New Zealand-based bioethicist Nicholas Agar argues in Slate that the need to vet risky treatments to increase healthy human lifespans implies using healthy poor people as experimental subjects. If this is so, then the longevity enterprise is inherently unethical. Agar explains:
It's not too difficult to entice those suffering from diseases of aging into clinical trials. For example, people with Alzheimer's recognize that they have a terrible illness. They understand that many experimental drugs don't work—that some may actually make them sicker. They view such risks as warranted.
Human trials of experimental therapies for aging as a disease are a different matter. The potential benefits may be huge, but so, too, are the risks. Furthermore, to prove that new therapies can extend the life spans of people free of any significant disease of aging, researchers will need to carry out tests on similar people—that is, experiencing healthy aging. Convincing such people to undertake risky treatment will be challenging.
As example of a risky anti-aging treatment, Agar then cites the proposal by theoretical biogeronlogist Aubrey de Grey to prevent cancer by halting the lengthening of telomeres. Telemores are the caps at the ends of chromosomes that become shorter as cells divide—when the telomeres have dwindled away, the cells stop dividing and become senescent. This telomere dwindling is thought to have evolved as a way to prevent a cell from turning cancerous. In fact, it turns out that most cancer cells reboot the genes that lengthen telomeres which then enables them to proliferate as tumors. Agar assumes that this treatment might work as advertised, but how do we find out?
….I would rather not be the first to test it after they're done with the mice and monkeys.
I suspect that people interested in SENS [Strategies for Engineered Negligible Senescence] are likely to be especially averse to the kinds of risks involved in clinical trials. They are, after all, being enticed by the promise of millennial life spans. Why would they sign up for dangerous clinical trials for anti-aging therapies when there's another option—paying others to do their dirty work? Unlike in some fictional portrayals, there won't be a single "cure" for aging that, once discovered, can be safely given to anyone who wants and can pay for it. Scientists will develop multiple therapies targeting distinct types of age-related damage. Each will need extensive testing, and there will inevitably be many false turns and disappointments along the way. Anti-aging researchers will need to be well-supplied with healthy human test subjects. A general recognition of the scientific possibility of radically extending human life spans will bring a sense of urgency. Human trials must happen ASAP if safe anti-aging therapies are to arrive in time to arrest the death spiral of biological decay awaiting today's 40-year-old supporters of SENS.
I suspect, then, that human guinea pigs for anti-aging trials will come disproportionately from the poor and disempowered.
So will the poor be conscripted as longevity research guinea pigs? Maybe not. Agar has a rather static view of biomedical research and what will be possible for future longevity researchers to know and test beforehand. Of course, proposed longevity treatments will first be extensively tested and perfected in animal models. Further, a vastly expanded bioinformatics enterprise will become crucial to understanding the ramifications of proposed anti-aging interventions. As scientific understanding improves, the risk-benefit calculations of various prospective treatments will shift in favor of proceeding.
Let's take a closer look at Agar's objection to telomere treatments as a longevity boosting strategy. In fact, researchers are already considering ways to target telomere regulation as a way to treat and cure cancer. Assuming that de Grey's hypothesis is correct, one side benefit of this research might be not only a cure for cancer but also treatments that lengthen healthy lifespans. In other words, cancer research could become longevity research. People with cancer would be happy to be enrolled in research that could result not only in cancer cures, but longer healthier lives as well. Most anti-aging research will piggy-back on biomedical research aimed at curing diseases.
Interestingly, some other researchers believe that ever dwindling telomeres cause cellular aging and argue that restoring telomeres could lengthen healthy lifespans. In fact, researchers at Harvard reported in 2010 that lengthening telomeres in genetically modified mice boosted their healthy lifespans.
So, according to Agar, next come the experiments on hapless poor people, right? Hardly. As it turns out some rich people who are eager to extend their lives are already paying considerable sums to take a supplement, TA-65, which has been shown to lengthen telomeres in humans. No poor people need apply.