The future is enhanced

Structural societal changes are about to fundamentally change the future of biotech, pharma, and the wellness industry for the better.

Feb 23, 2024

We are entering a golden age of human enhancement, where individuals will seek to greatly improve their functional capabilities - at physical, cognitive, and emotional levels. This will change the focus of entrepreneurs towards catering for these market demands and accelerate innovation. Those enhanced lifestyles will allow people to live longer, healthier, and happier lives.

Most human civilizations are based on ‘norms’, often shaped more by cultural and religious influences rather than scientific or objective facts. These norms range from things like political ideologies and economic paradigms, to dimensions such as sexuality, physical looks, and fashion. The 20^th century was no exception. In fact, in a historic dimension, it was one of the more rigid chapters of humanity, particularly with any norms related to our body and sex. Sure, there were differences in opinion, attitude, and taste, but the permitted range has always struck me as fundamentally narrow.

Modern Western medicine and our healthcare systems mirror that behavior by defining the norm of what a healthy, regular person should look and feel like. And that definition has been a pretty rigid and narrow one. Medical interventions have been typically reserved for when there is a (negative) departure from the norm, such as when somebody is defined as being sick or ill.

However, the definitions of ‘sick’ and ‘ill’ are not as clear-cut as one might think, and also often relate to the zeitgeist. Sure, when it comes to a viral or bacterial infection for example, it is pretty easy to recognize – some outside life form has invaded your body which shouldn’t be there. But other ailments such as mental health issues are harder to define.

And let’s not forget that in much of the Western World, any deviation from the sexual norm, such as being gay, was labelled as ‘sickness’ or a mental disorder until recently. Indeed, it was only in 2010 that the Council of Europe issued a recommendation that homosexuality should not be treated as a disease – and even in Europe this hasn’t been followed or adopted uniformly.

One of the effects of this obsession with the norm and the notion that medicine should only be used when there is a negative deviation is that over the last couple of decades, many biotech and pharma companies have focused increasingly on niche areas, on so called rare diseases, and on precision oncology. The motto was “the rarer the better” – a mindset that has often conflicted with my own perspective.

Let the following numbers sink in: The top 10 selling drugs sold US$ 36 billion in 2010 and were used by 112 million people. By 2020, the top 10 selling drugs sold US$ 93 billion but were used by only 18 million people. Pharmaceuticals became an economically larger market but at the same time treated fewer people.

In most other sectors where we as Apeiron Investment Group invest, the guiding principle is the opposite: the bigger the TAM (total addressable market), the better.

We are witnessing a seismic change

As we all know, societal norms are in a constant state of flux, often evolving rapidly, and so does our understanding of medicine.

One of the most profound and impactful movements of the past 70 years has been the queer movement, and particularly in recent times, the trans movement. The queer movement initiated a gradual liberation from the constraints of established sexual norms, advocating for the freedom to love whomever one pleases. Building upon this foundation, the trans movement took a further step by empowering individuals to define themselves more subjectively in terms of (gender) identification.

As it is often the case, such trailblazers push the boundaries well beyond their own communities. Societal changes trickle down and ultimately affect each and every one of us, albeit for the majority in more subtle ways. The queer movement, for example, not only emancipated queer people from the confines of narrow norms but also enabled straight people to explore their sexuality more openly.

I believe that the effects of the trans movement are only just beginning to permeate society and impact different parts of it in unexpected ways. A primary aim of the trans movement is to grant individuals all rights corresponding to their self-professed gender identity — from changes to identification documents to preferred forms of address to, in some cases, gender-affirming treatments. While these fundamental rights primarily concern those who identify as trans, my prediction is that, once again, every person will ultimately experience greater personal freedom as a result of the trans movement.

This time, I expect that the larger societal freedoms derived from those advancing the trans movement will ultimately extend to the ability to shape and enhance one's own body and mind according to individual desires and aspirations. We are liberating ourselves from the very narrow norms of what a ‘normal’ body is or what kind of people are considered ‘normal’ within society and handing back full liberty and autonomy to each and every one of us to define their own identity and how they realize that.

Before going forward with my thoughts, I want to emphasize that in no way do I want to compare the struggles, hardships (and unfortunately often severe emotional pain and physical abuse) so many trans people experience to the more ‘mundane’, often vanity-driven issues I am about to explore. But again, what I do believe is that their fight for their rights is changing the entirety of society in a hugely positive way and that each and every one of us will benefit from these changes by being given more freedom.

Ozempic: the first widely used enhancement drug

The biggest recent success story in biotech and pharma is that of so called GLP-1 receptor agonists like semaglutide (know by brand names Ozempic and Wegovy) and terzepetide (Mounjaro and Zepbound). Through astute marketing and public relations efforts, these drugs have garnered public perception as weight loss aids for everyone, though technically they are ‘only’ approved for their original purpose - treating diabetes – or weight loss for people with clinically recognized obesity or excess weight with weight-related conditions.

I am happy to ‘confess’ that I take Ozempic myself, because it makes managing my weight much easier - and I think I’m far from being clinically obese. And I know I am not alone. A recent poll found that nearly half of US adults (45%) say they would generally be interested in taking a safe and effective prescription weight loss drug, including nearly 6 in 10 (59%) of those who are currently trying to lose weight and half (51%) of those who are trying to lose fewer than 10 pounds[1].

This cultural shift has even permeated pop culture, with figures like Jimmy Kimmel referencing these drugs in high-profile events such as the Oscars[2]. In essence: The vast majority of people using GLP-1 receptor agonists are not people who are ‘sick’ in the classic definition; rather, they seek to lose weight as they feel better looking slimmer. They essentially want to enhance themselves.

And as is so often observed, shifts in the zeitgeist provide fertile ground for change, with financial incentives serving as potent accelerators. Novo Nordisk has added almost US$ 400 billion (!!!) in market cap since 2020, more or less entirely based on the success of one drug, semaglutide. You can safely assume that any pharma CEO in the world wants to repeat this success, which in my opinion is only possible with pharmaceuticals that address a large enough market, or TAM, and a medication that so radically shifts people’s health and how they feel as semaglutide does.

The Enhanced zeitgeist

The resounding success of semaglutide, combined with shifting societal norms, is poised to revolutionize our perspective on scientific potential and the utilization of medicines. I believe it will redefine the very essence of the pharmaceutical industry – from its core. No longer confined to treating sickness alone, medicine will increasingly serve as a tool for individuals (in consultation with their respective medical practitioners - see more below on this point) to modify, reshape, and enhance themselves according to their wants and desires.

For those use cases which are not fully covered by whatever a specific medical drug is approved for, “off-label-use” is an already existing legal framework that allows broader utilization. Once the FDA greenlights a drug, healthcare providers generally may prescribe the drug for an unapproved use when they judge that it is medically appropriate for their patient. As said above, strictly speaking, many users of semaglutide and terzepetide still use it “off-label”, since they are not clinically obese. However, this practice has historically been somewhat frowned upon by regulators, scientists, and many in the medical community, including even doctors[3].

My expectation is that the new autonomy we are gaining over our bodies will also make off-label-use more accepted and common and will make it a significant economic driver for the biotech pharma industry in the years ahead.

I anticipate that this transformation is going to hit us in different and distinct ‘waves’. I don’t mean that they will necessarily come one after the other, in chronological order, as some of them have already begun, but each of them will have their time in the press and zeitgeist, just as semaglutide and terzepetide have had over the last two years.

Sexual enhancement

The most beautiful thing in the world doesn’t come easy for everybody. There are multiple sexual dysfunctions, from not getting aroused at all, to not being technically able to perform, to reaching orgasm way too early.

So far, there is little help, except for erectile dysfunction with two of the most famous pill brands in the world: Viagra and Cialis. You could actually say that those two drugs were the very first “mass enhancers”, albeit with a narrow focus: Viagra and Cialis are for pure performance only (they don’t create arousal), and only for men. Women’s’ sexual health has been even more neglected than men’s.

Because sex is at the same time one of the most important and most suppressed, stigmatized, and tabooed topics in our lives, any form of sexual dysfunction often has much wider implications, such as decreased self-esteem, higher levels of personal distress, relationship issues, anxiety, depression, and so on.

Luckily, help is on the horizon - or is already here:

·      Testosterone Replacement Therapy (TRT) not only helps men to grow bigger muscles, but often also increases sexual libido.
·      MDMA therapy can not only help with PTSD but has also been an effective marriage counselling treatment since the 1960s, being used to “reignite the fire”. And many people will likely soon figure out that it’s way cheaper and less painful than a divorce.
·      Magic mushrooms have been shown to improve sexual function up to six months after their use, including enjoyment of sex, sexual arousal, satisfaction with sex, attraction to partner, their own physical appearance, communication, and their sense of connection[4].
·      Psilocybin - the active molecule in magic mushrooms - will likely replace classic antidepressants over time after approval by medical authorities. One of the key side effects of traditional antidepressants is the loss of libido for men and women and erectile dysfunction in men. Psilocybin carries none of these side effects.
·      Our portfolio company Kanna Health[5] is developing a novel treatment for premature ejaculation, a distressing condition in which patients ejaculate too quickly before or shortly after penetration (often within less than a minute). There are currently no treatments approved by the FDA, despite the condition affecting up to 20% of men.

Muscle enhancement

To augment muscle strength, endurance, and overall physical performance — all while enhancing appearance, of course – is the dream of many.

As with some of the innovation seen with new weight-loss drugs, those in the muscle category will find their roots in the quest for cures for other, more ‘traditional’ conditions. Therapies designed to combat conditions such as sarcopenia (age-related muscle loss) or muscular dystrophy may one day serve a broader population seeking general health improvements. Both of my longevity companies, Rejuveron Life Sciences and Cambrian Biopharma are dedicated to researching novel mechanisms of actions to promote muscle growth, and the interest from big pharma in this space is enormous.

However, the significance of these developments extends way beyond mere vanity – although I obviously think every person should have to right to be as vain as they please. Equally vital are the huge economic and social opportunities here. Frailty, for example, is a tremendous blight on society, way before it is called “sarcopenia”. If you look at why people retire from the workforce, it’s often because they’re in pain, have mobility issues, or simply don’t have the necessary energy levels to continue being an active participant in the workforce. If an older person has a fall, for example, they often simply don’t have the physical strength to absorb the shock of the experience, which leads to broken bones or worse, and so on.

So, it’s not just muscle health that you can enhance - it’s athleticism and basic mobility improvements that will help people continue being active members of society for longer. This represents a monumental economic and social opportunity, particularly amid declining population trends and an aging demographic.

You could say that wave has been here for a while because there are in fact many highly effective and – when done under medical supervision and in the correct dosages – safe muscle enhancers, like Testosterone Replacement Therapy (TRT) and Human Growth Hormone Therapy. But as with psychedelics, which have been deemed illegal for no scientific but solely political reasons, the ‘doping paranoia’ of the eighties and nineties has stigmatized and robbed us of many very helpful therapeutics.

Cognitive enhancement

This trend has actually been in motion for a while, with students (and many other people) around the world using medications like modafinil, Adderall, and Ritalin off-label to gain a competitive edge.

Even good old nicotine, now in the form of chewables, is increasingly being used for focus. And we all know the benefits of the most common enhancer: caffeine, a time-tested booster used for thousands of years.

But this is just the beginning. A new generation of ‘smart drugs’ is coming, some from biotech companies within our portfolio, which will enable people to excel to new, unprecedented levels. Memory, attention, and overall executive functions will be improved, leading to massive improvements in productivity and advances in creativity. People will be able to take control of how one of the most complex parts of themselves behaves – the brain – be it for work or for pleasure.

It will become increasingly difficult to justify why individuals who haven't been blessed with innate intellectual advantages in terms of IQ, concentration or ability should resign themselves to underperformance when tools exist to boost that performance.

And considering the challenge of an aging global population – these new enhancers offer a beacon of hope. Older generations will be empowered to preserve their cognitive faculties for longer durations, alongside advancements in therapies for age-related brain ailments like Parkinson's and Alzheimer's. This promises a more optimistic outlook for our later years, free from the fear of losing the very essence of who we are.

Even people who won’t use those drugs will benefit. It is plausible that a new generation of Einsteins could be created with the assistance of performance enhancing drugs – leading to even greater advances and progress for humanity.

Happiness enhancement

The fifth wave will be happiness, a trend I've long foreseen and actively championed by founding and investing in what are now the leading companies pioneering psychedelic compounds.

While all the approval studies for psychedelics focus on officially recognized diseases like treatment resistant depression, the data both from scientific studies and the millions of anecdotal users every year is very clear to me: psychedelics have the potential to enhance the level of happiness for every human being and help you rediscover yourself, which I believe is the basis of living a happy and fulfilled live. Why just stop at merely not feeling ill if one can actually feel great?

As I have always said, my personal belief is that the total addressable market for such psychedelic compounds will ultimately be 100% of the world population. I covered this in depth in my blog post from October 2021[6].

Transhumanism: the final wave

The final wave of enhancement will usher in true superhuman abilities through the seamless integration of technology into our bodies, a concept I find particularly compelling, especially in the realm of brain-computer interface (BCI) technology. In the not-so-distant future, I envision capabilities like super hearing, telekinesis, and telepathy becoming attainable through BCI advancements.

You may think I am going too wild or far into the future. I’m not. The truth is the foundation for this future is already here. Elon Musk’s announcement of Neuralink’s first human brain chip implantation has been making its waves online recently. But the integration of BCIs into humans isn't novel. My portfolio company, Blackrock Neurotech, has been at the forefront of BCI innovation since 2004.

More than 40 of the fewer than 50 individuals worldwide implanted with BCIs rely on Blackrock technology (unaffiliated with the Blackrock asset management firm). Blackrock’s incredible tech has enabled people to type emails, control robotic arms, create art, feel a sense of touch, even drive a car… all through the power of their thoughts alone! Check out their website, because it’s better to see the patient videos with your own eyes: blackrockneurotech.com.

The potential of BCI is staggering. From helping people with paralysis regain independence to aiding first responders, future applications of BCIs are just beginning to unfold. Science fiction is becoming science fact faster than most of us realize.

I am a conservative libertarian

While the tone of this blog post may suggest a laissez-faire attitude toward drug use, I must clarify that this is most certainly NOT the case. In my view, three fundamental principles guide everything discussed and proposed in these waves of enhancement:

1. Education

Society’s view and understanding of drugs is messed up. Period. A simple glance at the statistics in Professor David Nutt’s chart from The Lancet in 2010 below underscores this point. From a purely scientific standpoint, alcohol ranks as the most hazardous drug, closely followed by heroin. Conversely, now looking to the right, the ones with almost zero risk include psychedelics - and anabolic steroids don’t score that badly either.

Source: The Lancet[7]

Therefore, I believe that there's an urgent need for comprehensive education. Many of my own friends stopped drinking alcohol once they realized how bad it really is for them. Education is the cornerstone of informed, independent decision-making.

2. Reasonable age

One of life's greatest joys, and challenges, is the journey of self-discovery, figuring out who and what you are. While this can (and maybe should) be a life-long process, in our younger years some people frequently change their view of themselves - and have every right to do so.

From a physical perspective, the brain finishes developing and maturing in the mid-to-late twenties. The part of the brain behind the forehead, called the prefrontal cortex, is one of the last parts to mature. This area is responsible for essential skills like planning, prioritizing, and making good decisions[8].

Because of both the psychological and physical aspect, I don’t endorse ANY enhancement until at least 21 years of age. I’d even go so far as to say that any recreational drug, including and especially alcohol and cannabis, should be prohibited until that age or even into the late twenties when based on scientific facts.

Only when you know who you really are, and when your brain has fully matured, can and should you confidently start enhancing yourself.

From a spiritual perspective (I will write more about this in a separate post soon) I am generally against any form of "check out” drugs, which ultimately means I am against any form of recreational drug use that doesn’t serve a higher purpose. Life is too awesome to experience it with a constantly dampened and foggy mind. All drugs, including psychedelics, should be used strictly as catalytic agents for positive enhancement.

Or as one of the great psychedelic thinkers said:

“If you get the message, hang up the phone. For psychedelic drugs are simply instruments, like microscopes, telescopes, and telephones. The biologist does not sit with eye permanently glued to the microscope, he goes away and works on what he has seen.”

― Alan Watts

Which leads to my third point.

3. Strict regulation and medical supervision

I believe people should have the autonomy to engage in open discussion with their doctor about what they want to be, why they want to change, and how they want to ‘upgrade’ themselves. However, such endeavors in my opinion must be conducted using only regulator-approved drugs, accompanied by thorough knowledge of potential side effects, guidance, quality-controlled production, and the option for ongoing monitoring throughout their journey.

I want to be absolutely clear on this: I am not at all proposing making any of the substances mentioned in this post ‘over the counter’, or available as consumer products. They must be prescription only, and some of them – like most psychedelics – should only be taken under supervision by a facilitator, therapist, or doctor during consumption.

The Enhanced Games

One project I’ve recently been working on brings the principles discussed here to life today, and it’s focused on the world of sports – a realm that has resisted embracing and even shunned scientific progress for too long, at least officially.

I am very proud to be the co-founder of The Enhanced Games together with Aron D’Souza, the world’s first sporting event where performance enhancements are not just permitted, but actively endorsed. We’re going to celebrate what the human body can do with the help of science.

The Enhanced Games represents new model of sports, one that openly celebrates scientific innovation. Its core mission centers on building a platform that not only improves safety and fairness of competition, but also stimulates scientific breakthroughs and nurtures human advancement. The ability for athletes to achieve record-breaking accomplishments within a secure environment will inspire the public’s imagination, reinforcing the profound impact of science on human progress.

The Enhanced Games embody three core virtues:

1.    Fairness & transparency:
Independent studies suggest that about 40-50% of all professional athletes already take performance-enhancing drugs[9]. So how would you feel if you didn’t come first, and came in second place behind somebody whom you suspect of taking them? At the Enhanced Games, if an athlete wants to compete as a ‘natural’, they’ll feel much better about themselves and find a different type of solace in their achievements, because spectators can more easily contextualize their performance.
2.    Financial stability for athletes:
Unlike sports like soccer, basketball or baseball, many active elite athletes struggle financially and hardly make a living. This doesn’t include the few lucky ones who build up wealth after their athletic career[10]. This is a disgrace – and a systemic failure. We pledge to share a significant portion of our revenues with our athletes, acknowledging their dedication and contributions to the sporting community.
3.    Safety:
Consigning enhancement into the shadows increases the risk of misuse. By bringing it into the spotlight, our goal is to make it safer for athletes. Extensive screenings will be implemented to prevent the use of non-FDA-approved drugs or harmful doses, thereby mitigating potential side effects. Using illegal or non-FDA-approved drugs or using permitted categories in harmful doses that lead to negative or dangerous side effects will not be permitted at the games.

And a historic fun fact: We are in many ways bringing the original spirit of sport back, which was always to showcase what the human body can achieve in peak form. The ancient Greeks were known to enhance themselves before sporting games – and that was obviously well before the advent of modern science[11].

Ancient Greek athletes were said to consume certain potions or foods thought to confer some benefit on the playing field. Critically considered, the materials available at that time could be categorized as nutrients or nutritional supplements (like eggs, meat, blood) and real ‘drug-like’ substances with objectively expected activity, like bull testicles, or alcoholic beverages with their inevitable two-edged effect on performance. Potions were also used to patch up wounded athletes, so they could participate in the next round of the contest.

Luckily, today we know much more about how to do performance enhancement properly and safely, have many more options available and have refined our methods. For example, I am very happy that I can get my testosterone in shot format and don’t have to eat bull testicles like they used to!

A vision of a superhuman future…

The narrative I have outlined here presents a hopeful, optimistic vision of forthcoming scientific advancements that will allow us to re-engineer our minds and bodies. This really is the core dimension of the Next Human Agenda that I, and others, are shaping. I know many of you might read this with some apprehension, but I promise that as these advances arrive, any dystopian notions will vanish once you and those you love can benefit from them. Enhancement doesn’t always mean the ‘extreme’. For many it will simply be the opportunity to live a longer, healthier, and happier life. And who would say no to that?

And most importantly: Nobody should ever tell you who you are, whom you love and how you should feel, look and be.

That’s all for you to decide, and you alone.

To find out more about Christian and Enhancement:

Follow Christian on X: x.com/C_Angermayer

Follow Christian on LinkedIn: linkedin.com/in/christian-angermayer

Visit Apeiron: apeiron-investments.com

Visit the Enhanced Games: enhanced.org

[1] www.pharmavoice.com/news/ozempic-weight-loss-poll-half-americans/690794

[2] www.independent.co.uk/life-style/ozempic-jimmy-kimmel-oscars-monologue-last-night-b2299732.html

[3] www.fda.gov/patients/learn-about-expanded-access-and-other-treatment-options/understanding-unapproved-use-approved-drugs-label#:~:text=Unapproved%20use%20of%20an%20approved,a%20different%20type%20of%20cancer

[4] www.nature.com/articles/s41598-023-49817-4

[5] www.kanna.health/our-work