While dreams of a cure for aging have existed since Herodotus’s first writings of the fountain of youth, longevity research is a relatively modern area in science. In the 1930s, researchers began to suspect that there might be a cellular-level driver to aging. As the writer Seth Mnookin has reported, Cornell scientists discovered that rats kept on calorically restricted diets lived significantly longer than their well-fed peers. But it wasn’t until the late 1980s that the first genes associated with aging were discovered. Scientists identified genetic mutations that caused tiny roundworms called C. elegans to live longer. A few years later, researchers at MIT identified genes in yeast linked to longer lifespan—genes that are also present in humans. “That was a surprise because we thought that aging was too complicated to be controlled by single genes,” says Sinclair, who was part of this research.

Those genetic insights legitimized the research of scientists in the longevity field. Modifying the aging process in both microscopic worms and humans proved far more complex than simply editing out a genetic mutation, however. “At the beginning, we thought it would be simple—a clock!—but we’ve now found about 550 genes in the worm that modulate life span,” Gordon Lithgow, a leading C. elegans researcher, told the New Yorker in 2017. “And I suspect that half of the 20,000 genes in the worm’s genome are somehow involved.”

Even so, research into aging has since gathered momentum—and funding. Some of Sinclair’s own discoveries related to sirtuins have moved the field forward dramatically. He discovered that a compound called resveratrol—which is found in the skin of grapes—could activate sirtuins and intervene in aging. (It’s the same compound that Sinclair now takes himself, though it hasn’t been approved as an anti-aging drug.) “It was the first molecule that could mimic the [anti-aging] effects of diet and exercise [in the body],” he says.

Today many scientists who study aging will tell you that people are still looking at longevity in the wrong way. Sinclair is in the camp of researchers who want aging to be accepted as a disease that can be treated in the same way as high blood pressure—not something that can be cured, exactly, but something that can be managed far better than it is today, in a way that benefits overall health and forestalls death. “We haven’t really made a concerted effort, as a society or as a species, to get at the root cause of aging, largely because we didn’t think it was possible until recently,” says Sinclair. “But that’s rapidly changing.”

The likelihood for diseases like cancer and Alzheimer’s increases as the human body ages. These diseases are much more common among people in their sixties and beyond than people in their twenties and thirties. Thanks to medical advances like vaccines, antibiotics, and improved hygiene, people in richer nations are now routinely living into their eighties. But that also means more people are living with disease, sometimes for years, at the end of their lives.

“If all we were doing was stretching out the period of sickness, then none of this would be worth it,” says Sinclair. “But we feel confident that we will not just extend lifespan but compress that period of decline and sickness.” A 2013 paper published in the journal Health Affairs projects that delaying aging could add 2.2 years to life expectancy, most of which would be spent in good health, and would have an economic value of $7.1 trillion over the next 50 years, thanks in part to reduced health care costs. And in doing so, the longevity field could solve a problem that modern medicine itself created.

“We’ve created our own nightmare where people live longer but not better.”

Life expectancy at the turn of the 20th century in developed countries was between 45 and 50, with about 22% of all people born in 1900 dying before their 10th birthday, largely due to infectious diseases. As Olshansky outlines in an October 2018 paper published in the journal Journal of the American Medical Association, thanks to public health gains, 96% of infants born in developed countries today will live to 50 or older and 84% will live past 65. “The 30-year increase in life expectancy at birth in the past 100 years is one of humanity’s greatest achievements,” he writes. But public health was ill-prepared to deal with the much greater incidences of diseases that come with so many people living into old age. In the U.S alone one in every four deaths is from cancer and an estimated 5.7 million Americans are living with Alzheimer’s disease.

“We believe that modern medicine is a good start to human health,” says Sinclair. “It’s been successful in extending our lives, but we’ve reached a point where we’re not keeping people healthier in their old age.”

According to Sinclair, that’s partly because currently available drugs are developed to target what he describes as “symptoms of aging,” which include diseases like cancer and heart disease. Even with the availability of new treatments like statins, which lower cholesterol levels, heart disease remains the leading cause of death for Americans. While rates of cancer deaths are dropping year by year, the number of new cases and deaths is rising, due to a population that is both bigger and older; (46 million Americans are 65 or older now, a number projected to more than double by 2060). “We’re missing an opportunity to address the actual causes of these diseases,” says Sinclair. “We’ve created our own nightmare where people live longer but not better. It’s costing society and families a great deal of angst and money keeping people around who are unproductive and not really with us anymore. It’s the living dead.”

Another challenge for Life Biosciences is the fact that the U.S. Food and Drug Administration, the federal agency responsible for drug approval, does not appear to view aging as a medical condition. Any therapies that come through Life Biosciences will at least initially need to be approved to treat diseases, rather than treat aging on its own.

“People are skeptical that you can change both a person’s healthspan and their life span,” says Dr. Nir Barzilai, director of the Institute for Aging Research at the Albert Einstein College of Medicine and a medical adviser for Life Biosciences. “They think you will live longer with disease, but that’s not what we are saying. We are saying, ‘aging drives disease, and if you end aging, you end disease.’”

Not everyone agrees. In a 2017 editorial in the journal Advances in Gerontology, two researchers at the University of Chicago—Leonid A. Gavrilov and Natalia Gavrilova—argued that “aging is too broad a concept to be reduced to a single, specific pathology.”

“In our view, aging differs from disease in the same way that cause differs from effect,” they write. “Aging is the cause of many age-related diseases. Correspondingly, these age-related diseases are a consequence of aging. Thus, it is an oversimplification to recognize aging as a disease (as to equate cause and effect).”

Many longevity researchers—including Sinclair, Barzilai, and Olshansky—are hopeful that regulators will come to agree with them anyway. Conversations with regulators around the idea of building a framework for aging drugs to be assessed and approved have been productive, says Olshansky, who met with the FDA a few years ago. “We were expecting resistance. Not only did we not get resistance, but the FDA was great and helpful.”

There are also questions around which therapies for longer living are legitimate areas of research versus which ones are expensive and questionable marketing for life extension. While Life Biosciences plans to develop drugs that are taken through the federal approval process—rather than supplements that do not require clinical trials—there are a number of companies already selling pills marketed for anti-aging perks, including the kinds of supplements Sinclair takes personally. You can even get transfusions of blood plasma from young people, on the medically questionable grounds that it can rejuvenate the body. (The FDA recently recommended against such procedures).

Olshansky says there is longevity research and there are anti-aging supplements and “there’s a huge chasm between the two.” While longevity scientists may themselves be interested in living past 100, the distinction is really about living healthier for longer and not just reaching the centenarian milestone. “Maybe maximum lifespan will be 125, [or] maybe it will be 110, but I am honestly not interested in that,” he says.

But consumers may not easily understand that distinction. There are pills sold online today that claim to interfere with the aging process. And even though aging researchers—including Sinclair—may try them, support them, or sit on supplement companies’ advisory boards, supplements do not need to prove the same effectiveness that drugs do. A drug that targets aging pathways in the body and is approved by the federal government would signal the first real treatment for extending lifespan, but any such drug is likely many years away.

“If it were possible to safely slow aging, the positive consequences for human health would likely be substantial,” says Jeffrey Flier, a Harvard professor and former Harvard Medical School dean. “But it’s a very difficult problem, both scientifically and practically from the perspective of drug development. The end points—normal aging and death—take a very long time to be reached… Given the interest in achieving the goal, people are sometimes tempted to exaggerate how close they are. Buyer beware.”

While he may not approve of some of the therapies Sinclair takes on his personal time—“Nobody, especially scientists, should be taking any of these supplements until they are proven safe and efficacious”—Olshansky says Life Biosciences appears to be taking steps beyond the incremental.

“I approve of what David Sinclair is doing,” he says. “This kind of aging science not only makes sense but it’s the only pathway forward, and we need to pursue it aggressively.”

In the meantime, Sinclair is confident Life Biosciences will produce tangible results to convince more people, especially regulators, that drugs for aging are feasible—and that his company will discover them. “I can’t speak on behalf of everybody, but my hope is that within our lifetimes, we will see that doctors are able to prescribe medicines as a preventive measure against the diseases of aging,” he says.

The idea of picking up a prescription for a drug that stalls aging at the local pharmacy still feels like science fiction, but it’s a goal many longevity scientists believe we’ll achieve this century. And if they can do so, David Sinclair won’t be the only person who just might live to see the next one.