Wealth isn’t just measured in dollars—it’s measured in years.
Lifespan. Energy. Fertility. Cognitive edge. These are the new currencies of power.
These are also the new battlegrounds in our era of division and disagreement.
We used to think healthcare inequality meant lack of access. Now it means biological class warfare.
The gilded age is back. Only this time, it’s written in your bloodwork.
Health is now the ultimate vector of power, but also a symbol of the growing class divide.
Biology is becoming the new battleground for status, access, and agency.
Man in the Mirror
People don’t want to just live longer, they want to live better.
This has created a biological arms race.
Resentment grows: as average life expectancy stagnates, elites live longerand better.
The rich are not just opting out of the system, they are building their own. In so many areas of life, they are now immune to the consequences that affect the masses.
The new upper class will be thinner, smarter, faster, stronger in almost every way than you.
They have hacked their biology. Meanwhile, you’re still waiting for insurance pre-authorizations on your Z pak.
Yes, everyone will soon have access to a world class chatbot doctor—but only the elite will access true health, extended vitality, and biological sovereignty.
Fountains of Youth v Fountains of Dupe
I recently commented on a post by famed cardiologist and prolific commentator Eric Topol as he was promoting his new book on evidence based longevity
The point I was making was entirely lost on everyone. I got responses that these longevity clinics are not evidence based and shaking down vulnerable (but wealthy) patients. Why don’t I get that?
I do. But these clinics and services exist for a reason. They are tapping into a primal, visceral and urgent need for people to reclaim their health from broken hospitals, dismissive doctors, and predatory pharmaceutical companies.
This sentiment is striking the medical establishment like a punch in the gut.
This brewing resentment is tipping over and creating an alternative ecosystem for care that is looping in other patients, attracting venture funding, and creating influencers with real leverage (including the White House with RFK Jr and the MAHA movement).
In fact, Bizarro FDA Comish RFK Jr recently tweeted:
These clinics represented just one manifestation of the broad consensus that our healthcare is actually a sick-care system and failing everyone. It’s one of the few areas of agreement in our divided times.
The medical establishment has consistently failed to address, validate and incorporate this sentiment. As a result, patients are angry, skeptical and increasingly looking elsewhere.
As a result, the myth of medicine in America is fracturing.
We don’t have to cave to public pressure and support any number of scientifically inaccurate or poorly evidenced longevity bio-hacks that are du jour.
But we can use the moment to start a really productive dialogue – and that would be more useful than mere LinkedIn comments with eye rolling physicians.
Increasingly, I see patients with a gnawing sense of health FOMO – that they are missing on the latest pill, test, or supplement. Natural therapies that Western medicine ignores. Or advanced therapeutics they can’t access often due to cost or insurance limitations. These concerns are not entirely unfounded and often reiterated by physicians themselves.
There are few feelings worse than that of a missed opportunity.
These longevity clinics leverage that sentiment and add something even more potent: status.
The price tag, branding, and approach promote exclusivity, elitism, and escape—from aging, from the public system, and from the fate that awaits everyone else.
The promise is intoxicating. And it fuels the desire for more, faster and better care – but only if you can afford it.
That perception cannot be dismissed by simply quoting p values.
Facts alone will not change minds. We need a new cultural myth of healing in America that appeals to the same status anxiety, desire for preventative and collaborative health, and addresses the FOMO that drives people to alternative health options.
Our St. Johnson of Magical Thinking
Bryan Johnson (“the world’s most measured human”) has quickly become the modern face of biohacking (sucks to be you Dave Asprey). He lists a $2 million annual expenditure based on his “don’t die” philosophy and is centered around his biohacking company Blueprint.
He may be a tech bro narcissist who weaponizes NDAs against his own employees, but he also has a strong and growing following. He represents the anti-thesis of medical convention.
self directed health choices → agency
learning from his own data → self – awareness
physically fit and nutrition focused → vitality
emphasizes of supplements and bio-hack tools → de-emphasis on pharmaceuticals
utilized novel and experimental techniques → future oriented, open minded
sharing all his personal health data → transparency
For a lot of people, these basic principles of health ring true, and is the basis of a massive paradigm shift in how elites will manage their health and wellness.
But ask any PCP and you’ll get blank stares.
Meanwhile, the average American, however, will increasingly have a medication list that looks like this as they become older:
(not a real patient’s list)
Johnson, in this regard, represents the new avatar of the health optimized person.
Technology: Back to the Future
It seems there are new touted cures every day that promise to reverse the clock. Most are justlegerdemain.
CRISPR – one of the first things med students learn is cell biology and with it, genetics. It’s the basis of life itself. And now we can manipulate it. This gene editing technique can now cure forms of sickle cell anemia and even blindness. Stanley Qi, bio engineer at Stanford, describes it: “CRISPR is not merely a tool for research. It’s becoming a discipline, a driving force, and a promise that solves long-standing challenges from basic science, engineering, medicine, and the environment,”
Psychedelics – Mental health, especially depression and anxiety, are the most impactful diseases in terms of days living with disability. They are part of the growing threats to consciousness that also include neuro-degenerative diseases, among others. While research is still developing, psychedelics promise to truly revolutionize brain health diseases. In depression, this is sorely needed in particular. There hasn’t been a breakthrough class of therapeutics since the introduction of SSRI’s in the 1990’s. Despair is rising. This may be the cure.
G1P agents – I’ve previously written about how such drugs like Ozempic, Zepbound and others are “firewalls against modernity.” With remarkable effects on gut physiology, they can drastically improve metabolic health, obesity and more including other addictions including alcohol. A newer formulation (so called triple agent because of three mechanisms of action) retatrutide promises to be even more effective.
AI – AI with it’s ability to particular accelerate drug discovery will be the biggest innovation in medicine since the discovery of germ theory. To take the G1P example, it will be as if we started with retatrutide as opposed to its precursor liraglutide, which has much less pronounced anti-obesity and metabolic health benefits. AI could compress that timeline by decades and identify the most promising drug candidates immediately. How? AI has already understood most if not all of proteomics. Most drug discovery is trial and error and requires decades of basic science and clinical testing on candidates that may end up failing. AI portends to make targeted drug development a true reality – and with CRISPR – give us unprecedented ability to manipulate our DNA and physiology.
Wellness Supreme
This is the era where wellness converges with luxe self optimization. Think the trans-humanist ideal crossed with GOOP.
The Tomorrow List by Rusha Modi, MD is where cutting-edge ideas in health, business, and technology converge. Designed for thinkers, innovators, and leaders, we explore the forces shaping the future of medicine, longevity, and human performance—while decoding how they intersect with economics, policy, and culture. Expect sharp insights, deep dives into emerging trends, and unconventional wisdom you won’t find in mainstream discourse. If you’re building, leading, or rethinking the future of health and society, welcome to your next strategic advantage. Unsubscribe · Preferences
