Helping Us Live Longer: An Interview with Dylan Livingston

Dylan Livingston is the founder and president of the Alliance for Longevity Initiatives, which aims to create political action around helping us live longer

Dylan Livingston is the president and founder of the Alliance for Longevity Initiatives. It’s a 501(c)4 organization that is devoted to lobbying the government to fund research on the mechanisms behind aging and therapies that will treat it to help people live longer, healthier lives. They’re doing very important work. I can think of few causes more important than helping people have more time to enjoy their lives. There already is a growing longevity industry, but it needs more funding. I wrote about the case for a longevity moonshot funded by the government in an article for the Lincoln Network last year. Below is an email interview that I conducted with Dylan. If you’re interested in his work, you can check out his organization’s website here.

Why did you start the Alliance for Longevity Initiatives (A4LI), and what is the goal of your organization?

The Alliance for Longevity Initiatives (A4LI) is a 501(c)(4) nonprofit advocacy organization focused on increasing healthy life expectancy in the US by helping advance the development of drugs and therapies that target aging. I started A4LI because of a combination of two things. First, I had worked for the Biden campaign and various Democratic-backed organizations in the years leading up to 2020, and developed an impressive political rolodex because of it. I also had become tremendously interested in longevity science as a result of the COVID-19 pandemic, which coincided with my time with the Biden campaign. So it kind of made sense for me personally to try to cross my interest (longevity) with where my prior experience was (politics). Second, and probably more importantly, I noticed there weren’t any other organizations with this goal to advocate for increasing healthy life expectancy in the US through supporting the development of drugs that target aging. I noticed a bit of a gap in this blossoming biotech ecosystem, and I understood the importance of political advocacy especially in the context of bringing a fringe idea to the mainstream. With no clear leadership in the political space, I felt obligated to create A4LI as an entity.

What are the major policies that you’re advocating for?

Congressional allocation priorities don’t maximize the longevity industry's ability to be effective.  Right now, the National Institute on Aging’s Division of Aging Biology, the agency set up to research and fund geroscience-focused projects, is only allocated about $400 million dollars a year, compared to the roughly $52 billion dollar NIH budget. If aging therapeutics promise to prevent/treat the chronic diseases associated with aging, diseases the government spends billions of dollars trying to cure, why is research into aging therapeutics so small? That is something A4LI is looking to change — we want to increase that number to at least a billion dollars by 2025.

As I’m sure much of this audience knows, aging is not considered a disease in the eyes of the FDA, and we won’t be pushing for that designation change at this time. What we’re really looking to do is create a path forward for longevity/aging biotechnology companies, a path that gives them advantages while developing these drugs and therapies that will eventually target aging. A4LI would like to help create an analog to the Regenerative Medicine Advanced Therapy Pathway for companies that classify as “longevity medicine” companies. Under the “LMAT” Pathway, eligible longevity companies (as selected by the FDA) would be given advantages like being given fast-track or breakthrough therapy designation.

In a broader context, we want to make Congress a participant in and promoter of increasing healthy lifespan in the U.S. We want to see the U.S. adopt a similar position to the U.K., where they are pushing for “everyone to have five extra years of healthy, independent life by 2035.” However, we would like the U.S. government to be a bit more audacious. One thing the COVID-19 pandemic showed us is that when the U.S. government wants to get something done, like developing and distributing multiple effective vaccines, it can easily. Political will is very powerful. We want to give the longevity movement a COVID-19 level of political willpower.

What would be the benefit for individuals, the economy, the government budget, and society if people could be healthier into old age?

Individuals will benefit by being able to live in better health for longer. Aging therapies promise to ward off the diseases associated with aging, such as cancer, heart disease, Alzheimer’s, stroke, diabetes and the disabling conditions associated with aging, such as immune system dysfunction, arthritis, loss of muscle, etc. From that, individuals will be able to work longer, make more money and have more fulfilling careers. They’ll also be able to spend more time with their families and loved ones. Who doesn’t want that?

The economy will benefit in unprecedented ways from increasing healthy life expectancy. The various iterations of the longevity dividend argument state that we could see anywhere from ~$3 to $37 trillion dollars in added GDP by adding one extra year of life expectancy. These gains will come from reducing healthcare costs and a massive increase in population productivity, as our workforce will include older, more experienced workers with the clarity and energy of a younger worker.  The increase in GDP would help the US government balance its budget, which would allow the United States to continue to be a promoter of democracy and global stability (something that’s clearly needed at the moment and for the foreseeable future) while also being able to take care of its citizens back home. 

I think we would see more cross-generational relationships, both platonic and romantic. I think society would “relax” a bit more, in the sense that people wouldn’t be pressured to go to college out of high school, women wouldn’t feel pressured to have children at a certain time in their lives, etc. I think multiple careers in different areas will become common, and I think that’s a good thing for our economy — cross-disciplinary work generally results in great things. The introduction of effective gerotherapies will afford people more time to live in better health, and I think that would cause everyone to be a lot happier.

Tell me more about the future that you’re trying to create. Is it a future where people when they’re 80 can be nearly as healthy as when they were 30? Or where people can live past 100 and be healthy?

Officially, the organization is looking to increase life expectancy year over year, so the future A4LI is trying to create is one where politicians actively pass legislation that will achieve that goal. Personally though, of course I’d love to see a future where people can remain in a healthy, youthful state as they age. This may or may not be controversial, and I am not speaking for the organization here, but I want to see a future where aging and the poor health associated with it becomes optional. I want to see a world where your effort in taking care of your body directly correlates to how physically healthy you are. That really was one of the things that got me so invested in longevity — seeing my 94-year-old grandfather, (who takes excellent care for himself — daily mile-plus walks, eats perfect, and golfs regularly) terrified of COVID-19 strictly because of his age. The difference in the outcome of COVID between him and me is really just our age, not effort, and that’s one of the great injustices of life, an injustice I plan to dedicate my life to fixing.

Why do you think the US government hasn’t done more to try to increase our healthspans and lifespans?

Because for all of human history, we haven’t been able to manipulate the rates at which we age, until literally the last few years. I don’t blame them. But now that there is significant proof in the laboratory that the aging process can be manipulated, attention needs to be paid. There also hasn’t been any sort of public persuasion campaign — much of the money being spent is going toward the labs and drug development aspect (rightfully so), but if the longevity industry wants to see the government get more involved in increasing lifespan, the industry must become activists. The loudest and most well-funded activists are the ones that get the attention of Congress, plain and simple. If we want the government to take notice of longevity, we need to be among the loudest and most well funded, period; there is no way around that fact.

There have been recent private-sector efforts to conduct longevity research, like at Altos Labs and NewLimit. Is it possible that the private sector can do enough for longevity research without government involvement? Why do you think the government needs to get involved?

The US government’s budget dwarfs both companies' funding. The NIH alone has $52 billion dollars. And why is it bad if another player (the US government) throws its hat in the aging biomedical research ring? No one complains when new companies are getting funded each week. What’s the downside of allocating more funds toward aging research, and who cares where the funds are coming from? Also, these government funds are directed to more foundational research, which is a good thing because it allows VC’s to do their job properly (company build and commercialize) rather than seed a scientific concept that may or may not work. Also, something like 80% of the longevity companies in existence are based in the US, and we want the government involved so we can properly change policies and regulations to make it easier for the majority of the industry to operate more easily. NewLimit and Altos Labs are ultimately at the mercy of the FDA and US government, so I would assume they want to have a dialogue with Congress and regulators.  

Why do you think it’s important for therapies to treat aging directly, rather than individual diseases like cancer and Alzheimer’s?

Because gerotherapies have much wider-reaching effects than a drug focused on curing one specific disease. It’s worth noting that around 60% of people over 65 are dealing with more than one of these chronic, age-related diseases at one time. Gerotherapies would target all of the diseases that come with aging, unlike an Alzheimer’s or cancer drug which will only target that one specific disease. Again, don’t quote me exactly on the numbers, but we spend all this money and time to treat and cure cancer, but the fact of the matter is that curing cancer would only increase average lifespan in the US by like 2 years. Same with all of those diseases of aging — curing them gives you only a few more years of life. By taking this geroscience approach, we can tackle all of the diseases of aging at once and instead of us only gaining 2 years because we cure cancer, we would gain another 2 or so years from that, as well as another 2 from defeating diabetes, another 2 years for heart disease, etc., etc. So by creating successful gerotherapies, we can add a much more healthy lifespan to peoples lives rather than one disease at a time. Plus, aging therapies target things that impact quality of life, like muscle loss, weakened bones, arthritis – all the things that cause 75-year-olds to be less athletic and energetic than they were at 25 years old. My point is, gerotherapies or therapies that target aging have such a wide-reaching effect that it’s hard to argue against putting more research money into aging therapeutics development.

Some longevity advocates argue that the FDA is standing in the way of innovation in longevity. What kind of FDA reform, if any, do you think would be helpful to speed up innovation in longevity research?

A lot of people want to see “aging as a disease,” but the issue is that there aren’t biomarkers that the FDA and the entire aging research community can agree on. That’s a major obstacle, and gives FDA officials pause. What we would like to see happen is the establishment of the LMAT or Longevity Medicine Advanced Therapeutics pathway. This would be analogous to the RMAT (Regenerative Medicine Advanced Therapeutics pathway), but for drugs that target the aging or aspects of aging. Under LMAT, the most promising longevity therapeutics, as decided by the FDA, would be given special drug development priorities like breakthrough designation. Hopefully over time, we can get these companies who get accepted under the LMAT designation to work side-by-side with the FDA to establish and agree on biomarkers for aging in a public-private partnership type of agreement. We’re still working on the details of this policy proposal, so check back with us in a few weeks for more details.

Some people argue that science funding needs fundamental reform, since scientists spend a lot of their time writing grant proposals and avoid areas of research that are riskier because they’re less likely to get funding. Do you agree with that, and if so, what kind of reforms to science funding do you recommend?

That’s why we are pushing hard for ARPA-H to have program managers with a geroscience focus or project. ARPA-H was pretty much created to circumvent this issue, and allow for the higher-risk, highest-reward biomedical research endeavors, like developing drugs and therapies that target aging. The current administration supports ARPA-H too, which we’re happy about, but we want to make sure they understand where the focus needs to be – aging and rejuvenation therapeutic developments. 

What needs to be done to get politicians to prioritize longevity research? Do we need a mass movement?

What politicians need to do, first and foremost, is get this longevity caucus together. I truly believe that political and societal will is the biggest roadblock in the longevity formula. Leading scientists have more or less accepted that aging can be reversed, and big-time institutional investors and VC’s are funding these endeavors. Politicians need to get their act together in regard to the longevity biotech field, understand the unfathomable potential of this field to completely revolutionize humanity for the better, and support (via policy) everything from foundational drug discovery endeavors to commercializing said drugs. Politicians need to understand that the longevity dividend states that if we increase healthy lifespan, GDP also skyrockets and would relieve much of the issues we bicker about: funds for climate change, defense spending, welfare, etc. Having this caucus gives us an audience of decision-makers for the thesis above, and so that’s why setting up the caucus is the first thing Congress needs to get done to prioritize longevity research.

From there, they’ll need to completely buy into the geroscience approach. We don’t want this caucus to be a palliative care-focused caucus — one that discusses more accessible ramps for seniors, more meals on wheels, things like that. This caucus needs to be focused on pushing for research initiatives that will prevent elderly people from even needing things like wheelchairs and home service. We want all adults to be as self-sufficient as possible — it’s better for the patient and caregiver.

So to answer your question, no I don’t think we need a mass movement to get many of the things we want to get done, but don’t get me wrong, we’re pushing to create a mass movement regardless because the more voices calling for these reforms, the better. But I don’t anticipate that happening in the next year or two. We will need to create a mass movement once longevity therapies 1.0 are ready to hit the market, and will need to advocate that as many insurance providers cover said therapies, and that patients, sick or not, participate in these therapies so we, the United States, can achieve the tremendous economic reward associated with the longevity dividend.

How can people learn more about what you’re working on?

By visiting our website a4li.org and joining our mailing list. By becoming a member and quite honestly, contributing as much money as you feel comfortable contributing (as much as I personally hate to say that). The unfortunate fact in this 501(c)(4) political advocacy world is that your effectiveness is super closely tied to your fundraising levels.

Two of the most politically prominent 501(c)(4)s in the country, in my opinion, are the NRA and Sierra Club. There is a reason that gun laws have hardly changed in the last 30 years, and that’s because the NRA has been the fundraising behemoth that has the funds that allow them to hire advocates to advocate like hell for the policies they support. The reason that climate change has become the number one issue of the Democratic Party is because advocacy organizations like Sierra Club (and other groups) have hundreds of millions of dollars to pay for organizers, advocates and lobbyists. These two organizations attract polar opposite types of people, but they have two commonalities. They’re funded up the wazoo, and they’re funded by small dollar donations (less than $200) from people who believe in the cause. That’s what A4LI needs; we need all of the people in America who believe that the government should make a concerted effort to increase life expectancy to ALL put their money where their mouth is and financially support A4LI, even if it's not a ton. We need all of your help to make this world a better place, where people can live in more robust health for a much longer time.