The Funding Channels of Geroscience

Abstract

This review examines the interconnected channels of government, individual, and corporate funding for geroscience. A sometimes-slow flow of federal and philanthropic funding over 50 years is now becoming sufficient to understand how the processes of aging drive disease. The amount has not yet been enough to push the benefits of geroscience into new therapeutics, but that is poised to change. Prominent billionaires, venture capitalists, and new foundations are investing billions in researching approaches for preventing, delaying, or curing the chronic diseases of older people; major pharmaceutical companies are poised to join them once the Food and Drug Administration qualifies aging as a treatable condition. The coming decade could see considerable progress, not only in the science but also in the creation of fresh nonprofit and for-profit funding streams.

Funding for aging research, even after the arrival of the more cutting-edge term, “geroscience,” has not been easy to come by. Only now, half a century after efforts to understand the basic biology of aging began in earnest, has enough been invested and enough research completed to create a sense of cautious optimism that therapeutics to extend our healthy life spans may be only a few years away.

At first, the slow pace of funding was difficult to understand. Why would there not be universal support for efforts to assure we remain in top health, free of debilitating illness or disease, for much longer in our lives? Who would not want to use science to find ways to make our health span almost as long as our life span?

It has taken a long time to rebut the skeptics of aging science—and build a critical mass of government, philanthropic, and industry support for these efforts—partly because the public has lacked a clear understanding of what the field was accomplishing and what it is capable of achieving. Some have asserted our work is a waste of time and money, because they believe the aging process is immutable and so there is nothing meaningful that can be done to slow its debilitating effects (Peterson 1999). Others have insisted the success of our work would do more harm than good, because significantly increasing the population of older people would exacerbate the world's problem of too many people chasing too few resources, rattling society, and causing economic havoc (Vaiserman and Lushchak 2017).

Answering those arguments is easy for anyone reading this collection. A rapidly expanding body of scientific evidence shows that the effects of aging can be delayed in a broad range of species, probably including humans, meaning there are likely to be more ways to keep people healthy much longer in life. And a world populated by older people who are healthy and independent would be much less expensive for governments, and much more productive for the economy, than a world where a disproportionate share of older people is sick and reliant on others for care. A landmark study in 2021 concluded, in fact, that increasing healthy life expectancy in the United States by just one year would add an astonishing $38 trillion to the American economy over time, boosting the gross domestic product by 3.5% annually (Scott et al. 2021). Other research has found that people who live to be 100, the iconic milestone for a long and healthy life, have significantly compressed morbidity, the time at the end of life conscribed by illness or disability (Ismail et al. 2016). This means they get to live until their final days without sickness or debilitation, then simply die of “natural causes.”

Fortunately, the tide of misperception and disinterest about the benefits of aging research is turning, and signs of strengthened interest in funding have started to flourish, spurred in part by a generational shift among the U.S. governmental, philanthropic, and entrepreneurial leadership. The potential promise of geroscience was a “tough sell” in the past few decades to the thought leaders of the baby boom generation for many reasons, including a necessary focus on more immediately pressing problems. But, consciously or not, they may have collectively concluded that any breakthroughs promising to extend our lives would come too late to benefit them. But the shifting of the balance of power to generation X and the millennials, with decades of life ahead of them and much more confidence in science and technology, is part of what creates this time of cautious optimism (Fry 2020).

Government and philanthropic funding is supporting a considerable pipeline of research into the biology of aging. The coming decades should see considerable and demonstrable progress, not only in the science but also in the creation of new funding streams—mostly flowing through for-profit enterprises. A burgeoning list of startup biotechnology companies has already invested billions in potential treatments for the diseases of aging and will hopefully be joined in the next few years by the pharmaceutical behemoths, who would be more inclined to invest heavily if and when the Federal Food and Drug Administration is persuaded to recognize that slowing the effects aging could be achieved with interventions.

At that point, corporate America will likely take the lead for financing the acceleration of scientific advances in geroscience, and then pay to conduct the translational research required to bring the benefits of our work into the lives of millions across the globe.

THE FUNDERS: A REVIEW

The funding “ecosystem” that pays for aging science—an interconnected network of government agencies, biotechnology and pharmaceutical companies, and individual and foundation philanthropists—started to germinate more than a half a century ago and has been expanding ever since.

Government on the Ground Floor

The pivotal moment in the origin story of aging research funding was December 1971, when the White House Conference on Aging, a once-a-decade summit on aging policy, recommended the creation of the National Institute on Aging (NIA) (www.nia.nih.gov/about/history). Congress did so 3 years later (PL 93-296: www.govtrack.us/congress/bills/93/s775), and the NIA opened in the fall of 1974 with a mission to improve the health and well-being of older adults through federally supported research. It is now one of 27 centers and institutes within the National Institutes of Health, an arm of the Department of Health and Human Services. The NIA's overall budget has been growing rapidly—to $4.26 billion in fiscal 2022 (appropriations report: www.congress.gov/117/crpt/hrpt96/CRPT-117hrpt96.pdf) marking a 38% increase in just 4 years (NIA budget summary: www.nia.nih.gov/about/budget/fiscal-year-2021-budget#applang). But this is for researching all matters related to aging, and for many years congresses and presidents have made Alzheimer's disease and related dementia NIA's top priority; current law dictates that 80% of the agency's budget go to that endeavor (appropriations report: www.congress.gov/117/crpt/hrpt96/CRPT-117hrpt96.pdf, p. 131).

In addition, a decade ago saw the launch of the Trans-NIH Geroscience Interest Group, which seeks to stimulate interest and involvement throughout the agency in the basic science of aging (www.nia.nih.gov/gsig). The group now includes 21 of the 27 NIH centers, and by one estimate their cumulative funding for research focused on the basic biology of aging amounted to about 1% of the NIH budget in 2019, or $382 million (Leung and Kennedy 2019). Such an amount underscores how the federal government has been by far the largest funder of geroscience to date.

The Trans-NIH Geroscience Interest Group has also hosted three summits for scientists, advocates, and funders, conducts annual meetings on the NIH campus outside Washington, and hosts regular smaller workshops and meetings on topics of interest to the geroscience community.

That the NIH would act as a “convener” in this way suggests the science of aging is rising within the federal funding hierarchy. But there is still plenty more the federal government could do, starting with making much more detail available about its spending in the field.

The Foundational Foundations

The first significant philanthropic effort to focus on the biology of aging was launched in 1965 by successful commodities trader Paul F. Glenn, who chose to honor his grandparents by starting the Glenn Foundation for Medical Research. By the time Glenn died in 2020, he had endowed the foundation in perpetuity, and it had funded more than $100 million in research, mainly at the nine academic institutions hosting Glenn Centers for the Biology of Aging Research.

The other visionary philanthropist at this time was Irving S. Wright, MD, who founded the American Federation for Aging Research in 1981, a decade after the conclusion of his successful career as a cardiologist. He decided too little was being done to address the future clinical care needs of baby boomers, and that the best way was with funding to persuade talented scientists and physicians to pursue careers in research on aging. In the ensuing four decades, AFAR has raised almost $200 million from individuals, businesses, and other nonprofits, and used the money to support more than 4300 scientific investigators. In 2021, AFAR made 66 grants totaling $4.5 million.

Tech Billionaires Step In

The belief that science and technology can help us live longer and healthier has been of great interest to Silicon Valley culture since its beginning (Friend 2017), and the main benefactors of geroscience in the past two decades have been well-known technology entrepreneurs.

Larry Ellison, cofounder of what is now called the Oracle Corp., the world's second biggest software company, created the Ellison Medical Foundation in 1997, and it awarded nearly $430 million in the subsequent 15 years. Its executive director estimated more than 80% went to investigate the biology of aging (Leuty 2013), but that vein of funding was stopped without explanation in 2013.

The move seemed all the more surprising because it came just after Google cofounder and CEO Larry Page announced the launch of Calico—short for the California Life Company—a research and pharmaceutical business focused on studying the aging process and accompanying diseases (Miller and Pollack 2013).

Now under the umbrella of Google holding company Alphabet, since 2014 Calico has been in a partnership with AbbVie, a biopharmaceutical spinoff by Abbott Laboratories. Each firm has so far agreed to invest $1.75 billion in a shared effort to discover, develop, and bring to market therapies for patients with age-related diseases (press release: news.abbvie.com/news/press-releases/abbvie-and-calico-announce-second-extension-collaboration-focused-on-aging-and-age-related-diseases.htm?_ga=2.103653766.762962550.1658510688-100783079.1658510687).

The New Philanthropists

The collaboration between Calico and AbbVie, recently extended through 2030, underscores the fundamental division of labor in the world of American geroscience, with businesses focused almost entirely on the high-risk, high-reward enterprise of finding treatments or cures for specific diseases. (One modest exception to this has been Pfizer, which has donated $3.3 million to AFAR for basic research.) The federal government, foundations such as AFAR, and philanthropies have remained focused on critically needed research into the underlying biology of aging, which could someday form the basis of the entrepreneurs’ work.

Several significant new nonprofit players joined the funding arena in 2021, including The Astera Institute (astera.org) and the Impetus Grants (impetusgrants.org).

A consortium of biotech founders, clinicians, and longevity research institutions announced the Longevity Science Foundation, which says its commitment is to distribute more than $1 billion in a decade “to research, institutions and projects advancing healthy human longevity and extending the healthy human lifespan to more than 120 years.”

But that generosity looks to be outstripped, by an order of magnitude, by the Hevolution Foundation, established by royal decree in Saudi Arabia and headquartered in Riyadh. Hevolution is reportedly planning to allocate at least $1 billion annually in pursuit of its vision “to incentivize healthspan science across disciplines and borders for the benefit of all” (www.nist.gov/director/ vcat/biography-dr-mehmood-khan). Directing the spending will be CEO Mehmood Khan, MD, a former chief scientific officer at PepsiCo, and Felipe Sierra, PhD, who was the director of the NIA's Division of Aging Biology until 2020.

A Surge of Investment

Prominent billionaires and venture capitalists, meanwhile, pushed investment in longevity biotechnology into the billions for the first time in 2021. More than $2 billion was raised by such companies in more than 40 deals, according to Longevity.Technology, a news site for the ballooning industry, and more than a dozen of them were for more than $100 million (Newman 2021).

The year got off to a headline-grabbing start in January. After reportedly raising at least $270 million from investors including Amazon founder Jeff Bezos and Russian-born billionaire tech investor Yuri Milner, Altos Labs announced its startup with plans to create research operations in the Bay Area, Britain, and Japan and a mission to pursue biological reprogramming technology that can “restore cell health and resilience to reverse disease, injury, and the disabilities that can occur throughout life” (altoslabs.com).

And in March, German investor Christian Angermayer announced that two of the most prominent American longevity scientists, David Sinclair and Peter Attia, would take the helm of his new $200 million Frontier Acquisition Corp. Another German billionaire, Michael Greve, said he would invest more than $300 million in startups focused on life span extension. New U.S. venture capital funds focused on slowing aging that raised $100 million or more included Korify Capital, Apollo Health Ventures, and the Maximon Longevity Co-Investment Fund.

INVESTING IN PEOPLE

The world of aging research and geroscience has long been underpopulated. Work toward breakthroughs in the basic science of aging has been constrained by a limited pool of scientists willing to devote themselves to this work. There has not been a steady supply of early-stage, proof-of-concept clinical trials, and that has been a bottleneck in the development of geroscience interventions. And a critical barrier to the world of translation has been the scarcity of investigators with the combined training and expertise in clinical research, caring for older adults, and the aging biology that is essential to leading these trials.

While an abundance of biologists, biochemists, and physicians are eager to take high-paid positions doing research for pharmaceutical companies, there remains a persistent shortage of investigators making their careers in the world of academic research—not only because the compensation is generally less than in industry, but also because there have not been that many places offering opportunities for scientists to run their own laboratories.

By the Private Sector

While federal government spending that persuades people to start and stay in the aging sciences is as old as the National Institute on Aging's start in 1974, philanthropic efforts to increase and improve the geroscience workforce got off the ground in 1988. That is when the John A. Hartford Foundation created the Centers of Excellence in Geriatric Medicine and Geriatric Psychiatry, which paid for improved geriatrics teaching in medical schools on the expectation that doing so would increase the roster of physicians who take on investigations in aging science from the outset of their careers (Reuben et al. 2017). The initiative is widely credited with strengthening the national network of geriatrics programs (Isaacs et al. 2019), and has been a major driver of increased prestige for the field.

The John A. Hartford Foundation also took the lead in 1994, along with the Atlantic Philanthropies and several other foundations and nonprofits, in launching the Paul B. Beeson Physician Faculty Scholars in Aging Research Program. Named for an American infectious disease physician-scientist, it made $450,000 grants over 3 years—sufficient funds to entice a fresh cadre of physician-scientists to devote their energies to the field, not only by developing breakthrough research but also by mentoring and steering others into the field.

The Ellison Medical Foundation, created by Oracle Corp. cofounder Larry Ellison, also made major efforts to improve the aging research workforce by supporting the work of both first-time and senior investigators during a 15-year run that ended in 2013.

The Beeson awards were entirely foundation-funded for a decade, at which time the NIA added its support. This public–private partnership allowed the awards to grow for several years to as much as $800,000 over 5 years. With the program flourishing, the John A. Hartford Foundation and Atlantic Philanthropies have since wound down their support. The NIA is now the sole funder, with AFAR organizing the annual meetings.

Private support for building the workforce in the basic biology of aging has faded for much of the past decade, leaving AFAR as the main philanthropic player through a portfolio of programs, which offer a ladder of opportunity to support scientists to get established in the field and then remain for their careers, with $4.5 million in grants annually available for medical students, graduate students, postdoctoral fellows, and junior and senior faculty.

The American Aging Association, a prominent biogerontology nonprofit known as AGE, also dedicates resources to geroscience career development.

By the Public Sector

To be sure, however, the future of a robust aging research workforce is securely in the hands of the federal government. Academic research centers also play an important role, with both public and private funding, providing scientists with salaries, laboratory space, infrastructure, materials, and other support.

The National Institutes of Health delivers almost all this money, principally through the National Institute on Aging but with some grants allocated by the other arms of the NIH that focus on diseases that affect older people such as the National Cancer Institute and the National Heart, Lung, and Blood Institute.

The five main categories of NIH grant opportunities are coded by letters that do not always correspond exactly to the type of work getting funded. Whereas F is for fellowships, for example, a curious K is used for career development awards, grants made available usually for scientists already committed to specialized aspects of study (The Beeson awards fall into this category.) But there are also T grants (for training), including NIA awards to senior researchers willing to mentor newcomers to the aging field, and NIA grants to train medical students and postdoctoral fellows in aging science.

R is for research, and one category of NIA research grants is designed to whet the appetites of early career investigators for the field of geroscience. Known by the acronym GEMSSTAR (Grants for Early Medical or Surgical Specialists’ Transition to Aging Research), this money goes to early-career oncologists, neurologists, rheumatologists, anesthesiologists, nephrologists, emergency medicine physicians, and others with an interest in research leading them to subspecialize in older patients.

Beyond these grants to launch and sustain individuals’ careers in aging science, the NIA has several programs designed to enhance the workforce through collaboration, by fostering team approaches and by incubating cooperation among research institutions.

One fruitful effort has been the NIA Center Programs, providing more than 100 awards to institutions across the country. This includes the Nathan Shock Centers of Excellence in the Basic Biology of Aging (nathanshockcenters.org/about-the-centers) with the Pepper Older Americans Independence Centers (www.peppercenter.org), which focus on research and research career development on maintaining or restoring independence in older persons. But workforce development also happens at the Alzheimer's Disease Centers, the Resource Centers for Minority Aging Research, Roybal Centers for Translation Research in the Behavioral and Social Sciences of Aging, and the Centers on the Demography and Economics of Aging.

In 2018, the NIA started the Research Centers Collaborative Network, managed by AFAR and Wake Forest School of Medicine, to advance aging research by bringing different research groups and disciplines together.

The newest NIA effort, started in 2021, is the Translational Geroscience Network (www.gerosciencenetwork.org), a collaboration of researchers looking at clinical interventions that target fundamental mechanisms of aging to delay, prevent, or treat age-related diseases and disabilities as a group, instead of one at a time. The Translational Geroscience Network includes eight institutions across the United States (www.gerosciencenetwork.org). At this point, government and philanthropic support to create and preserve the workforce appears solid. The challenge ahead will be to prevent too many of these scientists, whose work remains foundational in the field, from leaving academic research for the shinier laboratories and more financially lucrative positions sprouting in the booming world of for-profit translational science.

INVESTING IN DISCOVERIES

The most important place in the world of pharmaceuticals is what the drug developers themselves ruefully call “the valley of death”—the long path, filled with scientific uncertainties and regulatory complexity, they must navigate to transform a discovery at the laboratory bench into a medicine taken at the bedside. Those who decide to finance such journeys must embrace their high-risk, high-reward nature and accept that many research insights will get “lost in translation” and never become therapeutics.

And the creation of drugs targeting the fundamental mechanisms of aging comes with far greater challenges than developing medicines to treat a particular illness (Le Couteur et al. 2022). That is because, unlike a disease, multiple biological pathways and processes get altered in every organ and tissue as we get older, and this cascade of change begins with the simple passage of time but is also affected by our genetics and environment. And yet an enormous and fast-growing roster of enterprises is working to develop treatments that retard or reverse the aging process, or ward off the chronic diseases of aging.

The National Institute on Aging now has nearly 100 people working for its Translational Gerontology Branch, where the drug design and development branch describes itself as working on medicines “that improve brain function and/or forestall the neurodegenerative process in age-related neurodegenerative disorders” (www.nia.nih.gov/research/labs/tgb).

More importantly, more than 100 biotech firms are now developing therapies to increase health span and life span, according to the news site Longevity.Technology, with new ones seemingly announcing themselves every week (longevity.technology/about-us).

One sign of the industry's rapid maturation was the creation in 2021 of its own trade group, The Longevity Biotechnology Association (longevitybiotech.org).

At the moment, these businesses seem to be making some of their biggest bets on these four therapeutic approaches to preventing, delaying, minimizing, or even curing the chronic diseases of aging:

• Cell reprogramming (Mosteiro et al. 2016): By “turning on” a handful of genes, almost any of our body's cell types—liver cell, skin cell, lung cell, brain cell—can be transformed in the laboratory to resemble the type of stem cell from which all our cells originated. Such cellular reprogramming may also restore many aspects of youthful cell function.

• Senolytics (Tchkonia and Kirkland 2018): Senescent cells are those too old and damaged to replicate and repair aging tissue, and they also can degrade surrounding tissue. A new category of drugs aims to selectively induce the death of senescent cells, and by clearing our bodies of them improve our overall health.

• Caloric restriction (de Cabo and Mattson 2019): Intermittent fasting, which reduces daily calorie intake without sacrificing nutrition, is seen as a straightforward way to extend healthy life span. For those unable to go without eating for more than half a day, therapeutics are being developed to mimic fasting's beneficial effects.

• Young blood (Conboy et al. 2003): It has been speculated for centuries that the blood of young people has substances capable of revitalizing older adults. Research now shows that blood of young mice rejuvenates the damaged heart, brain, and muscle of older mice—launching a major scientific search for the molecules involved.

The next step, which is detailed below, would be persuading the Food and Drug Administration that aging is its own indication for therapeutics—a regulatory breakthrough that would catalyze a surge of translational investment by the big pharmaceutical companies.

LOOKING AHEAD

The world of geroscience funding has entered the 2020s at a crucial juncture.

One could plausibly argue that the amount spent by the government, philanthropists, investors, and corporations has created a metaphorical glass half full: The funding has been sufficient for us to understand how the processes of aging drive chronic illnesses—and to set the stage for a new generation of investment in transformational treatments allowing us to live healthier lives for many additional years. But one could also argue the glass remains frustratingly half empty: The amount spent to date has not generated any blockbuster announcement and has not been enough to push the benefits of geroscience from the laboratories into our lives through a wave of new therapeutics.

The best way forward, of course, is to fill the vessel to the brim! To do so, it will be essential to prevent money from being wasted on the sketchy scientific meanderings of hucksters promising some magical path to the fountain of youth. Instead, strengthening and evolving the pipeline of research in the biology of aging, while supporting the efforts to translate that science into medicines targeting aging and age-related disease, is crucial.

Funding a robust pipeline of biomedical research into the processes of aging is what will generate the only reliable building blocks for a “gerofuture” filled with vitality and longevity for millions—by developing interventions that target the “hallmarks” of aging with the promise of delaying or preventing the onset of the most common age-related diseases or conditions.

In 2021, AFAR convened a trio of GeroFutures Think Tanks; an international gathering of two dozen experts from the biotech, biology, philanthropy, and private sectors explored opportunities and gaps in geroscience research, therapeutics, and collaboration and wrestled with tough questions about the main challenges and most promising areas of the work (GeroFutures Think Tanks report: www.afar.org/imported/Cover_GeroFuturesThinkTankReport_November2021-1.jpg).

The need for better collaboration between private and research sectors, within the United States and internationally, along with the need for interdisciplinary research on aging, stood out. And inadequate funding was most often cited as the top barrier to those things happening. Aging research does not have as high a profile among many other governments’ funding agencies as it does for the National Institutes of Health, but investments around the world remain inadequate to make the world of aging research attractive to young scientists. And so, the panelists called for a new wave of government, philanthropic, and industry funding to create research information clearinghouses and networks of collaborating laboratories, possibly on several continents, to generate a critical mass of researchers from different disciplines working together.

Private sector investors in geroscience have different priorities. They are keenly interested in discoveries with promise for a payoff in the near future. Work on biological aging clocks and biomarkers are of particular importance now, because understanding the pace of aging will not only increase opportunities for therapeutics but also unlock more investment opportunities. Research confirmed by multiple laboratories independently is also attractive to investors, as are discoveries that point toward a practical clinical path for addressing aging—in other words, finding an intervention that not only targets an existing disease but also looks to slow aging processes and affect the underlying biology of aging.

The surest way to stimulate research and development investment would be for the Food and Drug Administration to approve “aging” as an “indication”—meaning that the process of getting older is a medical condition, which, on its own, qualifies for treatments with FDA-approved medicine. Such an FDA ruling would dramatically shorten the time it takes transformative interventions to gain approval and reach the people who need them.

Moving forward with what is known as the TAME (Target Aging with Metformin) Trial would be a critical first step, because this project aims to provide proof-of-concept that the biology of aging can be targeted through therapeutic interventions. A campaign is nearing completion to raise $50 million to conduct clinical trials at 14 research institutions, involving more than 3000 people aged 65–79. The trial will test for 6 years whether taking the common diabetes drug Metformin delays the development or progression of such age-related chronic diseases as heart disease, cancer, and dementia. (The NIH's Geroscience Network recommended Metformin for such a trial because of its proven safety profile and low cost.)

If the answer is “yes,” as the trial's leader, AFAR's Scientific Director Nir Barzilai, MD, expects, that would provide the FDA with a strong rationale to open its regulatory doors and approve aging as its own indication. Biotech entrepreneurs and legacy pharmaceutical companies alike, and associated tranches of private and public investors, would then be incentivized to invest money into developing transformative interventions—because therapeutics to combat aging could gain FDA approval and reach the public in dramatically shortened time.

There are other challenges besides the long wait for the FDA's green light.

The world of aging research is populated by intensely smart people doing a wide range of promising research on provocative theories, and those scientists have drawn attention from a wide array of wealthy people, well-invested foundations, deep-pocketed entrepreneurs, major businesses, and the federal government. But those funders are still not putting enough money behind the work.

But this combined community of the funders and the funded does not speak with a single and unified voice about its priorities, and neither has it developed a cohesive group of leaders. To that end, a nascent communications and lobbying effort is developing. And its first modest if important goal has been to persuade congress, as part of its annual budget process, to get the NIA “to convene a meeting of experts across NIH, other relevant federal agencies, academic researchers, and the private sector to set a research agenda for the field” (Proposed FY 2023 National Institute on Aging appropriations bill report language, via American Federation for Aging Research: www.nia.nih.gov/sites/default/files/2022-03/nia-congressional-justification-2023.pdf.)

Another more miasmic but perhaps more immediate challenge is presented by the burgeoning anti-aging industry, which in recent decades has expanded far beyond the highly profitable and centuries-old world of selling age-obscuring cosmetics. Now, a raft of startups has been investing in purportedly scientific efforts to develop mechanisms that stop if not reverse the aging process—promising they are near the cusp of discovering the twenty-first century version of the Fountain of Youth, mentioned in myths since the fifth century BCE as a spring with waters that would restore to youth all who drank or bathed in it. In the interim, there is already a $1 billion-a-year American market in “nutraceuticals,” sometimes called “bioceuticals.” These foods, or products made from foods, are marketed as having physiological benefits or providing protection against chronic disease—and those claims and related products go largely unregulated, because the products exist in the same FDA category as dietary supplements and food additives.

Beyond the potential disappointment for consumers, of course, is the evident “brand confusion” that many Americans have when trying to distinguish between those peddling pseudoscience and those doing the science-based research into the biology of aging. Skepticism about all efforts to combat aging then tends to tarnish the legitimate as well as the illegitimate, and too often that has caused potentially rich veins of funding from wealthy individuals to dry up. Not helping the situation is the reality that some scientists who have distinguished themselves by producing serious research have developed products for businesses on the wrong side of the anti-aging divide.

These challenges, while significant, are nevertheless surmountable—and they will be surmounted fastest, and most triumphantly, when four decades of funding is rewarded with a headline-worthy discovery at the laboratory bench being translated for the bedside.