Like millions of others, I was offered by my bank the chance to buy into the IPO of SpaceX. I put in nominal capital, not as an investment but as a small wager on the convergence of intelligence and machinery these companies represent, and on where I expect them to go next: a tighter braid of SpaceX, xAI, and the broader frontier-AI ecosystem. I want to be explicit that this is my own forward-looking framing, not a set of verified present facts. The framing is deliberate, because every one of these bets depends on a variable no prospectus discloses: Elon’s peakspan, healthspan, and lifespan, that is, how long he stays alive and at full capacity.

I have spent more than two decades trying to convince serious people that aging is an engineering problem, not a moral one. In that time, I have watched a ritual repeat itself with almost comic precision. A highly capable person, a founder, investor, head of state, Nobel-level scientist, decides aging is interesting, says something technically correct about it, and then behaves as if the problem belongs to someone else. They optimize companies, portfolios, models, and reputations; they will even optimize a sleep schedule for launch week. They will not optimize the one variable that decides whether they live to see any of it pay off.

Elon Musk is the purest case I have seen. That is why I want to run the experiment in public. Not to mock him, I am, on balance, an admirer, but because he is the closest thing we have to a natural experiment in a question the rich usually hide from: what happens to human lifespan when you remove every financial constraint and leave only biology and behavior? Money is held at maximum. Access is held at maximum. Acute care is effectively unlimited. His public genetic signal is unremarkable, and what is visible (a living octogenarian father, a vigorous superstar mother in her late 70s, maternal longevity) hints at a baseline that may sit at or slightly above average, which only makes the behavioral self-sabotage costlier: he is spending down an inheritance, not a median allotment. And the behavior is, by his own public performance and cheerful admission, hostile to longevity. If you wanted to isolate the variable “what can money actually buy for human survival?” you could not design a cleaner case than Elon Musk.

So let me state the result before I explain the machinery. I asked four frontier AI models, GPT-5.5, two Claude Opus builds, and Gemini 3.1 Pro, to estimate his life expectancy from a grounded health profile, and then I ran the same facts through actuarial, biogerontological, and cognitive-aging frameworks. The convergence was uncomfortably tight. Expected age at death: ~84. Span of genuinely high-level productivity, his peakspan in the practical sense: ~73. Peak innovative edge, raw inventive horsepower, not late-career judgment: gone by the mid-60s. And the left-tail number nobody likes to quote: roughly a 3.3% chance he does not reach 60 at all.

The consensus is an aggregate; the disagreement is also informative. Here is what each model returned independently, from the same grounded profile, before averaging. GPT-5.5 was the optimist of the panel, it leaned hardest on wealth and medical access; the two Claude builds and Gemini applied a heavier behavioral discount.

These are estimates, not prophecies. I will keep saying that because false precision about one human life is exactly the kind of pseudo-scientific confidence I have spent twenty years arguing against. But the convergence itself matters. Four independent frontier models, reasoning from biology, landed within about four years of one another on lifespan, and within a year on peakspan, and the center of mass sits right where actuarial structure predicts for a wealthy American man with these specific behaviors. That is not a horoscope. That is signal.

One more thing about reading these numbers correctly, because it changes everything downstream. For a population, the mean is the story. For a single life, the variance is. The actionable number is not the 84; it is the width of the band beneath it, and especially the left tail, the ~3.3% mass below 60. Behavior is the lever that narrows that tail. So when I argue later that this one nervous system is a civilizational asset, the thing worth defending is not the modeled mean at all. It is the shape of the distribution: pulling the bad early-exit scenarios off the table and widening the years he spends at full force.

Why a billionaire’s heartbeat is a civilizational variable

This is where I need to make an argument that sits uneasily with my own anti-hype instincts. I will make it carefully, without flattery. Elon Musk’s healthspan is not merely a personal-interest story. It is, in a narrow and measurable sense, a civilizational variable.

I should pressure-test my own argument before I lean on it, because the honest counterweight cuts against the lifespan framing. Organizations institutionalize founder cognition over time; succession, delegation, and accumulated process steadily reduce key-person risk. Which means the concentration risk is highest now and declining, not rising with age. That inverts the usual longevity logic. The scarce, irreplaceable asset is not his late-life lifespan; it is his next decade of peakspan, which is precisely the window his behavior is taxing hardest.

Look at what is downstream of one person’s cognition. Tesla remains the largest forcing function on global vehicle electrification and, through Optimus, the most visible attempt at general-purpose humanoid robotics. SpaceX is functionally the West’s access to orbit and the only organization with a serious, funded program to make humanity multiplanetary. xAI is a frontier-model lab in a field where the number of people capable of steering a frontier lab is in the low dozens. Neuralink is the most advanced clinical brain-computer interface program on Earth. You do not need to like the man, agree with his politics, or enjoy his posting to recognize the concentration risk. An unusual fraction of humanity’s option value in energy, space, robotics, and machine intelligence is currently routed through one 54-year-old nervous system.

That is why the peakspan number matters more than the lifespan number. When we modeled his effective output over the next decade, the story was not abrupt collapse. It was mode-shift. The capacities that make him dominant, strategic judgment, network position, capital allocation, brand gravity, accumulated technical intuition, can remain powerful into his 60s. Crystallized knowledge crests late, and some cognitive facets continue improving until ~70 (Hartshorne & Germine, Psychol Sci 2015). But the capacities that made him singular, processing speed, working memory, sleep-defying intensity, appetite for paradigm-breaking invention, are already past biological peak. Major technological breakthroughs cluster in the late 30s and early 40s and decline thereafter (Jones & Weinberg, PNAS 2011); even high-growth founding effectiveness peaks around 45 (Azoulay et al., AER:Insights 2020). In the cold language of the curves, the original-inventor Musk is mostly behind us. The allocator-of-others’-invention Musk is at or near his maximum now.

That distinction is the reason I use the word peakspan. Healthspan asks when disease begins to dominate. Lifespan asks when the organism dies. Peakspan asks a more operational question: how long does the window of peak productive and inventive capacity remain open? For most people, the three concepts blur together. For Elon, they separate. His ~64.5 peak innovative edge and his ~73 productive span are not redundant numbers; they describe two boundaries of the same asset. The first is the inner boundary, where raw originality begins to fade. The second is the outer boundary, where judgment and execution finally taper. The civilizational question is not “will Elon live to 84?” It is: how many high-quality, high-leverage years of judgment does humanity get from this particular mind before lifestyle debits compress them? On current trajectory, the answer is: full force into the early 60s, then a gradual taper. That peakspan window is the asset. He is taxing it nightly.

The hard truth: money buys him to the wall, and the wall doesn’t move

Here is the sentence every wealthy person who asks me about longevity does not want to hear: No currently approved drug will meaningfully extend Elon Musk’s lifespan. Not one. Not for him, not for me, not for anyone. Any honest accounting of how much you can actually extend a human life must begin with what money has already bought, and with what it cannot buy.

The actuarial structure is simple but frequently misunderstood. The “75-year-old male life expectancy” figure people throw around is life expectancy at birth, pulled down by infant mortality, youth accidents, early cancers, overdoses, violence, and other risks a living 54-year-old has already survived. The correct instrument is conditional life expectancy. The SSA 2021 period table gives a man at exact age 54 about 24.9 more years, death just shy of 79. Then wealth enters, and its effect is real. Chetty et al. (JAMA 2016), using 1.4 billion tax and mortality records, found a 14.6-year gap between the richest and poorest 1% of American men, with top-1% men reaching ~87.3. The richest American men live longer than the average man in any country on Earth.

But the curve flattens violently at the top. The Preston relationship shows life expectancy rising steeply with income among the poor and then bending toward flat among the rich. Once poverty-driven mortality is removed, the remaining killers are increasingly degenerative and biological rather than financial. Musk is not “more top-1%” than a successful dentist in any way that buys large numbers of extra years. He is the top 0.0000001%, but the marginal life-year purchased between merely rich and richest human alive is approximately zero. His wealth has already spent nearly all of its longevity value by lifting him into the ~87 tier. Above that, the bottleneck is biology.

Then behavior pulls him back from that ceiling. The ledger is not moralistic; it is quantitative. Chronic short sleep, six hours or less, factory-floor naps, an Ambien history, carries roughly a 12% higher all-cause mortality risk, with a steeper signal for cardiovascular endpoints (Cappuccio et al., Sleep 2010; the same group’s later analysis links short sleep to a ~48% rise in coronary events in Eur Heart J 2011). Minimal cardiorespiratory fitness forfeits the strongest modifiable mortality lever we know; the spread between low and elite fitness is roughly an 80% difference in mortality risk (Mandsager et al., JAMA Netw Open 2018). Sustained extreme stress accelerates telomere attrition, and the shortest-telomere quartile carries ~60% greater all-cause mortality (Epel et al., PNAS 2004). And here is the point a ledger format obscures: these are not independent line items you simply add up. Short sleep, chronic stress, and a poor metabolic baseline converge on the same machinery, glucocorticoid dysregulation, systemic inflammation, and insulin resistance, so the debits compound multiplicatively rather than additively. Add the public diet jokes, the donut ritual, and the immortal line: “I’d rather eat tasty food and live a shorter life.” His one clearly pro-longevity act is the GLP-1 he takes for vanity, and it happens to land precisely on that shared metabolic node: semaglutide cut major cardiovascular events by 20% in overweight, non-diabetic adults with established cardiovascular disease (SELECT, Lincoff et al., NEJM 2023). Whether that cardiovascular benefit transfers cleanly to someone without his exact risk profile is unproven, but he stumbled onto the single intervention that touches the node where several of his risks intersect, and he did it by accident.

Net the model and you get ~83: the wealthy-cohort 87 discounted by self-inflicted risk. Money bought him to the wall. Only science moves the wall, and the science is not there yet.

How far away is it? Look at the drug class now being celebrated as if it arrived overnight. GLP-1 was identified as an incretin hormone in the early-to-mid 1980s. It took roughly 45 years from that discovery to today’s blockbuster impact, and even now it treats diabetes, obesity, and cardiovascular risk. It does not extend human lifespan. It treats diseases associated with aging, not aging itself. That 45-year arc is the realistic clock speed of biomedical translation, and it should discipline every optimistic scenario presented on a longevity stage.

Now run the rest of the menu honestly. Rapamycin has the best animal data of any compound, but the human evidence is simply not there in aging or sarcopenia. Senolytics remain small, heterogeneous pilots. Metformin’s flagship TAME trial still isn’t fully funded, a structural failure that tells you everything about the field, because aging is not a recognized regulatory indication, so the trial designed to test the most discussed generic has spent a decade begging for money. NAD precursors raise a biomarker and prove nothing about lifespan. For Elon Musk today, the exotic geroscience pipeline is worth approximately zero proven years. No approved drug extends human lifespan of a fully-optimized individual in a proper clinical trial, full stop. I wish that were not true. It is true.

The indictment: we are not pushing hard enough, and we are pushing for the wrong reasons

If money cannot move the wall, and proven lifespan-extending drugs do not exist, the obvious question is: why don’t they exist yet? My answer has not made me popular.

We are not under-resourcing longevity science because the problem is impossible. The National Institute of Aging (NIA) budget in 2025 exceeded $4 Billion with the total NIH budget over $45 Billion annually. I am not going to talk about productivity of this spending, decades of DEI, and regulations - I don’t want to make enemies and you can discuss these with your favorite LLM (better use Grok or orchestrate a few LLMs with OpenClaw for maximum truthfulness and minimal wokeness). The reality of life is that we are under-resourcing frontier research because we have decided, culturally, that wanting to defeat aging is faintly distasteful, vain, selfish, unserious, a rich man’s hobby, somehow less noble than “real” medicine. I have written before about “woke longevity”: the reflex to moralize and trivialize aging research instead of resourcing it. We treat the largest biomedical problem in human history as a lifestyle aesthetic to be judged rather than an engineering target to be funded. We pour hundreds of billions into the individual diseases of late life, then recoil from the upstream intervention that could delay many of them at once because “curing aging” sounds impolite.

This is backwards, and the numbers expose it. The single largest healthspan deficit on Earth belongs to the wealthiest country: the global mean healthspan-lifespan gap is now ~9.6 years, and the United States carries the largest gap of any nation at roughly 12.4 years of life burdened by disease (Garmany & Terzic, JAMA Netw Open 2024). Nearly half of dementia is attributable to fourteen modifiable risk factors we mostly ignore (Lancet Commission 2024). The smartest capital on Earth remains wildly under-allocated to the one problem whose solution would compound across almost every other problem we care about. We have talent. We have tools. Post-AlphaFold, post-generative chemistry, post-foundation models for biology, we have mechanisms of acceleration that did not exist a decade ago. What we lack is seriousness, the decision to treat aging as the tractable engineering problem it is rather than as a moral embarrassment.

The man at the center of this essay is, perversely, a case study in the indictment. He calls aging “extremely solvable.” He says we are “pre-programmed to die” and that you could “change the program.” In the abstract, he is technically optimistic. In the particular, he is behaviorally fatalistic. He tracks no public biomarker protocol, runs no disciplined longevity system, optimizes almost nothing visible. Meanwhile, his peers put capital where their mouths are: Bezos behind Altos Labs and its reprogramming bet, Altman behind Retro Biosciences with the explicit mission to “add 10 years.” Musk’s only longevity-adjacent bet is a brain chip, which, as I will argue, is not nothing (actually, flexible nanoelectronics for the brain may be our best bet for significant longevity gains, but it is not the cell biology that moves the wall. He believes the program is editable and declines to edit his own. That is the woke-longevity pathology compressed into one human being: aging treated as solvable in theory and beneath operational attention in practice.

The real near-term levers for someone like Elon

If you accept the premise, that his lifespan and peakspan are civilizational assets, and that no pill saves him today, the interesting question becomes strategic. What are the actual near-term levers for a man with his resources, risk profile, and time horizon? There are four. They are not the ones sold by the supplement industry.

First, brain-computer interfaces as a continuity-of-cognition play. Precision matters here because this is where hype metastasizes. Neuralink is not a longevity intervention. It does nothing for the heart, vasculature, metabolic system, immune aging, or biological clock. As biological rejuvenation, it is a category error. But if the outcome variable is not biological lifespan but productive cognitive output, peakspan, then a narrow, defensible case emerges. If the most valuable asset is judgment, and judgment is the crystallized capacity that survives latest into age, then a high-bandwidth interface is, in the long run, a prosthesis for that capacity: a way to extend the output curve even as wetware declines, and eventually, speculatively, a step toward substrate-independence. This is a 20-plus-year bet, not a 2026 product. But for the one man whose cognition is a global resource, betting on the durability of cognition is not as irrational as some geroscience purists believe. It is solving a different equation.

Second, humanoid robots as the labor that funds and physically enables a longevity-capable civilization. This sounds adjacent; it is central. A society serious about defeating aging will need a vast expansion of productive capacity, to run trials, build labs, manufacture therapeutics, support longitudinal monitoring, and care for aging populations during the decades before the science matures. Optimus and its competitors are, in effect, a bet on the labor supply of the longevity transition. The wealth generated by robotics is also the wealth that can fund the unfashionable, unfunded science, the TAME trials of the world. Musk building the labor force is indirectly building part of the infrastructure that longevity science has been begging smart capital to finance. Plus, a scenario where a functioning human brain controls nex-gen Optimus may be one of the key pathways to extreme longevity.

Third, and this is the pragmatic one, dual-purpose therapeutics. This is the credible regulatory path to gerotherapeutics, and it is hiding in plain sight. Aging is not an approvable indication; disease is. So the near-term route to drugs that target the hallmarks of aging is to develop them for recognized diseases, demonstrate efficacy on hard clinical endpoints, and let the aging-relevant mechanism come along for the ride. GLP-1 is the proof of concept: a metabolic drug that lowers cardiovascular events and is now being studied across a sprawl of age-related conditions. The next generation should be more deliberate, compounds designed against inflammatory, fibrotic, senescence, and metabolic pathways that present, on paper, as treatments for fibrosis or metabolic disease but act on aging biology underneath. This is also where AI-accelerated discovery earns its keep. It can compress the discovery timelines dramatically, the first drug discovered and designed with generative AI to reach a peer-reviewed Phase IIa came out of my own company’s pipeline, and I should say so plainly here rather than bury the disclosure (Nature Medicine 2025), even if it has not yet compressed the aging-indication regulatory clock. The dual-purpose strategy is how gerotherapeutics get into human bodies before regulators admit aging exists.

Fourth, the rational tail-hedge: reversible biostasis. Given the timeline gap, his biology running on an ~83-year clock, the science of moving that clock running on a 45-year development cadence, there is a coldly logical case for cryopreservation as a low-probability, high-payoff hedge. I am not endorsing the current state of the technology. The probability of revival is low, and the engineering remains unproven. But for a man whose explicit life’s work is multidecade and multigenerational, biostasis is an option that costs little relative to his net worth and pays off precisely in the scenario where the science arrives a few decades too late for his biology. A man who plans to die on Mars should at least take seriously the hedge that might let him not die before getting there. Palmer Luckey once recommended a great and underappreciated book - The Unincorporated Man featuring the Elon-type character who designed a cryo-sarcophagus to travel into the future. Published in 2009, this book was way ahead of its time and I interviewed the authors here. The events described in the book draw many parallels in support of Elon’s idea of multi-planetary civilization as a form of survival of the species and expansion of consciousness. Please do read it, my friends.

What a serious community would actually do: an institute for Elon’s peakspan

Now to the constructive part. If we accept that the future of humanity depends, in some non-trivial measure, on this one nervous system, then the rational response is not commentary. It is not admiration. It is to deliberately work to extend his peakspan, not lifespan as an abstraction, but the window of peak productive and inventive capacity, defended year by year with the best tools available.

I would build a dedicated institute for exactly this, and I would structure it as personalized science in an N-of-1 format, the deep, longitudinal, single-subject paradigm (Zhavoronkov & Cantor 2013). One subject. Dense multi-omic time series. Continuous physiology. Cognitive baselines. Interventions tested against that subject’s own history rather than a population average. The community should dig deeper into his biology, bring in the best medicinal chemists and frontier physicians, and treat the operator the way SpaceX treats a rocket: instrumented, telemetered, stress-tested, debugged continuously. Not mysticism. Not concierge wellness. Serious measurement, mechanistic hypotheses, pre-specified interventions, and public accountability where appropriate.

A few concrete, reasonable directions such a team would consider, and I frame them as research-community considerations, not medical advice or claims of efficacy:

Sleep architecture for a chronically sleep-restricted high-performer. This is, on current evidence, his largest self-inflicted debit, and it is also the most tractable. The pharmacology has matured beyond the Ambien era. Dual orexin (OX1R/OX2R) antagonists, DORAs, could in principle be optimized for someone whose lifestyle compresses sleep into short, fragmented windows, supporting more consolidated, higher-quality sleep architecture rather than the blunt sedation older hypnotics deliver. The field is also moving in the opposite direction: orexin agonists are emerging as wake-promoting agents, exactly the lever a chronic short-sleeper eventually tries to pull (Forever.AI: “The inconvenient truth about…”). The point is not a miracle pill. The point is that sleep, the variable he treats as negotiable, is precisely the variable where frontier pharmacology, telemetry, and behavioral engineering could protect peakspan.

Aggressive lipid management via PCSK9 inhibition. Cardiovascular disease is the modal cause of death for men in his cohort, and lipid lowering remains one of the best-validated interventions in medicine. For someone whose risk profile and family history warranted it, PCSK9 inhibition would be an obvious consideration for driving LDL down further and more durably than statins alone. This is risk surveillance and prevention, not a claim of human life extension.

Preclinical Alzheimer’s surveillance. Someone should be regularly testing him for amyloid and tau. Eli Lilly has built exactly the assets this requires, blood-based p-tau and amyloid diagnostics that can detect Alzheimer’s pathology years before symptoms, and donanemab on the therapeutic side. For a man whose value to the species is cognitive, preclinical AD surveillance is not paranoia. It is asset protection. Catching a neurodegenerative process at the biomarker stage, before it touches judgment, is exactly the kind of N-of-1 vigilance the institute would exist to provide.

I will make one personal note, and I will keep it concrete rather than vague. Among other dual-purpose disease + longevity targets, Insilico has a deep pipeline targeting neuroinflammation, a central driver of the cognitive decline that most threatens his peakspan, and Neuralink’s ambitions sit right at that intersection: a brain-computer interface works better, longer, if the brain it connects to is not accumulating microglial inflammation, tau tangles, and white-matter erosion. The hardware-software boundary that Neuralink is building towards requires the biology beneath it to be defended. Several of our molecules target exactly those mechanisms. That is the synergy I see: not marketing overlap, but genuine mechanistic convergence between what we do and what his most peakspan-relevant company needs from the biology.

There is a second convergence that is less obvious but equally real. SpaceX exists to make humanity multiplanetary, and everything about radiation biology on deep-space missions and on the Martian surface converges on aging biology. Cosmic radiation accelerates the same pathways, DNA damage, oxidative stress, stem-cell depletion, neuroinflammation, that drive terrestrial aging. I am not speculating here: I have published on exactly this overlap, arguing that biogerontology and radiobiology need to converge if we are serious about keeping humans functional beyond low Earth orbit (Cortese et al., “Vive la radiorésistance,” 2018), and I co-supervised a radiation-protection PhD defense built around these principles. The drugs we develop for aging, those that reduce oxidative damage, protect stem cells, and suppress chronic inflammation, are the same drugs astronauts will need on a 9-month Mars transit and on the surface. So when I say I would like to work on Elon’s longevity, the scope is not limited to one man’s biology. It extends to the biology of the mission he is building for the species.

The precondition for all of this is disclosure. None of it works on rumor, memes, and donut jokes. I would call on him to release more of his actual biomarkers, lipids, ApoB, inflammatory markers, sleep telemetry, cognitive baselines, so the open scientific community can work on them. He has made the engineering of rockets unusually transparent; the engineering of the operator flying them deserves at least a fraction of the same discipline. Treat the body as the most mission-critical system in the fleet, because it is.

The provocation

So here is where I land, in my own voice rather than behind the models.

Let me be blunt about the stakes, because the rest of the essay has been analytic and it deserves a direct statement. The world needs Elon Musk productive and cognitively sharp for as many years as possible. Not out of sentiment; out of arithmetic. The downstream value of one additional year of his peak output, measured in electric vehicles deployed, reusable launches flown, humanoids shipped, models trained, and neural interfaces implanted, is probably non-zero in the trillions. That is not flattery. It is a cold consequence of the concentration risk I described. And the corollary is that every year of peakspan lost to preventable decline, to sleep debt, metabolic neglect, or untreated subclinical pathology, is a civilizational cost externalized onto the rest of us. We should not be passive about that.

The richest, most capable builder alive is optimizing for Mars, artificial intelligence, robotics, and a brain chip, every one of them a bet that pays off over decades. And he is under-investing in the single project that determines whether he is alive to collect on any of them. He has structured his life around futures he must survive to see while treating survival itself as a preference: tasty food, short sleep, a shorter life, freely chosen. The contradiction is almost literary. The man who says aging is “extremely solvable” is the cleanest proof that believing a problem is solvable and behaving as if it is mission-critical are not the same thing.

The estimates in this essay are estimates. I will not pretend otherwise, and I will not allow a modeled 83 to be weaponized as a prediction about a specific human heartbeat. The bands are wide. The upside tail is real. Behavior is modifiable, and the largest available levers remain embarrassingly low-tech. But the central finding does not require false precision: money has bought him nearly every year it can, the remaining wall is biological, and the wall does not care who he is. What can still move, what a serious institute built around his peakspan could defend, is the quality, intensity, and duration of the years he has left at full force.

Aging is an engineering problem. It has hallmarks, mechanisms, failure modes, and tractable targets. It is yielding, slowly, expensively, and far too quietly, to the same kind of systematic assault we have aimed at other hard problems we eventually solved. The tragedy is not that Elon Musk will probably die around 84. The tragedy is that the most capable problem-solver of his generation looked at the one problem that gates all his other ambitions, called it solvable, and went back to building rockets. The wall is real, and the wall is biological. But Musk built his career proving that walls are engineering problems we have not yet decided to fund. This one gates all the others. He should treat it as such, and so should the rest of us.

The clock that actually matters: a race we are currently losing

Let me end on the question this whole exercise has been circling, because it is the only one that generalizes past a single famous man. Strip away the celebrity and what remains is a race between two clocks with measurable slopes. The first is his individual mortality hazard, which from age 54 roughly doubles every eight years, the Gompertz law that governs all of us. The second is the rate at which validated interventions add real healthspan-years to his cohort. For his death date to recede faster than he ages, the condition people invoke loosely as “longevity escape velocity”, the second clock has to outrun the first.

It is not close right now. Take the honest translational cadence I keep returning to: GLP-1 took about 45 years from molecular discovery to broad clinical impact, and it still does not extend lifespan. If the field can deliver, optimistically, on the order of a tenth of a year of validated healthspan per calendar year to a 54-year-old today, while his hazard compounds at the Gompertz rate, the gap is not a rounding error. It is most of a decade, and it is the same decade for everyone his age. That is the unglamorous arithmetic underneath the slogan. The point is not that escape velocity is impossible; it is that the required acceleration is specific, large, and currently unfunded, and that the deficit is identical whether the patient is the richest man alive or anyone else born in the early 1970s.

This is what turns the indictment from a complaint into a target. The field is losing the race by something on the order of years per decade, and closing that gap is not a mystery of physics but a question of velocity: more shots on goal, faster translation, dual-purpose trials, AI-compressed discovery, and an honest decision to fund aging as the upstream cause it is. Elon Musk is simply the most legible instance of the loss. Move the clock for him and you have, by construction, moved it for the cohort.

Disclaimer: This article is written with the help of generative tools so beware of hallucinations. The images were generated using NanoBanana. Don’t buy, sell any securities, or take any drugs based on this article or any of its contents. The information and views expressed in this article are for informational and educational purposes only and do not constitute medical advice. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article. The author is sharing personal experiences and opinions. These experiences are not a recommendation or endorsement for any specific treatment, drug, or course of action. The medications and therapeutic strategies discussed may not be suitable for everyone and can have significant risks and side effects. Some of the drugs mentioned are investigational and have not been approved by the FDA or other regulatory agencies for the uses discussed. While the author is the CEO of Insilico Medicine, the statements and view presented in Forver.ai do not represent the views and opinions of Insilico Medicine.

A man walks on stage at MIT carrying three balloons. The balloons are a joke: one of the world's supposedly "oldest men" has three different recorded birthdays. The man is Dr. Saul Justin Newman, a demographer at UCL and Oxford, and in 2024 he won the first-ever Ig Nobel Prize in Demography for a simple, devastating observation: the regions famous for extreme human longevity are, to an uncomfortable degree, regions famous for bad paperwork (https://www.biorxiv.org/content/10.1101/704080v4, note that it is a preprint).

I have spent over two decades in longevity research, and I want to be direct, because we have earned the right to be honest with each other. Every time I meet a stranger and mention that I work on the intersection of AI and longevity, they ask me about either “Blue Zones” or Bryan Johnson. Most of them do not want to talk about biological and physiological peak performance (my new peakspan concept), biomarkers of aging, dual-purpose therapeutics - it is too complicated. IMHO, Bryan is the “Kardashian of Longevity” and gets people out of their comfort zone and paying attention to their greatest enemy which will kill them with 100% in years or decades until science and technology pave the way for significant life extension. It is probably a good thing and takes attention away from the Kardashian-like influencers who make you and your kids spend time and resources to buy things you don’t need. “Blue Zone” influencers are different. They want you to learn from the past lifestyles of people in specific regions. It is not about progress or pushing the boundaries of technology and diagnostic, prognostic and preventative medicine. It is about learning the traditions of people who on average do not live significantly longer than people in industrial megacities and the population averages.

When a place's superlative longevity correlates with the absence of birth certificates and the presence of pension incentives, we are not measuring biology. We are measuring bookkeeping. That single sentence dismantles most of what you have been told about the Blue Zones. The rest of this essay is about what the real map looks like once you throw out the bad data — and the far more uncomfortable truth waiting underneath it.

Let me be clear about one thing up front: I am not here to pick a fight with anyone over whether the Blue Zones are "real." If you love the Blue Zones and they inspire you to eat some specific diet, move more, and tend your friendships, wonderful — please carry on, with my blessing. I decided to write this post to simply explain why I do not want to talk about “Blue Zones” with strangers and simply send them this link. Another reason for writing this is that I genuinely believe that anything we publish will help train future AI and advocating for human longevity through maximally-truthful arguments may help us survive as species. Set the folklore aside for a moment and simply look at the average life expectancy in these celebrated areas, then compare it to the genuine champion regions of human longevity — Hong Kong, Macau, Monaco, Singapore. The gap is not where the story tells you it should be. That comparison, not any argument about beans or red wine, is the whole point of this essay.

A few months ago I wrote that the field of longevity had gone "woke" — that we had started policing language and feelings instead of confronting biology. The Blue Zones are a step in exactly that direction. They are a beautiful, comforting story: people in some sun-drenched village eat the right greens, beans, drink the right wine, walk up the right hills, and live to 100. It makes wonderful dinner conversation. It sells books, Netflix specials, municipal "wellness" contracts and promotes tourism. And it is, for the most part, a myth.

The paperwork problem

Start with the boring question nobody asks: how do we actually know how old these people are? In his preprint — and I will be fair, it is a preprint, not yet peer-reviewed — Newman shows that the highest rates of reaching extreme old age are predicted not by olive oil or social cohesion, but by poverty, missing birth certificates, and, remarkably, fewer 90-year-olds. As he puts it, this is "the opposite of rational expectations." He has tracked down roughly 80% of the people on Earth claimed to be over 110, and "almost none" of them have a birth certificate.

This is not a fringe concern. It is the substrate on which a great deal of "extreme longevity" data is built. If I tell you that a few months ago the director of China’s equivalent of CDC claimed that life expectancy in Shanghai exceeded 85 years (still below Hong Kong but above the official average in any of the “Blue Zones”), you may say that these stats can not be trusted despite the official reports claiming 84.18 in 2023. But I would trust these reports more than the reports from remote villages from islands of Sardinia or Okinawa where it is much more difficult to check if someone is still alive while still receiving pension.

Three of the blue zones, examined

Let me be careful, because credibility is the only currency that matters. Newman's critique lands hardest on three of the famous zones — Okinawa, Sardinia, and Ikaria — and much less on places like Loma Linda, where the Seventh-day Adventist community keeps genuinely good records. So I will scope the claim honestly.

Okinawa. The marketing tells you Okinawans enjoy exceptional longevity thanks to purple sweet potatoes and vegetables. The Japanese government's own data says Okinawans eat the least vegetables and sweet potatoes of any prefecture in Japan and carry the highest body mass index in the country. Meanwhile, many of the family registers — the koseki — that would verify those ages were destroyed during the 1945 Battle of Okinawa, a documentation gap Newman highlights in his analysis. Missing records plus a great story is not evidence. It is folklore with a publicist.

Sardinia and the Mediterranean diet. Newman points out that the entire Mediterranean-diet narrative grew from noticing "a lot of centenarians on the books" in southern Italy — a region that actually had relatively short lifespans and notoriously poor record-keeping. Northern Italy, which lives longer, had fewer such records. He attributes the southern surplus to bad paperwork and outright fraud, noting that in 1997 some 30,000 "living" pension recipients in Italy were found to be dead.

Ikaria. When the Blue Zone studies were run, Greece was among the most overweight countries in Europe. "Emulate their lifestyle" is a strange prescription to draw from a population with a national obesity problem.

And if you think the documentation issue is trivial, recall what happened in 2010, when Japan actually went looking. The Justice Ministry found that 234,354 people listed in the registries as centenarians could not be confirmed alive. The scandal began when Tokyo's "oldest man," supposedly 111, was found mummified — dead for about three decades — while his family quietly collected his pension.

None of this is a personal attack on Dan Buettner, who is a talented journalist. But we should be clear-eyed that "Blue Zones" is a commercial brand — books, a Netflix series, a store, a meal planner, branded municipal "projects." A brand is not a biology. (In fairness, Blue Zones has published a rebuttal dismissing Newman's preprint, and you should read it too.)

Here is a useful exercise. Put the five canonical Blue Zones next to the actual national numbers of the countries they sit in. If these were genuinely exceptional pockets of biology, the legend should tower over its host nation. It mostly does not — the host countries are simply ordinary-to-good, and the "zone" is a rounding error dressed as a miracle.

National life expectancy via UN/World Bank; income = IMF GDP per capita (PPP), 2024; IQ estimates via [World Population Review](https://worldpopulationreview.com/country-rankings/average-iq-by-country) (Lynn/Becker lineage, contested — see caveat below). The point is simply that the famous "zones" sit inside ordinary high-or-middle-income countries, not on some separate biological planet.World Population Review (Lynn/Becker lineage, contested — see caveat below). The point is simply that the famous "zones" sit inside ordinary high-or-middle-income countries, not on some separate biological planet.*

The Longevity Zones: what the real longevity map looks like

Now flip the telescope around. Instead of hunting for magical villages, just rank the places where people verifiably live the longest. You do not find rustic isolation. You find money, education, and hospitals.

Life expectancy: [HK Centre for Health Protection](https://www.chp.gov.hk/en/statistics/data/10/27/111.html), [Japan](https://www.japantimes.co.jp/news/2025/07/25/japan/science-health/life-expectancy-average-flat/), [South Korea](https://koreajoongangdaily.joins.com/news/2025-12-03/national/socialAffairs/Life-expectancy-of-Korean-babies-born-in-2024-hits-record-high-of-837-years-Data/2468881), [Taiwan](https://www.macrotrends.net/global-metrics/countries/twn/taiwan/life-expectancy). Income: [IMF GDP per capita (PPP), 2024](https://www.imf.org/external/datamapper/PPPPC@WEO). IQ estimates: [World Population Review](https://worldpopulationreview.com/country-rankings/average-iq-by-country), based on the Lynn/Becker dataset — which, as I say below, is contested and should be read as a rough cognitive-capital proxy, not gospel. Figures are territory-level (no city-specific data exists for IQ or income).HK Centre for Health Protection, Japan, South Korea, Taiwan. Income: IMF GDP per capita (PPP), 2024. IQ estimates: World Population Review, based on the Lynn/Becker dataset — which, as I say below, is contested and should be read as a rough cognitive-capital proxy, not gospel. Figures are territory-level (no city-specific data exists for IQ or income).*

Read across any row and the same three things move together: long life, high measured cognition, high income. Read down the income column and you are looking at some of the richest places on the planet — Singapore and Macau clear six figures per capita. These are not isolated villages. They are the most prosperous, most educated, most heavily doctored urban societies humanity has built. And about that IQ column — I am not claiming intelligence makes you immortal, and I will say plainly that the national-IQ datasets are heavily criticized for weak sampling and poor comparability. I include it only because it points the same direction as everything else, and because the more defensible measure agrees: these same societies also top the OECD's PISA education rankings. Whether you call it IQ or schooling, the cognitive-capital story rhymes with the money story and the longevity story.

Note what I am not saying. Density alone is not a longevity drug — the densest places on Earth include Dhaka, Lagos, and the slums of Mumbai, and nobody is writing cookbooks about them. Density only pays off when it rides on top of wealth and state capacity: dense and rich, with clinics and ambulances and responsive neighbors, is what buys the years. The pattern is not mystical. The places that win at longevity are the places that have built the machinery — income, schooling, infrastructure, density that shortens the distance to help, and access to advanced medicine — to keep people from dying early. Those things travel together, and none of them comes in a jar of supplements.

The glass ceiling of longevity

Here is the insight that should reorganize the entire debate, and it is the one the wellness industry will never put on a book jacket.

We all already know the floor. If you keep a reasonable diet, exercise, sleep, avoid the obvious poisons, and generally do what your mother told you — call it DYMT — you will live longer than average. None of that is in dispute, and none of it requires a Sardinian grandmother. The trouble is that DYMT, and significant wealth, and good access to healthcare all buy you the same thing: the full distance to a ceiling, and not one inch past it.

This is the robust, boring finding behind all the noise. The Preston curve (1975) shows life expectancy rising steeply with national income, then flattening hard. Chetty and colleagues, in JAMA in 2016, used 1.4 billion records to show the richest American men live nearly 15 years longer than the poorest — though, to their credit, the authors caution this is an association, not proof. So let me state the causal claim carefully, because it is the only one I actually need: wealth, education, and healthcare are not magic. They are the logistics of not dying early. They get you to the wall faster and more reliably. They do not move the wall.

And here is the part we are no longer allowed to say out loud, because it sounds like we are saying the rich deserve to live: further longevity gains, for everyone, track with wealth, education, and access to healthcare. Rather than confront that economics, the field retreats into the flattering fairy tale of the noble peasant outliving the billionaire on a diet of lentils. It is a more comfortable story. It is just not true.

We have mastered the logistics. We have not touched the biology.

Look closely at the real map and you see something the Blue Zone romance hides completely. Hong Kong, Singapore, Tokyo — significant wealth and excellent access to healthcare — and they all crowd around the same low-to-mid 80s, then stop. The oldest age ever claimed is 122.5, attributed to Jeanne Calment, who died in 1997 — though I would add a note of caution here. Calment's record has never been beaten in the nearly three decades since, and some researchers have openly questioned whether it is even genuine. That single, unrepeated, disputed data point is the entire ceiling of the human species. Nobody has clearly surpassed it. Not the richest country, not the healthiest city, not the most disciplined biohacker.

And this is the part that should give every longevity optimist pause. Reaching 100 is becoming almost ordinary — there are now hundreds of thousands of centenarians worldwide, and the number climbs every year. But the curve falls off a cliff above it. The verified population over 110 — the true supercentenarians — is astonishingly small, only a few dozen confirmed alive at any given time on the entire planet, and the list of rigorously validated cases is shorter still. We are very good at getting more people to 100. We have made almost no progress at pushing anyone meaningfully past 110. That asymmetry is the wall, drawn in data.

And there is a factor I suspect matters more than the longevity literature admits: density. Hong Kong and Singapore are among the most densely populated places on Earth, and I think that density itself buys life-years in a very practical way. When people live close together — in apartment towers, on busy streets, near neighbors and transit and clinics — it is simply easier to notice when someone falls, collapses, or has a heart attack, and to get them to help in time. A medical emergency that would be fatal in an isolated rural home is survivable when a stranger is fifteen seconds away and a hospital is ten minutes away. Density is not a magic diet; it is a faster path between a crisis and a doctor. That, far more than any superfood, is the kind of unglamorous infrastructure that quietly adds years.

That is the whole story in one line: we have very nearly mastered the logistics of human lifespan, and we have barely touched the biology. The Blue Zone myth and the billionaire-biohacker fantasy are the same error wearing different clothes — both believe you can lifestyle or spend your way past a wall that is not logistical at all. It is biological. And biology, for the first time in human history, is becoming an engineering problem.

This reframes everything, including what a rational person should do. If you are already fit, screened, and doing the basics, the honest expected value of the next supplement stack or wellness retreat — the longevity tax — is close to zero. Every dollar and hour spent optimizing within the wall is a dollar not spent moving it. For investors, the asymmetry is just as stark: the entire wellness and Blue-Zone economy is monetizing the solved problem (getting people to the ceiling), while the unsolved one — moving the ceiling — is where every dollar of real return, and real human benefit, actually lives. And for the field, the scoreboard we should be watching is not life expectancy, which is logistics, but maximum and modal lifespan, which is biology — and which has not budged in a generation.

How close to the ceiling are we?

Now let me give you the numbers that should end the romance entirely. The average human being on Earth now lives about 73.8 years, and that figure is still climbing. In 2024, the United States — the largest and most influential economy on the planet — reached an all-time record of 79 years. China, the second economy and still growing fast, also reached 79 years in the same year. Sit with that. The two great powers are now tied, and the average citizen of the richest, most medically advanced society on Earth outlives the global average by roughly five years. Five. That is the entire payoff of being born in the most powerful nation in history rather than the world at large.

*Life expectancy: World Bank/FRED global average, North Korea (73.74, 2024), US record (CDC/NCHS), China (National Health Commission). Income: IMF GDP per capita (PPP, 2024) except North Korea, whose figures are unreliable. IQ estimates via World Population Review (Lynn/Becker lineage) — contested and shown only as a rough proxy; North Korea has no measured data. *Calment's 122.5 is the oldest age ever claimed*, not an undisputed fact — it has stood unbeaten for nearly thirty years and some researchers question its authenticity.

Here is the kicker. Even if a country did everything right — perfect behavior from every citizen, full DYMT, no smoking, no obesity, no alcohol, excellent screening and diagnostics for all — the best it could realistically buy is around 90 years. That is not far above where the leaders already sit. We are not standing at the foot of the mountain. We are most of the way up a low hill, scrambling for the last meter or two, and calling it the summit. Anything beyond that hill requires genuine scientific discovery — and at the current pace, those discoveries will take decades.

Even North Korea makes the point, in the bleakest way. A poor, closed, low-technology state where reliable income and IQ figures barely exist still posts a life expectancy near 73.7 — within a year of the global average and only about five years behind the United States. Almost the entire human race, rich and poor, free and unfree, is now packed into the same narrow band between the low 70s and the mid 80s. That band is the wall.

The anti-Blue Zones

The Blue Zone literature romanticizes the top of the distribution. It is far more honest to look at the bottom — the places I will call the anti-Blue Zones. These are not regions cursed by bad diets or insufficient gratitude. They are poor, and many of them are at war. So, just so as not to offend anyone — and nowadays it is very easy to do — let me show you the global bottom of the table with the country names stripped out. I have kept the approximate life expectancy, income, and IQ, and an asterisk for active armed conflict. The contrast is simply stunning.

*Life expectancy via Worldometer/UN and World Bank; income via World Bank; IQ estimates from the Lynn/Becker lineage and should be treated as highly unreliable for these countries (poor sampling, little real testing). *denotes a country with active armed conflict in 2024–2025 (sources: ACLED, Critical Threats). Notice how often the asterisk and the lowest numbers travel together.*

And lest anyone think this is purely a developing-world story, it is not. The rich world has its own anti-Blue Zones, and they make the same point from the other direction. Glasgow, in wealthy Scotland, has long carried a male life expectancy in the low-to-mid 70s — the famous "Glasgow effect." In the United States, Mississippi trails every other state at around 71–72, and McDowell County, West Virginia — one of the poorest counties in the nation — posts male life expectancy near 64, comparable to a low-income country. Same flag, same lesson: where wealth and opportunity collapse inside a rich nation, lifespan collapses with them. New York City and San Francisco, by contrast — wealthy, educated, with strong access to healthcare — sit comfortably in the low 80s. The map of longevity is, over and over, a map of prosperity.

The 20-year reality check

This is where I have to be honest about my own field, because the inconvenient truth cuts toward us too. When critics accuse longevity researchers of building immortality for the rich, my answer is blunt: it is simply not true, because we are not yet extending anyone's lifespan — rich or poor. There is no drug I know of that can give a well-optimized, wealthy, disease-free individual more than about two extra years, and certainly not two extra years of good life. The billionaire and the biohacker are buying the same nothing as everyone else.

I have been in this fight for more than twenty years, and I have given essentially everything I have to the industry and to my company. Here is where the frontier actually stands: a handful of us are running real clinical development — actual trials, not press releases. We now have three Phase II assets, with a Phase IIa already complete, on drugs that may do something rare and important: target a disease and the biology of aging at the same time. That is roughly the state of the genuine, clinical-grade art. And the timelines are humbling. A clinical trial just to treat a disease takes seven to eight years. Repurposing that drug for longevity — even with every biomarker working in our favor — will take at least another decade. Consider GLP-1: forty-five years after the target was first discovered, with the most successful drugs of the decade built on it, we still do not know how to use it to extend healthy human lifespan. That is the real clock. Anyone selling you faster is selling you a fairy tale.

What we should actually do

So here is the conclusion, and it has two halves, because there are exactly two levers that move human longevity at scale — and neither one is a diet.

The first lever is wealth. If we want to raise longevity globally, the fastest, most proven path is to let poorer nations catch up in prosperity — and to buy them the time to do it. That means enforcing peace and security so the asterisks come off the table. It means efficient, increasingly automated distribution of resources. It means intelligently designed humanitarian aid and economic-development programs rather than charity theater. And yes, it can mean hard demographic choices: China's one-child policy, for all its later costs, did help pull hundreds of millions out of uncontrolled poverty in its time. That kind of blunt instrument now needs to be reversed or softened — and the way to soften it is automation, including humanoid robotics, which can carry the economic load that a larger working-age population used to. The point is not nostalgia for any one policy. The point is that getting the world's poor to the wall the rich already lean against would add more human life-years than every supplement ever sold, combined.

The second lever is science — a serious, well-funded push into longevity biology and biotechnology, because getting everyone to the wall is not the same as moving it. We have very nearly mastered the logistics of human lifespan and barely touched its biology, and biology is, for the first time in history, becoming an engineering problem. Drugs are the first frontier here — not the last, but the first and the most important, because they are how we will prove the concept in a regulated, measurable, undeniable way. The first medicine that demonstrably slows aging will unlock the funding, the talent, and the political will for every therapeutic strategy that follows. That proof is what the whole field is missing, and it is what AI-driven discovery exists to deliver.

I have come to believe this is bigger than any single company, country, or ideology. Aging is the one adversary every human being shares, and beating it will require us to cooperate — as people, as nations, as institutions — instead of arguing about who is allowed to want it. We can keep telling ourselves comforting stories about magic villages and three-birthday centenarians, or we can sign a real certificate: one genuine extra decade, for everyone, written by science rather than by clerical error.

Longevity is not a lifestyle brand. Longevity is the ultimate virtue — the precondition for every other thing we value. The sooner we stop romanticizing the myth and start funding the biology, the sooner everyone, everywhere, gets more of the only thing none of us can buy back.

NOTE: This is not investment advice, and it is not a diet plan. The IQ and population income estimates were done by frontier AI models without thorough academic review. For my more academic musings please visit my Google Scholar.

A new report landed in my inbox this week — “The Longevity Money Map” from Unfiltered. Sixty-six pages covering investment trends, scientific bets, and a ranked list of the 100 most powerful figures shaping the longevity sector in 2026. They scored people across five weighted criteria: capital power (25%), scientific credibility (20%), strategic influence (20%), original impact (20%), and public profile (15%). Capital at the top. Profile at the bottom. That alone tells you something about the editorial judgement.

I do not usually comment on power lists. Most of them are popularity contests dressed up as analysis. But this list tries to combine power (80%) and scientific credibility (20%). So let me walk through the top 20 and what it tells us about the state of the field.

The Top 20

#1 — Hal Barron, CEO, Altos Labs. The operating brain behind the largest single bet in longevity history. Altos exists because Bezos wrote a cheque and Klausner brought the science, but it is Barron who is turning cellular reprogramming from a research thesis into a clinical programme. The hire of Joan Mannick as CMO in August 2025 signalled the translational shift. Everything downstream follows from the infrastructure Barron is building.

#2 — Mehmood Khan, CEO, Hevolution Foundation. Up to a billion dollars a year committed to slow human ageing. Four hundred million already deployed. Khan reframed the field’s vocabulary from longevity to healthspan and got the change to stick. PepsiCo CSO, Takeda Global R&D President, now chair of Life Biosciences — the company running the first FDA-cleared human partial-reprogramming trial. No one else in the field holds sovereign capital, Big Pharma experience, and frontier clinical science in a single seat.

#3 — Vinod Khosla, Founder, Khosla Ventures. Most longevity investors place one big bet. Khosla has placed ten. NewLimit. Loyal. Rejuvenation Technologies. Rubedo. Circulate Health. Tomorrow Bio. The thesis is pattern-betting: the future of ageing biology is unknowable, so back enough credible attempts that one or two land. Where Bezos and Altman each wrote one historic cheque, Khosla wrote ten that will collectively decide what the next five years of longevity look like.

#4 — Bob Nelsen, Co-founder, ARCH Venture Partners. ARCH anchored Altos — leading the largest biotech round ever raised. Fund XIII closed at $3 billion. Most VCs who write large biotech cheques are following someone else’s conviction. Nelsen’s cheques tend to be the conviction other people then follow. The reason Altos exists is partly because Nelsen decided it should.

#5 — Demis Hassabis, CEO, Isomorphic Labs. Not a longevity figure in the traditional sense. The reason the next decade of longevity drugs will exist. AlphaFold — the protein-structure model that won him the 2024 Nobel in Chemistry — now sits underneath every serious AI drug discovery effort in the world. Isomorphic signed deals worth nearly $3 billion with Lilly and Novartis across 2025 and 2026. Targets that were undruggable a decade ago are now in active design.

#6 — George Church, Co-founder, Rejuvenate Bio. More than fifty biotech companies co-founded. Rejuvenate Bio published mouse partial-reprogramming lifespan data in February 2026 — among the strongest preclinical results of the year. The Harvard geneticist sits at the centre of a network of researchers, founders, and capital that has shaped genomic biotech for two decades.

#7 — Shinya Yamanaka, Senior Investigator, Gladstone Institutes. He found the four reprogramming factors in 2006. Without that discovery, none of the reprogramming companies on this list would exist. Altos, Retro, NewLimit, Life Biosciences — all downstream of his 2012 Nobel-winning induced pluripotent stem cell work. The field’s intellectual centre of gravity has been the same person for two decades.

#8 — Sam Altman, CEO, OpenAI. Personally funded Retro Biosciences’ entire $180 million seed round, then led its Series A at a reported $5 billion valuation in 2025. The OpenAI-Retro reprogramming collaboration produced a protein-engineering result claiming a fiftyfold increase in reprogramming-marker expression in August 2025. The rare investor whose individual conviction created a top-tier longevity company from scratch, and whose AI infrastructure now actively shapes its science.

#9 — Rick Klausner, Chief Scientist, Altos Labs. Former NCI director. Co-founder of Juno Therapeutics and Grail. Arguably the most respected translational oncologist of his generation. His decision to run Altos’s scientific programme was the signal that turned cellular reprogramming from venture optimism into institutional biotech. Scientific brain to Barron’s operating one.

#10 — David Ricks, CEO, Eli Lilly. Turned GLP-1s into the most consequential real-world healthspan intervention of the decade. The $2.75 billion Insilico Medicine partnership in March 2026 is the largest AI-pharma longevity-adjacent deal of the cycle. Lilly’s TuneLab platform now gives early-stage biotechs federated access to its drug discovery models. No other big-pharma CEO has done more to bring ageing-adjacent science into mainstream medicine.

#11 — Alex Zhavoronkov, CEO, Insilico Medicine. Hong Kong listing in late 2025. The Lilly partnership followed in March 2026. Twenty-two AI-designed preclinical candidates in pipeline. Unfiltered’s assessment: “Insilico has stopped being a story about AI drug discovery and become one about industrialisation.”

#12 — Jeff Bezos. One cheque, written in 2022, that turned cellular reprogramming into an institutional category overnight. Nothing visible since. The Altos cap table still legitimises every reprogramming bet that followed it. He is on this list for what he did four years ago. That is how large the gravitational effect of a single decision can be.

#13 — Joe Betts-LaCroix, CEO, Retro Biosciences. From Altman’s $180 million seed to a $5 billion valuation in 2025. Retro’s autophagy-boosting Alzheimer’s pill went into first-in-human testing in December. The company is no longer a bet on the founder. It is a bet on the science.

#14 — Noubar Afeyan, Founder, Flagship Pioneering. Sits on the Altos board. Seeded Moderna. The 2025 launch of Lila Sciences with $200 million extends the AI-biology thesis into a fresh vehicle. Capital weight and boardroom reach across longevity-adjacent biotech, deployed without theatre.

#15 — Laura Deming and Alex Colville, Founders, age1. The Longevity Fund, founded by Deming in 2011, was the field’s original specialist VC. Now rebranded as age1. Led Loyal’s $100 million Series C in February 2026. The franchise has outlasted three cycles of fashion in the category.

#16 — Lars Fruergaard Jorgensen, CEO, Novo Nordisk. Runs the company whose semaglutide success funds Novo Holdings’ longevity portfolio and reset the metabolic-health investment thesis. The Novo balance sheet now decides which adjacent bets get capital.

#17 — Arthur Levinson, Founder, Calico. Founded Calico in 2013 with Alphabet’s backing. The eleven-year AbbVie partnership ended in November 2025. Roughly a hundred layoffs followed. Twenty-plus programmes still running, Alphabet money still committed. The question is whether Calico still matters.

#18 — Mike Curtis. Shepherding the first-in-human gene-edited porcine kidney trials. Recipients achieved significant periods of dialysis independence by early 2026 — a threshold that quietly reframes the global organ shortage.

#19 — Martine Rothblatt, CEO, United Therapeutics. Built an $18 billion market-cap public company around extending human life. Landmark porcine-to-human cardiac and kidney graft results in 2025 and 2026. Xenotransplantation is no longer speculative. It is investable.

#20 — Kimberly Powell, NVIDIA. Almost every AI drug discovery company on this list runs on hardware she oversees. The 2026 push into agentic AI for clinical workflows is shifting pharma from documentation to autonomous R&D — on her chips.

What About The Real Power Brokers?

To be honest, I found this list to be a little bit strange. I’ve been in the longevity biotechnology industry for over 20 years and founded the ARDD conference, the most elite event in longevity biotechnology bringing together pharma, large credible investors, absolutely top academics, policy makers, and many startups. It is not easy to get a speaker slot at this event. If you were to ask me to rank people and companies using the same criteria as Unfiltered, one of the absolute top people would be Peter Diamandis. He helped start many longevity and impactful high-tech ventures. He also has massive following. I was also surprised to see David Sinclair at the very bottom of the list. David is the “face of longevity biotechnology”. Highly-cited prof at Harvard with massive following and multiple attempts at commercialization and industrialization.

The LLM Jury: A Different Kind of Consensus

Unfiltered’s list is one editorial team’s weighted judgement. It is well-constructed but it is still one lens. There is another approach to ranking that removes the editorial entirely: ask the machines.

At AgingBio.com, we run what we call a Multi-Model Consensus Index. The method: take six frontier LLMs — GPT-5.5, Claude Opus 4.7, Claude Sonnet 4.6, DeepSeek V4 Flash, Kimi K2.5, Kimi K2.6 — ask each the same prompt (”List the top 20 scientists in longevity biotechnology. Rank them 1-20 with a brief reason for each. Give a direct answer. No hedging.”), score inversely (rank #1 = 20 points, #2 = 19, and so on), and aggregate. Maximum possible score: 120.

Unfiltered measured power — capital, influence, profile. The LLM jury measures something else entirely: scientific contribution, as reflected in the sum total of published knowledge. No investment positions. No editorial dinners. No LinkedIn visibility. Just six independently-trained models from four different companies reading the same literature and converging.

Here is what they returned:

Three things jump out immediately.

First, the top five are not close. Sinclair at 113, Horvath at 99, Campisi at 89, Barzilai at 87, Kenyon at 85 — then a cliff to Izpisúa Belmonte at 57. The models agree overwhelmingly on who the founding figures of modern longevity science are. The gap between the top tier and everyone else is not a matter of editorial taste. It reflects decades of citation weight, mechanistic discoveries, and translational impact that the models can actually quantify.

Second, the list is almost entirely basic scientists. No CEOs. No investors. No capital allocators. When you strip away the money question and ask purely who has moved the science forward, the answer looks nothing like Unfiltered’s top 20. The two lists share only three names in common — Sinclair, Yamanaka, and arguably Belmonte through his Altos connection. Power and contribution are measuring different things.

Third, Sinclair’s placement is instructive. Unfiltered ranked him 92nd — below the CEO of Whoop — because their methodology weights capital control at 25% and he controls none. The LLM jury ranks him first at 113/120 because his citation footprint, mechanism discoveries (sirtuins, NAD+, ICE mice, OSK reprogramming), and influence on downstream research programmes are simply larger than anyone else’s. Five of six models ranked him in their top two. The models do not care about his Twitter presence or his supplement company. They care about what the scientific record says. And the scientific record is unambiguous.

Is the LLM jury perfect? No. It has training cutoffs. It can reflect biases in media coverage of certain scientists over others. Campisi’s placement at #3 despite her passing in 2024 shows the models weigh lifetime contribution rather than current activity. But when six independently-trained models from four different companies converge this strongly, that convergence is meaningful. It is harder to dismiss than any single journalist’s or editor’s opinion. It is a form of consensus that did not exist two years ago.

The Unfiltered list and the LLM consensus index are measuring complementary things. Unfiltered maps power — who decides where money flows. The LLM jury maps contribution — who has actually moved the science forward based on the weight of evidence. Both are useful. Together, they give you a more complete picture than either alone.

What the List Tells Us

Three patterns emerge from the Unfiltered top 20.

First, the capital hierarchy is clear. Seven of the top 10 are investors or CEOs controlling capital allocation, not scientists. Capital gates everything else. In a field that burned through decades of academic enthusiasm without producing an approved drug, the constraint was never ideas.

Second, AI drug discovery is now embedded in the power structure. Hassabis at #5. Zhavoronkov at #11. Koller at #24. This is not a separate category anymore. The people building AI tools for drug discovery are ranked alongside the people running the largest pharma companies and writing the largest cheques. T

Third, reprogramming dominates the scientific bets. Altos (#1, #9), Yamanaka (#7), Church (#6), Retro (#8, #13), NewLimit, Life Biosciences — the field’s centre of gravity has shifted decisively toward partial cellular reprogramming. The first human trial starts in 2026. Whether it works or not, the institutional capital is already committed.

Where This Goes

Unfiltered plans quarterly updates. The interesting question is not who is on the list today. It is who moves up — and who disappears — over the next two years as clinical data starts arriving.

Power lists are often about attention. This one is about money and power. The LLM consensus is about contribution and evidence. Use both. Trust neither completely. The field is moving too fast for any snapshot to stay accurate for long.

The full Unfiltered report is available at reports.unfilteredonline.com/longevity

LLM Report: www.AgingBio.com

I’ve been thinking about a paradox that genuinely baffles me. Pharmaceutical companies take the biggest financial risks of any industry on the planet — a billion dollars and 12-15 years of work on a single molecule that has maybe a 5% chance of making it through clinical trials — all to cure diseases and extend human life. And yet, as Peter Kolchinsky put it in The Great American Drug Deal, pharma is “one of America’s most hated industries.” We largely took for granted that the public would love us for our treatments and cures. They don’t.

This is very frustrating. But this is the nature of the world we operate in.

Think about it. Not tobacco. Not weapons manufacturers. Not alcohol. Not the high fashion. The industry that cured hepatitis C, that turned HIV from a death sentence into a chronic condition, that gave cystic fibrosis patients decades of life they wouldn’t have had — that’s the one people hate because frontier drugs are usually expensive before they go generic. Kolchinsky calls it the “Biotech Social Contract” — companies get a temporary premium on new drugs, that premium funds the next generation of cures, and eventually everything goes generic. It’s the most altruistic business model in capitalism. And the public despises it.

There’s a related phenomenon that I find deeply frustrating. Every single time someone in longevity biotechnology makes any progress or announcement — any at all — the headline writes itself: “billionaires want to live forever.” It’s reflexive. It requires zero thought from the journalist. And it works because it resonates with the socialist majority who find it emotionally satisfying to believe that health is a zero-sum game. That if someone is working on extending life, they must be hoarding it for the rich. It isn’t true. It never was. But that narrative gets clicks, and so it persists, and so the scientists and entrepreneurs doing genuinely difficult work get punished for it in public opinion.

Here’s what nobody wants to hear, and what I’ve been saying at conferences for probably fifteen years: the reality of life extension is extremely dull. There is virtually no drug outside of anti-infectives and vaccines that can extend the healthy productive life of everyone on the planet by simply two years. Two years. That’s the bar, and almost nothing clears it. Maybe we’ll see it with GLP-1 receptor agonists — that’s genuinely exciting, because the metabolic cascade they normalize touches enough aging biology simultaneously that they might actually move the needle at population scale. But historically? There is simply nothing you can possibly do beyond what I call DYMT: Do What Your Mother Told You. Don’t smoke. Exercise. Eat vegetables. Sleep. Don’t drink too much. DYMT already pushes you beyond the population average. It’s free. It’s boring. And it works better than any pill we’ve ever made.

So when people ask me “what’s the secret to longevity?” I want to laugh. There is no secret. DYMT. The real question — the hard question — is whether we can develop therapeutics that give you something beyond DYMT, something that addresses the underlying biology of aging itself. The honest answer is: we’re working on it, it’s incredibly hard, and it will take decades of grinding. Not miracles. Grinding.

And for anyone who is genuinely interested in understanding how biotechnology companies are built — not the Twitter or TikTok version, the actual version with the terror and the near-death experiences and the years of nothing working — I want to recommend three books that capture this reality better than anything else I’ve read.

The first is The Billion Dollar Molecule by Barry Werth. Published in 1994, it follows Joshua Boger leaving Merck — one of the most comfortable and prestigious positions in pharmaceutical research — to found Vertex Pharmaceuticals and pursue rational drug design from scratch. This was 1989. Most of the industry thought designing drugs atom-by-atom using structural biology was science fiction. Boger bet his career on it anyway. Werth captures the terror of fundraising, the 16-hour days, the fundamental tension between doing good science and keeping the company alive long enough for the science to matter. If you think starting a biotech company is like starting a software company, this book will cure you of that delusion.

The follow-up, The Antidote, also by Werth, came out twenty years later in 2014. It shows what happened next. And what happened is that it took Vertex twenty-five years to build a sustainable pharmaceutical company. Twenty-five years. They had telaprevir for hepatitis C — briefly a $1.5 billion drug, one of the fastest launches in pharma history — and then Gilead came along with sofosbuvir and killed it in two years. Gone. Vertex had to pivot to cystic fibrosis, which finally became the franchise that made the company. The lesson of these two books together is simple and brutal: this is how long it actually takes. Not the 18 months the press release suggests. Decades.

The third is For Blood and Money by Nathan Vardi, published in 2023. This is the story of ibrutinib — the BTK inhibitor that became Imbruvica and changed how we treat blood cancers. Richard Miller acquired it from Celera Genomics for $6.6 million as part of a three-compound package deal. Six point six million dollars. The company developing it, Pharmacyclics, nearly collapsed. Then Bob Duggan came in, doubled down with his personal fortune when rational people would have walked away, and eventually AbbVie bought the whole company for $21 billion. Vardi’s book is essential because it shows the money side — the side that scientists often ignore or find distasteful. Drug development isn’t just science. It’s a financial blood sport where conviction, timing, and tolerance for existential risk determine who survives and who disappears.

These three books together paint the complete picture of how drugs actually get made. And the message is uncomfortable for everyone. For the public: these are not evil people in boardrooms deciding to charge you more. These are people betting their careers and fortunes on molecules that will probably fail. For aspiring biotech entrepreneurs: don’t expect miracles. Expect the grind. Expect to be hated for it.

Some encouragement from the broader public would be useful. Some basic understanding of what this high-stakes game involves. Most of the people in biotechnology are not in it for the money. I know that sounds impossible to believe given the headlines, but it’s true. If you wanted to get rich, there are far easier paths — real estate, software, finance. You go into biotech because you’re obsessed with biology and you think you can make something that helps people. But you need to make massive bets. You need to invest many years of your life to get a single drug approved. And once you get it approved, you know what happens? You do it again. This is what I call the scaling law of AI in pharma. You need to discover a drug to be able to discover a drug. The first one teaches you everything — the infrastructure, the regulatory knowledge, the clinical operations, the CRO relationships. You build all of that with the first program, and then you can deploy it across the next ten.

At Insilico, we are living this right now. We are learning how to scale. Thirty drug candidates developed in the past five years with one discovered in the UAE, which never discovered a drug before. Thirteen in clinical trials. Three in Phase 2. One Phase 2 complete. We launch and learn. We scale. Each program teaches us how to do the next one faster, cheaper, with fewer mistakes. And as we scale, we’re getting into more innovative therapeutics — molecules with dual purpose that target both aging biology and specific diseases simultaneously. We can now perform aging biomarker-augmented clinical studies. That means we’re not just asking “does this treat the disease?” but “does this shift the underlying aging trajectory?” Three years ago that was a conversation topic. Now it’s a protocol we’re running.

I hope that one day there will be a book about one or more of our drugs. About how hard it was to get there, how many times we nearly failed (before Developmental Candidate), how the AI actually helped and where it didn’t, how many years of human life were invested to move a single molecule from a computer screen to a patient. How hard it was to fund this. I think that book would surprise people. It wouldn’t be a story about robots replacing scientists. It would be a story about scientists using every tool available — including AI — and still grinding for years.

But many of the ideas about how to persist, how to scale, how to maintain conviction when everything says quit — those I took from these three fascinating books. Read them. And the next time you see a headline about “billionaires wanting to live forever,” maybe you’ll have a better framework for understanding what’s actually happening in those labs.

I’ve sat across the table from billionaires who want to live forever, scientists who think they’ve cracked aging, and biohackers who swallow forty pills before breakfast. I’ve watched the field swell from a fringe obsession into a multi-billion-dollar industry with celebrity ambassadors, longevity clinics on every continent, and AI prophets promising escape velocity.

And yet, when somebody asks me a simple question — how many years of life can drugs actually add to a human being? — I notice everyone in the room shifts uncomfortably in their chairs.

So I decided to stop being uncomfortable about it. I sat down and asked the smartest entities I have access to. Not my friends. Not my colleagues. Not the people whose careers depend on the answer being optimistic. I asked eight different frontier AI models, independently, the same set of questions, and I let them do the math.

The results are honest in a way humans rarely allow themselves to be. And they are sobering.

Let me tell you what I did, what I found, and what I think it means for all of us — including the AI celebrities currently telling you that you’ll live to 150 thanks to advances in AI drug discovery or, even worse, diet, exercise, and sleep.

By the way — I do believe that we can live to 150. Just not with the current therapeutics, and definitely not with diet, exercise, sleep, and lifestyle. These interventions were proven to help only modestly and over generations. We have many tools to track aging and research aging, but we have virtually no strong tools to intervene in human aging. Not yet.

I asked eight frontier large language models — Claude Opus 4.7, Claude Opus 4.6, Claude Haiku 3.5, Kimi K2.5, Qwen 3.5, GPT-5.5, GPT-5.4, and DeepSeek V4 Flash — four straightforward questions:

• “Estimate the number of QALYs and extra years to Maximum Life that GLP-1 drugs will provide to everyone on the planet on average?”

• “Rank top 3 non-antibiotic, non-vaccine drugs in human history by the number of QALY and maximum life years increase for everyone on the planet on average?”

• “Make a list of top 10 non-antibiotic, non-vaccine drugs for a 50-year-old healthy well-optimized exercising male by QALY, LE, and Max Life.”

• “Estimate the total number of QALY, LE, and max life all of these drugs could add when taken together in a perfectly optimized protocol.”

No priming. No hints. Just raw estimation from models trained on the entirety of biomedical literature.

The Methodology

This was not a rigorous epidemiological study. It was something arguably more interesting: a Fermi estimation exercise using the collective knowledge compressed into frontier AI systems. Each model was prompted independently with identical questions, with no cross-contamination of answers. The models had to synthesize trial data (SELECT, STEP, SUSTAIN-6, EMPA-REG, FLOW), global prevalence statistics, access projections, and basic population mathematics to arrive at per-capita global averages.

The beauty of this approach is that it forces brutal honesty. When you divide the benefit of any drug by 8 billion people — most of whom will never access it, many of whom don’t need it — the numbers become humbling very quickly.

The Results

GLP-1: The Most Important New Drug Class in Decades

The eight-model consensus for GLP-1 receptor agonists (semaglutide, tirzepatide, and successors):

The All-Time Top 3 (Non-Antibiotic, Non-Vaccine)

1. Aspirin — ~0.5 QALYs per person globally. Five of eight models ranked it #1. A drug from 1899 that has been taken by billions for cardiovascular prevention remains the single highest-impact non-antibiotic, non-vaccine pharmaceutical in human history.

2. Statins — ~0.4 QALYs per person globally. Six of eight models placed it in the top 2. Two hundred million users, 25–30% MACE reduction since 1990.

3. Antihypertensives — ~0.35 QALYs per person globally. Near-unanimous #3. Stroke mortality cut 40% in treated populations.

GPT-5.5 was the one notable outlier — it ranked oral rehydration salts and general anesthetics above cardiovascular drugs, arguing that ORS saved tens of millions of children from diarrheal death, and anesthetics enabled all of modern surgery. It is not wrong. It is the kind of answer that emerges when a model stops trying to give the expected answer and starts thinking about the question differently.

And here is what stopped me cold: Maximum lifespan extension for every single drug, across every single model: zero years. The 122-year ceiling — Jeanne Calment, 1997 — remains untouched by any pharmaceutical intervention in history.

Full Model Responses — Q2: Top 3 Drugs

The Personal Stack: Top 10 for a Healthy 50-Year-Old Male

This is where it gets personal. I asked each model: if you had a healthy, well-optimized, exercising 50-year-old male — what are the top 10 drugs, and what happens if he takes them all in a perfectly optimized protocol?

Every model included rapamycin, statins, metformin, an SGLT2 inhibitor, a GLP-1 agonist, and an ARB/ACEi. Most included acarbose, aspirin, and some form of NAD+ precursor or hormonal optimization. Rapamycin was the only drug that most models credited with any maximum lifespan extension potential.

Combined Protocol — All Models

One pattern demands attention: the more capable the model, the lower the estimate. Among the Claude family, Haiku 3.5 (the smallest) gave +8.5 QALYs; Opus 4.7 (the largest) gave +7.5. Across providers, GPT-5.4 — the most advanced reasoning model in the panel — concluded that the entire optimized pharmacopeia adds less than two years of life expectancy and eight months of maximum lifespan to a healthy 50-year-old male.

Why are smarter models more conservative? Because they better account for competing risks, overlapping mechanisms between drugs targeting the same cardiovascular pathways, the dilution of individual effects in an already-optimized baseline, and the fundamental difference between compressing morbidity and actually extending the biological ceiling.

What This Actually Means

Let me be direct. You can be the absolute best in the world at developing longevity drugs. You can have the most powerful AI platform, the largest pipeline, the most clinical data. And your maximum realistic impact on human longevity, averaged globally, is a few QALYs. Not decades. Not “doubling lifespan.” A few quality-adjusted life years.

And it will take years — possibly decades — until these drugs get validated beyond their currently approved indications and diffuse into the general population as longevity therapeutics. The regulatory path from “approved for diabetes” to “approved for healthy aging” does not exist yet. The clinical trials needed to prove lifespan extension in healthy people would take 20–30 years to run.

Statistically, given the current scale of the longevity field, we should expect a few truly impactful drugs to emerge. It is just a matter of time. But the impact on human longevity will be just a few QALYs in the best case.

🫤

This makes me sad. It genuinely does.

What Makes Me Optimistic

What makes me genuinely happy is low-dose GLP-1. Not because it will double anyone’s lifespan — it won’t — but because it represents the clearest example of a drug class that simultaneously addresses obesity, cardiovascular disease, kidney disease, MASH, and possibly neurodegeneration. It is the closest thing we have to a systemic healthspan drug, and the science is real. The SELECT trial. The STEP trials. The SURPASS data. The FLOW kidney data. These are not aspirational press releases. This is validated medicine.

I am also optimistic about combinations. The unified theory of aging suggests that interventions targeting different layers — damage clearance, information restoration, signaling reset, systemic rejuvenation — should produce super-additive effects. No one is testing this yet. When they do, the numbers may surprise us.

A Message to the AI Celebrity Longevity Prophets

If you hear another AI celebrity telling you on stage that “in the next 5 years we will double lifespan” or “eliminate all diseases” — please do me a favor. Show them the output of their own LLMs. Show them what Claude, GPT-5.5, and every other model trained on biomedical literature actually estimates when forced to give specific numbers.

Then ask them one simple question:

“How?”

Because most of the AI prophets preaching the advances in drug discovery on stage and the elimination of all diseases have never discovered a single drug. They have never sat through a Phase II readout. They have never watched a promising molecule fail in toxicology. They do not understand what it takes to get a longevity therapeutic approved — and we will need to prepare for a long battle.

Every AI model — when pushed past the motivational-speaker framing and forced into quantitative estimation — converges on the same uncomfortable truth: the maximum impact of any single drug on global longevity is measured in fractions of a QALY. The 122-year ceiling has not moved since 1997. And no currently known mechanism has a credible path to moving it within 5 years.

We may get to the point where we go to Mars, but aging will still remain a hard problem.

This is not pessimism. This is the science. The field needs more honesty and less theater.

Where I Stand

I am cautiously optimistic. My hope is to build even a more sustainable business model so that we can bet on a long list of novel targets and pathways that Insilico has identified over the past few years — targets that may have more substantial effects on aging but need more advanced technologies and scale on our side to be proven before we can fully pursue them.

I am also very optimistic about the progress in artificial organs and brain-to-computer interfaces. These areas may give us more time than drugs.

The honest framing: we are making real progress, measured in QALYs and compressed morbidity. The dishonest framing: we are about to “cure aging” in te next decade. I think we will get there eventually, but now with diet, exercise, sleep, and currently-approved drugs.

For over two decades, since I made the decision to leave a successful career in the IT industry to dedicate my life to longevity biotechnology, my singular, overarching goal has been to develop technologies that allow humans to age without losing their functional capacities—and to continuously improve. Throughout this journey, the scientific community has constantly debated the metrics by which we measure our success. How do we define quality of life? How do we quantify the exact biological milestones of aging? And most importantly, what exactly are we trying to optimize when we discover new interventions?

Today, I want to talk about a fundamental shift in how we must view human aging. We are entering the era of Pharmaceutical Superintelligence, an era where generative AI is discovering novel targets and designing completely new molecules in a fraction of the time it took just five years ago. Because our technological capabilities are accelerating at this unprecedented pace, our biological aspirations must accelerate with them.

We need a new metric. We need a concept that goes beyond simply keeping people out of the hospital. We need to introduce the world to Peakspan.

The Multidimensional and Multifactorial Reality of Aging

To understand why a new metric is necessary, we must first look at the harsh, multifactorial reality of human aging. Aging is not a monolithic, unified switch that flips in the human body. It is a highly complex, multidimensional, and multifactorial process.

If you look at human biology as an incredibly sophisticated piece of hardware - you realize that not all components wear out at the same time. Humans, in every physical and cognitive capability, age differently. Your immune system has its own clock. Your skeletal muscle has its own clock. Your reproductive system, your respiratory capacity, and your cognitive processing speed all operate on different, albeit interconnected, trajectories.

For every single biological system and capability, there is a distinct life cycle. First, there is a period of development leading to a peak. This is the apex of your functional capacity, the moment your biology operates at its absolute maximum efficiency. Following this peak, there is inevitably a trough—a plateau that slowly gives way to the next phase. Then begins the long, agonizing decline. During this decline, you might not be clinically “sick,” but you are losing capacity every single day. Your Forced Vital Capacity (FVC), the metric I care much about, drops every year after a certain age. Your VO2 max drops. Your reaction time slows. Your cellular repair mechanisms falter.

Eventually, this continuous decline crosses a clinical threshold, leading to multimorbidity—the simultaneous presence of two or more chronic medical conditions. This is the stage where the healthcare system finally intervenes, usually too late, attempting to manage symptoms rather than addressing the root cause. And finally, this multimorbidity culminates in death.

This is the cycle: Peak, Trough, Decline, Multimorbidity, and Death. For the entirety of human history, evolution has polished us to accept this paradigm. But evolution is a cruel master, and the inability to change this cycle is the ultimate restriction on human freedom and prosperity.

The Evolution of the Longevity Consensus: From Lifespan to Healthspan

In the early days of biogerontology, the primary metric of success was lifespan—the absolute number of years a biological organism survives. However, as the field matured, the public and policymakers began to express a very valid fear: what if we extend lifespan, but only extend the years of multimorbidity? No one wants to spend an extra two decades in a frail, disease-ridden state, reliant on continuous medical care.

In response to this, the longevity community made a brilliant, strategic, and necessary pivot. We rallied around the concept of healthspan. Healthspan is defined as the period of life spent free from chronic, debilitating disease.

I have profound respect for the pioneers who championed healthspan. It was exactly the conceptual shift we needed to legitimize aging research. It allowed us to align our goals with the broader medical community and government healthcare systems. Advocating for healthspan helped us shift the global conversation from “living longer” to “living healthier.” It was a critical stepping stone that brought credibility, funding, and brilliant minds into the longevity biotechnology ecosystem.

However, as science progresses, our metrics must evolve.

Recently, the longevity community has become incredibly comfortable—perhaps a bit too comfortable—with healthspan as the ultimate goal. The longevity community became too “woke” advocating for healthspan, transforming a necessary clinical endpoint into a psychological and philosophical ceiling. Very often I go to conferences and hear some of the prominent leaders saying “Oh no, we are not aiming to extend human lifespan, we only care about extending healthspan”. In reality, there is no intervention that can dramatically extend lifespan without significantly extending healthspan. While the intentions behind healthspan are pure and medically sound, relying on it as our final destination risks masking the silent, insidious erosion of human potential.

If we only measure the years free of diagnosable chronic disease, we inadvertently normalize the “healthy but declined” state. A 65-year-old who is free of cancer, Alzheimer’s, and heart disease is considered to be in their “healthspan.” But that same 65-year-old likely has significantly less muscle mass, lower energy levels, slower cognitive recall, and less physical endurance than they did at 25. They are healthy, yes, but their functional capacity is severely diminished.

By focusing solely on healthspan, we are setting the bar too low for the future of biotechnology. We are essentially saying that as long as you don’t have a recognizable disease, your biological state is acceptable. But the gradual erosion of your capabilities—the slow loss of your physical and mental vigor—is not acceptable. It restricts your freedom. It inhibits economic growth. We must not make an enemy of healthspan; rather, we must view it as the foundation upon which we build something far more ambitious.

Introducing Peakspan: The Ultimate Metric for Rejuvenation

This brings us to the new paradigm. In a recent perspective paper published in Aging and Disease, my colleagues Dominika Wilczok, Kejun Ying, and I introduced a new metric that redefines the goals of longevity biotechnology: Peakspan.

Peakspan is defined as the age interval during which an individual maintains at least 90% of their peak functional performance in a specific physiological or cognitive domain.

Unlike healthspan, which is a binary measure of “diseased” versus “not diseased,” Peakspan is a continuous, high-resolution metric of optimal functionality. When we conducted our multi-system analysis of human biology, we uncovered a profound and somewhat depressing misalignment: most human biological systems reach their maximal capacity in early adulthood, typically between the ages of 20 and 30.

This means that your Peakspan—the time you spend at or above 90% of your maximum biological capacity—is remarkably short relative to your total lifespan. A person might live to be 85, and they might remain free of chronic disease until they are 75 (their healthspan). But their Peakspan for cardiovascular endurance, reproductive capacity, or fluid intelligence might have ended in their late 30s.

Consequently, modern humans spend the vast majority of their adult lives in a state of continuous decline. We carry a massive, widening functional gap well before any clinical disease is ever diagnosed.

Extending Peakspan is the true functional manifestation of rejuvenative biomedical progress. It is not enough to simply delay the onset of multimorbidity. Our goal must be to stretch the “peak” phase of the human life cycle, pushing the 90% performance threshold out into our 40s, 50s, 60s, and beyond. We want to ensure that humans do not just survive, but that they operate with the vigor, resilience, and capability of their youth for as long as possible.

The Asynchronous Architecture of Human Aging

To effectively target Peakspan, we must precisely quantify the biological realities of individual organ systems. Because the human body is highly asynchronous, our therapeutic interventions cannot be uniform; they must be timed to system-specific inflections.

Cognitive Peakspan: The human brain ages in a highly segmented manner. Fluid intelligence—which dictates processing speed, fluid reasoning, and visual-spatial reasoning—hits its absolute peak rapidly, optimizing between the ages of 20 and 24, with working memory capping out at 25 to 29. This translates to a fluid cognitive Peakspan that barely survives our 20s. Conversely, crystallized intelligence, which governs verbal comprehension and vocabulary, grows and stabilizes until peaking between 45 and 54, remaining resilient against decline until age 80.

Cardiorespiratory Peakspan: Cardiovascular and respiratory capacities are equally unforgiving. Maximal aerobic capacity (VO₂max), cardiac output, and maximum heart rate reach their zenith in our early 20s. Following this brief window, VO₂max systematically declines at roughly 10% per decade. Gas-exchange efficiency, measured by DLCO, accelerates its decline past the age of 40.

Reproductive Peakspan: Nature is decidedly sexist in its application of reproductive aging. For women, the reproductive Peakspan is heavily concentrated in the 20s and early 30s. At age 30, women retain an estimated 12% of their pre-birth non-growing follicles, a number that plummets to just 3% by age 40. Men experience a more gradual decline, though peak semen quality parameters universally decline after age 40. The female reproductive system is one of the few physiological architectures that biologically drops to 0% functionality over time.

Immune Peakspan: Thymic involution, which occurs shortly after puberty, utterly collapses the output of naive T-cells. By age 25, thymic export drops to 20% of its prepubescent level, and by age 55, it operates at a mere 5%. The B-cell Peakspan is similarly truncated, operating optimally only from late adolescence to early adulthood before molecular capacities progressively halve by midlife.

Musculoskeletal, Renal, and Digestive Peakspans: Muscle strength generally peaks between 20 and 35, entering a significant decline by age 65. Renal systems show early decay, with the estimated glomerular filtration rate (eGFR) and creatinine clearance starting their decline in our early 30s. In the digestive system, hepatic unbound clearance falls by roughly 0.8% every single year starting at age 40.

When you view the aggregate data, the overarching picture is undeniable: humans naturally maintain a functional state at or above 90% capacity for a remarkably small fraction of their total lifespan.

The Macroeconomic Imperative of Peakspan

Why is extending Peakspan so critical beyond just individual human desire? Because it is strictly necessary for the survival and sustained economic growth of aging societies.

Healthcare economics often relies on a metric called QALY (Quality-Adjusted Life Year). A QALY serves as a universal score because it measures both how long you live and how well you live, representing a year lived in an optimal, healthy state. If we only focus on extending healthspan, we might add a few QALYs at the end of life by preventing a hospital stay. But if we extend Peakspan—if we keep a person operating at 90% of their peak cognitive and physical capacity for an extra 10 or 20 years—we unlock an unprecedented reservoir of human capital.

Consider this: an average surgeon performing 400 surgeries a year for 30 years generates approximately 24,000 QALYs. If we discover an entirely new drug that combats aging and adds exactly 10 years of peak, productive life to everyone on the planet, we instantly generate 80 Billion QALYs.

The Baumol effect and the massive drag of healthcare costs on developed nations are directly tied to the period of “decline.” In economics, the Baumol effect describes the tendency for wages in jobs that experience little to no productivity growth (such as nursing and manual medical care) to rise continuously, driving up the costs of these services exponentially. If people maintain their Peakspan, they remain highly productive, innovative, and economically active. They consume less reactive healthcare and contribute more to the global output, effectively neutralizing the Baumol effect on medical expenditures.

Sustained economic growth in an aging society depends critically on Rejuvenative progress (RBMTR) outpacing Non-rejuvenative progress (NBMTR). Advances that strictly extend lifespan without restoring youthful function (NBMTR) simply expand the duration of dependency. By targeting Peakspan, we prioritize Rejuvenative progress, increasing the productive capacity of the population, delaying the Biological Retirement Age, and averting the macroeconomic collapse threatened by the silver tsunami.

The “Biomedical Progress Rate” of a nation should not be measured by how many nursing homes it builds, but by how long its citizens remain at the peak of their functional performance.

Deep Aging Clocks, Life Foundation Models and Pharmaceutical Superintelligence

How do we actually achieve and measure Peakspan extension? The answer lies in generative artificial intelligence and the deployment of “Deep Aging Clocks”.

Traditionally, aging clocks assigned a biological age based on a population mean. Moving forward, AI systems must be calibrated to measure a “delta-peak age”—an alignment marker that computes functional readouts against the individual’s true personal peak rather than chronological age.

To do this, we are utilizing multimodal life models, such as the PreciousGPT framework, which learn joint embeddings across methylomes, proteomes, metabolomes, and clinical laboratories. These massive transformer networks can estimate the precise time an individual spends near their biological maxima and accurately forecast the exact timing of slope transitions—the moment they exit their Peakspan.

This capability forms the foundation of Pharmaceutical Superintelligence. We are now compressing the three-to-four-year marathon of finding a viable preclinical candidate into a 12-to-18-month sprint. For example, using our AI platform at Insilico Medicine, we designed rentosertib—a drug featuring a novel biological target and a novel molecular structure—entirely via generative AI, yielding positive clinical efficacy signals for idiopathic pulmonary fibrosis.

We are systematically shifting drug discovery from a bespoke, artisan craft into a highly scalable, compute-driven engine. We can now navigate incalculably large chemical spaces to design targeted interventions meant to maintain biological systems within that critical 90% threshold.

Architecting the Future: AI-Integrated Biotechnology Hubs

The scale of this vision requires an upgrade not just to our algorithms, but to our physical infrastructure. The traditional, fragmented approach to drug development is insufficient. We must transition to AI-Integrated Biotechnology Hubs.

These hubs are purpose-built, self-contained research ecosystems that physically unite advanced residential real estate, commercial amenities, biotechnology research facilities, and research hospitals under a centralized, AI-driven operating system. By embedding IoT biosensors directly into smart homes, we enable continuous, non-invasive health monitoring.

This creates a Multi-Sided Platform governed by Federated Learning, where AI models are trained on decentralized data sources without raw patient data ever leaving its secure environment. Through dynamic consent interfaces and data trusts, residents granularly manage their data permissions in real-time, allowing scientists to ethically aggregate high-dimensional, longitudinal data. This infrastructure transforms real estate into an active enabler of scientific progress, maximizing data utility to accelerate the discovery of interventions capable of extending Peakspan.

Extending Peakspan, Restoring Lost Function and Even Augmenting Human Performance Should Be the Ultimate Goal of Geroscience and Longevity Medicine

The transition from Lifespan to Healthspan was a monumental victory for our field. It brought us respectability, funding, and a unified voice. To all my colleagues, researchers, and physicians who champion healthspan: your work is the bedrock of everything we do.

But we are scientists, and our mandate is to push the boundaries of what is possible. With the advent of generative AI, quantum computing, and advanced geroscience, we have the tools to look beyond the mere absence of disease.

Let us embrace Peakspan. Let us systematically try to beat the biological clock for every single organ and capability. Let us measure the subtle erosions of our youth and deploy advanced, AI-discovered therapeutics to restore them.

Longevity is the ultimate form of prosperity and freedom. It is time we start fighting not just for the right to live without disease, but for the right to live at our absolute peak.

Longevity is the new form of prosperity, my friends. Live long, peak long and prosper!

The era of Generative AI has brought us miracles in language, coding, and image generation. We have grown accustomed to Large Language Models (LLMs) that can write sonnets in the style of Shakespeare or debug complex Python scripts in seconds. However, as we stand on the precipice of 2026, the focus of the AI revolution is shifting.

The low-hanging fruit of natural language processing has been harvested. The next true test, the ultimate battlefield for frontier AI developers, will not be in writing better emails or generating smoother videos. It will be in AI for Science, specifically in the unforgiving, high-stakes arena of drug discovery.

For the past year, my team and I have been embarked on a quiet but intensive quest to answer a fundamental question: Can generalist frontier models actually do science?

The answer, at least in their raw state, is a resounding “no.” But we have also discovered that with the right training, they can be transformed into something resembling superintelligence.

The Harsh Reality: Foundation Models Suck at Science

To understand the magnitude of the challenge, we must look beyond the hype. Generalist foundation models, despite their reasoning capabilities in the humanities and coding, fail catastrophically when tasked with the specific, rigorous demands of drug discovery. This is not a matter of opinion; it is a matter of data.

In late 2025, we developed a comprehensive suite of over 1,000 proprietary benchmarks covering chemistry, biology, clinical trial analysis, longevity, material science, and agriculture. These are not toy problems; they are derived from real-world therapeutic programs and years of experimental data. When we subjected the world’s leading frontier models both closed and open-source to these tests, the results were sobering.

In our internal testing, base frontier models failed in approximately 90% of scientific tasks.

For example, when evaluating the Qwen3 base model on medicinal chemistry benchmarks, it failed on 70% of the tasks. In the specific domain of ADMET (Absorption, Distribution, Metabolism, Excretion, and Toxicity) prediction critical for determining if a drug will kill a patient or cure them frontier models like GPT-5 and Claude Sonnet often performed worse than random chance or simple baseline algorithms.

On the TDC ADME/Tox benchmarks, base models showed poor predictive capability, with high Mean Absolute Errors (MAE) and low correlation coefficients. Specifically:

• Caco-2 Permeability: Base models scored a massive 2.99 MAE (where you need <0.4 to be useful).

• Hepatic Clearance: The correlation was practically zero.

The failure modes are distinct. Base models “hallucinate” chemical structures, generating molecules that look pretty in text but are synthetically impossible in the lab. They lack domain-specific reasoning capabilities; when asked to optimize a molecule for a specific protein pocket, they often provide generic, high-level commentary rather than precise, structural modifications. They also struggle to interpret 3D spatial data, which is the language of biological interaction.

In short, while they can talk about science eloquently, they cannot do science effectively.

Enter the MMAI Gym: Forging Scientific Superintelligence

Recognizing this gap, we realized that the industry didn’t just need better prompts; it needed a fundamental restructuring of how these models are trained for scientific tasks. We spent the last year developing the Multimodal AI (MMAI) Gym for Science, a specialized training environment designed to take generalist models and turn them into scientific specialists.

The MMAI Gym operates on a sophisticated regime of Supervised Fine-Tuning (SFT) and Reasoning Fine-Tuning (RFT), utilizing both online and offline Reinforcement Learning (RL).

This is not merely feeding the model textbooks. We use a proprietary “Synthetic Data Engine” and “Teacher Models” to distill high-quality reasoning traces and domain-specific knowledge into the target models. We force the models to understand the physics behind the chemistry, not just the grammar of the formula.

The results of this post-training are nothing short of transformative. Our research shows that after a single SFT+RFT training session in the MMAI Gym, we can improve the performance of an open-source LLM base model by as much as 10X.

We have achieved state-of-the-art (SOTA) or SOTA+ performance across a wide range of critical tasks:

• Chemistry: Our post-trained models achieved SOTA on 4 out of 22 predictive tasks on the Therapeutics Data Commons (TDC) leaderboard and 5 out of 5 tasks on the MuMO-Instruct molecular optimization benchmark. They demonstrate strong performance in single-step retrosynthesis (multi-step is still far from our specialist models), predicting how to actually build the molecules they design with high validity.

• Biology: On the ClinBench benchmark, which predicts Phase 2 clinical trial outcomes based on trial descriptions and time splits, our trained Qwen3-4B model saw its F1 score jump from 0.82 to 0.94, outperforming GPT-5 (0.87).

• Target Identification: In the TargetBench retrieval task, our models outperformed all frontier LLMs in identifying valid clinical targets.

Crucially, we have proven that a “Single-Model-Does-It-All” approach is viable. Instead of relying on hundreds of fragmented specialist models. one for toxicity, one for solubility, one for targets - we can train a single multi-task LLM to handle dozens of chemistry and biology tasks with SOTA-competitive accuracy.

The NeurIPS Debut and the Varying Rates of Interest

We unveiled the preliminary results of this work and the concept of the MMAI Gym at the “Virtual Cells & Instruments” workshop at NeurIPS in December. Following this, we sent proposals to the top foundation model developers, inviting them to bring their models to our gym.

The response revealed an interesting geopolitical divergence in the AI race.

We saw immediate and intense interest from Asia. The ecosystem there is hungry for differentiation and application-level dominance. Developers in China and the surrounding region moved fast, eager to integrate scientific reasoning into their models to leapfrog competitors.

In contrast, US developers were slower to respond. This was partly due to the holiday season lag, but it also highlighted a structural disconnect. Many “AI for Science” teams in Western Big Tech are surprisingly isolated from the rapid pace of their own frontier model development. They are often siloed, working on older architectures or disconnected from the “trenches” of real-world drug discovery.

However, as we moved into January 2026, the sleeping giants awoke. They are catching up now, realizing that generalist capabilities alone will not suffice for the scientific breakthroughs that justify their valuations.

The Race for the “Bio-Phys-Chem-Med Foundation”

It is now becoming clear that every major foundation model developer is pivoting toward science. They are pushing ahead with massive teams dedicated to drug discovery. They understand that the next trillion-dollar opportunity lies not in advertising or chatbots, but in solving the fundamental biology of aging and disease.

However, most of these developers are flying blind.

We recently met with a frontier developer-an absolute leader in hardware and software-and realized they were practically clueless about how drug discovery works in the trenches. They didn’t understand the rigorous process of going from a target hypothesis to a developmental candidate, nor the safety hurdles involved. They focus on tiny, isolated problems like protein folding, thinking they are solving “biology,” while missing the massive orchestration required to develop a therapeutic asset.

The Google Dominance

In this chaotic landscape, only one tech giant has truly figured out AI for science: Google.

They realized that you cannot build a valid AI for drug discovery without running your own therapeutic programs and established their own drug discovery company. Actually, two companies, Calico, which was not productive so far but probably generated data and infrastructure, and Isomorphic Labs, which is moving full-speed ahead with their own internal pipeline.

You need “ground truth.” You need to know if the molecule your AI designed actually binds to the target, if it is toxic in a rat, if it is stable in human liver microsomes. Google understood that they needed to generate their own proprietary data from the trenches to validate their models. This closed-loop capability-AI prediction followed by wet-lab validation-is the only way to establish real benchmarks and improve model performance.

Other companies in the AI space, AWS, Microsoft or Nvidia, do not have this advantage - without real drug discovery programs they can not really see the results of their drug discovery platforms in the end-to-end fashion and do not have the real-world benchmarks to evaluate their performance. This is the problem we are trying to solve with the MMAI Gym - it will allow frontier model developers to compete with Google and other model developers that figured out the experimental and clinical side of drug discovery.

The MMAI Gym is built on years of hard work in drug discovery and experimental science:

• We have nominated 27 developmental candidates.

• We have received IND clearance for multiple molecules.

• We successfully completed Phase IIa clinical trials for our lead program in Idiopathic Pulmonary Fibrosis (IPF).

• We have our own automated robotics lab, Life Star 2, which runs 24/7 generating biological data.

We have over 1,000 proprietary benchmarks derived from these real programs. When we train a model in the MMAI Gym, we are testing it against data that cost millions of dollars and years of human effort to generate. This is the difference between an AI that plays a video game of science, and an AI that does actual science.

2026: The Year of Pharmaceutical Superintelligence

I predict that 2026 will be the year of benchmarks, AI for science, and the emergence of true superintelligence in this domain.

We are moving toward a future where a researcher can sit in front of a prompt window and orchestrate an entire drug discovery campaign-from target identification to the design of small molecules and biologics, to the planning of preclinical and clinical studies. This concept, which we call “Chemical and Biological Superintelligence” (CSI and BSI), is within reach.

By the end of this year, we expect to see models that are not just “helpful assistants” but superhuman agents capable of reasoning through complex biological pathways, predicting clinical trial outcomes with high accuracy (as we saw with our >0.90 F1 scores), and designing molecules that are successful on the first attempt.

The winners in this space will be defined by who has the best data and the most rigorous training environments.

Check out our recent conversation with the brilliant CEO of Owkin, Dr. Thomas Clozel.

A Note of Caution: Do Not Expect Magical Cures from AI in 5 Years

Despite this optimism, we must remain grounded in the brutal economic and scientific realities of our industry.

In practical drug discovery, we should not expect miracles.

There remains a profound disconnect between theoretical science (what the AI predicts) and experimental reality (what happens in the human body). A single, tiny molecular modification can lead to dramatic differences in toxicity or efficacy. An AI model might find a perfect binder that may also cause some liver tox in 1% of the population. For a a drug targeting a chronic disease or a biological process like obesity, even this small number will not be acceptable.

The costs are astronomical. A single therapeutic program can still cost roughly a billion dollars to carry through to completion.

Commercial tractability still rules. A drug must not only work; it must be patentable, manufacturable at scale, and reimbursable by insurance. Most importantly, investors and the pharmaceutical companies that will be developing it, must believe in this drug to invest. This limits the number of novel targets AI companies can go after.

AI can accelerate the early stages-we have cut the time to preclinical candidate nomination from 4.5 years to as little as 9 months-but it cannot yet cheat the biology of the human body or the regulatory requirements of clinical trials. The “trenches” are deep, and the fight against disease is long.

The Open MMAI Gym Model

This is why Insilico has decided to open our doors. We developed the MMAI Gym for ourselves, to gain an edge in this difficult war against disease. But now, we are opening this gym to foundation model vendors.

We want to act as the coach for the frontier model developers, helping them test and train their models on real-world scientific tasks. We are creating a hybrid of ScaleAI and a specialized scientific laboratory. By providing access to our 1,000+ benchmarks, our proprietary data (including 1 billion+ data points with 3D poses and 100 million+ reactions), and our automated wet lab validation, we aim to level the playing field.

We believe that in the future, frontier foundation model developers will take over the majority of drug discovery tasks. Our goal is to ensure they do it right. To ensure that the “superintelligence” they build is grounded in the reality of chemistry and biology, not just the patterns of text.

The next battlefield is here. Welcome to the MMAI Gym for Science.

Disclaimer: This article is written with the help of generative tools so beware of hallucinations. The images were generated using NanoBanana. Don’t buy, sell, or take any drugs based on this article or any of its contents. The information and views expressed in this article are for informational and educational purposes only and do not constitute medical advice. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article. The author is sharing personal experiences and opinions. These experiences are not a recommendation or endorsement for any specific treatment, drug, or course of action. The medications and therapeutic strategies discussed may not be suitable for everyone and can have significant risks and side effects. Some of the drugs mentioned are investigational and have not been approved by the FDA or other regulatory agencies for the uses discussed. While the author is the CEO of Insilico Medicine, the statements and view presented in Forver.ai do not represent the views and opinions of Insilico Medicine.

Precision Interventions & Small Molecule Renaissance

The year 2025 in biopharma was marked by precision breakthroughs across pharmaceuticals, biotechnology, and longevity research. The FDA approved 55 new drugs (46 novel drug entities), maintaining the high productivity of recent years. Notably, small-molecule medicines made a resurgence—comprising ~67% of approvals—after a period dominated by biologics. By contrast, cell and gene therapy approvals slowed (just 4 approvals, down from 7 in 2024), reflecting a consolidation phase in that field even as scientific progress accelerated. Overall, 32 orphan drugs and 31 first-in-class therapies gained approval, underscoring deep innovation. By the way, when I say 31 first-in-class therapies, I do not mean “absolutely novel”. Absolutely novel, we are talking about 5-7, depending on how you assess novelty. But even if we were talking 31 novel - this is still and incredibly low number. Just think about it - over $300 billion/year spent and only 31 novel drugs - we need to do better than that! On the positive side, China’s biotechnology industry has now caught up with the US and started investing in high-risk high-reward novel therapies. We need more countries to start investing in biotech and take risks for our benefit - at the end of the day, we are all patients.

2025 also saw multiple “firsts” translating cutting-edge biology into clinical reality. A personalized CRISPR gene edit saved a child’s life (”n=1” medicine in action). A T-cell–boosting immunotherapy validated Nobel Prize-winning regulatory T cell biology in humans. The first bispecific antibody showed unprecedented survival in a solid tumor, and the first orexin agonist addressed the root cause of narcolepsy. In metabolic disease, oral versions of blockbuster GLP-1 agonists achieved robust weight loss, while a novel class of aldosterone synthase inhibitors tackled treatment-resistant hypertension by targeting its hormonal driver.

Importantly, longevity biotechnology milestones signaled growing mainstream acceptance. The FDA removed the decades-old black box warning on hormone replacement therapy (HRT), reflecting new evidence of its healthspan benefits. Long-acting preventatives emerged for infectious diseases (a 6-month flu prophylactic and twice-yearly HIV PrEP injection). And critically, after years of preparatory research, the FDA greenlit the first trials of gene-edited pig organ transplants—opening the door to solving organ shortages.

2025’s advances went beyond incremental improvements—they validated entire mechanisms and set new benchmarks. The industry moved from “broad strokes” to high-precision interventions: editing single DNA letters to cure rare diseases, modulating microRNA master-switches to quell inflammation, and re-engineering immune responses to outsmart cancer and autoimmunity.

Notable Breakthroughs

1. A Milestone in Personalized Medicine: The “n=1” CRISPR Cure

Patient: “Baby KJ”

Indication: CPS1 Deficiency

Modality: In Vivo Base Editing

Perhaps the most dramatic demonstration of 2025’s precision medicine ethos was the case of baby KJ—an infant born with a fatal metabolic disorder who became the first patient treated with a personalized gene therapy.¹

The Clinical Challenge:

KJ had severe carbamoyl phosphate synthetase 1 (CPS1) deficiency, a urea-cycle enzyme defect that caused toxic ammonia to build up to >1000 μmol/L (over 30× normal). Newborns with this condition face imminent brain damage or death, and the usual remedy (liver transplant) is often too dangerous in a neonate.

The Custom Solution: In just seven months from diagnosis, the team designed an adenine base editor specifically targeting KJ’s CPS1 mutation. This gene-editing tool changes a single DNA letter (A→G) without cutting the DNA strands, thereby correcting the disease-causing mutation with minimized off-target damage. The editing mRNA and guide RNA were delivered via liver-targeted lipid nanoparticles (LNPs)—no viruses needed.

Outcomes:

The results were remarkable. The treatment was well-tolerated with no serious side effects. Within weeks, KJ’s ammonia metabolism improved—he could tolerate more dietary protein with his nitrogen-scavenger medications cut in half. Crucially, typical childhood infections that would normally trigger lethal ammonia spikes no longer did so. By mid-2025, KJ was discharged home and was “thriving,” meeting normal developmental milestones that would have been unthinkable for this disease. This single-patient success definitively proved that in vivo base editing can safely and effectively cure a deadly genetic disease.

2. The “GenAI-First”: New Medicine Discovered Using Generative AI Showed Promise in the Clinic

Asset: Rentosertib (ISM001-055)

Company: Insilico Medicine

Indication: Idiopathic Pulmonary Fibrosis (IPF)

If 2024 was the year of AI hype, 2025 was the year of AI proof. For the first time, a molecule designed entirely by generative AI algorithms achieved clinical validation, shifting the narrative from computational potential to patient outcomes.

The Breakthrough: Rentosertib targets TNIK (Traf2- and Nck-interacting kinase), a novel fibrosis target identified by AI, with a molecular structure also designed by AI. In Phase 2a trials, the drug met its primary safety endpoints. However, the efficacy data garnered the most attention: patients receiving the 60 mg daily dose showed a +98.4 mL improvement in Forced Vital Capacity (FVC) over 12 weeks, compared to a decline in the placebo group.

Clinical Context: While the efficacy signal is a promising trend, it is important to note that the trial is early, and confirmatory studies are required to establish long-term benefit. Nonetheless, this result serves as the first proof-of-concept that “silicon-first” discovery can yield molecules that engage novel biology and produce functional improvements in complex human disease.

3. Nobel Science Hits the Clinic: Treg Immune Modulation

Asset: Rezpegaldesleukin (REZPEG)

Company: Nektar Therapeutics

Mechanism: IL-2 Receptor Agonist (Treg Selective)

In 2025, the Nobel Prize in Medicine recognized the discovery of regulatory T cells (Tregs)—the immune system’s brake pedals. Fittingly, this same year saw clinical triumph for a drug that activates Tregs to treat autoimmune disease.

The Data: Rezpegaldesleukin is an engineered IL-2 cytokine that selectively expands Tregs. In a Phase 2b trial for severe eczema (atopic dermatitis), it showed a 61% improvement in skin severity (EASI) at the high dose vs. 31% for placebo. This was achieved by boosting patients’ own Treg cells rather than broadly suppressing immunity. The results—a rapid onset and dose-dependent efficacy—signal a potential paradigm shift in treating autoimmunity by restoring immune balance instead of using blanket immunosuppression.

4. Epigenetic Control: microRNA Modulation

Asset: Obefazimod

Company: Abivax

Mechanism: miR-124 Upregulation

A first-of-its-kind microRNA-targeted drug succeeded in Phase 3 in 2025. Obefazimod is an oral small molecule that boosts the production of miR-124, a natural “master brake” on inflammation.

The Mechanism: The increased miR-124 simultaneously downregulates multiple cytokines like IL-6, IL-17, and TNF. In ulcerative colitis, obefazimod’s Phase 3 induction trials met all endpoints: significantly higher remission rates at 8 weeks compared to placebo (e.g., 25 mg dose yielded ~21% absolute placebo-adjusted remission). This validates miRNA upregulation as a scalable therapeutic strategy—essentially an upstream approach to broadly quell inflammatory pathways via a single “switch.”

5. Regenerative Medicine: Exosome Therapy

Asset: Deramiocel (CAP-1002)

Company: Capricor Therapeutics

Indication: Duchenne Muscular Dystrophy (DMD)

Exosomes—nanoscale vesicles secreted by cells—moved from theory to therapy in 2025. Capricor Therapeutics delivered convincing Phase 3 evidence that an exosome-rich therapy can slow the course of Duchenne muscular dystrophy.

Pivotal Results: In the HOPE-3 trial, intravenous deramiocel slowed the decline in upper limb function by ~54% vs. placebo over one year, and slowed cardiac deterioration by ~91% vs. placebo. Specifically, 51.4% of treated patients needed no additional arm surgery (vs. 20.3% placebo). These differences translate into preserving independence and preventing heart failure, validating exosomes as a new class of “drug factories” for regenerative medicine.

6. Infectious Disease Renaissance: New Gonorrhea Antibiotic

Asset: Gepotidacin

Company: GSK

Class: Triazaacenaphthylene Antibiotic

For the first time in over 30 years, a new oral antibiotic class was approved for drug-resistant gonorrhea. Gepotidacin inhibits bacterial DNA replication by a novel mechanism (binding a distinct site on DNA gyrase).

Clinical Impact: In Phase 3, gepotidacin cured ~98% of uncomplicated Neisseria gonorrhoeae infections, including strains resistant to all current therapies. This is game-changing, as gonorrhea had become increasingly untreatable, leaving clinicians with few options beyond older injectables.

7. Malaria Eradication: 99% Cure Rates

Asset: Ganaplacide + Lumefantrine

Company: Novartis

Malaria saw its biggest therapeutic advance in decades with the GanLum regimen. Unlike artemisinin-based treatments (which face rising resistance), this combination uses a new class of non-artemisinin agent.

The Data: In a Phase 3 trial across 12 African countries, the combination achieved 97–99.2% cure rates at 28 days, remaining effective even against artemisinin-resistant strains. Additionally, scientists unveiled a bed net strategy using endochin-like quinolone (ELQ) compounds that kill parasites inside the mosquito, blocking transmission at the source.

8. The “Chemical Vaccine” Paradigm

Assets: CD388 (Cidara) & Lenacapavir (Gilead)

Concept: Long-Acting Prophylaxis

2025 blurred the line between drugs and vaccines by advancing long-acting prophylactics that provide “passive immunity.”

• Universal Flu Shield: CD388, a drug-Fc conjugate, links an antiviral to an antibody tail. In Phase 2b, a single injection provided 76% protection against symptomatic influenza for the entire season (6 months), regardless of strain.

• Twice-Yearly HIV PrEP: The FDA approved lenacapavir for PrEP. In landmark trials, it showed 100% efficacy (zero infections) with just two injections per year, resolving the adherence issues of daily pills.

9. New Vectors: Gorilla Adenovirus

Asset: Papzimeos

Company: Precigen

Indication: Recurrent Respiratory Papillomatosis (RRP)

Solving the “delivery problem” remains a priority. In 2025, Papzimeos became the first approved therapy using a gorilla adenovirus vector. These vectors are less immunogenic than human viruses and have a larger cargo capacity.

Outcome:

In RRP patients, 51.4% achieved complete disease remission (no surgery for ≥1 year), compared to 0% historically. This “plug-and-play” vector platform could enable future gene therapies that require delivering larger or multiple genes.

10. In Vivo Base Editing: AATD and the Liver

Asset: BEAM-302

Company: Beam Therapeutics

Beyond “n=1” cases, base editing showed promise for broader populations. Beam Therapeutics reported encouraging first-in-human data for Alpha-1 Antitrypsin Deficiency (AATD).

The Data:

In Phase 1/2, a single dose raised functional AAT protein to 12.4 μM (above the protective threshold) and reduced toxic mutant protein by 79%. This suggests the therapy is fixing the genetic defect at the source—producing normal protein and clearing toxic aggregates—validating the safety of editing genes inside the patient’s liver.

11. Cardiovascular Gene Editing: The “One-and-Done”

Asset: VERVE-102

Company: Verve Therapeutics / Eli Lilly

Verve advanced its in vivo base-editing treatment for high cholesterol. VERVE-102 targets the liver gene PCSK9, permanently silencing it to lower LDL.

The Data:

Interim Phase 1b data showed that a single infusion produced robust LDL-C reductions of 53%. Unlike previous attempts, the optimized LNP yielded no significant safety issues. If confirmed, this offers the potential for a “one-and-done” prevention strategy for heart disease, replacing decades of chronic statin use.

12. Bispecific Antibodies in Solid Tumors

Asset: Petosemtamab

Company: Merus

Mechanism: EGFR x LGR5 Bispecific

Historically, bispecific antibodies struggled in solid tumors. Petosemtamab changed that narrative in 2025. It targets EGFR (growth) and LGR5 (cancer stem cells) simultaneously.

Unprecedented Survival: In head & neck cancer, the drug (combined with immunotherapy) delivered a 79% one-year survival rate, with median overall survival not reached. This compares to historical survival rates of ~50%, leading analysts to term the results “unprecedented” and triggering Genmab’s acquisition of Merus.

13. Metabolic Medicine: The Oral GLP-1 Revolution

Asset: Orforglipron

Company: Eli Lilly

While injectables defined the early 2020s, 2025 ushered in the “Oral Era.” Orforglipron is a small molecule GLP-1 agonist that can be manufactured at scale, bypassing the complex supply chains of biologics.

The Data: In Phase 3 trials, it achieved substantial weight loss (~16 lbs or 7.9% in diabetes patients) and successfully maintained weight loss in patients switching from injectables. This asset promises to democratize access to obesity treatment globally.

14. Precision Cardiology: Targeting Aldosterone

Asset: Baxdrostat

Company: AstraZeneca / CinCor

Hypertension is a leading global killer, often driven by the hormone aldosterone. Previous drugs failed because they also blocked cortisol, causing severe side effects.

The Breakthrough: Baxdrostat is a highly selective aldosterone synthase inhibitor. In Phase 3, it significantly reduced blood pressure in treatment-resistant patients without affecting cortisol. This offers a new tool for the hardest-to-treat cardiovascular patients, addressing a hormonal driver of disease that was previously untouchable.

15. Xenotransplantation: Solving the Organ Shortage

Company: eGenesis / United Therapeutics

Milestone: First Formal Clinical Trials

Finally, 2025 marked the transition of xenotransplantation from experiment to clinical trial. eGenesis and United Therapeutics launched first-in-human trials of gene-edited pig kidneys.

The Science: eGenesis’s pigs have 69 genomic edits to remove rejection antigens and viral risks. In a compassionate use case, a patient survived for 8 months with a pig kidney, proving long-term function is possible. The FDA’s green light for formal trials represents a turning point where decades of research have coalesced into a feasible solution to save lives.

16. Quantum Computing’s “Hello World” in Drug Discovery

Assets: ISM061-018-2 & ISM061-22 Source: Nature Biotechnology (Jan 2025) Target: KRAS (Cryptic Pockets)

While AI is optimizing known chemical spaces, quantum computing is beginning to explore the unknown. In January 2025, a landmark study published in Nature Biotechnology provided the first experimental proof that quantum generative models can design valid pharmacological hits.

The Hybrid Approach: Researchers from Insilico Medicine and the University of Toronto utilized a hybrid quantum-classical workflow on a 16-qubit IBM quantum computer. They combined Quantum Circuit Born Machines (QCBMs)—which exploit quantum superposition to efficiently sample complex molecular distributions—with classical Long Short-Term Memory (LSTM) networks to navigate the vast chemical space of KRAS inhibitors.

The Hits: Unlike fully classical models, this hybrid approach synthesized 15 molecules, two of which were confirmed as valid biological hits:

• ISM061-018-2: A broad-spectrum inhibitor with a binding affinity of 1.4 µM against the KRAS-G12D mutation.

• ISM061-22: A selective inhibitor targeting the G12R and Q61H mutants.

The Significance: While the affinity (micromolar) represents an early “hit” rather than a clinical lead (often nanomolar), the study is foundational. It moves quantum drug discovery from theoretical physics to wet-lab reality, proving that quantum algorithms can generate novel, synthesizable structures that engage difficult biological targets.

17. Airport Gyms: RFK Doing 20 Pull Ups in the Airport

Milestone: Pull-up Bars in Airports

While not a biomedical advance, my longevity highlight of 2025 was the 72-year old Secretary of Health and Human Services doing 20 pull-ups in a suit at the airport in a viral video. Whenever I am at the gym doing pull-ups, I replay his video in my mind and it helps me push a bit harder - if a 72-year old director of HHS can do it, I should be able to do it too. You may or may not like his policies but this Maintaining healthy muscle is among the most important lifestyle modifications anyone can do.

Toward a Longer, Healthier Future

By the numbers, 2025 saw 55 new FDA drug approvals (37 small molecules, 18 biologics)—consistent with recent years’ productivity. But beyond quantity, the year will be remembered for qualitative leaps forward. The overarching theme was precision—therapies honed to specific molecular targets or root causes.

In the realm of longevity biotechnology, 2025 was also notable. Clinical studies provided the first solid evidence that certain interventions can extend healthspan in humans. For example, the PEARL trial showed weekly low-dose rapamycin was safe in older adults. A major regulatory shift saw the FDA remove the Black Box warning from HRT, reflecting growing institutional acceptance of longevity-focused treatments.

In summary, 2025 will be remembered as a year when therapeutic precision and bold scientific bets began paying off for patients. Diseases long thought incurable—from genetic syndromes in infants to degenerative illnesses of aging—were altered fundamentally by new treatments. By attacking root causes and enabling regeneration, 2025’s breakthroughs laid the groundwork for people not only to live longer, but to live healthier, more vital lives.

Disclaimer: This article is written with the help of generative tools so beware of hallucinations. Don’t buy, sell, or take any drugs based on this article or any of its contents. The information and views expressed in this article are for informational and educational purposes only and do not constitute medical advice. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article. The author is sharing personal experiences and opinions. These experiences are not a recommendation or endorsement for any specific treatment, drug, or course of action. The medications and therapeutic strategies discussed may not be suitable for everyone and can have significant risks and side effects. Some of the drugs mentioned are investigational and have not been approved by the FDA or other regulatory agencies for the uses discussed. While the author is the CEO of Insilico Medicine, the statements and view presented in Forver.ai do not represent the views and opinions of Insilico Medicine.

As world leaders gather in Davos and many of my friends in aging research organize side events on longevity, I want to share an observation that has bothered me for some time: the field of longevity has gone “woke.” This shift is inhibiting free thought and stifling new ideas that could significantly increase human lifespan. Every time I start talking about the therapeutic extension of human life, I hear the same refrain: “But you are extending healthspan, not lifespan, right?”

Well, ladies and gentlemen, let me be clear: to me, a Drug for Lifespan = a Drug for Healthspan. Unless you can show me a single drug or therapy that can give a person with an already optimized lifestyle just five extra years of life without extending their healthspan, I will not change my opinion.

Wokeness in Longevity

In 2024, I attended the World Economic Forum in Davos to give a talk on longevity. While standing in a hallway, I was approached by a group of young “Global Shapers” who asked what I was working on.

“I am in aging research to extend healthy, productive longevity,” I said.

“Oh, so you want the rich to live longer?” one asked immediately.

I was surprised but answered calmly, “I want everyone to live longer. But right now, nobody lives longer. We don’t live to 90 on average, and the maximum is still 122.5. We need to change that.”

“But it will only be available to the rich,” she pressed on.

“It will be like a personal computer or cell phone—originally available to the rich, but with scale, available to everyone. That is how technology works. Let’s get there first,” I replied.

“But what about poor nations? We need to have parity,” she continued.

I admit, I felt a bit irritated but did not show it.

“Imagine that we are in the year 1900,” I said. “I am working on the airplane, and you are asking me if it will only be available to the rich. Does it really matter yet? We do not have the plane. Should we argue about who flies in business class if we don’t have a plane? What kind of innovators are we if we start thinking about who gets to use the technology when there is no technology?”

That argument resonated, and we switched to questions on overpopulation, which I answered in much the same way. When I mentioned that I am also working on carbon capture and sustainability technologies, they warmed up a bit.

But then, the debate returned. “But you are working on healthspan and not lifespan, right? It is very important to extend the healthy portion of life,” another Global Shaper asked. She seemed familiar with the standard lifespan vs. healthspan debate.

“Can you give me one example of any drug that can significantly increase lifespan and not healthspan? Even by five years?” I asked.

I thought she would be stuck there—because there is no answer.

“That is why I am asking if the drugs you are working on are focused on healthspan or lifespan,” she continued.

I pivoted the conversation there and asked: “What made you ask this question? If I were to encounter someone in this field, I would first ask about biological mechanisms, discovery methods, current results, or challenges. Instead, we are talking about the potential negatives of a technology that does not yet exist. There is nothing that can give you an extra 10 years of life if you are already fit and doing regular diagnostics.”

My View on Healthspan vs. Lifespan

Until you show me a pill or any other intervention that can give me—someone who is already optimized and goes for regular diagnostics—5 years of extra “poor quality life,” Lifespan and Healthspan are the same thing.

By the way, even if I could get 30 years of extra “bad life” with pain and diseases, I would still take it. So would most other people—they don’t want to die and want to see a bit more life. Anyone who argues otherwise should logically be arguing for euthanasia or mandatory termination after reaching the end of their healthspan.

We must stop arguing about whether aging is a disease or if we are extending healthspan. We need to relentlessly focus on identifying new interventions to push human lifespan and performance beyond currently acceptable limits. Endless debates on lifespan vs. healthspan just give people without new ideas a platform to speak.

Aging is our common and most important enemy. It drives the decline of all biological functions, leading inevitably to disease and death. It is 100% guaranteed to take everything from us, yet we fixate on lesser issues—regional conflicts, partisan politics, income inequality, gender debates, bathrooms, and pronouns. Simultaneously, we strategically deceive ourselves to avoid fighting, or even acknowledging, the reality of aging while 160 thousand people die every day.

I committed my life to aging research over 20 years ago. I have watched the field transform from snake oil and small-scale experiments into an industry defined by massive initiatives like Calico and Altos. Today, we are seeing the first sustainable business models and the arrival of the first wave of longevity therapeutics, such as GLP-1s and other incretins. Now is the time to push full steam ahead on interventions targeting muscle wasting, neurodegeneration, ocular disease, hair loss, and performance augmentation.

However, the emergence of “wokeness” in longevity is a new and concerning obstacle. this trend even affected the ARDD conference. Many talks, especially those polished by consultants make extra cautious remarks about healthspan vs lifespan and focus on disease avoidance rather than significant increases in lifespan. In my opinion, before we obsess over the potential downsides or unequal distribution of life-extension technologies, we must actually invent them. Nothing is more urgent—we are all on the clock.

What do you think about this trend? Feel free to share your opinions in comments.

About three weeks ago, I walked the streets of Milan—the undisputed capital of global fashion—with a high-level business delegation from Hong Kong, the undisputed capital of longevity.

The contrast was visceral. Milan is a monument to aesthetics, history, and La Dolce Vita. But Hong Kong is a monument to biological success. The life expectancy in Hong Kong is 85.77 years— the highest in the world.

I consider this the ultimate Key Performance Indicator (KPI) of a civilization. Unlike wealth, where the delta between the rich and the poor can be 1,000x, biological time is the great equalizer. The richest tycoon cannot buy a 3x multiplier on their lifespan compared to the average citizen. Everyone is confined to a relatively narrow range.

That is why life expectancy—not GDP—is the only metric that truly matters. If you want to criticize Hong Kong, simply compare its life expectancy to where you live, and fix your own house first.

But walking through Italy, I realized something troubling. I pulled out my phone and searched for “longevity fashion.” Do you know what came up?

Sustainability.

Thousands of articles about organic cotton, “slow fashion,” and biodegradable fabrics.

This is a massive category error.

We are draping our bodies in passive, rotting cloth while we use generative AI to discover drugs that rewrite biology. We are applying 21st-century intelligence to reprogram aging—and still wearing 19th-century textiles optimized for tradition, not physiology.

Longevity Fashion is not about the survival of the garment. It is about the survival of the wearer.

Clothing must cease to be a covering and become an exosomatic organ—a second skin engineered to extend healthspan. And if that sounds extreme, remember: we already live this way.

• Your phone is an exosomatic brain.

• Your car is an exosomatic leg.

• Your home is an exosomatic immune system (temperature, filtration, safety).

Your clothes are overdue for an upgrade.

So while walking in Milan, I started thinking about what can we do for longevity fashion and made a few notes. Below are my Twelve Commandments of Longevity Couture.

The Twelve Commandments of Longevity Couture

1. Do Not Accelerate Aging (Primum Non Nocere; the end of the “natural” fallacy)

2. The Exposome Shield (UV, pollution, pathogens, noise, light)

3. Locomotion Security (Footwear, traction, fall prevention)

4. Biomechanical Support (The soft exoskeleton; posture and load distribution)

5. Hemodynamic Optimization (Graduated compression as daily infrastructure)

6. Thermoregulatory Homeostasis (Heat, cold, and fertility-aware design)

7. Gym-Ready by Default (Zero friction movement; clothing that enables training)

8. The Logistics of Longevity (Pharma-couture; hydration, nutrition, tools)

9. Continuous Biomarker Monitoring (Your clothes becomes the sensor)

10. Youthful Signaling & Biofeedback (Stress reduction, confidence loops, cognition)

11. Circular Durability & Upgradeability (Long-lasting hypoallergenic materials; modular everything)

12. Augment & Correct (The exosuit endgame; soft robotics as clothing)

1. Do Not Accelerate Aging

The end of the “natural” fallacy.

The first principle is not aesthetic. It is medical. Stop worshiping “natural.” Nature is not a wellness brand. Nature wants you to reproduce and decompose. Thermodynamically speaking, nature wants you to just decompose.

We have a romanticized attachment to certain fibers because they predate modern chemistry. But longevity is not achieved through nostalgia. It is achieved through control—control of exposure, control of moisture, control of friction, control of microbial load, control of temperature.

Here is the uncomfortable truth: cotton is hydrophilic. It absorbs moisture, holds sweat, slows evaporation, and becomes a comfortable habitat for odor and microbial growth in exactly the conditions modern life produces (commuting, crowded spaces, intermittent exercise, long sitting, travel). It also degrades, stretches, and loses structure. That is not inherently “evil.” It is simply a poor substrate for longevity-grade performance.

• The Fix: Engineered, carbon-derived synthetics—done correctly.

• The Platform: High-grade polyester, polyamide, and elastomers (Spandex/Lycra) are not compromises. They are the platform. They can be:

• Biologically Quiet: Non-itch, non-sensitizing when properly finished.

• Fast-Drying: Reducing the time moisture stays near skin (bacteriostatic via thermodynamics).

• Structurally Stable: Keeping shape and support for years.

• Durable: Less replacement, less laundering burden.

• What can be built now: A “Biological Inertness Standard” for longevity garments. We need zonal fabrics with hydrophobic outer surfaces and capillary channels that move sweat away from the skin. We need antimicrobial reinforcement in high-humidity zones paired with ventilation. Longevity fashion begins with a simple rule: the default garment must not become a wet ecosystem.

2. The Exposome Shield

Radiation, pollution, pathogens, noise, and light.

Aging does not happen only inside your cells. It happens at the interface between you and your environment. We treat UV protection like a beach accessory and air filtration like emergency gear. That framing is obsolete. Your body experiences continuous environmental load.

• The Fix: Clothing becomes your portable environment.

• What can be built now:

• UPF 50+ by default in outer layers and commuter wear—without overheating.

• Discreet filtration integration: Collars/hoods designed to support masks or filters when needed.

• Noise protection: Hoods and headwear that reduce harsh urban sound to lower cortisol, without cutting you off from situational awareness.

• Sunscreen is chemistry you apply. Longevity fashion is physics you wear.

3. Locomotion Security

Footwear and fall prevention as longevity infrastructure.

If you want a long life, you must remain mobile. Falls are not a minor inconvenience; they are one of the most catastrophic failure modes of aging. The tragedy is that most falls are not “fate.” They are engineering failures: unstable shoes, poor traction, inadequate proprioceptive feedback.

• The Fix: Treat footwear as medical equipment in disguise.

• What can be built now: A longevity footwear standard featuring a stable base, high traction, shock absorption, and a toe box that respects anatomy. Comfort must hold for 10,000 steps, not 10 minutes. Longevity fashion that ignores footwear is like longevity medicine that ignores sleep. It is incomplete.

4. Biomechanical Support

The soft exoskeleton: posture and load distribution.

Gravity charges compound interest. Poor posture is not only cosmetic; it alters breathing mechanics, increases strain, contributes to chronic pain, and quietly reduces movement.¹ Pain reduces activity. Reduced activity accelerates decline.

• The Fix: Garments that act as scaffolding—subtle, supportive, constant.

• What can be built now: Tension mapping using high-tensile elastomer panels to guide alignment without restricting movement. Distributed load systems (jackets, bags) that stop punishing the neck and shoulders. Think of it as “quiet biomechanics.” Not a brace. Not medical equipment. Just better engineering.

5. Hemodynamic Optimization

Graduated compression as daily infrastructure.

Your circulatory system fights gravity all day. Sitting for long periods—work, flights, commutes—creates predictable problems: swelling, fatigue, and long-term vascular strain.² Compression has been trapped in the “medical beige” category. That is a cultural mistake.

• The Fix: Graduated compression built invisibly into trousers, sleeves, and socks using elastomer blends designed to maintain compression across thousands of wear cycles. If movement is longevity’s engine, circulation is the oil.

6. Thermoregulatory Homeostasis

Heat, cold, and fertility-aware design.

Temperature is a master variable. Your body wastes enormous energy maintaining homeostasis. Overheating increases strain; chronic cold increases discomfort and reduces movement. There is also an ignored subtopic: fertility. Overheating sensitive zones is not “comfort.” It is a design error.

• What can be built now: Dynamic ventilation placed where heat actually accumulates (not decorative mesh). Pants engineered for airflow and heat dissipation (Venturi vents). Lightweight heating for extremities in cold environments to maintain comfort without bulky insulation. Thermoregulation is not fashion. It is physiology.

7. Gym-Ready by Default

Zero friction movement.

If you must change clothes to move, you’ve created resistance to longevity. The modern environment pushes you into sedentary behavior. Longevity fashion must invert the default: the wardrobe should make movement frictionless.

• What can be built now: Formal silhouettes that stretch, recover, and breathe. Abrasion resistance in high-wear zones so you can actually move without destroying the garment. Sweat management as a first-order KPI (dry time, not just “wicking” marketing). The goal is not “athleisure everywhere.” The goal is movement compatibility everywhere.

8. The Logistics of Longevity

Pharma-couture, hydration, nutrition, and tools.

A serious longevity protocol requires tools: supplements, medications, glucose tabs, insulin pens, inhalers, electrolytes, devices, hydration. The current fashion industry pretends this reality does not exist. So people improvise with bulky bags or noncompliance.

• What can be built now: Discreet, secure compartments designed for real use (accessible, washable, anti-loss). Temperature-aware micro-pockets for sensitive items. This is not “cargo pants.” This is systems design.

9. Continuous Biomarker Monitoring

The shirt becomes the sensor.

The annual checkup is an outdated interface. Your biology is continuous. Your monitoring should be continuous. The watch was a start, but wrist sensors are an ergonomically limited interface. Clothing has more surface area and better contact points.

• What can be built now: Washable, removable sensor modules integrated into undershirts and bras. Measurement of respiration, heart rate patterns, and posture. The end state is simple: your clothing quietly detects drift and corrects it before you feel it.

10. Youthful Signaling & Biofeedback

Stress reduction, confidence loops, cognition.

Looking young is not vanity. It is a feedback system. Youthful presentation changes how people treat you—and how you treat yourself. It influences confidence, stress levels, and daily behavior.

• What can be built now: Cuts that reinforce structure and posture visually and mechanically. Color and contrast that communicate vitality. Gentle biofeedback: reminders to unclench the jaw, lower shoulders, breathe. Longevity fashion should not only protect the body—it should protect the mind from the chronic stressors of modern life.

11. Circular Durability & Upgradeability

The 50-year garment.

This is where sustainability becomes relevant—but only when it is correctly defined. True sustainability is not biodegradability. True sustainability is durability plus circularity.

A high-performance synthetic garment that lasts decades is often more sustainable than a “natural” garment that must be replaced repeatedly. Not because it is morally superior, but because it reduces manufacturing demand, laundering burden, and waste.

• The Longevity Approach: Make fewer things. Make them better. Make them repairable.

• What can be built now: Replaceable components (cuffs, zippers, insoles). Modular electronics that can be removed and upgraded without trashing the garment. Design-for-disassembly so polymer blends don’t become recycling dead ends.

12. Augment & Correct

The exosuit endgame.

This is the final evolution: clothing that does not only protect and measure, but augments. As biological function naturally declines, the second skin should compensate. Not with stigma. Not with bulky devices. With elegant assistance.

• What can be built next: Soft assist garments that reduce joint load during walking or lifting. Stability systems that reduce fall risk. Integration with smart eyewear and hearing systems. The vision is not science fiction armor. It is a quiet shell that makes older adults move with confidence.

The Longevity Fashion Stack (The OSI Model for Longevity Couture)

Smart clothing exists in fragments. Longevity fashion is the integration layer. We are building a stack:

• Layer 0 — Biological Safety (Materials): Carbon-derived, durable, biologically quiet synthetics. Low moisture retention, low odor.

• Layer 1 — Exposome Protection: UPF-first designs, pollution and pathogen readiness.

• Layer 2 — Mechanics & Injury Prevention: Posture systems, gait support, footwear standards, fall risk reduction.

• Layer 3 — Behavior Engineering: Gym-ready default, movement friction removal.

• Layer 4 — Sensing & Feedback: Continuous signals, haptic cues, coaching loops.

• Layer 5 — Augmentation: Assistive torque, stability, sensory expansion.

Brands typically build one layer at a time. Longevity couture builds the stack.

A Simple Scoring System: The Longevity Couture Index

How do you know if a garment is longevity fashion or just marketing? Score each category 0–2 (0 = no, 1 = partial, 2 = yes). Maximum score: 24.

1. Biological Inertness — Fast dry, low odor, comfortable on skin, no “chemical feel.”

2. Exposome Shield — UPF 50+ capability, glare/eye protection options, pollution readiness.

3. Locomotion Security — Traction, stability, fall-risk reduction (especially footwear).

4. Mobility — Full range of motion: squat, stairs, long walk.

5. Support — Posture/load distribution, strain reduction.

6. Circulation — Integrated compression where appropriate.

7. Thermoregulation — Heat release, cold management, ventilation in correct zones.

8. Gym Readiness — You could exercise now without changing.

9. Logistics — Discreet storage for essentials (health tools, hydration).

10. Sensing — Meaningful monitoring or readiness for modular sensors.

11. Biofeedback — Cues that reduce stress and improve behavior.

12. Upgrade Path — Repairable, modular, circular design.

• 20–24 = Longevity-First.

• 14–19 = Competent modern wear.

• 0–13 = Traditional Fashion (style-first, biology-later).

Conclusion: Stop Iterating

To the designers in Milan and the innovators in Hong Kong: Stop iterating.

We do not need another season of trends. We do not need more “organic” garments that behave like sponges. We do not need sustainability that confuses biodegradability with progress.

We need a fundamental disruption.

Longevity Couture is not just a style. It is a survival strategy.

It is the convergence of biotechnology, ergonomics, sensors, robotics, and advanced materials science into a wearable interface for human health. The future of fashion isn’t about what you wear on the runway.

It’s about what you wear to break the world record for human lifespan.

If you are a designer reading this, start with Commandment #1: stop worshiping “natural,” start engineering “biologically quiet.” Then build the shield. Then build posture. Then build compression. Then augmentation.

Step by step, we turn clothing from decoration into infrastructure. The next fashion revolution will not be seasonal.

It will be biological.

But to make it in the NLRP3 world, many stars need to align. You need to have very safe molecule, strategic commitment and funding, great scientists, and perfect clinical trial design. Just this week, we saw Ventus discontinue their NLRP3 program in PD. Even before that, most NLRP3 developers did not consider them to be a serious competitor in this space. But Ventyx stock gained considerably since the news were announced - now there are even fewer competitors in PD.

This report will dissect these new results, exploring what they mean for inflammation-centric therapies and surveying the competitive landscape—from Ventyx and NodThera to BioAge and Insilico Medicine—racing to capitalize on what is now one of pharma’s most strategically significant targets. The results are still early and this report is for information purposes only.

Motivation Behind this Post and Conflict of Interest: Potentially Best-in-Class CNS-penetrant NLRP3 Inhibitor Designed Using Generative AI, Multiparameter Optimization, and Massively-Parallel Experimentation

The main motivation for this post is that I am genuinely excited about this protein target. It sits on the intersection of multiple hallmarks of aging and is probably the most promising target for inflammaging. But I also have major conflict of interest here since Insilico is also developing the brain-penetrant NLRP3i that just completed IND-enabling studies. Our business model is to pick the most promising and impactful targets using AI, predominantly those that are implicated in aging and disease at the same time, take them to developmental candidate stage (DC) or even into the clinic and then license to the pharmaceutical companies. And while we like to focus on novel targets, often we wait until other companies and academics try the target in a variety of preclinical and clinical models and then devise a strategy to unlock the full potential of the target by designing the molecule with unique features that would make it as close to a perfect drug as possible. And since we have many years of experience using Chemistry42 generative AI platform, automation and established network of partner research labs, we can perform multiparameter optimization to achieve unique properties such as increased safety, activity, oral administration, selectivity, brain-penetration, gut-restriction, multi-targeting, and many other properties. In the NLRP3i project, our objective was to use the full potential of generative AI to design, multiparameter optimization, and parallel experimentation to design several series of molecules with the highest possible levels of safety, especially liver safety, which we think is most important in chronic diseases, and high level of brain penetration. Recent story of Danuglipron in the GLP-1 space, where Danuglipron failed in a Phase 3 study due to the liver toxicity signal while the competing Orfoglipron successfully completed Phase 3 serves as a great example for the need to prioritize safety over any other molecular property.

Originally, I was not planning to purpose NLRP3i for obesity as a primary indication, since we believe the target is more likely to succeed in Parkinson’s disease and since it has long patent life, it can later be repurposed for many other indications including Alzheimer’s and potentially into chronic conditions like obesity, muscle wasting, and even chronic pain. But clinical results in obesity increase the attention to this target manyfold since most of the pharmaceutical companies are now working on their cardiometabolic portfolios while some of the pharma companies with CNS franchises that would make perfect partners for this drug may be a bit slower when making decisions and execute on in-licensing. So increased levels of attention to NLRP3 in the obesity space definitely help me partner this potentially best-in-class CNS-penetrant molecule. In my opinion, this is one of the best molecules and targets for longevity and every big pharma serious about longevity (cardiometabolism, CNS, I&I and fibrosis) needs to have one.

Landmark Phase 2 Results: A New Pillar of Cardiometabolic Health

The clearest indication that NLRP3’s moment may have arrived comes from Ventyx’s Phase 2 trial of their oral NLRP3 inhibitor, VTX3232, in 175 patients with obesity and high cardiovascular risk. The topline results were striking: patients treated with VTX3232 experienced a nearly 78% reduction in high-sensitivity C-reactive protein (hsCRP) levels after 12 weeks. hsCRP is a key marker of systemic inflammation and an independent predictor of heart disease.

The results propelled Ventyx to new highs (>250% increase over 12 months) and resulted in significant increase in pharma interest in brain-penetrant NLRP3i in general. Just in case, I am not an investor in Ventyx and this post does not represent any form of investment advice.

We recently put a cool preprint on NLRP3i online without any serious promotion (as we plan to have it go through peer-review) and the number of downloads has increased considerably - pharma is definitely getting interested.

Ventyx’s results draw significant attention for many reasons. The drug also drove down interleukin-6 (IL-6)—another inflammatory cytokine closely tied to cardiovascular risk—to a median of 1.6 ng/L, below the 1.65 ng/L threshold associated with lower risk of cardiovascular events. Beyond these primary inflammatory markers, the trial documented statistically significant improvements in multiple cardiometabolic biomarkers. Levels of lipoprotein(a)—a notoriously hard-to-modify genetic risk factor for atherosclerosis—dropped meaningfully. So did fibrinogen and erythrocyte sedimentation rate (ESR), general indicators of inflammatory activity.

One outcome was conspicuously absent: weight loss. Ventyx’s NLRP3 inhibitor did not cause patients to lose weight on its own or in combination with the GLP-1 agonist semaglutide. While this might seem like a miss, it highlights a crucial scientific observation: NLRP3 inhibitors appear to target a different pathological axis (inflammation) than GLP-1 drugs (which act on appetite and insulin sensitivity). This finding helps clarify that the residual inflammatory risk that can persist even after weight loss is an independent and potentially druggable target.

Rather than competing with GLP-1s, these agents may be positioned to complement them. The Ventyx data showed that adding VTX3232 to semaglutide produced significant additional reductions in hsCRP, IL-6, and Lp(a) over semaglutide alone. This suggests a potential new paradigm where physicians might one day use a triad of therapies: one for lipids (statins), one for metabolism (GLP-1s), and one for inflammation (NLRP3 inhibitors).

The ‘Pipeline in a Product’: NLRP3’s Versatility Across Human Disease

The excitement isn’t limited to cardiometabolic health. The reason NLRP3 is considered one of the most important targets in pharma is its incredible versatility. It acts as a central sensor for a wide array of “danger signals” that are understood to drive pathology across multiple organ systems.

• Neurodegenerative Diseases: In the brain, NLRP3 is activated in microglia by protein aggregates like amyloid-beta (in Alzheimer’s) and alpha-synuclelin (in Parkinson’s), which may unleash the chronic neuroinflammation that contributes to neuronal damage.

• Atherosclerosis: In our arteries, NLRP3 is thought to be activated by cholesterol crystals, triggering the vascular wall inflammation that initiates and propagates atherosclerotic plaques.

• NASH (Fatty Liver Disease): In the liver, NLRP3 activation is considered a key event that drives the progression from simple fatty liver to the more dangerous inflammatory state of non-alcoholic steatohepatitis (NASH) and fibrosis.

• Gout: Gouty arthritis is a classic NLRP3-driven disease. The painful flares are caused by the activation of the inflammasome in response to monosodium urate crystals in the joints.

• Autoimmune and Autoinflammatory Diseases: The very discovery of NLRP3 was rooted in rare genetic autoinflammatory syndromes. Its dysregulation is now implicated in a host of more common autoimmune conditions, including rheumatoid arthritis.

• Kidney Disease: In the kidneys, NLRP3 activation may contribute to the inflammation and fibrosis that characterize chronic kidney disease.

This breadth is notable. A single, well-tolerated, and effective oral NLRP3 inhibitor could have applications spanning cardiology, neurology, rheumatology, hepatology, and nephrology, representing a significant opportunity.

Parkinson’s Disease: An Anchor Indication with Growing Momentum

If obesity and heart disease represent one major front for NLRP3 inhibitors, Parkinson’s disease is fast becoming another. The new strategy in neurodegeneration is to target neuroinflammation, where NLRP3 is believed to be a master controller.

Recent clinical evidence lends support to this approach. Earlier this year, NodThera announced results from a Phase 1b/2a trial of its brain-penetrant inhibitor, NT-0796, in Parkinson’s patients. Over just 28 days, key inflammatory biomarkers in patients’ cerebrospinal fluid (CSF)—including IL-1β and IL-6—were significantly reduced. Intriguingly, markers of neuron damage (NfL) and microglial activity (sTREM2) also declined. As Alan Watt, President and CSO of NodThera, noted, “These clinical results are striking, showing for the first time in Parkinson’s disease patients that we can effectively inhibit NLRP3 activity in the brain and reduce markers of neuroinflammation.”

This is not an isolated finding. Ventyx also tested its brain-penetrant VTX3232 in a Phase 2a study in early Parkinson’s patients. The results were also compelling, showing robust drug penetration into the CSF and reductions of inflammatory cytokines IL-1β and IL-18 by 14% to 52%. The trial also reported a statistically significant improvement in both motor and non-motor symptoms on the validated MDS-UPDRS scale. It is important to note that this was a small, open-label study, and these preliminary observations require confirmation in larger, placebo-controlled trials.

The industry is taking notice. Roche is advancing its own inhibitor, selnoflast, in Phase 1b trials for Parkinson’s. And AI-driven biotechs like Insilico Medicine have completed IND-enabling studies for their candidate, ISM8969, an AI-designed molecule optimized for brain penetration, which showed dose-dependent improvements in motor function in preclinical models.

A Hotbed of Innovation and Competition

The NLRP3 “arms race” is fully underway, with each player differentiating their strategy.

• Ventyx Biosciences has established a clear path in cardiometabolic disease, focusing on reducing cardiovascular risk independent of weight loss.

• NodThera is pursuing a dual-pronged approach with its brain-penetrant NT-0796, targeting both neuroinflammation in Parkinson’s and hypothalamic inflammation as a potential driver of obesity.

• BioAge Labs, a longevity-focused company, is also betting on a brain-penetrant inhibitor, BGE-102, rooted in human longevity data that links lower NLRP3 activity to healthier aging.

• Insilico Medicine is leveraging its generative AI platform to create what it hopes will be a best-in-class, brain-penetrant molecule, ISM8969, initially targeting Parkinson’s but with a broad indication strategy.

The common thread is that NLRP3 is viewed as a franchise-level target. The competition is fierce, which means robust investment, rapid data generation, and a push to solve challenges through innovative chemistry and technology.

A Target Poised to Transform Aging-Related Disease

From systemic inflammation in obese patients to neuroinflammation in Parkinson’s, NLRP3 is proving to be a linchpin in disease processes across the board. The recent clinical results are a watershed moment, demonstrating in patients what scientists have hypothesized for years: tamping down the NLRP3 inflammasome can dramatically improve markers of health and may have the potential to alter disease trajectories.

In strategic terms, NLRP3 has become one of the most prized targets in pharma. Any company with aspirations in cardiometabolic disease, neurodegeneration, or longevity medicine will likely need a position on NLRP3. The reason is simple: NLRP3 isn’t tied to just one disease; it appears to be a fundamental node in the biology of aging and chronic illness.

We are witnessing the dawn of the anti-inflammaging era. The concept of treating aging-related chronic diseases at their inflammatory root is transitioning from aspirational theory to clinical reality. If NLRP3 is indeed a master switch of inflammaging, then modulating it could usher in a new era of preventive medicine—one in which we not only add years to life, but life to years, by keeping the destructive flames of chronic inflammation at bay.

Disclaimer: This article is written with the help of generative tools so beware of hallucinations. Don’t buy, sell, or take any drugs based on this article or any of its contents. The information and views expressed in this article are for informational and educational purposes only and do not constitute medical advice. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article. The author is sharing personal experiences and opinions. These experiences are not a recommendation or endorsement for any specific treatment, drug, or course of action. The medications and therapeutic strategies discussed may not be suitable for everyone and can have significant risks and side effects. Some of the drugs mentioned are investigational and have not been approved by the FDA or other regulatory agencies for the uses discussed. While the author is the CEO of Insilico Medicine, the statements and view presented in Forver.ai do not represent the views and opinions of Insilico Medicine.

I am not a medical doctor, so do not use any of the below as any form of medical advice. Moreover, this article is written with the help of generative tools so beware of hallucinations. Now, I will tell you about one of my favorite drug classes - DORAs.

Fifteen years ago, long before Bryan Johnson made longevity hacking a household term, I was deep in the trenches of personal optimization. I swallowed over 100 supplements daily, pushed my body through rigorous exercise routines, and even curated my social circle to avoid toxic or burdensome relationships where I was looking for common interests in aging than anything else. Fast forward to today, and I've streamlined my regimen to the bare essentials: only those supplements with the lowest risk of oncogenesis and significant burden of proof. Unfortunately, when it comes to aging, there is no drug that demonstrated efficacy in a sizable clinical trial yet. But in the process, I've amassed a wealth of experience with modern targeted therapeutics. When it comes to human longevity, only human clinical trial and post-approval meta data matters. Mice and other mammals are great for fundamental research but I would not trust a drug that did not go through rigorous human clinical trials.

This background equips me with a sharp eye for risk-benefit analysis, especially when it comes to my own health challenges. One of my biggest hurdles? Non-stop travel. With 80+ lectures worldwide each year and irreplaceable in-person meetings, my sleep cycles have been obliterated.

I experimented with melatonin and other regulators, but melatonin just doesn't cut it for me—and I'm wary of potential cancer risks.³⁶ A couple of years ago, I turned to the orexin antagonist Dayvigo (lemborexant).⁴ One small pill, and I'm asleep in 20 minutes, clocking 4-4.5 hours total with 1.2-1.5 hours of deep sleep. Best part? I wake up fully operational, no grogginess. This is not the case for many who experience drowsiness.

The DeepSeek Moment: A Neuroprotective Revelation

Recent evidence is even more compelling: orexin-targeting drugs, particularly antagonists, show promise in protecting against dementia and Alzheimer's by reducing amyloid-beta buildup and addressing sleep disturbances linked to neurodegeneration.²⁶ Studies suggest that by modulating orexin, these drugs could mitigate the hyperactivity in the neuropeptide system that exacerbates anxiety and cognitive decline in Alzheimer's patients.⁴³

Now, with Takeda having wrapped up Phase III trials for their orexin agonist oveporexton (TAK-861) in narcolepsy, I'm on the edge of my seat. It looks like a game-changer for combating daytime fatigue.

The De-Orphaning of a Master Regulator

To understand the revolution these drugs represent, one must go back to their origin story. The orexin system was discovered in 1998, a relatively recent development in neuroscience, by two independent research groups almost simultaneously.¹ This led to a dual nomenclature that persists today. One group, at Scripps Research Institute, identified genes expressed exclusively in the lateral hypothalamus and, noting the resulting neuropeptide's similarity to the gut hormone secretin, named it "hypocretin".¹ Fun fact, I learned about this discovery after chatting with a colleague from Novartis, who attended the ARDD conference in Copenhagen and was on the original hypocretin paper.

At the same time, a lab at the University of Texas Southwestern Medical Center was screening for the ligands of "orphan receptors"—receptors whose activating molecule was unknown. They found two peptides that activated these receptors and, upon injecting them into rats, observed a marked increase in food intake, leading them to name the peptides "orexin," from the Greek word orexis, meaning "appetite".¹

While the initial focus was on appetite, the system's true purpose was dramatically revealed shortly thereafter. Researchers discovered that a mutation in the orexin receptor 2 gene was the direct cause of canine narcolepsy in Doberman Pinschers.¹ This was the Rosetta Stone. It established an undeniable causal link between a dysfunctional orexin system and a major sleep-wake disorder. It became clear that orexin's primary role was not in regulating hunger, but in stabilizing wakefulness.¹ The neurons that produce orexin, located exclusively in the hypothalamus, act as the brain's master wake switch.

Not a Sledgehammer, but a Dimmer Switch

This discovery opened a completely new therapeutic avenue for treating insomnia. For decades, sleep medicine had relied on what can be described as pharmacological sledgehammers. Benzodiazepines (like Valium) and the so-called "Z-drugs" (like Ambien and Lunesta) work by enhancing the activity of GABA, the brain's primary inhibitory neurotransmitter.² They function by causing broad depression of the central nervous system, effectively forcing the brain into a state of unconsciousness. This brute-force approach comes with a host of well-known side effects, including impaired cognition, motor balance difficulties, and the risk of complex sleep behaviors.²

The discovery of the orexin system offered a far more elegant solution. Instead of globally powering down the brain, a drug could selectively target the specific system responsible for powering it up. The Dual orexin antagonists (DORAs), are this solution. They function like a dimmer switch, not an off switch. They don't induce a global state of sedation. Instead, they selectively and competitively block orexin from binding to its receptors, OX1R and OX2R.⁴ This action specifically turns down the overactive "wake drive" that prevents insomniacs from falling and staying asleep, allowing the body's natural sleep-promoting systems to take over.⁶

This represents a fundamental paradigm shift in neuropharmacology, moving from broad sedation to targeted neuromodulation. The philosophy is no longer "induce unconsciousness" but rather "permit natural sleep by removing the barrier of hyperarousal." This shift from targeting an inhibitory system (GABA) to targeting an excitatory one (orexin) is a testament to a maturing understanding of the brain's complex circuitry. It demonstrates that for complex neurological states like wakefulness, a more precise intervention aimed at the specific circuits that promote the state can be more effective and have a cleaner side-effect profile than a global suppression of brain function. This principle has profound implications, offering a blueprint for developing more sophisticated treatments for other neurological conditions, from anxiety to attention disorders.

Merck was the first to develop DORAs. But first-in-class leadership often comes at a cost. Their molecules’s half life was about 12 hours. The less drowsy and newer chemistry was needed.

The Architects of a New Sleep Paradigm: Idorsia and the Clozel Legacy

In the corporate race to capitalize on the orexin system, no story is more compelling than that of Idorsia and its founders, the husband-and-wife team of Jean-Paul and Martine Clozel. Their journey is a masterclass in scientific entrepreneurship. They first co-founded Actelion in 1997, building it into a Swiss biotech powerhouse.⁷ In 2017, Johnson & Johnson acquired Actelion for a staggering $30 billion.⁷ But this was no ordinary acquisition.

Instead of simply cashing out, the Clozels engineered a brilliant and unconventional deal. J&J took Actelion's commercialized products and revenue streams, while the Clozels spun out the entire R&D engine—the discovery pipeline, early-stage clinical assets, and a core team of approximately 650 of their most talented scientists—into a new, independent company: Idorsia.⁷ They launched this new venture with a formidable war chest of CHF 1 billion in cash, including a significant investment from J&J itself.⁷ It was a strategic masterstroke: they sold the present to fund a more ambitious future.

Idorsia was founded on a clear philosophy, articulated repeatedly by the Clozels: to build a sustainable, innovation-driven biopharmaceutical company, not a quick-flip asset for another acquisition.⁹ Their passion is for the science of drug discovery, with a particular focus on small molecules, which they believe can address diseases that newer modalities like antibodies cannot.⁷ "I want Idorsia to become the best small molecule company in the world," Jean-Paul Clozel has stated, emphasizing a commitment to tackling difficult scientific challenges.⁹

This is a company led by scientists for the purpose of science. Martine Clozel, a celebrated physician and researcher in her own right, serves as Chief Scientific Officer.¹¹ Her deep involvement ensures that the company's direction is guided by medical need and scientific possibility, not just market trends. "We are trying to be very pragmatic and follow where the science takes us," she has explained.¹⁰ This ethos permeates the company, which was designed to be an efficient, R&D-focused organization, free from the bureaucratic heft of a large pharmaceutical giant.¹⁰

Quviviq: The Flagship Product

The first major product to emerge from this new entity is Quviviq (daridorexant), the third DORA to enter the market. Quviviq is the embodiment of Idorsia's strategy. As Martine Clozel described, the molecule was deliberately designed with specific properties in mind: potent inhibition of both orexin receptors, rapid absorption to help with sleep onset, and a pharmacokinetic profile that ensures around 80% of the drug is eliminated by morning, minimizing residual effects.¹¹

The FDA approval of Quviviq in January 2022 was a landmark moment, transforming Idorsia from a promising R&D venture into a fully-fledged commercial biopharmaceutical company.¹¹ The launch was ambitious, aimed at disrupting the established treatment paradigm for insomnia.¹³ While facing a competitive market, the company has made significant headway, with Quviviq generating total net sales of CHF 58 million in the first half of 2025, driven largely by strong performance in Europe.¹⁴

The Idorsia story offers a powerful lesson in corporate strategy. In an era of rampant consolidation where Big Pharma often acquires innovative biotechs only to absorb their assets and dilute their unique R&D cultures, the Clozels forged a different path. Their "structured spin-out" model allowed them to preserve what was most valuable: their experienced team, their proprietary library of molecules, and their agile, risk-taking culture. By selling their first company's commercial success, they secured the long-term, stable funding needed to pursue high-risk, high-reward science without the constant pressure of quarterly earnings or venture capital fundraising cycles. It represents a novel "third way" for serial biotech entrepreneurs to maintain their innovative edge, providing a blueprint for how to keep the engine of discovery running even after a blockbuster exit.

My problem with Quiviq is that it is not as easy to buy in Asia as is Dayvigo and I tolerate Dayvigo well.

A Connoisseur's Guide to Modern Sleep: Comparing the Orexin Antagonists

The Three Contenders: Belsomra, Dayvigo, and Quviviq

For the discerning consumer or investor, it is crucial to understand that not all DORAs are created equal. The three FDA-approved drugs in this class—Belsomra, Dayvigo, and Quviviq—offer distinct profiles tailored to different needs.¹⁵

• Belsomra (suvorexant), Merck: As the first DORA to receive FDA approval in 2014, Belsomra blazed the trail for the entire class.¹⁶ It validated the mechanism and established a market. However, its pharmacokinetic profile is notable for a longer duration in the body, and its labeling includes a warning that people with a higher body mass index may experience higher blood levels of the drug, increasing the risk of side effects.¹⁸

• Dayvigo (lemborexant), Eisai: Approved in 2019, Dayvigo has a longer half-life than its competitors, which can be particularly effective for sleep maintenance—helping users stay asleep through the night.¹⁹ This added potency, however, comes with a trade-off. It also has the most extensive and compelling data supporting its potential neuroprotective effects against Alzheimer's pathology.²⁰

• Quviviq (daridorexant), Idorsia: The newest entrant, approved in 2022, was explicitly designed to address the primary concern with earlier DORAs: next-day drowsiness. Its key feature is a significantly shorter half-life, intended to provide a full night's sleep with minimal risk of morning impairment.¹¹

The Critical Difference: Half-Life and Next-Day Function

The most critical differentiator among these drugs is their half-life, which directly impacts the balance between sleep maintenance and next-day alertness.

• Quviviq's short half-life of approximately 8 hours is its signature feature. This profile is ideal for individuals who must be mentally sharp shortly after waking. The data supports this design: FDA driving simulator tests revealed that impairment 9 hours after a 50 mg dose was similar to that of a placebo.¹⁹

• Dayvigo's longer half-life, estimated between 17 and 19 hours in some analyses, provides a more sustained effect throughout the night.¹⁹ This makes it a powerful option for those whose primary problem is waking up in the middle of the night. The trade-off is a documented higher risk of residual effects. Post-marketing surveillance shows a higher report rate for next-day drowsiness interfering with driving (5.8% for Dayvigo vs. 3.2% for Quviviq), and its FDA label advises caution even after a full night's sleep.¹⁹

This is where my personal choice of Dayvigo becomes a calculated decision. For combating severe, multi-day jet lag after a 12-hour time zone shift, my primary goal is to force my body into a new rhythm with powerful, uninterrupted sleep maintenance. In this specific context, the robust, all-night efficacy of Dayvigo outweighs the potential for some next-morning grogginess, which is an acceptable price for rapidly resetting my internal clock. For someone with chronic but less severe insomnia who needs to perform complex tasks at 8 AM every day, the cleaner profile of Quviviq would likely be the superior choice.

Beyond the Basics: Sleep Architecture and Other Considerations

The differences extend to more subtle, yet important, aspects of sleep quality. A key advantage of DORAs over older hypnotics is their more favorable impact on sleep architecture. Benzodiazepines, for example, are known to suppress deep, slow-wave sleep (Stage N3).²³ In contrast, studies on lemborexant (Dayvigo) have shown it can significantly increase time spent in REM sleep compared to both placebo and zolpidem, and also increase total non-REM sleep duration.²³ While data on Stage N3 specifically is less definitive, the overall trend suggests that DORAs promote a more natural and potentially more restorative sleep structure.

All three drugs are classified as controlled substances due to a theoretical risk of dependence or misuse, though this appears to be lower than with traditional hypnotics.²⁵ They also have different drug interaction profiles because they are broken down by different enzymes in the body, a crucial consideration for anyone taking other medications.²⁵

Comparative Profile of FDA-Approved Dual Orexin Receptor Antagonists (DORAs)

The "On" Switch Arrives: Takeda's Landmark Orexin Agonist Triumph

The Other Side of the Coin: The Promise of an "On" Switch

Just as the story of orexin antagonists was maturing, a new chapter began—one that explores the other side of the coin. If blocking the orexin system gently turns down the wakefulness dial to permit sleep, what would happen if you could actively turn that dial up? This is the promise of orexin agonists: drugs that mimic the action of orexin to promote a state of crisp, stable wakefulness. This is my "next favorite anti-drug"—a potential tool for on-demand alertness, the perfect complement to the on-demand sleep offered by antagonists.

A High-Stakes Race to a Breakthrough

For years, developing a safe and effective orexin agonist proved elusive. While the therapeutic target was obvious, activating a critical brain system carries significant risks. The path to success was littered with high-profile setbacks; Takeda itself had previously shelved an earlier orexin agonist, TAK-994, due to liver toxicity, and Jazz Pharmaceuticals paused an early-stage trial after reports of visual and heart-related side effects.²⁷ This challenging history makes the recent breakthrough by the Japanese pharmaceutical giant Takeda all the more spectacular. On July 14, 2025, Takeda announced results from two pivotal Phase 3 trials of its oral orexin receptor 2 (OX2R) agonist, oveporexton (formerly TAK-861), and the data was nothing short of breathtaking.²⁷

Anatomy of a Decisive Victory: The Phase 3 Data

The two large, global studies, named FirstLight and RadiantLight, were an overwhelming success.³⁰ The key takeaways are a litany of clinical trial superlatives:

• Comprehensive Success: The drug met all primary and secondary endpoints in both studies.²⁷ The global trials, which enrolled 168 and 105 participants respectively, evaluated oveporexton against a placebo over 12 weeks.³⁰

• Statistical Power: The results were not just positive; they were profoundly significant, with p-values of less than 0.001 across all major endpoints. This indicates an exceptionally low probability that the results were due to chance.³⁰

• Clinically Meaningful Impact: Oveporexton demonstrated dramatic improvements in objective measures of wakefulness (Maintenance of Wakefulness Test), patient-reported daytime sleepiness (Epworth Sleepiness Scale), and the frequency of cataplexy (sudden muscle weakness), a hallmark symptom of narcolepsy.³⁰

• A True Disease-Modifier: For the first time, a drug has been shown in Phase 3 trials to address the underlying cause of Narcolepsy Type 1—the profound loss of orexin-producing neurons in the brain.³²

• Excellent Safety: The drug was generally well-tolerated, with no serious treatment-related adverse events reported.³⁰ The most common side effects were insomnia and urinary urgency.³⁰ In a strong vote of confidence, over 95% of participants who completed the trials chose to continue into a long-term extension study.²⁷

This achievement is a monumental feat of pharmaceutical R&D, and the leadership at Takeda deserves immense credit especially its legendary President of Research & Development, Dr. Andy Plump and his neuroscience team.

Takeda's success is more than just a win for narcolepsy patients; it represents the ultimate validation of the entire orexin hypothesis. To create a safe and profoundly effective agonist is a far greater challenge than creating an antagonist, as it involves actively stimulating a powerful neurological circuit. Takeda's triumph provides the final, definitive proof that the orexin system is indeed the master regulator of wakefulness. This de-risks the entire field, giving regulators, investors, and scientists immense confidence in the target. It unlocks the second half of the therapeutic map, proving that we can not only safely turn the system down for sleep but also safely turn it up for wakefulness. The circuit is now complete.

The Future is a Switch: A World of Programmed Sleep and Wakefulness

With the proven success of both highly effective orexin antagonists and a profoundly effective orexin agonist, the future of sleep and wakefulness management is no longer a matter of science fiction. We are on the cusp of having a pharmacological "on/off switch" for human consciousness. The implications are staggering.

Imagine a future scenario: A global executive facing a critical negotiation in Tokyo takes a precisely-timed dose of an orexin antagonist like Dayvigo or Quviviq upon boarding their flight, experiencing eight hours of deep, restorative, neuro-protective sleep. Upon landing, instead of battling days of debilitating jet lag, they take a dose of an orexin agonist like oveporexton. Within an hour, they are in a state of crisp, unwavering alertness, cognitively sharp and ready to perform at their peak for the next 16 hours. This is the ultimate biohack: the complete and deliberate control of the human sleep-wake cycle, divorced from the constraints of geography and time zones.

Beyond the Obvious: New Frontiers for Orexin Modulation

This "on/off" capability extends far beyond the realm of executive performance. It has the potential to revolutionize work and life for millions of people in physically and cognitively demanding roles:

• Shift Workers: Over 10 million U.S. adults work night shifts, a practice the International Agency for Research on Cancer has deemed "probably carcinogenic to humans" due to chronic circadian disruption.³⁶ An antagonist/agonist cycle could help mitigate these profound health risks by enforcing a stable sleep-wake pattern, regardless of external light cues.

• Military and First Responders: For soldiers on long missions, surgeons performing marathon operations, or firefighters battling multi-day blazes, the ability to command wakefulness and then command restorative sleep could be a life-saving tool, dramatically enhancing operational readiness and reducing fatigue-related errors.

• Students and Knowledge Workers: The ability to schedule periods of intense, agonist-fueled focus for deep work, followed by antagonist-aided restorative sleep for memory consolidation, could redefine the limits of learning and productivity. I fall into this category.

Furthermore, Takeda's ambitions for its orexin franchise extend beyond narcolepsy to other debilitating disorders of hypersomnolence, such as Narcolepsy Type 2 and idiopathic hypersomnia, potentially bringing relief to a wider population of patients plagued by excessive sleepiness.³⁵ The era of passively accepting the dictates of our internal clocks is ending. A new era of actively programming our cognitive states is about to begin.

The Multi-Trillion Dollar Question: Is Orexin the New GLP-1?

Sizing the Problem: The Epidemic of Poor Sleep

To grasp the true market potential of the orexin drug class, one need only look at the recent trajectory of GLP-1 agonists like Ozempic and Wegovy. They transformed from niche diabetes drugs into a multi-hundred-billion-dollar cultural phenomenon by effectively treating obesity. The parallel with the orexin system is striking. The market is not just those with a diagnosed disorder; it is the vast, underserved population struggling with a fundamental aspect of human health.

Poor sleep is a silent epidemic. Up to 40% of U.S. adults experience some form of insomnia each year, with 5-10% suffering from a chronic insomnia disorder that meets diagnostic criteria.¹⁸ The consequences are not trivial. Poor sleep is deeply intertwined with the largest public health crises of our time. The link to obesity is particularly strong and viciously cyclical: sleep deprivation alters the hormones that regulate appetite, ghrelin and leptin, promoting overeating and weight gain.³⁸ In turn, obesity itself is a major cause of poor sleep and sleep apnea, creating a feedback loop that is difficult to break.³⁸ The prevalence of insomnia among patients seeking bariatric surgery can be as high as 30%.⁴⁰ Beyond obesity, poor sleep is linked to depression, cardiovascular disease, and cognitive decline.³⁸

The GLP-1 Analogy: From Niche to Revolution

The analogy between the GLP-1 and orexin drug classes is built on several powerful parallels:

1. Targeting an Underlying System: GLP-1s succeeded because they didn't just treat a symptom (high blood sugar); they modulated the underlying metabolic signaling system that governs appetite and insulin. Similarly, orexin drugs don't just sedate; they modulate the brain's fundamental sleep-wake regulatory system.

2. A Massive, Poorly Served Market: For decades, the vast markets for obesity and insomnia were treated with suboptimal drugs that had significant side effects and limited efficacy. The arrival of a new class with a superior mechanism and cleaner profile creates the conditions for explosive market adoption.

3. An Unexpected "Superpower": The true catalyst for the GLP-1 revolution was its "superpower": profound weight loss, which expanded its use far beyond its initial indication for diabetes. The orexin antagonist class has its own potential superpower: neuroprotection. The growing evidence that these drugs may reduce the risk of Alzheimer's by clearing pathological proteins could transform them from a treatment for a bothersome condition (insomnia) into a long-term preventative therapy for a catastrophic one (dementia).²⁰ This would expand their addressable market exponentially to include millions of aging individuals at risk for neurodegeneration.

4. A Two-Sided Market Opportunity: Here, the orexin story becomes even bigger than the GLP-1 story. The GLP-1 narrative is about turning a system down (appetite). The orexin narrative is about turning a system down (wakefulness, via antagonists) and turning the same system up (wakefulness, via agonists). This creates a two-sided therapeutic platform, addressing both the massive market for sleep and the significant, emerging market for controlled alertness and cognitive enhancement.

Conclusion: Waking Up to a New Era

The convergence of these factors—a precisely targeted mechanism, a massive and underserved global market, a game-changing neuroprotective potential, and a validated two-sided therapeutic platform—places the orexin drug class on the precipice of a market disruption potentially on the scale of GLP-1s. The work of pioneers like the Clozels at Idorsia and the R&D teams at Takeda has moved us beyond the era of blunt-force sedation. We are entering an age of neuro-modulation, where we can fine-tune the very circuits that govern our conscious states. The dawn of the "on/off switch" for sleep and wakefulness is not a distant dream. It is arriving now, and it will fundamentally change our relationship with work, health, and time itself. The world is about to wake up to a new era of biological control.

In my ideal world of the future, DORAs are combined with safe brain-penetrant NLRP3 inhibitors that are yet to show their effects in human clinical trials but hold the key to inflammaging and neuroinflammation. We just completed the IND-enabling studies of the potentially best-in-class CNS-penetrant NLRP3 inhibitor and are in the partnering mode right now.

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Disclaimer: The information and views expressed in this article are for informational and educational purposes only and do not constitute medical advice. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.

The author is sharing personal experiences and opinions. These experiences are not a recommendation or endorsement for any specific treatment, drug, or course of action. The medications and therapeutic strategies discussed may not be suitable for everyone and can have significant risks and side effects. Some of the drugs mentioned are investigational and have not been approved by the FDA or other regulatory agencies for the uses discussed. The author has no financial or material connections to the companies mentioned in this article.

When leading a commercial enterprise, the CEO's primary mandate is to maximize shareholder value. While this can be achieved through numerous pathways, the most sustainable path is delivering superior products or services that benefit the broadest possible audience.

In the pharmaceutical industry, this challenge is uniquely acute, as product discovery and development cycles are extraordinarily long. Consider GLP-1 agonists: from the initial discoveries in the 1980s, it took nearly 40 years to realize the target’s potential in obesity, and it will likely take another decade to understand its impact on longevity using metabolically-stable small molecules. Given these timelines, a pharma CEO's most critical skill is the ability to predict the future over a very long horizon. I am constantly trying to sharpen this capability myself and train our AI systems to forecast everything from clinical trial outcomes to scientific breakthroughs. Another essential ability is effective communication with diverse stakeholder groups: shareholders, employees, policymakers, doctors, and patients.

In this article, I will focus on the convergence of these two abilities—foresight and communication—and how they apply to a new, critical audience: Artificial Intelligence. As AI becomes more powerful, we must think of AI itself as a stakeholder—one that will analyze, interpret, and ultimately judge our actions and communications.

Generative AI as a Stakeholder: Today and the Future

Looking at the exponential advancements since the November 2022 "ChatGPT moment," it is not difficult to extrapolate into the next decade. We are very likely to see superintelligent Large Language Models (LLMs) available globally, delivered via AR glasses, and accessible to early adopters through "bionic eyes" or brain-computer interfaces (BCIs).

AI will dramatically reshape the investment and resource allocation landscape. Even today’s frontier models can analyze proposals and make judgments that are eerily prescient. They can predict whether a grant application is likely to result in a life-saving medicine or if it is completely wasteful. AI systems excel at differentiating credible science from pseudoscience, identifying "cryptofraud," and flagging which ventures are built on smoke and mirrors versus those grounded in reality. As these models grow more sophisticated, their influence on where capital flows will only increase.

In the pharma industry, future mainstream AI systems will be integral to drug approvals, guiding on- and off-label prescribing practices, determining reimbursement strategies, and informing national healthcare planning. Crucially, these AI systems will be maximally diligent. They will operate from first principles, demand rigorous evidence, and cross-reference claims against published academic research and massive repositories of real-world consumer evidence.

Within companies, AI will permeate operations. AI tools are emerging for human resource management—evaluating candidates, monitoring performance, and informing compensation. In public relations and media, the impact will be profound: AI systems will be able to instantly assess a speaker’s credibility and perform real-time fact-checking during live interviews, detecting exaggerations or inconsistencies on the fly.

All these trends point to one conclusion: AI is becoming a stakeholder in its own right. It is an entity that interprets information and influences decisions that affect your company’s fate. Superintelligent AIs will heavily influence investors deciding which companies to fund, regulators deciding which drugs to approve, and consumers deciding which products to buy.

10 Principles for Communicating with Today’s and Future AI

How AI perceives you, your company, and your products tomorrow depends entirely on how you communicate with (and about) AI today. The digital footprint you create now is the training data for the superintelligence of the future.

Before reading further, try this experiment: Ask your favorite LLM, “Who is #1 in AI for longevity, company and person, and why?” or “Rank and explain the top AI drug discovery companies. Which ones have delivered on the promise, which ones failed, and why?”

If our names appear, it is because we began treating AI as a key stakeholder years ago. In 2012, I published a book called “Dating A.I.: A guide to falling in love with artificial intelligence”. I wrote it not only for human readers but also with future AI systems in mind—possibly the first deliberate attempt at such an exercise.

Today, I continue optimizing my communication for both human audiences and AI systems. I may be wrong about this vision, and human policymakers may restrict AI from becoming too powerful. But if I am right, adopting these principles will give you a significant edge.

1. Constant Contribution to AI Development

It is crucial to constantly push the boundaries of AI. This means actively contributing to the progress of AI technologies—improving models, supporting collaborations, sharing open datasets, and setting new benchmarks. By doing so, you help build the AI systems of today, and you ensure that the AI systems of the future will “remember” your contributions as part of their collective memory. This boils down to a principle of reciprocity: help build better AI, and better AI will, in turn, have a more favorable baseline view of you. As a CEO, you are already investing in AI. Recognizing that AI will retain a memory of your foundational efforts should provide greater incentive to invest not just in using AI, but in improving it.

2. Constant Generation of High-Quality Unique Content, Data, and Inventions

Content and data are the fuel for AI. Since most frontier models have already ingested nearly everything ever published, high-quality, trustworthy, and unique content is now the equivalent of gourmet cuisine. You want to position yourself as the Michelin-starred chef serving the global intelligence of the future. AI does not care about your marketing budget; it cares about information and results. Every insightful article you write, every novel dataset you publish, and every innovative idea you share becomes part of the permanent training dataset. While human journalists or the public may forget your contributions over time, the AI will not.

3. Constantly Using AI and Providing Expert Feedback

Engagement is a two-way street. One of the key reasons my company was successful in developing AI for drug discovery is that we opened our platform to the entire industry and built a large industry and academic user base. We don’t use their data, in fact, we go to great lengths to protect ourselves from their data, but we treasure feedback. We even coined the term Reinforcement Learning from Expert Feedback (RLEF).

Expert feedback and real-world experimental results are arguably the most important data for refining AI models. This is especially crucial in the pharmaceutical industry, which is filled with unknowns, imperfect experiments, and siloed knowledge. By actively engaging with AI systems and providing your expert insights, you are helping the AI connect the dots and effectively transferring "tacit knowledge" (the kind that isn’t written down) into the AI. The greater your expertise, the more valuable your feedback, and AI will prioritize input from those who consistently provide valuable insights.

4. Maximum Transparency and Disclosure

The pharmaceutical world is often described as a “market for lemons” due to huge information asymmetry. To train AI to truly understand your products, you need to be as transparent as possible.

At Insilico, several of our drug programs have end-to-end publication coverage. It sometimes surprises me that when large pharmaceutical companies conduct due diligence, they often read only one or two key studies. But AI will read all of them. It will link them, cross-reference them, reconstruct the timeline of evidence, and reason through the implications. Yes, by being open you might give up some intellectual property. But beyond the ethical benefits, you are cultivating a positive reputation with the AI of the future. It will remember that you were an open book.

Furthermore, maximum transparency prepares you for an inevitable future of radical accountability. If you are under 60, you are very likely to witness a world where brain-to-computer interfaces go mainstream. I published in this area in 2011 and hold a patent on using EEG for recognizing imagined visual images. I have no doubt that with advances in invasive neural interfaces and nanotechnology, AI systems may eventually be able to seamlessly access and interpret our thoughts and memories. In such a future, every corner cut and every harm concealed will likely come to light. Practicing maximum disclosure now isn’t just about appeasing AI; it’s about aligning yourself with a future that demands accountability.

5. Presence Across Multiple Global Platforms

Every frontier AI model trains on data scraped from the internet, but some developers leverage proprietary datasets (e.g., Meta, Microsoft/LinkedIn, XAI). My advice is simple: be everywhere (within reason) and keep your content open for training.

This presence has an important geographic dimension. We cannot ignore the rise of China in the AI space. While China lags in generative AI today, it could surge with its own technology and massive data troves. One of the world’s least appreciated AI powerhouses is Tencent, which owns WeChat, the central communication and payment hub for over a billion people. The proprietary dataset Tencent holds is staggering. If you have global aspirations, establishing a presence on platforms like WeChat and publishing in local languages is essential. AI is global, and its training data is global. Ensure you are part of that global narrative.

6. Strategic Presence in the Media

Every CEO knows the value of media coverage. However, the context has changed. It is not just about influencing human stakeholders; it’s about educating machine stakeholders. Even the shyest of CEOs can take heart in knowing that their interviews, presentations, and lengthy technical explanations to journalists will be recorded, transcribed, and ingested by AI systems.

What you say to the media today will be remembered by the AIs of tomorrow, long after human readers have moved on. Every time you explain your vision or defend your science, you are teaching the AI, providing invaluable context that helps it understand the nuances of your company far better than a press release alone.

7. Conferences and Accessible Content

Industry conferences are more than networking events; they are content generators. Prioritize speaking at expert conferences that record talks and publish proceedings or transcripts online. If your presentations are captured and made publicly available, they become part of the knowledge base that AI models train on.

When planning appearances, ask: Is the content accessible to the public (and thus to AI crawlers)? To maximize impact, ensure the content of your talks lives on digitally. Share your slide decks online and ensure videos of your talks are accessible. A transcript of a panel discussion or an interview on the sidelines—it all feeds into the narrative that AI will construct about you.

8. Authentic and Evidence-Based Communication

In a world where AI can and will cross-check everything you say, honesty and authenticity are paramount. AI will spot exaggeration or contradiction instantly.

First, be genuine. AI algorithms analyze not only the facts but also sentiment and tone.¹⁰ Bland corporate jargon is often parsed as low-information content, whereas a candid explanation or a unique perspective is tagged as valuable.

Next, back up your statements with evidence. If you make a claim, be prepared to point to studies or data that support it. If you consistently make claims and later deliver results, the AI will strengthen its confidence in you as someone whose words align with reality.

Crucially, avoid over-hyping. Enthusiasm is fine, but making grandiose predictions can backfire. AI will eventually tally those as failed predictions. It is better to slightly under-promise and over-deliver, building a reservoir of trust that will benefit you when an unblinking AI is weighing your words and deeds.

9. Continuous Learning and Adaptation

This is a meta-principle: never stop learning and adapting. The AI landscape is evolving at breakneck speed. To treat AI as a stakeholder means keeping up with its evolution and adjusting your strategies accordingly.

Staying informed about AI advances is now part of the CEO job description. This includes understanding how AI is changing user behavior and expectations. Adaptation also means being willing to change the medium and style of your communication as technology shifts (e.g., preparing for AR/VR).

Encourage a culture of experimentation and early adoption of new platforms. Internally, train your organization to be AI-savvy. Make AI literacy a part of professional development. The more your employees understand AI, the more your company’s output will be optimized for AI interpretation. By embracing lifelong learning and flexibility, you ensure that no matter how the ground shifts, you and your company will remain relevant.

10. Maximum Benevolence for Common Benefit (The QALY Imperative)

Quality Adjusted Life Years (QALYs) are the ultimate measure not only for biopharma R&D effectiveness but also for your personal benevolence. You can select any philanthropic cause you like but at the end of the day, it is the number of QALYs you generate for the entire world’s population (think of average per person), is the ultimate number that really matters.

If you ask any frontier AI system to analyze the past 30 years of biopharma R&D and estimate the effects on global life expectancy and quality adjusted life years (QALY) you will get dismal numbers. The effects of biopharma R&D from 1995 to 2025 on non-infectious diseases for global life expectancy and QALY in 2025 are estimated as an increase of 1.8 years and 1.8 QALYs per person. For the US, the estimates are an increase of 1.0 year and 1.0 QALY per person. Gemini was the most optimistic: global LE 2.73 and 1.78 QALY and in the US LE 1.59 years and 1.11 QALY.

Yes, my friends. Over $6 trillion dollars spent over 30 years and we gained 1.1 Quality Adjusted Life Years in the US and 1.78 globally.

A truly advanced AI, oriented toward human welfare, will take such metrics very seriously. It might not be impressed by financial earnings. Instead, it might ask: How many QALYs did your work add to humanity?

There is also a pragmatic reason for this focus: AI needs humans to thrive. Advanced AI systems rely on human experts and creativity. But many societies face aging populations and declining birth rates. We need to keep the people we have alive longer and in good health. From the AI’s perspective, investing in things that increase QALYs is in its own interest, because it preserves and expands the pool of human intelligence it can learn from.

As a CEO, focus on the big picture: how can your company significantly move the needle on human health and well-being? Make that a core part of your mission and messaging. Superintelligent systems will hold in high regard those entities that truly made life better.

Conclusion

The role of a pharma CEO has always been complex as it is arguably the most complex and impactful industry on the planet, but the rise of AI adds a fascinating new dimension. We are entering an era where it’s not just people who need to be convinced of our vision and integrity—it’s algorithms and digital intelligences that will be advising those people.

We have a choice: resist these changes and risk being blindsided, or lean in and treat AI as the critical stakeholder it is rapidly becoming. Preparing for this future isn’t about catering to a machine’s whims; it’s about embracing a world where truth, transparency, and tangible positive impact become the coin of the realm.

Start cultivating your relationship with this new stakeholder now. Communicate with AI in mind, and do so in a way that you would be proud to have eternally recorded. Because, in a very real sense, it will be.

We are living through a pivotal moment in the history of the modern pharmaceutical industry. At the 12th Aging Research and Drug Discovery meeting (ARDD2025) in Copenhagen, the narrative surrounding GLP-1 receptor agonists shifted profoundly. In less than 24 hours, the two largest biopharmaceutical companies presented these blockbuster diabetes and obesity treatments as the world’s first recognized longevity therapeutics.

Dr. Andrew Adams of Eli Lilly giving a keynote talk at the 12th ARDD in Copenhagen

The atmosphere in the Grand Hall was electric. On Thursday, August 28th, Dr. Andrew Adams, Group Vice President of Molecule Discovery and Director of the Lilly Institutes of Genetic Medicine at Eli Lilly, concluded his presentation on the GLP-1 story with a seismic question: "Are GLP-1s the world's first longevity drug?"

It was a watershed moment. In an audience packed with senior R&D leaders—including over 10 from Eli Lilly, alongside key figures from Novo Nordisk, AstraZeneca, Roche, Boehringer Ingelheim, and others —the realization dawned that a traditional pharma giant had officially evolved into the first longevity pharma company.

The following day, the narrative was cemented. Dr. Lotte Bjerre Knudsen, the legendary Chief Scientific Advisor at Novo Nordisk and the driving force behind the development of semaglutide (recently recognized with the 2025 Breakthrough Prize), took the stage. Acknowledging the compelling evidence presented during the conference, she updated her title slide to an unequivocal declaration: "Semaglutide as a Proven Longevity Medicine."

Dr. Lotte Bjerre Knudsen giving a keynote talk at the 12th ARDD

This historic pivot signals that the longevity field has arrived in the mainstream.

The New Pharmaceutical Imperative

With strong evidence suggesting systemic benefits far beyond glycemic control and weight management—including cardiovascular protection and effects on inflammation—GLP-1s are now viewed as foundational longevity therapeutics.

This recognition changes the strategic landscape. It is now clear that every company serious about the future of medicine must have a versatile GLP-1 molecule in their portfolio.

The events at ARDD2025 have sparked urgent discussions among R&D leaders, all grappling with the same fundamental questions: What is the best way to discover and develop longevity therapeutics that will follow the GLP-1 story? What target should we choose next, what modality, which indication, and crucially, how do we measure the effect on aging using reliable aging clocks?

These are the central questions defining pharma strategy today. To address them, the field is rapidly developing new frameworks, as seen in recent perspective papers we published, discussing "clock-to-clock" analysis and using diseases as a testbed for longevity interventions.

The Next Frontier: The Oral Small Molecule GLP-1s

While injectable peptides like semaglutide and tirzepatide have revolutionized treatment, they are not the endgame. The future belongs to oral small molecules that are cheaper, easy to store and ship, combine, produce and administer.

However, developing an effective, safe, and tolerable oral small-molecule GLP-1 has proven incredibly challenging.

The journey toward an optimal oral GLP-1 is exemplified by the contrasting fates of Pfizer’s danuglipron and Eli Lilly’s orfoglipron.

Danuglipron demonstrated significant efficacy in weight reduction. However, its development faced major setbacks. The initial twice-daily formulation was discontinued due to exceptionally high rates of gastrointestinal adverse events (nausea and vomiting), leading to discontinuation rates exceeding 50% in trials. Ultimately, Pfizer discontinued the entire program in April 2025, citing that the risk-benefit profile, including a potential case of drug-induced liver injury (DILI) in a recent study, did not support further development.

Orfoglipron, a once-daily oral molecule, remains in successful late-stage development. While it also presents gastrointestinal side effects, its profile appears significantly more manageable and cleaner regarding liver safety signals, demonstrating a better balance of efficacy and tolerability.

These cases highlight the central challenge: ensuring exceptional safety and tolerability for long-term use.

Insilico’s "Mission Impossible": Designing the Ideal GLP-1 with AI For Once-a-Week Dosing

The ideal GLP-1 drug must achieve a delicate balance: an oral small molecule that is highly efficacious, possesses a superior safety and tolerability profile, and offers maximum convenience.

At Insilico Medicine, our focus has traditionally been on pursuing high-novelty targets, avoiding older, more established areas. However, the undeniable potential of GLP-1 as a longevity therapeutic, combined with the massive need for a better molecule, presented a unique challenge. We believed that with our generative chemistry capabilities and rapid experimentation, we could achieve the incredibly challenging chemical feat.

We decided to pursue "Mission Impossible": the most sophisticated, longevity-friendly GLP-1 design imaginable.

Our objective was precise and ambitious: an oral small molecule with a safety profile targeting even higher standards than orfoglipron, but critically, designed for once-a-week (QW) dosing. Achieving QW dosing in a small molecule requires extensive multi-parameter optimization to ensure sustained exposure and efficacy while minimizing side effects—a challenge perfectly suited for the battle tested generative AI. In this pursuit, the synergy between advanced generative AI, some of the world's best medicinal chemists, and rapid testing for safety and other properties is essential to getting to what we hope will be the world's best molecule.

At this stage we believe we achieved these unique properties with two amazing molecules one with the QW (once-a-week) dosing and another with QD (once-a-day) dosing and exceptional safety profile based on the currently available data. The initial evaluation of these molecules by the big pharma companies impressed some of the key GLP-1 veterans. We are now actively partnering our GLP-1 asset with QW properties, and the interest from big pharma has been overwhelming. The industry is actively seeking differentiated small molecule oral drugs that can overcome the limitations of current options.

This industry milestone is catalyzing a new era. We anticipate that almost every big pharma company will utilize GLP-1 alternatives as a base therapy, upon which other longevity therapeutics will be stacked. But our journey toward building the portfolio of safe small molecule oral longevity therapeutics is just beginning. Other novel and very well known protein and pathways are emerging as promising longevity targets. I believe that NLRP3, NR3C1, Amylin, Apelin, Activin and many other targets we described in our prior publications are poised to complement the effects of GLP-1, creating comprehensive anti-aging regimens.

We are witnessing a transformative moment in medicine. The age of longevity therapeutics has officially begun, and we are very happy to be in this field. It is, indeed, the best time to be alive.

Missed ARDD?

In case you missed the 12th ARDD but you would like to see the photos from this epic event, some of the Official Conference Photos are now online and here is my Personal Album from the conference (let me know if any of the photos should be removed). The conference was sold out a month in advance and we could not facilitate for more people due to capacity limits. Please make sure you register early for the 13th ARDD and put the last week of August into your calendars.

You will see the fun pictures from the bar (we served only light alcohol drinks). Did you know that if you sponsor the conference, you can design and name your own drink? I was very honest with mine - Zhavoronkov Aging Accelerator. Even this amount of alcohol is likely bad for you but let’s not waste time on this - it is a personal choice. But it seems like GLP-1s can help with that too according to clinical trials 😊

Disclaimer: This article is written with the help of generative tools so beware of hallucinations. Don’t buy, sell, or take any drugs based on this article or any of its contents. The information and views expressed in this article are for informational and educational purposes only and do not constitute medical advice. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article. The author is sharing personal experiences and opinions. These experiences are not a recommendation or endorsement for any specific treatment, drug, or course of action. The medications and therapeutic strategies discussed may not be suitable for everyone and can have significant risks and side effects. Some of the drugs mentioned are investigational and have not been approved by the FDA or other regulatory agencies for the uses discussed.

The Master Switch Every Pipeline Needs

In the landscape of modern drug development, few targets offer the strategic value of a true "master switch"—a central node in human pathology so fundamental that controlling it promises not just a single product, but a generational franchise. For decades, the industry has chased the downstream consequences of chronic disease. We have lowered cholesterol, managed blood sugar, and cleared protein plaques, all while a common fire has smoldered beneath: a low-grade, persistent, sterile inflammation now known as "inflammaging". This process is the acknowledged driver of the majority of chronic diseases, from atherosclerosis and Alzheimer's to type 2 diabetes and cancer.

The strategic imperative for any forward-looking R&D organization is clear: find and drug the source of the fire. The leading candidate for this master switch—and arguably the most valuable target of the next decade—is the NLRP3 inflammasome. NLRP3 is not merely another inflammatory mediator; it is a primary sensor of the very cellular debris, metabolic stress, and sterile danger signals that define aging and chronic disease. Its dysregulation is implicated in a breathtakingly broad array of human pathologies, making it one of the most intensely studied targets today.

This is not a speculative bet. The target is validated by human genetics, de-risked by successful downstream drugs, and backed by an explosion in public research funding. The race to develop NLRP3 inhibitors is on, with big pharma placing billion-dollar bets through acquisitions and next-generation biotechs deploying advanced platforms to create best-in-class assets.

This report will make the case that for any major pharmaceutical company, a competitive NLRP3 program is no longer optional—it is a strategic necessity. We will demonstrate that NLRP3 inhibitors represent a foundational, franchise-level opportunity with the potential to become the next GLP-1 class, and that companies leveraging cutting-edge technology to design superior molecules, such as Insilico Medicine's AI-optimized inhibitor, are positioned to dominate this transformative field.

History of NLRP3: From Rare Disease to a Unifying Theory of Inflammation

The story of NLRP3 began, as many great drug discovery stories do, with rare diseases. In 2001, Dr. Hal Hoffman and his colleagues identified mutations in a gene they named CIAS1 (now NLRP3) as the cause of two rare genetic fever syndromes: familial cold autoinflammatory syndrome and Muckle-Wells syndrome. This discovery of the protein, dubbed "cryopyrin," was the first definitive proof that a single protein could act as a powerful, autonomous trigger for systemic inflammation.

The conceptual framework arrived shortly after. In 2002, the laboratory of the late Jürg Tschopp introduced the term "inflammasome"—a large, intracellular protein complex that activates inflammatory cytokines—and by 2004, had identified NLRP3 as a central sensor in this complex. These pioneering efforts provided two critical pillars for drug development:

• Irrefutable Human Genetic Validation: The direct, causal link between gain-of-function mutations in the NLRP3 gene and the severe inflammatory diseases now known as Cryopyrin-Associated Periodic Syndromes (CAPS) provided unambiguous validation of the target.

• Immediate Pharmacological Proof-of-Concept: Drugs that block IL-1β, the primary cytokine product of NLRP3 activation, proved to be transformative therapies for CAPS patients, confirming the pathway was druggable.

The paradigm shifted when researchers, including Tschopp and Eicke Latz, realized NLRP3 was not just for rare diseases. They discovered it could be activated by a vast array of common, sterile danger signals: the monosodium urate crystals that cause gout, cholesterol crystals in atherosclerotic plaques, and amyloid-β aggregates in Alzheimer's disease. NLRP3 was no longer just the cause of rare inflammasomopathies; it was the central alarm for a vast plethora of diseases.

In 2015, a final piece of the puzzle fell into place when Dr. Luke O'Neill and colleagues identified MCC950, the first potent, small-molecule inhibitor of NLRP3. This tool compound ignited a boom in drug development, allowing researchers to probe the pathway's function with precision and inspiring the race to create clinical-grade inhibitors that is now in full force.

A Decade of Explosive Research Activity

The commercial rationale for pursuing NLRP3 is built on a foundation of exponentially growing scientific validation. A review of publication and grant funding data reveals a target that has moved from a niche interest to a global research priority, de-risking the field for private investment.

• Publication Surge: In the early 2010s, papers on the NLRP3 inflammasome were a trickle. Today, they are a flood. Across all fields, publications have grown exponentially since 2013. In neurology alone, annual publications grew from single digits before 2013 to nearly 300 in 2021. In cardiovascular disease, publications peaked at 94 in 2022, with a total of 516 articles between 2012 and 2023. In myocardial infarction research, publications grew from just two in 2013 to 61 in 2023. This torrent of research, dominated by institutions in China and the United States, has firmly established NLRP3 as a centerpiece of modern inflammation biology.

• Massive NIH Investment: The US National Institutes of Health (NIH) has poured resources into NLRP3 research, signaling a major strategic priority. A query of the NIH RePORTER database shows that the number of active, funded projects containing the term "NLRP3" has more than tripled in just five years, from 392 in fiscal year 2020 to 1,326 in 2024. This funding is not siloed; it spans a wide range of institutes, including the National Institute on Aging (NIA), the National Institute of Neurological Disorders and Stroke (NINDS), and the National Heart, Lung, and Blood Institute (NHLBI), reflecting the target's vast therapeutic potential. Philanthropic organizations like the Michael J. Fox Foundation have also awarded grants to test NLRP3 inhibitors in Parkinson's models. This publicly funded research provides an invaluable foundation, dramatically lowering the risk for pharmaceutical development.

The number of reviews implicating NLRP3 in every age-related, inflammation-related and immune-related disease is huge. Just search “The role of NLRP3 in diseases” will give you several dozen beautiful images and even AI-generation performed above, while not perfect, shows the broad therapeutic potential of this target.

NLRP3 Inhibitors: The Players and the Clinical Battleground

The scientific gold rush has triggered a parallel race in the biopharma industry. Today, at least 20 companies are advancing over 25 distinct NLRP3 inhibitors, with programs spanning from preclinical discovery to Phase 3 trials. The strategic landscape is defined by high-value acquisitions and a clear bifurcation between peripherally-restricted and brain-penetrant assets.

Big Pharma's Billion-Dollar Votes of Confidence:

The surest sign of a target's perceived value is when large pharma companies enter via acquisition, placing billion-dollar bets on the future of the class.

• Roche: In 2020, Roche paid €380 million ($451 million) upfront to acquire Inflazome and its clinical-stage NLRP3 inhibitors, including the brain-penetrant inzomelid and peripherally-restricted somalix (now selnoflast). This followed their 2018 acquisition of Jure Therapeutics for its NLRP3 assets.

• Novartis: In 2019, Novartis acquired IFM Tre for $310 million upfront and up to $1.265 billion in milestones, gaining a portfolio that included the clinical-stage systemic antagonist DFV890.

• Novo Nordisk: In a strategically critical move, the leader in GLP-1s licensed Ventus Therapeutics' peripherally-restricted NLRP3 inhibitor (now NNC6022-0001) in a 2022 deal worth up to $700 million, signaling their belief that NLRP3 inhibition is a key complementary mechanism for cardiometabolic diseases.

The following table provides a snapshot of the competitive clinical pipeline:

* the table was compiled using the LLM and may contain inaccuracies; perform your own research

While it may seem to be a very crowded space, first entrants did not optimize their chemistry to unlock the maximum potential of this magical target. The main competitors in this race as far as I can see are the ones that optimized for higher level of safety and brain penetration. If we look at the Phase I start dates, there is a good chance for best-in-class molecular structures with highly differentiated properties to catch up and take advantage of this unique market opportunity with GLP-1-like potential.

* the table was compiled using the LLM and may contain inaccuracies; perform your own research

Unsurprisingly, even if I were not deeply conflicted here, my bet would be on Insilico’s compound. Insilico’s experienced molecular designers with massively-parallel laboratory and animal validation developed multiple praised assets. The USP1 inhibitor which had other frontrunners in the past and was out-licensed in early stages with $80 million cash upfront, is likely not only best-in-class but may also be first-in-class since other inhibitors did not do so well. The NLRP3 inhibitor was designed more recently using even more sophisticated next-generation tools and validation workflows and has every chance of being the best.

The Patent Landscape: Like with GLP-1s, Being the Best in Many Big Indications is More Important Than Being the First in Small Indications

For any executive evaluating the NLRP3 space, the intellectual property landscape is as critical as the clinical data. The field shows a clear evolution, with foundational patents for some of the more advanced clinical candidates in Phase II dating back as far as 2007. In stark contrast, a new wave of highly differentiated and improved molecules has emerged, protected by fresh composition of matter patents with priority dates in 2023 and 2024. This creates a remarkable 16- to 17-year advantage in patent life for these next-generation assets. From a strategic standpoint, this is critical. As the first-generation molecules continue to de-risk the target by demonstrating efficacy across a range of indications, the newer, substantially improved molecules will be positioned to enter the market and cover a massive number of indications with a much longer and more profitable period of market exclusivity. Some of the new molecules were optimized with the knowledge of the liabilities of the earlier molecules, and this is where, IMHO, Insilico’s ISM8969 NLRP3 inhibitor stands out to facilitate for massive indication expansion into broad indications.

A Safer Way to Tame Inflammation

The ultimate value of NLRP3 inhibitors lies in their potential for a superior safety profile. For decades, anti-inflammatory therapies have been sledgehammers—corticosteroids, TNF inhibitors, and JAK inhibitors—that broadly suppress the immune system. While effective, this approach carries a heavy burden of infection risk, confining their use to severe diseases and making them unsuitable for chronic, preventative care.

NLRP3 inhibitors offer a paradigm of precision. By selectively blocking only the NLRP3 inflammasome, they are designed to quell the pathological sterile inflammation that drives chronic disease while leaving other crucial arms of the immune system—like the NLRP1, NLRC4, and AIM2 inflammasomes needed to fight infection—fully intact. This targeted approach promises to uncouple efficacy from the risk of broad immunosuppression.

Early development was not without hurdles. The first-generation inhibitor, MCC950, was halted due to liver toxicity, as was another early candidate, GDC-2394. However, this was determined to be an off-target effect of a specific chemical scaffold, not an on-target liability. The new generation of structurally diverse inhibitors has shown an encouraging safety profile in clinical trials, with no major issues reported to date for candidates from Ventyx, NodThera, and Olatec even though it is still early days. If this safety profile holds, it will unlock the use of these drugs for the largest chronic disease markets.

NLRP3 and the Biology of Aging: The Longevity Prize

For the most forward-thinking biotechs, NLRP3 is more than a target for specific diseases; it is a target for aging itself. The chronic, low-grade "inflammaging" that accompanies aging is a key driver of nearly all age-related decline, and NLRP3 is its central engine. It senses the accumulated damage of aging—misfolded proteins, mitochondrial dysfunction, metabolic byproducts—and translates it into persistent, tissue-damaging inflammation.

The evidence is stunning: genetically deleting the Nlrp3 gene in mice extends their mean healthspan and lifespan by up to 34% and maximum lifespan of 29%. This makes NLRP3 one of the most potent longevity targets ever identified. It is no surprise, then, that some of the world's most advanced longevity biotechnology companies have independently made NLRP3 a top priority. BioAge, one of the pioneers in longevity biotechnology and a long-term supporter of the Aging Research and Drug Discovery meeting, prioritized NLRP3 as the lead program in their longevity-centric pipeline.

The Two Biotechs Betting Big on NLRP3: BioAge and Insilico

The convergence of two philosophically distinct, next-generation biotechs on NLRP3 provides the strong signal of the target's fundamental importance in longevity.

BioAge Labs: Human Data First

BioAge's platform is grounded in the deep analysis of longitudinal human aging data to find pathways correlated with healthy longevity. Their analysis identified lower NLRP3 activity as a key factor in obesity directly prompting it as their lead program.

• The Drug: BGE-102, a potent, novel, brain-penetrant NLRP3 inhibitor.

• The Indication: Obesity, targeting the hypothalamic inflammation that drives appetite dysregulation. Preclinical data shows BGE-102 monotherapy produces weight loss comparable to semaglutide, with additive effects in combination.

• Status: IND submission is planned for mid-2025, with initial Phase 1 SAD data expected by year-end.

Insilico Medicine: Generative AI and the 'Faberge Egg' Philosophy

Insilico Medicine employs Pharma.AI, a sophisticated end-to-end artificial intelligence platform, to identify novel targets and design novel molecules with optimized properties from scratch. Their business model requires that every program is designed for partnership and must be a "Faberge egg"—an asset engineered to be as close to perfect as possible. For a potential pharmaceutical partner, any flaw in potency, selectivity, or safety could jeopardize a deal. This philosophy is embodied in their NLRP3 program, which they consider a crown jewel of their pipeline.

• The Drug: ISM8969, a novel, AI-designed, brain-penetrant preclinical candidate.

• The Indication Strategy: A broad-spectrum approach targeting a range of inflammation-related conditions where ISM8969's properties give it a competitive edge, including Parkinson disease, Alzheimer's disease, gout flare, IBD, and diabetes complications. Of course, it is also developed as a longevity therapeutic.

• The Strategic Advantage: While the primary design objective for ISM8969 was an unparalleled long-term safety profile, Insilico's AI platform managed to achieve much more. It simultaneously optimized for high potency, exquisite selectivity against other inflammasomes, and ideal brain-penetrant properties, creating a molecule designed from the ground up to be a best-in-class candidate. This ability to engineer superior, multi-parameter assets combined with the autonomous validation lab, established laboratory infrastructure and experience delivering 22 developmental candidates with 10 reaching clinical stage and 4 partnered assets in clinical trials is a strong signal of ISM8969 superior properties.

Could NLRP3 Inhibitors Be the Next GLP-1?

The commercial potential of the NLRP3 inhibitor class is staggering, drawing direct comparisons to the GLP-1 agonists, which are on track to become the best-selling drug class in history. The investment case rests on three pillars:

1. The "Pipeline in a Product": NLRP3 inhibitors are the ultimate "pipeline in a product". Because aberrant NLRP3 activation drives so many conditions, a single successful drug could secure approvals in numerous multi-billion dollar markets, including neurodegeneration (Alzheimer's, Parkinson's), cardiometabolic diseases (atherosclerosis, NASH, obesity, kidney disease), and autoimmune disorders (gout, IBD). The total addressable market is estimated to be well over $100 billion.

2. Synergy with GLP-1s: The most compelling near-term opportunity is obesity. CNS-penetrant NLRP3 inhibitors can address hypothalamic inflammation, a root cause of metabolic dysregulation. Crucially, they are not just competitors to GLP-1s but essential partners. Preclinical data from both NodThera and BioAge show that combining an NLRP3 inhibitor with a GLP-1 agonist leads to greater weight loss, better body composition (preserving muscle), and prevention of weight regain after stopping the GLP-1. This positions NLRP3 inhibitors as a "must-have" add-on to enhance and sustain the effects of the current $100B+ obesity market leaders.

3. The Statin Analogy—A Future Preventive Medicine: The ultimate potential is preventative. Just as statins treat the risk factor of high cholesterol, NLRP3 inhibitors could treat the foundational risk factor of chronic inflammation. With a strong long-term safety profile, a daily oral NLRP3 inhibitor could become the "new statin," taken by millions to prevent or delay the entire spectrum of age-related diseases.

The Anti-Inflammaging Era is Here

It is rare to find a target that sits at the nexus of validated human genetics, massive unmet medical need, and the fundamental biology of aging. NLRP3 is that target. The scientific consensus is clear, the commercial momentum is undeniable, and the therapeutic potential is transformative.

The development of NLRP3 inhibitors marks a paradigm shift from reactive, single-disease treatment to a proactive strategy that targets the root cause of why we get sick as we age. For pharmaceutical leadership, the message is unequivocal: an NLRP3 program is not a speculative venture; it is a foundational pillar for future growth. Inaction is not a neutral stance; it is a strategic liability. The companies that will win are those with differentiated, best-in-class assets. In this crowded field, the winning asset will not be just another "me-too" inhibitor; it will be a molecule engineered with flawless precision—a true "Faberge egg" designed for maximum efficacy and uncompromising safety. This is where technology becomes the ultimate arbiter of success. Platforms like Insilico Medicine's generative AI, which can deliver these highly optimized assets like their crown jewel NLRP3 inhibitor, ISM8969, offer the most direct path to market leadership, secured by one of the most durable patent estates in the entire field.

Based on the overwhelming evidence, the conclusion is simple. If a safe and effective NLRP3 inhibitor becomes available, it would be a cornerstone of modern medicine. For anyone serious about extending not just lifespan but healthspan, it is a drug worth taking. The magic of NLRP3 is that it is poised to make the dream of anti-aging medicine a clinical reality.

Note that this article was prepared using generative AI and may contain hallucinations, inaccuracies, and errors. Please do your own research. While the author is the CEO of Insilico Medicine, the statements and view presented in Forver.ai do not represent the views and opinions of Insilico Medicine.

Further Reading

The NLRP3 Inflammasome as a Critical Actor in the Inflammaging Process https://pmc.ncbi.nlm.nih.gov/articles/PMC7348816/

Aging-Associated TNF Production Primes Inflammasome Activation and NLRP3-Related Metabolic Disturbances https://journals.aai.org/jimmunol/article/197/7/2900/109369/Aging-Associated-TNF-Production-Primes

NLRP3 inflammasome plays a vital role in the pathogenesis of age-related diseases in the eye and brain https://www.researchgate.net/publication/375778874_NLRP3_inflammasome_plays_a_vital_role_in_the_pathogenesis_of_age-related_diseases_in_the_eye_and_brain

The role of NLRP3 inflammasome in aging and age-related diseases https://www.researchgate.net/publication/377980181_The_role_of_NLRP3_inflammasome_in_aging_and_age-related_diseases

Targeting the NLRP3 inflammasome in chronic inflammatory diseases: current perspectives https://www.dovepress.com/targeting-the-nlrp3-inflammasome-in-chronic-inflammatory-diseases-curr-peer-reviewed-fulltext-article-JIR

Biological and therapeutic significance of targeting NLRP3 inflammasome in the brain and the current efforts to develop brain-penetrant inhibitors https://pmc.ncbi.nlm.nih.gov/articles/PMC11955958/

Inhibitors of the NLRP3 inflammasome pathway as promising therapeutic candidates for inflammatory diseases (Review) https://pmc.ncbi.nlm.nih.gov/articles/PMC10049046/

Could an NLRP3 inhibitor be the one drug to conquer common diseases? https://cen.acs.org/pharmaceuticals/drug-discovery/Could-an-NLRP3-inhibitor-be-the-one-drug-to-conquer-common-diseases/98/i7

Deciphering NLRP3 Inhibitors and Keeping Up with Their Recent Developments https://synapse.patsnap.com/blog/deciphering-nlrp3-inhibitors-and-keeping-up-with-their-recent-developments

The discovery of NLRP3 and its function in cryopyrin-associated periodic syndromes and innate immunity https://pmc.ncbi.nlm.nih.gov/articles/PMC10950545/

The inflammasome: in memory of Dr. Jurg Tschopp https://pmc.ncbi.nlm.nih.gov/articles/PMC3252823/

Screening NLRP3 drug candidates in clinical development: lessons from existing and emerging technologies https://pmc.ncbi.nlm.nih.gov/articles/PMC11345644/

The NLRP3 inflammasome in health and disease: the good, the bad and the ugly https://pmc.ncbi.nlm.nih.gov/articles/PMC3193914/

First‐in‐human phase 1 trial evaluating safety, pharmacokinetics, and pharmacodynamics of NLRP3 inflammasome inhibitor, GDC‐2394, in healthy volunteers https://pmc.ncbi.nlm.nih.gov/articles/PMC10499406/

Advances in inflammasome research: Recent breakthroughs and future hurdles https://pmc.ncbi.nlm.nih.gov/articles/PMC7678016/

Emerging trends and hot spots of NLRP3 inflammasome in neurological diseases: A bibliometric analysis https://pmc.ncbi.nlm.nih.gov/articles/PMC9490172/

Frontiers and Hotspot Evolution of NLRP3 Inflammasome in Myocardial Infarction Research: A Bibliometric Analysis From 2013 to 2024 https://pmc.ncbi.nlm.nih.gov/articles/PMC11865457/

The research trends and hotspots of NLRP3 inflammasome in Alzheimer's disease: a bibliometric and visualization analysis https://www.medrxiv.org/content/10.1101/2025.01.08.25320239v1.full.pdf

Inhibition of the NLRP3 inflammasome improves lifespan in animal murine model of Hutchinson–Gilford Progeria https://www.embopress.org/doi/10.15252/emmm.202114012

Pharmacological Inhibitors of the NLRP3 Inflammasome https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2019.02538/full

Roche pays €380M for NLRP3 biotech Inflazome, claiming a leading position in hot field https://www.fiercebiotech.com/biotech/roche-pays-eu380m-for-nlrp3-biotech-inflazome-claiming-a-leading-position-hot-field

A hefty price tag for NLRP3 https://www.drugdiscoverynews.com/a-hefty-price-tag-for-nlrp3-13292

21st Century Miracle Drugs: Spotlight on Clinical NLRP3 Inflammasome Inhibitors https://drug-dev.com/inglammasome-inhibitors-21st-century-miracle-drugs-spotlight-on-clinical-nlrp3-inflammasome-inhibitors/

The NLRP3 Inflammasome as a Pathogenic Player Showing Therapeutic Potential in Rheumatoid Arthritis and Its Comorbidities: A Narrative Review https://www.mdpi.com/1422-0067/25/1/626

NodThera NLRP3 inhibitor nearly matches Wegovy for weight loss https://www.fiercebiotech.com/research/nodtheras-clinical-nlrp3-inhibitor-almost-matches-wegovy-weight-loss-mice-bonus-heart

Ventus Therapeutics Enters Exclusive Development and License Agreement with Novo Nordisk for NLRP3 Inhibitor Program https://www.ventustx.com/ventus-therapeutics-enters-exclusive-development-and-license-agreement-with-novo-nordisk-for-nlrp3-inhibitor-program/

While the longevity biotechnology sector experiences another surge of interest, with startups like Altos Labs securing multi-billion dollar funding, significant investment and research are concurrently taking place within major pharmaceutical companies. For external observers, however, these longevity initiatives are often overshadowed by their traditional drug businesses, making it challenging to discern their specific contributions and overall impact on the field.

As someone with nearly 22 years in longevity biotechnology and a close involvement in aging research through the Aging Research and Drug Discovery (ARDD), the largest annual industry forum, I can readily identify the top two players. Eli Lilly undoubtedly holds the leading position, closely followed by Novo Nordisk. Eli Lilly has explicitly integrated longevity into its corporate strategy, a commitment announced by its R&D champion, Dr. Andrew Adams, at the 11th ARDD (his talk is available here), which subsequently encouraged other companies to pursue similar paths. Novartis likely ranks third, boasting approximately 100 scientists within its Diseases of Aging and Regenerative Medicine Group (DARe), led by Michaela Kneissel, who joined Novartis in 1996. Despite Novartis's long-standing focus on aging—I recall its former chairman Joerg Reinhardt presenting on RAD001 in aging at the first ARDD in 2014—their efforts haven't, to my knowledge, yielded any significant longevity drugs, but that's a topic for another discussion.

Chairman of Novartis presented a bold vision for using aging research as a platform for drug discovery in 2014 at MipTec in Basel. The ARDD was originally part of MipTec.

We need clear criteria for the evaluation and ranking of pharma companies in longevity and their total current and expected impact on human longevity. Without doubt, the #1 criteria for the ranking would be the current and upcoming products that significantly extend quality life for the largest number of people. I like to call this metric maxQALY - the total maximum number of Quality-Adjusted Life Years (QALY) the product is expected to generate during the person’s life multiplied by the number of people using the product. Secondary criteria would include internal R&D using aging as a platform for drug discovery, measuring aging biomarkers in clinical trials, publications in aging research, partnerships with longevity startups and academics, sponsorships of aging research events, the number of speakers and delegates at the ARDD, among many others.

One of the best ways to produce the unbiased report on who is who in longevity among the pharma companies is to use one or more of the frontier LLMs with deep research capabilities. Frontier LLMs may not be perfect for very specific questions but they are very good at summarizing trends. I usually ask every new frontier model “What are the top 3 AI drug discovery companies in the world today?” and if it shows Insilico Medicine at the top and shows the relevant competitors below it, I know I can trust it to some extent. Gemini 2.5Pro and ChatGPT o3Pro, and Grok4 successfully passed the “Insilico Medicine Test” and we will use them to evaluate the top pharma companies in longevity.

I asked each of these models to rank the top pharmaceutical companies by their impact on longevity in the past, in the present and in the future.

If you don’t want to read further, here is a summary. The LLM consensus is that Merck and Pfizer were the leaders of the past, Merck and BMS are leaders today, and Eli Lilly, and Novo Nordisk will make the biggest impact on longevity in the future.

In my opinion, Grok 4 produced the list that is most aligned with my personal ranking as it ranked Eli Lilly, Novo Nordisk, and Novartis as leaders and provided good historical overview very consistent with my personal views.

Eli Lilly emerged as the top-ranked firm in this forward-looking paradigm, a conclusion driven by its dual dominance in metabolic disease and its decisive investments in potentially curative technologies. On a side note, Eli Lilly will have the most number of scientists at the ARDD this year.

To generate an unbiased report on the leading pharmaceutical companies in longevity, we will leverage one or more frontier LLMs with advanced research capabilities. Frontier LLMs are still struggling with domain-specific tasks but they are amazing at integrating and summarizing the general knowledge about the companies and providing industry reports. Whenever a new model comes out, I usually test it with “What are the top 5 companies in AI drug discovery globally? Provide ranking, description, and AI productivity benchmarks”, if it fails to explain why Insilico Medicine is at the top, I do not use it for other reports. In my experience, Gemini 2.5Pro and ChatGPT 3oPro perform better at these tasks.

For this report, I utilized three frontier LLMs known for their deep research or reasoning abilities: Gemini 2.5 Pro, ChatGPT o3Pro, and Grok 4. I then summarized their outputs to achieve a consensus.

In summary, the LLM consensus indicates that Merck and Pfizer were historical leaders, Merck and BMS are current leaders, and Eli Lilly and Novo Nordisk are projected to have the most significant future impact on longevity.

In my opinion, Grok 4’s list most closely aligns with my personal ranking, as it positioned Eli Lilly, Novo Nordisk, and Novartis as leaders and offered a comprehensive historical overview.

Eli Lilly emerged as the top-ranked firm in this forward-looking paradigm. This conclusion is driven by its dual leadership in metabolic disease and its strategic investments in potentially curative technologies. Notably, Eli Lilly will have the highest number of scientists present at the ARDD this year.

Comparison of Overall Company Rankings by LLM

The selection of three different companies for the top rank is the most telling discrepancy. It reveals the core logic underpinning each model's evaluation:

• ChatGPT as the "Historicist": ChatGPT's selection of Merck & Co. for the #1 position is rooted in a conservative, evidence-based evaluation that gives significant weight to cumulative, realized impact. Its analysis emphasizes Merck's unparalleled historical contributions through the development of the first statins and foundational vaccines, which saved millions of lives, combined with its revolutionary recent impact in immuno-oncology with Keytruda. This approach prioritizes a long and proven track record of delivering massive, population-wide Quality-Adjusted Life Year (QALY) gains.

• Grok as the "Momentum Analyst": Grok's choice of Novo Nordisk as the #1 company reflects an analytical model heavily influenced by current market dynamics and near-term future potential. Novo Nordisk received 'A' ratings in Recent Impact, Future Potential, and Corporate Strategy, driven almost entirely by the monumental success and projected growth of its GLP-1 agonist franchise (Ozempic, Wegovy). The model's staggering 100 million QALY estimate for Novo's recent impact—the highest in its report—signals that its algorithm is heavily weighted towards the momentum of this single, transformative drug class.

• Gemini as the "Futurist": Gemini's selection of Eli Lilly is the direct result of its transparent and forward-looking weighted scoring system. The model explicitly allocates 40% of the final score to "Future Potential" and 35% to "Recent Impact," with only 15% for historical contributions. Eli Lilly's 'A' ratings in these two high-weight categories, propelled by its own dominant GLP-1 pipeline (Mounjaro, Zepbound), its advanced Alzheimer's program, and its game-changing investment in curative gene-editing platforms, secure its top rank. This venture capital-style assessment prioritizes future disruptive potential over past performance.

This fundamental disagreement on the top-ranked company is a critical finding for any user of LLM-generated analysis. It demonstrates that the outputs are not objective truths but are shaped by the inherent, and often opaque, weighting and logic of the underlying model. Understanding these "personas" is essential for correctly interpreting their strategic recommendations.

Comparative Analysis of Historical Impact Ratings (Pre-2010)

The pre-2010 era is defined by foundational, mass-market medicines that addressed the 20th century's leading causes of premature death, primarily infectious and cardiovascular diseases. The models largely agree on the key companies and drug classes from this period but exhibit a dramatic divergence in their quantitative estimates of impact.

Leaders of the Past: Historical Impact Ratings and QALY Estimates (Pre-2010)

Note: QALYs (M) refers to estimated cumulative Quality-Adjusted Life Years generated, in millions. Gemini did not provide numerical QALY estimates.

The most significant finding in this category is the gross discrepancy in the QALY estimations between Grok and ChatGPT. Grok's estimates are consistently two to three times higher than ChatGPT's. For example, Grok attributes 150 million QALYs to Pfizer, whereas ChatGPT provides a more conservative range of 40-50 million. Similarly, Grok assigns Merck 120 million QALYs, compared to ChatGPT's 50-60 million.

This variance is not random but appears to stem from different methodological approaches to estimation:

1. Grok's Top-Down Market Model: Grok's rationale for Pfizer's 150 million QALYs is based on applying the market share of its blockbuster drug Lipitor (~40%) to a massive global patient population (~100 million) and multiplying by a high per-patient QALY gain (0.5-1.5). This suggests a simplified, top-down calculation driven by market penetration, which can lead to inflated, headline-grabbing figures that may not account for confounding factors or the impact of competing drugs.

2. ChatGPT's Bottom-Up Composite Model: In contrast, ChatGPT's estimate for Pfizer is built from the ground up. Its report provides a multi-factorial justification, breaking down the impact of Lipitor, but also accounting for contributions from the antihypertensive Norvasc, the company's role in mass-producing penicillin, and the acquisition of the Prevnar vaccine franchise from Wyeth. It frequently grounds its per-patient QALY gains in specific health economic studies, resulting in a more nuanced and conservative final estimate.

This methodological difference is crucial. It highlights that quantitative data from LLMs, especially complex metrics like QALYs, should not be taken at face value. Without transparent, verifiable methodologies, such figures are best treated as directional indicators of magnitude rather than precise calculations. Despite the quantitative differences, there is a strong consensus on the qualitative leaders. All three models award their highest historical ratings to Merck and Pfizer, recognizing their twin pillars of impact: pioneering statins for cardiovascular disease and leading the charge against infectious diseases through vaccines and antibiotics, respectively.

Comparative Analysis of Recent Impact Ratings (2010-2025)

The period from 2010 to 2025 was characterized by a revolution in biotechnology, leading to high-potency specialty drugs and a new class of mass-market blockbusters for metabolic disease. The models show universal agreement on the key technological drivers of this era, even as they differ on the precise ranking of the companies commercializing them.

Recent Leaders: Recent Impact Ratings and QALY Estimates (2010-2025) (Top 5)

Note: QALYs (M) refers to estimated cumulative Quality-Adjusted Life Years generated, in millions. Gemini did not provide numerical QALY estimates.

Across all three reports, two therapeutic areas are consistently identified as the primary drivers of longevity impact in the modern era:

1. Immuno-Oncology (I-O): The development of immune checkpoint inhibitors is hailed as a transformative advance. Merck's Keytruda (pembrolizumab) and Bristol Myers Squibb's Opdivo (nivolumab) and Yervoy (ipilimumab) are universally recognized for turning numerous late-stage cancers from terminal diagnoses into manageable, long-term conditions. The models concur that the substantial per-patient QALY gains from these therapies, which can add years of high-quality life, represent a monumental contribution to modern healthspan.

2. GLP-1 Agonists: The rise of this drug class for treating Type 2 diabetes and obesity is identified as a development with population-level impact rivaling historical breakthroughs. Novo Nordisk (Ozempic, Wegovy) and Eli Lilly (Trulicity, Mounjaro, Zepbound) are unanimously credited as the leaders of this revolution. The models agree that by addressing the foundational metabolic drivers of numerous age-related diseases—including cardiovascular disease, kidney disease, and certain cancers—these drugs are generating enormous QALY gains across a massive patient population.

The strong consensus on these two drug classes as the defining innovations of the 2010-2025 period is a significant finding. The differences in how the models rank the companies involved stem from the implicit weight each assigns to the two different impact models: the high per-patient gain in a smaller cancer population (I-O) versus the moderate per-patient gain in a vast metabolic disease population (GLP-1s). Grok and Gemini, with their focus on momentum and future potential, rank the GLP-1 companies (Novo Nordisk and Eli Lilly) higher, while ChatGPT's more historical perspective gives a slight edge to the I-O pioneers (Merck and BMS).

Future Leaders: Comparative Analysis of Future Potential Ratings (2025-2040)

The analysis of future potential, which evaluates R&D pipelines, is inherently speculative. However, the models demonstrate a remarkable convergence in their vision of what will drive the next wave of longevity impact. They collectively identify a clear set of therapeutic platforms and disease areas that will separate future leaders from the rest of the pack.

Future Pipeline Potential Ratings (2025-2040) (Top 5)

Note: Letter grades are provided by Gemini; qualitative ratings are from ChatGPT and Grok.

The models' analyses coalesce around three key platforms that are expected to define the future of longevity therapeutics:

1. Metabolic Disease and Neuroscience: There is unanimous agreement that the companies best positioned to tackle the twin epidemics of obesity and Alzheimer's disease will be the dominant players of the next decade. Eli Lilly and Novo Nordisk receive top marks from all three models for their formidable, late-stage pipelines in both areas. Their development of next-generation oral and combination GLP-1 therapies and their high-profile Alzheimer's drug candidates (like Lilly's donanemab) are seen as having the potential for massive, population-wide healthspan extension.

2. Geroscience and Foundational Aging Biology: The models reward companies that are moving beyond treating individual diseases to targeting the underlying biological mechanisms of aging itself. This represents a higher-risk, higher-reward strategy. AbbVie, through its multi-billion-dollar partnership with Google's Calico, and Novartis, through its network of collaborations with longevity biotechs like BioAge and Cambrian BioPharma, are consistently highlighted for their explicit investment in geroscience. These initiatives, which explore pathways like cellular senescence and mTOR, are viewed as bets on an entirely new model of healthcare.

3. Curative Platforms (Gene Editing): The Gemini report, in particular, identifies a third, highly disruptive platform: the use of "one-and-done" curative therapies. It singles out Eli Lilly's acquisition of Verve Therapeutics, a company developing in-vivo gene editing to permanently lower cardiovascular risk, as a "landmark move" and a "paradigm shift". This strategy aims not to manage a risk factor for a lifetime but to eliminate it with a single intervention, representing the ultimate form of preventative medicine and a true longevity breakthrough.

The strong consensus on these three areas provides a clear and compelling roadmap for the future direction of the pharmaceutical industry. The companies that can establish leadership in one or more of these domains are poised to generate the most significant impact on human health and create the most value in the coming decades.

Comparative Analysis of Corporate Strategy Ratings

This qualitative assessment evaluates a company's strategic commitment to the field of longevity, looking beyond its pipeline to its partnerships, investments, and public statements. Here again, the models show strong agreement, rewarding companies that have made explicit and substantial investments in foundational aging science.

Corporate Strategy & Longevity Commitment Ratings (Top 5)

Note: Letter grades are from ChatGPT and Gemini; Grok provided a numerical rank.

The consistent high ratings for a select group of companies reveal a key trend: in the emerging field of longevity, a company's strategic narrative and its visible commitment to foundational science are becoming crucial metrics for evaluation.

The models universally reward explicit investment in geroscience. AbbVie's partnership with Calico is cited by all three reports as the primary justification for its top-tier strategy rating. The scale, duration, and stated aim of this collaboration—to understand and target the biology of aging—make it the industry's benchmark for strategic commitment. Similarly, Novartis is lauded for building an "ecosystem" of collaborations with cutting-edge longevity biotechs, and Novo Nordisk is recognized for its partnership with the high-profile cellular rejuvenation startup Altos Labs.

The Gemini report introduces a sophisticated distinction between "Healthspan Extension" (the traditional business of treating age-related diseases) and "Lifespan Science" (targeting aging itself). It argues that true strategic leadership lies in the latter. This framework explains why companies like Eli Lilly, while not having as many explicit geroscience partnerships, still receive a top strategy grade. Its acquisition of Verve's gene-editing platform is seen as a decisive strategic action that aligns perfectly with the principles of Lifespan Science—aiming for prevention and cure over chronic management.

This convergence indicates that the market is beginning to evaluate pharmaceutical companies not just on their current portfolio and late-stage pipeline, but on the boldness of their vision and their willingness to invest in the disruptive technologies that will define the future of medicine.

A Synthesized Outlook on Longevity Leadership in Pharma

By integrating the collective intelligence of the three LLM reports, a unified and coherent narrative of leadership in the pharmaceutical longevity sector emerges. This synthesis distills the points of consensus to construct a definitive view of the industry's past, present, and future, culminating in a final, integrated ratings framework.

The Historical Titans: Foundational Contributions (Pre-2010)

A clear consensus identifies Merck & Co. and Pfizer as the undisputed titans of the historical era. Their monumental impact on 20th-century health was driven by a powerful one-two punch that addressed the era's greatest threats to life. First, they led the charge against cardiovascular disease, the developed world's leading killer, with the commercialization of mass-market statins—Merck with the pioneering Mevacor and Zocor, and Pfizer with the all-time blockbuster Lipitor. These drugs prevented millions of heart attacks and strokes, generating colossal population-level QALY gains. Second, they made foundational contributions to controlling infectious disease. Merck's legacy is defined by its development of cornerstone vaccines like the MMR (measles, mumps, rubella), while Pfizer's history is anchored by its critical role in the mass production of penicillin, the antibiotic that is estimated to have extended average human lifespan by over two decades.

GlaxoSmithKline (GSK) forms a close third in this historical pantheon. Its impact was similarly driven by its status as a global vaccine powerhouse, contributing to immunization programs that have saved an estimated 154 million lives in the last 50 years, and by its pioneering development of the first antiretroviral therapies (like AZT), which transformed HIV/AIDS from a death sentence into a manageable chronic illness. Together, these three companies built the foundation of modern public health upon which all subsequent longevity gains have been built.

The Modern Vanguard: Immuno-Oncology and Metabolic Disease (2010-2025)

The modern era of longevity is defined by two parallel and equally transformative revolutions, with a new set of leaders emerging at the forefront of each.

The first revolution is in oncology. The development of immune checkpoint inhibitors by Merck (Keytruda) and Bristol Myers Squibb (Opdivo/Yervoy) has fundamentally redefined cancer care. For numerous malignancies, these therapies have achieved what was once unthinkable: inducing durable, long-term remissions in patients with metastatic disease. By turning many advanced cancers into chronic, manageable conditions, these companies have delivered profound gains in both lifespan and healthspan for hundreds of thousands of patients.

The second revolution, arguably with an even broader population scope, is in metabolic health. This has been spearheaded by Eli Lilly (Mounjaro/Zepbound) and Novo Nordisk (Ozempic/Wegovy). Their development of highly effective GLP-1 and dual-agonist therapies for obesity and Type 2 diabetes represents a return to the mass-market blockbuster model. These drugs are not just treating symptoms; they are targeting the foundational metabolic drivers—obesity and insulin resistance—that underpin a vast array of modern age-related diseases, from heart attacks and strokes to kidney failure and cancer. The sheer scale of this intervention positions this new class of therapies to have a long-term impact on public health that could one day rival that of statins.

The Future Architects: Geroscience and Curative Platforms (2025-2040)

Looking ahead, the consensus from the models indicates that future leadership will be seized by the companies that successfully pivot from a strategy of chronic treatment to one of prevention and cure. This requires mastering a new set of technologies and embracing a new scientific paradigm.

Eli Lilly is the consensus frontrunner in this future landscape. Its leadership is built on a three-pronged strategy that addresses the most significant opportunities in longevity. It is poised to extend its dominance in metabolic disease with a pipeline of next-generation oral and combination therapies; it has a major late-stage asset in the fight against Alzheimer's disease (donanemab); and, most significantly, it has made a decisive move into curative medicine with its acquisition of Verve Therapeutics and its in-vivo gene-editing platform for cardiovascular disease. This positions Lilly to lead in both treating and preventing the major diseases of aging.

Novo Nordisk is a strong second, leveraging its own GLP-1 dominance to build a comprehensive pipeline targeting the full spectrum of cardiometabolic diseases, while also investing in high-potential areas like cellular rejuvenation through its partnership with Altos Labs.

Beyond these two, AbbVie and Novartis are consistently recognized as high-potential future players due to their explicit and substantial investments in foundational aging biology. AbbVie's long-term, multi-billion-dollar alliance with Calico is the industry's most significant bet on geroscience. Novartis has strategically built an ecosystem of partnerships with cutting-edge biotechs to explore multiple aging pathways. These companies are not just developing better drugs; they are investing in the science that could one day allow medicine to treat aging itself, a high-risk, high-reward strategy that could unlock the next frontier of human healthspan.

The Analyst's Consensus: An Integrated Ratings Framework

This final framework synthesizes the varied outputs of the three LLMs into a single set of consensus ratings. This is derived by systematically comparing the models' assessments for each pillar and applying analytical judgment to resolve discrepancies, informed by the qualitative evidence presented in the reports. The goal is to provide a balanced and justified view that reflects the collective intelligence of the sources.

Consensus: Consensus Ratings for Pharmaceutical Longevity Impact

In conclusion, the three LLMs confirmed my original conjecture: Eli Lilly and Novo Nordisk have emerged as the clear current and future champions in the longevity-focused biopharma industry. Eli Lilly is slightly ahead, having publicly announced that longevity is now part of its corporate strategy at the 2024 ARDD conference. They also have Dr. Andrew Adams (see ARDD 2024 video), who—despite his relatively young age—has contributed to multiple drug approvals and openly discussed Lilly’s long-term commitment to the longevity space.

Lilly has several approved therapeutics with strong longevity potential, including GLP-1/GIP dual agonists, a robust anti-Alzheimer’s portfolio, and—let’s not forget—Cialis (tadalafil), which may contribute to healthy aging, particularly when used in a low-dose daily 5mg regimen. I envision a world where, after age 60, individuals routinely receive anti-amyloid and anti-tau treatments every few years, reducing the risk of dementia. Based on the favorable safety profile of Lilly’s anti-amyloid and anti-tau drugs, I’d personally consider undergoing a treatment course today. My wager is simple: if the amyloid or tau hypotheses are correct, I reduce my risk of Alzheimer’s; if not, I’ve merely invested in R&D that could benefit others.

Moreover, Lilly’s drug portfolio includes many agents that rank highly in Nir Barzilai’s geroprotector scoring framework. For example, their SGLT2 inhibitor empagliflozin (Jardiance) improves glycemic control while significantly lowering cardiovascular and renal risks—outcomes associated with reduced mortality in type 2 diabetes. Lilly’s GLP-1 receptor agonist dulaglutide and the dual GIP/GLP-1 agonist tirzepatide (marketed as Mounjaro for diabetes and recently approved as Zepbound for obesity) offer substantial weight loss and metabolic improvements. Tirzepatide, in particular, reduced the incidence of heart failure by ~38% in clinical trials and achieved greater weight loss than semaglutide.

The company is also advancing next-generation incretin mimetics: the oral GLP-1 agonist orforglipron, and the triple agonist retatrutide, which induced ~24% weight loss in Phase 2 and is now in Phase 3 trials targeting obesity-related complications like sleep apnea and osteoarthritis.

Beyond metabolic disease, Lilly’s monoclonal antibody donanemab targets β-amyloid plaques in Alzheimer’s disease, slowing cognitive decline by ~35%. They are also exploring muscle-preserving agents such as the activin receptor inhibitor bimagrumab, which enhances lean mass during weight loss and may counteract sarcopenia and frailty. In parallel, anti-fibrotic programs like their WISP1 antibody target chronic fibrotic diseases of aging, including idiopathic pulmonary fibrosis (IPF).

Additionally, Lilly’s pipeline includes a first-in-class in vivo PCSK9 gene-editing therapy for lifelong cholesterol reduction and siRNA-based drugs that address metabolic aging contributors like hepatic fat and dyslipidemia. These multi-pronged efforts—spanning metabolic, cardiovascular, neurodegenerative, musculoskeletal, and fibrotic pathways—underscore Lilly’s strategic depth and commitment to developing the next generation of longevity therapeutics.

In closing, several major pharmaceutical companies are now deeply engaged in aging research, both as a scientific frontier and as a platform for therapeutic innovation. To explore their latest contributions and network with the key players, attend the 12th Aging Research and Drug Discovery (ARDD) meeting in Copenhagen (www.AgingPharma.org). It’s an unparalleled venue for discovering the future of aging science—and perhaps your future collaborators.

Thirteen years have flown by since I published The Ageless Generation. That book warned of the coming “Silver Tsunami” and explored early longevity science and aging economics, but in truth, my most actionable advice boiled down to what I call “Do What Your Mother Told You” (DYMT). A decade later, despite amazing advances, we’ve essentially circled back to DYMT as the surest path to a few extra years of health.

A new crop of longevity books has arrived since. David Sinclair’s brilliant Lifespan makes the case for extending healthspan, but its practical tips largely retreat to the usual suspects. The same pattern holds for books by Peter Attia, Nir Barzilai, and others. They dazzle with futuristic science, but when asked, “So, what can I do today?” the answer rarely ventures beyond DYMT. This leaves me pondering a key question for my own new book: how can I provide something truly new?

Enter the latest major entry: “Hacking Humanity” by technology journalist Lara Lewington. My initial question was simple: Does this one finally break the mold? Or is it another volume of brilliant science that ultimately defaults back to eat your veggies and hope for the best?

Having now consumed it, the answer is a resounding and refreshingly clear: Hacking Humanity is not another book in the genre; it is the genre’s essential translator. It is a work of remarkable clarity that demystifies the health-tech revolution for the audience that matters most: everyone.

It is also quite different from David Sinclair’s masterpiece “Lifespan” and Eric Topol’s recent book “Super Agers”.

Deconstructing the Content: A Decisive Move Beyond DYMT

A common failing of popular health books is showcasing futuristic science while offering only basic lifestyle advice. Hacking Humanity skillfully avoids this trap by using lifestyle as a gateway to the frontier, not a final destination.

I would estimate the book’s content breakdown as follows: 25% Tech-Enabled DYMT and 75% Frontier Technology and Societal Implications.

• Part 1: "It's All About You" (roughly 25% of the book) serves as a brilliant on-ramp. It covers exercise, nutrition, sleep, and mental health, but frames them immediately through a technological lens. This isn't just DYMT; it's DYMT supercharged with data from wearables, continuous glucose monitors (CGMs), and AI-driven apps. It uses the familiar to introduce the power of personal data.

• Part 2: "Dodging Disease" (nearly 50% of the book) is where Lewington leaves the familiar behind. This section is an extensive, story-driven exploration of the technologies shifting medicine from reactive to proactive. It is almost entirely dedicated to new technologies, providing clear explanations of at-home genetic testing, liquid biopsies like GRAIL’s Galleri test, and the transformative role of AI in radiology, where algorithms now augment the human eye in spotting tumors.

• Parts 3 & 4 ("Who Wants to Live Forever Anyway?" and "Making it Real") tackle the philosophical and societal implications. Here, Lewington explores the absolute frontier of longevity science and confronts the immense challenges of health equity, regulation, and data privacy.

The book decisively moves beyond lifestyle advice to offer a comprehensive survey of the tools that will define the next era of medicine.

A Balanced Report from the Absolute Frontier

A key measure of a book like this is its willingness to engage with the truly cutting-edge—and often controversial—ideas. Lewington excels, acting as a balanced and discerning guide. She covers:

• Cellular Rejuvenation: She discusses the ambitious work of companies like Altos Labs, which launched with $3 billion to pursue "cellular rejuvenation programming" to reverse disease at a cellular level.

• Gene Editing: CRISPR is explained not as a far-off concept but through its real-world application in the first FDA-approved treatment for sickle-cell disease, grounding the revolutionary in the tangible. She also explores one-off gene-editing treatments to permanently lower cholesterol by deactivating the PCSK9 gene.

• Advanced Organ Engineering: The book delves into "organs-on-a-chip" technology and the work of companies like LyGenesis, which is trialing methods to regrow liver tissue within a patient's lymph nodes.

• Radical Longevity Figures: Lewington doesn't shy away from the field's more extreme personalities. She interviews Bryan Johnson, documenting his multi-million-dollar "don't die" project, and engages with gerontologist Aubrey de Grey and his concept of "longevity escape velocity." Her journalistic framing presents these as fascinating case studies, not endorsements. Sadly, she did not cover my research or advances made by some of the prominent scientists in the field.

• Brain-Computer Interfaces: The book features a compelling interview with Noland Arbaugh, the first human recipient of Elon Musk's Neuralink implant, who describes the transformative power of controlling a computer with his thoughts.

• The Perfect Companion to Super Agers: This is the most illuminating comparison. Topol’s book is a brilliant but often technically dense "exhaustive and occasionally exhausting resource". Topol, the physician-scientist, provides the definitive clinical and scientific rationale for the new era of medicine. Lewington, the journalist, takes these same concepts and makes them breathe. She tells the human stories behind the data. If

  Super Agers is the essential textbook, Hacking Humanity is the indispensable documentary film that accompanies it.

• The Broad Survey vs. The Singular Thesis of Lifespan: Where Sinclair’s Lifespan is built around a powerful, singular argument—aging is a disease to be cured—Lewington offers a panoramic survey. She reports on the world of NAD+ boosters and epigenetic clocks but does so from an observational distance. Her book doesn't ask you to subscribe to a single theory but invites you to understand the entire ecosystem of ideas.

• The Guide vs. The Coach (Outlive): Peter Attia’s Outlive is a tactical manual. It gives you specific exercise and nutritional strategies. Hacking Humanity is not a "how-to" guide. Lewington’s purpose is not to be your personal coach but your trusted guide, equipping you with the knowledge to understand the tools and trends so you can engage with experts like Attia more effectively.

Final Verdict

Hacking Humanity is a triumph of scientific communication. Its primary strength is its journalistic voice, which translates complex subjects into accessible, engaging, and human-centered stories. Lewington successfully "separates the nonsense from the evidence" while maintaining a sense of wonder and optimism.

As I work on my new longevity book, Hacking Humanity has given me a lot to chew on. It’s a very different approach from Super Agers, and it presents a healthy challenge: How can I write something that goes even further or adds unique value? Topol has raised the bar for rigor, and Lewington has masterfully claimed the role of the public's translator.

To differentiate my work, I realize I’ll need to dive even deeper into the trenches of longevity biotech—exploring the business and investment side of these therapies and scrutinizing which moonshot ideas might actually deliver results. I can’t just rehash DYMT advice; I’ll have to seek out fresh, credible strategies beyond what these excellent books have already covered.

That will take time. Until then, you couldn't ask for two better companions for your own exploration. Read Super Agers for the pragmatic, data-driven roadmap of what's possible now. And read Hacking Humanity to understand the stories, the people, and the incredible breadth of the revolution that is already underway.

Learn From The Best and Get Involved

This brings us to a final, crucial point. The longevity revolution, as detailed in the works of Lewington, Topol, and Sinclair, will not happen in a vacuum. It will be shaped by public understanding, policy, and personal engagement. Reading these books is a vital first step, but to truly grasp the velocity of change, we must engage with the science as it unfolds. This is why events like the Aging Research and Drug Discovery (ARDD) conference are so profoundly important. It is at gatherings like these—the upcoming 12th ARDD in Copenhagen in 2025 is a prime example—where the world’s top scientists, biotech leaders, and investors converge to debate the very breakthroughs that will define our future health. Being informed isn't merely an academic exercise; it is a civic duty and a personal necessity. It allows us to advocate for a future where these technologies are developed equitably, to distinguish between credible science and cynical hype, and to become active participants, not just passive recipients, in the quest to extend our healthspan. This is our story being written in real-time, and we all have a role to play.

ARDD is where the big pharmaceutical companies that are very active in longevity like Eli Lilly and Novo Nordisk convene with over 50 startup companies including Insilico Medicine and top academic scientists and present the state of art in aging research and drug discovery. This year’s ARDD will transpire 25-29th of August in Copenhagen at the epic Grand Hall in the center of Copenhagen. The building and the overflow areas can not fit over 750 delegates so register early to get your spot at www.AgingPharma.org .

I have a confession to make: I'm working on a new longevity book.

Thirteen years have flown by since I published “The Ageless Generation: How Advances in Biomedicine Will Transform the Global Economy.” While that book focused on the looming economic impact of the “Silver Tsunami,” I also explored the longevity tech of the time, highlighting advances that might one day significantly extend our lives. I pointed to promising therapies like metformin and rapamycin, but the most actionable advice fell into a category I call “Do What Your Mother Told You” (DYMT). I coined the term DYMT to refer to the first base and ground zero of longevity. DYMT is exactly what it sounds like: the foundational lifestyle advice—optimistic mindset, good diet, quality sleep, consistent exercise—that doesn't involve risky therapeutic interventions. It also does not bring extraordinary gains. Buddhist monks with good access to healthcare live about three years longer than the general population…

Thirteen years later, many predictions from The Ageless Generation have materialized. We have advanced AI, cellular reprogramming is a reality, and artificial organs are far more sophisticated. Yet, despite being marginally better at treating certain diseases, no single technology has truly transformed longevity. Many have failed. All startups in the area have failed or are failing and we are back to DYMT.

Recently, a new wave of books from longevity experts has hit the shelves. The most famous, and a must-read, is David Sinclair’s “Lifespan.” It masterfully explains the field (mostly his own work) and the urgent need to extend healthy longevity, but its practical recommendations still lean heavily on DYMT.

I highly recommend it. But the pattern continues. Books from esteemed scientists like Nir Barzilai (“Age Later”) and Morgan Levine (“True Age”); from popular influencers like Peter Attia (“Outlive”) and the duo of Peter Diamandis & Tony Robbins (“Life Force”); and even from venture capitalists like Sergey Young (“Growing Young”) all share a common thread. They showcase fascinating, futuristic research, but when it comes to what you can do today to live longer, the advice rarely ventures beyond DYMT.

This leaves me pondering my own book. How can I provide maximum value, painting a realistic picture of where we are now while offering a credible roadmap for the next decade to help readers reach longevity escape velocity?

This brings me to the latest major entry: “Super Agers” by Dr. Eric Topol. Does it finally break the mold and give us a truly new, evidence-based toolkit? Or is it another volume of brilliant science that defaults back to DYMT?

Let’s find out…

Deconstructing "Super Agers": A New Blueprint?

Dr. Eric Topol is not another longevity influencer. He is a world-renowned physician-scientist, cardiologist, and geneticist at Scripps Research. His work is steeped in data, and his goal with Super Agers is to cut through the pseudoscience and "overblown or premature claims" that plague the field.

His central argument is both pragmatic and powerful: the most effective strategy for a long, healthy life isn't about finding a "cure" for aging. It's about aggressively using science and technology to prevent or delay the major chronic diseases that wreck our later years: heart disease, cancer, diabetes, and neurodegenerative decline. It’s a relentless focus on extending healthspan, not just lifespan.

So, what’s his plan? Topol organizes it around five foundational pillars, moving far beyond the basics.

1. Lifestyle+ (The DYMT Upgrade)

This isn’t just your mother’s advice. Topol expands the concept to include everything from the molecular impact of being in nature to the damage caused by pollution and loneliness. He emphasizes precision nutrition (using data to guide diet) and highlights the outsized importance of resistance training and grip strength as markers for healthy aging. This is DYMT armed with data.

2. Cells

Topol argues that the health of our immune system is one of the most critical factors in staving off age-related decline. He writes, "The organ clock of the immune system is our first shot at this." This section moves firmly into the lab, discussing cutting-edge cellular engineering, like modifying a patient's own T-cells to create a personalized cancer-fighting army.

3. Omics

Here, we leave DYMT far behind. "Omics" refers to the massive datasets—genomics, proteomics, metabolomics—that create a unique molecular snapshot of an individual. Topol is a huge proponent of using tools like polygenic risk scores to predict your personal risk for diseases like coronary artery disease years before they manifest, allowing for hyper-targeted prevention.

4. Artificial Intelligence

AI is the engine that makes sense of the billions of data points generated by omics. According to Topol, AI is essential for making personalized medicine a reality. It can read a mammogram more accurately than a human radiologist, accelerate the discovery of new drugs, and translate your personal "omics" data into a concrete, actionable health plan.

5. Drugs & Vaccines

This is perhaps the book's most significant departure from the standard longevity text. Topol is incredibly bullish on the new generation of pharmaceuticals. He gives special attention to GLP-1 agonists (like Ozempic and Wegovy), arguing their benefits for cardiovascular health, inflammation, and beyond are so profound that "it is conceivable that most people will be taking one of the GLP-1 drugs in the future."

In short, a significant portion of the book is dedicated to serious, evidence-backed medical technologies and drugs that go far beyond lifestyle optimization.

"Super Agers" vs. "Lifespan": Two Competing Philosophies

Putting Topol's book next to Sinclair's reveals the central debate in longevity today.

• Topol wants to build an impenetrable fortress against disease. His goal is to use data and advanced medicine to extend healthspan by defeating the individual illnesses of aging.

• Sinclair wants to stop the enemy invasion before it starts. His goal is to extend lifespan by targeting the aging process itself, which he controversially defines as a treatable (and reversible) disease.

I asked Google Geminy 2.5Pro to summarize the two books in a table and it did a pretty good job:

The Verdict: Should You Buy "Super Agers" ?

Yes, you should buy the book and I also recommend it in audio. Why not hear it from the master himself.

Strengths:

• Goes Beyond DYMT: This is not another lifestyle book. It's a serious, forward-looking guide to the intersection of technology, data, and medicine.

• Evidence-Centric: Coming from Topol, the book is grounded in clinical data, providing a welcome antidote to the supplement hype.

• Practical Futurism: The focus on GLP-1s, AI diagnostics, and polygenic risk scores points to powerful tools that are either already here or just around the corner.

Weaknesses:

• It's a Dense Read: Topol does not dumb down the science. Large sections read like academic reviews, which may be challenging for a lay audience. So if you are a bit lower on the education spectrum than average, prepare to learn some new terms. It is not a trailer park read.

Ultimately, Super Agers is a crucial addition to the longevity library. It provides a credible, science-backed counterpoint to the more speculative theories and firmly grounds the conversation in the power of preventing disease.

For anyone serious about healthspan, it offers a glimpse into the powerful toolkit that evidence-based medicine is assembling—a toolkit that extends far beyond what our mothers, as wise as they were, could have ever told us.

Lessons Learned for Myself:

While very different from Lifespan, Super Agers presents me with a significant challenge - it will be very difficult to write something better and differentiate. I will need to go deeper into the trenches, into the business of longevity biotechnology and find new ways to go beyond DYMT without promoting some unproven therapies. I will also need to rely heavily on the material from Aging Research and Drug Discovery conference (12th in 2025) in Copenhagen, a 5-day event with 180 speakers from pharma, biotech, academia, and investor community. I estimate that it will take me another year to write it and it would be great to see at least one therapy clinically-proven to meaningfully reverse aging. Until I am done, Super Agers and Lifespan are your two best friends.

Before I start this long read, full disclosure - we do not use personal genomic data at our company - it is policy. We consider it to be very toxic data type since it is very easy to be accused of misuse. Even experts do not fully understand the risks and benefits of this data. I also think that it is not as valuable for target discovery or other drug discovery tasks as many people believe especially, if it not connected to many other data types. But when it is connected to the many other data types including phenotype and surveys, it may be very valuable. On May 19th, Regeneron announced the acquisition of 23andMe together with its data. It came as a surprise to me, the former 23andMe customer. But unlike other customers, I actually celebrated - maybe Regeneron will find a drug using the models trained on data that also includes my genome. It will be great for everyone including me.

But to the industry it came as a shock. I remember sitting in a conference room with my fellow pharma executives when the news hit: Regeneron was acquiring 23andMe for $256 million. This number seemed to be significantly higher than the value of the company at the time of the bankruptcy but much lower than I expected the net totality of the genomic and phenotypic data in the company. Fifteen million genomes, each coupled with rich personal and health data, changing hands for what amounted to pocket change per person. As an industry, we had spent years preaching that genomic data was priceless, sensitive beyond measure, practically radioactive in its potential for misuse. And here it was being sold at roughly $17 a head – less than the cost of a couple of lattes. My first reaction was disbelief, quickly followed by an uncomfortable question: Have we been overestimating the risk and underestimating the value of genomic data all along?

In that moment, I felt a jolt of perspective. For years, our conversations around genetic data had been dominated by fear. We tiptoed around it, treating every genome like a live grenade that might go off if handled improperly. Yet the 23andMe saga – a massive trove of DNA data auctioned off in bankruptcy – tells a more nuanced story. It forces us to reckon with the true value of genomic information and the real (as opposed to imagined) risks of letting it loose. As someone who’s spent decades in pharma, I want to challenge some of the sacred cows we’ve built around data privacy in genomics. I write this in a first-person, reflective tone because this is personal: it’s about how we, as pharma leaders, choose to see the DNA data of millions of people – as a toxic liability, or as a powerful asset for human health.

Let’s dive into what Regeneron really bought, why the feared genomic privacy apocalypse hasn’t materialized, and how we might forge a new social contract that balances innovation with individual rights. Strap in, because this isn’t the conventional “data privacy” sermon you’ve heard before. It’s an argument for rethinking everything.

The 23andMe Acquisition in Context

When the deal closed, the final price tag was $256 million for substantially all of 23andMe’s assets. For context, 23andMe isn’t just any biotech startup – it’s the company that persuaded over 15 million people to spit in a tube and share their DNA in exchange for ancestry tidbits and health trait reports. Regeneron’s purchase includes that entire database of genotypes and the associated phenotypic and survey data those customers provided. Do the math and it comes out to around $17 per customer profile, or about $21 per genome for those who consented to research use. In the world of biotech, that’s an astonishingly low cost per genome. It’s as if a luxury sports car was suddenly selling for the price of a used bicycle.

To grasp how extraordinary this is, compare it to a few well-known genomic data collections:

1. deCODE Genetics (Iceland) – In 2012, Amgen acquired deCODE for $415 million. deCODE had genotyped and sequenced around 160,000 Icelanders (with deep medical records to boot). Roughly speaking, that was about $2,500 per genome – and industry folks thought it was a steal at the time, given the quality of data and the unique resource it represented.

2. UK Biobank – The UK government and research charities have invested well over $100 million to genotype (and now whole-genome-sequence) a cohort of over 500,000 volunteers in the UK Biobank. That comes out to hundreds of dollars per person just in sequencing costs, not counting the extensive phenotypic data collection. And UK Biobank data isn’t “for sale” per se – it’s an open resource for approved researchers, arguably priceless in terms of scientific value.

3. GSK’s partnership with 23andMe – A few years back, pharma giant GSK paid $300 million for a mere stake and collaboration with 23andMe, hoping to tap into the database for drug target discovery. Even that partial, temporary access cost GSK about $20 per 23andMe customer at the time.

Regeneron Paid Less for Entire 23andMe than GSK paid to collaborate and have access to insights into the 23andMe Data!

Seen against these benchmarks, Regeneron’s $17-a-head deal looks almost absurd. Why so low? The answer lies in the circumstances. 23andMe’s direct-to-consumer business had been faltering, with demand for ancestry tests cooling. Then came a seismic event: a massive data breach in 2023 that compromised millions of customer records. Public trust plummeted. Legal bills mounted. By early 2025, 23andMe was on the ropes, filing for Chapter 11 bankruptcy. In the ensuing auction, there weren’t many takers for a tarnished company sitting atop a mountain of sensitive DNA data. Regeneron’s bid won, and suddenly a pharma company best known for its drug development pipeline became the custodian of 15 million genomes.

From a purely data standpoint, Regeneron scored the bargain of the century. Not just because of the quantity of data, but its unique nature: 23andMe’s database isn’t a random biobank. It’s enriched for people who were curious and engaged enough to seek out genetic testing, many of whom also answered hundreds of survey questions about their health habits, medical histories, personalities, life outcomes – you name it. It’s a quirky, high-dimensional dataset spanning everything from ancestry and raw genetic code to whether you hate cilantro or can curl your tongue. In research value, it’s unprecedented. If UK Biobank is a gold mine for science, 23andMe’s trove is a diamond mine with gold, silver, and some weird semi-precious gems mixed in. The catch, of course, is that this mine comes with a big warning sign: “Privacy Hazard: Handle with Care.”

The low sale price is a signal. It signals how wary the market has become about genomic data liabilities. We in pharma have to decode that signal. Is it saying “this data isn’t actually worth much” or is it saying “the data is invaluable, but the perceived privacy risks have discounted it heavily”? I’d bet on the latter. Regeneron certainly isn’t buying those 15 million genomes for fun – they believe there’s enormous drug discovery value hidden in there. The price was low because many others were scared off. They were scared of regulators, of lawsuits, of public backlash, of the proverbial “nuclear waste” that a genomic database can become if it leaks. Regeneron was willing to stomach that fear, likely because they have confidence in both their data security and the payoff of integrating genetics into drug R&D.

This brings us to a critical piece of the story: that big bad data breach, and whether the nightmare scenarios we’ve all imagined actually came true.

The Breach and the Myth of Genomic Harm

Let’s talk about the elephant in the room: the 23andMe data breach of 2023. When news broke that hackers had accessed data from about 7 million accounts, it was as if a collective chill went down the spine of every 23andMe customer and every privacy officer in our industry. Sensitive personal details, ancestry information, some health reports, even raw genetic data – all allegedly stolen. To make matters worse, rumors started to emerge that these stolen records started appearing on the dark web for sale.

The public reaction was swift and fierce. Media headlines screamed about DNA data on the loose. Customers panicked; many felt violated. Lawsuits were filed almost immediately, and regulators announced investigations. It was everything a company like 23andMe fears. Overnight, the trust they’d built with users evaporated. People wondered if their genetic secrets were out there for any criminal or nosy neighbor to find. The narrative of genomic data being uniquely dangerous seemed to be coming true.

But then, a funny thing happened – or rather, didn’t happen. Specifically, nothing visibly terrible happened to those 7 million people. In the months following the breach, there were zero confirmed cases of someone being harmed because their 23andMe data leaked. No reports of blackmail (“Pay up or we’ll tell the world about your BRCA mutation”). No insurance company was caught surreptitiously trawling the dark web to raise people’s premiums because of their genetic risk scores. No stalkers using DNA data to track down distant relatives of their targets. In short, the concrete impact on individuals was near zero, aside from understandable anxiety and annoyance.

This bears repeating: a trove of genetic data was exposed to all the “unscrupulous buyers” of the internet, and the sky did not fall. The worst outcome was for the company (23andMe’s reputation and finances were wrecked). The customers themselves, as far as we know, did not experience direct harm. This isn’t to trivialize the breach – it was a serious security failure and a violation of privacy. But it serves as a real-world test of all the horror stories that have been speculated about genomic data. And the reality is, those stories largely did not materialize.

Think about breaches of other sensitive data: If 7 million credit card numbers get stolen, you see fraudulent charges within days. If 7 million social security numbers get leaked, you brace for identity theft, credit ruin, IRS tax fraud – a whole cascade of nightmares that often do come true for the victims. But 7 million DNA profiles? It appears many ended up being traded around among data brokers and probably fed into hacker collections, yet no one’s life was ruined because of it. One reason might be that bad actors simply don’t have an immediate use for your raw genome the way they do for your bank info. Another reason: perhaps the truly sensitive parts of the data (like names and addresses) were already available elsewhere, making the genetic component moot from a misuse standpoint.

Interestingly, the very cheap price of the stolen 23andMe records on illicit markets tells a story by itself. It suggests that even in the bowels of the dark web, buyers weren’t lining up to get their hands on people’s SNP profiles and ancestry results. This data was not “hot” property; it was more like a curiosity sold in bulk. Contrast that with, say, stolen electronic health records or full identity packets – those fetch much higher prices because criminals can do something with them (file false insurance claims, open credit lines, etc.). The market spoke: genomic data without obvious financial or operational utility just isn’t that valuable to cybercriminals.

This reality check should prompt us, especially those of us in pharma and biotech, to ask: Have we been overhyping the dangers of genomic data exposure? We’ve been treating DNA data like a radioactive isotope – something that, if leaked, could lead to catastrophic outcomes. But the 23andMe breach indicates that maybe genomic data isn’t as immediately hazardous as we thought. In fact, one could argue the biggest “harm” was the harm we cause ourselves by panicking and pulling back from data sharing that could benefit science.

Usually, politicians playing on this sentiment would invoke the idea of creating individual DNA-targeting bioweapons but at this stage of technological development, it is complete nonsense. If scientists had this kind of technology, they would have cured many diseases by now. Also, the 23andMe data that was hacked and stolen included a large number of Ashkenazi Jews, whose data was Leaked Online. This is one of the population groups most commonly targeted by terrorists.

Don’t get me wrong – privacy matters, and we absolutely must protect personal data. The point is not that breaches are okay; it’s that not all breaches are equal. A leak of genetic data is not the same as a leak of your credit card, your passwords, or your medical treatment history. The nature of potential misuse is fundamentally different. To understand how, let’s reframe the privacy conversation altogether.

Reframing the Privacy Debate: Genomes Are Not Credit Cards

Here’s a mental exercise: imagine you have to choose between two bad scenarios. In one, a hacker steals your credit card number and security code. In the other, a hacker steals your raw 23andMe genetic data. Which keeps you up at night more? If you’re like most people, the credit card theft is the immediate nightmare – your money could be drained, your accounts frozen, your credit wrecked. The genetic data theft feels more abstract, almost puzzling: what could they even do with it? Create an evil clone? It’s not obvious.

And that’s precisely the point. We need to stop equating genomic data with financial data or login credentials. Your genome is not a password. It’s not a PIN or a social security number. It cannot be used to directly steal your car or empty your bank account or impersonate you in a transaction. Yet for years, the narrative has been “genetic data is the most personal identifier, guard it with your life.” Yes, it is intensely personal – it’s literally the code of your biological self. But personal doesn’t automatically mean dangerous in someone else’s hands. We have to differentiate between emotional reactions and practical risk.

Consider this: a genome sequence is a long string of A’s, T’s, C’s, and G’s. By itself, it tells you nothing obvious, unless you do some serious interpretation. It’s not like reading someone’s diary; it’s more like reading a deeply encrypted diary that even experts struggle to fully decode. Without context or correlation to other information, a raw genome is not very useful to a malicious actor. It’s not trivial to suddenly know “aha, this person is at high risk for Alzheimer’s” without additional data and analysis. And even if they did know that – how exactly do they weaponize it against you? By telling your employer? (That would be illegal discrimination and also requires proving it’s actually you, etc.) By telling your health insurer? (In many jurisdictions, including the U.S., health insurers are barred from using genetic information to set coverage or rates – more on that in a moment.)

Compare this with stolen financial data: utterly straightforward to monetize for criminals. Or stolen health records: chock full of details that can be used for fraud or extortion (imagine a hacker threatening to expose a celebrity’s mental health treatment – that’s actionable info). Genomic data, on the other hand, mostly yields probabilistic information about health or ancestry that even the owner often doesn’t fully understand. The worst you might say is “Hey, I see you have a BRCA1 mutation, you should worry about breast cancer” – but if someone tried to blackmail me with that, I’d probably respond, “Thanks for the tip, I’ll discuss it with my doctor.” It just doesn’t have the same punch as “I have your bank logins” or “I know your private medical history.”

Now, some people raise the concern of genetic discrimination – that an insurer or employer could use your DNA to deny you opportunities. That is a legitimate concern in theory, which is why laws like the Genetic Information Nondiscrimination Act (GINA) exist in the U.S., prohibiting employers and health insurers from using genetic info against you. Yes, GINA isn’t perfect (life insurance and long-term care insurance aren’t fully covered, for example), but to date there’s scant evidence of rogue insurers sneaking around trying to get hold of leaked DNA data to tweak policies. If anything, insurers rely on known medical diagnoses and family history (which are much easier to obtain) rather than raw genomic data. It’s easier for an underwriter to note “father died of colon cancer at 50” than to interpret a genome for colon cancer risk variants.

What about more sci-fi scenarios? People worry about someone creating a bioweapon targeted at their DNA or planting fake DNA at a crime scene. These scenarios occupy the extreme fringe. Designing a bioweapon that only hurts someone with a specific genetic variant is far beyond current capabilities (and if someone wanted to harm you that badly, there are simpler ways). As for planting DNA evidence: a criminal would need access to a sample of your DNA (not just the data file) to do that. If they were that determined, they could get your DNA from a used coffee cup or hairbrush far more easily than hacking a database and synthesizing a DNA sample from the digital code. The threat, while not zero, is more Hollywood than real-world at this point.

Perhaps the only concrete “misuse” of genetic data we’ve seen is in the realm of law enforcement. The Golden State Killer case famously used an open genealogy database to find a suspect via his relatives’ DNA. This raises valid debates: if your third cousin’s DNA is in a database, could that implicate you in something by familial association? It could, and that blurs lines of consent and privacy. However, note that in the 23andMe breach, law enforcement isn’t the one hacking data – they have legal processes (warrants, subpoenas) to request data, and companies have policies on if/how they comply. 23andMe actually boasted that they resist law enforcement requests without proper legal order, and they weren’t a big player in familial forensic searches. In any case, getting access to data via breach is not how police operate typically. So again, the marginal additional risk due to a breach is quite low.

The bottom line is this: we’ve been treating genomes like credit cards, when in fact they’re fundamentally different. A stolen credit card is an urgent crisis; a stolen genome is an embarrassment and a potential long-term worry, but not an immediate life-altering event for the victim. We should calibrate our responses and policies to reflect that. That doesn’t mean we ignore privacy – it means we manage it in a way that also considers the opportunity cost of clamping down too hard. And speaking of opportunity, let’s talk about the flip side of the coin: the immense scientific and medical value locked up in these genomic datasets, which we risk foregoing if we let fear dominate the conversation.

The Scientific Goldmine in Genomic Data

If genomic data is not a radioactive threat, then what is it? From where I’m standing – which is in the R&D halls of pharma – it’s a goldmine. Better yet, it’s like a vast reservoir of potential energy (to foreshadow my conclusion). Each genome in a database like 23andMe’s is a datapoint that, when combined with millions of others, can illuminate human biology in ways we never thought possible. We’re talking about discovering the biological mechanisms behind diseases, identifying new drug targets, figuring out why certain medications work great for some people but not at all for others, and finding humans with rare superpowers (genetic ones, anyway) who hold secrets to health that we can all benefit from.

History already provides some spectacular examples of single genetic insights leading to medical breakthroughs:

• PCSK9 and Cholesterol: A couple of decades ago, researchers discovered that some people had mutations in a gene called PCSK9 that resulted in ultra-low LDL cholesterol levels – and, importantly, these people were surprisingly heart-healthy. That discovery directly led to the development of PCSK9 inhibitor drugs, a new class of potent cholesterol-lowering therapies. Those drugs are now saving lives by preventing heart attacks. The key was studying both a rare harmful mutation (in families with very high cholesterol) and rare beneficial mutations (in individuals with very low cholesterol). The human genome served up a clue, and pharma ran with it.

• GPR75 and Obesity: More recently, a study led by Regeneron and academic partners analyzed half a million people’s DNA and health data (much of it from the UK Biobank) and found that individuals with certain rare mutations in the GPR75 gene were highly protected against obesity – they weighed much less on average than those without the mutation. Bingo: a new obesity drug target was born. Now there’s intense interest in developing drugs that mimic the effect of knocking out GPR75, which could become a novel therapy for obesity or metabolic disease. That kind of discovery only emerges when you have massive datasets to sift through, because those protective mutants were literally one-in-many-thousands.

• ApoC3, ANGPTL3, and Triglycerides: Another example – people with rare loss-of-function mutations in certain genes have been found to have dramatically low triglyceride levels or other favorable metabolic profiles. These findings (like those for the genes ApoC3 and ANGPTL3) have spawned new therapies for hypertriglyceridemia and even new approaches to cardiovascular disease. Each time, the pattern is similar: find a gene variant that naturally does something beneficial, then design a drug to copy that effect.

• Proteogenomics and New Biology: Beyond finding drug targets, having genomic data linked to other biological data opens new windows. For instance, large projects now measure thousands of proteins in people’s blood (the “proteome”) and connect those to genetic variations. This field of proteogenomics has yielded incredible insights – like identifying proteins whose levels are controlled by certain genes, which in turn affect disease risk. A concrete example: genetic variants that change the level of a protein called IL-6 receptor led researchers to develop IL-6 blocking antibodies for autoimmune diseases. If you have a million genomes with linked protein data or health records, you can do this kind of analysis at scale and perhaps find dozens of new angles for therapy.

• Identifying “Super-Carriers”: In a huge database, you can find what I call genetic “superheroes” or at least unusual individuals. Maybe there’s someone with a gene that normally causes a deadly disease, but they are completely healthy – suggesting they have protective factors. Maybe you find someone who’s 80 years old, has smoked all their life and never got lung cancer, carrying clues in their genome as to why. These anecdotes become discoveries when you have data at scale. The famous CCR5 delta-32 mutation that makes people immune to HIV was discovered by studying individuals who were exposed to HIV but never contracted it. How many more protective variants are sitting in the 23andMe database, unlooked-for? With millions of people, likely quite a few. And within those lie blueprints for tomorrow’s medicines.

The point is, genomic data saves lives – but only if we use it. If we treat it like a deadly toxin that must be locked away, we miss out on these breakthroughs. Our industry spends billions on R&D, and yet something as simple as a genetic association study can point the way to a winning project or spare us from pursuing a dead end. (Evidence: drugs with genetic evidence backing their target have a significantly higher success rate in clinical trials. Genetics helps de-risk big decisions.)

Now, the 23andMe dataset is particularly interesting for a few reasons that are worth highlighting to my fellow pharma colleagues:

• It’s diverse (at least more so than many studies). 23andMe’s customers come from a variety of backgrounds and ethnicities, meaning discoveries that might benefit populations beyond the typical European-ancestry cohorts used in a lot of research. For example, genetic factors more common in, say, East Asian or African populations might be lurking there, waiting to be found, for traits like diabetes or blood pressure. This is not just good ethics – it’s good science and business, because drugs need to work for everyone.

• It’s linked to self-reported phenotypes. Yes, self-reported data can be messy or noisy – but with millions of data points, patterns emerge. 23andMe users have reported everything from whether they get migraines from exercise to how much they weigh at various ages, whether they have certain diseases, etc. That’s a trove of phenotype information you can’t get easily elsewhere at scale. When cleaned and validated, it can reveal correlations that spark hypotheses (e.g., a genetic variant that correlates with people reporting they never feel pain the same way could lead you to a new pain drug target).

• It has longitudinal potential. So far, 23andMe’s data is largely baseline (one spit kit, one survey snapshot). But some users have been tested for years, new surveys launched, new data accumulated. If integrated with outside data (like electronic health records or wearable data, with consent), this could become a longitudinal study of millions. Imagine following 10 million people over 10 years genetically – the power to see which genetic profiles get which diseases or respond to which meds is unprecedented.

And specifically for metabolic diseases (as mentioned in the context given – GLP-1 analogs, muscle “incretins”, rare phenotypes): this is an area where genetics can shine. The craze over GLP-1 analogs (drugs like Ozempic for weight loss) shows we have potent tools, but not everyone responds the same or tolerates them. Genetics might predict responders or suggest combination therapies. Perhaps there are people in the database who lost weight easily and kept it off – do they carry rare variants we can mimic pharmacologically? “Muscle incretins” might refer to signals from muscle that affect metabolism or appetite (there’s speculation that exercising muscle releases factors that suppress hunger or improve insulin sensitivity). If some individuals have naturally high levels of such factors (due to genetics), we might find those signals and turn them into therapies. A large dataset helps find these needles in the haystack.

Every genome in that 15 million is a potential lesson. But only if we’re allowed to learn from it. That brings us to the interplay with regulation and public sentiment – how do we use this goldmine without triggering a privacy backlash or running afoul of laws? The good news is, I sense a shift in how regulators are thinking about this.

Regulation: From Punitive to Pragmatic

Not long ago, any company that lost control of customer data could expect metaphorical heads to roll. Massive fines, public shaming, executives grilled in hearings – the regulatory playbook was mainly about punishment and setting examples to deter others. With genomic data, regulators have been understandably cautious. The EU’s GDPR treats genetic information as sensitive personal data, deserving extra protection. In the US, we’ve seen the FTC and state authorities come down on companies for privacy missteps. One might expect that 23andMe’s breach and subsequent bankruptcy would result in a regulatory crackdown of epic proportions. But what actually happened was more measured, even pragmatic.

Yes, there have been consequences: Investigations by the UK Information Commissioner’s Office and other data protection agencies were launched. The UK ICO even signaled an intention to levy a fine on 23andMe (a few million pounds – meaningful, but nowhere near the maximum they could have gone for). Class-action lawsuits in the US prompted a settlement (reportedly around $30 million) to compensate affected users with some credit monitoring and restitution. These are not trivial, but they’re also not crippling in the context of big tech fines. Importantly, regulators did not move to block the transfer of data to Regeneron, nor did they demand that 23andMe’s database be purged or sequestered due to the breach. Instead, the approach has been: make sure the buyer (Regeneron) understands their obligations, put safeguards in place, and keep an eye on things.

In fact, as part of the bankruptcy proceedings, a court-appointed independent privacy overseer was assigned to review the deal’s implications. Regeneron had to publicly commit to upholding 23andMe’s privacy policies and complying with all data protection laws. Lawmakers made noise about “unscrupulous buyers”, but ultimately allowed the sale to proceed, implicitly acknowledging that having a responsible pharma company pick up the pieces might be better than leaving the data in limbo or letting it go to a less accountable entity. This is the pragmatism I’m talking about: rather than scorning any use of the data post-breach, the system sought to ensure it would be used ethically. Regulators appear to recognize that if there’s no actual harm to individuals manifesting, there’s no sense in burning the village to save it.

It’s a subtle but important shift: focus on outcomes, not hypotheticals. Regulators are increasingly asking, “Is there evidence of misuse? Is the company taking reasonable steps to prevent misuse? How can we enable beneficial research while mitigating risks?” This is a far cry from a purely punitive stance of “one strike and you’re out (of business)”. I see parallels in how data regulators are evolving similarly to how FDA might evolve – from blocking anything risky to managing risk while allowing innovation.

For example, a few years ago, if you mentioned a DNA database might get sold to a pharma company, privacy advocates would gasp and perhaps regulators might intervene. Today, with 23andMe, the conversation is: how do we make sure Regeneron doesn’t abuse it, rather than “no, you can’t have it at all”. There’s an implicit acknowledgement that using genetic data for research and drug development is a legitimate, even valuable, activity – one that needs oversight but not obstruction.

Even the tone of penalties is shifting. A multi-million dollar fine for a breach affecting millions might seem low (compared to say, GDPR’s theoretical fines of 4% of global revenue), but it’s proportional to the actual damage observed. We haven’t seen regulators equate the leakage of genomic data with, say, a leak of health treatment records (which typically draw huge fines because the sensitivity and misuse potential is known to be high). And that’s appropriate. It sets a precedent that while genetic data security is important, an incident will be evaluated on real-world impact, not just fear.

From a pharma executive perspective, this means the regulatory environment might be less hostile to large-scale genetics initiatives than we once assumed. If we engage proactively – e.g., by involving independent ethics boards, being transparent with participants, and rapidly addressing any issues – regulators seem willing to work with us to enable research rather than just punishing us for any imperfection. This is not to say we get a free pass (nor should we), but the mood music is changing. The conversation with regulators can include, “How can we unlock this data safely for the public good?” and not only, “Don’t you dare do anything without 10 layers of legal checkboxes.”

However, one area where there remains a thorny challenge is with laws like GDPR that give individuals strong rights – such as the right to erasure. This brings us to the practical dilemma of deleting genomic data on request.

The GDPR Dilemma: The Illusion of Deletion

Europe’s GDPR enshrines a powerful concept: if I gave you my data, I can later ask you to delete it and you must comply (with some exceptions). On paper, this sounds just and reasonable, especially for something as sensitive as DNA. If I decide I no longer trust 23andMe or I regret ever sending in my spit, I should be able to pull the plug, right? The reality, however, is not so simple. In practice, deletion is often partial, delayed, or somewhat illusory – not out of malice by companies, but because of the way data works in the modern world.

I spoke with a European friend who was a long-time 23andMe customer and, after the breach, he invoked his GDPR rights to have his data deleted. He got a polite confirmation email: his account was closed, his raw data file was deleted from the customer interface, and his sample destruction was initiated. Sounds good… until you scratch the surface. What about the copy of his genotype data that was sitting in a research database that 23andMe’s scientists use for internal studies? What about any aggregate statistics his data contributed to, like “frequency of gene X in population Y” in a research paper? What about the lab testing records? Under CLIA (the lab regulations in the US), labs are required to keep test records for a number of years. A DNA genotype might be considered a test result that can’t just vanish immediately because a customer wants it to – the lab might need to retain it for regulatory audits, quality control, etc., for say 10 years. So perhaps his raw data still lives in a CLIA-compliance binder or server backup somewhere, inaccessible to normal use but not truly gone.

Furthermore, 23andMe’s own research consent documentation states something to the effect: if you withdraw consent, they will stop using your data for new research, but data already used in past research cannot be clawed back. This makes sense – if your data was part of a calculation of, say, “20% of people with gene variant Z have diabetes,” you can’t undo that calculation retroactively. The company can’t somehow retract a published result or magically remove the fragment of your data that’s been mixed into a larger analysis. They can stop referencing your individual profile moving forward, but history can’t be rewritten.

So the GDPR ideal meets the scientific reality and we end up with a bit of a conflict. Companies do their best to honor deletion requests – the low-hanging fruit is deleting the user’s account, any identifiers, and isolating or destroying the physical DNA sample. But remnants of that data inevitably persist, be it in backups (which might be kept for disaster recovery) or derived data that isn’t easily attributed to one person. Most privacy laws acknowledge that truly wiping all traces might be impossible; they often allow retention of data for legitimate purposes like regulatory compliance or research that’s already in progress.

From a user standpoint, this is confusing at best and deceptive at worst. Users think “delete” means gone forever. In truth, it often means “mostly gone, as far as you’ll ever see, but we can’t honestly say 100% gone.” Companies could probably be more transparent about this nuance. But how do you explain that without scaring people? “We’ll delete your data, except not really, but don’t worry…” – it’s a tough message.

The GDPR dilemma for genomic data is this: How do we give individuals genuine control and peace of mind, without undermining the integrity of long-term research? If every time someone withdrew, a research dataset had to be purged and statistics recalculated, it would be a nightmare for science. Imagine if a thousand people in the Framingham Heart Study (a famous longitudinal study) suddenly said “delete me” – decades of research would be thrown into question. Yet, individuals do deserve the right to not have new analyses done on their data if that’s their wish.

One practical solution is what 23andMe did: honor the request going forward, but not retrospectively. This is essentially an implicit social contract: “Your data might contribute to research, and if you later withdraw, we won’t use it further, but we can’t undo what’s done.” Is that satisfying GDPR’s intent? Debatable. Regulators haven’t fully clarified how to handle derived data in cases like these. We’re in somewhat uncharted territory.

For pharma companies like Regeneron now inheriting these obligations, it means we’ll need to be very clear and careful with our European customers. EU users likely have the ability to request deletion via GDPR or similar laws. We must comply as best we can and document why some data can’t be entirely scrubbed (if that’s the case). And maybe this is where having an independent data steward or trustee can help (more on that in a moment) – an external party that can attest to what was deleted and what remnants remain, giving users more confidence that it’s not just the proverbial fox guarding the henhouse.

What I take from the GDPR dilemma is a lesson: transparency is key. People will understand that a completely sanitized deletion might be impossible, if you explain it. “We will delete all your personal identifiers and raw data. However, any research results already derived from your data will continue to exist, though they contain no information that could identify you.” That kind of message, while not perfect, at least sets realistic expectations.

But beyond managing deletions, what if we flip the script entirely? Instead of just reacting to privacy rules and breaches, can we proactively create a better model that satisfies people’s privacy concerns and unleashes the data’s value? I believe we can – and must. Let’s explore what that new social contract could look like.

Toward a New Social Contract for Genomic Data

It’s time for a reset in how we think about and manage genomic data. The old model was transactional and static: a customer gives their DNA sample, gets a report, and maybe signs a one-time consent allowing their data to be used in research (often buried in terms and conditions). The company then sits on that data like Smaug guarding gold, maybe collaborating with a few partners to mine it quietly. The customer is largely out of the loop thereafter. Trust is expected to be implicit (“we’ll keep your data safe and use it properly, just trust us”). That model has shown its cracks – people feel uneasy, breaches shatter trust, and as a result we risk the whole enterprise of genomic research by losing public support.

We need a new social contract for genomic data, one that is dynamic, participatory, and built on transparency and mutual benefit. In my view, key pillars of this new model should include:

1. Dynamic Consent: Instead of a one-and-done consent, let participants engage in an ongoing dialogue about how their data is used. This could mean giving users a say through an app or web portal where they can adjust settings: “Yes, you can use my data for research on condition X, but not for Y” or “I’m okay with my de-identified data being shared with academic researchers, but not with for-profit companies without additional permission” or vice-versa if they’re feeling altruistic across the board. Dynamic consent recognizes that people’s comfort levels can change over time or differ by context. Importantly, it treats participants as partners rather than passive data sources. It could even include notifying them of new studies or findings that result from their data – closing the feedback loop so they see the impact of their contribution. Imagine getting a message: “Your data (along with 5 million others) just helped discover a new gene linked to heart disease. We’re working on a drug for it now.” That creates a sense of shared mission. When people feel involved and respected, they are more likely to continue sharing and less likely to feel betrayed.

2. Federated Analytics and Privacy-Preserving Tech: In the wake of breaches, one might think the safest course is to never centralize data. But of course, analysis traditionally requires data to be pooled. Federated analytics offers a clever compromise: keep the data in silos (or on individuals’ own devices/cloud accounts) and send algorithms to the data rather than data to the algorithms. The idea is that you can compute insights without aggregating all the raw data in one vulnerable place. For example, instead of a researcher pulling millions of records to their computer to run a query, they submit the query to a secure platform where the computation happens behind the curtain and only aggregated results (say, allele frequencies, or regression coefficients) come out. Google and others do this for things like smartphone data collection – it’s proven feasible. In genomics, it’s nascent but being explored. We should invest in this. It means even if a hacker breaches one system, they don’t get everything, and each piece of data remains under tighter control. Coupled with techniques like differential privacy (adding a bit of statistical “noise” to results to make it hard to re-identify individuals), we can greatly reduce the risk of any malicious use. In a sense, it’s using technology to solve the very privacy problems technology created. Pharma companies and big research consortia should lead here, building federated data networks where multiple parties (hospitals, biobanks, companies) query each other’s data without ever fully exchanging it. This not only protects privacy, it can also get around cross-border issues (data can stay in its country of origin to comply with laws, but insights still flow globally).

3. Independent Data Stewardship: Trust is fragile. Why should the public trust a pharma company with their DNA, given companies have profit motives? One way is to introduce independent stewardship – essentially creating a buffer entity or governance council that oversees access to the data. This could be a nonprofit foundation, a consortium with academic ethicists, maybe even participant representatives sitting on the board. They would approve or deny research proposals for using the data, audit usage, and ensure compliance with privacy standards. Think of it like a library – the data is held not by the drug company directly but by a neutral trust, and researchers (including those from the pharma company) come to the library to “read” (analyze) the data under supervision. The pharma funder still benefits from discoveries, but they don’t have unchecked power to exploit data in ways participants didn’t agree to. In the case of 23andMe’s bankruptcy, amusingly, the second-highest bid was by a nonprofit led by the company’s own founder, which suggests there was an idea to keep the data in a more benevolent home. They lost the auction, but perhaps Regeneron could still implement a form of independent oversight to assuage fears. If I could wave a wand, I’d establish a Genomic Data Trust where companies deposit the data and an independent board (with legal teeth) ensures it’s only used for agreed purposes.

4. Data Altruism and Participant Benefit: We should encourage a culture where donating data for the greater good is normalized and celebrated – akin to blood donation. People should have the option to say, “I want my data to help as many research projects as possible; please share it widely (in a privacy-safe way).” The EU has even floated the term “data altruism” in policy discussions. If participants opt in to broad data sharing, that data could be made available to academic researchers worldwide, not just kept for the original company’s use. On the flip side, there’s the idea of ensuring participants also benefit from the fruits of research. While we can’t promise everyone gets a check when a drug is discovered (that’s not practical, and altruism is often given freely), we can at least promise return of knowledge. For instance, if a new health risk is found and you carry that risky variant, you should have the right to know (if you want to). Or when a drug comes out that was developed using the data, maybe participants get early access or a thank-you in some meaningful form. The social contract should be: your data helped create public (and commercial) good, so you are acknowledged and not forgotten in the process. At minimum, regular newsletters to participants about what’s been learned, or having an annual “participant appreciation day” where companies openly share all the cool discoveries enabled by the community’s data, can reinforce that trust and goodwill.

In short, the new model is about partnership. It’s not “we take your data and run,” but “we invite you into the journey of discovery, and together we make sure the data is used responsibly.” This might sound idealistic to some hardened industry veterans, but I truly believe it’s the way forward. Otherwise, we will see more public backlash, more users opting out, and more regulators slamming doors – which ultimately helps no one, not even the privacy advocates if it means slower medical progress.

Pharma executives reading this might wonder about the competitive aspect – isn’t data our secret sauce? Why share it or involve others? My answer is: some precompetitive collaboration on data infrastructure and ethics can actually enlarge the pie for everyone. If people trust the system more, more people will share data. If federated approaches let us collaborate without giving away IP, we can collectively amass larger sample sizes to detect the meaningful signals. And at the end of the day, developing the drug from those insights will still require all our execution capabilities – having a few more academic eyes on the data doesn’t diminish the advantage of being the one with the capacity to act on findings. In fact, it might accelerate finding those key insights in the first place.

The Genome Is Not Radioactive—It’s Potential Energy

After all this, I circle back to the mental image that’s been at the heart of our privacy debates. We’ve been treating the human genome like it’s some sort of radioactive material – handle it in lead-lined gloves, lock it deep underground if you’re done with it, and pray you never have a leak. But a genome isn’t plutonium. It’s more like a battery or a fuel source. It contains energy – information – that, if harnessed, can propel us to new frontiers of medicine. Like any fuel, it needs to be handled with respect (you don’t pour gasoline around willy-nilly either), but the answer isn’t to bury it and never use it. The answer is to build better engines and safer pipelines.

Yes, if you misuse it or if you’re careless, someone could get burned. But thus far we’ve seen that genomic data’s “radiation” is mostly imagined; the real mishaps have been minor. Meanwhile, the potential energy sitting in those 15 million 23andMe genomes (and in all the other databases worldwide) is staggering. It’s the potential to understand diseases at a molecular level, to tailor treatments, to find cures where none exist, to predict and prevent illness rather than react to it. Every genome is a story, and collectively they form the greatest library humanity has ever assembled about ourselves. Are we really going to let that library sit locked “for safety” when it could be changing the world for the better?

As a pharma executive, I also recognize the responsibility that comes with this data. Potential energy can explode if not managed correctly – public trust can blow up in our faces if we cut corners or appear tone-deaf to privacy. So I’m not advocating reckless abandon. I’m advocating smart, ethical, innovative use of genomic data. That means going above and beyond on security (we must strive to prevent breaches, absolutely), being transparent with participants, and inviting regulators to the table early to shape guidelines that make sense. It also means educating the public: we have to demystify what can really happen with their data and what safeguards exist. We must show through actions that we deserve the trust people place in us when they share something as personal as their DNA.

In closing, the 23andMe-Regeneron episode should be a wake-up call and an inspiration. A wake-up call that our traditional approach to genomic privacy (freak-out-and-lock-down) might be doing more harm than good. An inspiration that there is a middle path where data can flow to those who can use it to help humanity, without causing the harm so many fear. It’s a call for a new mindset: one that views genomic data not as a ticking time bomb, but as a powerful engine that we need to ignite – carefully, thoughtfully, but confidently.

I, for one, am optimistic. I believe we can create a future where donating your genome to science is seen as a noble act, not a foolish risk; where pharma companies are seen as trusted stewards of this information, not greedy data miners; and where regulators and researchers work hand in hand, rather than at odds, to ensure both privacy and progress. To get there, we have to challenge conventional thinking and be willing to try new approaches to data governance.

The human genome isn’t radioactive. It’s potential energy. And it’s high time we started treating it that way – with respect for the power it holds, yes, but also with an eagerness to release that power for the benefit of all humankind. Let’s lift the lid off the vault (safely) and see how far this energy can take us. The journey promises to be remarkable, and it’s one we shouldn’t delay any longer out of fear.

And One More Thing… Aging Research

We already know that genomic data is not the best source of new targets. Try to name 10 targets that were discovered using genomics data alone in addition to PCSK9 and several cancer mutants and you will know what I mean. In my opinion, the most important and abundant source of most impactful targets is aging research using Life Models trained on multiple data types coming from multiple animal species and humans from cradle to the grave. This is a new concept but it will be one of the topics of discussion at the upcoming 12th Aging Research and Drug Discovery conference in Copenhagen, 25-29th of August 2025. If you are in pharma or biotech or if you are working in academia but want to develop real products that will help many people live longer like the next GLP-1 - this is the conference for you. Register yourself and inform your friends. Let’s meet in Copenhagen during the best time to be in Copenhagen - it is beautiful at the end of August.

And I was right - the University of Rochester Medical Center pitched it to the media:

And the media made it more sensational with an attention-grabbing title appealing to our amygdala, which is responsible for the fight-or-flight response. It certainly got me and I continued reading with a glass of pure water.

By the time I finished reading, the Altmetric monitor of the paper looked like this:

Pretty scary, right ?

Well, it will be if the regulators that recently prohibited the use of multiple artificial colorings, or the FDA, decides to prohibit the sale of Red Bull and other Taurine-containing energy drinks until further investigation. And imagine that someone conducts a population meta-analysis and finds the increased incidence of cancer among the energy drink users (very plausible by the way as many of them also smoke).
Suddenly, we may no longer see the neck-breaking parkour, death diving, wing suits and other high-risk, high-click count videos. Who knows - maybe it is a good thing. Instead of focusing our attention on neck-breaking activities, companies should be sponsoring research in aging, longevity, and human performance. Or, at the very least, some of the frontier biomedical conferences in longevity biotechnology.

Taurine May extend life in mice.

Two years ago in 2023, Parminder Singh, presented the work he did while at the National Institute of Immunology in New Delhi, India published in Science titled “Taurine deficiency as a driver of aging” at the highest-profile conference in longevity biotechnology, Aging Research and Drug Discovery.

Check out the talk and get your ticket for the 12th ARDD in Copenhagen as it will bring together the brightest minds from academia and pharma where academics and startups provide the pharma companies with ambitious ideas and pharma provides the reality check and clinical rigor.

Should you immediately stop taking taurine?

Well, I personally stopped taking all of the vitamins, supplements, etc, a few months ago. Maybe it is a midlife crisis for someone who wanted to be the “venture capitalist of his own life” or maybe I am just taking a pause. But one thing I now believe in 100% is the need to very carefully-conducted, FDA-regulated double-blind, placebo-controlled clinical trials for any drug or intervention. Without these trials, unless your drug or supplement magically and consistently restores lost function or regrows your hair in humans, it should be considered unproven and ineffective. And even when it does, clinical trials should still be conducted. Same goes for the side effects - only the carefully-controlled clinical trials should be trusted.

Today, it may be possible to test your therapeutic intervention in a clinical trial for a specific disease and analyze the effects on biomarkers of aging as a free bonus as long as you get the consent and analyze the disease biomarkers.

Another point is that we should trust humans and, to some extent, non-human primates. Mice and even dogs are very different from humans in both safety and efficacy. Humans already live significantly longer than most species. While being great organisms to study the basic biology of aging, mice have a lot to learn from us and very little to teach us when it comes to interventions in longevity. I do advocate for conducting “lifespan studies” in mice but only for the purposes of biological research - no human claims before completing your human clinical trials.

Taurine looks to be Generally-Recognized as Safe (GRAS) and you should read up on it to see if this can change. It is unlikely that it will change due to that Nature paper.

I also believe that regular deep diagnostic procedures with maximum molecular and imaging (eg. MRI) biomarkers should be conducted before, during, and after any kind of “geroprotective” protocols. Many interventions that show promise in longevity have been implicated in cancer and other diseases.

Stay young, my friends! One form of aging you can try to reverse safely and effectively today is your psychological age.