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Credit: https://www.fightaging.org/archives/2021/05/revisiting-the-end-of-the-disease-era/

Transitioning from the disease era to the prevention era in aging

June 1, 2021

Since the birth of modern medicine, the focal point of treatment has always been centered towards chronic diseases.
And while this model is essential, it does not work well when it comes to managing age-related diseases.
Instead, we should introduce a model that focuses on the prevention of aging, rather than the treatment of chronic diseases that stem from old age.

The traditional concept of defining a disease works well when we’re talking about infectious conditions. That is, we identify a pathogen, we determine that the pathogen is causing a series of symptoms—and then we work towards introducing a method of intervention for the patient. Which in this case, can be anything from eliminating the pathogen from the body to hindering its ability to cause any further damage. Traditional medicine has been largely concerned with battling infectious diseases. And this is why this archaic business model is completely ingrained in practically every facet of the medical community. Unfortunately, the model isn’t suitable when handling age-related diseases. The circumstances change entirely. Aging consists of a network of layered, interacting, and underlying processes that cause tissue dysfunction and molecular damage. Everything from arterial stiffening, to calcification, to senescent cells and even cross-links causes hypertension—which then harms vital organs such as the brain and kidneys. As the symptoms become more severe, they eventually cross over from the idea of not being a disease to the point of “we’ll call this a disease.” But calling it a disease doesn’t really help determine what should be done about it. In retrospect, this particular disease model was formed at a time when treating infectious diseases was the primary concern for the medical fraternity. And in a sense, it laid the foundations that guided researchers to creating some of the most effective strategies to treat the worst diseases in modern history. Where the model did fail—as we mentioned earlier—is in age-related diseases. And this can be noted by the fact that there has been very little progress made in this field of medicine as compared to the radical advances made in medical technology, computing, life science and research. There’s no questioning that a different approach is desired to analyze aging and its effects. Currently, aging is largely left to the concept of first identifying a cluster of symptoms and then treating the disease causing these symptoms. We fail to focus on treating the exact mechanism of aging. It’s only until recent times that we have gradually shifted our attention from disease as the focus of medicine and the target of medical intervention. Most age-related ailments are complex. And let’s not forget that a large number of the elderly are affected by multimorbidity—the condition of living with two or more chronic diseases. This has led a section of the medical fraternity to question whether the function of a disease should be the central focus in medical care. In a thought-provoking paper written in 2004 titled, The end of the disease era, the authors criticized medicinal practices that centralized exclusively on disease. Instead, they championed a more radical approach that centered on managing multimorbidity. Instead of focusing on treating one disease at a time, medicine should work towards treating a unique combination of diseases—and particularly their effect on physical and psychological functioning; not to mention the effect they have on life plans, goals, and daily activities. The focus becomes less on survival and more on how an organism becomes diseased and weakened overtime. This proposed model is a very fine example of how to consider the concept of multimorbidity instead of discrete pathological states as the major objective of geriatric medicine. In such a model, it’s the health of the aging person that is the reason behind the patient having multiple chronic diseases. The model sees function as the construct that is used to determine how the individual lives in the environment. Function, not disease, is the object of care. The same situation also applies if we analyze this model from a molecular standpoint. Researchers are not interested in finding out the alterations in metabolic pathways that cause a given pathology. They are more focused on seeing how these given pathways maintain functionality over time. In turn, we can delay the onset of multiple diseases caused by old age. And even though it’s still in its infancy, this new model emphasizes on prevention instead of reaction even when a certain clinical phenotype is absent.

References: https://www.fightaging.org/archives/2021/05/revisiting-the-end-of-the-disease-era/

Transitioning from the disease era to the prevention era in aging

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