Perspective on the aging field:
Much focus on late life, death, lifespan/longevity in the aging field. Much discussion of how long people want to, or should, live & whether death is good or bad. Maybe too much. My focus is on the early part of adult life, not the end. On re-achieving early-adult (prime-of-life) biology, repeatedly. I'd love to see more focus/discussion of this early end of adult life as the goal, not just death avoidance. Longevity is just a side effect of re-achieving optimal adult health.

Oversimplifying, adult life has 3 stages (w/ fuzzy boundaries):

1. early adulthood: peak adult health / prime-of-life,
2. midlife: in which pathologies of aging progress mostly unnoticed by traditional clinical medicine paradigm,
3. late life: in which age-related diseases progress & cross clinical diagnosis boundaries.

The geroscience hypothesis is at core a claim that stage 2's age-related pathologies underlie (substantially all of) stage 3's age-related diseases.

Traditional clinical medicine, medical regulation (eg FDA process), government funding & private biotech/biopharma funding are all focused primarily on stage 3 (& to a lesser extent on stage 2 for the minority of age-related diseases with good surrogate endpoints & preventative standard-of-care). The 'longevity' focused & slow-aging paradigm subsets of the broader aging field try to reframe medicine to focus also on stage 2 & to slow the transitions from 1->2 & 2->3. The 'rejuvenation' subset of the field tries to jump from stage 3->2 and/or 2->1. That is my focus.

I don't think about death or longevity primarily & I wish 'aging' or 'rejuvenation' were used as labels for the field more than 'longevity'. To me, the key aspect of the field in the long run (the end-goal) is the difference between the biology of early-adult/prime-of-life health (stage 1) & midlife when aging pathologies progress (stage 2). Re-achieving the biology of that early period repeatedly as long as possible is the motivating goal. Avoidance of death is purely a side effect that needs no explicit consideration (eg, of its moral worthiness).

Consider Alzheimer's Disease (AD). If someone gets early AD, we want to cure it & restore their brain & cognition to its earlier optimal health not primarily because it will make them live longer but because the degeneration of the disease is itself so horrible & worthy of avoiding/curing. Same reason avoiding/curing osteoarthritis & countless other aging pathologies is justified. In AD's case it will increase lifespan, but not so much for OA. Even ignoring the good of saving/extending lives, there's ample ethical justification for avoiding age-related decline. Age-related worsening of biological state is worthy of reversing for its own sake. Postponed death is only a side effect. It's mostly while the technology is being developed & not yet fully available that it matters how long lives are extended in order to delay death until future breakthroughs arrive.

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This view would give the field a better image to the lay public than (esp rich) people selfishly trying to live forever. Athletes (even rich ones) trying to maintain good physical health are viewed positively. Few resent anyone trying to postpone/reverse physical/bio decline.

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Re-achieving peak biology as the field's goal also neatly avoids any pro-death trance. People can think death gives life meaning all they want. Far fewer think physiological & mental decline give life meaning. (Aubrey probably should have called it the pro-death trance rather than pro-aging trance as most of the justifications people use to criticize the fight against aging are actually appeals to what's good about death, not what's good aging's biological deterioration.)

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This view also explains my pref for rejuvenation over slow-aging approaches. Slowing aging still worthy over trad medicine. Healthspan mostly means stages 1-2 (health generally meaning only absence of clinical disease) but even healthy 60yos have declined hugely vs 30yo biology. Thus, I prefer '(primeoflife)-span' as a concept over 'healthspan'. But ideally being able to re-achieve it, not just slow the exit from it, for the sake of all those who are already past it.

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