Future of Longevity
Fuelled by research, technology and patients newfound desire to lean in, longevity startups are challenging how we approach living long and living well.
The quest for eternal life is as old as it is juicy. It has mystified humans all across the globe, at all different junctures. Often, with some pretty dire consequences.
Gilgamesh and Qin Shi Huang, the first emperor of China, were both spellbound by the pursuit. Gilgamesh’s gruelling quest for eternal life ended in tears, and little to show for it. While Qin Shi Huang upped his family's obsession with immortality by putting out an executive order to search for a potion that would give him eternal life. Despite this, and his many other wishful, weird and wacky attempts to live forever, he died relatively young compared to his ancestors.
Flash forward to 2023 and the quest for eternal life is hotting up. Billionaires have been particularly forthcoming at throwing their weight (and dollars) behind the pursuit of long, glorious life. As is often the case, the tech bros are fast followers to billionaires, in a way that is ingratiating, self aggrandising and frankly, off putting.
There’s a bit of collective cringe that comes from watching the tech community follow the optimising obsession that rich people set in motion. Especially when it reads like a satire. Take the Rejuvenation Olympics; a public leaderboard where you share longevity hacks, boast about your biological age and win by ‘never crossing the finish line’. Your biological age (not your chronological age) is what age you are according to your organ health, epigenetic gene expression, immune health and more. To compete, participants must submit their biological age, via a test kit made by TruDiagnostic.
Though a seemingly harmless initiative with a Monty Python twist, this sort of shameless longevity flexing puts a large chunk of the population off optimising their health in simple, meaningful ways. And ultimately, for longevity to become a truly venture backable industry, it must move beyond billionaires and their early adopter fan clubs. But as with most industries, we need the outliers to drive innovation that can trickle into the mainstream. And we need it now as health is going backwards and chronic illness is spreading. In America, the number of 50+ year olds with at least one chronic disease is estimated to almost double from 72 million to 143 million by 2050.
Billionaires eyeing eternal youth
The focus on longevity comes at a poignant time in the venture ecosystem. To date, the majority of unicorns have focused on relatively surface trimmings (we’re looking at you Facebook) while human and planetary health deteriorate. Perhaps part of the interest in longevity comes from a growing fatigue at such triflings and a desire to point our collective intelligence and efforts towards something more meaningful. A less generous take would highlight the dizzying levels of hubris behind the desire to live forever, as well as the irresistible challenge of cracking a nigh impossible nut. Cringe factor aside, we believe helping people expand their health span and feel good for longer is a problem worth working on; and makes a nice change from the spade of startups setting out to optimise eyeballs. It’s also fertile ground to be frollicking in. The longevity industry is projected to be worth $44.2 billion by 2030, up from $25.1 billion in 2020. And by 2050, 1 in 3 people will be 50+ (up from 1 in 4 today). This rapid growth will have a significant impact on everything from job creation to healthcare to goods and services. Longevity might be a meme paradise right now, but we believe there is an opportunity to build something large and generational, with the right idea, team and timing.
Before we go on, let’s put some parameters around a very expansive topic. There’s lots of intersection between healthcare, longevity, anti-ageing and broader societal wellness. For our article, we’re primarily talking about longevity, but will dip into the other segments where appropriate. Additionally, while many startups are focusing on longevity for both people and the planet, we will be focusing our efforts on human longevity.
Historically, anything that brushes ‘healthcare’ feels like a poisoned chalice. There’s been $100 billion deployed into digital health since 2010 and little to show for it. Investors are wary and carry noticeable scar tissue after getting an unwelcome taste of just how complex the industry is. In America, there is a convoluted multi-payer system, an entrenched medical establishment and layered incentive structures that complicate behaviour change. While in Australia, it's unclear who will pay for new approaches to health and longevity.
In the past, the medical establishment has received tech and VC involvement in their space with an overt eye roll. This is partly because of the pie-eyed optimism new entrants bring around how simple it will be to change the system; as well as an overly inflated view on the skillsets they have. For example, a tech outsider sees the opportunity to screen, prevent and digitise; not recognising it's the execution (not the insight) that’s the hard part. Optimism gets slandered as ignorance and progress grinds to a halt. Previous patterns aside, it’s clear that the answer to longevity does not lie in the tech community coming in all guns blazing; rather a collaborative approach that embraces a knowledge base that runs deep.
What changes are afoot?
Longevity Participation
As frustration with our clogged medical system grows, more people are taking their health into their own hands. This is fuelled by increasing access to information, as well as scientific influencers, like Andrew Huberman and Peter Attia, who talk openly and precisely about ways to improve both health and longevity. As well as the spade of billionaires sharing their personal longevity hacks in the public arena. Because of this, taking care of yourself and the pursuit of long life has become a supreme flex; it requires intelligence and resources and accordingly has become a source of dinner party fodder for the elite and aspirational. The final thrust behind this trend is the increasing ability to attain hyper personalised and tailored treatments. Once you have a program designed to your needs, with precision, adherence and positive outcomes increase.
Preventative Care is Hot- An ageing population is driving our healthcare system towards a crisis point. A shift to preventative care gives us the ability to foresee and predict illnesses before they strike. There’s a large role for diagnostics here, which can act as a crystal ball to our future selves to help us get ahead of problems before they happen. It’s very hard to contemplate ageing and decay; and any tools that can make this real for us create the impetus to act while we can. Not only is this a more effective approach; it’s proven to be more economical across many chronic diseases. Slowly but surely, insurance providers, as well as the government, are coming to the preventative party. The trend will continue to grow as hardware costs come down and more people take charge of their own wellbeing, eschewing a traditional doctor-led approach to health; something we should welcome as our current systems buckle under pressure. That said, our health care system is not currently set up to manage preventative care; which makes the space particularly ripe for vertically integrated startups ready to take a meaningful bite out of the preventative pie.
Or Not?
It’s worth noting that not everyone is hot on diagnostics. In fact, some of the loudest opponents are radiologists themselves - even though they stand to gain the most from a culture obsessed with scans.The first reason is false positives (or negatives) as they only measure you at a moment in time. Further, diagnostics reduce human health to binary ‘good’ and ‘bad’ when in reality there’s lots of grey area that only years of practice can pick up on. And most importantly, when you rely on a diagnostic, you miss the broader clues and signs that make up a person’s health. Of course, you can retest; but then the cost and stress threshold gets called into question. Often there’s months in between repeat scans - which is plenty of time to crumble into a pit of despair. Even waiting for results of scans can be nerve wracking and induce 'scanxiety'. Then of course there is radiation exposure to contend with, and some cancers (like pancreatic and oesophagus) are hard to pick up on a scan at all.
The medical establishment is quick to label private diagnostic companies ‘fishing trips’ where they go hunting for problems and question the real improvement to life these tools bring. They’re also quick to point out that some problems are bad to catch early on as they should not be treated - leaving you with a stressed patient who lives with the uncomfortable knowledge that they are degenerating. Even diagnostics, which seem like a no brainer, are contentious. If you find something, your health insurance goes up and once you’re in the system, a battery of further tests are often required and before you know it, things snowball into what’s called a ‘cascade of care’. It’s a lot of money, time and energy. And when the tab is picked up by the taxpayer, that’s a problem for all of us.
From Hacks to Habit
Right now there are a lot of silver bullets that promise quick fixes to prevent ageing. Unsurprisingly, this naive approach is as short-sighted as it is futile. What’s more likely to have lasting results is when an individual experiments, trials and tests to identify what works for them and then incorporates that into their routine. Easier said than done. Behaviour change is no joke. Especially when results are hard to see. We’ve seen the same dynamic shift in performance marketing (what started as an obsession with growth hacks is now falling in line with a more holistic understanding of marketing fundamentals) and even skincare ageing (we’re less interested in miracle creams and more aware of total wellness from hydration to sleep to exercise). While people may have more data at their fingertips, thanks to wearables and the quantified self movement, we also know that over reliance on these doesn’t unlock health. It’s important to know what’s going on, big picture, but then get on with a life well lived instead of agonising over minute variances in your personal health dashboard. Already the Apple watch has introduced a ‘journal’ app that allows millions to track their health, sleep and breathwork and observe their impact in real time.
Health Span > Life Span
As we move towards preventative care, we’re also making a collective shift towards measuring the quality of years lived, not just increasing the number. That means years living without chronic or debilitating disease and decline. After all, there’s not much point living longer if we’re not living well. In 2021, it was determined that the last 9 years of someone’s life was spent in a state of deterioration. The goal is to reduce this number; and tracking healthspan is the first step towards progress. In theory, a focus on preventative care can improve health span; which in turn improves life span. In the EU, this metric is established and tracked by the European Commission.
Beyond Biohacking
In light of the above, longevity is often misunderstood to be the extreme wellness and biohacking obsessions of the elite. Things like intense food restrictions, hyper personalised exercise routines, draconian sleep regimes and a never-ending cocktail of supplements are a surface-level approach to longevity. Where things get really interesting, and where the category is evolving, goes far beyond. We’re seeing impact at cellular health and DNA level, including things like biological reprogramming, reconstituting human blood and gene therapy.
Cellular level - as we get older a variety of issues with cells appear. They either stop or are slow to divide, struggle to repair themselves by cleaning out any damaged parts, or are forced to carry on functioning with deteriorated mitochondria (the powerhouse of the cell). Many biotech startups are addressing the issue of ageing from this microscopic level; and addressing the various calamities that can happen to cells one by one.
Gene level - One of the key reasons we age is the protective caps at the end of our chromosomes, called telomeres and how they shorten over time. When they fully disintegrate, our DNA becomes damaged. A field of Telomere Therapeutics has emerged to focus on stopping that shortening and treating age-related disease.
Red Tape Rebellion
Right now, in America, a drug cannot get regulatory approval for longevity or slowing the ageing process; it has to directly take on a known disease associated with ageing - like dementia or Parkinson's. Accordingly, a lot of companies are approaching drug development and subsequent marketing efforts around specific indications. There is hot debate about the ethics of this. Many feel that drugs that improve overall quality of life, while helping prevent the onset of decay, should be allowed to exist in a class of their own. Unsurprisingly, some companies choose to get political and are pushing to get this classification overturned, while others focus their efforts on creative ways around.
Who will win in this opportunity space?
Addressing Elitism
Even before we layer in the costs to access new longevity solves, rich people already live longer. In fact, men in poor parts of England are predicted to live almost a decade less than those who live in the wealthy areas. Startups that win will be able to find ways to scale beyond an elite few; and lead a conversation about the equity of ageing.
DeSci
Decentralised Science builds on citizen science and open science to change how science is developed and value is shared. Simplistically, there are separate ‘channels’ dedicated to different aspects of scientific development; from research, to peer review and to drug development. Many of these DAOs have a ‘build in public’ mantra which is a fundamental break from the traditional biotech model. Winning startups will find ways to develop a new ownership and distribution structure, while accelerating the discovery and adoption of scientific gains.
Trusted Medical Concierge
With newness comes both trepidation and excitement. While there will always be early adopters (especially when there are bragging rights involved) companies that can invite people into the longevity space in a warm, personal way will see success. Though we may be recognising AI can deliver better outcomes than humans in many instances in the medical field; the reassurance of a real, live human goes a long way when chartering new and delicate ground.
The Intersection of Software and Science
To help hasten the adoption of discoveries, and make them more accessible, startups that win will look more like software companies than biotech companies. This is really about taking a lot of the massive inroads made in labs and using software to shorten the pathway to real impact. Things so familiar to the tech world, like workflow optimisation, big data, AI modelling and mass sharing and learning are now becoming embedded in next generation longevity startups. Software’s playbook can accelerate adoption and outcomes of the most promising discoveries on the planet.
A Healthy Ecosystem
Our health is an accumulation of all we do; what we eat, how we sleep, how stressed we are, the connection we feel and how we move our bodies. Startups that recognise where they fit in a person’s life and take into account the mental, physical, social and spiritual components that they operate within, will find greater success. In fact, it is estimated that only 20% of the modifiable contributors to an individual’s health are related to medical care - with non-clinical factors (like diet, exercise, mental health, social connection, sense of purpose) driving the rest. The Okinawa Centenarian Study, which investigates 100 year olds, backs this up. They found that physical exercise, a healthy diet, a sense of belonging and rituals, a supportive network and sense of purpose all contribute meaningfully to long life. Things like Tovertafel, a game-inspired therapy that allows those in care to interact and play together is proven to reduce sadness and increase social connection in adults living with dementia.
It’s A Group Effort
The answer to better, longer life cannot lie with one startup, it’s about all of us collectively reimagining what living longer could look like. Longevity startups are just one part of this pie. It’s about how we design our cities, rejig employment practices, rework transport solutions, tailor consumer products and create new offers around things like finance and insurance; all wrapped in a narrative that encourages us to reimagine what it is to age and what contributions older people can have to our society. This will require both deep collaboration and bold imagination.
“Maximizing healthspan is a 'Moonshot' of our age. Like the 1960s Apollo expedition, we need major, coordinated, mission-driven efforts from government and the private sector. But in return, expect profound economic and societal benefits. Our population's health and wellbeing is one of our most important, but undervalued, strategic assets” says recent Melbourne arrival, Stephen Johnston, who founded and sold global startup community Ageing2.0 and now works on healthy longevity for SOMPO Digital Lab.
Who is Currently Making Waves?
There are some players who are taking an existing service/treatment and making it more accessible, while others are on the cutting edge of longevity. Here is a selection of businesses that are creating heat and moving the category forward.
Tomorrow Biostasis - this cryopreservation startup is pioneering an advanced medical procedure that puts someone into a ‘biological pause’ after their legal death. This works on the premise that there will be future technologies that can revive us. This Berlin startup offers its freezing and storage services in Switzerland.
Loyal - This biotech is taking the concept of long life to our four legged friends. While critics say this enters the longevity conversation from a place of privilege, advocates argue that it’s faster and cheaper to get things right on animals. This could actually be of greater benefit to humans as discoveries can be bridged across species quickly. Currently, Loyal have two drugs in development. The first targets cellular mechanism and glucose metabolism in large and giant-breed dogs, who have considerably shorter lifespans than smaller doggos (something you rarely see within species). The second drug targets metabolic fitness in dogs of any breed and size, in order to replicate the same effect on lifespan that calorie restriction does in mice. Through our investment in Lyka, who improve a dog’s lifespan through nutrition, we have seen the huge appeal of doggo longevity.
Spring Discovery - this biotech-meets-software company raised $22 million and have built a powerful tool called MegaMap. Designed to ‘give scientists superpowers’, it allows them to see how cells behave across multiple conditions; overlaid with the impact of drugs and compounds already in market. Powered by machine learning, this tool allows scientists to see patterns and get to answers fast.
Epiterna: This startup is focusing on accessible ways to improve lifespan; by focusing on chemical compounds already approved for us in humans, dogs and cats. Innovating around small molecule drugs was a deliberate choice to ensure their products become available to all people, not just billionaires.
Everlab - is a privatised primary care system to take health from reactive to preventative. The Everlab protocol is an annual membership offering diagnostics and personalised interventions based on patient history, risks, and goals. It helps people take control of their health, understand personal risk factors, detect disease early and find ways to improve quality of life and performance.
Gene and Cell Corrections — at the gene level, Telomere Therapeutics is developing a telomerase gene therapy that counteracts telomere shortening and can treat age-related diseases. While at the cellular level, Cellvie is developing technology that will allow therapeutic mitochondria transplantation. This technology introduces functional mitochondria into organs with failing mitochondria, with the goal of increasing the survival of tissues from injury and may reinvigorate ageing tissues in general.
VitaDao - this DAO, with a focus on longevity research, recently closed a $4.1 million round of funding; with participation from bigwigs like Pfizer. The community chooses what to research and incubate, with the view to commercialising the IP discovered. Even the capital raise needed community approval before coming into effect.
Adam Erectile Tracker - though it’s likely making waves because it sounds preposterous, this wearable ring tracks nightly erections as a precursor to overall health. The science goes something like this... Each night, a man should have about 3-5 erection episodes - lasting around 1.503 hours. If they don't, it means reduced tissue oxygenation and increased penile fibrosis. This can lead to erectile dysfunction and are also linked to cardiovascular disease, diabetes and hormone issues.
Regeneration & Regrowth Startups: LyGenesis uses cell therapy to regrow organs and eGenesis creates cells capable of turning into organs. Both startups aim to help the 20 people that die each day from waiting for an organ transplant; in the US alone. Similarly, Cellbricks developed a 3D printer for artificially made organs and human tissue and sees a future where biofabrication is a common medical practice. Finally, BioSplice uses splicing techniques to assist tissue-level regeneration to treat cancer, osteoarthritis, and other diseases.
Saint Haven: This private wellness club in Melbourne is dedicated to holistic health, longevity and reverse-ageing. Property magnate Tim Gurner built Saint Haven with the goal of combining discoveries from his personal health journey and global travels. The club has a suite of services available to members, like hyperbaric chambers, hot and cold thermal pools, vitamin-C showers, a meditation cave, IV drips, cryotherapy, breathwork, nutrition, anti-ageing and strengthening training. Members are encouraged to wear an Oura ring so their health can be monitored, and have access to a personal wellness coach to keep them on track. The price tag means the proposition appeals to the elite, bound by a mindset of wanting to live their best life and optimise their wellbeing.
10 years from now
Fortunately, we see a broader definition of health taking centre stage; with startups that look across the pillars of ageing cropping up to tackle things like loneliness, finding meaningful work and living with a sense of purpose. This will mean more collaboration between industries; and more unlikely partnerships that bridge seemingly disparate worlds. Critically, we will see ‘old people’ more intertwined in society. This will manifest as senior citizens staying employed for longer, better integrated aged-care facilities and mobility solutions that keep seniors capable for longer.
At the same time, we will start to see a move towards personalised medicine. For the wealthy, this will be the only form of medicine. This new gold standard will combine diagnostics with a health coach to keep you on track, while also integrating with real world decision points and incentives. Imagine getting health nudges at the supermarket, or tokens for walking to work, or smart devices that monitor you early, often and discreetly, apps that keep you mentally fit and prevent cognitive decline, rewards for following a health plan and perks for keeping your social connections tight. On top of this, we will have broadly reached consensus on the goldilocks level of knowledge needed to optimise our health; and capture data to enable us to find simple ways to boost our longevity. This will move longevity from a single-minded pursuit to a way of life available to more people. Once studies can back up smaller longevity hacks, critical players like insurers and governments will get involved and help make them more accessible.
We won't have made a huge inroad on eternal life, but we’ll be living better quality lives for longer. And the early adopters and wealthy who were able to benefit from personalised medicine will be nudging our public health system and insurers to adopt many of its principles.
50 years from now
Technology has already doubled life expectancy over the last 150 years. And as we get closer to curing chronic illness and stopping or improving the reproduction of cells (the two greatest contributors to death), it feels safe to assume we will remain on a positive trajectory. That plus the fact that there are already some organisms out there, like turtles, that can theoretically live forever - assuming they can steer clear of predators!
To get this right, the two things that must hold true are that we’ve a) found a way to make these discoveries available to everyone and b) found a way to think long-term, holistically and collaboratively across many industries, from our employment, to our family structures, to our education systems and of course our environment.
If we really manage to live for a lot longer, then we’ve got a lot of head scratchers to resolve. Most critically, what does life in a post ageing world look like?
It’s easy to see a real risk of economic and planetary disaster. On the economy side, we’re already seeing traces of disaster in Japan: a shrinking labour force, more strain on social services, less taxes and a need for even more resources. While on the planetary side, we’re not able to support infinite life. How will we actually be able to survive, in a sustainable way?
We will also see the divide between rich and poor become untenable, with ageing deserts and longevity oases existing in equal measure. As these divides exacerbate, eventually a boiling point will emerge. If we take this to its most extreme, we might see a world portrayed in sci-fi like Altered Carbon, where the rich can transport their brain from healthy body to healthy body, thereby living forever.
Then of course, there are political consequences. The implications of an ageing population on democracies are well studied; some even posing the thought experiment of placing an age cap on voting eligibility. After all, shouldn't the youth get the most say over the planet and society they live in? What happens to democracy if we’re all living to 100?
If death becomes rare, will we all become terrified of dying? How does that change our appetite for risk and danger?
What does a life look like if we are thinking in millennia, not minutes? How does that change how we think about spending our time, approaching study, committing to a career, consuming resources, finding meaning, entering relationships and creating family units?
Nice read. David Sinclair and David Asprey, amongst others like Bob Harari are huge contributors to the longevity scene