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The nature of evidence in aging research
Posted on June 5th, 2017 by Dr Andrew A. Parsons in Pharma R&D
It seems a while since there was focus on aging as a suitable target for pharmaceutical intervention. The days of Sirtuins and red wine may be long gone, but the scope of the opportunity to support healthy aging is becoming more relevant. It was therefore with some interest that I noticed several recent articles in FierceBiotech.
Developments in muscle regeneration have identified a critical step involved with the stem cell-induced regeneration of new muscle tissue (1). As the article points out, inducing old cells to create new ones may carry risks associated with impaired cell function and even tumor production. However, this research could provide insights into how to prevent muscle loss and potential decline in motor function. Such an approach may have applications in a number of areas.
Focus on the aging condition seems to be becoming popular again. Interest in how to “stay young” is certainly not new; this has been a topic in folk stories and plenty of Hollywood productions for many years. Our drive to stay healthy and offset the aging process sustains the use of nonprescription products, cosmeceuticals, food additives and diet choice. Although it may be unlikely that R&D will develop an elixir of youth, there appears to be growing interest in the re-purposing of some older products such as metformin (2) and interest in the power of stem cells for rejuvenation (3).
There are many potential risks associated with the non-regulated use of medicines, particularly with stem cell approaches. However, it struck me that the issue of translating scientific knowledge into evidence-based approaches is likely to be highly challenging in this area. The traditional approach of randomized controlled trials within a process that is very individual to our own situation and context will need to recruit large numbers of individuals to allow for our individual differences.
This challenge is not unique to the pharmaceutical R&D sector, and other professional groups are starting to note the move of our industry to a personalized approach (4). In her article, Prof. Jordan notes the difficulties in translating the observation that we rely on a range of learning styles. By definition, these styles are influenced by our context and situation. We are therefore likely to use a range of approaches even though we may have a preference. Perhaps not surprisingly, putting learners into rigid style groups has not led to clear benefits in group outcomes. She notes the differences between an evidence-based treatment (EBT) and an evidence-based practice (EBP). These key differences were first outlined with a focus on autism (5) and provide some food for thought for the real-world use of medicines.
An EBT is a specific treatment of a condition with a pre-defined agent, often used with pharmaceutical agents. An EBP uses individual scientific design to work with an individual person. These approaches are just different ways of looking at the issue of creating evidence. This key difference in epistemology (different ways of knowing) is perhaps something to inform the critical interface of medical and social functions which are represented in aging and other conditions.
What might happen if we take this dual approach? I think it will be an impetus for designing treatment solutions rather than treatment products. It will support a shift in the focus much more centrally towards the individual, rather than the group. Of course, there are no simple answers for the range of issues concerning medicine safety, efficacy and effectiveness. However, as other industries look to the personalized medicine approach, perhaps the pharma industry needs to learn from other sectors about how to best offer lifestyle solutions.
With the development of more personalized, focused technologies from health tech to individual medicine, these issues will require some thought and action.
- Jordan, R. (2017), Why don’t educators listen to us? Psychologist (May) page 2
- Mesibov, G.B. & Shea, V. (2011). Evidence-based practice and autism. Autism 15: 114-133.
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Dr Andrew A. Parsons
Director of Reciprocal Minds Limited & Chairman of Pharmasum Therapeutics AS
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