Just how bad are we at treating age-related diseases?
122 comments
·June 4, 2025QuadmasterXLII
hn_throwaway_99
Most of the conditions you've mentioned there have exogenous causes (i.e. diseases or environmental toxins), and I question your inclusion of many of the ones that don't (who thinks we have "conquered" breast cancer??).
But we have made very little progress in staving off degenerative-type diseases. Even the primary degenerative disease you mention, knee failure, we cure largely with a wholesale replacement. That obviously isn't applicable to organs we can't just swap out.
owenpalmer
Swapping out organs may be an option in the future. I'm getting a bioengineering degree so I can't work in organ engineering research. We're definitely not there yet, but there's a lot of interesting research happening in this area.
giantg2
I agree. Rates of cancer and diabetes are up. We might have better treatments than in the past, but I though I even saw graphs showing that overall cancer fatalities rates are flat - a lower percentage of people die from it, but the increase in cases mostly offsets that (depends on the specific type).
BurningFrog
One angle is that as we find cures for other diseases, cancer rates go up because we live long enough to get cancer.
The sum of all causes of death will very likely continue to be 100%...
groby_b
"Conquered" is a loaded term, but a 43% reduction in mortality since 1990 is nothing to sneeze at.
The 5 year survival rate for localized (early stage) breast cancer is 99%
Did we remove it as a cause of death? No. But the prognosis is much less dire by now than it was even a few decades ago.
Very few causes are ever completely "conquered", they just move down in relative relevance.
hn_throwaway_99
A huge part of that increase in 5 year survival rate is just earlier detection, though.
I fully acknowledge that we've made large strides in understanding and treating breast cancer, but in most cases, once it spreads it's still "game over", and so it is still an immensely fearful experience for people to go through. Contrast that with, for example, HIV. 35 years ago it was probably the scariest disease there was, considered a guaranteed death sentence. Now it is largely preventable with PrEP, and treatments are so good that it is a manageable condition with lifespans on par with HIV-negative people for most of those who diligently follow their treatments.
thinkingtoilet
We have by no means conquered prostate cancer. It is still extremely deadly.
hwillis
The average age of diagnosis is 67 and 95% of those men live as long as you would expect them to normally. It is certainly not cured, and treatment can be very disruptive and unpleasant, but it's definitely not "extremely deadly" with modern medical care.
fridder
Perhaps not but when it is aggressive, it is very deadly. They told my dad they were thinking he could have 10 years, he got three. Seems like when it stops responding to hormone suppression things can deteriorate quickly.
tim333
It makes up for that in being common though. The most common cancer in male non smokers and fifth leading cause of death worldwide (presumably amongst males https://pmc.ncbi.nlm.nih.gov/articles/PMC6497009/)
AstroBen
> live as long as you would expect them to
We also need to think about quality of life, which tends to go way down after you're diagnosed with one of these diseases
Prevention and delay is significantly better than management or even curing
samastur
Not being extremely deadly is low bar since most of your life (with some luck) will be spent being old. I'd rather see my years being more than bearable.
windowshopping
I know, I read that list and I was like "what?" Since when is even half of that stuff "conquered"?
ryandrake
I agree. To me, using the very strong word "conquered" implies that a condition or disease is eradicated, like smallpox. Or, at the very least that we have a reliable way to prevent it.
CGMthrowaway
Worth adding to the list are osteoporosis, secondary infection, hearing loss, macular degeneration (need more advancement here), hypothyroidism, chronic kidney, acute consequences of heart disease/ stroke prevention.
Not all of the solutions can be called "cures" but a solution nonetheless is better than nothing and calling it "old age, shit out of luck."
genezeta
Parkinson's fairly frequent too.
close04
> and have conquered yellow fever, consumption, diabetes, knee failure, glaucoma, smoking related lung cancer, prostate cancer, hookworm, environmental lead poisoning, environmental arsenic poisoning, black lung, breast cancer, and syphilis.
What's your definition of "conquered"? In the US breast cancer is the most common type of cancer, and together with lung cancers account for ~500k cases each year. 100k of those people will die within 5 years.
Now we created new issues to replace the old. Microplastic, PFAS, antibiotic resistance, obesity, etc.
And my knees want to have a word with your assessment :).
Qem
I also wouldn't count prostate cancer on the "conquered" group, as recent news about the great Scott Adams reminds us.
aesclepius
Scott Adams, the Holocaust-denying, vaccine-denying and anti-diversity, equality and and inclusion, cartoonist?
vixen99
For anyone who saw the flagged comment: I found this: Scott Adams has questioned the methodology behind the figure of 6 million Jews killed in the Holocaust, suggesting it may not be as well-documented as commonly believed. However, he does not outright deny that the Holocaust occurred, stating that "no reasonable person doubts that the Holocaust happened."
cogman10
He has a lot of weird anti establishment takes. For example, that evolution isn't real [1]
I'm not 100% on the reasons. Seems like he simply has a lot of hubris.
[1] https://dilbertblog.typepad.com/the_dilbert_blog/2007/03/fos...
myrion
There's no much difference between the two positions, and the former is very much a lead-in to the latter.
jajko
> So, if you know someone old and suffering, its probably alzheimers.
Thats very far from reality, I presume you don't know many old people or speak to them about their ailments?
QuadmasterXLII
It could just be genetic luck, and the privelege that most people I interact with have access to the best treatment for diseases that have treatments, but around me the worst suffering is mostly alzheimers, striking in the late 70s to 80s.
AnimalMuppet
You're right that there is far more to it than Alzheimers. Still, Quadmaster has half a point. It's probably not consumption (tuberculosis), or hookworm. It's much less likely than it was to be black lung. Even smoking is decreasing, though it will take another generation for that to show up in the old people.
So we're making progress. But we don't see it, because that becomes the new normal, and we see all these remaining things that cause problems for old people.
close04
TB killed 1.25 million in 2023 and the WHO considers it the world’s leading cause of death from a single infectious agent, outpaced only temporarily by COVID.
thaumasiotes
> Still, Quadmaster has half a point. It's probably not consumption (tuberculosis), or hookworm. It's much less likely than it was to be black lung.
But that's not because we got better at treating hookworm or black lung. The big ideas there are "wear shoes" and "don't work as a miner". You don't have to treat a problem you never have.
(Wikipedia: "There is no cure or discovered treatments for pneumoconiosis.")
piombisallow
Most of the things you listed aren't aging related
QuadmasterXLII
“Aging related” just means we don’t know what causes it, and yes we are much better at treating things when we know their cause. For example, right now parkinsons is aging related and we can’t do a thing about it, but there is increasing evidence that it is caused by some pollutant or toxin. If we find the toxin, then parkinsons will stop being age related. Mesothelioma is a historical case of this: for 100 years it was an untreatable aging related disease, it’s now obviously not an aging related disease, and the treatment is don’t breath asbestos.
chaosbutters314
you forgot HIV/AIDS. we have the tools to basically snuff it out in 60-80 years if every male was on prep
mattmaroon
I think there’s a good chance we snuff it out in 80 years even if they aren’t. Actual cures seem to be on the horizon.
pureagave
Why would every male need to be on prep?
const_cast
To prevent HIV so then we abolish it. Like how we got rid of Polio and such.
PrEP just happens to actually work here, but I guess condoms could too. But historically that's not gonna happen.
It's probably not worth the effort, though. But we can, and do, eradicate diseases via preventative mechanisms. Which is astounding.
david-gpu
Look at how hard it has been to eradicate diseases that only require a couple of doses of a vaccine. How feasible do you think it would be to provide daily prep to every male in the world? Even in developed countries with free vaccinations we are suffering from measles outbreaks in 2025.
ryandrake
For diseases like measles, it's entirely due to human stupidity and society's unwillingness to oppose the stupidity and take the public health steps necessary to eradicate the disease. I agree with you. We're never going to complete any global public health project that relies on uninformed (or misinformed) people making voluntary decisions.
fragmede
Are those really developed countries? A decent free public school education is a requirement for a nation to be considered developed.
Herodotus38
Interesting, I wouldn't classify IPF (idiopathic pulmonary fibrosis) as a disease of aging in the same way as the other diseases (MASH, Alzheimer's, etc..) like the author did here. Although I do appreciate the intent to show how limited we are. It's kind of like how cancer is clearly a disease of aging but it wasn't included in here because people think of it differently.
I treat a lot of old people, and IPF is at least a couple orders of magnitude rarer than the other conditions listed. Age does play a role because it shows up when people are older, but there is something else at play in it (autoimmune, genetics) that makes people hit the unlucky lottery.
I bring this up so that people reading this don't conflate normal aging related changes to the lungs with IPF. IPF is a horrible disease that kills the person in a few years (2-5 after diagnosis).
bentt
We are bad at most things that are complex and require behavior change. Maybe our best victory in recent years has been the vilification of tobacco. It didn't get any less physically pleasurable to smoke, but the combination of political, social, economic, and medical pressure has turned the tide.
It takes a lot.
steveBK123
And none of these changes are permanent!
Look at the cultural attitudes towards smoking pot. Often the same cities/governments/people what were fining cigarette smoking out of existence suddenly have a hands-off attitude towards pot.
In NYC its illegal to smoke or drink in parks, but you can walk through a park reeking of pot and see cops writing tickets to the 2 kids who hid their beer too poorly.
david-gpu
I suggest reading about the different effects of smoking typical amounts of tobacco vs cannabis, and comparing the magnitude of the damage, both at the individual and societal level.
I really dislike the smell of cannabis and can count with the fingers of one hand how often I vape it per year, so I am not exactly an advocate, but comparing it with tobacco is silly.
steveBK123
I'm doubtful of any motivated reasoning/research that one type of smoke in your lungs is dramatically better than another type of smoke in your lungs... compared with.. no smoke in your lungs.
Have an edible, do whatever you want in your own home, enjoy. But don't rationalize the laissez faire attitude towards one type of secondhand smoke over another.
jf22
Not to nitpick but smelling like pot is not a crime.
steveBK123
Smoking in public parks is
jaapz
But smoking pot is equally unhealthy as smoking tobacco
vharuck
Yup. A lot of people blame environmental hazards for perceived clusters of cancer patients in neighborhoods. But behaviors are much bigger contributors to cancer risk these days. The best ways by far to avoid cancer these days are (1) don't smoke, (2) maintain a healthy BMI, (3) don't drink, and (4) eat plenty of vegetables. If you want to further reduce your risk of dying of cancer, (5) get the recommended screenings, and (6) get regular physical checkups and talk to your doctor about any new health problems.
Reducing one's cancer risk is well within the power of any person. But "People should just have more willpower" is an ineffectual public policy.
a2tech
All the cool kids are back to smoking because vaping became too mainstream.
dagw
Yea. My daughter is 15, and while I don't think she smokes, when we've talked about the dangers of vaping and smoking, she has said that she would never vape, just because it's so lame, but that she finds smoking so much cooler.
shafyy
She's right, smoking is much cooler.
Qem
Electronic cigarretes should be made at least as bad smelling as the original ones. Without the foul stench that acted as a barrier of entry before, I suspect vaping has potential to eventually get >50% of the population hooked.
jaapz
In the Netherlands, we banned flavoured vapes. Now every 12-16 year old has a vape dealer. Just banning is not enough. Society needs to decide vaping is as bad as smoking.
Currently it's still somewhat accepted to vape inside of public buildings. Which, IMHO, is insane
jimt1234
My mother is in the early stages of Alzheimer's. It's terrible. I wouldn't recommend my experience on anyone. That might sound selfish, but it's just so painful to watch her deteriorate, knowing there's nothing that can be done. I watched her take a cognitive test recently - draw a clock, put the hands at 10 after 5. She worked on it for a minute or two, struggled, got it all wrong, then forgot what she was doing. It was one of the most painful things I've ever witnessed.
Sorry for the non-constructive comment. I guess the only constructive-ish thing is to recommend that if you've got elderly loved ones exhibiting short-term memory issues, get them tested ASAP. Then, get the "legal stuff" started right away (powers of attorney).
quesera
That's awful. I've recently gone through a similar process with an aging relative.
Two takeaways for me:
The things the medical industry will do to keep people "alive" are extraordinary, and expensive, and (in some cases) abuses of the concept of "living".
Moving to a sane jurisdiction where assisted suicide is legal is the only possible (but not guaranteed) strategy to approach this problem in a dignified way.
(OK, some people will argue that suicide is never dignified or moral or whatever, but I am not interested in their opinions about what I can do with my body in this situation, or really any others)
jmward01
I like this article, but it, like a lot of things in medicine, seems to focus on the wrong question. It isn't about disease x, it is about quantity and quality of life. I thought the part about Geographic atrophy drugs really emphasized this well. The drugs do -something- but have no impact on quality of life. I really want drug trials to focus on these two things and not proxies like 'lesion growth' which doesn't appear to have a meaningful impact on quality of life. If quality and quantity of life are improving then we can say that we are improving medicine otherwise we are just increasing medicine or worse, medicine is hurting as quality of life drops due to medical procedures that provide no real benefit but have real cost.
bluGill
Quality of life is what everyone cares about, but is is expensive to study. We want this things like lesion growth becuase they are much easier/faster, and thus cheaper to study. There is only so many people who can do this research, and the more work they have to do in one study the less work they can do in others. You can study lesion growth with just 100 people that you follow for a year or two - this is possible for just one person (though for double blind reasons you still want a small team). To study quality of life there are so many other variables that you need tens of thousands of subjects that you follow for a decade just so you can be sure that you can statistically isolate the non-factors.
Thus last I checked statins were only proven to prevent heart attacks in males under the age of 65 who have already had a heart attack. That is a large enough group to show results, and their change of heart attacks is known to be higher than normal so you don't have to study as well. Does this really mean other people should take statins, and if so who - hard to know. Our best evidence after years of study is that high cholesterol increases your odds of a heart attack, but a few people live to their 80s with high cholestrol without ever having a heart attack and nobody really knows why. (I haven't looked at the above in about 10 years so I might not know about some more recent science) We would like better study about statins and quality of life, but those are really expensive, and that is depsite statins being cheap and a lot of people willing to take part in a study.
jmward01
I agree with the need for proxies, but if they are used then there needs to be strong evidence that they are valid and studies should report both the proxy results and the implied quality/quantity of life results based on the proxy results. This would help to put the true potential impact into perspective AND help with followup studies that can more easily check the actual impacts observed verses the predicted impact based on the proxy values. Keeping the focus on quality/quantity at every stage, especially if it is just mentioning that there isn't a strong connection between the study objective and real utility, is deeply important.
narrator
We'd be much closer to a cure if there wasn't that research fraud about the causes of Alzheimers that led science down a dead end for years[1].
[1]https://www.discovermagazine.com/the-sciences/false-alzheime...
Elaris
Reading this article reminded me of my grandparents. In their time, people feared tuberculosis or stroke. Now, when I visit nursing homes, I hear more conversations about memory loss, knee pain, and insomnia. Even my mother now often has trouble sleeping, which has become a daily annoyance in her life. We have indeed made great progress. Many diseases that would have killed people in the past are now controllable and even less common. But at the same time, it seems that we have replaced a new batch of problems: Alzheimer's, loneliness, polypharmacy, insomnia. We live longer, but are we really living better?
bombcar
Loneliness seems to stand out as one that we could "treat" if we really wanted to, as a society.
The problem is it's not something you can pay someone to solve.
Larrikin
Whatever happened to those blood transplants people were getting from younger people? Logically it made sense, but I'm guessing after further study it didn't pan out? Or was it just a trend that didn't get any follow up?
GoatInGrey
There is still ongoing research and testing. It's at a state where we know it has some effect, but we don't know what exactly it is doing and therefore do not have a clear path to optimization.
https://onlinelibrary.wiley.com/doi/10.1111/acel.70103
https://longevity.technology/news/human-trial-finds-therapeu...
1970-01-01
There's weak science behind it. Basically it works, but you need to be a crazy person to think that it is a novel way to cheat death. Death remains undefeated.
GoatInGrey
Treating aging is not the same as treating death. The reason the two are colloquially linked is because aging has been by far the dominant driver of death for all of human history. To your point, aging has never failed to kill a human.
There are a couple reasons to believe that aging is malleable.
One is that we know how to de-age human cells using the same factors that fertilized oocytes use to de-age the underlying egg cell (typically many decades in age). https://en.wikipedia.org/wiki/Induced_pluripotent_stem_cell
The second is that nature has examples of biological immortality. Planaria are a fascinating one as they have among the trashiest, most mutated genome on the planet. They're even polypoid, where they have multiple sets of chromosomes, but they're simultaneously the best regenerators on the planet. Despite having a discrete nervous system and centralized brain, you can slice a planaria into hundreds of pieces, and each of those will regenerate into a full, functional adult. They don't age, they don't get cancer. The issue is that we have no idea how this happens. So there is still a lot for us to learn about the fundamentals of aging and regeneration overall.
1970-01-01
You 2nd point sounds like a quest for literal reincarnation. It is great sci-fi material; When the organism is no longer a single unit, at no point does death occur. The organisms survive continuously, yet they lose no external feature. Is it cheating death? Well, what happens when the original mind meets its millionth copy?
preachermon
> aging has been by far the dominant driver of death for all of human history
not dominant if mean life expectancy is < 40. Aging only has an impact after age 55.
(and if 55 seems young, you have a cushy life)
preachermon
One, ethics
Two, ethics,
Three, it took something like 10K young people per old person to make it work, and it was at best a proof of concept
Four, ethics
otikik
Yeah, Peter Thiel does not have problems One,Two and Four. And Three is a minor inconvenience.
directevolve
Why do you think there’s an ethical problem with this type of blood transfusion?
lenerdenator
Treating?
We're great at that.
Curing?
Horrible.
Which is a real problem seeing as how people want to spend as much money as possible for diminishing returns on lifespan.
BobBagwill
I have this age-related eye disease where all the text on a web page appears to be in a tiny, spindly font, and it appears to fade in as it scrolls. I would blame my eyeglasses, but I'm not wearing any. :-)
projektfu
I'm experiencing that as well. I think the best solution is to get off the computer.
mixmastamyk
Scroll fade is likely due to a low quality screen, and could be replaced with a newer one.
BobBagwill
Nah, JK, it's a stupid CSS trick.
catigula
Unfortunately there's no current or proposed medical treatment for the inevitability of death and degradation on that path, so the only real treatment is philosophical.
At least in Western society, if any of you have experienced this struggle with an older relative burning through resources to desperately cling to life you know that we seem to lack some fundamental ability to approach or handle this topic philosophically.
In no time I'll in the same boat. Secular society doesn't really have a great answer here.
quesera
My secular answer is to live in a jurisdiction which allows assisted suicide, and to have a clear plan registered with my doctors, lawyers, and family.
My fear is that I will lose the decision-making agency quickly and unexpectedly and have my clear wishes disregarded for some stupid technical reason which would require someone to take professional or legal risk to fulfill them.
I've built a room in my house which is designed to be easily disconnected from the building HVAC such that I can safely discharge, and then automatically vent to outdoors, bottles of compressed gaseous nitrogen or helium.
For safety, the prep for discharge requires a few minutes of work, with hands and brain that are at least marginally nimble. I worry very much about the risk of waiting too long, or having a debilitating issue crop up unexpectedly (I am presently of sound mind and body, and not old).
catigula
I'm sorry but this answer is very abnormal for most people so it's not a great application of philosophy.
quesera
I would argue that it is the philosophy that is lacking.
We are afraid of death. That's stupid. Any life model that fails to account for death, is flawed in the extreme. I prefer mine, but I certainly would not impose it on others.
tsoukase
Alzheimer's, Parkinson's, secondary progressive multiple sclerosis, ALS and all other neuro-degenerative diseases are age related and incurable. We are far from aproaching their causes, much more their cure.
I believe they share the same underlying mechanisms (loss of neurons), though in different regions, and their cure is equivalent to immortality.
Anything that we are good at treating doesn’t seem like an age related disease anymore, but we’re really clearing out the scourges if you look at historical cause of death statistics. We haven’t made any progress on Alzheimer’s, and have conquered yellow fever, consumption, diabetes, knee failure, glaucoma, smoking related lung cancer, prostate cancer, hookworm, environmental lead poisoning, environmental arsenic poisoning, black lung, breast cancer, and syphilis. So, if you know someone old and suffering, its probably alzheimers.