David Sinclair, ILC’s Chief Executive, reflects on the ICLAM conference in Estoril, Portugal in May 2025 and on meeting Jay Olshansky, a professor at the School of Public Health, University of Illinois Chicago. 

I had the real pleasure last month of presenting a “double-header” keynote at the International Committee for Insurance Medicine conference in Portugal.

I’m definitely not worthy of the billing, but it was fun – and a real honour – to speak alongside Professor Jay Olshansky.

Rather than reflect on my own (truly inspirational, of course) presentation on the future of ageing, I wanted to share some thoughts on Professor Olshansky’s contribution.

Jay reflected on how remarkable medical and health advances have been, arguing that without them, the limits to life expectancy might still be in the mid-60s – with a few outliers.

He has recently published on the Implausibility of radical life extension in humans in the twenty-first century. Simply put, the mathematics alone make it extremely difficult to see how radical life extension could be achieved. We would probably need to cure everything to reach an average life expectancy of 90 – and even then, vast numbers would need to live well beyond this to shift the average.

Back in 2008, the geneticist Steve Jones made similar arguments:

“If you want to know what utopia looks like,” he says, “just look around you. The human race has reached the point where it can step off the evolutionary treadmill. Advances in technology, medicine and culture mean it isn’t just the fittest who get to pass their genes on to the next generation.

In ancient times, half our children would have died before the age of twenty. In Western societies today, 98% survive to the age of 21, and life expectancy is so good that even eliminating accidents and infectious disease would only raise it by another year or two. These days, almost everyone gets to hand their genes on through their children.”

We’ve long known that there are diminishing returns in life expectancy growth. Professor Olshansky reminded us that Gompertz (1825) and Makeham (1887) outlined the “law of mortality” – the exponentially increasing rate of mortality with age – and introduced the idea of life table entropy.

The real challenge today isn’t life extension – it’s addressing what Professor Olshansky calls the red zone, broadly defined as the gap between life expectancy and healthy life expectancy. He argued that while the red zone may always exist, it needn’t last 10 years.

And therein lies an opportunity. Over recent years, the idea of geroscience – the study of the relationship between ageing and common age-related diseases – has gained significant traction. Professor Olshansky argued that we are on the verge of a breakthrough.

There has been growing interest in metformin as a potential low-cost intervention, while others are exploring the potential of GLP-1 receptor agonists. One audience member suggested that the way our bodies process insulin might hold the key. Who knows? Jay was clear that he didn’t know what the breakthrough would be – but he made the case that we can and should be exploring medications that target ageing itself, not just individual diseases.

The move towards geroscience has led some to argue for ageing to be classified as a disease. The WHO nearly accepted that position a few years ago. I agree with Jay that ageing is “no more a disease than puberty or menopause”.

So why are people pushing for this? Partly because if ageing is defined as a disease, it becomes easier to justify investment – both from governments and from private sector funders – in therapeutic interventions. Jay argued that we don’t really need to worry about this, as regulators (at least in the US) have already accepted the rationale for targeting ageing.

In recent years, I’ve observed growing attention to the science of longevity and life extension – but there is a risk that we are selling false hope. “Longevity is the second oldest profession,” Jay quipped.

He also stressed that solutions don’t lie solely in medication. If insulin regulation – or calorie balance – is important, then we should be focusing more on exercise and diet.