From the SENS point of view [1] a number of the Hallmarks are downstream consequences of the causes of aging; e.g. epigenetic alterations are a reaction to molecular damage. Attempting to use those hallmarks as a place to intervene is doomed to achieve marginal benefits at best. You can't cure an age-related disease by patching over its late consequences.

Aging is a spreading tree of cause and consequence, emerging from a few root cause forms of damage. Intervene at later branchings in the tree, and you cover ever fewer downstream harms. It would be like trying to prevent a complicated iron sculpture from collapsing by propping up a few pieces here and there rather than by de-rusting/rustproofing the whole thing. Intervention as close to the root causes as possible is the only effective way forward, given how challenging it is achieve anything in medical biotechnology.

At the time the Hallmarks of Aging was published, it was noted for completely failing to reference any of the existing SENS literature, despite including some of the SENS line items such as senescent cell accumulation. The Hallmarks - and the related Seven Pillars of Aging [2] that seems to be less well promoted - would clearly not exist without more than a decade of aggressive advocacy within the scientific community for SENS and the treatment of aging, but the Hallmarks authors chose to behave as though that prior work never happened.

[1]: https://www.sens.org/research/introduction-to-sens-research

[2]: https://www.fightaging.org/archives/2014/11/the-seven-pillar...