If there’s one phrase the June 2024 U.S. presidential debate may entirely eliminate from the English vocabulary it’s that age is a meaningless number. Often attributed to boxer Muhammad Ali, who grudgingly retired at age 39, this centuries-old idea has had far-reaching consequences in global politics, as life expectancy more than doubled since the start of the 20th century, and presidents’ ages shifted upwards. We say “age is what we make of it” to ourselves and to policymakers, and think it’s a harmless way to dignify the aged. But how true is it? And if it isn’t true, why would we lie?
For centuries, we have confused our narrative of what aging should be with what its ruthless biology is. Yet pretending that biological age does not matter is at best myopic, and at worst, it’s a dangerous story to our governments, families, and economies. In just 11 years — between 2018 and 2029 — U.S. spending on Social Security and Medicare will more than double, from $1.3 trillion to $2.7 trillion per year. As we age, our odds of getting sick and dying by basically anything go up exponentially. If smoking increases our chances of getting cancer by a factor of 15, aging does so 100-fold. At age 65, less than 5% of people are diagnosed with Alzheimer’s. Beyond age 85, nearly half the population has some form of dementia. Biological aging is the biggest risk factor for most chronic diseases; it’s a neglected factor in global pandemics; and it even plays a role in rare diseases.
This explains why in hospitals, if there’s one marker next to a patient’s name, it’s their age. How many birthday candles we have blown out is an archaic surrogate marker of biological aging. Yet it’s the best we have. Chronological age is so telling of overall health that physicians everywhere rely on it for life-or-death decisions, from evaluating the risks of cancer screening to rationing hospital beds.
Despite all this, our ethics prevent us from speaking of aging as biology. Instead, we blanket it with cultural and normative meanings, as if we could decide what aging is by devising new stories about what it should be. We like to think of aging as a blessing: a feat designed by evolution, “for the good of the species,” or else by gods determined to furnish life with meaning by making us grow old and die at just the right age. All this gets in the way of our devising real solutions to improve the biology of aging.
The argument that the human lifespan was designed by evolutionary or divine forces to have a just-right, natural length misses the fact that as far as nature is concerned, most of us (if we had even been born) would be dead. We owe our unnaturally long lives to antibiotics, vaccines, sanitation, and more generally, medicine. The evolutionary argument — that aging exists for our wellbeing, not despite it — overlooks how evolution would not intently optimize for an exponential rise in our odds of not surviving and not reproducing. (There’s a reason why menopause is a relative rarity in the animal kingdom, and far from a prerequisite for late-life health.)
We know intuitively that some people age more quickly than others. Studies suggest that humans who live to be 100 often have no secret diet or exercise, but the right parents. Lifestyle choices also never extended our maximum lifespan. That is, humans cannot buy a 150-year healthy life with wellness retreats. The primary reason why we age poorly relative to other species is our biological makeup. Some mammals, like bowhead whales, do live to be 200 in good health. Others, like the naked-mole rat, appear not to age at all — or at least not the way humans do.
Indeed, if naked-mole rats had to ration hospital beds or cancer imaging, chronological age would be far from a helpful surrogate marker. It’s not a stretch of language to say how many birthday candles they had blown out would be meaningless. Naked-mole rats are the equivalent of 80-year-old humans having the same risk of cognitive impairment, frailty, death by COVID, or from a broken rib in their late golden years as during college. For Homo Sapiens, though, age is a notably reliable predictor of both health and social status.
Why, then, do we keep on insisting age is “just what we make of it”?
First, despite our self-proclaimed reputation as a vicious species, we’re mostly empathetic with other humans. (Increasingly, also with other animals and, depending on whom you ask, our planet.) Our morals, institutions, and laws — despite their equally dubious renown — have helped us to mostly do away with animalesque actions like cannibalism, blood rituals, constant crime, and other feats of nature. We favor treating people with dignity, when possible. We’re also the most ingenious branch of storytelling apes.
For centuries, we could do little about the fact that our innate biology, though optimized for traits like intelligence, fell rather short on healthy longevity. So we invented stories that helped us embrace how as we age, we become weaker, slower, and likelier to cost more than we add to our governments and families. We told similar stories when it came to heart transplants (which were heretical until just a few decades) and IVF. But these stories were unhelpful. Though their effects on delaying scientific discoveries or economic growth cannot be quantified, it’s not far-fetched to suspect millions of lives were lost because of them.
Today, the very fact that we utter sentences like “we should embrace aging” reveals a quirk of language. We call “aging” the molecular damage that leads to some 70% of all funerals in the U.S. and the wisdom, kindness, and overall emotional intelligence that tends to compound the longer we live. We also become offended when we hear sentences like “we should treat and prevent biological aging,” as if this would mean to treat or prevent being human.
Increasingly, studies suggest we can therapeutically target aging. This means our cognitive function could remain robust throughout our lifespan. And it means in future presidential debates, we may watch the sharpest-ever candidates in history, since they’d benefit from both wisdom and mental acuity. Of course, this could exacerbate power imbalances. Our current institutions, policies, moral frameworks and laws are not fit for 150-year-old humans. But from that, it does not follow that new institutions, policies, and moral frameworks cannot be created. To arrive at the conclusion that we may wish not to treat aging as biology because our current culture cannot handle it would be as circular as to say, in the 1920’s, that women should not vote, or same-sex marriage should not be legal because we lacked the legal, institutional, or cultural infrastructures for these shifts.
Today, a mere 0.54% of all National Institutes of Health funding goes to research on aging biology. Worse still, a recent proposal argued for the dismantling of the National Institute of Aging. Real dignity to Americans of all ages would be to create an all-new, robustly funded office within a federal agency devoted to mapping the mechanisms that drive human aging. One that openly admits that aging is biology, and supports not just research on late-stage neurodegenerative diseases, but on the underlying molecular damage that leads to them. Real dignity for governments, economies, and families may be to admit that aging is biology — not story.
Age can be “what we make of it.” But it won’t be through our embracing it as a cultural-narrative phenomenon, when it’s a likely druggable feat of biology. To make something truly good out of aging, we may need to improve it — just as we improved our biology when it comes to our natural vulnerability to pandemics, heart attacks, and infertility. Then, we may just find again that biology need not be destiny.