Living Longer & Stronger: Top Health News and Breakthroughs Over the Last 15 Years

As we mark Zoomer’s 15th anniversary, we look at some of the top stories over the past fifteen years in medicine, pharmacology, health care, longevity, biotechnology and healthy aging.

 

Fifteen years ago, Donna Sharman likely would have not survived the severe stroke that felled her one morning on the floor of her Calgary kitchen. “She either would have died or been left severely disabled,” says Dr. Patrice Lindsay, Director of Health Systems Change at the Heart and Stroke Foundation, Canada.

A clot lodged in the larger vessels leading to the brain means a good portion of the brain gets cut off from circulation, Lindsay explains.

But when Sharman suffered the stroke 10 years ago, there was a groundbreaking new procedure for treating stroke being tested in a clinical trial at Foothills Medical Centre.

The endoscopic procedure, snaking through an artery in her groin and into her brain, snared the clot, pulled it out cleanly and restored blood flow to her brain.

“It had never been done before,” says Lindsay. “It was a huge breakthrough for stroke.”

Today, Sharman, 69, is leading an active, healthy life.

“I’m helping my daughter homeschool our five grandchildren, I got into watercolour painting, my husband and I took up pickleball and I walk our black Lab every day. All thanks to the endovascular treatment.”

The procedure that rescued Sharman was just one of many breakthroughs and transformations over the last 15 years in medicine, pharmacology, health care, longevity, biotechnology and healthy aging.

For example, advances in cancer medicine have been so remarkable that even if cancer were completely eradicated, population life expectancy would increase only by about three years.

That’s because, more and more, “People don’t die of cancer, they die with cancer,” says biotech research guru Alex Zhavoronkov. “Most people die of cardiovascular diseases. The cardiovascular system does not tolerate old age. It accumulates damage and then fails.

“But with today’s diagnostics, survival rates for cancer are very high and targeted therapies can quickly and aggressively kill cancer.”

Even the death rate for lung cancer, the leading cause of cancer death in Canada, is declining, despite the aging population.

“The gains in longevity will continue,” says Dr. Samir Sinha, Director of Geriatrics at Mount Sinai and the University Health Network Hospitals in Toronto. “Part of the reasons we’ve made gains in the last 15 years is that the death rates from heart disease and cancer have fallen by more than 50 per cent, thanks to better prevention of heart disease and advances in cancer therapy.” 

One novel targeted cancer therapy is Provenge, approved 13 years ago for treating prostate cancer. It was the first cancer vaccine using a type of immune cell, called dendritic cell, to kick-start the immune system. A clinical trial showed that the vaccine reduced the risk of death by 22.5 per cent. 

More recent research suggests that a dendritic cell vaccine may help patients with HER2-positive breast cancer.

 

Meanwhile, the mRNA platform first used for COVID-19 vaccines has now made possible an effective vaccine against respiratory syncytial virus (RSV) in adults 60 and older.

Moderna announced recently that its vaccine is 83.7 per cent effective at preventing the lower-respiratory-tract disease. Just in the area of vaccines, the achievements in the last 15 years have been significant, and every step ahead in the lab is leading to new and innovative solutions to preventing and controlling disease.

For an overview of progress in health care, medicine and research — especially as it affects older Canadians — over the last 15 years and what we can expect and hope for in the next 15 years, Zoomer surveyed three world-renowned, Canadian experts:  

• Dr. William Reichman, 66, president and CEO of Toronto’s Baycrest and Centre for Aging + Brain Health Innovation 
• Dr. Samir Sinha, 46, director of Geriatrics at Sinai Health and the University Health Network Hospitals in Toronto
• Alex Zhavoronkov, 45, Queens University alumnus, founder and CEO of Insilico, an international artificial intelligence drug discovery company dedicated to extending human productive longevity and transforming the drug discovery process

 

Dr. Reichman, from your perch at Baycrest, what changes have you seen and where do we go from here?

 

The most dramatic change is that, historically, the focus on seniors has been to address disease and disability once illness arises — disease management and intervening with acute illness. Now, there’s been a major shift to a huge focus on prevention and wellness promotion and the impact of lifestyle on health, not only on risk factors, like hypertension and obesity, but also on wellness behaviours to avoid the consequences of aging: mental and physical exercise, social connection, better nutrition, more education with lifelong learning. In the past, these things were never thought about in dealing with older people.

Another shift that’s occurring in the care of older people [is that we thought] historically doing more for frail older people was in their best interest. Now, the trend is the opposite. It’s a philosophy called ‘re-ablement.’ Instead of doing everything you possibly can, only do what they absolutely need you to do to encourage them to do more for themselves.

Even with dementia, the more you enable them to do for themselves the longer they function at a higher level. When they come to us [at Baycrest], with the Possibilities program, we encourage them to do as much for themselves as they can. They no longer have a private companion and their functional abilities improve. We do what is absolutely necessary, no more than that, and encourage them to do as much as they can. It’s quite a new philosophy. People are functioning at a higher level physically and mentally when urged with the right supports to do more for themselves.

Another change is that, historically, older adults were very comfortable with the paternalism of doctors, relying on doctors as the source of all information. It was ‘doctor knows best’ and questioning the doctor was seen as disrespectful. But in my generation of aging baby boomers, we’re not going to listen passively to what the doctor tells us. We’re getting information from many sources, taking more control over our health care and decision-making, questioning, weighing pros and cons and understanding rationale. We’re much better informed than older patients used to be. The problem is that sometimes the information from social media and Google is not the best. The job of doctors and health care professionals is to guide people to the best sources of information, help them be more critical about what they read and be better educated consumers.

There’s a recalibration of health care happening. Hospitals are going to get smaller, offering services that can only be offered in a hospital. They’ll largely be critical care units. Routine medical and surgical procedures will be available primarily outside of the hospital setting. The local pharmacy will be a place for health care, with pharmacists and other staff doing more health monitoring, diagnosing and treating.

Most older adults still prefer to be cared for at home as they become more frail. Policy makers have to adapt to that and invest in more home care rather than older styles of nursing homes. But there is also an increased need for new models of congregate care, more resident centred, more holistic, much less constrained by restrictions, more customized and respectful of life history.

Staying at home sounds good but the practical reality is that it’s not always great. You can become increasingly isolated, the care provider may be someone from another culture with whom you have little in common, it may be a younger person spending time on their cell phone, an adult daughter may need to take time off work to get you to the doctor. It’s not so easy. My mother passed away last January. We wanted her to stay at home but it became impossible to manage and she had a much better quality of life in a congregate care environment, and it was much better for the family. One problem is the longer wait for people to go into congregate care, so people coming in are older and more frail and when they come in they need way more care, requiring more staffing, more use of health care, physicians and nurses. 

Where were you in your life 15 years ago, when you were 51?

I was working at Baycrest. I was recruited 16 years ago.  I would say I was in my best shape in my 50s. I was into fitness, weightlifting. I took strict care of myself. In my 60s, I put on a lot of weight and I have less hair. Hopefully I’ll get back to being fit. I was always a better than average athlete. I never imagined that in my 50s I’d be in better physical condition than I was in my 30s and 40s.

At any age, we can optimize how we feel and how we perform, even if we’re overweight. It’s never too late. At any age, you can get yourself into the best possible shape. We have people coming into Baycrest with terrible frailty and discovering interests and abilities that they never knew were possible until they came here.

Where will you be 15 years from now, when you’re 81?

I won’t be working at Baycrest, if I’m still around. I will do what I need to do to keep my brain active. I’ll be more interested in mentoring, investing more of my time and effort in helping younger doctors figure out different options. I have a home in New York and I’m very interested in New York history and Dutch history. So I might become a tour guide.

 

Dr. Sinha, you’re both a geriatric clinician at Sinai Hospital in Toronto and a passionate advocate for older Canadians. What changes have you seen in the last 15 years or so and where do we go from here?

 

There have been big changes between then and now, looking back 15 years. When I started practicing medicine in 2010, 13 per cent of the population was 65 or older. Within less than a decade from now, one-quarter of our population will be 65 or older. That’s a huge seismic shift. Boomers started to turn 65 in 2011 and by 2031, that group will be turning 85. So, our overall aging population will not only double in size, but there will also be a significantly larger cohort of adults 85 and older. 

Currently, one in three Canadians 85 and older are living in long-term care or retirement homes. With greater age comes greater disability in later decades of life. So, the big question about the future is how we can better support those groups. Right now, we spend a lot less on providing home and community care than some countries, including the Netherlands and Denmark, and a greater proportion on providing care in large institutional care settings. 

The other challenge, compared to today, is that by 2050, there will be 30 per cent fewer family caregivers available to provide unpaid care, and not enough home and community support forcing more and more people into institutional settings. Right now, more than 50,000 Canadians are on a wait list for institutional care. When I look to the future, it’s currently not very hopeful unless Canada makes big changes. allowing people to stay in their own homes, with more flexible delivery of home care services and with safer, high-quality, home-like long-term care.

What happened in long-term care homes during the pandemic (lockdowns, deaths) made Canadians much more aware of what the state of long-term care is like in Canada, and what comes with an underfunded system. It strengthened the resolve of older Canadians to steer clear of institutional settings. Close to 100 per cent of people 65 and older now want to stay in their own homes as long as possible.

New types of long-term care that we know are safer and are of high quality, will mean spending more, with small home-like settings, like the Green House model pioneered in the U.S. People need to have single rooms with their own bathrooms. This not only preserves dignity, but it also provides better infection control. The pandemic started getting people thinking more about positive movements in the fight direction. But we can’t actually provide good, safe high-quality care unless we staff these homes appropriately as well. In Ontario, at the start of the pandemic, there were two hours and 45 minutes direct care for each resident. We established that it should at least be four hours a day.

Aging is not a disease. It’s a normal, natural process. Aging is living. If you think of aging as a disease, then you think of people who are older as problematic and disease-ridden, to be tolerated at best. We have to do better at promoting healthy aging with vaccinations, preventing falls and leading active lives. 

The biggest thing we’re struggling with now is dementia. Age is the greatest risk factor. Right now, we don’t have anything that cures dementia or significantly slows its progress. Some of the recently announced new therapies (lecanemab, donanemab) sadly are not really breakthroughs but might help people a tiny bit and do help more understanding of dementia. 

The key is that these medicines are incredibly good at clearing amyloid in the brain, but what these studies have told us is that it’s not just amyloid that causes dementia. It’s much more complicated. I’m hopeful that over the next 15 years, there’ll be significant advances in the management and treatment of dementia as we all get older. What most of my patients fear is the potential risk of developing dementia because it robs you of your independence. It’s a horrible disease.

Where were you in life 15 years ago, when you were 31?

I was just finishing up training as a geriatrician at Hopkins. I arrived here in 2010 to set up the new geriatrics program at Sinai Health and the University Health Network, on the cusp of baby boomers turning 65.

Where will you be in 15 years, when you’re 61?

I hope to be seeing patients in downtown Toronto as an active clinician. I’m passionate about continuing to advance research, policy and advocacy to better support the needs of older adults. As I march towards becoming an older adult myself, I want to make sure Canada is a great place to grow old.

 

Alex Zhavoronkov, you work and travel tirelessly as founder and CEO of biotech company Insilico and as founder of the Aging Research and Drug Discovery meeting, which gathered for the tenth year recently in Copenhagen, all in service of managing the diseases of aging and aging itself. Have we made progress in the last 15 years? Will the next 15 years bring results?

 

Much of what we do is highly experimental. We look for targets, the locks that you need to develop the keys for. We work on developing dual-purpose therapeutics, targeting age-related diseases and at the same time targeting drivers playing a role in aging itself. It’s impossible now to develop drugs directly for aging because it’s not a commercially viable business model. But besides going after a specific set of diseases, we also focus on aging research.

There are some drugs being tested in the real world, but these are very long-term clinical trials for longevity. Drugs thought to be possibilities — rapamycin, metformin — we don’t know if they work on human aging or not. My company is not involved in repurposing old drugs for longevity, but if I were to bet on one drug and research deeper for longevity, that would be rapamycin. But it has substantial side-effects. If something is super safe, it often doesn’t work.

People in their 70s don’t have a lot of options besides prevention. Do what your mother told you: diet, exercise, sleep, regular diagnostics. But people in their 50s and 60s should start thinking about the aging clock and lifestyle interventions. We need to accelerate this research, maybe focus not so much on geopolitics and gender studies and think about the most important priority, which is aging. And accept a little bit of blame for not pushing the government and the public for more aging research.

My company, Insilico, is currently very bullish on several areas, including fibrosis. Fibrotic diseases are very much associated with aging: kidney fibrosis and chronic kidney disease driven by fibrosis, cardiovascular fibrosis, lung fibrosis. If the body loses some cells and cannot replenish them quickly, it puts in fibrotic tissues. Think of bandages on cuts. This makes it more difficult for stem cells to proliferate and is one reason for decline of function. Much of my research is focused on a drug that is anti-fibrotic. Using AI, we went all the way in pre-clinical studies and we’re now in Phase II trials. 

We also have multiple other drugs in various stages. We’re very bullish on inflammatory bowel disease, repairing the gut barrier between the intestine and blood. Part of aging in humans is driven by the barrier function that declines over time. We also have many cancer drugs we’re bringing forward. Based on preclinical data, these programs have favourable safety profiles and have promising development potential. This fall, we sold one of our cancer drugs, a deal of $80 million upfront. And we’re using the same form of AI to look at senolytics — killing old senescent cells to make room for new ones. My mission in life is to cure aging, but we need to ensure that it is done right. History is a graveyard of promising longevity drugs.

We need to figure out a multifactorial strategy for longevity. My company wouldn’t be able to cure aging. I don’t think it’s within our range of capability. But hopefully, we can extend life significantly while also addressing certain diseases. We are highly focused on aging as a long-term goal, but also on cancer and other diseases to ensure keeping the lights going. Also, part of my company is working on platforms, selling my AI software that is used by many academics and pharmaceutical companies. 

One of the central themes in anti-aging research is the rapid advancement of our ability to measure aging with different biomarkers —  methylation, imaging, proteomics — different modalities of data to predict biological age and to use these to interpret which are most important and establish causality, which are driving and which are passengers. One marker might be predictive but not the driver. Another interesting direction is cellular reprogramming,  how to make cells younger, not all the way back to stem cells but to a state that is younger. 

Artificial intelligence has been the key driving force behind research in aging. It can monitor minute changes and trends that happen in the course of aging. We can use these massive longitudinal data sets to understand how we age, for example, the key proteins driving the diseases of aging. But even if we had a pretty good hypothesis in hand, going from discovery using AI to clinical trials would take eight to 10 years for an age-related condition.

What were you doing 15 years ago, when you were 30?

I was already 100 per cent dedicated to longevity biotechnology research. I knew that I would need to postpone any aspirations of having a family or standard paradigm of human life. I started working on multiple projects in AI, longevity and regenerative medicine in parallel. I did not really optimize for longevity but rather for performance. I also wanted to know everyone working in the different areas related to longevity biotechnology and started helping organize events and interest groups around the world. This helped build a pretty powerful network. 

 Where do you expect to be in life 15 years from now, when you’re 60?

I expect to feel, look, and act at least 10 years younger than peers primarily due to good genetics and basic geroprotective interventions. There is a good chance that in 15 years, if we work hard and if there are no dramatic events, wars, or economic collapses, we may have the first regenerative medicine treatments that will help us replace some of the old cells, tissues and organs. Also, robotic technology, including humanoid robot helpers and robotic augmentations will further increase the utility of my life. I also have high hopes for Insilico Medicine. I think it is already at the very forefront of AI-powered drug discovery, exceeding my wildest expectations. Many of the targets we are going after have dual purposes, targeting aging and disease. And if we are lucky, some of these programs may go mainstream and help me and billions of people around the world live significantly longer. So, 60 may not be as bad as it looks today. At least, we should have a broader toolkit to fight and prevent age-related diseases. 

 

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