Repairing Ageing or Curing Ageing?

When we talk about curing ageing, it is tempting to imagine that there is one obvious objective, which is to find a way to stop the human body from deteriorating and therefore allow people to remain healthy for much longer than they do today. There are two different ways of approaching that goal, one approach is to repair the damage that ageing causes, while the other is to alter the underlying biological processes that cause ageing in the first place.

The longevity scientist Aubrey de Grey's philosophy is built around the idea that ageing can be understood, at least in large part, as an accumulation of molecular and cellular damage. Rather than attempting to prevent every biochemical process that produces this damage, he proposes developing therapies that can periodically repair or remove it, and the important point here is that the objective is not simply to treat the diseases that tend to appear in old age, but instead to intervene earlier and repair the underlying cellular and molecular problems before they eventually develop into disease.

He divides ageing damage into several broad categories, including the loss of cells, the accumulation of senescent cells, mitochondrial mutations, intracellular and extracellular waste and structural changes such as extracellular crosslinking. The proposed solutions therefore include regenerative medicine, gene therapies, molecular waste removal and the elimination of senescent cells, among other approaches. This is a serious and intellectually appealing way of thinking about ageing because, if an ageing body accumulates damage over time, it seems reasonable to ask why we should not simply find ways to remove that damage and restore the body to a more functional state. A classic car provides a useful analogy for understanding the idea.

Imagine a classic car that is kept in exceptionally good working order for several decades, and as its tyres gradually wear out, they are replaced, while its brakes are renewed when they begin to deteriorate and, eventually, components of the engine are replaced as they become worn out. The suspension can also be renewed, the electrical system can be repaired when faults develop, and the bodywork can be restored when it begins to corrode. If this process of maintenance is sufficiently effective, then there is no obvious reason, at least in principle, why a sufficiently well-maintained car could not remain functional for an extraordinarily long period of time.

De Grey explicitly makes use of this kind of engineering-maintenance analogy, because his argument is essentially that the human body could similarly be maintained by repairing the damage that normal metabolism inevitably produces over time. There is something quite compelling about this idea because we do not necessarily need to understand every single detail of why a car ages in order to keep repairing it; instead, we need to understand what has gone wrong, identify the component that has failed or deteriorated, and then develop a reliable way of fixing or replacing it. If that principle can be successfully transferred from engineering to biology, then perhaps we could maintain a human body in much the same way.

However, this is where I have a philosophical reservation, because even if we eventually develop extraordinarily sophisticated rejuvenation medicine, there remains an important question about what exactly we would mean by having "cured" ageing. Suppose, for example, that at the age of 60 you undergo a treatment that restores your tissues to something resembling their condition when you were 40, and as a result you remain healthy for another 20 years. At 80, the damage has accumulated again, and so you undergo another treatment, while at 100 you require another, and then at 120 you require another after that.

Such a development would unquestionably represent an astonishing medical achievement, because it could allow people to remain healthy for vastly longer than they do today. Nevertheless, we would still have to ask whether we had actually cured ageing, or whether we had simply become exceptionally good at maintaining an ageing organism. To me, that distinction is important, because there is a conceptual difference between stopping a biological process and repeatedly repairing the consequences produced by that process.

A facelift provides a relatively simple illustration of this distinction. A facelift can make an ageing face look considerably younger, and although the result can be dramatic, the underlying biological processes of ageing continue regardless. Eventually, therefore, another facelift might be required, and nobody would normally describe the original facelift as having cured ageing. It has altered one of the visible consequences of ageing, but it has not fundamentally changed the process that produced that consequence.

Likewise, imagine a future in which we could repeatedly restore an elderly person's tissues to a youthful state, perhaps even making an 80-year-old function biologically more like a 40-year-old. That would certainly be revolutionary medicine, and it could potentially transform the human experience of old age, but if the underlying biological ageing process continued beneath the treatment and continued producing the same forms of damage, then I would still describe this as a form of age management. It would be extraordinarily sophisticated and effective age management, but it would nevertheless still be age management.

This is where the classic-car analogy becomes particularly interesting, because de Grey's answer is essentially that it does not necessarily matter whether the car's components would naturally deteriorate if we become sufficiently good at replacing them. If the car can remain permanently functional because we are capable of continually repairing whatever goes wrong, then from a practical perspective we have effectively defeated the consequences of ageing, even if we have not eliminated every underlying reason why individual components would otherwise deteriorate. I think that is a perfectly reasonable definition of success, and indeed, from a practical medical perspective, it might be the definition that matters most. However, there is another way of looking at the same car, and that is to ask whether we could eventually discover why every component was wearing out in the first place.

Suppose that, rather than continually replacing the car's parts, we discovered how to alter the underlying mechanisms that caused those parts to deteriorate. Imagine that we could change the engine so that it no longer gradually wore out, alter the suspension so that it no longer degraded, prevent the electrical system from accumulating faults, and protect the bodywork from corroding. In that situation, we would no longer merely have become exceptionally good at repairing an old car; instead, we would have fundamentally changed the ageing process of the car itself.

That, to me, is a fundamentally different achievement, and it is a distinction that I think can become lost when the term "anti-ageing" is used too broadly. If we use the same phrase to describe everything from slowing biological deterioration to periodically repairing accumulated damage and, ultimately, completely preventing the biological processes associated with ageing, then we risk treating very different achievements as though they were essentially the same thing.

There is actually a third approach as well, because rather than repairing damage after it has appeared, we can attempt to slow the rate at which that damage accumulates in the first place. This is where many of the interventions being investigated within geroscience sit, because exercise, nutrition and various pharmacological interventions might influence processes such as metabolism, nutrient sensing, inflammation, mitochondrial function, autophagy and other biological mechanisms that are associated with ageing.

The drug Rapamycin is particularly interesting in this context because it targets mTOR, which is a major nutrient and growth-sensing pathway, and its effects have made it one of the more extensively studied pharmacological approaches to slowing certain aspects of ageing. However, even here, there is an important conceptual distinction, because slowing ageing is not necessarily the same thing as stopping ageing. If a drug reduces the rate at which biological deterioration occurs by 20%, for example, that could still be enormously valuable if it means that a person remains healthy for several additional years. Nevertheless, the underlying ageing process would still be operating, albeit at a slower rate.

This is why I find the distinction between slowing, repairing and stopping ageing so useful, because it allows us to separate several different goals that are sometimes grouped together under the same general term. Slowing ageing means that damage accumulates more slowly, while repairing ageing means that accumulated damage is periodically removed or corrected, and stopping ageing would mean that the underlying processes responsible for progressive biological deterioration had been fundamentally altered. Reversing ageing would then take the idea one step further, because it would involve restoring an already old organism to a younger biological state and then somehow allowing it to remain in that state rather than simply beginning the ageing process again.

None of this means that the “repair-and-repeat” approach should be dismissed, because far from being something I would consider undesirable, it could represent one of the greatest achievements in the history of medicine. If I could choose between ageing normally and having access to periodic treatments that restored my biological condition to that of a much younger person, I would choose the latter. A treatment that allowed an 80-year-old (I am not 80, by the way!) to function more like a healthy 50-year-old would be an extraordinary achievement, even if that treatment had to be repeated throughout the person's life, and de Grey's concept of “longevity escape velocity” makes the argument considerably more ambitious still.

The basic idea behind longevity escape velocity is that the first generation of rejuvenation therapies does not necessarily have to solve every form of ageing damage once and for all. Instead, those therapies would only need to provide enough additional healthy life for subsequent generations of technology to be developed, and those improved therapies could then provide additional time for still better therapies to emerge. In this way, each generation of medicine could potentially extend healthy life sufficiently for the next generation of medicine to arrive before the damage of ageing once again became overwhelming.

Under that scenario, medicine could theoretically remain ahead of ageing indefinitely, and the person would therefore not necessarily receive exactly the same treatment every few years forever because the treatments themselves would continue to improve. First-generation rejuvenation might repair some forms of damage, while second-generation therapies could repair a broader range of problems, and third-generation therapies might become considerably more precise, effective and safer. Eventually, the cumulative effect of these improvements could potentially result in indefinite healthy life, which is an extremely interesting possibility even if it does not quite amount to what I would personally call a cure for the ageing process itself.

For me, a genuine cure for ageing would require something more fundamental. Imagine, for example, that at the age of 60 a person undergoes an intervention that restores their biological state to approximately that of a 40-year-old, but instead of simply allowing the same ageing processes to begin again, the intervention has fundamentally altered whatever mechanisms are responsible for progressive biological deterioration. In that situation, the person could remain biologically around 40 even as their chronological age continued to increase, so that at 70 they were still biologically 40, at 80 they were still biologically 40, and even at 100 or 120 they remained approximately at that same biological state.

Such a person might still eventually die from an accident, an infection, cancer or some other disease, because preventing ageing would not necessarily make someone completely invulnerable to every possible cause of death. However, they would no longer be undergoing the progressive biological deterioration that we currently call ageing, and therefore I think such an intervention would genuinely deserve to be described as a cure. It would no longer be a matter of continually putting a plaster over the consequences of ageing; instead, it would be more like removing the mechanism that keeps producing the wound. There is also no reason to think that these different approaches are mutually exclusive, because the eventual longevity toolbox could contain several different layers that work alongside one another.

Bob Dylan and the Art of Recontextualising

When Bob Dylan was given the Nobel Prize in Literature in 2016, the Swedish Academy praised him for 'having created new poetic expressions within the great American song tradition'. As a Dylan fan for over 30 years, I can wholeheartedly agree with this assessment. But I would take it further. For me, his true genius lies in his use of “intertextuality” (a literary term for borrowing elements from other creative works and making them resonate with meanings that they might not have had in their original context.)

To many Dylan fans, what I have just said might seem to diminish him as a genius. For me, the opposite is the case. This aspect of Dylan is paramount to understanding how the organisation of his songs’ texts creates such wide-ranging meanings seemingly effortlessly. Put another way, his use of sampling, recontextualising and stitching together disparate fragments of human culture is exactly what makes his work uniquely resonant. Dylan's originality, in other words, partly comes from his ability to be “unoriginal”.

Dylan did not invent the technique of borrowing lines for intertextual purposes. He inherited it from the traditional folk, blues and ballad traditions of the early 20th century. In those genres, song lyrics were not necessarily set in stone but were more fluid. Singers habitually borrowed a verse from, say, a 19th-century ballad and another from a Mississippi Delta blues song, placing them both within another song. A song was less a fixed object than part of a constantly evolving tradition.

So what Dylan did was not particularly remarkable within the folk tradition. But he took this folk ethos and elevated it into a modern fine art. One could argue that this approach had already been developed in literature, most notably by T. S. Eliot. The Waste Land, for example, is constructed from fragments of different literary, religious and cultural traditions. Eliot takes material from Shakespeare, Dante, the Bible, popular songs and classical literature and places it into a new context. But I would argue that Dylan took to this approach more naturally than Eliot. Eliot made the collage visible. Dylan made it invisible yet more effective.

That distinction is important. Eliot often wants us to notice the collision between the different sources. Dylan frequently conceals the seams. A listener can hear a Dylan song and experience it as a unified piece of writing without necessarily realising that parts of it may have originated decades, centuries or even thousands of years earlier.

Here are just three examples of Dylan’s intertextual approach.

In his 2001 album Love and Theft, he borrowed several lines from Confessions of a Yakuza, a 1989 book by Junichi Saga. When Saga heard about this, he was apparently flattered. In his 2006 album Modern Times, Dylan borrowed fragments from the Roman poet Ovid and the Civil War poet Henry Timrod. And in his 1985 song 'Tight Connection to My Heart', he borrowed a line from a 1967 episode of Star Trek spoken by Captain Kirk.

The important point is that Dylan isn't simply taking phrases because he likes the way they sound. His genius is not merely in finding a phrase, but in knowing where to place it. That is where borrowing becomes transformation.

In its original context, a line or phrase serves a particular, often functional purpose. But when Dylan takes that line and places it somewhere completely different, its meaning changes because its surroundings have changed. ‘I’ll go along with the charade’, for example, is a line from Star Trek. In that context it is simply dialogue spoken by Captain Kirk. But when Dylan places it into a song about emotional exhaustion and failed relationships, the phrase suddenly becomes a poignant reflection on human deception and the performance of a relationship that has already begun to collapse.

This is why I think it is useful to think of Dylan as an editor of human experience. An editor doesn't necessarily create all the raw material. The genius lies in selection, arrangement and juxtaposition: knowing which fragments belong together and understanding what happens when they are placed alongside one another.

The same principle applies on a much larger scale. Dylan has absorbed biblical language, blues idioms, folk ballads, Beat poetry, noir fiction, cinema, Shakespeare, old songs and the American vernacular.

When a Dylan song contains fragments of old folk songs, biblical verse, noir films and classic literature, it gathers an innate sense of historical weight. Even if a listener does not identify the exact origin of a line, the song can still feel oddly familiar. There is a sense that they have heard something like this before, even if they cannot quite say where. Dylan therefore creates a concentrated web of shared human memory.

The song feels timeless not because it was written in a vacuum, but because it is constructed from the very building blocks of the culture around it. He takes language that already carries cultural associations and gives those associations a purpose.

Dylan's genius isn't merely that he creates language from nothing. It is that he knows which pieces of language already exist, understands the cultural weight they carry and knows exactly where to put them. He is, in that sense, not simply a songwriter. He is a curator of human language and memory.

That, to me, is why Bob Dylan is a genius.

'Why the Rise of "Professors of Practice" Is Fracturing Higher Education' by Ryan Soames—guest blogger

In higher education, few initiatives cause as much unspoken resentment, or ideological friction, as the rise of the "Professor of Practice". Originally intended to bring real-world experience in government, diplomacy, business and public leadership into universities, these appointments have become increasingly common across elite institutions.

At their best, they offer students direct access to people who have shaped policy, negotiated treaties or led major organisations. At their worst, they blur the line between practical authority and academic authority, turning faculty appointments into prestige assets rather than scholarly ones. This distinction matters because practical expertise and scholarly expertise are not the same thing.

The traditional academic route is long and arduous. Earning a doctorate and securing a permanent academic position typically requires years of methodological training, peer review, original research and sustained contribution to a discipline's knowledge base. Universities have historically treated that process as the foundation of intellectual authority.

Practitioner appointments depend on a different kind of expertise: execution rather than analysis. Having governed a country, negotiated a peace agreement or run a multinational company undoubtedly offers valuable insights into decision-making. But critics argue that having done a job is not the same as understanding the broader systems that produce its successes and failures.

Without formal training in research methods or pedagogy, practitioner-led courses can drift towards memoir delivered as lecture, rich in personal anecdotes, but less equipped to teach students how to interrogate evidence, construct arguments or conduct independent research.

The timing of this trend makes it particularly contentious. It has expanded alongside a deepening employment crisis for early-career academics. Across many universities, doctoral graduates and postdoctoral researchers face years of temporary contracts, insecure employment and shrinking opportunities for permanent positions.

To someone who has spent a decade publishing papers, teaching seminars and surviving on precarious contracts, watching a university create a high-profile faculty role for a former politician or public figure can feel less like innovation than institutional contradiction. It sends an uncomfortable message: that public visibility may be rewarded more generously than years of scholarly labour.

Universities rarely present these appointments in those terms. They emphasise mentorship, networking opportunities and exposure to real-world experience. Those benefits are genuine. But there is another incentive that receives far less attention.

In an increasingly competitive higher education market, famous names function as powerful institutional brands. A former prime minister, celebrated author or internationally recognised diplomat can attract media coverage, impress prospective students, reassure funding donors and open doors to influential guest speakers and corporate partnerships. These appointments generate prestige that extends well beyond the seminar room. But when reputation becomes the primary return on investment, educational value risks becoming a secondary consideration.

Perhaps the deepest concern is political rather than economic. Universities have traditionally understood themselves as places where power is examined critically. Yet when former policy-makers become permanent academic figures, that relationship can become more complicated.

The seminar room risks becoming a platform for retrospective justification rather than critical scrutiny. Instead of being examined primarily through scholarship, controversial decisions (from foreign interventions to economic reforms) might be filtered through the institutional legitimacy that accompanies a prestigious faculty title.

None of this means practitioners should be excluded from universities. Guest lectures, visiting fellowships, executive seminars and co-taught courses can create exactly the kind of productive dialogue between theory and practice that universities should encourage. The problem begins when institutions confuse practical distinction with scholarly distinction.

A university should not treat celebrity as a substitute for academic achievement, nor political prominence as an equivalent form of intellectual authority. If Professors of Practice become permanent, highly compensated symbols of institutional prestige while research departments and junior scholars continue to absorb the pressures of austerity, universities risk undermining the very values they claim to defend.

Higher education should remain a home for rigorous inquiry, independent scholarship and intellectual criticism, not a retirement home for prestige.

The Day Joni Disappeared

Back in 1988, I found myself in a situation that made me panic. I was sitting in my bedroom, letting my female hamster, Joni, play on the floor, when, out of nowhere, she spotted a small hole in the corner of the room where the floorboards didn't quite meet the wall. Before I could move to block her path, she ran straight down into the pitch-black void beneath the floorboards.

I was terrified. I kept thinking, what if she can't find her way back out and starves to death, squeaking for help that I couldn't give her? I immediately turned off the TV, which was showing the film The Outlaw Josey Wales, so that the room would be in silence, the better for me to hear her shuffling around beneath the floorboards.

I then got the small hamster ladder from her cage and lowered it down into the hole, hoping that she would somehow come across it in the dark and climb out. Then all I could do was wait anxiously, listening to every slight scratch she made beneath the floorboards.

What I didn't know at the time was that, to a hamster, being under floorboards is no big deal. Unlike humans, who, if they were small enough to crawl beneath floorboards, would probably have no idea how to navigate their way out of such a dark labyrinth, hamsters are natural nocturnal burrowers. They can navigate tunnel systems using their sense of smell.

From the second Joni disappeared down the hole, she was leaving behind a scent trail that she could use to smell her way back to the entrance. In effect, she had her own chemical GPS system.

After what felt like hours, but was only around 20 minutes, her tiny face appeared at the edge of the hole. She had found her way back and climbed up the ladder. She looked at my relieved face as if to say, “Why were you so worried? This is what I do”. She was entirely unfazed by the ordeal. I ran over to her, picked her up and kissed her.

She was completely covered in underfloor dust and looked like a Victorian urchin chimney sweep. It took her days of licking her fur coat to get rid of the soot.

She was a resilient, clever little pet, and although her loss to the fatal hamster disease wet tail six months later was heartbreaking for me, that floorboard adventure is one of my favourite memories of her.

It was terrifying at the time, but it proved just how remarkable hamsters are.

A Sunday Walk in 1980s Liverpool

In April 1980, when I was 16 years old, I would go for walks in Liverpool city centre on Sunday afternoons. On one such afternoon, as I was walking down Upper Parliament Street and reached its junction with Great George Street, I came across the ruins of the David Lewis Youth Club on the corner. The building had stood on that spot for 74 years before being demolished earlier that month. It had ceased operating as a youth club in 1977, and I never knew it as a living place. My only contact with it was seeing its remains that Sunday afternoon in 1980, when the building had already fallen into dereliction.

What remained was a mountain-like pile of reddish stone slabs, rising to a height of around fifteen feet, or so it seemed to me. The original building had been around a hundred feet long, and the rubble covered much of its footprint, heaped up into rough, uneven mounds.

Being more adventurous in those days, I decided to investigate. The site wasn’t cordoned off, as it would be now, so I began to climb the rubble cautiously, feeling like an explorer in dangerous territory, which it was—one slip and I could have been seriously injured if not killed.

When I reached the highest point and looked out across the surrounding area, catching a glimpse of the docklands and the River Mersey beyond, I felt like Alexander the Great surveying a conquered city.

The David Lewis Youth Club had once seemed a solid monument to Victorian philanthropy, a place explicitly built for young people. Now it was reduced to dust (a casualty of a road-widening scheme) and, looking back, its demolition seemed symbolic of Liverpool’s decline over the previous 30 years.

I carried on with my walk into the city centre. In 1980, Sundays were satisfyingly quiet. Almost everything was closed: the shops, the cafés, the offices. The few exceptions were the museum and art gallery, the three cinemas—the Odeon, the ABC and the Futurist; a handful of chip shops and a couple of Wimpy fast-food outlets, then known as “Wimpy Bars”. To the best of my recollection, there were no McDonald’s or Burger King branches in Liverpool at that time.

Apart from myself and a few other people out walking, it felt like I was walking around a village whose population had fled. I enjoyed the lack of hustle and bustle, and looking in department-store windows imagining what I would buy if I had the money.

Looking back now, I don’t remember the city centre as being run-down. The streets were clean, the buildings largely intact and the newer architecture of the late 1960s and early 1970s were streamlined and neat. There was little street furniture and none of the visual clutter that there is now.

The silence of Sundays contrasted with weekdays, then, the city centre offered young people a range youth-oriented of places to go: trendy cafés, music shops, free or discounted courses, a wide network of youth clubs, discounted access to theatres and cinemas; and informal community hubs such as the Open Eye Gallery café and the Unity Theatre café, alongside many other places to congregate and feel part of a shared cultural life. So as a 16-year-old, I never felt I was living in a city in decline.