Field Notes: JPM 2026
Healthcare bursting at the seams, and a national longevity strategy roundtable.
Norn Group’s longevity-relevant takes from the JPM healthcare conference.
Plenty of other options if you want extensive coverage of biotech deals. If you want to chuckle your way through a masterful Lovecraftian exposition of JPM, look here.
Healthcare has to change
Many discussion threads felt like loose ends of a fraying fabric: US healthcare can’t continue in its current form. With luck, this will help enable longevity medicines.
People are frustrated by costs and a lack of agency in their own (proactive) health. Biotech companies and investors too are frustrated by the cost of bringing drugs to people, driven in part by the cost of US-based clinical trials. Every part of healthcare is getting more expensive, faster than the medicines we usually complain about. While HHS enthusiastically champions FDA modernization to address these issues, consumers are increasingly exploring ways to sidestep the agency entirely.
Healthcare won’t change overnight, but some things will shift in the next few years.
The DIY Health Zeitgeist
Everyone wants GLP-1s. After a brief gold rush for aggressive telemedicine companies, Novo and Lilly obliged by launching direct-to-consumer sales. Once that door was opened and subcutaneous injections become normal, people start asking what else is available. This triggered a big ‘Chinese peptide’ craze, including various experimental drugs still in clinical trials. The ‘peptide’ brand is so strong that some pill mills are labeling non-peptide drugs as peptides…
The FDA should recognize the latent demand for agency on our health, and adapt accordingly. As it is, the peptide craze has ushered in a wave of longevitainment, normalizing circumvention of a ‘too reactive’ healthcare system in favor of a pre-FDA 'apothecary' model informed by friends and tweets. Much like the apothecaries of old, most consumers won’t benefit, and some will be harmed. For complex diseases, the FDA plays a critical role in enforcing scientific truth-seeking. If medicine ends up like supplements, either from too aggressive deregulation or from lack of adaption leading to consumer actions, we’ll stop getting medicines that actually work because sales costs less than science.
N=1, or ‘DIY with a vengeance’
Some who want greater medical agency have urgent, life-or-death, reasons1. Some cancers and genetic diseases are so rare that treatments are effectively personalized to a single individual, which our healthcare system isn’t set up for. Elliot Hershberg and Hannu Rajaniemi organized a great event to discuss what would help expand options for patients who need such therapies.
Notably, the FDA announced a new ‘Plausible Mechanism’ pathway (which you’d think they would have published open access…) last year. Former commissioner Janet Woodcock published a response bringing in ideas from how we treat surgery, which notably does not need clinical trials before doctors can try new ideas. It’s interesting to think about how doctors could be enabled to try new treatments and combinations in order to support preventative medicine broadly.
Stepping back, the N=1 model could be a powerful way to accelerate medicines when the readouts are clear, like weight loss, cancer, or viral load. But for prevention and any disease without black-and-white outcomes, scattered N=1 trials won’t give us any clear answers. The solution is to establish thoroughly validated surrogate endpoints, like cholesterol, to give us clean data across small trials.
The Geopolitics of Clinical Trial Abundance
Ruxandra Teslo and IFP coined the excellent term ‘Clinical Trial Abundance’, and hosted an event on this topic. This is largely in response to the rising trend of US biotech running trials overseas where costs can be halved and investigator-led trials can be started months than in the US. Or, of course, rely on China to run faster trials and buy assets with human data. You can imagine that this is not a desirable state of affairs for the FDA/US government.
Longevity companies are hit harder than most, even if they don’t run actual aging trials, given the costs and durations for age-related diseases. The Alliance for Longevity Initiatives (A4LI) hosted an event where Jim' O’Neill and longevity biotech leaders discussed options for cheaper and faster early human data in the US. A common concept here is a ‘barbell strategy’, where we make sure early trials are robust on safety, then grant accelerated approval based on reasonable evidence, followed by rigorous enforcement of confirmatory evidence. This would move longevity trials out of ‘untenable’ territory by enabling commercial returns within the drug patent life. Notably this mechanism already exists in veterinary medicine (which Loyal is taking advantage of).
These are aspects of the same broader trend: As healthcare costs rise it becomes more expensive to prove that drugs work in humans which kneecaps new drugs and preventative medicine, the rare parts of the healthcare system with the potential to improve care per dollar. This trend has been ongoing for a long time, and consumers increasingly want to take health into their own hands. Something has to shift.
Solutions & progress
ARPA-H National Longevity Strategy Roundtable
Norn Group organized a roundtable, where a group of academic and biotech leaders came together with ARPA-H leadership to discuss bottlenecks for longevity, and where ARPA-style projects could push us past the ‘valley of death’ between academic work and market-driven progress.
Key takeaway is that ARPA-H is keen to do what it was made to do: Take bold bets that could fundamentally change how we keep Americans healthy, and is looking seriously at longevity science for ways to do that. This is great! I’m hopeful for followup to produce impactful new ARPA-H programs.
There was also discussion of how to incentivize medicines that prevent age-related diseases. This kind of medicine simply isn’t financially viable without some kind of accelerated approval pathway, because the time to make the medicine and show effects in humans would eat up almost all of the 20 year patent life. Surrogate endpoints is one way out of this conundrum.
One of the most important thing ARPA-H can do for longevity is to create a ‘CASP for measuring aging’ to address the surrogate question, as I wrote about earlier this month:
Pharma keeps tip-toeing in
This year’s JPM had at least two sessions organized by investment bankers, and I kept seeing longevity companies and investors in the floor Eli Lilly had rented. Other pharmas also made comments about curiosity around longevity (typically alongside questions about endpoints and accelerated approval).
One topic discussed both at the roundtable and elsewhere is how best to make use of the trove of ‘non-commercial’ drugs that the biopharma industry has created. Drugs whose patent life has expired, or that simply aren’t doing well commercially. This would be a cool way for pharma to dip their toes into longevity trials, without adding risk to the blockbuster drugs that keep them in business.
Clearly defined trial requirements, with accelerated approval, is likely needed to unlock more companies investing in longevity. There are many ways the HHS could act on this, ranging from new regulatory mechanisms to simply issuing crystal clear guidance documents for diseases of aging.
Check out Elliot Hershberg‘s excellent story on Sid:
great info! thank you for sharing!