Somewhere in the future I envision a global population of people who, on average, live to 100 and stay healthy to the end of their lives. The first part of that equation—staying alive to 100 or even more—is becoming increasingly likely. According to current projections, the average baby girl born in 2030 in the industrialized world can expect to live to 92 years of age.1 But will she be enjoying an active, vital life at that age? Probably not––unless we can find ways to prevent age-related chronic illness and frailty.
This is the impetus behind the Janssen Prevention Center. One year ago, the Janssen Pharmaceutical Companies of Johnson & Johnson announced the launch of our center to break new ground in the area of disease prevention. The focus of our work is to discover ways to prevent the illness and infirmity that typically come with age.
Life expectancy at birth across the sexes has increased over the past 150 years by approximately 3 months each year. In the industrialized countries, this gain has been mainly attributable to reduced child mortality (between 1900 and 1925), then to reduced mortality among adults under 65 years of age (between 1925 and 1975) and from around the 1990s to increased survival among people aged 65 and older. Developing countries are following behind this trend.2
As a result, life expectancy is now mainly determined by what happens in the elderly. Three factors play a role here: aging itself, age-related diseases, and the tendency for elderly people to have multiple diseases. These days, more than 50% of elderly people live with two chronic diseases and die with three or more. These are the illnesses that must be prevented to extend everyone’s health span, or number of healthy years.
Lifelong freedom from disease
At the Janssen Prevention Center, we envision a world where everyone lives a productive life free from debilitating chronic illness. I invented the term ‘immorbidity’ to describe this state of aging in total freedom from disease. To me, the road to immorbidity is quite clear, as is the need to explore this new terrain.
Without the intervention of science, our life span will keep increasing, but our health span will not. In other words, the period of suffering in old age will increase if we don’t do something. But what should we do? First, we must extend the health span by preventing diseases that come with age, such as cardiovascular disease, cancers, Alzheimer’s disease and frailty. Next, or in parallel, we must slow down biological aging during the health span. The ultimate goal will be for people to reach their 100th birthday in good health – and leave this world peacefully when their vital functions give out.
This raises the question of what ‘health’ really is. Many of us are incubating a chronic disease (or more than one) even while we feel completely healthy. The problem is, we don’t know which diseases, if any, we are incubating and how long it will take before we become ill.
To establish how healthy we really are––that is, whether we are already incubating a disease––two kinds of biological measurements, or ‘biomarkers’, need to be developed. One should indicate increased risk for a disease, by marking the start of the incubation period. The other should predict the time left before symptomatic disease will appear, in the absence of effective intervention.
These biomarkers could be universal, reflecting the progression of biological age, or specific for each of the diseases that come with age. When assessing a person’s ‘true’ health, we have to take into account that every individual is a complex melting pot of modifiable risk factors.
Maintaining health for life
What can we do to stay healthy as we age? At the moment, we can try to reduce our risks for chronic illnesses by adopting a healthier lifestyle: by eating better, sleeping more, drinking less, quitting smoking and moving more.
I believe that one day healthcare professionals will be able to prescribe more personalized, targeted and effective preventive interventions. I foresee that individuals will be able to take a safe preventive medicine to eliminate their proven increased risk of chronic illness. The beneficial effect of this intervention will be measurable, because it will change biomarker levels from ‘bad’ (predicting a short time to disease) to ‘good’ (indicating the long-term or indefinite postponement of disease).
I envision a world where it is normal for people to stay healthy for 100 years or more – because prevention markers are available to simply measure health status and guide individuals to good health. And everyone has access to preventive medicines that can preserve their health and vitality all the way to the end of a long, fulfilled life. I’m proud that the Janssen Prevention Center is driving research on both fronts.
Jaap Goudsmit was appointed Global Head of the Janssen Prevention Center, part of the Janssen Pharmaceutical Companies of Johnson & Johnson, on January 1, 2015. Before then, he was Chief Executive Officer and Chief Scientific Officer of the Crucell Vaccine Institute (CVI), a discovery institute founded shortly after the acquisition of vaccine company Crucell by Johnson & Johnson in 2011. He is an M.D., Ph.D., and a medical microbiologist by background. He has held various positions at the Academic Medical Center (AMC) of the University of Amsterdam, the Netherlands, and has been a professor at the AMC since 1989. Prof. Goudsmit is special advisor to Trevor Mundel, President of Global Health at the Bill & Melinda Gates Foundation, and chairs an external advisory board that supports the foundation’s HIV program. He was founding chair of the Scientific Advisory Committee of the International AIDS Vaccine Initiative (IAVI) and cofounder of EuroVac, the European Union vaccine effort against HIV.
1 Source: Nature, Vol 492, 6 December 2012
2 Source: Nature, Vol 492, 6 December 2012