diabetes medications called SGLT2 inhibitors, which also offer benefits for the heart and kidneys.
The program will then assess whether novel compounds specifically designed to target aging biology can be evaluated using the same methodology. If the score proves accurate, it will transcend its role as a research tool; individuals could utilize a simple testing kit to determine the impact of their lifestyle choices or treatments on their health trajectory. Our aim is for this testing kit to cost less than $100 by 2031.
While PROSPR concentrates on prevention, reversing age-related decline necessitates more significant interventions. Frailty represents a clear area of need. Unlike a singular disease, frailty is a condition characterized by the simultaneous deterioration of multiple bodily systems—muscles, bones, the immune system, and the brain—leading to weakness, increased susceptibility to falls, vulnerability to infections, and a high risk of hospitalization. The five-year survival rate for individuals experiencing frailty is approximately 50%, yet the condition is primarily managed with palliative measures such as exercise and nutrition, which, while beneficial, are insufficient.
Addressing aging requires more than just pharmaceutical interventions. ARPA-H is also exploring methods to restore brain function by replacing damaged brain components with a program developed by Cortical.io.
Although this work is still in its early stages, it signifies a fundamental shift in viewing age-related decline not as an inevitable consequence of time, but as a problem that can be effectively addressed with the full power of modern medicine.