Author: Vaishnavi Moturi

In November of 2023, Celine Halioa’s startup, Loyal, secured the first FDA approval for a groundbreaking drug that aims to extend lifespan. It attempts to do so in dogs initially, owing to the difficulty of testing longevity drugs in humans who have a longer lifespan than dogs. Pending successful clinical trials, Loyal aspires to transition into humans - a milestone that encapsulates the ultimate goal of the startup. This prospect of extending lifespan seems to be borne out of science fiction - and rightfully so considering the novelty of the field at large coupled with big pharma’s overwhelming focus on tackling concrete diseases instead, such as Alzheimer’s and Parkinson's’. Yet, this science fiction may come to define our society, if longevity becomes a central focus instead of healthspan (the number of healthy living years as opposed to the definitive number of years a human lives).

Loyal’s program, termed LOY-001 addresses the unfortunate reality that larger dog breeds, on average, live shorter lifespans than smaller breeds. Through meticulous research, Loyal uncovered a compelling connection: elevated levels of IGF-1, a hormone that fuels cell growth. LOY-001 takes the form of an injectable treatment, and if successful, could serve as a promising harbinger, heralding a new era of anti-aging drugs. Like Loyal, the global zeitgeist - at least within Silicon Valley - lately appears to mirror a fascination with the elusive concept of immortality - or at least, some close version of it. We term it longevity - broadly defined as having a longer than normal lifespan. This term has become synonymous with the buzz and bustle of Silicon Valley - full of promise, unbridled optimism, and sometimes questionable strategies for achieving this undefined age.

Beyond enriching the already wealthy, critics also argue that an excessive focus on longevity will only serve to exacerbate existing healthcare inequalities because channeling resources into longevity effectively diverts money away from addressing preventable conditions and essential preventive measures, such as early diagnosis for diseases like cancer (many cancers today, for instance, have very high survival rates only if diagnosed early).

Nevertheless, collective hype for longevity startups persists unabated. However, it is critical to acknowledge that the path for biotech companies is far from smooth, marked by the unpredictable terrain of securing consistent funding from Silicon Valley - a landscape where taking the collective hype for granted would effectively destroy these startups.

These longevity biotech startups are increasingly consciously forcing themselves to steer away from the often unjust preconceived stereotypes imposed by Eroom’s law - a word that flips Moore’s law on its head and instead of describing the fast-paced landscape of cheaper and more advanced technology, portrays Biotech as increasingly sedate characterized by lackluster drug discovery rates. By doing so, they ultimately hope to transform the perception of biotech companies as laborious, risky, and time-consuming into more fast-paced “cool” Silicon-valley-esque tech startups in the hopes that this will not only attract more investors but also further increase collective hype in this arena - just as the “dropout student working in a garage to the establishment of a million dollars business” cliche has persisted.

Our world itself has become sicker - this much is undeniable - not as a consequence of declining healthcare, but as a consequence of our aggregate decline in quality of lifestyle coupled with our increasingly aging population (as deaths from preventable diseases such as Chickenpox and Hepatitis decline). From fitness to diet, an unfortunate side effect of the capitalistic economy is the embellishment of fast food through pervasive advertising and the promotion of cheap, nutritionally deficient options. Sickness has become entrenched in human society, as medicines and escalating costs of healthcare take center stage. Given the apparent decline in our society's well-being, doesn’t it make sense for our world to focus on creating longer, healthier lives? While striving for this noble goal, an important question arises: should we be allocating billions of dollars to potentially dubious startups, or would it be more pragmatic to channel these efforts into transforming the collective mindset of our country? Inspiring change at the individual level to enhance our lifestyles seems both a more cost-effective and achievable approach, at least at first glance.

While affecting change at the individual level is an appealing goal, critics argue that it oversimplifies the complex web of factors that influence our well-being - many of which are out of our control owing to factors such as genetics and even our environment. Thus, focusing on aging as a disease, which is ultimately what all the disparate longevity startups have in common, might serve as a positive paradigm shift, fostering innovative solutions to what we now see as an intractable problem.

“Aging” as a disease, refers to tackling aging as a homogenous issue rather than addressing specific age-related diseases separately, as they are commonly addressed today (age-related diseases include but are not limited to Alzheimer’s and Cardiovascular disease). To achieve such an idealistic goal, startups turn their attention to the molecular dysfunction common across all age-related diseases: specifically, telomere shortening, cellular senescence, and mitochondrial dysfunction. Such cellular processes refer to the shortening of chromosomes that house our genes, immortal cells that accumulate and form plaques, and dysfunction of our cells' energy-producing organelle, respectively. While such dysfunctions are indeed common across age-related diseases, many argue that holding such a holistic approach risks oversimplifying the innumerable nuances that each disease poses. For instance, Alzheimer’s disease and Cardiovascular disease have distinct clinical manifestations that cannot be explained solely by those cellular abnormalities. Further criticism involves the distinct aging patterns amongst individuals, and attributing aging as solely a function of shared molecular mechanisms direly overlooks the genetic, lifestyle, and environmental factors that contribute to the populations’ diverse aging trajectories. An additional shortcoming involves the actual molecular processes themselves - which are often viewed as a reductionist approach that fails to consider how aging is impacted by a myriad of factors and focusing on just one or even a few molecular processes risks neglecting other critical inflection points of aging.

Numerous critics, therefore, continue to emphasize the importance of considering the complexity inherent in the aging process and caution against overly simplistic frameworks that inadvertently sideline the specificities of individual age-related diseases and the unique experiences of aging individuals.

Beyond the scientific durability of longevity startups, however, ethical considerations inevitably arise when considering a novel biotech idea (as they did when gene editing and brain-computer interfaces emerged). While the ethical considerations of gene editing and brain-computer interfaces were and are primarily grounded in morality, the ethics surrounding longevity startups primarily involve the risk of compounding healthcare inequalities due to the probable exorbitant pricing of such novel drugs. Pricing for new drugs in general, is often inaccessible to the general public - for instance, the median yearly price for new drugs approved by the FDA was around 200,000 dollars - considerably impractical for most patients. Will these longevity companies, striving to distance themselves from Eroom's law, also break away from the trend of imposing socially unacceptable, unreasonably exorbitant drug prices?

Longevity is undeniably a field charged with enormous potential, and if society treads cautiously, this field may well come to define a new era in which aging is preventable and living long healthier lives becomes a more achievable goal for every human being. Such a lofty goal remains merely allure to many, yet with continued collective optimism and innovating ideas, perhaps it is a near reality.