Now Marconi, a professor in the School of Medicine’s Division of Infectious Diseases and professor of Global Health in the Rollins School of Public Health, is spreading that concept further. He recently co-edited a special issue that publicly challenges biomedical research’s traditional focus on individual aging-related diseases such as diabetes, cancer, heart disease and dementia in favor of science that examines healthy aging perspectives across the whole human animal.
We asked Marconi about how to approach such a complicated scientific topic and where he believes the most progress can be made in studying the aging process.
How did you get involved with this research?
We started many years ago, working with the program. We recruited 60 individuals who were doing well on their HIV treatment. Their viral load was suppressed, but they didn't have a good CD4 count response (a standard measure of the progression of the HIV virus). Those individuals tend to have more inflammation than people who have a good response. We enrolled them in a study where we randomized them either to a meditation program and training intervention for two hours a week, or they received a holistic health care education program for the same two hours each week. It turned out that the meditation program not only improved measures of well being and reduced stress levels, which were expected psychological benefits, but it also improved markers of inflammation.
This to me confirmed a longstanding belief that the connection between the mind, body, and spirit is quite strong. Therefore, we believe there are many ways we could use practices like yoga, Tai Chi, meditation and exercise to help improve the aging process in a holistic way.
What is healthy aging to you?
First, I believe we should not overemphasize the discovery of a pill to make people live longer. I don't believe we will improve upon the maximum lifespan of a human being in the near future and I'm not entirely sure that's a good idea.
Instead, we should prioritize and value the well-being and contributions individuals who are living over the age of 65. We should ensure that our fragmented society does not increase isolation for older individuals. We should also make the practical aspects of living in a digital environment easier as we age rather than more complicated and confusing. We need to treasure their wisdom, experiences and historical connections.
Secondly, we should identify ways to holistically improve healthspan and quality of life by reducing the emergence and severity of age associated comorbidities, such as diabetes, cardiovascular disease, cognitive impairment and frailty. We can either treat these diseases individually or use holistic approaches that target the key pathways which addresses the whole person and can prevent new conditions from occurring.
How widespread is that idea in aging science right now?
When we started down this road more than a decade ago, it definitely was a fringe discussion. There were even some individuals who were resistant to it. But around the same time, individuals here at Emory started a program called the Predictive Health Institute which focused on comprehensive health care and a mission to revise medical school education with this in mind. The goal was to approach health care and clinical science not in terms of disease and medical care, but in terms of health, wellness and prevention on a holistic level.When you talk about seeing and studying all the influences on aging, how can you study something that complex scientifically?
Whenever you try to wrap your arms around something as complex as the bio-psychosocial model of human health, you can easily become confounded when analyzing data. What we try to do is use complementary methods to triangulate our findings.
You can use a traditional epidemiologic approach where we adjust our models for clinical and demographic factors such as age, sex, ancestry, medical comorbidities, etc.
Then at the same time, we use unsupervised approaches such as AI or machine learning, where you can put all of these variables and many more into a model. Then, without including any biases about these variables, the computer will run thousands upon thousands of different analyses.
Then there's a third approach. That's where we do a modified approach between the first two and then triangulate all three. We consider how do the various molecular mechanisms work together. We identify the key pathways that are critical to multiple functions throughout the body that if you inhibit them, then important changes can occur. By characterizing these important processes, we can focus our analyses more directly than if we're just awash in a sea of proteins, DNA and molecules. So we examine this middle strategy and then we revisit the other two approaches. At this stage, we look for any evidence of synonymous pathways across the three different approaches. That is essentially how we triangulate the data.
What we're finding is that there are key pathways that repeatedly surface and by interrogating those pathways, whether through traditional therapies or through behavioral interventions, you can achieve holistic outcomes.
What kind of holistic interventions can have an impact on the aging process?
Certain interventions are holistic by having multiple separate components that address various aspects of a person such as their physiological and psychological wellbeing. Individuals who meditate have less stress, better concentration and more effective problem solving skills.Are you finding researchers from the different disciplines receptive to your call for more research on these approaches?
Most of my collaborators embrace a holistic approach. Some still need more encouragement. I have been quite impressed to see many clinical and even very basic scientists quite open to a holistic approach to either health care interventions or the underlying biology. It is refreshing to hear basic scientists suggest interventions that include social and behavioral aspects of an individual.