On this episode of Lifespan News, Ryan O’Shea discusses the possible ramifications of including aging in the ICD-11.
ScriptThe debate about whether or not aging is or should be considered a disease has been taking place for years, and recent developments with ICD-11, which has now formally been adopted, are raising the issue again. Things seem to be changing back and forth, and there’s a lot of disagreement even within the longevity community. We’ll get you up to speed, and explain why it matters, on this episode of Lifespan News! The International Classification of Diseases, or ICD, is a tool maintained by the World Health Organization to standardize the process of capturing and sharing data about “Diseases and Related Health Problems”. Early forms of this can be traced back centuries, but today it is interwoven into policy making, funding decisions, insurance, and more. So, it’s very important. The 11th version of the ICD was started in 2007 but finally came into effect in January of 2022, though it will take some time for changes to be fully implemented. In ICD-11, a new category of codes, called extension codes, have been added. These codes serve as adjectives, adding additional detail. One of these new extension codes, XT9T, means “Ageing-related”, or more specifically, it means “caused by pathological processes which persistently lead to the loss of organism’s adaptation and progress in older ages”. Another change has caused even more controversy. ICD-10 had a code for what can be called “senile debility”. ICD-11 replaces this with code MG2A, originally meaning “old age”. Here “old age” is categorized as a “general symptom”, rather than a specific disease. Defining aging as a disease has long been a goal of many members of the longevity community, and they welcomed these changes in ICD-11. However, this spurred quite a bit of debate. In October of 2021, an international group of psychiatrists published a comment titled “Not a disease: a global call for action urging revision of the ICD-11 classification of old age”. This argument was focused on the idea that the MG2A code was pathologizing chronological age, potentially leading to an increase in ageism and discrimination. They said “We strongly suggest that WHO consider revising the proposed ICD-11 classification because old age is an ageist term…” They instead suggest using the term frailty, which can be defined without being tied to chronological age. And here, I think they have a strong point. I totally agree that chronological age should and will continue to be less and less important, and less meaningful. After all, what we really care about is biological aging. It doesn’t make any sense to pick an arbitrary age and say that anyone over that suffers from the disease of old age. That seems silly today, and it will seem even more silly in the decades to come. Instead, what would be important to get across is the idea that just because an elderly person’s health issues may be common in their peers doesn’t mean that it’s okay. Today, it may be “normal” or “expected” to experience some level of decline as chronological age increases, but that doesn’t mean that it shouldn’t be treated as the medical condition that it is. Older people should not be expected to accept and put up with health issues that are treated in younger people just because of their age. To me that would be an example of truly consequential ageism that we should fight. This is a point that Nicola made in a previous X10 video that we released on this topic. Here’s how he put it – “It makes zero sense to have different values for health indicators depending on your age. Higher blood pressure may be “normal” for the elderly, but that only means that we generally expect their pressure to be higher, not that healthy blood pressure is higher for the elderly. How common or uncommon higher pressure in the old may be means absolutely nothing in terms of how good or bad it is for them. This kind of reasoning is pretty much a case of appeal to normality—a logical fallacy that says basically that, if something is common, then it’s also all right—and is brought up by some as a reason why aging couldn’t be a disease: it happens to everyone. Huh… so? Everybody gets the flu—should we throw it out of the ICD?” So, I’ve expressed where I agree with those who are arguing against including “Old age” in ICD-11. But I also disagree with them quite a bit. For example, they write “The use of the term old age would empower the anti-ageing industry, which is worth billions of dollars per year globally with the promise of eternal youth, an irresistible yet futile concept.” Ultimately, time may tell if they are right about that, but I don’t think they are. Regardless, it seems that their argument had some impact. The definition of MG2A has been changed from “Old Age” to “Ageing associated decline in intrinsic capacity” in the ICD-11. This caused even more back and forth. Reacting to the news, David Sinclair Tweeted “The exciting move by the @WHO to define AGING as a treatable MEDICAL CONDITION has, sadly, reverted.” and linked to his own correspondence in The Lancet, co-signed by other longevity leaders. There they argued that “The MG2A code is representative of the paradigm shift in the definition of an individual’s age, from chronological to biological, and will promote the development of therapies to optimise biological age.” Another correspondence from Daria Khaltourina and others says this: “…far from discriminating against the rights of older persons and fostering neglect for their curative or preventive health care, the ICD-11 codes for old age and ageing-related causality do exactly the opposite: they draw the public and professional attention to the specific health problems of older persons and call to action to improve the prevention and cures specifically for older persons. Thus, these designations are the very opposite of ageism.” Aubrey de Grey also got in on the discussion, answering a question posed on Quora with the following. “I’m sure that the reason they changed it was that “old age” connotes merely having been born a long time ago, and says nothing about health, hence it was obviously a dumb term to have used in the first place. As for impacting medical practice, the effects will be enormous, because the ICD is used worldwide to document and guide what treatments are prescribed, hence it hugely influences the incentive structure in the medical industry as regards investing in development of treatments.” Nir Barzilai of the American Federation for Aging Research provided some of his comments on the subject in a recent Alliance for Longevity Initiatives event. “If we call aging a disease a lot of things have to happen. The FDA has to come into action. I can tell you that I’m against it. Not that aging is not the mother of the diseases, but actually elderly, we just saw, they don’t want to be called diseased. What do we do? We isolate them, we put them in islands, they become lonely. We just had that. The FDA doesn’t want to call aging a disease. The AARP doesn’t want to call aging a disease.” So, what does this all mean? Well, almost no one can agree. This topic gets deep into the weeds of semantics and meaning and everyone seems to define and interpret things differently. The one thing that can be agreed upon is that, whatever decision is made, it will be hugely consequential. There’s no easy answer, and we expect to be following this debate for years to come. If that doesn’t scare you away please subscribe. I’m Ryan O’Shea, and we’ll see you next time on Lifespan News!
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