1:12. 0:43. 0:21. Each morning, countless Americans open their New York Times app, fingers hovering over the Mini Crossword, ready to shave off mere fractions of a second from their personal best time — a daily ritual of racing against the clock, pursuing an elusive new record. Down to 0:19. Then 0:18. The thrill of watching the clock tick lower and lower.
Our obsession with time isn’t limited to daily puzzles; it extends to the ultimate race: the quest for a longer life. This pursuit is anything but new — humans have been trying to outmaneuver death since we first became aware of our own mortality. From ancient Egyptian hieroglyphs to Chinese alchemical texts, from Plato's musings to Aristotle's contemplations, the dream of extending life has echoed through millennia of human civilization. However, what took centuries of philosophical pondering to even conceptualize has now quickly become a reality through scientific advancement. In short, modern medicine has transformed the abstract theories of Plato and Aristotle into concrete gains. At the beginning of the 19th century, no country's life expectancy exceeded 40 years, but today, the global average life expectancy is estimated to be 72.6 years [3]. Although life expectancy has increased across all ages, most of our dramatic gains in average lifespan have come from technological and medical breakthroughs focused on preventing early deaths — keeping infants alive, curing infectious diseases, and making childbirth safer.
Consequently, modern medicine has been so successful in curbing death rates among the young that we've nearly exhausted all possible improvements in early-life mortality. Now, researchers must shift their focus to a new frontier: preventing deaths in old age itself. Unlike preventing early mortality, extending life in old age means confronting bodies that have accumulated decades of biological wear and tear, where cellular damage, chronic inflammation, and deteriorating systems create a maelstrom of mortality risk. In other words, each additional year of life expectancy has become increasingly harder to achieve.
This challenge has led scientists down an unexpected path as researchers have begun to focus on tackling old age from its roots: can we slow aging itself? The answer may lie in an unlikely source. Rapamycin, first discovered in the soil of Easter Island, isn't a mythical fountain of youth —but its effects may have the potential to change how we experience aging itself.
Historically, Rapamycin has been used as an oral immunosuppressant for organ transplant patients. Recent research has uncovered, however, that at low doses, rapamycin appears to reduce inflammation by inhibiting the mTOR signaling pathway, which serves as a critical regulator of aging and the body's lifespan [1]. Inspired by this discovery, scientists such as Dr. Matt Kaeberlein have started testing in animal models, with results indicating that rapamycin usage in mice can result in up to a 30% increase in lifespan [2]. Further research has proved even more successful, as shown in a trial where a one-time 3-month dosage of rapamycin in mice resulted in longer life and substantial improvements in murine heart function [2]. Due to the extensive genetic similarities between mice and humans, scientists have started to hypothesize that rapamycin may have similarly beneficial effects on human life spans.
Despite promising results in animal models, significant hurdles remain before rapamycin can be considered a viable option for improving human longevity. The long-term effects in humans are still unknown, and an optimal dosage for anti-aging purposes has yet to be established. Complicating matters further, the FDA doesn't currently recognize aging as a disease, which means that 1) drugs targeting aging specifically aren’t eligible for approval as treatments, and 2) clinical trials using rapamycin are plagued by ill-fitted regulatory constraints. Thus, leading researchers on aging and rapamycin, including Dr. Matt Kaeberlein and Dr. Eric Verdin, publicly advise against using rapamycin for life extension. The twist? They are taking it themselves, prescribed off-label [4].
The actions of leading longevity researchers speak louder than their words. Dr. Kaeberlein and Dr. Verdin's actions serve antithetical to their public advice. But why? For them and many others, they don't have enough years left in their lives to wait for conclusive results from long-term studies; it's now or never. So, while unapproved, is it safe to bet on rapamycin extending your life without knowing its long-term impacts?
The answer varies for each individual, but regardless of personal choice, rapamycin represents a concerning shift in our approach to longevity — the pursuit of potentially harmful quick fixes over proven routines. While exercise, nutrition, and lifestyle modifications require consistent effort, they build a foundation for comprehensive health that extends beyond mere lifespan. Rapamycin, in contrast, offers a seductive shortcut that bypasses these holistic benefits. By reducing the complex journey of healthy aging to a pill, we not only risk oversimplifying the multifaceted factors that contribute to longevity but also ignore the importance of lifestyle, environment, and social determinants of health in favor of quick pharmacological fixes.
However, the strongest argument against rapamycin’s usage lies in its potential to deepen America's already severe health disparities. Off-label prescriptions and high costs mean that even if rapamycin proves effective for human longevity, its benefits will flow primarily to the wealthy. This accessibility issue creates an unprecedented form of inequality where money doesn’t just buy better healthcare, but also more years of life itself. In an increasingly costly healthcare environment, the wealthy already enjoy longer lives due to better access to healthcare, nutrition, and healthy lifestyles. Adding rapamycin to this equation would only widen the existing life expectancy gap, fostering a society where longevity becomes a luxury good rather than a human right.
Crucially, the most urgent step isn't deciding whether to take rapamycin; rather, it is reconsidering how we view aging itself. Our current regulatory framework, which doesn't recognize aging as a disease, creates a pharmaceutical catch-22: we can't properly study anti-aging treatments because aging isn't classified as a treatable condition, yet we hesitate to classify it as such because we lack proven treatments. Breaking this cycle requires a fundamental shift in how we conceptualize and regulate aging intervention research. Only by acknowledging aging as a medical condition—rather than as an inevitable decline—can we create the regulatory framework needed to properly study, develop, and equitably distribute treatments like rapamycin.
Until then, we're left with an uncomfortable reality: a promising compound that sits in regulatory limbo, prescribed off-label by those who can afford it, while the broader implications of its use remain underexplored. Ultimately, the debate around rapamycin isn't just about a potential life-extending drug—it's a mirror reflecting our society's complex relationship with aging, inequality, and the lengths we'll go to add a few more numbers to our personal timers.
Graphic by Monica Rashkov
Reviewed by Nick Hoffmann
References
Abuery, A. (2024, July 1). Could a decades-old transplant drug unlock the secret to longer life? NPR. https://www.npr.org/sections/shots-health-news/2024/07/01/nx-s1-5008777/rapamycin-aging-disease-drug-humans-research
Kaeberlein, M. (2024, January 15). Rapamycin: The most promising life extension drug [Video]. YouTube. https://www.youtube.com/watch?v=DcxgEwQKx8Q
Roser, M., Ortiz-Ospina, E., & Ritchie, H. (2024). Life Expectancy. Our World in Data. https://ourworldindata.org/life-expectancy-globally
Whalen, J. (2024, March 15). A transplant drug shows promise for extending life. Should you take it? The Washington Post. https://www.washingtonpost.com/business/2024/03/15/rapamycin-longevity-drug/
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