The State of Healthy Longevity in 2026: Ten Wicked Issues Revisited
As we enter 2026, healthy longevity continues to mature as both a scientific discipline and a commercial endeavour. Progress is real, but uneven; ambition is high, but structural constraints remain. Before looking forward, it is worth taking stock of where the field stood at the close of 2025 — as a baseline for understanding what the next phase of progress should focus on.
2025 was a year in which healthy longevity as a scientific and commercial field really began to come of age. However, like the life of any teenager, not all the spots had disappeared, occasional arguments flared, and yet we had glimpses of future maturity.
Let me summarise the progress we made against my 10 Wicked Issues. Patchy progress, but what more can we expect, on a very demanding list:
Issue #1: Finding and filling the gaps in the science base
The fundamental science saw some new revelations, but also some mysterious findings. Inflammaging remained one of the most important aging mechanisms, but we saw that the cytokine signatures of aging are very different in industrialised and indigenous populations, leading to the idea that inflammaging may not be an inevitable consequence of aging but rather the accumulation of exposures we have in the developed world. The concept of “gerozymes” as new potential modifiers of cellular programming also appeared. The Thalion initiative, focused on basic geroscience, was getting off the ground, although encountering some of the challenges that much basic bioscience in the US is now facing.
Issue #2: Deciding which mechanisms of aging to prioritise
Prioritising mechanisms for intervention saw some real achievement, with promising senolytics and products from epigenetic reprogramming entering the clinic, albeit for diagnosed disease rather than the process of aging itself. As we enter 2026, we see FDA approval of Life Biosciences trials using Yamanaka factors to reset cellular epigenetics, in this case for a specific form of glaucoma.
Issue #3: Converging on the best biomarkers of aging to measure impact
Reliable, validated and consistently applied biomarkers of aging remain one of the critical keys to unlock overall progress in the field. There were individual biomarker advances, such as the demonstration that the markers of both brain and immune system aging correlate with long-term mortality risk. There was also the conclusion of the first phase of the Biomarkers of Aging Challenge. A Delphi survey of biomarker experts identified 460 distinct markers, but then — via successive rounds of ranking — converged on 14 consensus markers that met criteria such as reliability, clinical relevance, invasiveness, cost, and prediction of biological age (versus chronological age). So, slowly but surely, the field is approaching what it most needs: well-accepted metrics of the effectiveness of anti-aging interventions.
Issue #4: Constructing rigorous clinical trials to demonstrate what works and for whom
This issue concerns the construction of rigorous clinical trials. Building consensus on biomarkers is a sine qua non for this, but we also saw some progress on methodology for trials conducted on older people. The TAME trial on metformin recruited more patients but remains chronically underfunded. Some promising trials on rapamycin and senolytics did, however, get off the ground. The XPRIZE stimulated Mount Sinai to start multi-agent trials on rapamycin, metformin, spermidine and GLP-1 agonists. One of the few clinically trialled supplements, Urolithin A, along with Fisetin, was being studied on both aging biomarkers and sleep. But in quantitative terms, somewhere between 10 and 25 geroscience trials began in 2025, against some 5,000 total industry-sponsored trials (and perhaps four times as many total trials). So geroscience still represents a tiny fraction of clinical trials.
Issue #5: Developing networks of professionally managed, protocol-driven clinics
Until 2025, I had seen the emergence of networks of professionally managed, protocol-driven clinics as a key vehicle for conducting anti-aging trials, but as I observe the field I am becoming less sure of this as a route. We have seen the continued formation of scores of individual and largely commercially oriented clinics across the world. To bring some structure and discipline to this part of the sector, there has been steady progress led by the Healthy Longevity Medicine Society towards common, evidence-based protocols. Some chains of clinics, like Fountain Life, with its five sites across the US, have been enrolling their clients in FDA-approved trials for advanced therapies such as cell or exosome therapy. But objectively speaking, we are really no closer to creating trial networks capable of conducting trials of anti-aging therapies with sufficient scale and rigour. That must probably await the adoption of healthy longevity into academic medical centres that already have trial infrastructure and seasoned investigators.
Issue #6: Shaping regulatory attitudes, policies, and practices
On regulation, we saw the FDA beginning to grapple with the need to accept surrogate endpoints for aging, knowing that otherwise trials will be infeasibly long and costly. Right-to-Try developments in the US have allowed the use of a variety of cell and other therapies that have not gone through conventional development. There has also been an attempt to create draft US legislation (the THRIVE initiative, sponsored by the Kitalys Institute) to be applied to drugs, diagnostics, devices and nutritionals. This draft bill anticipated a three-tier approval process depending on the level of evidence, with a focus on ensuring adequate periods of exclusivity to incentivise development. This bill has yet to be introduced in Congress. I believe we have yet to see a well-structured collaborative effort to shape the future regulatory landscape for anti-aging therapies between academics, companies and sympathetic regulators. I have been calling for such an effort for some time and hope to catalyse it in 2026.
Issue #7: Designing reimbursement systems
Without a clear regulatory pathway, there is unfortunately little or no prospect of routine reimbursement by private or state insurers for anti-aging therapies; they will remain available only on a self-pay basis and therefore restricted to the affluent. However, in 2025 some began to speak of anti-obesity GLP-1 agonists such as Wegovy as healthy longevity therapies, and many insurance plans in the US and elsewhere are covering these drugs, albeit typically only for their approved indications. Personally, I see these medicines — approved and reimbursed for a condition that is primarily a risk factor for future disease — as a potential springboard for other classes of risk-reducing therapies in the future.
Issue #8: Reducing the costs of effective innovations
Cost reduction has not yet been a major focus in the field. Indeed, many of the therapies seen as most exciting, such as stem cell therapy, are inherently costly. However, as we enter 2026, India — one of the world’s most potent cost-reduction workshops — is signing trade deals to gain lower tariff access to first-world markets. This may ultimately help pave the way to reduced costs, perhaps initially most visible in the device arena.
Issue #9: Applying data science, AI, and diagnostic tools to mine medical records
AI remains the flavour of the decade in bioscience, from revolutionising drug discovery to speeding clinical development and improving manufacturing efficiency. In healthy longevity there is intense activity to apply AI and digital-twin approaches to designing personalised healthspan strategies. Given the enormous inter-individual variability in response to almost all therapeutic interventions, precision medicine — and by extension precision healthspan — remains the goal. Solutions launched last year on this theme include Function Health Medical Intelligence, Tolion Brain Coach and EON.Health. The principal challenge here will not be the machine-learning tools themselves, but the availability of consistent, high-quality, multi-modal data on which to train them.
Issue #10: Creating a compelling public and political narrative
Finally, issue number ten concerns the public discourse around healthy longevity. Here, we see an increasingly lively debate about how best to describe our endeavour. Some, like me, emphasise healthspan and feel that a narrow focus on “longevity” evokes public images of elite billionaires pursuing immortality. Others argue that striving for longer lifespans will naturally extend periods of good health, rendering the distinction artificial. We shall see.
Taken together, progress across these ten wicked issues in 2025 was real but fragmentary. Discovery science continues, but translation, coordination and system-level alignment remain the limiting factors in applying geroscience in practice. As we move through 2026, the central question for healthy longevity may be less about whether promising science exists, and more about whether the field can organise itself — across research, regulation, clinics and public discourse — to turn that promise into scalable, credible impact. This is where I intend to focus my own efforts in the year ahead.
