Daniel Promislow sits in his office at Tufts University's Jean Mayer USDA Human Nutrition Research Center on Aging in Boston, pondering a question that most longevity researchers rarely ask: What happens to society when people simply don't die?
While geroscientists around the world race to develop drugs that can delay aging and extend human lifespan, Promislow has turned his attention to the unspoken consequences of success. Geroscience—the study of biological aging—assumes that all age-related decline happens through specific biological pathways, and that by targeting these pathways with new drugs called gerotherapeutics, we might fundamentally alter how long humans live. But before we celebrate such breakthroughs, Promislow argues in his recent paper "Lessons for Responsible Geroscience From the History of Longevity" in the AMA Journal of Ethics, we need to reckon with what those longer lives might actually look like.
The field is moving fast. GLP-1 agonists like Ozempic, originally developed to treat diabetes, have shown unexpected powers—reducing obesity, improving heart function, and decreasing mortality from multiple causes. Statins and antihypertensives, drugs already widely prescribed, appear to be functioning as gerotherapeutics, helping people live longer and healthier lives. Dozens of clinical trials are now testing aging-related pathways, with more launching each year. Yet no drug has been formally tested for its ability to extend human lifespan itself—such a trial would take decades and raise profound ethical questions.
The conversation around responsible aging research crystallized for Promislow when he began attending geroscience conferences where biologists discussed the mechanisms of aging, yet no one in the room was a bioethicist, economist, historian, or public health expert. Meeting Nicolai Wohns, a Ph.D. student at the University of Washington who shared his concerns, they began asking a different set of questions. The result was their collaborative paper, framing gerotherapeutics within historical and philosophical context.
That history is worth remembering. Over the past 150 years, human lifespan has doubled—not primarily through medical wizardry, but through agriculture, antibiotics, vaccines, and public health advances that prevented childhood infectious diseases. Now geroscientists are turning their attention to diseases of later life. If they succeed, the ripples could reshape civilization.
Consider the practical complications. Who will have access to life-extending drugs, and who will be denied them? What happens to someone who takes a pill expecting to work another thirty years, only to find that Social Security, already stretched thin, cannot support them? Americans already struggle to save for retirement; longer lifespans could crack the foundation of the entire system.
Then there are the social implications that rarely make it into laboratory discussions. Imagine a drug so powerful that a sixty-year-old could reasonably expect another forty or fifty healthy years. What if you took it, but your children and grandchildren refused? You might live to see great-grandchildren die before you do. The ideal scenario geroscientists envision—living to advanced age in youthful health, then quietly fading away—assumes a kind of orderly mortality that biology may never grant us. The harder question isn't whether we can extend life. It's whether we've thought about what comes next.