American life expectancy: What happens next?

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The United States has witnessed an astounding extension of life expectancy in the last century.

Now, as Americans live longer, the challenge is to have lives that are not just longer, but healthier.

Three experts convened for “Tackling America’s life-expectancy crisis,” a panel discussion held at the Financial Times US Pharma and Biotech Summit, held May 16 in New York.

Linda P. Fried, MD, MPH
_{© Columbia University}

A century ago, the average American life expectancy at birth was 47 years, or 36 for African Americans, said Linda P. Fried, MD, MPH, dean of the Columbia University Mailman School of Public Health. Now it is in the mid- to upper 70s, she said.

Much of that is a result of a century of investments in public health, education, poverty alleviation, and more recently, medical care, Fried said. Her undergraduate students in their 20s expect to live to be 80 to 100 years old – conditioned on one thing.

“They say, if I’m healthy,” Fried said. The challenge for all of society is that Americans hope to have more years of health, not just more years of life.

“Unfortunately, we are seeing the opposite,” Fried said. “And that’s the challenge for this century, is how to add health to these longer years. It doesn’t have to be a bad news story.”

New meds coming

Jacob Kimmel, PhD
_{© NewLimit}

Part of that will include developing new medicines, said Jacob Kimmel, PhD, co-founder and head of research for NewLimit, a company researching epigenetic medicines that reprogram genes to a more youthful state.

“It’s really shocking If you actually just look at a curve of any therapeutic area you're interested in age is a huge access of variation there. And so you're going to need to be able to find some medicines that are capable of attacking some of those common mechanisms that underlie the increase in the incidence of those pathologies, in addition to specific symptomatic treatment of each and every one,” Kimmel said.

‘We’re all going to die’

Josh Wolfe
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Josh Wolfe, co-founder and managing partner of Lux Capital, a venture capital firm, said people describe his approach as pessimistic, while he considers himself a realist.

“I will say also, as much as this particular panel was about longevity, I have good news, which is that there's brilliant people in the audience and billions of dollars, incredible scientific talent,” he said. “And the bad news or, if you're me, the realist news is, we're all going to die.”

Wolfe said his physician predicted how he would die – not from heart disease or cancer, but getting hit by an e-bike delivery guy. “And I’ve got to tell you, it is the most important thing that any medical practitioner has done for me, because every time I step off the street, there is some guy going 30 miles (per hour) down the bike lane the wrong way with, like, DoorDash, and he saved my life.”

Lowering life expectancy

Wolfe prompted laughs from his fellow panelists and the audience, but he described a low-technology intervention, said Moderator Andrew Dunn, senior biopharma correspondent for Endpoints News. He asked whether the nation is maximizing tools currently available, such as vaccinations and public health campaigns.

Life expectancy is going down in the United States, Fried said, exacerbated by the COVID-19 pandemic, drug abuse, gun violence, and cardiovascular disease, diabetes and obesity manifesting in younger and younger people. As a physician, 10% to 20% of population health comes from medical care, but the nation has disinvested in the 70% that comes from prevention and promotion of public health.

“Since the 1960s, the U.S. has heavily disinvested in all the dimensions of public health, including its public health system, and we're basically getting what we're not paying for societally, because we now, while I said that 70% of health comes from public health, the U.S. puts less than 3% of its health dollars into public health, so there’s quite a substantial mismatch,” Fried said.

A New York native, Wolfe compared his youth in Brooklyn with his current residence in Tribeca, where health outcomes are very different. In the poorer neighborhood, residents contend with gun violence, drug overdoses, lack of sleep, exercise and nutrition, and sometimes with polluting industrial sites that make asthma worse, he said.

Fried agreed and noted advanced therapeutics could help patients, but have potential to widen health disparities that already are widening. She cited economist Adam Smith, who said capitalist societies succeed when there is adequate investment in public good that raises everyone’s well-being.

Spread of technology

New technology is hard to develop and when introduced to society, it usually is inefficient, which often means it’s expensive, Kimmel said. An example is mRNA technology, which became affordable and accessible to billions of people in a relatively short time due to the pandemic. Once new technologies are deployed, people start to repurpose and redeploy them. Another example is statins, a medicine broadly used throughout the population and falling in price as demand drives improvements on supply. There will always be demand, he said.

“Josh keeps reminding us we're all going to die, myself included,” Kimmel said. “And so because that demand will be so high, I am a big believer in the fact that the technology will drive down costs, as you've seen elsewhere in the industry over time.”

The idea of taking aging cells and making them like young ones again dates at least from the 1960s, when one researcher began that process with frog eggs, Kimmel said. Now machine learning can help human researchers pick experiments and, if those are not successful, better select the next experiments. That capability did not exist 20 or even 10 years ago, he said.

Subtracting weight, adding years

Another technology that could affect human longevity is the new glucagon-like peptide-1 agonist (GLP-1) drugs. The medicines used to treat diabetes and for weight loss have become pharmaceutical blockbusters, with new research on new benefit weekly. “We can’t stop talking about them,” Dunn said.

The effects of the drugs may plateau, Fried said. Human beings are not good at staying on medicines forever because it is hard to manage and pay for. And as people take more drugs to combat health issues, there is increased risk of side effects and harmful drug interactions, she said.

“So those are, I think, open questions as at least as far as I know the data,” Fried said. “The question that's not open, is that prevention, if we invested in it, would work better.” Speaking from long experience as a clinician, Fried said turning around weight gain “after it has substantial metabolic effects is really hard. Really, really hard.”

Wolfe said he is interested in physical and neurological degeneration. As people age, they tend to lose muscle mass, which can lead to falls and fractures and diabetes-related conditions because muscles take up glucose. Neurological degeneration is important “because you can live longer, but if you're losing your mind and your memory, that's probably the worst thing that can happen,” he said.