Access to experimental medical treatments is expanding across the US

A couple of weeks ago I was in Washington, DC, for a gathering of scientists, policymakers, and longevity enthusiasts. They had come together to discuss ways to speed along the development of drugs and other treatments that might extend the human lifespan.

One approach that came up was to simply make experimental drugs more easily accessible. Let people try drugs that might help them live longer, the argument went. Some groups have been pushing bills to do just that in Montana, a state whose constitution explicitly values personal liberty.

A couple of years ago, a longevity lobbying group helped develop a bill that expanded on the state’s existing Right to Try law, which allowed seriously ill people to apply for access to experimental drugs (that is, drugs that have not been approved by drug regulators). The expansion, which was passed in 2023, opened access for people who are not seriously ill. 

Over the last few months, the group has been pushing further—for a new bill that sets out exactly how clinics can sell experimental, unproven treatments in the state to anyone who wants them. At the end of the second day of the event, the man next to me looked at his phone. “It just passed,” he told me. (The lobbying group has since announced that the state’s governor Greg Gianforte has signed the bill into law, but when I called his office, Gianforte’s staff said they could not legally tell me whether or not he has.)

The passing of the bill could make Montana something of a US hub for experimental treatments. But it represents a wider trend: the creep of Right to Try across the US. And a potentially dangerous departure from evidence-based medicine.

In the US, drugs must be tested in human volunteers before they can be approved and sold. Early-stage clinical trials are small and check for safety. Later trials test both the safety and efficacy of a new drug.

The system is designed to keep people safe and to prevent manufacturers from selling ineffective or dangerous products. It’s meant to protect us from snake oil.

But people who are seriously ill and who have exhausted all other treatment options are often desperate to try experimental drugs. They might see it as a last hope. Sometimes they can volunteer for clinical trials, but time, distance, and eligibility can rule out that option.

Since the 1980s, seriously or terminally ill people who cannot take part in a trial for some reason can apply for access to experimental treatments through a “compassionate use” program run by the US Food and Drug Administration (FDA). The FDA authorizes almost all of the compassionate use requests it receives (although manufacturers don’t always agree to provide their drug for various reasons).

But that wasn’t enough for the Goldwater Institute, a libertarian organization that in 2014 drafted a model Right to Try law for people who are terminally ill. Versions of this draft have since been passed into law in 41 US states, and the US has had a federal Right to Try law since 2018. These laws generally allow people who are seriously ill to apply for access to drugs that have only been through the very first stages of clinical trials, provided they give informed consent.

Some have argued that these laws have been driven by a dislike of both drug regulation and the FDA. After all, they are designed to achieve the same result as the compassionate use program. The only difference is that they bypass the FDA.

Either way, it’s worth noting just how early-stage these treatments are. A drug that has been through phase I trials might have been tested in just 20 healthy people. Yes, these trials are designed to test the safety of a drug, but they are never conclusive. At that point in a drug’s development, no one can know how a sick person—who is likely to be taking other medicines— will react to it.

Now these Right to Try laws are being expanded even more. The Montana bill, which goes the furthest, will enable people who are not seriously ill to access unproven treatments, and other states have been making moves in the same direction.

Just this week, Georgia’s governor signed into law the Hope for Georgia Patients Act, which allows people with life-threatening illnesses to access personalized treatments, those that are “unique to and produced exclusively for an individual patient based on his or her own genetic profile.” Similar laws, known as “Right to Try 2.0,”  have been passed in other states, too, including Arizona, Mississippi, and North Carolina.

And last year, Utah passed a law that allows health care providers (including chiropractors, podiatrists, midwives, and naturopaths) to deliver unapproved placental stem cell therapies. These treatments involve cells collected from placentas, which are thought to hold promise for tissue regeneration. But they haven’t been through human trials. They can cost tens of thousands of dollars, and their effects are unknown. Utah’s law was described as a “pretty blatant broadbrush challenge to the FDA’s authority” by an attorney who specializes in FDA law. And it’s one that could put patients at risk.

Laws like these spark a lot of very sensitive debates. Some argue that it’s a question of medical autonomy, and that people should have the right to choose what they put in their own bodies.

And many argue there’s a cost-benefit calculation to be made. A seriously ill person potentially has more to gain and less to lose from trying an experimental drug, compared to someone who is in good health.

But everyone needs to be protected from ineffective drugs. Most ethicists think it’s unethical to sell a treatment when you have no idea if it will work, and that argument has been supported by numerous US court decisions over the years. 

There could be a financial incentive for doctors to recommend an experimental drug, especially when they are granted protections by law. (Right to Try laws tend to protect prescribing doctors from disciplinary action and litigation should something go wrong.)

On top of all this, many ethicists are also concerned that the FDA’s drug approval process itself has been on a downward slide over the last decade or so. An increasing number of drug approvals are fast-tracked based on weak evidence, they argue.

Scientists and ethicists on both sides of the debate are now waiting to see what unfolds under the new US administration.  

In the meantime, a quote from Diana Zuckerman, president of the nonprofit National Center for Health Research, comes to mind: “Sometimes hope helps people do better,” she told me a couple of years ago. “But in medicine, isn’t it better to have hope based on evidence rather than hope based on hype?”

This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, sign up here.

This baby boy was treated with the first personalized gene-editing drug

Doctors say they constructed a bespoke gene-editing treatment in less than seven months and used it to treat a baby with a deadly metabolic condition.

The rapid-fire attempt to rewrite the child’s DNA marks the first time gene editing has been tailored to treat a single individual, according to a report published in the New England Journal of Medicine.

The baby who was treated, Kyle “KJ” Muldoon Jr., suffers from a rare metabolic condition caused by a particularly unusual gene misspelling.

Researchers say their attempt to correct the error demonstrates the high level of precision new types of gene editors offer. 

“I don’t think I’m exaggerating when I say that this is the future of medicine,” says Kiran Musunuru, an expert in gene editing at the University of Pennsylvania whose team designed the drug. “My hope is that someday no rare disease patients will die prematurely from misspellings in their genes, because we’ll be able to correct them.”

The project also highlights what some experts are calling a growing crisis in gene-editing technology. That’s because even though the technology could cure thousands of genetic conditions, most are so rare that companies could never recoup the costs of developing a treatment for them. 

In KJ’s case, the treatment was programmed to correct a single letter of DNA in his cells.

“In reality, this drug will probably never be used again,” says Rebecca Ahrens-Nicklas, a physician at the Children’s Hospital of Philadelphia who treats metabolic diseases in children and who led the overall effort to treat the child.

That effort involved more than 45 scientists and doctors as well as pro bono assistance from several biotechnology companies. Musunuru says he cannot estimate how much it had cost in time and effort.

Eventually, he says, the cost of custom gene-editing treatments might be similar to that of liver transplants, which is around $800,000, not including lifelong medical care and drugs.

The researchers used a new version of CRISPR technology, called base editing, that can replace a single letter of DNA at a specific location. 

Previous versions of CRISPR have generally been used to delete genes, not rewrite them to restore their function.

The researchers say they were looking for a patient to treat when they learned about KJ. After he was born in August, a doctor noted that the infant was lethargic. Tests found he had a metabolic disorder that leads to the buildup of ammonia, a condition that’s frequently fatal without a liver transplant.

In KJ’s case, gene sequencing showed that the cause was a misspelled letter in the gene CPS1 that stopped it from making a vital enzyme.

The researchers approached KJ’s parents, Nicole and Kyle Muldoon, with the idea of using gene editing to try to correct their baby’s DNA. After they agreed, a race ensued to design the editing drug, test it in animals, and get permission from the US Food and Drug Administration to treat KJ in a one-off experiment.

The team says the boy, who hasn’t turned one yet, received three doses of the gene-editing treatment, of gradually increasing strength. They can’t yet determine exactly how well the gene editor worked because they don’t want to take a liver biopsy, which would be needed to check if KJ’s genes have really been corrected.

But Ahrens-Nicklas says that because the child is “growing and thriving,” she thinks the editing has been at least partly successful and that he may now have “a milder form of this horrific disease.”

“He’s received three doses of the therapy without any complications, and is showing some early signs of benefit,” she says. “It’s really important to say that it’s still very early, so we will need to continue to watch KJ closely to fully understand the full effects of this therapy.”

The case suggests a future in which parents will take sick children to a clinic where their DNA will be sequenced, and then they will rapidly receive individualized treatments. Currently, this would only work for liver diseases, for which it’s easier to deliver gene-editing instructions, but eventually it might also become a possible approach for treating brain diseases and conditions like muscular dystrophy.

The experiment is drawing attention to a gap between what gene editing can do and what treatments are likely to become available to people who need them.

So far, biotechnology companies testing gene editing are working only on fairly common gene conditions, like sickle cell disease, leaving hundreds of ultra-rare conditions aside. One-off treatments, like the one helping KJ, are too expensive to create and get approved without some way to recoup the costs.

The apparent success in treating KJ, however, is making it even more urgent to figure out a way forward. Researchers acknowledge that they don’t yet know how to scale up personalized treatment, although Musunuru says initial steps to standardize the process are underway at his university and in Europe.

A US court just put ownership of CRISPR back in play

The CRISPR patents are back in play.

On Monday, the US Court of Appeals for the Federal Circuit said scientists Jennifer Doudna and Emmanuelle Charpentier will get another chance to show they ought to own the key patents on what many consider the defining biotechnology invention of the 21st century.

The pair shared a 2020 Nobel Prize for developing the versatile gene-editing system, which is already being used to treat various genetic disorders, including sickle cell disease

But when key US patent rights were granted in 2014 to researcher Feng Zhang of the Broad Institute of MIT and Harvard, the decision set off a bitter dispute in which hundreds of millions of dollars—as well as scientific bragging rights—are at stake.

The new decision is a boost for the Nobelists, who had previously faced a string of demoralizing reversals over the patent rights in both the US and Europe.

“This goes to who was the first to invent, who has priority, and who is entitled to the broadest patents,” says Jacob Sherkow, a law professor at the University of Illinois. 

He says there is now at least a chance that Doudna and Charpentier “could walk away as the clear winner.”

The CRISPR patent battle is among the most byzantine ever, putting the technology alongside the steam engine, the telephone, the lightbulb, and the laser among the most hotly contested inventions in history.

In 2012, Doudna and Charpentier were first to publish a description of a CRISPR gene editor that could be programmed to precisely cut DNA in a test tube. There’s no dispute about that.

However, the patent fight relates to the use of CRISPR to edit inside animal cells—like those of human beings. That’s considered a distinct invention, and one both sides say they were first to come up with that very same year. 

In patent law, this moment is known as conception—the instant a lightbulb appears over an inventor’s head, revealing a definite and workable plan for how an invention is going to function.

In 2022, a specialized body called the Patent Trial and Appeal Board, or PTAB, decided that Doudna and Charpentier hadn’t fully conceived the invention because they initially encountered trouble getting their editor to work in fish and other species. Indeed, they had so much trouble that Zhang scooped them with a 2013 publication demonstrating he could use CRISPR to edit human cells.

The Nobelists appealed the finding, and yesterday the appeals court vacated it, saying the patent board applied the wrong standard and needs to reconsider the case. 

According to the court, Doudna and Charpentier didn’t have to “know their invention would work” to get credit for conceiving it. What could matter more, the court said, is that it actually did work in the end. 

In a statement, the University of California, Berkeley, applauded the call for a do-over.  

“Today’s decision creates an opportunity for the PTAB to reevaluate the evidence under the correct legal standard and confirm what the rest of the world has recognized: that the Doudna and Charpentier team were the first to develop this groundbreaking technology for the world to share,” Jeff Lamken, one of Berkeley’s attorneys, said in the statement.

The Broad Institute posted a statement saying it is “confident” the appeals board “will again confirm Broad’s patents, because the underlying facts have not changed.”

The decision is likely to reopen the investigation into what was written in 13-year-old lab notebooks and whether Zhang based his research, in part, on what he learned from Doudna and Charpentier’s publications. 

The case will now return to the patent board for a further look, although Sherkow says the court finding can also be appealed directly to the US Supreme Court. 

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.”

Your gut microbes might encourage criminal behavior

A few years ago, a Belgian man in his 30s drove into a lamppost. Twice. Local authorities found that his blood alcohol level was four times the legal limit. Over the space of a few years, the man was apprehended for drunk driving three times. And on all three occasions, he insisted he hadn’t been drinking.

He was telling the truth. A doctor later diagnosed auto-brewery syndrome—a rare condition in which the body makes its own alcohol. Microbes living inside the man’s body were fermenting the carbohydrates in his diet to create ethanol. Last year, he was acquitted of drunk driving.

His case, along with several other scientific studies, raises a fascinating question for microbiology, neuroscience, and the law: How much of our behavior can we blame on our microbes?

Each of us hosts vast communities of tiny bacteria, archaea (which are a bit like bacteria), fungi, and even viruses all over our bodies. The largest collection resides in our guts, which play home to trillions of them. You have more microbial cells than human cells in your body. In some ways, we’re more microbe than human.

Microbiologists are still getting to grips with what all these microbes do. Some seem to help us break down food. Others produce chemicals that are important for our health in some way. But the picture is extremely complicated, partly because of the myriad ways microbes can interact with each other.

But they also interact with the human nervous system. Microbes can produce compounds that affect the way neurons work. They also influence the functioning of the immune system, which can have knock-on effects on the brain. And they seem to be able to communicate with the brain via the vagus nerve.

If microbes can influence our brains, could they also explain some of our behavior, including the criminal sort? Some microbiologists think so, at least in theory. “Microbes control us more than we think they do,” says Emma Allen-Vercoe, a microbiologist at the University of Guelph in Canada.

Researchers have come up with a name for applications of microbiology to criminal law: the legalome. A better understanding of how microbes influence our behavior could not only affect legal proceedings but also shape crime prevention and rehabilitation efforts, argue Susan Prescott, a pediatrician and immunologist at the University of Western Australia, and her colleagues.

“For the person unaware that they have auto-brewery syndrome, we can argue that microbes are like a marionettist pulling the strings in what would otherwise be labeled as criminal behavior,” says Prescott.

Auto-brewery syndrome is a fairly straightforward example (it has been involved in the acquittal of at least two people so far), but other brain-microbe relationships are likely to be more complicated. We do know a little about one microbe that seems to influence behavior: Toxoplasmosis gondii, a parasite that reproduces in cats and spreads to other animals via cat feces.

The parasite is best known for changing the behavior of rodents in ways that make them easier prey—an infection seems to make mice permanently lose their fear of cats. Research in humans is nowhere near conclusive, but some studies have linked infections with the parasite to personality changes, increased aggression, and impulsivity.

“That’s an example of microbiology that we know affects the brain and could potentially affect the legal standpoint of someone who’s being tried for a crime,” says Allen-Vercoe. “They might say ‘My microbes made me do it,’ and I might believe them.”

There’s more evidence linking gut microbes to behavior in mice, which are some of the most well-studied creatures. One study involved fecal transplants—a procedure that involves inserting fecal matter from one animal into the intestines of another. Because feces contain so much gut bacteria, fecal transplants can go some way to swap out a gut microbiome. (Humans are doing this too—and it seems to be a remarkably effective way to treat persistent C. difficile infections in people.)

Back in 2013, scientists at McMaster University in Canada performed fecal transplants between two strains of mice, one that is known for being timid and another that tends to be rather gregarious. This swapping of gut microbes also seemed to swap their behavior—the timid mice became more gregarious, and vice versa.

Microbiologists have since held up this study as one of the clearest demonstrations of how changing gut microbes can change behavior—at least in mice. “But the question is: How much do they control you, and how much is the human part of you able to overcome that control?” says Allen-Vercoe. “And that’s a really tough question to answer.”

After all, our gut microbiomes, though relatively stable, can change. Your diet, exercise routine, environment, and even the people you live with can shape the communities of microbes that live on and in you. And the ways these communities shift and influence behavior might be slightly different for everyone. Pinning down precise links between certain microbes and criminal behaviors will be extremely difficult, if not impossible. 

“I don’t think you’re going to be able to take someone’s microbiome and say ‘Oh, look—you’ve got bug X, and that means you’re a serial killer,” says Allen-Vercoe.

Either way, Prescott hopes that advances in microbiology and metabolomics might help us better understand the links between microbes, the chemicals they produce, and criminal behaviors—and potentially even treat those behaviors.

“We could get to a place where microbial interventions are a part of therapeutic programming,” she says.

This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, sign up here.

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.

Longevity clinics around the world are selling unproven treatments

The quest for long, healthy life—and even immortality—is probably almost as old as humans are, but it’s never been hotter than it is right now. Today my newsfeed is full of claims about diets, exercise routines, and supplements that will help me live longer.

A lot of it is marketing fluff, of course. It should be fairly obvious that a healthy, plant-rich diet and moderate exercise will help keep you in good shape. And no drugs or supplements have yet been proved to extend human lifespan.

The growing field of longevity medicine is apparently aiming for something in between these two ends of the wellness spectrum. By combining the established tools of clinical medicine (think blood tests and scans) with some more experimental ones (tests that measure your biological age), these clinics promise to help their clients improve their health and longevity.

But a survey of longevity clinics around the world, carried out by an organization that publishes updates and research on the industry, is revealing a messier picture. In reality, these clinics—most of which cater only to the very wealthy—vary wildly in their offerings.

Today, the number of longevity clinics is thought to be somewhere in the hundreds. The proponents of these clinics say they represent the future of medicine. “We can write new rules on how we treat patients,” Eric Verdin, who directs the Buck Institute for Research on Aging, said at a professional meeting last year.

Phil Newman, who runs Longevity.Technology, a company that tracks the longevity industry, says he knows of 320 longevity clinics operating around the world. Some operate multiple centers on an international scale, while others involve a single “practitioner” incorporating some element of “longevity” into the treatments offered, he says. To get a better idea of what these offerings might be, Newman and his colleagues conducted a survey of 82 clinics around the world, including the US, Australia, Brazil, and multiple countries in Europe and Asia.

Some of the results are not all that surprising. Three-quarters of the clinics said that most of their clients were Gen Xers, aged between 44 and 59. This makes sense—anecdotally, it’s around this age that many people start to feel the effects of aging. And research suggests that waves of molecular changes associated with aging hit us in our 40s and again in our 60s. (Longevity influencers Bryan Johnson, Andrew Huberman, and Peter Attia all fall into this age group too.)

And I wasn’t surprised to see that plenty of clinics are offering aesthetic treatments, focusing more on how old their clients look. Of the clinics surveyed, 28% said they offered Botox injections, 35% offered hair loss treatments, and 38% offered “facial rejuvenation procedures.”  “The distinction between longevity medicine and aesthetic medicine remains blurred,” Andrea Maier of the National University of Singapore, and cofounder of a private longevity clinic, wrote in a commentary on the report.

Maier is also former president of the Healthy Longevity Medicine Society, an organization that was set up with the aim of establishing clinical standards and credibility for longevity clinics. Other results from the survey underline how much of a challenge this will be; many clinics are still offering unproven treatments. Over a third of the clinics said they offered stem-cell treatments, for example. There is no evidence that those treatments will help people live longer—and they are not without risk, either.

I was a little surprised to see that most of the clinics are also offering prescription medicines off label. In other words, drugs that have been approved for specific medical issues are apparently being prescribed for aging instead. This is also not without risks—all medicines have side effects. And, again, none of them have been proved to slow or reverse human aging.

And these prescriptions are coming from certified medical doctors. More than 80% of clinics reported that their practice was overseen by a medical doctor with more than 10 years of clinical experience.

It was also a little surprising to learn that despite their high fees, most of these clinics are not making a profit. For clients, the annual costs of attending a longevity clinic range between $10,000 and $150,000, according to Fountain Life, a company with clinics in Florida and Prague. But only 39% of the surveyed clinics said they were turning a profit and 30% said they were “approaching breaking even,” while 16% said they were operating at a loss.

Proponents of longevity clinics have high hopes for the field. They see longevity medicine as nothing short of a revolution—a move away from reactive treatments and toward proactive health maintenance. But these survey results show just how far they have to go.

This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, 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. 

2.

Sophie walks by Martin’s poster after she is done presenting her own. She is not immediately impressed by his work. It is not published, for one thing. But she sees how it is attention-grabbing and relevant, even necessary. He has a little crowd listening to him. He notices her—a frowning girl—standing in the back and begins to talk louder, hoping she hears.

“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. 

3.

They find one another in the hotel bar among other graduate students. The students are talking about the logistics of their futures: Who is going for a postdoc, who will opt for industry, do any have job offers already, where will their research have the most impact, is it worth spending years working toward something so uncertain? They stay up too late, dissecting journal articles they’ve read as if they were debating politics. They enjoy the freedom away from their labs and PIs. 

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 …” 

4-18.

Martin is enamored with Sophie. She is not only brilliant; she is helpful. She strengthens his papers with precise edits and grounds his arguments with stronger evidence. Sophie is enamored with Martin. He is not only ambitious; he is supportive and adventurous. He encourages her to try new activities and tools, both in and out of work, like learning to ride a motorcycle or using CRISPR.

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.

19.

“Join Abyssinian,” Sophie offers.

The company is growing. They want more researchers with data science backgrounds. He takes the job, drawn more by their future together than by the science.

20-35.

For a long time, they are happy. They marry. They do their research. They travel. Sophie visits Martin’s extended family in France. Martin goes with Sophie to her cousin’s wedding in Taipei. They get a dog. The dog dies. They are both devastated but increasingly motivated to better understand the mechanisms of aging. Maybe their next dog will have the opportunity to live longer. They do not get a next dog.

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.”

40.

At dinner on his 35th birthday, a friend jokes that Martin is now middle-aged. Sophie laughs and agrees, though she is older than Martin. Martin joins in the laughter, but this small comment unlocks a sense of urgency inside him. What once felt hypothetical—his own death, the death of his wife—now appears very close. He can feel his wrinkles forming.  

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.” 

43.

He begins taking supplements touted by tech influencers. He goes on a calorie-restricted diet. He gets weekly vitamin IV sessions. He looks into blood transfusions from young donors, but Sophie tells him to stop with all the fake science. She says he’s being ridiculous, that what he’s doing could be dangerous.  

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.

44.

One day, during a meeting, Martin says to Jerry, a well-­respected scientist at Abyssinian and in the electron microscopy imaging community at large, that EM is an outdated, old, crusty technology. Martin says it is stupid to use it when there are more advanced, cutting-edge methods, like cryo-EM and super-resolution microscopy. Martin has always been outspoken, but this instance veers into rudeness. 

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? 

45-49.

They continue to argue and the arguments are roundabout, typically ending with Sophie crying, absconding to her sister’s house, and the two of them not speaking for short periods of time.

50.

What hurts Sophie most is Martin’s persistent dismissal of death as merely an engineering problem to be solved. Sophie thinks of the ways the C. elegans she observes regulate their lifespans in response to environmental stress. The complex dance of genes and proteins that orchestrates their aging process. In the previous month’s experiment, a seemingly simple mutation produced unexpected effects across three generations of worms. Nature’s complexity still humbles her daily. There is still so much unknown. 

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.”

50.

Martin blames the past. He realizes he should have tried harder to become a professor. Let Sophie make the industry money—he could have had academic clout. Professor Warwick. It would have had a nice sound to it. To his dismay, everyone in his lab calls him Martin. Abyssinian has a first-name policy. Something about flat hierarchies making for better collaboration. Good ideas could come from anyone, even a lowly, unintelligent senior associate scientist in Martin’s lab who barely understands how to process a data set. A great idea could come from anyone at all—except him, apparently. Sophie has made that clear.

51-59.

They live in a tenuous peace for some time, perfecting the art of careful scheduling: separate coffee times, meetings avoided, short conversations that stick to the day-to-day facts of their lives.

60.

Then Martin stands up to interrupt a presentation by the VP of research to announce that studying natural aging is pointless since they will soon eliminate it entirely. While Jerry may have shrugged off Martin’s aggressiveness, the VP does not. This leads to a blowout fight between Martin and many of his colleagues, in which Martin refuses to apologize and calls them all shortsighted idiots. 

Sophie watches with a mixture of fear and awe. Martin thinks: Can’t she, my wife, just side with me this once? 

61.

Back at home:

Martin at the kitchen counter, methodically crushing his evening supplements into powder. “I’m trying to save humanity.” He taps the powder into his protein shake with the precision of a scientist measuring reagents. “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.”

64.

Martin doesn’t hear from his wife for four days, despite texting her 16 times—12 too many, by his count. He finally breaks down enough to call her in the evening, after a couple of glasses of aged whisky (a gift from a former colleague, which Martin has rarely touched and kept hidden in the far back of a desk drawer). 

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

66.

Forget her, he thinks, leaning back in his Steelcase chair, adjusted specifically for his long runner’s legs and shorter­-than-average torso. At 39, Martin’s spreadsheets of vitals now show an upward trajectory; proof of his ability to reverse his biological age. Sophie does not appreciate this. He stares out his office window, down at the employees crawling around Abyssinian Bio’s main quad. How small, he thinks. How significantly unaware of the future’s true possibilities. Sophie is like them. 

67.

Forget her, he thinks again as he turns down a bay toward Robert, one of his struggling postdocs, who is sitting at his bench staring at his laptop. As Martin approaches, Robert minimizes several windows, leaving only his home screen behind.

“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.

71.

Martin feels better after writing it out. He rereads it a couple times, feels even better. Then he has the idea to send his writing to the department administrator. He asks her to create a new tab on his lab page, titled “Immortality Promise,” and to post his piece there. That will get his message across to Sophie and everyone at Abyssinian. 

72.

Sophie’s boss, Ray, is the first to email her. The subject line: “martn” [sic]. No further words in the body. Ray is known to be short and blunt in all his communications, but his meaning is always clear. They’ve had enough conversations about Martin by then. She is already in the process of slowly shutting down his projects, has been ignoring his texts and calls because of this. Now she has to move even faster. 

73.

Sophie leaves her office and goes into the lab. As an executive, she is not expected to do experiments, but watching a thousand tiny worms crawl across their agar plates soothes her. Each of the ones she now looks at carries a fluorescent marker she designed to track mitochondrial dynamics during aging. The green glow pulses with their movements, like stars blinking in a microscopic galaxy. She spent years developing this strain of C. elegans, carefully selecting for longevity without sacrificing health. The worms that lived longest weren’t always the healthiest—a truth about aging that seemed to elude Martin. Those worms taught her more about the genuine complexity of aging. Just last week, she observed something unexpected: The mitochondrial networks in her long-lived strains showed subtle patterns of reorganization never documented before. The discovery felt intimate, like being trusted with a secret.

“How are things looking?” Jerry appears beside her. “That new strain expressing the dual markers?”

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. 

74.

She sees in his words a man who has abandoned the fundamental principles of science. His piece reads like a religious text or science fiction story, casting himself as the hero. He isn’t pursuing research anymore. He hasn’t been for a long time. 

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.

75.

“You’re giving the keynote at next month’s Gordon conference,” Jerry reminds her, pulling her back to reality. “Don’t let this overshadow that.”

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. 

76.

The knock on her office door comes at 2:45. Linda from HR, right on schedule. Sophie walks with her to conference room B2, two floors below, where Martin’s group resides. Through the glass walls of each lab, they see scientists working at their benches. One adjusts a microscope’s focus. Another pipettes clear liquid into rows of tubes. Three researchers point at data on a screen. Each person is investigating some aspect of aging, one careful experiment at a time. The work will continue, with or without Martin.

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.

77.

Martin walks in at 3:00. Linda from HR shifts in her chair. Sophie is the one to hand the papers over to Martin; this much she owes him. They contain words like “termination” and “effective immediately.” Martin’s face complicates itself when he looks them over. Sophie hands over a pen and he signs quickly.  

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.