Last year Ruxandra Teslo, a policy analyst who focuses on clinical trials, posted an idea for supercharging medical AI systems: Use data from failed biotech companies.
By bidding at their bankruptcy proceedings, she proposed, it might be possible to obtain detailed regulatory filings, manufacturing strategies, and safety data—types of information usually considered trade secrets. She called these documents “biotech’s lost archive” and said they could be used to help train AIs that would act as powerful copilots in the often opaque drug approval process.
Today the OpenAI Foundation, the nonprofit parent of OpenAI, said it would fund her idea as part of a new effort it calls Public Data for Health, which aims to help artificial intelligence make big leaps in medicine by paying to create “high-quality scientific datasets.”
The basic idea is that AI isn’t going to be capable of making important breakthroughs in curing disease unless researchers can feed the models much more information than they have so far.
“Everyone is recognizing that data is the biggest bottleneck in successfully applying AI to biology,” says Morgan Levine, a former vice president for computation at Altos Labs, a longevity company.
In its initial round of data grants, the OpenAI Foundation also announced that it would give $40 million to a program to collect data about novel cancer vaccines at the University of North Carolina, Chapel Hill, and support OpenAdmet, a group that runs competitions in which researchers try to predict drug effects.
Teslo’s idea for a biotech archive received $500,000 and will be pursued by 1Day Sooner, an advocacy group representing clinical trial volunteers, which she advises.
“We expect many remaining breakthroughs in preventing and curing disease to come from pairing the intelligence of new models with more observations of the world—in other words, more data,” the OpenAI Foundation said in a statement.
OpenAI started as a nonprofit, but leader Sam Altman restructured it to form a for-profit corporation that develops new models, launches products, and is now planning an initial public offering of stock that could value it at $1 trillion.
Because the foundation holds a 26% equity stake in OpenAI, it is now be on track to become the richest charitable organization on the planet, potentially sitting on $250 billion in stock value. (By comparison, the Gates Foundation and a trust associated with it held about $180 billion at the end of 2025.)
Making good use of that kind of money will not be easy. The foundation, based in San Francisco, is still hiring for many key roles and started ramping up its grantmaking only this year. Its largest single gift so far, of $100 million, was awarded in August to the Common Health Coalition, an organization that helps patients get access to drugs for hepatitis C.
OpenAI’s charitable efforts come even as apocalyptic fears have broken out about the possibility that runaway AI could wipe out all human life, possibly by launching a deadly bioweapon.
Those fears have been stoked by AI company insiders, some of whom say the chance of human extinction within the next decade is 10% or more. Last week, Altman and xAI founder Elon Musk both endorsed a call by Anthropic CEO Dario Amodei to “slow the pace at which we improve the capabilities of AI models” so that risk prevention can catch up.
Jacob Trefethen, an executive at the foundation, says it essentially operates separately from OpenAI but shares an official mission of ensuring that artificial intelligence “benefits all of humanity.”
“We’re starting grantmaking when we think the best way to achieve that mission is to make grants to external nonprofits, research institutions, and other third parties,” Trefethen said in an interview. He says the foundation hopes to give away $1 billion by the end of the year.
The $500,000 grant to 1Day Sooner will help the group prove it can obtain the data troves of bankrupt companies, says the organization’s president and cofounder, Josh Morrison. He thinks nonexclusive copies of company datasets could be acquired for only “a few tens of thousands of dollars” each.
His organization is currently in possession of three datasets, two of them donated by Lumen Bioscience, a biotech that previously used the Chapter 11 strategy to gain insights into another company’s drug development efforts.
Morrison says two other attempts to obtain drug company files this year proved unsuccessful, after 1Day Sooner’s bids were not accepted.
Bankruptcies could become what some are calling a “new land grab” for AI training. Last month, Google won a bid to take over the corporate data of the failed carrier Spirit Airlines, including 100 million emails. That led to objections from flight attendants and others who worried that private or proprietary data could be exposed.
The drug company files that 1Day Sooner is seeking are known as common technical documents. They typically contain the back-and-forth between companies and regulators, as well as detailed scientific and medical measurements, and essentially provide everything that is known about a drug.
According to Teslo, who is a writer for Works In Progress and a nonresident fellow at the Institute for Progress, a think tank in Washington, DC, a stockpile of such files could help turn an AI into a regulatory expert, which in her view could be one of the main ways AI helps speed cures to market.
“People say ‘We will invent AI, and AI will cure cancer,’ but that’s very removed from the messy reality and the regulatory process,” she says. “About 70% of the money and time in drug development is spent in clinical development—organizing the trials and testing the drug—but despite that, the process is basically a black box, especially for small biotech companies generating the innovations.”
Once an organ is removed from a donor’s body, the clock starts ticking. Surgeons usually flush the organ with a preservative solution, bag it, and put it on ice—where it immediately starts to degrade. The team has a matter of hours to get it into a recipient’s body.
There’s another option—one that has been growing in popularity in recent years, especially for donated organs that aren’t in the healthiest state. Some hospitals opt to put them on machines that pump them with nutrients and remove waste products, usually for around six to 12 hours. It’s a bit like being back in a body.
This allows doctors to assess the organs, and some recent studies suggest that time spent on these perfusion machines helps them do better once they’re transplanted. Now, scientists have found that perfused organs seem to get younger, at least at a molecular level.
The research, shared with MIT Technology Review, provides molecular clues as to why organs from younger donors are known to have a higher success rate. It might also help explain why perfused organs are less likely to fail once they make it into a recipient.
The researchers behind the study hope to find new ways to test the health of donated organs and potentially develop additional tools to repair organs that might otherwise be discarded. “If [we] can improve the utilization of organs beyond what the current systems can do, then that’s a win in my book,” says Jesse Poganik, who studies aging at Brigham and Women’s Hospital in Boston and coauthored the study.
Clocking organs
Poganik—along with colleagues including Heidi Yeh and Alban Longchamp, transplant surgeons at Mass General Brigham—used “aging clocks” to assess donated livers. These are scientific tools designed to measure biological age—a result that is meant to convey more about the health status of an organ (or person) than chronological age.
In an initial experiment, the team used a clock to look at the patterns of chemical marks on DNA in 37 samples taken from 19 donated livers. Such epigenetic patterns are known to change as we age. But when the team compared samples from livers kept on ice and those that were perfused, the team found a “striking” pattern in the latter.
“Machine-perfused livers, in spite of being older or having other disadvantageous characteristics, had a biological age that was lower than [non-perfused] livers that were chronologically younger,” says Yeh, who led the work.
To investigate further, Yeh and her colleagues analyzed another 208 samples from 103 donated livers. This time, they used different aging clocks—ones that essentially measure how genes are working. They studied samples biopsied from the livers after they had been stored for up to around six hours either in cold storage or on machine perfusion.
In most cases, they also assessed a second sample taken around an hour after the livers had been transplanted into a recipient. Once the organ’s blood supply is reestablished in the body, “you have a few other things to do,” says Longchamp. “Then you just do a quick biopsy before you close.”
According to the clocks, which were developed to measure age and risk of death, the machine-perfused livers were biologically younger, the team found. “Pumping them at 34 degrees with oxygen and nutrients actually reversed the biological age,” says Longchamp. The results have been been shared with colleagues at an industry conference, he says.
“If you adjust out chronological age … to have a fair head-to-head comparison, the difference between the two is on the order of 30%,” says Poganik. “It’s logical to say that perfusion drives this effect.”
The biological ages of all the livers tended to increase as soon as they were put into a recipient’s body, probably as a result of stresses on the organs. But still, the effect endured—the perfused organs remained biologically younger.
Nathanael Raschzok, a transplant surgeon at Charité Universitätsmedizin Berlin in Germany who was not involved in the research, says the work is impressive. But it’s not yet clear what these changes might mean for the recipients of these organs, he says. The organs in the study were donated by people in their 30s, 40s, and 50s. Raschzok wants to know the effect of perfusion on the liver of an 80-year-old. “Every so often, we use organs from 70-, 80-, 85-year-old donors,” he says.
A better understanding of why the organs appear to be getting biologically younger might lead to therapies that achieve the same effect with a drug that could potentially be used to treat a donated organ for a fraction of the price, he adds. That’s important because perfusion is expensive—Raschzok says it costs around €10,000 in Germany (a quarter of the budget for a transplant), while the cost in the US comes to around $80,000 to $100,000 per organ, says Yeh.
Molecular repair
Yeh and her colleagues weren’t able to study most of the livers before perfusion. That’s because donated organs are generally not considered to be under the purview of the hospital until they’ve been placed on perfusion machines, she says. (Organ procurement procedures vary, but for the team as Mass General Brigham, donated organs are put on perfusion devices at the donor’s hospital. “There’s this sort of nebulous period where it’s not clear who the organ belongs to,” says Yeh.)
Still, by looking at the genes and molecular pathways that seem to be altered in perfused organs, she and her colleagues can garner some clues. At a molecular level, the team saw changes in cell pathways linked to inflammation and the structure of tissues, for example. They also saw more activity in a pathway that allows cells to remove and recycle damaged cell parts, says Yeh.
Poganik hopes to develop some kind of test that would determine which organs, on the basis of their biological age, are suitable for transplantation. He and his colleagues are also experimenting with potential drug treatments that might push the biological age of an organ even lower.
In the meantime, any liver that is not from a “perfect, young, brain-dead donor” could probably benefit from perfusion, says Yeh. The devices are already transforming transplant surgery. Just a few years ago, she says, she and her colleagues would avoid using livers from people who’d suffered a circulatory death (when the heart stops beating and there’s a damaging lack of blood flow to organs) and were over 40. Today, they use livers from such donors over the age of 70. “Perfusion has completely changed the landscape of transplantation in the last three years,” she says.
Every year, MIT Technology Review puts together a list of some of the brightest and best young minds working across science and technology. Our 35 Innovators Under 35 are the ones to watch—people whose research and technical work stands to shape the future of their fields.
This year, the list includes nine people who are transforming biotech. And this week, I’m going to give you a taste of some of the very cool stuff five of them are working on, which includes lifesaving innovations and groundbreaking “age reversal” tech.
1. Preventing maternal deaths
Let’s start with Paschal Kija, a 28-year-old who has developed a device to treat postpartum hemorrhage—a dangerous birth complication that contributes to around 29% of maternal deaths in his home country, Tanzania. The Mkanda Salama (“Safe Wrap” in Swahili) is easy to use and costs just $70. A study found that it stopped postpartum bleeding in 73% of women within 20 minutes.
2. Making brain electrodes inspired by Japanese art
For decades, scientists have been developing, testing, and implanting brain electrodes. These devices are literally inserted into people’s brains, so while they can help us understand brain activity and treat various neurological disorders, it’s not totally surprising that they can also cause a bit of damage. Xiao Yang, 34, is working on ultra-small electrodes, which she hopes will have less of an impact on surrounding brain tissue. Her electrodes are flexible, too—in fact, they look a lot like actual neurons.
Yang is also creating sheets of electrodes to study brain cells in the lab. Inspired by kirigami—the traditional Japanese art of cutting paper to form three-dimensional shapes—she’s created a sheet of electrodes with a honeycombed structure shaped like a spiral basket. And she’s already using it to study brain cells.
3. Developing an all-new treatment for baby KJ
In 2024, Kyle “KJ” Muldoon Jr. was born with a rare and potentially fatal genetic disorder. Sarah Grandinette was a member of a team that developed an entirely new, personalized treatment for him—a gene-editing therapy essentially designed to correct a genetic misspelling.
Grandinette, who is now 26, created cells with KJ’s genetic variant and used them to screen gene-editing approaches; then she tested potential medicines in mice and monkeys. KJ ultimately got his first dose of the resulting treatment when he was about seven months old. He responded well and was eventually discharged from hospital. He’s “doing pretty great,” she says.
4. Reversing the aging process to treat eye disease
The buzziest tech in longevity right now centers on reprogramming—attempts to rewind the age of cells by resetting them to a more embryonic-like state. In a study published in 2020, Yuancheng (Ryan) Lu (now 34) and his colleagues showed that a reprogramming therapy reversed vision loss in aged, blind mice. Now an almost identical version of that therapy is being tested in people with eye disease. Life Biosciences, the company developing the drug, dosed its first volunteer in June.
5. Using AI to design new viruses
Last year, Samuel King used a generative AI model to come up with new genetic blueprints for bacteriophages—teeny viruses that can infect bacteria. Once he had those blueprints, he printed them out as strands of DNA. In experiments, he found that those AI-designed viruses could create new copies of themselves, burst out of bacterial cells, and infect other nearby bacteria. Viruses aren’t alive, but King, 27, hopes that AI-designed life forms might one day be used to make drugs or soak up pollution.
You can read more about these innovators, and the others on the biotech list, here.
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.
The entrance of major AI companies into healthcare is a meaningful and welcome development, accelerating the technical foundation available to the industry.
Their models are increasingly capable of processing long clinical records, interpreting complex terminology, comparing documentation against evidence and generating coherent summaries from large volumes of information. For clinicians, operators, and administrative teams who spend significant time searching through fragmented data, these advances are helping reduce cognitive burden and make high-value information easier to access.
But healthcare leaders should not confuse model capability with operational capability.
Healthcare’s administrative challenges are caused by fragmented information, fragmented workflows, and fragmented accountability, not a lack of information. The industry has spent decades investing in systems that capture activity: electronic health records, billing platforms, payer portals, scheduling systems, call center platforms, and analytics applications. Each system records something important. But few were designed to reason across the full chain of decisions that determines whether patients get timely access, clinicians have the right documentation and providers are reimbursed appropriately.
This is the problem that AI must now confront.
Revenue cycle is becoming one of healthcare AI’s proving grounds
The revenue cycle is the process healthcare providers use to get paid for care — from scheduling and registration through coding, billing, payer follow-up, and payment collection.
It is unusually suited to rigorous AI deployment because it combines high transaction volume, complex reasoning, structured and unstructured data, measurable outcomes, and significant operational variation. It also sits at the intersection of financial performance, patient access, and administrative workload.
A single claim can be influenced by patient insurance information, clinical documentation, coding rules, payer-specific policies, prior authorization requirements, medical necessity criteria, and many other data sources and operational processes. A breakdown in any one of those areas can create downstream consequences weeks or months later.
This is why generic automation has often fallen short.
Traditional robotic process automation works well when workflows are stable and rules are predictable, but healthcare administration is neither. Payer requirements change. Documentation expectations evolve. Exceptions are common and often material.
Large language models improve part of the equation, extracting meaning from narrative text, summarizing records and supporting reasoning over complex documentation. But when used alone, they inherit important limitations. They may produce plausible outputs without sufficient traceability. They may lack awareness of local workflow constraints. They may miss payer-specific history or context that determines whether an action is likely to change an outcome.
Why foundation models will become necessary but insufficient
The major AI firms are solving real technical problems for healthcare.
Better context windows make it easier to process longitudinal records. Stronger reasoning improves the interpretation of complex clinical scenarios. Better multimodal capabilities may eventually help connect text, imaging, structured data, and clinical signals in more useful ways. Safer model behavior and healthcare-specific tuning will continue to improve adoption.
These capabilities will make healthcare work faster, more consistent and easier to navigate. But they will not, on their own, solve deep-rooted administrative complexity.
Much of healthcare’s operational knowledge does not live in general medical literature, coding manuals, or public payer guidance. It lives in the accumulated experience of what actually happens after decisions are made. For example:
Why does one appeal strategy outperform another?
Which documentation gaps are most likely to cause reimbursement delay?
How does a specific payer respond to a particular clinical argument?
These insights are behavioral, operational, and longitudinal. They emerge from years of transactions, outcomes, exceptions, and human judgment.
As foundation models become more capable, access to baseline healthcare knowledge will become less differentiating. Most leading systems will be able to interpret ICD-10 codes, recognize medical terminology, summarize payer policies, and reason over public clinical criteria. The durable advantage will come from how organizations combine that model intelligence with proprietary operational data, structured knowledge, workflow context, and governance.
The technical shift: From automation to orchestration
Agentic orchestration turns foundation model understanding into coordinated action — intelligence that can follow work across systems, apply the right rules, adapt when something changes, and keep learning from what happens next.
A prior authorization workflow, for example, may require retrieving clinical documentation through fast healthcare interoperability resources (FHIR) APIs, mapping patient history to payer criteria, identifying missing evidence, generating a submission packet, routing exceptions to a specialist, monitoring payer response, adjusting patient care pathways, and learning from the outcome.
This type of workflow requires coordination. It also requires guardrails: regulatory requirements, privacy standards, clinical policies, coding rules, payer criteria, and organizational risk thresholds. One promising approach is hybrid architecture that combines LLMs with structured knowledge bases, symbolic logic, reinforcement learning, and deterministic validation layers.
At Ensemble, this is the design principle behind EIQ, our revenue cycle intelligence engine. EIQ brings together operational activity, clinical documentation, payer behavior, and reimbursement outcomes into a continuously learning intelligence layer that’s integrated with the hospital’s electronic health record (EHR). It supplements the system of record with a system of intelligence, designed to connect information and surface actions most likely to improve outcomes.
EIQ uses a neuro-symbolic approach that combines LLMs and custom small language models with rules-based reasoning. That architecture is built on one of the most robust datasets in healthcare, informed by more than a decade of award-winning operational performance, transaction history, payer behavior, and operator decision-making. The language models help interpret information and generate human-readable outputs. The symbolic layer represents policies, rules, payer requirements, and workflow constraints so the system can apply guardrails, make reasoning steps more traceable and recommend actions that fit the specific operational context.
What the next decade will reward
The contribution of major AI firms to healthcare will be significant. Their models will become faster, safer, more capable, and more accessible.
But the next decade of healthcare AI will be defined by integration, not model capability alone.
The organizations that create the most value will be those that connect models to governed data, operational workflows, domain expertise, human oversight, and measurable outcomes. They will understand that healthcare intelligence cannot live in a separate interface. It has to exist inside the decisions that shape access, documentation reimbursement, and patient experience.
This content was produced by Ensemble. It was not written by MIT Technology Review’s editorial staff.
Yuancheng (Ryan) Lu is obsessed with aging. And with eyes. As he steps outside the Whitehead Institute in Cambridge, Massachusetts, his aviator glasses darken automatically in the sun. Age-related blindness runs in his family. A great-aunt in China, the story goes, was killed crossing a road because she couldn’t see oncoming traffic. And Lu’s own 23andMe test came back with a mutation for macular degeneration, a top cause of vision loss in old age. Exposure to bright sunlight is another risk factor—thus the shades. “They protect me,” he says. “Plus, they look cool.”
Lu, 34, works on gene therapies to prevent age-related vision loss. “I think the eye is a really unique system to study aging and rejuvenation,” he says. “I could give a whole presentation.” Pushing up my reading glasses, I lean in to listen.
Lu is behind one of the coolest results in rejuvenation science—and in eye research. In 2018, while earning his PhD at Harvard Medical School, he used an age-reversal technique called reprogramming to repair the optic nerves of mice. He crushed the nerves, blinding the animals, and then injected the cells with a gene therapy meant to restore them to a youthful state. Sixteen days later, the nerves were growing back, their axons showing up through a microscope as spidery orange filaments.
As hype around age reversal swirls, Lu has been busy in the lab searching for what he calls “the next generation of rejuvenation therapies.”
The head of that lab, the longevity scientist David Sinclair, remembers when Lu texted him the pictures: “He asked me, ‘What do you see here?’ And I said, ‘I see the future.’” Later tests carried out in a box with rotating bars of light showed the mice were tracking the changes. They could see again.
This year, nearly the exact genetic therapy Lu created for mice entered human clinical trials. On June 9, the startup Life Biosciences, which Sinclair cofounded and in which Lu owns a small stake, announced it had injected the treatment into the eye of a person with glaucoma. The trial has been big news. A headline in the New York Times suggested the technology could “change humanity.” Posters on X gushed, with one declaring that “the fountain of youth is here.”
“It’s remarkable that what he developed as a student is now going into humans,” says Sinclair of the treatment, now called ER-100. “It’s barely even changed since he built it.”
Reprogramming refers to an age-restoring process that takes place inside an embryo. It’s why babies are born young, not old: The DNA they’ve inherited from their parents has been scrubbed and reset. In 2006, Japanese researchers showed they could cause the process to occur in the lab by introducing just four key genes, known by the acronym OSKM. Add these to a cell from a 100-year-old and it will turn into a stem cell that acts as if it was plucked from an embryo.
That’s powerful stuff. But we don’t want to turn people into blobs of stem-cell protoplasm. Lu figured out a way to control the effect. He trimmed the list of genes to just OSK—leaving out M, for Myc, the one most likely to cause dangerous changes like cancer. His extra flash of insight was that reprogramming could be tested on the optic nerve; the eye is particularly accessible.
Lu’s result, published in Nature in 2020, helped set off an investment rush. Since then, US tech billionaires have placed huge bets on private companies like Altos Labs and NewLimit to explore reprogramming and anti-aging medicine. The day I spoke with Lu, he’d spent the morning meeting with the business magnate Zhong Shanshan, one of China’s richest people.
Still, as hype around age reversal swirls, Lu has been notably absent from the public conversation. He’s been busy in the lab searching for what he calls “the next generation of rejuvenation therapies.” With a sigh, Lu describes the grueling effort over the last six years to understand what OSK really does. The treatment remains toxic to many cell types, and he says it’s becoming obvious that different factors drive aging in each kind. This year, for example, he identified a gene responsible for protecting the retina from damage by free radicals—the main cause of age-related macular degeneration.
While Sinclair, his former boss, believes humans could live to be 200, Lu disagrees. There’s just too much that goes wrong as we age. His work with OSK, he says, was more a proof of concept than a silver bullet. But it did change the conversation. “Six years ago, you couldn’t talk about rejuvenation. We didn’t use that word—there was pushback,” Lu tells me. “But I think people have accepted the concept that you can really reverse molecular age.”
His son, Brody, was born in March 2023. It wasn’t long before he started to show signs of developmental delay, says DeVault. As time went on, Brody started missing key milestones in speech, movement, and coordination, he says.
When Brody was around two and a half years old, a genetic test revealed creatine transporter deficiency—a rare condition in which the brain and muscles lack the energy they need to develop.
There are no cures for Brody’s condition. But DeVault has learned of a company developing a drug that might help. That drug is still in the early stages of development and has only been tested in animals and a small number of healthy adults. Doctors can’t prescribe it.
DeVault knows the drug might not work. But he’s doing all he can to access it regardless. And a new law in Montana could make it easier for people in his position to get access to treatments—at least in theory.
Today, Brody is three years old. His dad describes him as a happy, curious, and loving little boy who wants to learn. But Brody struggles to communicate. “He’s got no words, really,” says DeVault. “He wants to communicate more than he’s able to … which then turns into frustration.”
It’s difficult for Brody to tell his parents whether he’s hot, cold, hungry, thirsty, uncomfortable, or even in pain, says DeVault. He recently found Brody standing on an anthill in the backyard, being bitten by red ants. “These fire ants were just going to town on his feet … and he was just looking,” he says.
Brody has muscle weakness too. “He can’t move very fast, he doesn’t have a ton of strength … and it takes a lot of energy for him to walk balanced,” says DeVault. “His arms are skinnier than [those of] his nine-month-old sister.”
It’s concerning, but DeVault is most worried about Brody’s neurological development. Toddlers’ brains are exceptionally “plastic”—the first years of a child’s life are thought to be crucial for long-term brain development.
A biotechnology company in France is working on a drug to help people like Brody. Creatine usually provides brain cells with energy. People with creatine transporter deficiency (CTD) can’t get creatine into the brain.
The team at Ceres Brain Therapeutics is developing a treatment designed to bypass this issue and effectively deliver creatine directly to the brain. So far, the team has seen promising results in mice, says Ceres CEO Thomas Joudinaud.
The company also recently completed a phase I clinical trial that involved testing various doses of the drug, which is delivered as a nasal spray, in 48 healthy adult volunteers. That trial has not yet been published, says Joudinaud. The drug has not been tested in people with CTD, or in children.
“I look at this, and I’m like, that is my one shot for Brody,” says DeVault.
Kris DeVault, his son Brody, and his wife and young daughter.
COURTESY OF THE DEVAULT FAMILY
Joudinaud is planning a phase II trial in people with CTD, as well as others with amyotrophic lateral sclerosis. But that trial will take place in France, and it’s unlikely that Brody will be able to take part, says DeVault.
Ceres can’t make the drug available to Brody under an expanded access scheme run by the US Food and Drug Administration either, because the drug has not been registered with the FDA, and because it is currently manufactured in a way that does not comply with FDA regulations, says Joudinaud.
Even if that phase II trial is successful, and if the drug is ultimately approved, it is unlikely to reach the US market for at least a few years. DeVault is worried that will be too late for Brody—he’ll be “past his plasticity window” by then, he says.
Now, with the adoption of a new law in Montana, he theoretically has another option. Montana has had a “right to try” law—which allows terminally ill people to apply for access to unapproved drugs—in place since 2015. In 2023, a new law technically expanded this option to people who were not terminally ill, providing the drugs have been through preliminary phase I clinical trials. A second law aimed to clarify how clinics could sell and administer those treatments to patients. And last weekend, the state’s department of Health and Human Services finalized a set of rules for those clinics.
An experimental treatment review board (ETRB) has been established to review applications for access to experimental, unproven, and unapproved drugs. And it is set to review its first two applications in the coming weeks.
Ceres could also apply to Montana’s ETRB to sell its experimental treatment to Brody’s parents via a clinic in the state. But Joudinaud is reluctant, at least for the time being. While he thinks that Montana’s setup is “very interesting and very pragmatic” and “suitable for our drug,” he’s worried about getting on the wrong side of the FDA.
DeVault has been pleading with FDA staffers for a written statement essentially promising that biotech companies participating in Montana’s program won’t be penalized later on, especially when they eventually try to get their drugs approved in the US. But he hasn’t made any progress.
Now he’s looking beyond Montana. He’s considering accessing treatment in Próspera, a private city and “special economic zone” in Roatán, Honduras, where a clinic sells unproven stem-cell and gene therapies, among others.
Many scientists have cautioned against the use of such “offshore” clinics. Even when it comes to Montana, scientists, bioethicists, and health law experts will caution that phase I clinical trials don’t prove a drug is safe. And they certainly don’t prove a drug’s efficacy, either.
When I spoke to Aaron Kesselheim, a professor of medicine at Harvard Medical School with expertise in health policy and drug regulation, about the Montana law earlier this week, he made his concerns clear. “Patients who want these kinds of treatments deserve them to be rigorously assessed so that [they] can better understand what they’re getting themselves into, and what they’re paying their hard-earned money for.”
But DeVault pushes back on these arguments. “I’m a full-grown human being,” he says. “I’m capable of going to Vegas right now … blowing it all on the poker table, [or] I can go to the gun shop and buy a silenced [semi-automatic rifle] … how come I can’t make a decision to purchase a potential treatment that might change the entire trajectory of my son’s life?”
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.
As of this week in Montana, any biotech company with an experimental drug has a clear path to selling it to consumers. Companies whose drugs have been through preliminary testing—sometimes in as few as 10 healthy people—can pay $12,500 to apply to a newly established review board for approval. Once its treatment is rubber-stamped, the company can set the price of the drug and sell it via experimental treatment clinics, the first of which is likely to be up and running around the end of this year.
Montana’s latest right-to-try legislation is unique. While other jurisdictions with similar laws limit access to drugs to people with terminal illness, in Montana access is theoretically available to anyone who gives informed consent and can pay. That includes people desperate for treatments for rare diseases. It also includes those who are interested in longevity and want to try out drugs pitched as preventive therapies.
The state’s Department of Health and Human Services recently finalized rules to implement the law. The rules stipulate that patient consumers provide fully informed consent and that each application be reviewed by a board that includes a Montana-certified doctor, expert scientists, and an ethicist. Supporters of the law stress that they want the process to be responsible. “It will be done in a very rigorous way, with qualified medical professionals and appropriate oversight,” says Matt Kaeberlein, a scientist on the first board, which was formed independently of the state health department.
But other experts are worried about the potential for harm in selling unproven treatments to people without oversight from the US Food and Drug Administration. “I would be concerned,” says Aaron Kesselheim, a professor of medicine at Harvard Medical School with expertise in health policy and drug regulation.
Montana first passed a right-to-try law in 2015. In 2023, with the support of state senator Ken Bogner, the state expanded the law to include all patients, not those just with terminal disease. Last year, Bogner told MIT Technology Review that his vision was to focus “more on preventative medicine” rather than “just treating diseases once they show up.”
Bogner says he had “started working on a bill” that would become the 2023 law when the Alliance for Longevity Initiatives (A4LI), a nonprofit “dedicated to advancing legislation and policies aimed at increasing healthy human lifespan,” got in touch. A4LI connected Bogner with others who helped draft the bill and testified in support of it.
Once that law was in place, the tech entrepreneur and longevity enthusiast Niklas Anzinger got involved. Anzinger has been working to establish a jurisdiction to fast-track the search for drugs that might deliver radical life extension. He is based in Próspera—a private city and “special economic zone” in Roatán, Honduras, which is already home to a separate clinic that sells experimental stem-cell and gene therapies. Anzinger founded a community there called Infinita City; he has also founded an investment company and a “service providing” company, both of which include the name Infinita.
Over the last couple of years, Anzinger has switched his focus to the US. “Now we think that Montana is a better model, because it’s building on … existing regulatory precedents,” he says. Once Montana’s 2023 law was passed, he adds, he worked with a handful of unnamed biotech companies to draft a second bill—one that laid out the specific terms under which clinics can offer unapproved drugs. That law was passed in April 2025 and adopted the following month.
Since then, Anzinger, Bogner, and others have been waiting for the state’s Department of Health and Human Services to finalize specific rules for treatment centers—a set of operational guidelines and requirements that any clinic offering treatments unapproved by the FDA must meet under Montana’s law. “The rules have been taking a very long time,” says Anzinger. “Then on Friday, we heard they were effective … from Saturday [July 25].” The rules have since been published online.
Following the rules
With the new rules in hand, Anzinger and his colleague Stephen Martin, Infinita’s US lead, got to work. The first step was to establish an independent experimental treatment review board—a panel of five experts to evaluate applications for access. Anzinger and Martin started recruiting candidates months ago.
The state’s first board, named the Montana ETRB, was officially announced by Infinita earlier this week. For the time being, it is the state’s only review board, although Anzinger says that other groups are free to establish their own. After Bogner raised concerns that the board’s website wrongly implied that it was an official state body, the site was updated to note that “It is a private service run by Montana Governance Services Inc.” That company is “a local Montana registered entity, but it is under the Infinita umbrella,” says Anzinger.
Infinita will pay board members a flat fee, funded by the $12,500 companies will have to pay to have their applications reviewed. Anzinger stresses that the board members, and their decisions, will be independent of Infinita.
In accordance with the rules, the board includes a Montana-licensed doctor: James Burke, an oncologist. It also includes a bioethicist: Jessica Flanigan, a libertarian who is known for her strong views in support of self-medication and her book Pharmaceutical Freedom.
The other three members are familiar faces in the longevity community—all of whom are well respected in the field. “When we looked at our own network, these were some of the best guys,” says Martin. They include Felipe Sierra, who formerly held a senior role at the National Institutes of Health’s arm focused on aging. More recently, Sierra served as chief scientific officer at Hevolution Foundation, a nonprofit that funds research into extending healthy lifespan with the support of the government of Saudi Arabia.
Matt Kaeberlein, who formerly led the Dog Aging Project and has studied the potential for rapamycin as a longevity therapeutic, also features. So does Jamie Justice, a gerontologist who is also executive director of the X Prize Healthspan competition, which has $101 million in prize money up for grabs for researchers who find ways to treat the signs of aging.
“I saw an opportunity to help build a safe, transparent, and scientifically rigorous process for implementing Montana’s newly expanded right-to-try legislation, particularly as it applies to longevity medicines and aging-related interventions,” says Justice. “Science is moving quickly, and I wanted to help ensure that as it develops, it does so with real rigor and accountability.”
Kaeberlein, who has a prominent media presence, has long raised his own concerns about access to other unproven treatments, including peptides and stem-cell therapies. He sees Montana’s setup as offering a more regulated environment—one that offers scientific oversight, ensures informed consent, and allows for data collection.
Applications incoming
While many of the bill’s original supporters were interested in longevity, the initial interest in making drugs more accessible in Montana is coming from companies and individuals looking to treat specific diseases.
“We were actually surprised that much of the interest … is actually more from oncology [and] neurodegenerative disease,” says Anzinger. This focus, he says, is “very compatible” with Infinita’s mission. “We’re not trying to convince everyone … to support radical life extension,” he says. Anything that extends health and human life, including treating cancer and neurodegenerative disease, is part of what longevity means to him, he says.
Martin says that two applications have already been submitted to the newly formed review board. They’ve come from biotech companies that are developing drugs for neuropathy and hearing loss, he says. “I expect we’re going to get started on them this week,” he says.
One of the applications was submitted by Stanley Kim, CEO of WinSanTor. His company is developing a treatment for peripheral neuropathy, a painful nerve condition that can be a consequence of cancer treatment or diabetes. The drug is currently in phase II trials, but Kim says he regularly receives messages from people who are desperate to access it, to the point of being suicidal. He hopes that not only will he be able to make the drug accessible to those people, but he’ll also be able to collect data from them—data that might help accelerate the drug’s approval process.
“We have a newsletter [that is sent to] around 15,000 patients,” says Kim. “Not all of them will be able to go to Montana, but many of them, I think, will.” His company still plans to continue with regular clinical trials as well.
But not all biotech companies with early-stage drugs feel comfortable submitting an application—at least not yet. Thomas Joudinaud, CEO of a French biotechnology company called Ceres Brain Therapeutics, has fielded a request from a person keen to access the company’s experimental drug in Montana. He says that while Montana’s system is “very interesting and very pragmatic” and “suitable for our drug,” he won’t be submitting an application for the time being. He is concerned that if anything goes wrong in Montana, it may jeopardize the company’s standing with the FDA, which wields the power to approve or reject the sale of its treatments to broader populations.
Martin and others have asked the FDA for some kind of assurance that biotech companies participating in Montana’s program won’t be penalized later on. But the agency hasn’t provided them with more than a restatement of the federal Right to Try Act.
“As a matter of policy, the FDA does not comment on state legislation,” an FDA spokesperson wrote in response to a request for clarification from MIT Technology Review.
Even if the FDA were to provide some kind of assurance, it wouldn’t necessarily protect biotech companies in the long term, cautions Chris Robertson, a specialist in health law at Boston University. The FDA’s position could change with a new presidential administration, he says: “I wouldn’t bet on anything that the FDA is saying today being applicable when the rubber hits the road later.”
Companies that want to stay on good terms with the FDA would be safest taking the expanded-access route, says Robertson. That’s the pathway the FDA already uses for people who are seriously or terminally ill, have run out of options, and want to try experimental drugs that have not yet been through clinical trials. The FDA approves over 99% of these applications, says Harvard’s Kesselheim.
“The FDA isn’t a bottleneck but in fact exists to help ensure that expanded-access programs are aboveboard and that patients who receive [the drugs] are able to contribute knowledge about [them],” says Kesselheim. He says he doesn’t think that any “legitimate manufacturer” should fear having to go through the FDA’s expanded-access process, which the agency says takes “less than 45 minutes” to fill out.
The cost of experimenting
There are some key differences between expanded access, which allows seriously ill people to apply for access to experimental drugs that might not have been through any human trials, and Montana’s approach. In theory, a person doesn’t need to be seriously ill to access experimental drugs in Montana.
“In Montana, patients may be eligible for preventive or earlier-stage interventions if they provide informed consent and meet the program’s requirements, so the breadth of potential therapies and situations is much broader,” says Kaeberlein, the Montana ETRB member, who is an affiliate professor at the University of Washington in Seattle.
Kaeberlein also highlights another key difference, which is cost. Companies that make their treatments available through expanded access are only able to charge for the costs of making, transporting, and monitoring the drug, and they must justify the eventual price to the FDA. In Montana, they can charge whatever price they want. Stanley of WinSanTor says he plans to sell his drugs “at cost.” But Ceres’s Joudinaud says that he’d be more interested in selling his at a market price. When asked what that might be, he hinted that the prices of new drugs for rare diseases can be high. In recent years, the median price of such drugs was $218,872.
“Instead of simply creating a legal pathway for patients, it also creates a business model that companies may actually be willing to use,” says Kaeberlein.
But the moment when people start spending money on these treatments is already fast approaching. While Montana’s first ETRB prepares to review its first applications, clinics that hope to be part of the program are busy addressing the requirements laid out in the state’s new rules. Treatment rooms are being outfitted. Medical directors are being hired. And experimental treatments should be reaching patients in the coming months.
This week, I covered a fascinating effort to preserve organs outside the body. There’s a huge shortage of donor organs, and one of the main reasons is time—they survive only a matter of hours outside the body, even when they’re kept on ice.
Doctors dream of organ banks—stores of human organs that can be preserved for days, weeks, months, or even longer. That would allow them to run tests on organs, find the best matches for them, and transport the organs to those recipients.
In new research, one team has been able to supercool the kidneys of pigs—animals whose organs are of a similar size to human ones—and preserve them for days. The kidneys survived being stored at −4 °C (25 °F) and eventually reimplanted back into pigs. And that’s just the latest development in a field that is positively buzzing.
It has proved super difficult to freeze organs. Once ice forms in them, they’re done. The ice crystals create all kinds of damage and render the organs unusable. That hasn’t stopped many researchers from trying.
Some have focused on cryopreservation—rapid extreme cooling that essentially leaves cells in a glasslike state. This process is now routine for eggs, sperm, and embryos, which are cooled to −196 °C in less than two seconds and can be used even after decades in storage.
No one has managed to cryopreserve and thaw human organs for transplantation. But plenty of human bodies and brains have been stored at ultra-low temperatures in the hope that they might one day be rewarmed and brought back to life. (You can read more about why some people opt for cryonics here.)
In March, I wrote about Stephen L. Coles, a gerontologist who had opted to cryopreserve his own brain. After the scientist died in 2014, his body was taken to Alcor, a cryonics facility in Arizona. A team at the facility removed Coles’s head, perfused his brain with cryoprotective chemicals (which work like antifreeze), removed the brain from the skull, and cooled it to −146 °C.
When Coles’s friend Greg Fahy, a cryobiologist, studied pieces of his brain years later, he found that the brain cells, which had shrunk, “bounced back” once they were rewarmed. But that doesn’t mean the cells are alive, or that it might one day be possible to reanimate the brain. As Matthew Powell Palm of Texas A&M told me at the time: “There are so many ways those neurons could be toast.”
Powell Palm is working on other ways to preserve organs. It was he, along with his colleagues, who managed to store supercooled pig kidneys and successfully transplant them, in a study described as “a landmark achievement.” Those organs did better than kidneys stored on ice, he says.
His approach didn’t require cryoprotectants. But other teams are exploring potential chemical cocktails that might allow them to store organs at lower temperatures, potentially for longer periods of time. (More on this in The Checkup soon!)
Another way to prolong the lifespan of an organ is to use a machine that perfuses it with nutrients, mimicking what happens inside the body. Machine perfusion devices have become more commonly used over the last decade or so and are typically used to maintain livers and kidneys for up to about 24 hours.
Researchers are now adapting this protocol for a growing list of organs, even eyeballs—a recent feat that might enable whole-eye transplants. In March, I went to visit scientists in Valencia who had developed a perfusion system for uteruses. They had used their device—which they nicknamed “Mother”—to keep a human uterus alive for a day.
It’s an exciting time for organ preservation. Keep an eye out for more coverage from MIT Technology Review in the coming weeks.
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.
When it comes to organ donation, time is everything. As soon as an organ has been carefully removed from a donor’s body, it starts to deteriorate. Surgeons have a matter of hours to get it into a recipient. Leave it too long and the organ will become unusable.
In most cases, organs will be kept on ice during that time, at around 4 °C (39 °F). They cannot be frozen—in previous attempts, ice has formed, causing all kinds of damage.
Matthew Powell Palm at Texas A&M University and his colleagues have an alternative solution—a device that allows organs to be cooled to -4 °C (25 °F) without forming any ice.
Now, in new research with pig organs, his team has shown that kidneys, at least, can be supercooled and preserved in the device for days. Once rewarmed, the organs have been successfully transplanted into animals, and they seem to do better than organs kept on ice.
The work represents “a landmark achievement,” says Kevin Myer, president and CEO of LifeGift, an organ procurement organization based in Texas, who was not involved in the research.
Cooling organs
Powell Palm hopes this approach could ultimately help ease the organ shortage crisis. Today, there are more than 104,000 people waiting for a kidney transplant in the US alone. It is estimated that 17 people die every day in the US while waiting for a transplant. That’s partly due to a lack of donated kidneys, but it’s also because many of those that are available never make it to a recipient. In some years, around one in three donated kidneys end up being discarded, often because they end up too degraded to use by the time they reach a recipient. Kidneys can be stored on ice for around 24 hours or placed in devices that aim to mimic the conditions of the body, also for up to around 24 hours. That’s not always long enough to find a suitable recipient and transport the organ, says Myer.
Scientists around the world have been working on ways to store organs for longer by cooling them to even chillier temperatures. Cooling an organ slows its metabolism—the colder you go, the greater the effect, and the longer you can store it.
We’ve long been able to successfully cryopreserve eggs, sperm, and embryos, but it’s much harder to freeze large organs. Teams have been exploring various temperatures and cryoprotectants (chemicals that essentially work like antifreeze), but so far no one has been able to freeze human organs for transplantation.
As a thermodynamicist, Powell Palm explored another approach. By keeping an organ submerged at a constant pressure, it should be possible to prevent the formation of ice at temperatures a little below 0 °C, without the need for cryoprotectants (which might have side effects and would need to be approved before being used in human transplants).
To test this theory, Powell Palm and his colleagues have created a device that does just that. The device itself is essentially a hermetically sealed chamber with a transparent lid. At its base is a device that monitors the organ’s temperature and checks for the formation of ice. Organs are submerged in a solution that is already commonly used to preserve them for transplant. “I always describe this as low-tech high science,” says Powell Palm. “A lot of work has gone into understanding the … kinetics at play in this system, but ultimately … it’s quite simple.”
Supercooled kidneys
To test their device, Powell Palm and his colleagues first removed single kidneys from pigs. The organs were flushed with the same commonly used solution to remove the blood, just as transplant organs are. The team then kept some kidneys on ice for either two hours or 24 hours, to mimic standard conditions used in human transplantation. They also put some of the removed kidneys in their device for 24, 48, or 72 hours.
The stored kidneys were then each transplanted back into the original donor pigs. Each pig’s second kidney was removed in the same procedure, leaving each animal with only the kidney that had been stored, and reimplanted.
Once the 24-hour supercooled kidneys were transplanted, they immediately began producing urine—a key indication that they were working. The team members also measured other markers of kidney function and found that the organs appeared to be working normally within about 10 days of being transplanted.
A kidney that was supercooled for 72 hours recovers once it is transplanted back into a pig.
COURTESY RONALD SELLERS, POWELL-PALM LAB, TEXAS A&M UNIVERSITY
That’s slower than kidneys stored on ice for two hours but much quicker than kidneys kept on ice for 24 hours, says Powell Palm.
The organs that were kept supercooled for 48 and 72 hours performed similarly, he says. “Even at three days—triple the clinical standard—we’re getting recovery that is faster than … [what has been] the gold standard for the last three decades,” he says. “So we’re really, really pumped about this.”
“It is impressive,” says Heidi Yeh, a transplant surgeon at Mass General Brigham for Children, who also researches organ preservation technologies. “Often kidneys that have been stored for 48 hours [in other studies] take a week or two before they start working again.”
Organs that grow
The supercooled organs seem to work well in the long term, too. Over a 30-day period, the pigs grew by around 30%—and the kidneys grew with them, almost doubling in size to compensate for both the pigs’ growth and the lack of a second kidney. The team monitored one of the pigs for 200 days before removing and analyzing its kidney. Even at that point the organ looked healthy, says Powell Palm. He and his colleagues presented the findings at the American Transplant Congress in Boston last month.
Earlier this year, researchers in Canada showed they could also cool pig kidneys to below-zero temperatures and transplant them into pigs. The team’s protocol included the use of a cryoprotectant, and organs were stored for up to 48 hours before being transplanted into pigs. Those organs survived for a week.
In supercooling organs for 72 hours and showing that they do well for 30 days or more, Powell Palm and his colleagues have broken new ground. “It’s the first time this has ever been reported in history,” he says.
Those extra hours could make all the difference, says Myer of LifeGift. The advance could give doctors more time to evaluate the kidneys, match them to the most suitable donors, and physically get the organs to their intended recipients in time. It could enable international donations and open up cheaper transport options, he adds. “Right now, with kidney transplantation the assumed limit is 18 to 24 hours,” he says. “If we can get up to 72 hours … that would change everything.”
Powell Palm and his colleagues think they may even be able to go beyond 72 hours. In preliminary studies, organs that had been stored for up to 120 hours appeared healthy, although those organs have not yet been transplanted.
And because the process doesn’t require any cryoprotective chemicals, the team members are hoping for an accelerated approval from the US Food and Drug Administration, which would allow them to test the device in human transplantations.
The storage device is simple and compact, so Powell Palm thinks it will be easy to transport. It hasn’t been tested for air travel yet, but it has been used to take supercooled kidneys across the US in the back of a Kia Sorento, he says: “From a stability perspective, we view this as an even higher bar.”
Powell Palm and his colleague Sebastian Giwa plan to launch a company dedicated to developing the technology, along with other protocols that “stop biological time,” in the coming months, he says.
Perimenopause has entered the chat. Perimenopause—and its better-known relative, menopause—used to be considered taboo. Not anymore, thanks at least in part to TV doctors and social media influencers. Perhaps it’s my age, but these days, both my algorithm and my conversations with friends increasingly swing toward perimenopause.
Menopause is defined as the life stage that occurs a year after a person has had their last period. Perimenopause is the sometimes years-long period before that point, which can also feature all the symptoms we’d typically associate with menopause.
Today, information about perimenopause is more prevalent and accessible than ever. If you’re a woman in your 40s and you’re not feeling 100%, chances are there’ll be someone online ready to tell you you’re in perimenopause. And that you might want to start spending your money on blood tests, apps, and supplements or demanding hormone replacement therapy. But as regular readers might have guessed by this point, it’s not that simple.
Perimenopause tends to start around the age of 46 or 47. It’s during this time that many women start to experience some symptoms like hot flashes, irregular or unusually heavy periods, or anxiety, for example. And it can be heavy going. “Often symptoms are at their worst in the perimenopause,” says Mary Ann Lumsden, former president of the International Menopause Society.
That’s because hormones can fluctuate wildly. Levels of estrogen, progesterone, luteinizing hormone, and follicle-stimulating hormone can roller-coaster before leveling off after menopause. And that’s why, despite what some marketers will claim, there is no test for perimenopause.
“You can’t interpret hormone [measures] because they change so much,” says Lumsden. “And that is quite normal.”
That doesn’t mean women should have to put up with symptoms. But exactly how those symptoms are treated is another topic that has been clouded by misinformation.
Last week, I told a friend about some unusually bad pelvic pain I’d experienced. Her immediate advice was to find out if I was perimenopausal and, if I was, to request hormone replacement therapy (HRT) as soon as possible. If my doctor wouldn’t prescribe it, she continued, I should simply find another doctor who would.
This line of thinking has been heavily promoted on social media platforms, says Paula Briggs, a former chair of the British Menopause Society who currently leads the menopause service at Liverpool Women’s Hospital. But it’s not helpful.
HRT is essentially designed to top up or replace hormones like estrogen and progesterone, which naturally decline around menopause. There are lots of different drugs that can be taken in lots of different ways and at various doses.
While it does come with some risks and won’t suit everyone, HRT can be immensely helpful for many menopausal women. Not only can it help with many of the common symptoms of menopause, but it can also help prevent osteoporosis and maintain muscle strength.
But these drugs were trialed in, and approved for, menopausal women, says Lumsden. They won’t have the same effects in perimenopausal women. “If you give standard HRT, it may well get swamped by [the woman’s] own hormone production,” she says.
HRT can also cause abnormal bleeding in perimenopausal women, says Briggs.
She’s concerned about the messaging on perimenopause that is being promoted on social media. Particularly worrisome, she says, is the way younger women are being encouraged to assume they are perimenopausal and seek out HRT treatment.
“It’s almost cult-like, this idea that everybody must have HRT,” she says.
And then there are the supplements. There’s been an explosion in marketing for vitamins and supplements specifically targeted to middle-aged and menopausal women. But the evidence for these, too, is either limited or nonexistent. “I can’t see a mechanism for a lot of them,” says Lumsden.
Women who take these supplements don’t always know what they’re getting. Some of Lumsden’s patients have told her they take testosterone supplements to manage their symptoms. But blood tests revealed no increase in testosterone levels. “Whatever they’re getting, it’s not testosterone,” she says.
At any rate, not all the symptoms women experience in midlife can be blamed on hormones. The lengthy lists of perimenopause symptoms shared on social media include fatigue, brain fog, aches and pains, digestive issues, and more. “These do not link closely to the obvious menstrual cycle changes and hormone changes … across menopause,” says Nanette Santoro, a professor of obstetrics and gynecology at the University of Colorado Anschutz who studies menopause.
If you’re experiencing any symptoms, it’s worth getting them checked out to make sure they’re not being caused by something else. My own pelvic pain, for example, is almost definitely the result of endometriosis—a condition that can be made worse by HRT, Lumsden tells me.
At any rate, by the time women reach their 40s, many are already juggling care for children and aging parents, often while holding down a job (and dealing with pressures from societies that don’t appear to value older women). It’s an exhausting time—and not all of that exhaustion can be blamed on hormones.
As Santoro puts it: “Attributing everything unpleasant that happens to a woman over 35 to perimenopause is not based on any scientific evidence.”
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.
Ties van der Meer doesn’t know how many siblings he has.
The 47-year-old was conceived at a private fertility clinic in the Netherlands using sperm provided by an anonymous donor. After the Netherlands banned anonymous donation in 2004, the doctor who ran the clinic destroyed records that might have identified those donors, he says.
He describes the situation as “problematic.” Children have a right to know their biological parents, he says. While he did ultimately track down one sibling, who helped him identify his father along with other genetic relatives, he may have others he’ll never find.
Other donor-conceived people who have been able to track down siblings have found they have tens or even hundreds of them. One donor-conceived woman who found 25 half-siblings over the course of seven years told the Guardian, “It does make you feel a bit mass-produced.”
We need international limits on the number of children a single donor can contribute to, a European fertility organization argued yesterday. At a conference in London, members laid out plans to start with a Europe-wide limit.
Today many countries, including the UK, have banned anonymous egg and sperm donation. But anonymity can’t be guaranteed even in places where it is technically allowed. Genetic tests offered by companies like Ancestry and 23andMe, along with genetic registries, have made it much easier for donor-conceived people to find parents and siblings who share their genes.
And because sperm can be frozen and stored for years before it is eventually used, the current set-up can result in situations where donor-conceived people discover the identity of a genetic parent only after the person’s death. They might also find that they have siblings of very different ages, all around the world.
Stories like these can be distressing for donor-conceived people. And there are other reasons why limits are considered important. The offspring of a prolific donor might be at risk of unknowingly forming romantic or sexual relationships, for instance. And some people are concerned that a donor with a harmful genetic mutation might pass that down to many children.
This is unlikely, given the level of screening that most donors undergo. But it has happened. A man who donated his sperm to a sperm bank in Denmark was found to have a genetic mutation that significantly increased the risk of multiple cancers. But his sperm had already been used to conceive at least 197 children across Europe. Some of those children developed cancer. Some died.
Many countries already have legal limits for donors. In Malta and Cyprus, for example, both egg and sperm donors are allowed to contribute to the birth of just a single child, according to data presented at the European Society of Human Reproduction and Embryology (ESHRE) meeting in London on July 8.
Other countries set limits based on the number of families a single donor can contribute to, allowing recipients to have children who share a genetic link. In the UK, that limit is set at 10 families per donor.
But these limits are difficult to enforce, partly because donated gametes don’t necessarily stay in their original country. In Denmark, the national limit is set at 12 families. But the country is a major exporter of sperm. In the UK, for example, more than half of sperm donations in 2020 were imported—with most of those coming from either Denmark or the US.
“The only thing that really makes sense is a transnational limit,” Jackson Kirkman-Brown, a professor of reproductive biology at the University of Birmingham, said at the meeting.
Kirkman-Brown and his colleagues have spent months putting together a document that represents ESHRE’s position on these limits. After consulting with fertility specialists, clinics, sperm and egg banks, donors, and donor-conceived people, the team has developed a plan to start with a Europe-wide limit on sperm and egg donations.
ESHRE is calling on sperm and egg banks, as well as fertility clinics, to respect an initial limit of 50 families per donor. That’s still very high, according to a handful of people I spoke to at the meeting. But at least it’s a start.
Europe should move toward setting limits at 15 families per donor, Kirkman-Brown said. “We may find that 15 is also too high,” says Vasanti Jadva, who studies the psychological well-being of people conceived using donated eggs, sperm, and embryos at City St George’s in London. “We still don’t know what the right number is.”
It will be difficult to enforce these limits, too. And if they end up limiting the supply of donor sperm, there’s a chance that some people will turn to unregulated sperm donations from people who do not undergo health screening. Unregulated donations can lead to other problems for prospective parents, including the possibility that donors will seek parental rights over the children conceived using their sperm.
And it will be even harder to establish international limits. When I asked the American Society of Reproductive Medicine for its thoughts on ESHRE’s proposed limits, a representative directed me to a guidance document saying “it has been suggested” that for a population of 800,000, single donors should be limited to “no more than 25 births” in order to avoid the risk that relatives will have children together. (Considering the US has a population of over 340 million, the total figure could be pretty high, but many sperm banks opt to limit the number of families contributed to by a single donor at around 25.)
Van der Meer thinks that even a limit of five families from a single donor would be high. International donation makes it even harder for donor-conceived people to connect with genetic relatives, so the limit for international contributions should be set at two families, he says.
Still, he thinks ESHRE’s suggested limit is a “positive first step.” Van der Meer has managed to track down a sibling, his father, and nephews, aunts, and uncles. He hopes that future policies respect the rights of donor-conceived children to know, and be in contact with, their genetic relatives.
“But,” he says, “you have to start somewhere.”
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.
The common cold comes for us all—often more than once a year. And there is no way to prevent it. The best you can do is take vitamin C and stay away from people with the sniffles.
Now, the payment company Stripe, founded by brothers Patrick and John Collison, says it will fund a new $500-million nonprofit whose goal is preventing both the common cold and the flu. Its eventual aim is to get rid of respiratory viruses altogether.
The new organization, called Intercept, will use grants and investments to back prevention approaches, including vaccines, as well as large-scale air-cleaning systems for schools, offices, and other public spaces.
In addition to Stripe, other funders include Anthropic, Flu Lab, the OpenAI Foundation, as well as Bill Gates and several traders at the quantitative investing fund Jane Street Capital, according to an Intercept spokesperson.
“I think we treat respiratory infections as a minor nuisance, but have really underweighted the burden that they impose on society,” says Nan Ransohoff, the Stripe executive leading the initiative along with Charlie Petty, a venture capitalist who joined Stripe this year. The average person will spend 5% of their lifetime fighting a cold or the flu, according to Ransohoff.
Despite that, drug companies put relatively little effort into preventing colds. Part of the problem is that the sniffles are caused by more than 200 different viruses, according to the American Lung Association, with rhinoviruses being the most common culprits. There are so many that it typically doesn’t pay to try to stop any one of them with a vaccine. “When pharma companies look at it, it’s not as attractive as other things they could work on,” says Ransohoff. “So it hasn’t attracted the resources.”
Stripe previously organized a $1.8 billion program called Frontier to encourage the development of carbon removal technology, as a way of countering climate change. Ransohoff says removing carbon from the atmosphere and getting rid of respiratory viruses are similar in that each is “technically possible” but they “lack commercial incentives.”
The concept for Intercept took shape after Ransohoff started talking to David Veesler, a structural biologist and vaccine designer at the University of Washington, who argued that it’s possible to come up with broad countermeasures that work against many viruses at once.
“He effectively sort of nerd-sniped me,” Ransohoff says of Vessler. “He convinced me that this is technically possible. He also helped me understand that some of the reasons that this hasn’t been done before was sort of an incentive problem.”
Veesler says the growing toolkit available to scientists includes RNA drugs, antibodies, and computational protein design. For instance, one idea is to engineer virus-grabbing proteins that people could spray in their nasal passages, to catch viruses before they can infect people.
“Most people just accept these viruses as a fact of life, and that got us thinking: do we have to accept it?” says Veesler. “The more we thought about it, the more we realized that many of these problems have not been worked on with modern technologies.”
The project takes inspiration from efforts to fight the covid-19 virus, where Veesler’s group was among those involved in the speedy development of vaccines, anti-viral drugs, and antibodies.
According to Ransohoff, Intercept’s advisers will include Peter Marks, a former top FDA official, as well as Moncef Slaoui, the pharmaceutical executive who led the US coronavirus vaccine effort, Operation Warp Speed.
A key challenge for Intercept will be coming up with ways to counter many—even all—viruses at one time. That accounts for the group’s interest in air-cleaning technology, such as using strong ultraviolet light to inactivate viruses. The idea, the group says, is to remove viruses from the air in the same way municipalities remove impurities from the water supply before it’s piped to people’s homes.
The US funds about $6.5 billion a year in virus research through the National Institute of Allergy and Infectious Disease, or NIAID. But that agency’s budget hasn’t grown in recent years, leaving more room for private philanthropy.
And Stripe’s Collison brothers have become some of the most reliable philanthropists in viral research. After giving away “fast grants” to help labs during the covid-19 pandemic, they later joined other donors who committed $650 million to establish the Arc Institute, in Palo Alto, which has developed AI models for biological research.
“The diversity of viruses is just too large and seems daunting, so people don’t even try,” says Veesler. “I’m happy that someone is ready to help scientists, not accepting the status quo, and doing something different.”
This week, I covered the story of Casey Harrell—a man with ALS who is “the first power user” of a brain implant, according to the researchers who worked with him. Harrell is paralyzed and unable to speak coherently without the device. He has now spent almost three years using a brain-computer interface (BCI) that enables him to “speak,” surf the web, and perform his job as a climate activist, largely independently.
Since Harrell was implanted with the device, in July 2023, a team at the University of California, Davis, has worked with him to adjust and improve its offerings. They’ve refined its accuracy, for example. And they’ve introduced settings including a privacy mode and a “profanity filter” that lets Harrell talk to his daughter without risking accidental swearing.
Harrell told me that, for him, the device is “nothing short of revolutionary!” It has enabled him to maintain an income, reconnect with friends and family, and read to his daughter.
The team that developed his BCI is one of several working on ways to use technology to allow people with paralysis to communicate, engage with the online world, and regain some independence. And Harrell is one of a growing number of people volunteering their brains to, as he puts it, “pay it forward and do the scientific research … [and] get some personal benefit.”
Over the past couple of years, the number of BCI trial volunteers has soared. This year, China became the first country to approve a BCI for medical use. Advances in technology are allowing engineers to provide more features than ever. BCI research is properly taking off.
I should first point out that BCIs come in different forms. Harrell’s device includes a set of electrodes embedded in his brain that pick up the electrical activity associated with speech. Those electrodes are connected to two docking ports on top of his head that can be plugged into a computer.
That computer is loaded with software trained to decode his brain signals into phonemes (units of sound in speech) and predict what Harrell wants to say. He can then use an eye gaze tracker to make any corrections before the speech is played out loud.
But some BCIs don’t need to be “plugged in”—they’re fully implanted and wireless. Others are less invasive; they might involve placing wired electrodes on the surface of the brain or simply wearing a cap of electrodes, for example. There are trade-offs—the closer you get to the neurons you want to record from, the better your signal will be. But generally speaking, the more invasive the surgery, the higher the risk of complications.
BCIs can also have different functions. Harrell has ALS, but most BCIs in use today are sitting in the brains of people with spinal cord injuries. Typically, these individuals have some degree of paralysis; for example, they may be unable to move their arms and legs, but their face and ability to speak are unaffected. In those cases, BCIs can be used to control other kinds of devices that might help with mobility.
In 2024, Michelle Patrick-Krueger, then at the University of Houston, and her colleagues published a roundup of all trials of BCIs conducted between 1998, which is when they believe the first device was implanted, and the end of 2023. They identified 21 research groups that, among them, had trialed BCIs in a total of 67 volunteers.
“Since then, that number has increased a lot,” says Mariska Vansteensel, a BCI researcher at University Medical Center Utrecht. In January, Neuralink (the BCI company founded by trillionaire Elon Musk) announced that it has implanted 21 people with its device in the past two years.
Synchron, another BCI company, is currently testing its devices in trials in North America and Australia. Shanghai-based Neuracle has been trialing a BCI since November 2024, and it recently obtained approval for the device to be used outside of clinical trials. Precision Neuroscience, cofounded by a former co-creator of rival Neuralink, is also trialing its BCI, which sits on the surface of the brain.
At the same time, academic research has continued. The UC Davis team that worked with Harrell is part of BrainGate—a BCI research effort that has been running for the past two decades. Other academic teams are exploring a variety of devices, from the fully implanted to the minimally invasive.
Since 2024, when Patrick-Krueger’s paper was published, the number of people who have been implanted with a brain electrode has more than doubled, according to Vansteensel. “My current estimation would be around 150 people,” she says.
The technology is improving too. Take the BrainGate trial, for example. The first 17 years of that trial focused on the use of what researchers call “point-and-click” communication—allowing users to control a cursor and “click” with their brain activity. But in recent years the team has pivoted toward decoding speech, says David Brandman, the lead investigator on the team (and the person who implanted Harrell’s electrodes). Today, Harrell’s device uses a voice clone—the speech it produces is based on previous recordings of Harrell’s voice.
But BCIs are still experimental. And plenty of questions remain about who might benefit from them—and how long the devices will last. So far, most BCIs have been implanted in people with spinal cord injuries. We know even less about how they might benefit other people who have ALS, for example. In some cases where the devices initially helped people with ALS—even someone who was completely locked in—the BCIs eventually stopped working. And scientists don’t really know why.
The only way they’ll find out is through more research—and the participation of volunteers like Harrell. So it’s exciting to see trials truly take off. And I promise I’ll update you on where they stand two years from now.
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.
Casey Harrell has had a set of electrodes embedded in his brain for almost three years. Harrell, who has amyotrophic lateral sclerosis (ALS) and is paralyzed, first used his brain-computer interface (BCI) to “speak” sentences with the help of a research team in 2023.
Since then, Harrell has clocked thousands of hours of use. He can use the device largely independently, once he’s been “plugged in” with the help of a carer. His team has added new features to it, and Harrell also uses it to surf the web and perform his job.
“Living with a disease like ALS, you are supposed to have diminished dreams. I do not,” Harrell tells MIT Technology Review. “Any one of these things would be an absolute godsend of improvement. To have all of them, and many, many more, is truly revolutionary.”
Within the first 22.6 months after the device was implanted, Harrell had used it for more than 3,800 hours at home without any researchers present, the team reported today in the journal Nature Medicine. “He’s the first power user of a speech BCI,” says team member Sergey Stavisky, a neuroengineer at the University of California, Davis.
Decoding speech
Three years ago, Harrell entrusted David Brandman, an associate professor of neurological surgery at the University of California, Davis, and his colleagues with his brain. Harrell, who was 45 at the time, had already been diagnosed with ALS, a degenerative disease that robs people of the use of their muscles.
Harrell was dependent on others to control his wheelchair and to dress and feed him. He had difficulty speaking; people struggled to understand what he was saying. Then Brandman and his colleagues asked if he’d like to trial a brain implant that might help him communicate. “The industry was [on the] cusp of a transformation, and I wanted to be part of it,” says Harrell. He signed up.
In July 2023, during a five-hour operation, doctors implanted four arrays of 64 electrodes each into his brain. Each pair of arrays was wired to a “pedestal” connection point—creating two docking locations on the exterior of his skull to connect the electrodes to a computer.
The team had long been working on developing algorithms to decode brain activity into speech. Their system works by recording activity from the speech motor cortex—a region of the brain responsible for the movements that allow us to speak.
“There are 39 phonemes that make up all the sounds in the [American] English language,” says Nicholas Card, a neuroengineer at UC Davis and member of the team. Mapping neural activity related to producing each of those phonemes can allow the team to create a personalized speech decoder and software that can “speak” those words. “We first go from brain data to phonemes, and then from phonemes to words,” he says.
They started using the device around a month after the surgery. The team got Harrell’s speech decoder working on the first day, says Card. On that day in August, Harrell used the device to speak with a 50-word vocabulary, and 99.6% of the words were as he’d intended. That vocabulary was later expanded to 125,000 words with 97.5% accuracy.
At the time, it was unclear how long the device might last. Brain-computer interfaces are still new—not many people have had them implanted for long periods of time. Scar tissue can form around electrodes in a person’s brain, interfering with their ability to pick up neural activity, for example. But that doesn’t seem to be the case for Harrell.
Power user
In another advance, Harrell is now able to use the device more independently. In 2023, members of the research team would have to visit Harrell at his home and physically connect and disconnect him from the device on the days he wanted to use it. Not anymore. The team has since automated more of the system—today, Harrell’s care partner can don and doff it for him. “He’ll wake up, get plugged in, and just get going,” says Stavisky.
This is important, says Mariska Vansteesel, a BCI researcher at Utrecht Medical Center who was not involved in the trial. “For these technologies to be relevant for patients, we really need to test them in settings in which they will eventually be used … to demonstrate that it has value, that it’s usable, and that it functions well without the constant involvement of a research team,” she says.
Casey Harrell uses his BCI to speak in “private mode.”
The team has also worked to improve the system itself. It is now 99% accurate, says Stavisky. Harrell can also control a cursor—a game changer that enables him to use his personal computer to send text messages and emails, surf the web, and keep up with his job as an environmental activist.
Over the years, the team has updated the system to accommodate specific requests from Harrell. He is now able to switch on a “privacy mode”—when active, any decoded text will be automatically deleted. He can also opt to use a “profanity filter” while he’s talking to his young daughter.
“We have been able to add on to the software side of the device … improving the accuracy and adding more bells and whistles to enable me to be more independent when using the device,” says Harrell. “We are making the road as we walk it, or roll it, so to speak.”
Nothing short of revolutionary
Vansteesel cautions that while the device is working well for Harrell, there’s no guarantee it will work as well, or as long, for other people with ALS. Over the last decade, she has worked with a woman with ALS who used a fully implanted device to communicate using “brain clicks”—cursor clicks made using brain activity. The woman used her BCI for seven years, but it stopped working toward the end of that period, apparently due to brain degeneration.
At any rate, not everyone with ALS will be willing to undergo invasive brain surgery, says Jane Huggins, who is developing noninvasive BCIs at the University of Michigan and was not involved in the trial. “Long-term, independent use with efficient and accurate communication is kind of the holy grail of BCI,” she says. “But we have been finding a consistent aversion to hospital stays among people with progressive conditions like ALS.”
Harrell, however, calls the device “nothing short of revolutionary.” “This has allowed me to keep working and earn money and insurance for my family. This is reconnecting me with friends and family who are too shy or too afraid to come over and not be able to understand me,” Harrell says. “With my seven-year-old daughter, I am able to create a bond that I wasn’t before able to forge. Now I can read to them and help them sharpen their own reading skills. By doing so, I am able to share the responsibility of parenting with my wife, who does so much caregiving for me and also our daughter.”
Stavisky and his colleagues hope to improve the device further still. “We’re never satisfied,” he says. One aim is to eventually restore Harrell’s “full voice.” They are working on a “brain-to-voice” system that could directly decode brain activity to a speaking voice, complete with natural-sounding cadence, inflection and intonation—a voice that could sound happy, angry, or sarcastic, for example.
“I was quietly confident that I could get some personal benefit from the system,” says Harrell. “Never in a million years would I think that I would achieve this much.”
Earlier this week, Life Biosciences, a biotech company focused on reversing age-related diseases, announced that it had dosed its first volunteer. A person with glaucoma has had an experimental treatment injected straight into their eyeball.
The idea is to try to treat the disease—which can cause vision loss—by regenerating healthy nerves in the eye. But David Sinclair, the chairman and cofounder of the company behind the trial, hopes to go further. If the treatment can reverse glaucoma, perhaps similar treatments can reverse other diseases of aging. Maybe, just maybe, they can reverse aging altogether.
The approach is designed to work by “reprogramming” cells to a younger state. It’s one of many strategies being explored by biotech companies looking to slow and reverse the process of aging. But of all of them, it seems to be the one that is truly taking off.
Aging is complicated. As we get older, we experience so many changes across pretty much all our biological systems. Scientists have tried to categorize these effects. In 2013, one team published a seminal paper describing nine “hallmarks of aging.” That list features many of the processes scientists have attempted to target. But some of those targets have fallen in and out of fashion over the years.
Take telomere attrition, for example. Telomeres are DNA sequences at the ends of our chromosomes, often likened to the plastic caps that stop the ends of our shoelaces from fraying. When cells divide, telomeres shorten until, eventually, the DNA is vulnerable to damage.
When I started reporting on aging, telomere shortening was all the rage. Shrinking telomeres had been linked to age-related diseases of the heart and brain. Shortened telomeres were considered a sign of premature aging. In 2015 Liz Parrish, CEO of the biotech company BioViva, injected herself with an experimental gene therapy that she hoped might lengthen her telomeres.
Then it suddenly seemed to go out of style. Research continued, but all the excitement within the aging and longevity community seemed to move on to another hallmark. (Parrish also continued with self-experimentation; she calls herself “the most genetically modified person on Earth.”)
That hallmark was cellular senescence. This happens when cells stop dividing but don’t die, instead entering a “zombie” state in which they churn out chemicals that can cause harmful inflammation.
Senescent cells gradually accumulate in pretty much every organ studied, where they are thought to contribute to age-related damage. Why not just periodically clear them out? When a team of scientists took that approach in mice in 2011, they found they could delay the onset of age-related conditions like cataracts and hunchback. The treated mice even looked younger.
But when scientists at Unity Biotechnology trialed a similar approach in people with osteoarthritis and an age-related eye condition in the late 2010s and early 2020s, the results were disappointing. The company laid off every employee in May last year and has since shuttered entirely.
Again, that doesn’t mean senolytic drugs that target “zombie cells” won’t work. But it feels as if many in the field have moved on. These days, the buzz is all about reprogramming.
The idea here is to essentially return cells to a young state. It’s based on the Nobel Prize–winning discovery that four genetic factors can turn an adult cell into a stem cell, which can be encouraged to develop into pretty much any other cell type.
Running parallel to all this research are repeated injections of hundreds of millions of dollars in funding. In 2021, my colleague Antonio Regalado reported on the founding of the biotech company Altos Labs to pursue reprogramming for rejuvenation.
Altos was funded by the billionaire Yuri Milner—reportedly along with Jeff Bezos, among others—to the tune of $3 billion, a previously unheard-of figure for a biotech startup. Other well-funded companies have since sprung up in this space.
There’s Retro Biosciences, for instance, which is pursuing reprogramming (among other approaches) in an effort to add 10 years of healthy life to human lifespans. Retro’s launch was supported by $180 million from OpenAI’s Sam Altman. Last month, the company announced a valuation of $1.8 billion.
NewLimit, another billionaire-backed biotech exploring reprogramming, says it has promising results from research in mice. It plans to trial a drug designed to rejuvenate the liver in people next year. Last week, the company announced it had raised $435 million toward reaching that goal, among others.
Life Biosciences, which was founded by the Harvard biologist David Sinclair, most recently secured $80 million to support its research. The eye trial is now officially underway, but Sinclair also has plans for whole-body rejuvenation. Earlier this week, he told my colleague Antonio that he plans to test a “highly, highly confidential” oral reprogramming drug as part of a $101 million competition organized by the XPrize Foundation.
Reprogramming has certainly caught the attention of scientists, biotech companies, and investors. Studies in mice are hugely promising. Human trials are launching. And research in the field has billions of dollars’ worth of support.A lot of people in the field are really excited about reprogramming. But it comes with risks. And we still don’t know if it will work. The question now is: Do we finally have a rejuvenation drug within reach? And if not, what will the next research trend look like?
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.
Correction: This article has been updated to reflect that Liz Parrish claimed to have undergone her first experimental gene therapy in 2015, not 2017.
MIT Technology Review Explains:Let our writers untangle the complex, messy world of science and technology to help you understand what’s coming next. You can read more from the series here.
Your brain lives in the dark space of your skull. Yet it knows when the wind lifts the hairs on your skin, when your heart is racing, when your gut tightens with fear.
It’s also, right now, predicting what you’ll read next as your eyes move across this page. It’s picking up signals that help it make sense of what’s happening around you and prepare you to act if you need to stay safe. You aren’t usually aware that your brain is doing all that.
Our senses take in information at a staggering rate—roughly 11 million bits flood in every second from our skin, eyes, ears, and more. That’s nearly three paperback novels’ worth of data every second. Only a sliver reaches our conscious awareness. Researchers estimate that our conscious minds can process roughly 10 to 60 bits of information per second, about the rate at which you’re reading this sentence. That’s a ratio of about one conscious bit to hundreds of thousands of unconscious bits.
And that’s a mercy. As Moriah Thomason, a neuroscientist at NYU Langone, says, “Thank goodness we’re built like this. There’s a layer of what we have access to in conscious awareness. And then we have a right-under-the-surface amount. There is only a certain amount we are meant to ‘hold in mind’ in order to function successfully.”
What you are aware of: Your stomach growling when you’re hungry. Your palms sweating before you speak in public. The breath you just took, if you pay attention to it. Even your heartbeat, which some people can sense from the inside without feeling their pulse in their wrist.
Scientists have a word for how we sense ourselves from the inside: interoception.
The term was coined in 1906 by the British neurophysiologist Charles Sherrington. For most of the 20th century it remained largely confined to textbooks. Today, thanks to a 2021 Nobel Prize and new tools that can map the interoceptive system across the body, the study of this facility is suddenly quite hot. As researchers decode how signals move between body and brain, a clearer picture is starting to take shape—with implications for how we understand and treat conditions from obesity to chronic pain to anxiety.
The field began to take off in the 1990s. In 1994, the neurologist Antonio Damasio published a book with a pointed title: Descartes’ Error. He challenged the historical separation of thinking and feeling, arguing that our ability to choose and act is driven by feelings, and those feelings in turn are shaped by the body’s signals, such as your gut clenching or your skin going clammy. When we lose that connection between feeling and thinking, as one of Damasio’s patients did after surgery to treat a brain tumor, we may still be able to reason with perfect logic about the pros and cons of traveling on a Tuesday or a Wednesday. But without the emotional signals that help us predict what a choice will feel like, our reason spins and circles, and we cannot decide.
A contemporary of Damasio’s, the neuroscientist Bud Craig, spent his career asking one question: How do you feel? He charted how the brain builds an inner map of the body and updates it in real time every moment you are alive.
Think of the captain’s bridge on the USS Enterprise, where a live map displays the status of the ship’s critical systems: oxygen levels, energy availability, hull integrity, shield strength. Another set of indicators senses things outside the ship: asteroid belts, enemy ships, radiation, life signs, and spatial anomalies not yet understood.
Your brain, only about the size of your two fists pressed together, creates a map like this for your entire body, along with a map of the outside world, from data streaming in through your five senses. Together, they feed into your brain’s working model of you in the world, now and across time—where you are, who you are, your expectations for what’s about to happen (based on everything you know), and what all that means for you.
When someone asks “How are you doing?” we consult our maps and report back on our status. We might say we’re happy, depleted, anxious, or energetic. These feelings are always a braid of emotional and physical sensations. They’re what your interoceptive navigational system serves up to your awareness when you sense yourself from the inside.
As we grow up, we learn to interpret what these sensations mean—interpretations that, in turn, can alter our physiology, emotions, and behavior. Research by the psychologist Alia Crum shows that people who embrace a “stress is enhancing” mindset produce more growth hormones than people who have a “stress is debilitating” mindset. They also experience more positive emotions and greater cognitive flexibility.
Language also matters. We learn words for the textures of our feelings—words that then shape how we feel and act. People low in emotional “granularity”—as the psychologist Marc Brackett calls the ability to distinguish between closely related feelings—react more impulsively under stress and are less able to find meaning in difficult experiences.But mindsets and emotional intelligence are malleable. We can learn that “anxious” is different from “terrified,” and we can even reframe how we interpret our body’s sensations. Instead of thinking of the butterflies in our bellies as annoying, we can welcome them as our body’s way of preparing us for a peak performance.
Scientists have long understood that the interoceptive information informing these lived experiences travels via two major systems: nerves and humors (blood and lymph). Now they’re actively studying a third system—the “interstitium,” a network of fluid-filled spaces woven throughout the body’s connective fascia that may also play a role in communication.
But until recently, scientific understanding of this interoceptive system looked like a high-level schematic that left out vital details—how information travels from the outside environment in, how it moves from your body to your brain, and how it is integrated and interpreted within your brain. Researchers are now racing to explore what the neuroscientist Catherine Tallon-Baudry calls this “new continent of awareness.”
The wandering highway
One of the most active areas of research centers on the vagus nerve, the main component of the parasympathetic nervous system and an information highway carrying news from your organs up to your brain and back down to your body. The vagus has become a celebrity nerve, ubiquitous in wellness podcasts and trauma therapy. “Tone your vagus nerve.” “Activate your parasympathetic system.” The language suggests a single thing you can target, like a muscle. The reality, as Steve Liberles at Harvard Medical School is discovering, is far more interesting.
Liberles has spent most of his career mapping what he calls “the great wide unknown” of one of our largest and longest nerves. He speaks the way he works—methodically, without overselling. But the questions driving him are huge. How do we sense our body’s inner state? What information flows through which channels? And how does the brain decide what to do with it?
“When I’m nervous giving a talk in front of a thousand people,” he says, “my heart might race. I might get butterflies in my stomach. I might get goosebumps on my skin.” We all know what he’s talking about.
“It’s bizarre,” he muses. “Your brain has to send a signal to the gut, and then the gut back to the brain, to tell you you’re nervous?” He pauses. “This just shows there is this intimate connectivity between the brain and the body that’s real.”
The vagus is often called the calming nerve, because it controls “rest and digest” functions that quiet our body after the sympathetic nervous system revs us up with “fight or flight” impulses to handle danger or stress.
But it is also doing something else: It’s listening to us inside. Anatomists have known for over a century that roughly 80% of its fibers carry information upward, from body to brain. Think of it as a two-lane highway with far more traffic headed north. What scientists are just beginning to understand in detail is what those signals are saying.
Liberles is decoding the vagus with molecular precision and finding that its messaging system is unexpectedly diverse. So far, his research has uncovered dozens of types of vagus nerve cells, each wired to a specific organ. Team Red relays information about the heart; Team Blue, the gut.
Within those teams, each courier has a unique job that’s different from those all its teammates perform. Liberles found 10 types in the lungs alone. Until then, only one lung reflex had ever been identified, in 1868. One nerve courier carries information about breathing rate; another the stretch of your lungs; yet another information about airway threats, like food going down the wrong pipe.
“It’s super exciting to think about what each of these neurons is doing,” he told me in a conversation last fall, a flash of intensity breaking through the calm. “Where does it go in the body? What is it sensing? What is it controlling?”
The doors of the cell
Liberles is mapping the vagus information highways. But highways need on-ramps for signals to enter. For years, one of neurobiology’s biggest mysteries was the molecular on-ramp for our sense of touch.
Somewhere, something in our bodies was converting physical force into an electrical signal that the nervous system could understand. But no one knew how.
Solving that mystery required a scientist willing to trust a hunch when the data couldn’t show the way.
Ardem Patapoutian grew up in Lebanon and fled the country’s civil war at 18, landing in Los Angeles, where he delivered pizzas and wrote horoscopes for a local newspaper before falling in love with science at UCLA.
In the 1990s, as a postdoc at the University of California, San Francisco, he became fascinated with our sense of touch—the last of the five major senses not yet understood at the molecular level. The lung stretch signal that Liberles’s vagus neurons carry to the brain? No one had ever figured out how that signal began.
“How do you feel the embrace of a loved one? How do your fingers distinguish one texture of hair from another?” Patapoutian invites us to wonder in his 2021 Nobel Prize lecture. The problem: Most cellular communication works through chemistry. But mechanical force offers no molecule to bind. How does the body translate physical pressure into the electrochemical language that neurons speak?
Scientists knew that the answer had to be an ion channel—a protein gate embedded in cell membranes that opens to let electrically charged particles into the cell. But tracking down the one responsible for touch turned out to be absurdly difficult. Ion channels are a hundred thousandth the size of a cell, invisible to ordinary microscopes. Worse, they don’t resemble each other. You can’t recognize one by its shape or its sequence of amino acids. Even with one right in front of you, nothing would tell you it was there.
At Scripps, where he works now, Patapoutian decided to try an unusual approach. He’d try to find cells that showed sensitivity to touch and destroy their internal genetic blueprint one gene at a time—hunting for the move that would make the cell go numb. It was tedious, expensive, and possibly a dead end. “A lot of people made fun of us,” he says.
Two years in, Patapoutian’s collaborator Bertrand Coste had burned through half his postdoctoral appointment with no results. Patapoutian said: Another 30 genes, and then we decide whether to continue.
What kept them going, Patapoutian told me, was informed intuition. “As you gain more experience, you have this sense of what’s going to work, what’s not going to work. Sometimes the data cannot answer the question of when to stop or when to continue. There has to be another process. If you start trusting it, it gives you an avenue to continue.”
They’d found it—the mechanism behind something you feel every day.
They named the protein they identified PIEZO, from the Greek piezi, meaning pressure. There are two variations, PIEZO1 and PIEZO2, each responsible for sensing different kinds of pressure in the body. They’re elegant in their design—over 2,500 amino acids folded into a three-bladed propeller-shaped gate embedded in cell membranes. When pressure stretches the membrane, the gate opens and electrically charged ions flood through, translating physical pressure into an electrical signal that the brain can understand—all within milliseconds.
Patapoutian calls scientific discovery a dream that survives reality. He won the Nobel Prize in medicine in 2021 for his discovery of PIEZO, sharing the award with David Julius of UCSF for his work on how cells sense temperature. Now researchers are finding PIEZO proteins everywhere—skin, organs, blood vessels, and even red blood cells, where they help the cells squeeze through narrow capillaries. They’re how your brain knows where your hand is in space without looking at it, a sense called proprioception. They’re in plants too, enabling roots to sense pressure as they push down into the earth.
PIEZO was just the beginning. With a $14.5 million grant from the US National Institutes of Health, Patapoutian and his collaborators are now mapping the body’s entire interoceptive system—as many internal senses as he can find, he says.8
Patapoutian has translated his discovery into a unique form of public outreach. At scientific conferences, he sometimes rolls up his sleeve mid-lecture to reveal half his arm covered in ink—a gigantic PIEZO protein in exquisite anatomical detail, its blades spreading across his biceps. Then he flexes. The tattoo flexes with him, the structure bending exactly as the real protein does when pressure opens the gate.
“At a pub or a party,” he explains, smiling, “how else would I demonstrate this beautiful structure?”
Orchestrating the field
Steve Liberles is mapping a major interoception highway. Ardem Patapoutian discovered the gates of touch. Meanwhile, Wen Chen at the National Institutes of Health is pulling the field together, putting neuroscientists, immunologists, physiologists, and clinicians into the same room. The demand, she says, has been enormous.
She tested her pitch at a dinner party with NIH colleagues a few years ago. You’re hungry right now—that’s interoception. You’re thirsty—that’s interoception. Heads nodded as she pointed around the table.
“We can’t have just the brain or just the body,” she told me. “We need to look at the whole person.”
In 2018 she organized a symposium on interoception where Liberles was one of the invitees, along with researchers and practitioners of meditation and yoga. “It was not their thing,” she says, laughing as she recalls how uncomfortable some of the researchers looked. But the practitioners were excited to finally meet scientists who were studying the inner mechanisms of what they did.
That was followed by a series of NIH workshops on interoception that spanned topics from basic science to clinical practice. Patapoutian was the keynote speaker for the first one.
The NIH began funding scientists to chart the neural circuits of interoception and bringing them together to talk about their findings. Partway through one of these meetings, the equipment failed for an hour. More than 1,000 people stayed online, waiting for it to come back.
“We were shocked at the turnout,” she says. “There was much bigger interest than we could have imagined.”
Chen is now building infrastructure to match the demand: a formal community, funding mechanisms, a venue where cardiologists and neuroscientists and clinicians can all find each other. And she’s redefining the field as she goes; interoception is not a one-way signal from body to brain but a continuous two-way communication system, each direction shaping the other in real time.10
Liberles’s nervousness on stage is that two-way loop in action. Signals from his racing heart and belly butterflies travel up to the brain, which weaves them into an interpretation: This is anxiety, and this is what to do to handle it. His actions produce fresh signals that the brain reads in light of its ongoing predictions about what will happen next. In the body-brain communication loop, each player constantly updates the other.
I asked Wen what her work on interoception might mean for another inner sense: intuition. “People talk about ‘gut feelings,’” I said. “How does that relate to interoception?”
“Intuition might be the bridge where interoception moves from unconscious processing to conscious awareness,” she answered. “If that’s true, then intuition is not magic. It’s physiology.”
But it depends on how we read the signals. Intuition is like pain. It tells you something, but it’s not always clear what. “Perhaps we can treat intuition as a source of data,” she says. “Meaningful, but probably not complete.”
“Maybe we can be grounded in both—in feeling and fact.”
Which raises a more personal question: What do you do with the signals your body is sending?
One avenue for exploration is therapeutic intervention—both pharmacological and neural stimulation. Vagal nerve stimulation has treated epilepsy and depression for four decades, but as Liberles puts it, it’s like pressing all the keys on the piano to hit one note. Weight-loss drugs like Ozempic act in part through vagal pathways but can cause nausea as a side effect, because the targeting isn’t precise enough. Map the body’s circuits with enough accuracy and you might hit the note you actually want.
Another area of active research is psychological and behavioral—teaching people how to detect and even shape interoceptive signals. Low interoceptive awareness is linked to mental-health disorders and stress-related physical conditions.11 But like emotional intelligence, it’s not fixed. Researchers are finding that people can boost their body awareness by, for example, learning to detect their heartbeats from the inside—now a common measure of interoceptive awareness.12 Other interventions focus on body-based therapies and conscious activation of the parasympathetic “rest and digest” system to improve emotional and physical well-being. The placebo effect is another example of the mind acting on the body through expectation alone.
The signals we once dismissed as vague feelings—when your gut tightens before you know why, when your body says yes or no before your mind catches up—those are real. How we interpret them and whether we act on them is another frontier.
It’s clear that gut feelings play a role in scientific research, especially when the path forward looks foggy. Patapoutian’s informed intuition kept him and his colleagues going long enough to find PIEZO, a reminder that major discoveries often start with a hunch that is later tested against evidence. Chen puts it well: Maybe we can be grounded in both feeling and fact.
Katherine W. Isaacs is a writer and senior lecturer at the MIT Sloan School of Management. Her teaching and research focus on the intersection of psychology, technology, and innovation. Originally trained as a biologist and later as a social psychologist, she is currently working on a book called Gut Feel, about intuition, interoception, and embodied decision-making.
Testosterone. Methenolone. Nandrolone. Human growth hormone and EPO. Meldonium, modafinil, and mixed amphetamine salts. Clomiphene, anastrozole, levothyroxine, and liothyronine. Patches and capsules, creams and pills. A whole galaxy of steroids, metabolic modulators, and synthetic hormones coursing through the blood of a few dozen swimmers, sprinters, and weightlifters. And millions of dollars up for grabs for athletes who could break world records and usher in the age of superhumanity.
On Sunday, May 24, at a $50 million arena built in a casino parking lot in Las Vegas, I witnessed a libertarian thought experiment come to life. The inaugural Enhanced Games were the first sporting competition where participants were encouraged to take performance-enhancing drugs. The founders say they’re challenging dated sporting norms and helping to build a world where we can all live better, longer lives. Critics say the event is an embarrassment, that it glamorizes the use of dangerous substances and puts lives at risk.
The open-air venue was compact and decked out in bright blue, with a six-lane, 100-meter track down one side, a four-lane Olympic-length swimming pool down the other, and a weightlifting platform and stage at the front. You could see the golden façade of the Trump Hotel looming in the background. The scene had all the trappings of an NFL game, with the too-loud music and crowd work on the big screen—a “flex cam” gave the well-muscled an excuse to unveil their biceps. Between events, adverts flashed up for the line of performance products sold by Enhanced, the company behind the event: injectable peptides that supposedly support cellular energy and skin elasticity, daily supplement powders with names like “Stronger” and “Longer.”
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Australian swimmer James Magnussen was the first athlete to sign up with Enhanced but hasn’t broken any world records. He finished last in his two events in Las Vegas.
The day started with the weightlifters, under the blazing sun. But by 4 p.m., only one of them had even attempted a world-record lift. Two had pulled out injured. Some athletes were competing without taking drugs because of the money on offer, and as the competition went on, they had the better of their enhanced peers: Hunter Amstrong, a 25-year-old American swimmer and triple Olympic medalist, won the backstroke by more than a second. In the men’s 100-meter sprint, the non-enhanced US athlete Fred Kerley romped to an easy victory. “Man, they gotta do better than that,” he said of his doped opponents in his post-race interview. “They need to train a little harder, get on that shit a little bit more.”
At the bar, bodybuilders swapped before-and-after pictures and talked about their stacks, and VCs and finance bros traded LinkedIn details. Lukas Lakutsin, a 6-foot-10, 354-pound Russian bodybuilder who was milling around the entrance to the VIP suites, initially told me he didn’t use any performance-enhancing drugs. Except testosterone replacement therapy, of course. But he didn’t think that really counted. “I’m almost 34 years old,” he said. “I need to do this to stay strong.”
The “protocol” for Enhanced athletes only includes FDA-approved drugs. While Enhanced’s team might make recommendations, individuals have the final say on what they want to take, if anything.
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Jeremy Sigal, an influencer and author, wore a USA tank top that showed off hugely muscled arms adorned with prison tattoos. He told me he was proudly natural, in both his health and his personal life. “I’ve got an exceptional credit score,” he said. He has written 12 books on marketing and leadership. Later, I looked up his most recent book online. It’s called Simp to Pimp: 10 Steps to Fix Why She’s Not Banging You and lists AI as a coauthor.
What I saw in Las Vegas probably wasn’t the future of sport. But it was a perfect encapsulation of our present moment, as Silicon Valley biohackers, alt-right looksmaxxers, Make America Healthy Again boosters, and longevity-obsessed scientists all vie to remake reality in their own image. For them, the Enhanced Games offered a glimpse of a future where medical advances push the human race to new heights, and where they never have to get old.
I’ve tracked Enhanced’s journey from a crazy idea scribbled on a napkin to a public company valued at $1.2 billion. Behind the scenes, there have been power struggles, life-changing victories, and moments of total farce. As I recently, finally, watched the games unfold, two questions bounced around my head: Were they right? And what does that mean for the rest of us?
In December 2022, the Australian entrepreneur Aron D’Souza flew to Miami to spend New Year’s Eve with his friend and mentor Peter Thiel. A decade earlier, D’Souza had helped Thiel orchestrate the lawsuit that bankrupted Gawker—a stunning revenge against the gossipy New York media blog that had outed him as gay. Now he was armed with a disruptive idea that he thought Thiel, the billionaire cofounder of PayPal and Palantir, would love. It was inspired by the buff bodies he’d been seeing at the gym, highlighting a disconnect between a workout culture where the use of steroids was an open secret and a sporting establishment where it was, at least on paper, an inviolable taboo.
His initial pitch was provocative and confrontational: a grand sporting event to rival the Olympic Games, where competitors could take any substance they wanted—their body, their choice. The first time I met D’Souza, in the spring of 2024, he had founded the company and attracted some initial investment but seemed obsessed with taking on the fat cats at the International Olympic Committee and reinventing sports (even though he didn’t seem to be a huge sports fan himself). On Enhanced’s Discord server, I found a folder full of memes with names like IOC Clowns.jpg. The whole thing felt very unserious.
That would change.
D’Souza told me that Thiel had previously introduced him to Christian Angermayer, a German biotech billionaire, who would come onboard at Enhanced. He’s funded clinical trials of psychedelics through his company Atai Life Sciences and is helping bring them into the medical mainstream as a treatment for depression and anxiety. Angermayer says he spotted an opportunity to do the same thing for steroids. What he really wants is to redefine medicine, he told me. Its focus has already changed from treating disease to trying to prevent it; actively enhancing people’s health, he says, is just the next logical step.
By early 2024, Angermayer had brought his own people into key roles. The team included Michael Sagner, an anti-aging expert and private doctor who works with many of Hollywood’s leading men, and Max Martin, who has the jawline and cheekbones of an Instagram looksmaxxing influencer and the boundless enthusiasm of a puppy. (He started his own enhancement program a few years ago, when he was just 27.) Sagner would head up Enhanced’s medical commission, making sure the games were safe for the athletes. It was Martin’s job to make sure they actually happened.
In early May, Enhanced began trading on the New York Stock Exchange with an initial value of $1.2 billion. Christian Angermayer stands far right with Max Martin to his left (front row), and Aron D’Souza next to him.
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Tensions sparked as D’Souza’s freewheeling style clashed with the more sensible image that Sagner and others were now keen to present. “It was not just his personality and his abrasive way of talking,” Sagner told me recently. “Even when he was briefed on a scientific fact, he would just completely ignore it and say something outrageous.”
But the more outrageous D’Souza got, the more attention his idea received. In February 2024, James Magnussen, a retired Australian swimmer, became the organization’s first official athlete, and Enhanced promised to pay a million dollars to him, or anyone else, who could break the world record in the 50-meter freestyle.
The notion of a “steroid olympics,” as many have dubbed the Enhanced Games, had been kicking around for decades—for instance, in a Wiredarticle from the early 2000s and an SNLsketch from the 1980s. Two things helped finally make the Enhanced Games a reality. First, in November 2024, Donald Trump was again elected president of the United States. The Biden administration had been actively hostile to the games, but the founders saw a more receptive political environment in Trump world. Not long after the election, Enhanced announced a new tranche of funding led by 1789 Capital, a venture capital firm whose partners include Donald Trump Jr.
And second, in February 2025, an enhanced swimmer finished the 50-meter freestyle faster than anyone in human history. It wasn’t Magnussen, though. He had been injecting himself with testosterone to grow muscle, plus a cocktail of peptides that aimed to speed up recovery—but his journey hadn’t quite worked the way he’d planned.
A combination of reputational issues (no pools wanted to host his training) and physical complications (the regimen did help him get stronger, but he packed on so much muscle that it slowed him down in the water) meant he watched from the sidelines as the Bulgarian-Greek swimmer Kristian Gkolomeev—who had finished fifth at the Paris Olympics in 2024—came in two-hundredths of a second under the record and won a million-dollar payout from Enhanced. The idea has always been that breaking records would effectively prove the legitimacy of this enhancement project: Look what we can do now.
Enhanced swimmers like Magnussen (right) wore supersuits to compete, though they’ve been banned by World Aquatics since 2010.
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Gkolomeev, though, had a different motivation for participating: “One successful year in the Enhanced Games and I could make as much as I would in almost 10 careers,” he told me not long after setting the new record (notably, wearing a kind of “supersuit” that’s been banned by World Aquatics since 2010). Enhanced was paying its athletes a regular salary, on top of any potential bonus. And he had a young family to support and feared that the four-year stretch to the next Olympics would be long and precarious.
In May 2025, with a world record in the bag and a friendly administration in the White House, Enhanced was ready to announce its first games: They’d take place in May 2026 at Resorts World in Las Vegas.
At the same time, D’Souza made another big reveal: Enhanced Performance Products, a line of supplements available for a monthly subscription. The Enhanced Games now seemed less like a sporting event and more like a loss leader for selling testosterone injections, GLP-1s, or a range of peptides that are claimed, with little scientific evidence, to improve sleep or skin elasticity. Perhaps it was all a brilliantly executed marketing stunt.
“The games themselves now seem almost secondary to what appears to be an online marketplace for hormones, peptides, and other performance-enhancing compounds,” says Astrid Kristine Bjørnebekk, a steroids expert at Oslo University Hospital. “From my perspective, this significantly changes the nature of the project. It is one thing to organize a closed sporting event built around controversial principles, but openly marketing and commercializing substances such as testosterone, hGH, GLP-1 drugs, peptides, and other pharmacological compounds is something else entirely.”
As the games approached, more athletes joined. Some were genuinely elite. The US sprinter Kerley—who is serving a two-year ban for missing three drug tests—had won silver in the 100 meters in the Tokyo Olympics and a bronze in Paris. Ben Proud, a British swimmer, had won silver at the Paris Olympics and dozens of medals at world and European championships and the Commonwealth Games. He had been mulling over joining the Enhanced Games ever since the idea first emerged, but the tipping point seemed to come when Gkolomeev’s record was announced.
Some participants, like Magnussen and another swimmer, Megan Romano, had been tempted out of retirement. Romano hadn’t swum competitively for almost a decade. Others were at the start of their careers but ready to cash in their chips and bid goodbye to Olympic dreams for a potential six-figure payday. The $1 million payouts were reserved for records in the two flagship events—the 50-meter freestyle and the 100-meter sprint—but winning any other event would mean a prize of $250,000, with an additional $250,000 bonus for setting a world record.
Athletes would get paid even if they just showed up and finished last—as much as $50,000. This is all on top of the salaries that stretched into six figures in some cases, making the payout from the games more than many athletes make in a year.
Sport’s governing bodies reacted to each new athlete announcement with fury. World Aquatics threatened to ban for life any athlete who participated in the games, even if they didn’t take any drugs. Enhanced responded with an $800 million antitrust lawsuit against the global swimming organization, the World Anti-Doping Agency, and USA Swimming, alleging misuse of monopoly power.
American Fred Kerley (right) won the 100-meter sprint without performance enhancing drugs.
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In November 2025, a court in New York dismissed the case. Three days later, D’Souza, the mind behind the entire project, was out. A notice on Enhanced’s website said he had “transitioned out of the company’s day-to-day operations.” Martin would take over as CEO. “The investors basically said we need someone a bit more serious,” Sagner told me. In conversations, execs at Enhanced played down any suggestion of a feud—D’Souza was simply the ideas man, with little interest in the day-to-day dreariness of actually running a company. (Enhanced spokesperson Chris Jones wrote in a statement that “there is no tension between Aron and Enhanced that I’m aware of.” D’Souza did not respond to a request for comment.)
I got the sense that Enhanced, in its new iteration as a pharmaceutical subscription company, was almost embarrassed by the games. When I visited enhanced.com a couple of months before the event, they had been relegated to a sub-heading on the home page. D’Souza’s showmanship had helped get attention for what was becoming a run-of-the-mill telehealth business like Hims & Hers—albeit one well timed to take advantage of a shifting regulatory landscape around peptides, which Robert F. Kennedy Jr., the US secretary of health and human services, has been pushing the FDA to approve despite a lack of evidence that they’re actually effective.
Sagner is still loosely involved with Enhanced, but he says the medical commission was not consulted before it launched its line of performance products. (Jones did not respond to a question regarding this claim.) Sagner is scathing about what he sees as the “hype” around peptides. “I can tell you already, peptides do nothing,” he says—with the exception of human growth hormone and GLP-1. “The peptides that people use, black-market peptides that they buy online—they do nothing. We have tested them; 80% of them contain nothing. It’s saline solution, salt water, and some of them are contaminated.”
At the end of January 2026, a group of around 40 swimmers, weightlifters, and sprinters arrived in Abu Dhabi to start their individualized enhancement “protocol,” as Enhanced calls it. Officially, they would be taking part in a clinical trial, pending approval by the Abu Dhabi government and overseen by Guido Pieles, a Qatar-based cardiologist who has taken over the reins of Enhanced’s medical commission from Sagner.
The day started with the weightlifters, but by late afternoon, only one of them had even attempted a world-record lift.
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They would be allowed to choose only from a menu of specific FDA-approved drugs. Pieles broke them down into five categories: testosterone variants and growth hormones, which can both boost muscle mass; metabolic modulators that can tweak how the body burns fat; stimulants like Adderall to improve focus; and EPO, which can increase the amount of oxygen the blood is able to carry. While Enhanced’s team might recommend particular things, the athletes would have the final say on what they wanted to take, if anything. (As Oslo University’s Bjørnebekk points out, FDA approval “does not mean the substances are inherently safe, particularly not when used for enhancement purposes.”)
There would be regular blood tests, heart scans, and brain scans and access to the best training facilities money could buy. Pieles and others say the clinical trial will help inform the line of supplements Enhanced is offering consumers, but there’s actually very little overlap between the drugs the athletes were taking and the substances the company is currently selling.
Not long after they arrived in the Middle East, the athletes were awakened by the sound of explosions at a military base near their hotel. The US and Israel had struck Iran, and the Iranian regime was responding by peppering the region with missiles. “It wasn’t a pleasant situation,” says Andrii Govorov, the world record holder in the 50-meter butterfly, who a year earlier had become one of the first swimmers to join Enhanced. Govorov had some experience in these matters—back in Ukraine, he’d had a business selling cars that helped fund his swimming career, but he’d lost it after the Russian invasion.
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Swimming, sprinting, and weightlifting were the focus of the first Enhanced Games but in many ways the sports were the sideshow.
The conflict exacerbated delays in getting approval for the clinical trial and sourcing the drugs, and as a result, what was supposed to be a 12-week enhancement protocol got cut down to eight weeks. The athletes didn’t actually start taking the drugs until toward the end of March. For those who had always been clean, that represented the irreversible crossing of a line. “The first injection was very emotional, very tricky to navigate,” says Proud. “For me, that was the day I went from the Ben Proud that I always knew to a new person.”
Proud was joined in the enhancement program by his girlfriend, Emily Barclay, who had swum at college level without ever appearing at a major international event; she was working as a swimming teacher at a school in England. After that first injection, they left Abu Dhabi and spent a few days in Dubai as they reckoned with what they had done. “I just couldn’t be around the team,” Proud says. “I wanted to be by myself and feel those feelings, because it is a big deal to make that step, and I felt it.”
Those feelings were soon forgotten, though, as the drugs kicked in. Proud says he had incredible energy, and a drive to train that he hadn’t experienced before. Shania Collins, an American sprinter, says she had “increased strength, increased recovery, and increased mental clarity at practice.” Sagner and several athletes admitted there were some side effects: acne and some swelling around the joints; unwanted hair growth for the women, unwanted hair loss for the men.
Like Kerley, sprinter Tristan Evelyn from Barbados competed without taking any drugs. She too won big in Vegas, besting her Enhanced peers in two events.
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One thing the athletes wouldn’t talk about, though, is what drugs they were actually taking. They all had the same reason: not wanting to encourage copycats who might take enhancements without a doctor on hand to tailor programs to their needs.
The one exception was Thor Björnsson (testosterone, deca-durabolin, anastrozole, halotestin), a hulking Icelandic deadlifter and former World’s Strongest Man who played The Mountain on Game of Thrones. Björnsson first heard about the games on Joe Rogan’s podcast and was immediately interested. The rules for strongman competitions are somewhat less stringent than those for Olympic sports, though, and he actually had to reduce the number of substances he was taking to meet Enhanced’s FDA requirements.
Icelandic strongman Thor Björnsson actually had to reduce the number of substances he was taking to meet Enhanced’s FDA requirements.
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There is some debate over how much doping some of the athletes were actually doing. In a conversation last year, Gkolomeev told me he’d only really been “microdosing,” and he confirmed that his 2026 enhancement program was largely the same. Sagner says the doses the athletes were taking were a fraction of the amounts some Olympic athletes had been caught using in the past. I heard that a few athletes had decided not to take steroids or growth hormones and were only using modafinil, a narcolepsy medication that’s thought to improve focus.
The day before the games, I asked Angermayer what it would mean if clean athletes like Kerley and Armstrong won their events—what impact it would have on Enhanced’s business model of using sports as a showcase for its line of performance products if the people using those products didn’t actually win anything. “I know what you mean, but mostly our business model is headlines to drive attention,” he said. “Any debate is good for us.”
In early May, Enhanced began trading on the New York Stock Exchange with an initial value of $1.2 billion.
That same week, it was finally go time. The athletes and coaches left Abu Dhabi and flew to Las Vegas, where they were put up in five-star luxury at the Conrad hotel inside Resorts World while they made their final preparations.
When I got there a few weeks later, toward the end of May, I found it jarring to see these hulking presences walking around the casino in their Enhanced sportswear, weaving their way through packs of half-drunk tourists, with slot machines flashing in the background and cigarette smoke hanging in the air. I had expected the games to be a bigger deal within the city itself, but they were just one of a thousand things happening in Vegas that weekend—drowned out by a series of BTS shows at the football stadium, by the Golden Knights in the NHL playoffs, by No Doubt’s residency at the Sphere.
If this was a sporting earthquake, it was one whose tremors were mainly being felt online, where bodybuilding influencers livestreamed to their followers on Kick and Twitch, and where thousands watched on YouTube and Rumble. (D’Souza once told me he’d had “every major sports broadcaster” vying for the rights; in the end, Enhanced struck an exclusive streaming deal with Roku in the US.)
No tickets were sold, so the crowd was a mix of invited guests, investors, and influencers, some of whom had reportedly been flown in on a chartered jet.
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On the morning of the games, Enhanced held a medical symposium that was supposed to provide a taste of the company’s long-term objectives. The first speaker was Bryan Johnson, the longevity-obsessed entrepreneur famous for plowing his personal fortune into wild attempts to reverse his aging: receiving transfusions of his teenage son’s plasma, measuring his nighttime erections, taking more than 100 supplement pills a day. He spends $2 million per year on all this, but he looked pale and vampiric as he delivered the slightly off-brand message that, really, the most important thing was getting a good night’s sleep: “You don’t need to chase IV infusions; you don’t need to chase crystals. You don’t really need to do much of anything.”
At 2 p.m., I took two escalators from the conference room down to the arena, where spectators were filtering in. Though it had cost $50 million, it had been constructed in just three and a half weeks, and it showed; on the media tour the previous day, there were still loose screws on the floor of the bleachers.
There were a few thousand seats in an open grandstand down one side, and two rows of VIP suites on the other. No tickets were sold, so it was a strange mix of invited guests, investors, and influencers, some of whom had reportedly been flown in from Los Angeles on a chartered jet. The rapper Tyga was the biggest name to grace the “blue carpet,” although I did also spot Fabio James, a Michael Jackson look-alike who has had surgery to make the resemblance even stronger. Rumors swirled that Peter Thiel might show up; they proved unfounded.
In attendance was Fabio James, a Michael Jackson look-alike who has had surgery to make the resemblance even stronger.
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A few hours before the doors opened, journalists got a stern message from the organizers trying to bar us from interviewing guests. Still, I talked to a Cambridge professor who wanted to use Enhanced as a case study in innovation for his MBA students, a retired Brazilian swimmer with the Olympic rings tattooed on his forearm, and a biotech investor wearing an Enron hat. Proud’s family and friends were sheltered from the blazing sun in the shadow of the big screen.
D’Souza was nowhere to be seen. Nor was he really mentioned at all—not during the introductory press conference, where Martin was introduced as the “founder of the Enhanced Games,” nor during the event itself, where the athletes showered praise on Angermayer and Martin. But the tens of millions D’Souza had banked from the stock listing likely softened any blow. Plus, he’s already moved on to his next provocative venture: an AI-powered arbitration platform designed to scrutinize the work of journalists on behalf of the rich and powerful.
As the sun set behind the hills, casting the arena in soft gold light, there were still no world records. That and the wins for clean athletes seemed to put the whole Enhanced project in jeopardy—the knives were already being sharpened online. I asked the organizers whether this threatened the legitimacy of the project.
German swimmer Marius Kusch was among the dozen or so athletes who hit personal bests in Vegas.
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“Our response is that enhancements help athletes improve and, in some cases, break records. And yes, some non-enhanced athletes also won—because talent and ability also matter,” Enhanced’s Jones emailed last week. “Breaking world records is incredibly hard as the margin is infinitesimal, as we witnessed. Ignoring that 13 athletes some of whom 10 years later broke personal bests is disingenuous and selective reporting.”
Megan Romano was one of them, swimming faster in the 50-meter freestyle at 35 than she had at 22. And Emily Barclay knocked two seconds off her fastest time in the 100-meter freestyle, coming in second in that event and winning the 50-meter freestyle; she went home with a check for $375,000. “No one’s ever heard of this girl,” said Enhanced swim coach Brett Hawke afterwards. “She’s retired; she’s a nobody. She comes out tonight and swims a time that would have got a bronze medal in Paris.” For all the talk of “superhumanity” and pushing the boundaries of performance, making a 35-year-old feel 22 again is probably the perfect marketing message for the products Enhanced wants to sell.
Angermayer cheers on swimmer Megan Romano, who swam faster in the 50-meter freestyle at 35 than she did at 22.
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Enhanced’s executives say people should take enhancements only with medical supervision, but price could be a barrier to heeding that advice. The battery of health tests the company was giving its athletes in the run-up to the games cost $25,000 per athlete per month. The drugs themselves start at $75 a month and go up toward $200. While Jones says the products “are in line with industry price points,” there were almost certainly people watching who saw the drug-altered physiques of athletes like Gkolomeev or Magnussen and decided to find cheaper, less safe alternatives on unlicensed websites.
“Many of these substances require medical supervision and prescriptions, and several are associated with potentially serious long-term health consequences,” says Bjørnebekk. “Presenting them in this lifestyle-oriented and commercial format risks normalizing use while downplaying the medical risks and uncertainties.”
Although his world record-breaking time won’t stand as the official record, swimmer Kristian Gkolomeev will walk away from the Enhanced Games with a million dollar prize in the 50-meter freestyle.
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Before the night was over, Gkolomeev again had the chance to right the Enhanced ship. The final event of the night was the men’s 50-meter freestyle swim. His 2025 time had been surpassed by the Australian swimmer Cam McEvoy (without a supersuit) at the China Swimming Open a couple of months before, so he needed to lose another two-hundredths of a second to beat the new record of 20.88 seconds.
Gkolomeev was wearing the same supersuit he’d used the previous year, and he’d shaved off his mustache for a little extra streamlining. But he messed up his start—doing four kicks instead of five—and was trailing Proud at the halfway mark. His long arms levered him forward, though, and he reached the wall in 20.81. The spectators were on their feet as “WORLD RECORD” flashed red on the big screen. Martin vaulted over the glass partition from the VIP suites, beaming, to embrace Gkolomeev. They had their record.
Or did they? Online, people shared screenshots from the video feed, purporting to show that the clock had stopped before Gkolomeev’s hand touched the pressure sensor at the end of the pool. An Enhanced spokesperson gave a statement to the Guardian dismissing this as “completely unfounded internet drivel.” But hey—live by the sword, die by the sword. It’s quite possible Gkolomeev didn’t care. He had another million in the bank.
It remains to be seen if it’ll work out so well for the other athletes. Enhanced organizers recently announced a prize of $10 million for anyone who can break Usain Bolt’s 100-meter world record in 2027. They are adamant that the games will happen again next year. If they don’t, dozens of sporting careers will be over, and the athletes will join the long list of victims of VC-backed disruption.
My personal prediction is that Enhanced will pivot away from the risk and uncertainty of a flagship event—the company’s valuation plunged by almost $800 million when markets opened after what was perceived as an underwhelming set of results in Vegas. I expect you’ll see individual stunts and challenges, tightly controlled and filmed for virality and probably featuring your favorite YouTubers—think Björnsson bench-pressing Jake Paul.
D’Souza’s initial idea has served its purpose by capturing the world’s attention. But that won’t necessarily translate into success either. Though the company has had plenty of hype over the last 12 months, SEC filings published as part of its stock exchange listing reveal that it generated only $2,755 in revenue from its enhancements business in the first three months of 2026. Would what happened in Vegas be enough to juice sales?
Martin, Enhanced’s CEO, cheers on athletes from the stands. Company leadership insists the competition will take place again next year.
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As the athletes gathered on the stage to receive their prizes, Martin took the microphone and addressed the crowd. “Enhanced is culture,” he said. “We are at the pulse of where the world is going.” On this, at least, he’s probably right. Testosterone replacement therapy is rapidly moving into the mainstream, and while the science may still not be there on peptides, they have certainly exploded in popularity in the two years since Enhanced launched. And there are undoubtedly more substances yet to be discovered that will promise to improve people’s lives, or at least hold their appearance in stasis. The enhanced age is upon us, whether we want it or not.
As the fireworks went off and the Killersclosed out the event with “When You Were Young” (“Congratulations to … whoever deserves it,” said frontman Brandon Flowers), I wondered what that might mean for us mere mortals. Invoking Hunter S. Thompson’s Fear and Loathing in Las Vegas in a story about drugs and Las Vegas may be a cliché, but it struck me that fear played a big part in all of this. Fear of missing out. Fear of getting old. Fear of never making a dime on your life’s pursuit. Fear of waking up one morning and seeing your flabby, sunken face in the mirror while everyone around you shines and grins and thrives with white-toothed, alien smiles.
Before joining Enhanced, Romano had not swum competitively in almost a decade.
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But the big problem with Enhanced’s vision of superhumanity is the question of who gets to join in. “People will be able to enhance themselves if they have enough money,” Sagner had told me the night before the games. The rest of us, I fear, will just have to function as normal human beings.
Amit Katwala is a journalist and author covering science, culture, and where they collide. His latest book is Tremors in the Blood: Murder, Obsession and the Birth of the Lie Detector. He is based in London.
The outspoken longevity scientist David Sinclair has been predicting that one day, you’ll go to the doctor and get a prescription that will make you 10 years younger.
Now MIT Technology Review has learned that he has plans to launch human tests of an oral “reprogramming” drug as part of a $101 million competition organized by the XPrize Foundation.
The foundation is offering cash awards to teams able to “restore” a person to an earlier apparent age, as measured by improvements in immune, cognitive, and muscle function.
The grand prize goes to any team able to show a 10-year (or greater) relative improvement after one year of treatment.
Reached by phone, Sinclair, a biologist at Harvard Medical School, confirmed that he plans to give an oral drug mixture to volunteers in a bid to seek “evidence for age restoration in humans.”
The trial, if it goes forward, will be a significant new development in the race to harness so-called epigenetic reprogramming. That technology is based on the discovery, 20 years ago, of powerful genes able to turn an adult cell into a stem cell similar to those found in embryos.
The age-reversal effect is believed to occur via a resetting of molecular controls on DNA known as epigenetic marks, which help determine a cell’s overall metabolism and identity.
Companies are now racing to use that phenomenon for a new form of rejuvenation medicine. Only this January, one of Sinclair’s companies, Life Biosciences, made news by winning approval to launch an initial human trial using a set of powerful reprogramming genes. The company announced today it had treated its first patient.
But that test involves a complex gene therapy and is limited to patients’ eyes, where it could treat conditions like glaucoma.
Sinclair’s new plan is bolder: a reprogramming drug you’d swallow in order to promote such effects across the body.
“What we’re aiming to do is to epigenetically restore the animal and eventually the person,” he says. “It is true that we’ve been doing extensive animal studies with the oral agent and are looking to compete in the XPrize.”
This alternative method, chemical reprogramming, uses drugs to mimic the effects of the embryonic genes. That is significant because drug compounds can travel through the bloodstream, reaching most or all cells in a person’s body.
Some experts expressed caution, saying the chemical process, at least as used in labs, is extremely harsh and not even particularly effective. “Who doesn’t dream of whole-body rejuvenation? I think it’s a great goal,” says Sergiy Velychko, founder of Soxogen, a stealth reprogramming company in Boston. “But these chemicals are used in very, very high concentrations for cell reprogramming.”
Sinclair declined to describe the exact makeup of the drug candidate, code-named SL-100, calling its contents “highly, highly confidential.”
However, he has previously published lab studies of what he called “epigenetic age-reversal cocktails,” which mixed powerful chemicals with known supplements and commercially available medicines.
It’s those latter components that would be easiest to test on people, since doctors are free to prescribe them, even for unusual objectives like age reversal. James Clement, head of Betterhumans, an organization that specializes in life-extension studies using existing drugs, said in a message that he is “running clinical trials” of an oral reprogramming cocktail for Sinclair’s XPrize team.
Sinclair’s team is competing in the XPrize Healthspan Competition, launched in 2023. It follows several previous competitions that focused on commercial spaceflight, lunar landings, and other goals. The XPrize Foundation is led by executive chairman Peter Diamandis, also an active promoter of longevity research.
“If two teams are equivalent, they would split the award,” says Jamie Justice, a doctor and executive director for the contest, which was bankrolled by Saudi Arabia’s Hevolution Foundation, “But it will be incredibly hard to even get to one winner.”
Justice says a judging panel is now in the process of picking 10 finalists from 65 teams that have been exploring health foods, lifestyle interventions, digital trackers, and drug compounds.
Sinclair’s team, Justice says, was a late entrant to the contest, but like all teams, it would be required to move into wider human tests starting this year. “You have to be ready and in trials,” she says.
The race to harness the reprogramming phenomenon and apply it to living people is heating up, even outside the XPrize competition. On June 2, a startup called NewLimit, founded by the crypto billionaire Brian Armstrong, said it had raised a further $435 million, from investors including Peter Thiel’s Founders Fund, to support what it calls “age reprogramming.”
The company says it is working toward delivering genetic reprogramming instructions to the liver, to treat diseases of that organ.
But Sinclair has been saying that whole-body rejuvenation is a possibility too. And for that, chemicals, rather than gene therapy, could be the most practical strategy.
Sinclair says his lab has been searching for such compounds and is starting to use AI “to improve the oral agents that we’re testing.”
Chemical reprogramming cocktails, as used in labs, typically involve a mix of vitamins, approved drugs, and experimental molecules. For instance, one recipe Sinclair filed a patent on includes the supplement forskolin, the antidepressant tranylcypromine, and an experimental chemical, laduviglusib, which has been tested against Alzheimer’s, among other ingredients.
“In those days it was a six-factor cocktail,” Sinclair says of his earlier research. “But we’ve come a long way. I can’t disclose what’s in it, but it’s an improvement and an advance on that, and we’ve done a number of animal studies. They are not published, but we’ve been doing them for a long time, and we want to make sure that we’ve done a full investigation of safety and efficacy before we release any of the data.”
While Sinclair’s results aren’t published, other teams say attempts to reverse the age of entire animals using chemical drugs haven’t worked yet. Last year, the lab of Vadim Gladyshev, another Harvard biologist and a member of a different XPrize team, reported on its attempt to rejuvenate mice by installing pumps in their bodies that released controlled doses of seven compounds.
Gladyshev says the procedure proved to be toxic. “The idea was to see if we could rejuvenate whole animals. Unfortunately, we have not found [the right] conditions,” he says. “At low concentrations there was no effect, and high concentrations were toxic.”
Gladyshev says he doesn’t know what is in Sinclair’s cocktail, but says that “trying to improve the combinations makes sense.”
Sinclair, who is the author of several books on aging and has a large social media following, has frequently been criticized by other scientists for making unproven rejuvenation claims.
In 2024, he resigned as president of the Academy for Health and Lifespan Research after claiming that a supplement developed by a company his brother runs had “reversed” the age of dogs, a claim for which there was so little evidence that one scientist called it a “lie.”
Part of the problem is that scientists still disagree on how to measure aging. And they don’t have a reliable way to measure age reversal, either, should it ever be achieved.
Justice, the XPRIZE director, says a primary purpose of the competition is to solve that problem by encouraging the development of standardized measures of aging. That is so that anti-aging drugs can be assessed reliably, and, one-day, approved by regulators if they work.
“We as a scientific field have been forced to ask, ‘If a medicine improves how we age, how would we know?” Justice said during a public meeting with FDA officials in May. “If something worked, what would convince us as scientists, what’s meaningful to the general public?”
Finalists in the Healthspan competition will be announced in August.
This week I’ve been at SXSW London. There’s been music, film, and a lot—and I mean a lot—of talk about AI. I also had the opportunity to sit down with Gloria Mark, a psychologist at the University of California, Irvine, who has spent the last 30 years studying how people interact with digital technologies.
Early in her career, the biggest concerns were the potential impacts of internet and email use on our brains. We may laugh those concerns off today, but it’s true that as the technologies became more ubiquitous and ingrained in our daily lives, our attention spans began to shrink.
Mark is worried that things are only getting worse. The title of our session was “Have we lost control of our brains?” Unfortunately, Mark told me, the answer is yes.
Around two decades ago, Mark started wondering about how our use of devices might affect our attention spans. She set up what she calls “living laboratories,” using sensors and trackers to monitor adult volunteers’ attention, mood, and behavior when they were using devices.
In 2003, she found that the average user had an attention span of around two and a half minutes. That’s how long people could spend focused on one thing before moving on to something else. “That surprised me at the time,” she told me during our session on Wednesday. “I thought: Wow, this is really short.”
But when she repeated the experiment in 2012, she found that attention spans had shrunk—all the way down to around 75 seconds on average, she said. In research she conducted between 2014 and 2020, attention spans shrank further still—to a mere 47 seconds, on average. Yikes.
And it’s not good for us. Mark told me that she’s found switching our attention so frequently is stressful. “We would have people wear heart rate monitors, and … we would see direct correlation between switching attention fast and stress going up,” she told me.
All this distraction makes it harder for us to get stuff done, too. “It just takes longer to do any single task if you’re switching your attention,” she told me. “It’s not great for performance. It’s not great for our emotional well-being.”
And that’s for adults. What about the effects of digital technologies on children? A few months ago, Meta (which owns Facebook and Instagram) and Google’s YouTube were ordered to pay millions of dollars in damages to a 20-year-old woman who had accused the companies of creating products that led her to develop a childhood addiction.
Just a couple of weeks ago, Meta settled another lawsuit, this one brought by a rural school district in Kentucky. The district had also accused the company of designing addictive products that were harmful to students and had sought more than $60 million to cover the costs of their mental-health needs. Around 1,200 other school districts are taking similar legal action against social media companies.
But social media isn’t all bad, all the time. It can provide opportunities for some people, including those from marginalized groups, to form connections that might otherwise be difficult. A 2024 survey of LGBTQ+ teenagers found that while some described social media as a place of rejection and fear, others described it as a place where they felt a sense of belonging, where they could develop friendships and cultivate their identity.
In truth, we can’t definitively say what effects using social media is having on children across the board, says Mark. “There have been lots and lots of studies, and the evidence is to date inconclusive,” she told me. (Despite what you might read in best-selling books on the subject.)
Mark is hopeful that large, long-term studies might finally start shedding a bit more light on this question. An effort of this nature is underway in Australia, which enacted a social media ban for under-16s at the end of last year.
Given this uncertainty over a 20-year-old technology, I wondered if Mark had any thoughts on the potential impacts of AI—an obviously much newer offering that within the space of a couple of years appears to have become deeply integrated into our digital lives.
She told me she’s worried.
When we put in effort to do something—such as evaluating or summarizing content—we’re doing what’s known as “depth of processing,” she told me. “When you’re actively engaged with information, you’re processing it on a very deep level,” she said. “Then you’re more likely to learn it, to understand it, [and] to retain it.”
That’s not happening when most people use AI bots like ChatGPT, Claude, and Gemini. When we ask these tools to write, summarize, or evaluate for us, we’re no longer doing that depth of processing. “You’re deferring your cognitive work to AI,” she said. “And it’s not good for us.”
The risk is that our cognitive abilities will weaken over time. “If you’re not constantly exercising your muscles, they can atrophy,” Mark said. “And that’s exactly what can happen with our minds.” People with weaker critical thinking skills are more likely to fall prey to misinformation, she added.
Interactions with AI-powered “synthetic companions” can be just as harmful. Relationships between human beings take work—time, effort, and understanding. None of that is needed if you’re forming a relationship with a sycophantic bot. The “muscle” we risk atrophying here is emotional intelligence, which surveys suggest is already on the decline, said Mark.
She’s not painting a particularly rosy picture.
“If we continue on this trajectory, attention spans are diminished, loneliness is rising, boredom is rising, emotional intelligence decreasing, and actually our sense of purpose, according to studies, is also decreasing,” she said.
Luckily, she thinks we can course-correct by changing our relationship with these technologies. The key factor is effort.
The more effort we put into something, the deeper the satisfaction we stand to gain, Mark told me. That means making an effort to read a book rather than skimming its summary, and to meet with friends in person when you can. Try not to use GPS in places where you can probably manage without it.
“I love technology; we can’t give it up,” she told me. “[But] we have to learn how to create new life routines.”
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.
One day last October, sitting in the courtyard of his house in China’s Henan province, Dong Hui decided to see if he could hold a pen to write.
Dong, 39, had sustained spinal cord injuries in a car accident six years earlier that left him paralyzed from the neck down. Slowly but determinedly, he wrote his name, “Thank you,” and then the date. This was the result of an 11-month-long rehabilitation enabled by an implant in his brain. Before that process, Dong could move his arms slightly but wasn’t able to use his fingers.
“I couldn’t believe I was able to write again. I was so excited I even missed a stroke in my name,” he told MIT Technology Review on a video call.
In November 2024, Dong became one of the first people in China to be given an invasive brain-computer interface (BCI) through brain surgery. He had signed up for a clinical trial with the device’s developer one month after seeing on TV how a BCI had apparently enabled another paralyzed Chinese man to hold his granddaughter.
This March, the implant Dong uses became the first invasive BCI product in the world to be approved for use beyond clinical trials. It’s now available to some patients with paralysis in their limbs due to spinal cord injuries. We spoke to a range of experts to understand why the device was able to reach this global milestone, what makes this moment so significant, and what to expect next.
A world first
Dong’s brain implant is a coin-size device called NEO. It was developed by Neuracle Technology, a Shanghai-based startup, together with researchers at Tsinghua University in Beijing.
During a procedure that took just over an hour and a half, the device’s sensors, which collect Dong’s brain signals, were placed on his dura mater, the tough outer layer of tissue that covers and protects the brain. The signals are transmitted to a computer by an implant placed on Dong’s skull. The computer then translates the signals into commands for a soft robotic glove Dong wears during the 2.5-hour training sessions he completes each day to help him learn to grab.
Dong started his rehabilitation around a week after surgery. “On the ninth day of my training, my right hand successfully grabbed a ball without the glove,” he says. “That was a miraculous moment.”
Now he continues with his training at home. He wants to be able to control his hands better in order to put on clothes, eat, and do other daily tasks without troubling his aging parents.
A growing number of people with traumatic injuries in China are now poised to tread a similar path thanks to NEO’s recent approval. According to China’s National Medical Products Administration, the bureau responsible for drug supervision, the product is suitable for patients between 18 and 60 who have paralysis in all limbs due to spinal cord injuries but still have some residual function in their arms.
NEO beat several other BCIs to approval, including one from Neuralink, a California-based company founded by Elon Musk. Since October 2023, Neuracle has conducted 36 clinical trials using NEO, including the one on Dong. Thirty-two of them took place in the space of a few months in 2025, with the details about one of the four first in-person trials published in a preprint paper last July. Neuracle did not reply to a request for comment from MIT Technology Review.
One reason for NEO’s fast approval could be that it has a “relatively less invasive” design than counterparts such as Neuralink’s N1 brain chip, says Avinash Singh, a BCI researcher at the University of Technology Sydney. NEO’s eight sensors sit on top of the brain’s protective membrane while Neuralink’s N1 chip directly penetrates the cortex, the outermost layer of the brain itself. Neuracle’s device faces fewer regulatory constraints because it presents a lower risk of hemorrhage, glial scarring, and long-term signal degradation, Singh says.
China’s strong support for its BCI industry also means that NEO was put on an expedited regulatory pathway; in comparison, the approval process of the US Food and Drug Administration can take several years, Singh adds.
A big boost for BCIs
NEO’s approval is hugely important for the global BCI industry, says Wang Shouyan, a neuroscientist at Fudan University in Shanghai who was not involved in research or trialing for NEO. Even though research and development on BCIs has taken place for several decades, most of it happened in the lab. The news means that BCIs are now ready for large-scale manufacturing and clinical use in China, Wang says.
For Dong, however, it means something much more personal. “Now, it will be able to help not only me, but also thousands and thousands of other patients suffering from spinal cord injuries in China who are tortured by despair each day,” he says of NEO. “It will bring them hope and change their lives.”
Days after NEO was approved, China started incorporating it into the country’s health insurance system by assigning it a unique code. This is one of the first steps toward a future where eligible Chinese patients pay a certain percentage of the BCI’s price if they need it during their treatment.
The growth of China’s BCI industry is expected to accelerate thanks to the government’s policy support and financial backing. The country’s latest five-year plan, published on the same day Neuracle received its approval, lists BCI as one of six key industries important to China’s future tech competitiveness, alongside quantum technology, humanoid robots, and others. Several Chinese startups, including NeuroXess and StairMed, have already worked in the field for many years.
“China’s decision to double down on becoming a global leader in the field owes in part to what these companies have already accomplished,” says Meicen Sun, an information scientist at the University of Illinois Urbana-Champaign who studies information and technology policy.
But, Sun says, the biggest advantage China may have is that Chinese people, particularly patients like Dong, tend to welcome this technology and are genuinely enthusiastic about it. In comparison, in the US and Western Europe, testing technologies on human bodies elicits an “ick factor,” triggering concerns and even resistance, she says.
Cooperation in a cold climate
NEO has become the world’s first invasive BCI to go commercial, but scientists interviewed by MIT Technology Review caution against comparing Chinese and US efforts through the lens of a race.
A race implies an endpoint, but it is hard to say where that is for the development of BCIs, says Nick Ramsey, a neuroscientist at Radboud University Nijmegen in the Netherlands. Also, the US and China have fundamentally different visions, Sun says. The US is primarily concerned with being the first to do something and achieving state-of-the-art performance, while winning to China means capturing more consumers and using technology to deliver solutions on a societal scale.
“Being exceptional and being accessible are two diametrically opposed definitions of winning,” Sun says.
In fact, neurotechnology has emerged as a rare tech sector where US-China collaboration is still happening despite geopolitical tensions. The US company Axoft, based in Cambridge, Massachusetts, says it has teamed up with a Chinese company and a hospital in Shanghai to test its BCI on four patients in China and has plans to expand its trials in the country.
Looking forward, China’s BCI industry is expected to speed up its growth over the next five years thanks to strong government support. “There is no comparable national-level ambition or coordinated map elsewhere in the world at the moment,” says Singh.
More BCIs are also in the pipeline for domestic approval in the country, including Beinao-1, developed by the Chinese Institute for Brain Research in Beijing and its affiliated startup, NeuCyber NeuroTech. The device, which sits on the dura mater, is designed to help those who have movement and speech difficulties due to spinal cord injuries or amyotrophic lateral sclerosis. These candidates could get the green light as early as 2028, Singh says.
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