Life Extension Should Come with Wisdom: Reflections and Questions for the Geroscience and Longevity Community

Introduction

Longevity biotechnology, or geroscience, is undergoing a resurgence. The idea that aging is not inevitable, but a process with biological causes into which molecular tools can intervene, is becoming widely recognized. Still, for its advocates, the field has a long way to go to achieve the support and recognition it deserves, mainly in terms of increased funding for research and a more suitable regulatory landscape. Enthusiasm for the field in recent years has been accompanied by the publication of several books that have become best sellers, ^{1 –4} millions invested in start-ups (e.g., Altos Lab with an investment of $3 billion ¹ ), and over a hundred start-ups founded to tackle aging. ² In parallel, meetings and conferences centered around the possibilities of longevity hare taking place. Although the RADD (Revolution Against Disease and Death) Fest and Aubrey de Gray’s biannual conference in Cambridge, UK, were among the first to seriously consider the possibility of defeating aging, nowadays longevity advocates find it difficult to attend all the conferences held yearly. Currently, scientific conferences compete for the time of renowned researchers and advocates of the field with retreats, festivals, and gatherings exclusive to investors. These events often include in their programs discussions about policy and regulatory change, based on the premise that current regulatory frameworks do not accommodate longevity interventions and lack incentives for the development of “gerotherapeutics.” Largely absent from these conversations have been discussions about ethical and the social implications of longevity biotechnology, that is, whether it is morally permissible to alter the nature of the human, and the repercussions of such changes in terms of how societies are structured. However, for longevity to be widely adopted and embraced by the public, it is crucial to have open conversations at an early stage about the movement’s purposes and goals and its alignment with public needs. The vision of defying aging, time, and death carries with it a number of social, ethical, and legal implications, which deserve consideration as research in the field continues to advance rapidly. ⁵ In this article, I lay out three considerations for the longevity community to engage with ethics and science–society relations.

Questions about how to live a good life have been at the heart of ethics, ⁶ and discussions about the desirability and possibility of living forever have long remained the domain of philosophers and ethicists, often with authors taking strong sides against and in favor. ⁷ As expected, longevity scientists and advocates share the belief that aging is a problem that needs to be solved with better biomedicine; ³ arguably, the vision that aging can be slowed or stopped has been the steppingstone for the emergence of geroscience. Nevertheless, such a belief can result in a tunnel vision that isolates longevity actors from understanding public attitudes and societal views on the project of longevity. If the field aims to be taken seriously and become a “cause” that moves voters and results in policy change, it is important to incorporate public values into research, along with taking actions to build public trust. ⁸

To be clear, it is understandable that scientific conferences and advocacy meetings about longevity biotechnology presuppose the positive outcomes of geroscience. This is the case for many other scientific fields that have had the potential to be seen as controversial or transgressive, such as genome editing, synthetic biology, and regenerative medicine, or even geoengineering, or artificial intelligence (AI), more broadly. A case in point is offered by genome editing, which bears similarities with geroscience, as both share the potential to redefine the human future: both are projects of optimizing the human, led by scientists and actors who decide the human future by developing the tools to change our biology.

Even though genome editing has been identified to pose ethical dilemmas, such as risks for future offspring, furthering societal divides, enabling human enhancement, and raising stigma against disability, ⁹ finding appropriate spaces for deliberation about its ends and purposes has proven difficult. Dedicated fora such as the International Summits on Genome Editing, held in 2015, 2018, and 2023, started as a response from the scientific community before the possibility that CRISPR/Cas9 technology could be applied to humans. Anticipation did not last long, since in 2018 scientist He Jiankui reported the birth of the first genome-edited humans in China, an event that met with widespread condemnation from the scientific community. ¹⁰ Nonetheless, given the high moral stakes of genome editing, the International Summits on Genome Editing have fallen short of questioning whether it is a good idea to edit humans in the first place. In the Third International Summit on Genome Editing held in 2023, only one 45-minute panel was dedicated to science-society relations, titled “Roles and challenges in public engagement,” in comparison to a plethora of sessions dedicated to the scientific state of the art during the 3-day summit. ⁴

The case of genome editing is relevant for longevity biotech, since it illustrates the difficulties and challenges of raising questions in scientific meetings. Given the excitement about longevity biotechnology and the rapid pace of advancement, it is understandable that scientific meetings focus on the “science” of longevity more than its social implications. In many cases, social dimensions are referred to in positive terms, such as the great economic opportunities to be derived from a population that may live healthier for longer, and thus would require less healthcare coverage, and can be productive for longer. But this perspective assumes the potential gains of longevity, introducing bias into what are the parameters acceptable for discussion.

Longevity-oriented conferences or gatherings in recent years ⁵ that have allocated sessions for discussing social and policy issues often aim to make the case for the importance of longevity, address regulatory and legal barriers, or display advocacy efforts to promote the field. For example, Andrew Steele spoke at the Longevity Summit Dublin on the economic benefits of advances in health span; last year, Michael Ringel spoke about the economics of longevity at the Aging Research & Drug Discovery Meeting. In fact, the Longevity Summit Dublin has provided a good balance of scientific talks with talks focusing on regulatory and legal issues, as well as science communication. In some cases, discussions about ethics have been led by antideath advocates, such as Patrick Linden (author of “The Case Against Death”) at the Longevity States conference organized by Vitalia in May 2024. ⁶ Policy advocates such as Dylan Livingston from the Alliance for Longevity Initiatives or Janet Marchibroda from the Bipartisan Policy Center have spoken about their experiences advocating on Capital Hill. Noteworthy, Andrew Steele has spoken about how to communicate longevity science to the public and convince potential supporters.

In what follows, I highlight three areas of concern for the longevity community (Table 1), in their efforts to capture the public imagination and earn public support in pursuit of their goal to achieve the Vulcan salute, “live long and prosper.” This article is based on the author’s participation in longevity conferences and advocacy meetings (in person and online), interviews with longevity actors (e.g., scientists, advocates), and analysis of gray literature, news articles, scientific literature, podcasts, and social media.

Open up Deliberation About the Ends and Purposes of Geroscience

The first recommendation is to broaden the range of debate to lay citizens, without assuming that extending lifespan is a priority for most people, or that they consider it ethically permissible. Earlier commentators have called for the importance of asking the public if they are on board with defying the natural limits of aging as, if successful, repercussions would impact all of society. ^11,12 Longevity advocates often make the case that if the public knew more about the possibilities of defying death or were shown a “success story” that proves the geroscience hypothesis—that aging is a driver of chronic disease ⁷ —then the public would be more enthusiastic about research in geroscience and would support the mobilization of funds and regulatory change. Hence, this is an invitation to engage more openly with lay citizens who are not involved in the longevity “movement” and opening up spaces in conferences to debate the ethical and social implications of geroscience, rather than taking their desirability for granted. Who would be against living longer, healthier lives? Some have claimed that a life well lived does not need to be long. ¹³ But such an assertion may raise eyebrows depending on how the nuances of health, disease, aging, and enhancement are framed. It even brings to the fore whether such categories remain relevant in today’s biomedicine. Many criticisms of biotechnology’s pushing of frontiers owe to the idea that such advances cross boundaries of what is perceived as the natural (and divine) order of things. ¹⁴ In contrast, biotechnologists justify their tampering with nature by claiming that they are setting us free from the constraints of evolution, which has accidentally left us with a shorter lifespan than what otherwise could be possible, biologically speaking. Nevertheless, the life extension community seems to place us on a trajectory to live longer lives very soon, if not in a few years, within a few decades.

Often, scientific meetings gather scientists, experts, and advocates who share an interest in a given discipline or topic, creating an environment in which the “public” is often left out of the conversations, as was the case in the Asilomar Conference of 1975, where the scientific community gathered to decide the future of safety guidelines for recombinant DNA. ¹⁵ The longevity community assumes that the public approves of its efforts to help humans live longer and even rejuvenate the human body, but various studies have shown mixed views rather than unanimous support for the field, as well as a mixed capacity of the public to identify salient ethical challenges. ^11,16,17 As such, the longevity community would benefit from enabling a broader conversation about public perceptions of longevity research, as well as the needs and concerns of potential patients or users of proposed interventions. In the Biomarkers of Age symposium held in December 2023 at The Buck Institute for Aging, George Kuchel from the University of Connecticut recognized the importance of engaging with the public in a panel discussion in which he was asked about his favorite use of a biomarker. Kuchel commented, “it’s in the context of what matters to our patients. I think what’s really important is that we haven’t asked our patients what’s important to them. […] Find out what actually matters to people out there from a geroscience perspective, because everything we’ve said so far is based on what we as individuals feel.” This insight should be the point of departure for the life extension community as a precondition to attaining public trust. The research community must involve the public as early as possible and ask whether the desire for future technologies and this aggressive approach to healthcare is widely shared by the public. ¹⁸ What sort of patient responsibility for preventing health issues is being imagined when treatments are being designed? Is the average citizen in favor of living longer and under what terms? Would longevity interventions be affordable and what about those who cannot afford them? What would be the case if only those with sufficient retirement savings or other sources of income could afford to live longer? How can consumers trust whether antiaging interventions work? These are just a handful of the questions that the public may have. These are pressing issues, considering that the United States has the lowest life expectancy among high-income countries, reflecting gaps in access to healthcare. ¹⁹ Building trust from the public requires that investors, entrepreneurs, scientists, and advocates of biogerontology are open about their goals and credible in being seen as genuinely seeking to benefit all of society, rather than just themselves or a privileged few. A recurrent concern about emerging biotechnologies is their potential to widen existing structural inequalities and the gap between the “haves” and the “have-nots.” In other words, those engaged in longevity technologies must also be engaged in ensuring that such advances will not segregate society into those who can afford to live longer and those who remain subject to the calamities of their bodies’ constraints, social standing, and environmental makeup.

Scientists continue to operate under the assumption that society—and regulation—will catch up with advances in life extension. An example of an effort toward the extension of the normalization of antiaging treatments in society is the recent announcement that LOY-001, an antiaging therapeutic for use in large dogs, developed by the company Loyal, in 2023 met a milestone that put it closer to FDA approval. ⁸ Treating dogs is a step toward making these drugs available in humans, ²⁰ a test of sorts to see how society (and canine biology) will respond. This announcement is a good reminder that public opinion is both shaped by and itself shapes scientific advances and may respond in positive or negative ways to the current framings of longevity research. Implicit in this framing is that if dogs respond well to these interventions, they could be suitable for adaption to humans, sidestepping the question of whether this development is in the public’s best interest. We seem to be slowly walking into a future in which delaying aging becomes the norm, without first asking the people who will inhabit it whether this is a future in which they and their descendants want to live.

Making Distinctions: Health span and Lifespan

Unless society embraces longevity research as a policy choice, extending the human lifespan will remain an aspiration. ²¹ The longevity community has not arrived at an agreement about a key objective of the field: extending lifespan, the length of time a person lives, or extending health span, the period of a person’s life lived in good health. ²² For instance, the US National Institute on Aging seeks to understand “the nature of aging and the aging process, and diseases and conditions associated with growing older, in order to extend the healthy, active years of life.” ⁹ On the contrary, some aim to live for as long as possible, as the Vitalist declaration suggests: “Life and health are good. Death is humanity’s core problem, and aging its primary agent.” ¹⁰ The making of such categories and concepts carries meanings about the purpose of research and who it is for, serving to articulate certain research directions and financial resources over others. Hence, a second line of questioning for the life extension community involves the need to delineate more clearly which the longevity community primarily seeks: increasing lifespan or health span? Whichever the community prioritizes—lifespan or health span—can have profound implications for whether geroscience is widely adopted and earns the political support needed to pass reforms and secure more public investment. Simply put, living “forever” may seem for many an excentric goal, out of tune with their health and lifestyle priorities. As some interviewees have expressed, the longevity community is seen as moving from a “fringe” movement to becoming more “mainstream.” For this change to continue, it is important to determine whether the priority is to increase health span, which is arguably the main goal of medicine, or increase lifespan, which can be seen as a transgressive and vanity project. Notably, the Dublin longevity declaration written in 2023 makes a commitment to health span, rather than lifespan, as the focus of longevity medicine: “A concerted effort has been made in the longevity field to institutionalize the word ‘healthspan’”. ¹¹

Whether life extension come to be perceived as transgressing the limits of the body and the natural order lies in the balance. Health span has come to dominate discussions about the goal of geroscience, both in advocacy and supporting organizations. ^23,24 The recently launched XPRIZE Health span, “a 7-year, $101 million global competition to revolutionize the way we approach human aging,” ¹² emphasizes promoting “healthy aging” rather than increasing lifespan. XPRIZE founder Peter Diamandis wrote on November 20, 2023, in X, after the announcement of the prize: “People around the world are living longer, but quality of life has not kept pace … it’s time to revolutionize the way we age. Working across all sectors, we can democratize health and create a future where healthy aging is accessible for everyone and full of potential.” Nevertheless, alongside the healthcare revolution that some claim is brewing, communities, and nonprofits are making efforts to normalize the idea of defying death. Examples include Bryan Johnson’s “don’t die” movement, ²⁵ Vitalism’s vision of “reaching unlimited healthy human lifespan” ¹³ and “establishing Longevity States to allow every human to live in optimal health indefinitely,” or Vitalia’s goal of creating novel jurisdictions, self-governing cities, where experimentation can be accelerated with the goal to “extend healthy lifespan for all.” ¹⁴

The longevity biotech community is making the building blocks upon which the possibility of life extension can be evaluated and promoted. Hence, it is important to foster debates about the community’s position on the goal of living longer, and whether it embraces such a future for humankind. This can be the tipping point for the public to support or reject the vision of pursuing living longer or healthy aging.

Longevity, Billionaires, and Start-Ups

The involvement of tech billionaires in longevity start-ups has been recurringly reported in the news, for example, since Calico’s founding made the cover of Time magazine in 2013, ¹⁵ bringing attention to meetings only accessible to “mega-rich” investors. ²⁶ The support of wealthy donors of geroscience raises questions about whether accountability mechanisms are in place, whether such funds would be better allocated toward more pressing needs, and whether private investors are acting with the interest of the public in mind.

Tech billionaires like Amazon founder Jeff Bezos, Google cofounder Larry Page, and PayPal cofounder Peter Thiel have been known to be betting on available treatments to rejuvenate themselves. ²⁷ Others, like Bryan Johnson, have embarked on a program of self-experimentation and self-optimization by developing a protocol that delegates the body to run itself, rather than Johnson himself, who renounces most of his agency in the process. ¹⁶ As such, it should come as no surprise that the media has become used to portraying longevity research as the realm of the rich who want to live forever, in isolation from society. ²⁸ Also unsurprisingly, such news raises questions: for whom are these technologies being developed and has wealth inequality grown so much that the wealthy have become too detached from the needs of the ordinary citizen? This concern is the basis of recent sci-fi films that revolve around the oppressed rebelling against an elite that owns even time and age, as in the films Paradise (2023) and In Time (2011). As a participant at the Biomarkers of Age consortium explained to me, the field attracts wealthy investors because “time has become the ultimate commodity.” Besides no small sums of money funneling into promises of living forever—with companies like Retro Bioscience receiving $180 million from the cofounder and CEO of OpenAI, Sam Altman ¹⁷ —the longevity “ecosystem” is sprouting nonprofits, foundations, investment funds, and news outlets bent on turning into reality the vision of delaying death and slowing aging.

Besides wealthy investors, nonprofits are also investing hefty amounts into the field (e.g., Saudi Arabia’s Hevolution Foundation), as they seek to fill a gap in state-led funding and are willing to take higher risks for higher returns. ²⁹ ,18 Furthermore, proponents of the field also seek to reconfigure relationships with the state and bring forward a different paradigm of clinical trials for longevity purposes, as advances are now constrained by current regulations and the FDA’s framework for approving drugs based on indications of disease. ³⁰ In this sense, private investment and the harnessing of state resources to tackle aging as a target of disease have the potential to redefine the priorities of healthcare toward a more systemic approach that emphasizes maintaining well-being and prevention rather than ameliorating disease, or “sick care.” Nevertheless, it may be difficult for the public to perceive private investments as devoted to improving the lives of the majority, rather than perceiving these efforts as high-tech advances that will benefit just a select few.

Moreover, the influx of capital into the life extension community is reshaping and uprooting the traditional roles of scientists, as they are drafted into start-ups, possibly inspired by better salaries, scientific acclaim, and more funding than they would find in universities and research centers. For example, Nobel Prize winner Steve Horvath, famous for his “Horvath epigenetic clock,” ¹⁹ has moved from his professor position at the University of California Los Angeles to Altos Labs as principal investigator. The rise in the life sciences of the corporate scientist has been widespread in recent decades, ³¹ just as universities have themselves changed to be more market- and innovation-oriented. ³² In addition to questions about how the goals of commercializing research and regulatory structures shape the priorities and promises of life extension research, we should also be mindful of the allure of corporate research to reduce the restrictions on research or remove moral stopgaps. Scientists in universities are bound to procedures for conducting research, such as obtaining approval for their experiments from Institutional Review Boards, Institutional Biosafety Committees, or Embryonic Stem Cell Research Oversight committees. The extent to which corporate scientists face equivalent administrative tasks is not yet clear, but a tendency to prioritize commercialization over ethically sound science may prevail.

In sum, the fascination with billionaires wanting to live forever so often portrayed in the media and the appearance of nonstate and nonscientific institutions in the life extension landscape may distract attention from asking what priorities and problems are being served by biogerontology research, as the field aims to reshape our understanding of health, disease, and enhancement. ³³ The coverage of such stories in the media, perhaps inevitably, can convey the notion that billionaires and start-ups are beyond the mechanisms of scientific accountability, and whoever has the means to pursue living forever, will be allowed to do so.

Concluding Remarks

Science and technology shape and are shaped by local, historical, and cultural contexts; they reflect predominant values and ways of thinking in society. Narratives about science in society acquire meanings that are shaped, not only by scientific facts but also by the context and cultures in which knowledge is produced and interpreted. However, scientists and scientific meetings tend to narrow down the scope of their interventions to the biology or the latest scientific advances and the evidence that supports them. This narrowing puts aside questions about ethical, social, and political domains. In this essay, I invite enthusiasts of life extension to broaden the purview of their discussions about health span and delayed aging, reflecting upon the current cultural assumptions in which many declare that defying death not only could be possible but should be attempted. ³⁴ The field reflects changing relationships between society and time, health, and the body, influenced by the advent of private actors with a massive influx of capital, which may ultimately shape regulation, funding priorities, and social attitudes. Biotechnology has shown us that nature’s constraints are not as strong as once thought, and reforming the human body has become a political arena.

Engaging in a broader conversation about life extension technologies is difficult, since we are wired to cling to life. ³⁵ Spaces in which values and science are articulated, such as scientific conferences, can also constitute spaces for deliberation about the conditions in which living longer and healthier is possible or desirable. Questions regarding who funds research and commercial efforts; who stands to benefit; and what conceptualizations of health, disease, and enhancement are being mobilized, are too important to be left out of the discussion.