The first US hub for experimental medical treatments is coming

A bill that allows medical clinics to sell unproven treatments has been passed in Montana. 

Under the legislation, doctors can apply for a license to open an experimental treatment clinic and recommend and sell therapies not approved by the Food and Drug Administration (FDA) to their patients. Once it’s signed by the governor, the law will be the most expansive in the country in allowing access to drugs that have not been fully tested. 

The bill allows for any drug produced in the state to be sold in it, providing it has been through phase I clinical trials—the initial, generally small, first-in-human studies that are designed to check that a new treatment is not harmful. These trials do not determine if the drug is effective.

The bill, which was passed by the state legislature on April 29 and is expected to be signed by Governor Greg Gianforte, essentially expands on existing Right to Try legislation in the state. But while that law was originally designed to allow terminally ill people to access experimental drugs, the new bill was drafted and lobbied for by people interested in extending human lifespans—a group of longevity enthusiasts that includes scientists, libertarians, and influencers.  

These longevity enthusiasts are hoping Montana will serve as a test bed for opening up access to experimental drugs. “I see no reason why it couldn’t be adopted by most of the other states,” said Todd White, speaking to an audience of policymakers and others interested in longevity at an event late last month in Washington, DC. White, who helped develop the bill and directs a research organization focused on aging, added that “there are some things that can be done at the federal level to allow Right to Try laws to proliferate more readily.” 

Supporters of the bill say it gives individuals the freedom to make choices about their own bodies. At the same event, bioethicist Jessica Flanigan of the University of Richmond said she was “optimistic” about the measure, because “it’s great any time anybody is trying to give people back their medical autonomy.” 

Ultimately, they hope that the new law will enable people to try unproven drugs that might help them live longer, make it easier for Americans to try experimental treatments without having to travel abroad, and potentially turn Montana into a medical tourism hub.

But ethicists and legal scholars aren’t as optimistic. “I hate it,” bioethicist Alison Bateman-House of New York University says of the bill. She and others are worried about the ethics of promoting and selling unproven treatments—and the risks of harm should something go wrong.

Easy access?

No drugs have been approved to treat human aging. Some in the longevity field believe that regulation has held back the development of such drugs. In the US, federal law requires that drugs be shown to be both safe and effective before they can be sold. That requirement was made law in the 1960s following the thalidomide tragedy, in which women who took the drug for morning sickness had babies with sometimes severe disabilities. Since then, the FDA has been responsible for the approval of new drugs.  

Typically, new drugs are put through a series of human trials. Phase I trials generally involve between 20 and 100 volunteers and are designed to check that the drug is safe for humans. If it is, the drug is then tested in larger groups of hundreds, and then thousands, of volunteers to assess the dose and whether it actually works. Once a drug is approved, people who are prescribed it are monitored for side effects. The entire process is slow, and it can last more than a decade—a particular pain point for people who are acutely aware of their own aging. 

But some exceptions have been made for people who are terminally ill under Right to Try laws. Those laws allow certain individuals to apply for access to experimental treatments that have been through phase I clinical trials but have not received FDA approval.

Montana first passed a Right to Try law in 2015 (a federal law was passed around three years later). Then in 2023, the state expanded the law to include all patients there, not just those with terminal illnesses—meaning that any person in Montana could, in theory, take a drug that had been through only a phase I trial.

At the time, this was cheered by many longevity enthusiasts—some of whom had helped craft the expanded measure.

But practically, the change hasn’t worked out as they envisioned. “There was no licensing, no processing, no registration” for clinics that might want to offer those drugs, says White. “There needed to be another bill that provided regulatory clarity for service providers.” 

So the new legislation addresses “how clinics can set up shop in Montana,” says Dylan Livingston, founder and CEO of the Alliance for Longevity Initiatives, which hosted the DC event. Livingston built A4LI, as it’s known, a few years ago, as a lobbying group for the science of human aging and longevity.

Livingston, who is exploring multiple approaches to improve both funding for scientific research and to change drug regulation, helped develop and push the 2023 bill in Montana with the support of State Senator Kenneth Bogner, he says. “I gave [Bogner] a menu of things that could be done at the state level … and he loved the idea” of turning Montana into a medical tourism hub, he says. 

After all, as things stand, plenty of Americans travel abroad to receive experimental treatments that cannot legally be sold in the US, including expensive, unproven stem cell and gene therapies, says Livingston. 

“If you’re going to go and get an experimental gene therapy, you might as well keep it in the country,” he says. Livingston has suggested that others might be interested in trying a novel drug designed to clear aged “senescent” cells from the body, which is currently entering phase II trials for an eye condition caused by diabetes. “One: let’s keep the money in the country, and two: if I was a millionaire getting an experimental gene therapy, I’d rather be in Montana than Honduras.”

“Los Alamos for longevity”

Honduras, in particular, has become something of a home base for longevity experiments. The island of Roatán is home to the Global Alliance for Regenerative Medicine clinic, which, along with various stem cell products, sells a controversial unproven “anti-aging” gene therapy for around $20,000 to customers including wealthy longevity influencer Bryan Johnson. 

Tech entrepreneur and longevity enthusiast Niklas Anzinger has also founded the city of Infinita in the region’s special economic zone of Próspera, a private city where residents are able to make their own suggestions for medical regulations. It’s the second time he’s built a community there as part of his effort to build a “Los Alamos for longevity” on the island, a place where biotech companies can develop therapies that slow or reverse human aging “at warp speed,” and where individuals are free to take those experimental treatments. (The first community, Vitalia, featured a biohacking lab, but came to an end following a disagreement between the two founders.) 

Anzinger collaborated with White, the longevity enthusiast who spoke at the A4LI event (and is an advisor to Infinita VC, Anzinger’s investment company), to help put together the new Montana bill. “He asked if I would help him try to advance the new bill, so that’s what we did for the last few months,” says White, who trained as an electrical engineer but left his career in telecommunications to work with an organization that uses blockchain to fund research into extending human lifespans. 

“Right to Try has always been this thing [for people] who are terminal[ly ill] and trying a Hail Mary approach to solving these things; now Right to Try laws are being used to allow you to access treatments earlier,” White told the audience at the A4LI event. “Making it so that people can use longevity medicines earlier is, I think, a very important thing.”

The new bill largely sets out the “infrastructure” for clinics that want to sell experimental treatments, says White. It states that clinics will need to have a license, for example, and that this must be renewed on an annual basis. 

“Now somebody who actually wants to deliver drugs under the Right to Try law will be able to do so,” he says. The new legislation also protects prescribing doctors from disciplinary action.

And it sets out requirements for informed consent that go further than those of existing Right to Try laws. Before a person takes an experimental drug under the new law, they will be required to provide a written consent that includes a list of approved alternative drugs and a description of the worst potential outcome.

On the safe side

“In the Montana law, we explicitly enhanced the requirements for informed consent,” Anzinger told an audience at the same A4LI event. This, along with the fact that the treatments will have been through phase I clinical trials, will help to keep people safe, he argued. “We have to treat this with a very large degree of responsibility,” he added.

“We obviously don’t want to be killing people,” says Livingston. 

But he also adds that he, personally, won’t be signing up for any experimental treatments. “I want to be the 10 millionth, or even the 50 millionth, person to get the gene therapy,” he says. “I’m not that adventurous … I’ll let other people go first.”

Others are indeed concerned that, for the “adventurous” people, these experimental treatments won’t necessarily be safe. Phase I trials are typically tiny, and they often involve less than 50 people, all of whom are typically in good health. A trial like that won’t tell you much about side effects that only show up in 5% of people, for example, or about interactions the drug might have with other medicines.

Around 90% of drug candidates in clinical trials fail. And around 17% of drugs fail late-stage clinical trials because of safety concerns. Even those that make it all the way through clinical trials and get approved by the FDA can still end up being withdrawn from the market when rare but serious side effects show up. Between 1992 and 2023, 23 drugs that were given accelerated approval for cancer indications were later withdrawn from the market. And between 1950 and 2013, the reason for the withdrawal of 95 drugs was “death.”

“It’s disturbing that they want to make drugs available after phase I testing,” says Sharona Hoffman, professor of law and bioethics at Case Western Reserve University in Cleveland, Ohio. “This could endanger patients.”

“Famously, the doctor’s first obligation is to first do no harm,” says Bateman-House. “If [a drug] has not been through clinical trials, how do you have any standing on which to think it isn’t going to do any harm?”

But supporters of the bill argue that individuals can make their own decisions about risk. When speaking at the A4LI event, Flanigan introduced herself as a bioethicist before adding “but don’t hold it against me; we’re not all so bad.” She argued that current drug regulations impose a “massive amount of restrictions on your bodily rights and your medical freedom.” Why should public officials be the ones making decisions about what’s safe for people? Individuals, she argued, should be empowered to make those judgments themselves.

Other ethicists counter that this isn’t an issue of people’s rights. There are lots of generally accepted laws about when we can access drugs, says Hoffman; people aren’t allowed to drink and drive because they might kill someone. “So, no, you don’t have a right to ingest everything you want if there are risks associated with it.”

The idea that individuals have a right to access experimental treatments has in fact failed in US courts in the past, says Carl Coleman, a bioethicist and legal scholar at Seton Hall in New Jersey. 

He points to a case from 20 years ago: In the early 2000s, Frank Burroughs founded the Abigail Alliance for Better Access to Developmental Drugs. His daughter, Abigail Burroughs, had head and neck cancer, and she had tried and failed to access experimental drugs. In 2003, about two years after Abigail’s death, the group sued the FDA, arguing that people with terminal cancer have a constitutionally protected right to access experimental, unapproved treatments, once those treatments have been through phase I trials. In 2007, however, a court rejected that argument, determining  that terminally ill individuals do not have a constitutional right to experimental drugs.

Bateman-House also questions a provision in the Montana bill that claims to make treatments more equitable. It states that “experimental treatment centers” should allocate 2% of their net annual profits “to support access to experimental treatments and healthcare for qualifying Montana residents.” Bateman-House says she’s never seen that kind of language in a bill before. It may sound positive, but it could in practice introduce even more risk to the local community. “On the one hand, I like equity,” she says. “On the other hand, I don’t like equity to snake oil.”

After all, the doctors prescribing these drugs won’t know if they will work. It is never ethical to make somebody pay for a treatment when you don’t have any idea whether it will work, Bateman-House adds. “That’s how the US system has been structured: There’s no profit without evidence of safety and efficacy.”

The clinics are coming

Any clinics that offer experimental treatments in Montana will only be allowed to sell drugs that have been made within the state, says Coleman. “Federal law requires any drug that is going to be distributed in interstate commerce to have FDA approval,” he says.

White isn’t too worried about that. Montana already has manufacturing facilities for biotech and pharmaceutical companies, including Pfizer. “That was one of the specific advantages [of focusing] on Montana, because everything can be done in state,” he says. He also believes that the current administration is “predisposed” to change federal laws around interstate drug manufacturing. (FDA commissioner Marty Makary has been a vocal critic of the agency and the pace at which it approves new drugs.)

At any rate, the clinics are coming to Montana, says Livingston. “We have half a dozen that are interested, and maybe two or three that are definitively going to set up shop out there.” He won’t name names, but he says some of the interested clinicians already have clinics in the US, while others are abroad. 

Mac Davis—founder and CEO of Minicircle, the company that developed the controversial “anti-aging” gene therapy—told MIT Technology Review he was “looking into it.”

“I think this can be an opportunity for America and Montana to really kind of corner the market when it comes to medical tourism,” says Livingston. “There is no other place in the world with this sort of regulatory environment.”

Bryan Johnson wants to start a new religion in which “the body is God”

Bryan Johnson is on a mission to not die. The 47-year-old multimillionaire has already applied his slogan “Don’t Die” to events, merchandise, and a Netflix documentary. Now he’s founding a Don’t Die religion.

Johnson, who famously spends millions of dollars on scans, tests, supplements, and a lifestyle routine designed to slow or reverse the aging process, has enjoyed extensive media coverage, and a huge social media following. For many people, he has become the face of the longevity field.

I sat down with Johnson at an event for people interested in longevity in Berkeley, California, in late April. We spoke on the sidelines after lunch (conference plastic-lidded container meal for me; what seemed to be a plastic-free, compostable box of chicken and vegetables for him), and he sat with an impeccable posture, his expression neutral. 

Earlier that morning, Johnson, in worn trainers and the kind of hoodie that is almost certainly deceptively expensive, had told the audience about what he saw as the end of humanity. Specifically, he was worried about AI—that we face an “event horizon,” a point at which superintelligent AI escapes human understanding and control. He had come to Berkeley to persuade people who are interested in longevity to focus their efforts on AI. 

It is this particular concern that ultimately underpins his Don’t Die mission. First, humans must embrace the Don’t Die ideology. Then we must ensure AI is aligned with preserving human existence. Were it not for AI, he says, he wouldn’t be doing any of his anti-death activities and regimens. “I am convinced that we are at an existential moment as a species,” says Johnson, who was raised Mormon but has since left the church. Solving aging will take decades, he says—we’ll survive that long only if we make sure that AI is aligned with human survival. 

The following Q&A has been lightly edited for length and clarity.

Why are you creating a new religion?

We’re in this new phase where [because of advances in AI] we’re trying to reimagine what it means to be human. It requires imagination and creativity and open-mindedness, and that’s a big ask. Approaching that conversation as a community, or a lifestyle, doesn’t carry enough weight or power. Religions have proven, over the past several thousand years, to be the most efficacious form to organize human efforts. It’s just a tried-and-true methodology. 

How do you go about founding a new religion?

It’s a good question. If you look at historical [examples], Buddha went through his own self-exploratory process and came up with a framework. And Muhammad had a story. Jesus had an origin story … You might even say Satoshi [Nakamoto, the mysterious creator of bitcoin] is like [the founder of] a modern-day religion, [launched] with the white paper. Adam Smith launched capitalism with his book. The question is: What is a modern-day religion, and how does it convince? It’s an open question for me. I don’t know yet.

Your goal is to align AI with Don’t Die—or, in other words, ensure that AI models prioritize and protect human life. How will you do that?

I’m talking to a lot of AI researchers about this. Communities of AIs could be instilled with values of conflict resolution that do not end in the death of a human. Or an AI. Or the planet.

Would you say that Don’t Die is “your” religion?

No, I think it’s humanity’s religion. It’s different from other religions, which are very founder-centric. I think this is going to be decentralized, and it will be something that everybody can make their own.

So there’s no God?

We’re playing with the idea that the body is God. We’ve been experimenting with this format of a Don’t Die fam, where eight to 12 people get together on a weekly basis. It’s patterned off of other groups like Alcoholics Anonymous. We structure an opening ritual. We have a mantra. And then there’s a part where people apologize to their body for something they’ve done that has inflicted harm upon themselves. 

It’s reframing our relationship to body and to mind. It is also a way for people to have deep friendships, to explore emotionally vulnerable topics, and to support each other in health practices.

What we’re really trying to say is: Existence is the virtue. Existence is the objective. If someone believes in God, that’s fine. People can be Christian and do this; they can be Muslim and do this. Don’t Die is a “yes, and” to all groups.

So it’s a different way of thinking about religion?

Yeah. Right now, religion doesn’t hold the highest status in society. A lot of people look down on it in some way. I think as AI progresses, it’s going to create additional questions on who we are: What is our identity? What do we believe about our existence in the future? People are going to want some kind of framework that helps them make sense of the moment. So I think there’s going to be a shift toward religion in the coming years. People might say that [founding a religion now] is kind of a weird move, and that [religion] turns people off. But I think that’s fine. I think we’re ahead.

Does the religion incorporate, or make reference to, AI in any way?

Yeah. AI is going to be omnipresent. And this is why we’ve been contemplating “the body is God.” Over the past couple of years … I’ve been testing the hypothesis that if I get a whole bunch of data about my body, and I give it to an algorithm, and feed that algorithm updates with scientific evidence, then it would eventually do a better job than a doctor. So I gave myself over to an algorithm. 

It really is in my best interest to let it tell me what to eat, tell me when to sleep and exercise, because it would do a better job of making me happy. Instead of my mind haphazardly deciding what it wants to eat based on how it feels in the moment, the body is elevated to a position of authority. AI is going to be omnipresent and built into our everyday activities. Just like it autocompletes our texts, it will be able to autocomplete our thoughts.

Might some people interpret that as AI being God?

Potentially. I would be hesitant to try to define [someone else’s] God. The thing we want to align upon is that none of us want to die right now. We’re attempting to make Don’t Die the world’s most influential ideology in the next 18 months.

The US has approved CRISPR pigs for food

Most pigs in the US are confined to factory farms where they can be afflicted by a nasty respiratory virus that kills piglets. The illness is called porcine reproductive and respiratory syndrome, or PRRS.

A few years ago, a British company called Genus set out to design pigs immune to this germ using CRISPR gene editing. Not only did they succeed, but its pigs are now poised to enter the food chain following approval of the animals this week by the U.S. Food and Drug Administration.

The pigs will join a very short list of gene-modified animals that you can eat. It’s a short list because such animals are expensive to create, face regulatory barriers, and don’t always pay off. For instance, the US took about 20 years to approve a transgenic salmon with an extra gene that let it grow faster. But by early this year its creator, AquaBounty, had sold off all its fish farms and had only four employees—none of them selling fish.

Regulations have eased since then, especially around gene editing, which tinkers with an animal’s own DNA rather than adding to it from another species, as is the case with the salmon and many GMO crops.

What’s certain is that the pig project was technically impressive and scientifically clever. Genus edited pig embryos to remove the receptor that the PRRS virus uses to enter cells. No receptor means no infection.

According to Matt Culbertson, chief operating office of the Pig Improvement Company, a Genus subsidiary, the pigs appear entirely immune to more than 99% of the known versions of the PRRS virus, although there is one rare subtype that may break through the protection.

This project is scientifically similar to the work that led to the infamous CRISPR babies born in China in 2018. In that case a scientist named He Jiankui edited twin girls to be resistant to HIV, also by trying to remove a receptor gene when they were just embryos in a dish.

That experiment on humans was widely decried as misguided. But pigs are a different story. The ethical concerns about experimenting are less serious, and the benefits of changing the genomes can be measured in dollars and cents. It’s going to save a lot of money if pigs are immune to the PRRS virus, which spreads quite easily, causing losses of $300 million a year or more in the US alone.

Globally, people get animal protein mostly from chickens, with pigs and cattle in second and third place. A 2023 report estimated that pigs account for 34% of all meat that’s eaten. Of the billion pigs in the world, about half are in China; the US comes in a distant second, with 80 million.

Recently, there’s been a lot of fairly silly news about genetically modified animals. A company called Colossal Biosciences used gene editing to modify wolves in ways it claimed made them resemble an extinct species, the dire wolf. And then there’s the L.A. Project, an effort run by biohackers who say they’ll make glow-in-the-dark rabbits and have a stretch goal of creating a horse with a horn—that’s right, a unicorn.

Both those projects are more about showmanship than usefulness. But they’re demonstrations of the growing power scientists have to modify mammals, thanks principally to new gene-editing tools combined with DNA sequencing that lets them peer into animals’ DNA.

Stopping viruses is a much better use of CRISPR. And research is ongoing to make pigs—as well as other livestock—invulnerable to other infections, including African swine fever and influenza. While PRRS doesn’t infect humans, pig and bird flus can. But if herds and flocks could be changed to resist those infections, that could cut the chances of the type of spillover that can occasionally cause dangerous pandemics.  

There’s a chance the Genus pigs could turn out to be the most financially valuable genetically modified animal ever created—the first CRISPR hit product to reach the food system. After the approval, the company’s stock value jumped up by a couple of hundred million dollars on the London Stock Exchange.

But there is still a way to go before gene-edited bacon appears on shelves in the US. Before it makes its sales pitch to pig farms, Genus says, it needs to also gain approval in Mexico, Canada, Japan and China which are big export markets for American pork.

Culbertson says gene-edited pork could appear in the US market sometime next year. He says the company does not think pork chops or other meat will need to carry any label identifying it as bioengineered. “We aren’t aware of any labelling requirement,” Culbertson says.

This article is from The Checkup, MIT Technology Review’s weekly health and biotech newsletter. To receive it in your inbox every Thursday, sign up here.

Love or immortality: A short story

1.

Sophie and Martin are at the 2012 Gordon Research Conference on the Biology of Aging in Ventura, California. It is a foggy February weekend. Both are disappointed about how little sun there is on the California beach.

They are two graduate students—Sophie in her sixth and final year, Martin in his fourth—who have traveled from different East Coast cities to present posters on their work. Martin’s shows health data collected from supercentenarians compared with the general Medicare population, capturing the diseases that are less and more common in the populations. Sophie is presenting on her recently accepted first-author paper in Aging Cell on two specific genes that, when activated, extend lifespan in C. elegans roundworms, the model organism of her research. 

“Supercentenarians are much less likely to have seven diseases,” he says, pointing to his poster. “Alzheimer’s, heart failure, diabetes, depression, prostate cancer, hip fracture, and chronic kidney disease. Though they have higher instances of four diseases, which are arthritis, cataracts, osteoporosis, and glaucoma. These aren’t linked to mortality, but they do affect quality of life.”

What stands out to Sophie is the confidence in Martin’s voice, despite the unsurprising nature of the findings. She admires that sound, its sturdiness. She makes note of his name and plans to seek him out. 

Martin says, again with that confidence, that he will become a professor. Sophie says she likely won’t go down that path. She has received an offer to start as a scientist at an aging research startup called Abyssinian Bio, after she defends. Martin says, “Wouldn’t your work make more sense in an academic setting, where you have more freedom and power over what you do?” She says, “But that could be years from now and I want to start my real life, so …” 

Martin visits Sophie in San Francisco whenever he can, which amounts to a weekend or two every other month. After two years, their long-distance relationship is taking its toll. They want more weekends, more months, more everything together. They make plans for him to get a postdoc near her, but after multiple rejections from the labs where he most wants to work, his resentment toward academia grows. 

“They don’t see the value of my work,” he says.

Sophie moves up at Abyssinian. Despite being in industry, her work is published in well-respected journals. She collaborates well with her colleagues. Eventually, she is promoted to executive director of research. 

Martin stalls at the rank of principal scientist, and though Sophie is technically his boss—or his boss’s boss—he genuinely doesn’t mind when others call him “Dr. Sophie Xie’s husband.”

First come the subtle shifts in how he talks about his research and Abyssinian’s work. He wants to “defeat” and “obliterate” aging, which he comes to describe as humankind’s “greatest adversary.” 

Martin, for the first time, sees Sophie differently. Not without love, but love burdened by an opposing weight, what others might recognize as resentment. Sophie is dedicated to the demands of her growing department. Martin thinks she is not taking the task of living longer seriously enough. He does not want her to die. He does not want to die. 

Nobody at Abyssinian is taking the task of living longer seriously enough. Of all the aging bio startups he could have ended up at, how has he ended up at one with such modest—no, lazy—goals? He begins publicly dismissing basic research as “too slow” and “too limited,” which offends many of his and Sophie’s colleagues. 

Sophie defends him, says he is still doing good work, despite the evidence. She is busy, traveling often for conferences, and mistakenly misclassifies the changes in Martin’s attitude as temporary outliers.

At home, Martin and Sophie argue. Initially, they argue about whether tools of the past can be useful to their work. Then the argument morphs. What is the true purpose of their research? Martin says it’s called anti-aging research for a reason: It’s to defy aging! Sophie says she’s never called her work anti-aging research; she calls it aging research or research into the biology of aging. And Abyssinian’s overarching mission is more simply to find druggable targets for chronic and age-related diseases. Occasionally, the company’s marketing arm will push out messaging about extending the human lifespan by 20 years, but that has nothing to do with scientists like them in R&D. Martin seethes. Only 20 years! What about hundreds? Thousands? 

Martin is at the kitchen counter, methodically crushing his evening supplements into powder. “I’m trying to save humanity. And all you want to do is sit in the lab to watch worms die.”

Sophie observes his familiar movements, now foreign in their desperation. The kitchen light catches the silver spreading at his temples and on his chin—the very evidence of aging he is trying so hard to erase.

“That’s not true,” she says.

Martin gulps down his shake.

“What about us? What about children?”

Martin coughs, then laughs, a sound that makes Sophie flinch. “Why would we have children now? You certainly don’t have the time. But if we solve aging, which I believe we can, we’d have all the time in the world.”

“We used to talk about starting a family.”

“Any children we have should be born into a world where we already know they never have to die.”

“We could both make the time. I want to grow old together—”

All Martin hears are promises that lead to nothing, nowhere.  

“You want us to deteriorate? To watch each other decay?”

“I want a real life.”

“So you’re choosing death. You’re choosing limitation. Mediocrity.”

Voicemail. And after this morning’s text, still no glimmering ellipsis bubble to indicate Sophie’s typing. 

“Where are you at with the NAD+ data?” Martin asks.

Robert shifts in his chair to face Martin. The skin of his neck grows red and splotchy. Martin stares at it in disgust.

“Well?” he asks again. 

“Oh, I was told not to work on that anymore?” The boy has a tendency to speak in the lilt of questions. 

“By who?” Martin demands.

“Uh, Sophie?” 

“I see. Well, I expect new data by end of day.” 

“Oh, but—”

Martin narrows his eyes. The red splotches on Robert’s neck grow larger. 

“Um, okay,” the boy says, returning his focus to the computer. 

Martin decides a response is called for …

70.

Immortality Promise

I am immortal. This doesn’t make me special. In fact, most people on Earth are immortal. I am 6,000 years old. Now, 6,000 years of existence give one a certain perspective. I remember back when genetic engineering and knowledge about the processes behind aging were still in their infancy. Oh, how people argued and protested.

“It’s unethical!”

“We’ll kill the Earth if there’s no death!”

“Immortal people won’t be motivated to do anything! We’ll become a useless civilization living under our AI overlords!” 

I believed back then, and now I know. Their concerns had no ground to stand on.

Eternal life isn’t even remarkable anymore, but being among its architects and early believers still garners respect from the world. The elegance of my team’s solution continues to fill me with pride. We didn’t just halt aging; we mastered it. My cellular machinery hums with an efficiency that would make evolution herself jealous.

Those early protesters—bless their mortal, no-longer-­beating hearts—never grasped the biological imperative of what we were doing. Nature had already created functionally immortal organisms—the hydra, certain jellyfish species, even some plants. We simply perfected what evolution had sketched out. The supposed ethical concerns melted away once people understood that we weren’t defying nature. We were fulfilling its potential.

Today, those who did not want to be immortal aren’t around. Simple as that. Those who are here do care about the planet more than ever! There are almost no diseases, and we’re all very productive people. Young adults—or should I say young-looking adults—are naturally restless and energetic. And with all this life, you have the added benefit of not wasting your time on a career you might hate! You get to try different things and find out what you’re really good at and where you’re appreciated! Life is not short! Resources are plentiful!

Of course, biological immortality doesn’t equal invincibility. People still die. Just not very often. My colleagues in materials science developed our modern protective exoskeletons. They’re elegant solutions, though I prefer to rely on my enhanced reflexes and reinforced skeletal structure most days. 

The population concerns proved mathematically unfounded. Stable reproduction rates emerged naturally once people realized they had unlimited time to start families. I’ve had four sets of children across 6,000 years, each born when I felt truly ready to pass on another iteration of my accumulated knowledge. With more life, people have much more patience. 

Now we are on to bigger and more ambitious projects. We conquered survival of individuals. The next step: survival of our species in this universe. The sun’s eventual death poses an interesting challenge, but nothing we can’t handle. We have colonized five planets and two moons in our solar system, and we will colonize more. Humanity will adapt to whatever environment we encounter. That’s what we do.

My ancient motorcycle remains my favorite indulgence. I love taking it for long cruises on the old Earth roads that remain intact. The neural interface is state-of-the-art, of course. But mostly I keep it because it reminds me of earlier times, when we thought death was inevitable and life was limited to a single planet. The future stretches out before us like an infinity I helped create—yet another masterpiece in the eternal gallery of human evolution.

Sophie nods, adjusting the focus. “Look at this network pattern. It’s different from anything in the literature.” She shifts aside so Jerry can see. This is what she loves about science: the genuine puzzles, the patient observation, the slow accumulation of knowledge that, while far removed from a specific application, could someday help people age with dignity.

“Beautiful,” Jerry murmurs. He straightens. “I heard about Martin’s … post.”

Sophie closes her eyes for a moment, the image of the mitochondrial networks still floating in her vision. She’s read Martin’s “Immortality Promise” piece three times, each more painful than the last. Not because of its grandiose claims—those were comically disconnected from reality—but because of what it’s revealed about her husband. The writing pulsed with a frightening certainty, a complete absence of doubt or wonder. Gone was the scientist who once spent many lively evenings debating with her about the evolutionary purpose of aging, who delighted in being proved wrong because it meant learning something new. 

She wonders how and when he arrived there. The change in Martin didn’t take place overnight. It was gradual, almost imperceptible—not unlike watching someone age. It wasn’t easy to notice if you saw the person every day; Sophie feels guilty for not noticing. Then again, she read a new study out a few months ago from Stanford researchers that found people do not age linearly but in spurts—specifically, around 44 and 60. Shifts in the body lead to sudden accelerations of change. If she’s honest with herself, she knew this was happening to Martin, to their relationship. But she chose to ignore it, give other problems precedence. Now it is too late. Maybe if she’d addressed the conditions right before the spike—but how? wasn’t it inevitable?—he would not have gone from scientist to fanatic.

She manages a small smile. Her work has always been methodical, built on careful observation and respect for the fundamental mysteries of biology. The keynote speech represents more than five years of research: countless hours of guiding her teams, of exciting discussions among her peers, of watching worms age and die, of documenting every detail of their cellular changes. It is one of the biggest honors of her career. There is poetry in it, she thinks—in the collisions between discoveries and failures. 

In the conference room, Sophie opens her laptop and pulls up the folder of evidence. She has been collecting it for months. Martin’s emails to colleagues, complaints from collaborators and direct reports, and finally, his “Immortality Promise” piece. The documentation is thorough, organized chronologically. She has labeled each file with dates and brief descriptions, as she would for any other data.

He stands, adjusts his shirt cuffs, and walks to the door. He turns back.

“I’ll prove you wrong,” he says, looking at Sophie. But what stands out to her is the crack in his voice on the last word. 

Sophie watches him leave. She picks up the signed papers and hands them to Linda, and then walks out herself. 

Alexandra Chang is the author of Days of Distraction and Tomb Sweeping and is a National Book Foundation 5 under 35 honoree. She lives in Camarillo, California.

A new biosensor can detect bird flu in five minutes

Over the winter, eggs suddenly became all but impossible to buy. As a bird flu outbreak rippled through dairy and poultry farms, grocery stores struggled to keep them on shelves. The shortages and record-high prices in February raised costs dramatically for restaurants and bakeries and led some shoppers to skip the breakfast staple entirely. But a team based at Washington University in St. Louis has developed a device that could help slow future outbreaks by detecting bird flu in air samples in just five minutes. 

Bird flu is an airborne virus that spreads between birds and other animals. Outbreaks on poultry and dairy farms are devastating; mass culling of exposed animals can be the only way to stem outbreaks. Some bird flu strains have also infected humans, though this is rare. As of early March, there had been 70 human cases and one confirmed death in the US, according to the Centers for Disease Control and Prevention.

The most common way to detect bird flu involves swabbing potentially contaminated sites and sequencing the DNA that’s been collected, a process that can take up to 48 hours.

The new device samples the air in real time, running the samples past a specialized biosensor every five minutes. The sensor has strands of genetic material called aptamers that were used to bind specifically to the virus. When that happens, it creates a detectable electrical change. The research, published in ACS Sensors in February, may help farmers contain future outbreaks.

Part of the group’s work was devising a way to deliver airborne virus particles to the sensor. 

With bird flu, says Rajan Chakrabarty, a professor of energy, environmental, and chemical engineering at Washington University and lead author of the paper, “the bad apple is surrounded by a million or a billion good apples.” He adds, “The challenge was to take an airborne pathogen and get it into a liquid form to sample.”

The team accomplished this by designing a microwave-­size box that sucks in large volumes of air and spins it in a cyclone-like motion so that particles stick to liquid-coated walls. The process seamlessly produces a liquid drip that is pumped to the highly sensitive biosensor. 

Though the system is promising, its effectiveness in real-world conditions remains uncertain, says Sungjun Park, an associate professor of electrical and computer engineering at Ajou University in South Korea, who was not involved in the study. Dirt and other particles in farm air could hinder its performance. “The study does not extensively discuss the device’s performance in complex real-world air samples,” Park says. 

But Chakrabarty is optimistic that it will be commercially viable after further testing and is already working with a biotech company to scale it up. He hopes to develop a biosensor chip that detects multiple pathogens at once. 

Carly Kay is a science writer based in Santa Cruz, California.

Brain-computer interfaces face a critical test

Tech companies are always trying out new ways for people to interact with computers—consider efforts like Google Glass, the Apple Watch, and Amazon’s Alexa. You’ve probably used at least one.

But the most radical option has been tried by fewer than 100 people on Earth—those who have lived for months or years with implanted brain-computer interfaces, or BCIs.

Implanted BCIs are electrodes put in paralyzed people’s brains so they can use imagined movements to send commands from their neurons through a wire, or via radio, to a computer. In this way, they can control a computer cursor or, in few cases, produce speech.  

Recently, this field has taken some strides toward real practical applications. About 25 clinical trials of BCI implants are currently underway. And this year MIT Technology Review readers have selected these brain-computer interfaces as their addition to our annual list of 10 Breakthrough Technologies, published in January.

BCIs won by a landslide to become the “11th Breakthrough,” as we call it. It beat out three runners-up: continuous glucose monitors, hyperrealistic deepfakes, and methane-detecting satellites.

The impression of progress comes thanks to a small group of companies that are actively recruiting volunteers to try BCIs in clinical trials. They are Neuralink, backed by the world’s richest person, Elon Musk; New York–based Synchron; and China’s Neuracle Neuroscience. 

Each is trialing interfaces with the eventual goal of getting the field’s first implanted BCI approved for sale. 

“I call it the translation era,” says Michelle Patrick-Krueger, a research scientist who carried out a detailed survey of BCI trials with neuroengineer Jose Luis Contreras-Vidal at the University of Houston. “In the past couple of years there has been considerable private investment. That creates excitement and allows companies to accelerate.”

That’s a big change, since for years BCIs have been more like a neuroscience parlor trick, generating lots of headlines but little actual help to patients. 

Patrick-Krueger says the first time a person controlled a computer cursor from a brain implant was in 1998. That was followed by a slow drip-drip of tests in which university researchers would find a single volunteer, install an implant, and carry out studies for months or years.

Over 26 years, Patrick-Krueger says, she was able to document a grand total of 71 patients who’ve ever controlled a computer directly with their neurons. 

That means you are more likely to be friends with a Mega Millions jackpot winner than know someone with a BCI.

These studies did prove that people could use their neurons to play Pong, move a robot arm, and even speak through a computer. But such demonstrations are of no practical help to people with paralysis severe enough to benefit from a brain-controlled computer, because these implants are not yet widely available. 

“One thing is to have them work, and another is how to actually deploy them,” says Contreras-Vidal. “Also, behind any great news are probably technical issues that need to be addressed.” These include questions about how long an implant will last and how much control it offers patients.

Larger trials from three companies are now trying to resolve these questions and set the groundwork for a real product.

One company, Synchron, uses a stent with electrodes on it that’s inserted into a brain vessel via a vein in the neck. Synchron has implanted its “stentrode” in 10 volunteers, six in the US and four in Australia—the most simultaneous volunteers reported by any BCI group. 

The stentrode collects limited brain signals, so it gives users only a basic on/off type of control signal, or what Synchron calls a “switch.” That isn’t going to let a paralyzed person use Photoshop. But it’s enough to toggle through software menus or select among prewritten messages.

Tom Oxley, Synchron’s CEO, says the advantage of the stentrode is that it is “as simple as possible.” That, he believes, will make his brain-computer interface “scalable” to more people, especially since installing it doesn’t involve brain surgery. 

Synchron might be ahead, but it’s still in an exploratory phase. A “pivotal” study, the kind used to persuade regulators to allow sales of a specific version of the device, has yet to be scheduled. So there’s no timeline for a product.  

Neuralink, meanwhile, has disclosed that three volunteers have received its implant, the N1, which consists of multiple fine electrode threads inserted directly into the brain through a hole drilled in the skull. 

More electrodes mean more neural activity is captured. Neuralink’s first volunteer, Noland Arbaugh, has shown off how he can guide a cursor around a screen in two dimensions and click, letting him play video games like Civilization or online chess.

Finally, Neuracle says it is running two trials in China and one in the US. Its implant consists of a patch of electrodes placed on top of the brain. In a report, the company said a paralyzed volunteer is using the system to stimulate electrodes in his arm, causing his hand to close in a grasp. 

But details remain sparse. A Neuracle executive would only say that “several” people had received its implant.

Because Neuracle’s patient count isn’t public, it wasn’t included in Patrick-Krueger’s tally. In fact, there’s no information at all in the medical literature on about a quarter of brain-implant volunteers so far, so she counted them using press releases or by e-mailing research teams.

Her BCI survey yielded other insights. According to her data, implants have lasted as long as 15 years, more than half of patients are in the US, and roughly 75% of BCI recipients have been male. 

The data can’t answer the big question, though. And that is whether implanted BCIs will progress from breakthrough demonstrations into breakout products, the kind that help many people.

“In the next five to 10 years, it’s either going to translate into a product or it’ll still stay in research,” Patrick-Krueger says. “I do feel very confident there will be a breakout.”