I asked every frontier AI model the same simple question: how many years of healthy life can drugs actually buy us? The answers were humbling — and the smarter the model, the more humbling they got.
Unfortunately simulated intelligence is trained on the wrong data and does not have any actual intelligence. While it can be a great tool, it's definitely going to give the wrong answer in this situation.
Finally, a post worth reading from the longevity substack. I spent years tunneling the longevity rabbit hole, but no longer; we've only got 122 years. I'm not going to waste them.
These are painful words, but true. I envy you; I always wanted to be you. What you do and how you approach it, how you think, the level of integrity and truthfulness you possess, is admirable. I'm glad you're in this place, at this time, the person to push these matters forward, even if it's ultimately very slow and difficult work.
Really thought-provoking perspective. Advances in prevention, lifestyle medicine, and emerging therapies are expanding our understanding of what’s possible. Perhaps the most important question isn’t “How many years can we add to life?” but “How much life can we add to those years?” Thanks for sharing this insightful overview.
I think our best bet today is to measure and optimize. Avoid deficiency, avoid hidden disease, and keep the body in as optimal shape as feasible. ...and hope a drug will come in time before the above is no longer enough.
Alex, really valuable piece, and the intellectual honesty about lifespan QALYs is refreshing in a field that badly needs it.
One pushback: I think the framing measures the wrong thing. The 122-year ceiling is the wrong scoreboard. Healthspan is. SELECT delivered a 20% MACE reduction, 73% reduction in incident diabetes, and 22% lower renal risk in 17,604 non-diabetic patients, that's a systemic healthspan effect across four organ systems, not a lifespan-ceiling effect, and it's already validated. The Lancet Commission's 2024 finding that 45% of dementia cases are potentially preventable through modifiable risk factors is in the same category. None of this moves Calment's 122. All of it moves the morbidity curve.
Your QALY-per-capita-global frame is the right tool for procurement and public health prioritization. It's the wrong tool for the individual question of "how do I stay functional at 80." Different denominators, different conclusions.
The field's real failure hasn't been overpromising lifespan, it's been letting itself be judged on lifespan in the first place.
Agree with the need to be humble about what currently exists, but also optimism about what is coming with one-time therapies, organ regeneration, etc. There's another point to be made, however, which is that we have the wrong concept about living longer.
We focus too much on # of years alive, because it's easy to measure, and not nearly enough on number of years without serious disease, i.e. healthspan. The common thread among superagers is years lived free of multiple chronic diseases. Thus, the most important metric to track progress in increasing lifespan broadly is the median age of multimorbidity onset (where multimorbidity is defined as 3+ chronic conditions). For this reason, I agree that GLP-1s (and successors) along with (hopefully) one-time therapies like PCSK9 inhibitors can have multi-systemic value.
It's also why, as I argue in my book Life for Health, we will only realize the potential of drugs like GLP-1s by building systems purpose built for the the multi-decade threat posed by chronic and age-related disease. It's crazy to solve decades-long disease threats using health insurance systems meant for short-term, acute and routine issues; and which are hard-wired to treat progressive threats progressively, rather than intervening as early and decisively as possible. Defeating chronic and age-related disease requires bigger investments, earlier to reverse disease (where it already exists) and ongoing efforts to maintain health and predict/prevent future risk. That's a much longer ROI than any health insurance scheme now allows, and it requires everyone to be aligned around long-term outcomes like getting people to Medicare age without chronic disease -- individuals, insurers, clinicians, and drugmakers. For these reasons, life insurance is a much better financial (and systemic) framework than health insurance, paying everyone (over time) the absence of disease as well as the decisive treatment of it.
I love this paper. I always had this feeling after so many years of reading books , articles, and etc on longevity . It is probably like the period of discovering DNA , and like 50/60 years, had to pass afterwards, in order to begin to get the benefits from this discovery. Surfing the Map from Moscow to Vladivostok is nothing like taking the trans-Siberian train , or traversing the Ural mountains on motorbike. We still have long way of translating ideas into reality. Lots of hipsters and hip and wakes .. but the road of longevity unfortunately becomes crowded with charlatans and impostors and false prophets .Thanks Alex for a great approach. modesty has always been and is nothing but a reflection of high intelligence .👍
The seminal breakthroughs could appear at any moment, given the many angles being pursued by many gifted and funded pursuers. Get back to discovery activities, and let the journey be the destination until further notice. I'd gamble on a serious breakthrough within five years, but actually expect to die before it reaches me (currently age 73). I am just a soldier in humanity's greatest war. Why would I expect to fare better than a Russian recruit in WW2?
As a 62-year old man, I am not in the least surprised at the results although I would love for my cautious views to be challenged. As it is, I expect to need biostasis if I'm going to see much of the future.
I wonder what these eight AI models would say about your post on NLRP3...
I'm 67, and I'm extremely confident I know a lot more about anti-aging than the various simulated intelligence models. (they have no intelligence, they don't "think" and they are trained on the wrong data).
We humans keep looking for a magic pill, or amazingly like in this article actually consider a few of them. Reality is more complex. It's essential to factor in mental attitude, physical activity, overall diet and once you've got all of those "good" then you add on a few impressive pills (none of which were listed in this article).
Vitamin C & Vitamin D & a top quality multi (to provide B vitamins and small amounts of many, many other things)
All combined with an active lifestyle, plenty of purified water (and some Gerolsteiner water), and healthy food.
Many nutrients won't be noticed unless you take a sufficient dosage (not that a small dosage isn't doing some good, but it might not be enough to observe) and good quality products (that does not mean expensive but if you are getting your vitamins from the local grocery or Costco well you probably are completely wasting your money).
Basics like Vitamin C and Vitamin D are extremely important long term but are usually taken in far too small of dosages.
Unfortunately simulated intelligence is trained on the wrong data and does not have any actual intelligence. While it can be a great tool, it's definitely going to give the wrong answer in this situation.
The wrong "drugs" are being looked at. 😇
Finally, a post worth reading from the longevity substack. I spent years tunneling the longevity rabbit hole, but no longer; we've only got 122 years. I'm not going to waste them.
These are painful words, but true. I envy you; I always wanted to be you. What you do and how you approach it, how you think, the level of integrity and truthfulness you possess, is admirable. I'm glad you're in this place, at this time, the person to push these matters forward, even if it's ultimately very slow and difficult work.
Really thought-provoking perspective. Advances in prevention, lifestyle medicine, and emerging therapies are expanding our understanding of what’s possible. Perhaps the most important question isn’t “How many years can we add to life?” but “How much life can we add to those years?” Thanks for sharing this insightful overview.
I think our best bet today is to measure and optimize. Avoid deficiency, avoid hidden disease, and keep the body in as optimal shape as feasible. ...and hope a drug will come in time before the above is no longer enough.
Both ironic and sobering
Alex, really valuable piece, and the intellectual honesty about lifespan QALYs is refreshing in a field that badly needs it.
One pushback: I think the framing measures the wrong thing. The 122-year ceiling is the wrong scoreboard. Healthspan is. SELECT delivered a 20% MACE reduction, 73% reduction in incident diabetes, and 22% lower renal risk in 17,604 non-diabetic patients, that's a systemic healthspan effect across four organ systems, not a lifespan-ceiling effect, and it's already validated. The Lancet Commission's 2024 finding that 45% of dementia cases are potentially preventable through modifiable risk factors is in the same category. None of this moves Calment's 122. All of it moves the morbidity curve.
Your QALY-per-capita-global frame is the right tool for procurement and public health prioritization. It's the wrong tool for the individual question of "how do I stay functional at 80." Different denominators, different conclusions.
The field's real failure hasn't been overpromising lifespan, it's been letting itself be judged on lifespan in the first place.
Agree with the need to be humble about what currently exists, but also optimism about what is coming with one-time therapies, organ regeneration, etc. There's another point to be made, however, which is that we have the wrong concept about living longer.
We focus too much on # of years alive, because it's easy to measure, and not nearly enough on number of years without serious disease, i.e. healthspan. The common thread among superagers is years lived free of multiple chronic diseases. Thus, the most important metric to track progress in increasing lifespan broadly is the median age of multimorbidity onset (where multimorbidity is defined as 3+ chronic conditions). For this reason, I agree that GLP-1s (and successors) along with (hopefully) one-time therapies like PCSK9 inhibitors can have multi-systemic value.
It's also why, as I argue in my book Life for Health, we will only realize the potential of drugs like GLP-1s by building systems purpose built for the the multi-decade threat posed by chronic and age-related disease. It's crazy to solve decades-long disease threats using health insurance systems meant for short-term, acute and routine issues; and which are hard-wired to treat progressive threats progressively, rather than intervening as early and decisively as possible. Defeating chronic and age-related disease requires bigger investments, earlier to reverse disease (where it already exists) and ongoing efforts to maintain health and predict/prevent future risk. That's a much longer ROI than any health insurance scheme now allows, and it requires everyone to be aligned around long-term outcomes like getting people to Medicare age without chronic disease -- individuals, insurers, clinicians, and drugmakers. For these reasons, life insurance is a much better financial (and systemic) framework than health insurance, paying everyone (over time) the absence of disease as well as the decisive treatment of it.
I love this paper. I always had this feeling after so many years of reading books , articles, and etc on longevity . It is probably like the period of discovering DNA , and like 50/60 years, had to pass afterwards, in order to begin to get the benefits from this discovery. Surfing the Map from Moscow to Vladivostok is nothing like taking the trans-Siberian train , or traversing the Ural mountains on motorbike. We still have long way of translating ideas into reality. Lots of hipsters and hip and wakes .. but the road of longevity unfortunately becomes crowded with charlatans and impostors and false prophets .Thanks Alex for a great approach. modesty has always been and is nothing but a reflection of high intelligence .👍
A quiet revolution is unfolding at the intersection of AI and biology.
Drug discovery is no longer limited to laboratories, long timelines, and trial-heavy processes.
It is becoming computational.
AI is now being used to design molecules, analyze genetic data, and predict how drugs will behave. before they are ever tested in the real world.
This changes everything.
What once took years
can now begin in simulations.
What once relied on trial and error
is now guided by data and prediction.
And with the rise of generative AI and multimodal biology platforms, we are moving toward something even more powerful:
The ability to design biology itself.
But this shift comes with complexity.
Biology is not code.
It is layered, adaptive, and unpredictable.
Which means the future of medicine will not just depend on how fast we can innovate
But how accurately we can understand what we are building.
This is not just a technological advancement.
It is the beginning of a new system
where intelligence is applied not to machines alone,
but to life itself.
The seminal breakthroughs could appear at any moment, given the many angles being pursued by many gifted and funded pursuers. Get back to discovery activities, and let the journey be the destination until further notice. I'd gamble on a serious breakthrough within five years, but actually expect to die before it reaches me (currently age 73). I am just a soldier in humanity's greatest war. Why would I expect to fare better than a Russian recruit in WW2?
As a 62-year old man, I am not in the least surprised at the results although I would love for my cautious views to be challenged. As it is, I expect to need biostasis if I'm going to see much of the future.
I wonder what these eight AI models would say about your post on NLRP3...
I'm 67, and I'm extremely confident I know a lot more about anti-aging than the various simulated intelligence models. (they have no intelligence, they don't "think" and they are trained on the wrong data).
We humans keep looking for a magic pill, or amazingly like in this article actually consider a few of them. Reality is more complex. It's essential to factor in mental attitude, physical activity, overall diet and once you've got all of those "good" then you add on a few impressive pills (none of which were listed in this article).
I'm aiming for 120 in good health.
Why not sharing them here for everyone to see and comment?
Sure:
Omega 3s - DHA & EPA
Lithium (low dose like 1 mg per day)
Nicotinamide Riboside
Resveratrol (98% purity research grade)
Magnesium Threonate
Proteolytic (systemic) Enzymes
Curcumin
Iodine & Iodide
Ergothioneine
He Shou Wu (maybe?)
Vitamin C & Vitamin D & a top quality multi (to provide B vitamins and small amounts of many, many other things)
All combined with an active lifestyle, plenty of purified water (and some Gerolsteiner water), and healthy food.
Many nutrients won't be noticed unless you take a sufficient dosage (not that a small dosage isn't doing some good, but it might not be enough to observe) and good quality products (that does not mean expensive but if you are getting your vitamins from the local grocery or Costco well you probably are completely wasting your money).
Basics like Vitamin C and Vitamin D are extremely important long term but are usually taken in far too small of dosages.