HMN 2026: What are the potential problems of living longer: Q&A

Many scientists are trying to determine just how much medical intervention can lengthen the human lifespan. But Daniel Promislow, senior scientist and scientific advisor at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, is interested in a different question: If humans suddenly start living longer, what might the consequences be?

It’s something we all need to consider as more and more aging research labs work to identify pathways for countering age-related decline, paving the way to develop life-extending drugs, says Promislow, who has laid out his argument in “Lessons for Responsible Geroscience From the History of Longevity,” which appears in AMA Journal of Ethics.

What is geroscience, for those who aren’t familiar with the term? Can you talk about what’s emerging from the field?

Daniel Promislow: Geroscience is the study of biological aging, based on the assumption that all age-related change happens through particular pathways. Drugs developed to delay or decrease the effects of aging, whether dermatological or ophthalmological, are referred to as gerotherapeutics.

GLP-1 agonists like Ozempic came out of a lab studying diabetes. We then discovered that they can reduce obesity, that they improve heart function and decrease the risks of lots of other causes of mortality. Given their effects on many age-related diseases, they seem to have what we imagine would be the effects of a gerotherapeutic drug.

Many geroscientists suggest that statins and antihypertensives are also potential candidates as gerotherapeutic drugs. They’re helping people live healthier longer.

There are currently no clinical trials testing the ability of a drug to make people live longer—it would be an extremely long and costly trial, and there are ethical considerations that make it challenging. But in the last few years, we’ve begun to see dozens of clinical trials in aging research labs testing specific pathways and their ability to help with aging-related conditions, and there will only be more of them.

What sparked the conversation for you around responsible aging research?

I had long been interested in the broader implications of the field. I go to a lot of aging meetings where researchers talk about the basic biology of aging, and potential ways to slow or delay aging through biological interventions. Not surprisingly, those meetings don’t include experts in public health, history, bioethics, or economics.

At the University of Washington, I met a Ph.D. student named Nicolai Wohns who wanted to talk to biologists who work on aging about ethics. Our conversations led us to co-author this article. We thought, “How do we place this whole world of gerotherapeutics in a philosophical and historical context?”

And we realized that the world itself is changing. In the last 150 years, improvements in agriculture, antibiotics, vaccines, and many public health advances have doubled the average human lifespan. Much of this effect is thanks to our ability to prevent childhood infectious diseases. Geroscientists are now focused on trying to decrease or delay diseases that occur later in life. If they are successful, this could have enormous implications.

If a drug to treat aging were to become available, what problems could potentially arise?

There are issues surrounding equity and justice. Who has access to these drugs, and who might be denied access if they want them? What about the people who do take the drugs and suddenly have to support themselves financially for many more years than they had anticipated?

We already know that many people in this country aren’t able to save enough money for retirement. Longer lifespans could put greater pressure on the Social Security system.

Beyond the economic consequences for the next generation, we should also ask about social implications. What if we had a pill that could greatly increase the chances of a 60 year-old living another 40 or 50 years or longer? Imagine if you took this pill, but your children and grandchildren wanted nothing to do with it. You could end up outliving even your grandchildren.

Geroscientists have often described as “ideal” a scenario where people live to late age in a state of health as good as in their younger years, and then at some point—say, 100 years old—just don’t wake up. If science could get us there, what would that world look like, and how would we prepare for it?

In the paper that Nicolai and I wrote, we aren’t saying, “Here’s what’s going to happen.” At its heart, the paper is a first effort from Nicolai and me to call for people to come together and start to have these conversations, and to be really thoughtful about the issues.

Where do you hope these questions of ethics take you and your colleagues from here?

The geroscience community needs to engage with experts in public health, human behavior, ethics, and economics to have bigger conversations about the future we’re trying to create, and the implications of success. If there are negative implications, how can we work with experts in other areas to make sure that everybody benefits and that we minimize the costs?

The field of geroscience is fascinating, and it’s an exciting time, but there is a lot that we still need to figure out. I’m thrilled about having moved to Tufts and to Boston, where so many experts in economics, sociology, public health, and other disciplines are thinking deeply about aging. And the geroscience community here is world class.

I’m excited to help bring them all together to address the possible impacts of a longer-lived population. At this time, I’m still running a lab, but it feels like the right time in my career to also focus on bringing thoughtful people together to sorting out these questions.

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