 The debate about whether or not aging is or should be considered a disease have been raging for years, and recent developments with the 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 recording and sharing data about diseases and related health problems. Early forms of this date back centuries, but today it is interwoven into policymaking, 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 the 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, XT-90, means aging related, or more specifically, it means caused by pathological processes which persistently lead to the loss of organisms adaptation and progress in older ages. Another change has caused even more controversy. ICD-10 had a code for what could be called senile debility. ICD-11 replaces this code with 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 to 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 agist's 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 will and should continue to be less and less important and less meaningful. After all, what we really care about is biological aging. It doesn't make sense to choose an arbitrary age and say that anyone over that suffers from Old Age. That seems silly today and 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's okay. Today, it may be normal or expected to experience some level of decline with chronological aging, but that doesn't mean that it shouldn't be treated like the medical condition that it is. Older people should not be expected to accept or 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 all 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 them to have a higher blood pressure, not that healthy blood pressure is higher in the elderly. How common or uncommon higher pressure may be in the old 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, that is a logical fallacy that says basically that if something is common then it's also alright, and it is brought up by some as a reason why aging couldn't be a disease. I would suggest watching that entire video because he makes a ton of great points. So I've already expressed where I agree with the people 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-aging 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 aging associated decline in intrinsic capacity. 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 he linked 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 and the definition of an individual's age, from chronological to biological, and will promote the development of therapies to optimize biological age. Another correspondence from Daria Colterina 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 aging-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 weighed 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 canote 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. Near Barzalai, from the American Federation for Aging Research, provided some of his comments on the subject and a recent event with the Alliance for Longevity Initiatives. And if we call aging a disease, a lot of things have to happen, right? 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 sow. They don't want to be called a disease. What do we do? We isolate them, we put them in islands, we throw them, become lonely, right? We just had that. The FDA doesn't want to call aging a disease. ARP doesn't want to call aging a disease. So what does this all mean? Well, 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's going to 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.