As researchers work to make death optional, investors see a chance for huge returns. But has the human body already reached its limits?
Excerpt – Health became a competition, encouraged by the advent of watches that track your vital signs and biomarker-based “clocks” that measure your aging. Podcasters converted sad-sack men into biohackers, who juiced themselves with everything from Ayurvedic herbs to electromagnetic-frequency beds. (Most biohackers are men, for the same reason that most gambling addicts are men.) In 2013, there were fewer than a hundred longevity clinics around the globe; a decade later, there were more than three thousand. [..]
Thanks to such advances as antibiotics and better sanitation, our life spans have roughly doubled since 1900. Back then, the leading causes of death were pneumonia, tuberculosis, and diarrhea. Now we die of the maladies of old age—heart disease, cancer, strokes, Alzheimer’s. The downside is that we go lingeringly, in ways that we and our children regret. The average American dies at seventy-seven, after twelve years of bad health; if you are old enough to buy a senior-citizen ticket, you are likely to have a chronic disease, or perhaps two.
While the most zealous biohackers seek eternal life, many of the clinicians who oversee their care hope instead to increase their “health span”—the years lived without illness. Traditional life-style therapies, such as Dr. Dean Ornish’s popular approach (“Eat well, move more, stress less, love more”), increase health span. But attempts to target a specific aging dynamic with a specific molecule have mostly just increased scientific vexation. Dr. Jordan Shlain, who runs five longevity clinics, told me, “Everything you do to improve your health span can improve your life span. Everything you do to improve your life span is fucking bullshit.” [..]
In trying to live longer, we’re fighting our own imperfection: every time a cell divides, a few thousand mistakes can be introduced into its DNA. We’re also fighting the entropic forces—time, gravity, and oxygen—that ravage pretty much everything. The authors of a seminal paper in Cell distinguished twelve hallmarks of aging: such signs of impaired self-regulation as DNA instability, mitochondrial dysfunction, chronic inflammation, cellular senescence (when burned-out cells start oozing toxic sludge), and stem-cell exhaustion. Though the authors noted that all twelve hallmarks “are strongly related,” they could not establish whether the indicators were diverse expressions of one fundamental process or whether they evolved independently.
[..] interventions that arrest one hallmark of aging often accelerate others. Rapamycin is popular with biohackers because it inhibits the senescent cells that cause inflammation—a condition so associated with aging that it’s often called “inflammaging.” But having too few senescent cells is dangerous, because senescence helps block tumors. Almost nothing the body does is always bad or always good: we walk a narrow footbridge between atrophy (cells failing to replicate properly) and cancer (cells replicating all too well). Caloric restriction, a “natural” alternative to rapamycin, shares some of its benefits—but it can also shrink muscle mass, lower your libido, and suppress neuronal function. Plus, you’re hungry all the time.
The body seems to require a Goldilocks solution for pretty much everything. And yet, to realize significant gains in longevity, we’ll need to significantly disrupt our natural functions. “If it can’t kill you, it probably doesn’t work,” Matt Scholz, the C.E.O. of Oisín, a biotech startup that’s tackling age-related frailty, told me. “That’s maybe not the best way to put it, but you’re perturbing a complex system, so you need to be really doing something.”
[..] can patients be restored enough to do youthful things? Function is somewhat theoretical in middle age, when almost everyone can get out of a chair and walk across a room, but after that it becomes starkly tangible. In a study of men aged eighty-five and older, only a quarter of the slowest walkers survived five years, while nearly all the fastest walkers did. Among the elderly, having difficulty bathing is as grimly determinative of mortality as having heart failure.
For the XPrize, the protocol will be a single-year trial of healthy people aged fifty to eighty, to determine whether a therapy can improve their functional benchmarks by twenty years or more. The tests for strength currently include VO2 max, lower-body power, and muscle mass; those for cognition include appraisals of executive function, processing speed, and memory. The tests for immune function, which is harder to measure, will likely involve a blood-based biomarker. [..]
Biohackers hear lots of conflicting advice about where to focus their energies. Luigi Ferrucci, the scientific director of the National Institute on Aging, suggests that the key is the mitochondria, the battery of the cell. Tony Wyss-Coray, a leading neuroscientist, says that “the brain is the biggest predictor of mortality.” Dr. Peter Attia, who wrote the midlife-health primer “Outlive,” believes that strong muscles are vital: they prevent falls, keep the body from accumulating fat, and even protect against dementia. Tenzin Wangyal Rinpoche, a teacher of Tibetan Buddhism, suggests a different course of action: “Not paying for a gym membership, not struggling to eat the right things, not trying to love someone who I have a difficult relationship with!” There is only one necessity, he says. “I have to get eight hours of sleep!”
Scientists often overlook an organ that has an outsized influence on half of the population: the ovaries. Chiefly owing to the ovaries, which age about 2.5 times faster than women’s other organs, men and women decline so differently that they might almost be separate species. Men die more of heart attacks, women of Alzheimer’s. Women live seven years longer, as a global average, and their immune systems endure better—but they spend a much greater proportion of their lives in poor health. Women benefit more from exercise, because they burn lipids, a more efficient energy source than the carbs that men burn. Yet intermittent fasting can upset the menstrual cycle, and women lose muscle mass from caloric restriction more rapidly than men. So no therapy will work equally well, or even in the same manner, for both sexes. (Because so few scientists are focussed on female longevity, XPrize is trying to establish a prize for ovarian health.)
The encompassing issue is that we’re all fighting natural selection, whose sole criterion is the genes we pass on. The theory of disposable soma holds that, once we’ve reproduced, our body—our soma—is no longer useful. A corollary, with the ungainly name of antagonistic pleiotropy, holds that many of the factors that help us to produce and raise children later curtail our lives. “Cholesterol builds your brain and your gonads when you’re young—and it clogs your brain and your heart when you’re old,” Nir Barzilai, a leading geroscientist, told me. “IGF-1 growth hormone is helpful if you’re younger than fifty, because it promotes muscle growth. That same high level, in an older person, kills you. Metformin”—a diabetes drug biohackers take because some studies show that it decreases mortality—“reduces IGF-1, reduces the testosterone we need to build muscle. So, if you’re under fifty and you’re taking it, that’s an idiotic decision.”
[..] According to Dr. Michael Roizen of the Cleveland Clinic, you can make a thirty-two-year difference in your life span by implementing the no-brainer stuff (sleep, diet, exercise, etc.), but you can gain only four years by taking supplements.
[..] Numerous papers have concluded that genes determine only seven to thirty per cent of longevity, while behavioral choices play a much larger role. Your health, in this view, is not just an opportunity but a responsibility. If you get cancer and die young, it’s your fault for not perfecting your stack. One can imagine a future in which, if you didn’t take every conceivable step to optimize your health, you’d face not only disapproval from your A.I. doctor but denial of claims from your A.I. insurance company. [..]
Nearly every longevity advocate believes at least two things that can’t yet be proved: we will soon discover the secret to eternal life, and we will be better off once we do. [Leader of the Don’t Die movement] Bryan Johnson, like many others, maintains that A.I. is on the verge of unlocking the medical obstacles to immortality. But, he acknowledged, “I don’t think that anyone knows” exactly how it will do so. Faith without proof is a religious outlook, and Johnson announced earlier this year that a religion is what his Don’t Die movement would become. “The words ‘community,’ ‘ethical framework,’ ‘philosophy’—humans won’t devote their whole identity to them,” he told me. “Religion, for better or worse, is a framework that has motivated people to do phenomenal things.”
[Longevity entrepreneur Peter] Diamandis bridles at this idea, worrying that framing the quest as a religion will “discredit longevity in people’s minds.” Yet he knows that his own prognostications are impervious to fact checking. “Some people tell me, ‘Well, you’ve created a religion around abundance,’ ” he said. “And there are elements of faith in that mind-set.”
Full article, T Friend, The New Yorker, 2025.8.4