In a recent Reddit discussion, philanthropist Bill Gates had this to say about the present growth in research aimed at extending healthy life spans:

It seems pretty egocentric while we still have malaria and TB for rich people to fund things so they can live longer. It would be nice to live longer though I admit.

The comments were of course replicated far and wide in the echo chamber of the press: Gates has a soapbox of an enviable size, even among billionaires. The context here is the Silicon Valley network of wealth that, in quite different ways, funds both Google Venture's new California Life Company investment and the less flashy but so far much more important rejuvenation research and advocacy organized by the SENS Research Foundation. It is also worth recalling that Microsoft cofounder Paul Allen continues to pour a large amount of wealth into cutting edge biotechnology research. The philanthropy of the Bill and Melinda Gates Foundation by comparison is focused on improving the lot of the poor directly, as a matter of delivering and implementing existing technological capabilities rather than building completely new things. Though of course they do fund malaria and other infectious disease research in a big way, which is definitely cutting edge biotechnology.

Both advancing the cutting edge and delivering existing capabilities to the poor are viable approaches to making the world a better place. There must be progress at the cutting edge to produce new medicine and other important technologies. Much of the early stage novel, risky, ground-breaking research only happens because it is funded by philanthropy. Large funding sources in government and business are risk averse and much more interested in supporting incremental but certain progress - yet the only reason that progress even exists in the first place is that someone was willing to put money on the very early stage work that made it possible. Similarly once a new technology is shown to be possible it is a good thing to aid deployment and continued improvements in implementation that help ease the hurdles to bring the results to less fortunate regions of the world. That part of the development process has many of the same problems as early stage research: a lot of people willing to fund a sure thing, and far too few willing to sink money into solutions for what look like roadblocks and dead ends. The sure things never do much; it is the radical new approaches that enable real progress.

Everyone gets to chose where they put their money and how they think about the world. It is nonetheless always disappointing to see influential people completely misunderstand the point of longevity science. Comments like those made by Gates could just as well have been applied to heart disease fifty years ago. Why are all those rich people funding heart treatments and better drugs for an age-related condition? Isn't that just selfish? Yet the distinct character of our era is that access to technology is comparatively flat: the progression of availability from expensive and inaccessible to accessible to the vast majority of people occurs very rapidly. Look at the spread of mobile phones and internet access over the past two decades as an example of what happens in a market where governments interfere far less than is done in medicine. Even in medicine, many of the medical technologies funded by rich people in past decades, and initially only available to the wealthy and connected in their earliest forms, are now available in places that include rural India and reaches of Africa. Such as those drugs for heart conditions.

Improving medicine is not about making things happen for the wealthy. It is about whether we all win together or we all lose together. Mocking or shunning improvements aimed at preventing the suffering and frailty of aging because some wealthy person might get the treatments first is lunacy: all technologies are available to the wealthy first and far in advance of the rest of us. That is what being wealthy gets you, pretty much by definition, and if it serves as an incentive to get them involved then all the better. They fund the first wave, and the rest of us obtain access in the later stages of development, when the new technology moves beyond prototypes and first generation implementations to become better, cheaper, and more robust.

Here is another way of looking at this: what causes the greatest harm to poor people? It isn't malaria. It is aging, and by a long, long way. Malaria killed in the vicinity of 650,000 people in 2012. In that same year somewhere north of 40 million people aged to death. More than three quarters of the world's population are exceptionally poor compared to the people we call poor in the US: so perhaps 30 million or more of those deaths fall into that demographic, fifty times as many as caused by malaria. I think it fair to say that degenerative aging places a far worse burden upon those individuals than on you and I. It is terrible for all of us, and kills all of us if we're lucky enough to evade the rest of the life's slings and arrows, but there's a big difference between being old and frail in agrarian poverty versus a first world city. If you are a rational, compassionate, utilitarian individual - and few are, sadly - then it should be clear that the best thing that can be done with limited resources is to work as rapidly as possible to produce effective treatments for aging that prevent and reverse age-related disease. Just getting a first generation of these treatments into the development pipeline at all, and not even taking any further steps beyond that to help speed things along, guarantees that the poor of the near future will have far better lives as a result. We would hope to do more than just that of course.

The greatest positive change we can create in the world is to eliminate the pain and suffering of aging through medical science. The outcome in terms of future lives saved and lives improved is so large in comparison to the treatment of any specific disease, even endemic diseases such as malaria, that it compels attention. That said, overall medical research funding is tiny in comparison to the wealth that flows through the entertainment industry, that goes towards killing people in ever more inventive ways, that is used to make candy, that changes the color of a US president's vest from red to blue, and so on. We like our wars and our circuses, and the scraps left over after that is done are all that goes towards making the world better by building new medical technologies. There is more than enough funding out there to cure every disease, to grow the life science research community by a factor of a hundred, and achieve countless other important goals besides. People just choose to spend it on other things, all ultimately pointless, forgotten, and irrelevant in the long term. The only thing that really matters is progress in technology, and especially in medicine, but persuading the world of that fact is still a hard sell.