In an episode from the fifth season of Grey’s Anatomy, Miranda Bailey, played by Chandra Wilson, orchestrates an ambitious 12-person paired kidney transplant surgery. Six living donors each give one of their kidneys to a stranger and six recipients receive one in return. While the show, which is still on the air almost 18 years later, often blurs the line between fact and fiction, this particular form of kidney transplant, called a paired kidney exchange chain, has become increasingly common in the United States.
Rewatching the show (sue me), I wondered if such donation chains are viable for other organs (or tissues) that can be donated by living donors. The liver, the only organ that can regenerate itself over a span of six to eight weeks, struck me as a particularly notable candidate. As with any surgical procedure, donating part of one carries some risk, but in most cases a person can safely continue to lead a healthy life afterward. And the need for them far exceeds what deceased donors can provide. Right now, there are more than 100,000 people on the waitlist for organs.
Over the past decade, using organs from living donors to meet organ demand has emerged as a particularly effective strategy.
In 2025, around 24 percent of kidney transplants used living donors, according to preliminary data from the Organ Procurement and Transplantation Network (OPTN), the public-private partnership responsible for maintaining equitable organ allocation policies. Infrastructural advances, such as the establishment of the National Kidney Registry (NKR) in 2007, have helped reduce wait time for kidneys, provided financial support for donors, and facilitated close to 11,000 paired exchange kidney transplants. In a paired exchange, two patients who each have a willing but incompatible organ donor simply swap donors — my donor gives to you, yours gives to me. Ultimately, both of us receive a kidney that our bodies are more likely to accept.
By contrast, only about 6 percent of the roughly 12,000 liver transplants performed in the US last year used living donors.
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While the number of living donor liver transplants has trended generally upwards over the last decade, the success of living kidney donation suggests that a similar path might be possible for the liver here, too. The US already has what it takes — a potentially lifesaving supply of living donor livers — but it lacks the infrastructure to turn willing liver donors into transplants at scale. That may actually be starting to change, as surgeons around the country are working to build out the interconnected systems and standards that they need to do their work.
Organ access is a multifaceted problem in the US. While the country has largely drawn on organs from deceased donors to meet organ demand, living donors grow more important by the day. A patient’s position on the liver waitlist is determined by their Model for End-Stage Liver Disease (MELD) score. It is a number between 6 and 40 that helps doctors decide how soon the patient needs a new liver. Sometimes, if a patient gets too sick, surgery is unsafe, or if they have problems with substance abuse, they are no longer transplant eligible.
Living liver donors are especially important because transplantation is the only treatment for end-stage liver failure — there are no alternative options. For patients in end-stage kidney failure, a dialysis machine can artificially take over the function of a kidney, and temporarily help manage their condition as they wait for an organ match. But a person experiencing liver failure has no such interventions available to them. They continue to get sicker and sicker the longer they hold on. Around one in five liver transplant candidates die waiting for a new liver.
Living liver donors go through extensive health screens to ensure that their liver quality is good for transplant. Research indicates that the resulting donated organs lead to equal or better overall survival, compared to deceased donors. A transplant surgery with a living donor can also be scheduled, unlike those that rely on deceased donors, which are based on when an organ becomes available. This means that living donor livers usually don’t have to be transported long distances (since the donor can travel to the recipient before the surgery) and the amount of time the liver is without blood and has to be artificially preserved is very short — an important metric in donor organ viability.
Earlier this year, doctors at the University Health Transplant Institute in San Antonio performed a seven-pair living donor liver exchange, the largest such chain in the country. Over a period of six weeks, the liver transplant surgeons matched seven people willing to donate a portion of their livers to seven other recipients who needed the life-saving transplant. Like most of these paired exchange chains, the logistically complicated process was set into motion by a non-directed living liver donor — someone who was willing to donate a liver to a stranger.. Other donors in the chain, by contrast, had a specific person they hoped to donate to with whom they weren’t immediately compatible.
Blood type and liver size are two main considerations when doctors match donor livers to recipients. Individuals with Type O blood usually have the longest wait times for donor livers because they can only receive them from others with the same blood type. In other cases, the size or anatomy of the donor liver can be incompatible with the recipient.
An estimated 2 percent to 17 percent of living liver donors are rejected from donating to their intended recipient because of blood type, size, or anatomical incompatibility of the system of bile ducts. A major benefit of living donation is that if someone wants to donate their liver to a specific person, but they are not a match, both the donor and the recipient can participate in liver paired exchange programs — two or more incompatible donor-recipient pairs can swap donors.
“For each living donor transplant that you do, you are actually doing two transplants,” said Dr. Jonathan Cullen, a liver transplant surgeon who participated in the liver paired exchange at University Health Transplant Institute.
By that, he means that any time a living donor provides a liver, they also free up an organ on the deceased donor list for someone who might need it more. If we had more living donors, we could save even more lives — especially of those lower on the waitlist — but we need to overcome a few barriers first.
If living donor liver transplants have so much potential, why are they still so underutilised? The answer depends on whom you ask.
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“Center expertise is very important when it comes to living donations. You want to obviously have your operation done at a center that’s done a lot of these,” said Alyson Kaplan, a transplant hepatologist at Tufts Medical Center and lead author of the study. “Not every transplant center has a living donor program — and so, as you can imagine, not every transplant fellow is going to get exposed to living donation.”
The surgeries are also resource intensive, especially when they are paired exchanges. In the seven-paired liver exchange at the University Health Transplant Institute in San Antonio, two attending faculty surgeons were required for every donor operation and two to four of the same for the recipient surgeries, according to Cullen.
Plus, many of the steps in the liver transplant process are not standardised. There doesn’t yet exist a central organ matching organization for living donor livers along the lines of the National Kidney Registry, and there are no formalized protocols for how living livers are chosen and allocated, or how potential donors are screened. These procedures can differ from center to center, which can complicate attempts to collaborate or share resources.
With living kidney donation, by contrast, the NKR partners with transplant centers and helps them standardize their processes, said Kaplan. The majority of certified kidney transplant centers in the US perform living donor transplants. That combination of shared standards and widely available surgeons makes it easier for one team to procure the organ from the donor and another to perform the recipient transplant, even if the donor-recipient pair is geographically separated.
Donor kidneys can be matched efficiently to recipients thanks in part to the work of American economist Alvin Roth, who won the Nobel prize in 2012 for the theory of stable allocations and practice of market design. His work increased the efficiency and speed of several matching processes, including paired donor-recipient kidney allocations and residency matching for medical students.
“The kind of algorithmic help that people like me can give is very, very similar,” said Roth on whether his work can be applied to liver transplants too. “Almost the same software works. What changes is the compatibility matrix.”
For now, individual institutions that perform paired exchange living donor liver transplants usually do the matching in-house, manually comparing donor-recipient profiles and screening for risks. Kaplan’s study found that 92 percent of living donor liver transplant programs that had never performed this surgery would consider conducting it.
But without enough funding, Kaplan said, a big infrastructural boost like this one is hard to execute on a national scale.
Both infrastructure and funding are necessary to scale living donor liver transplants nationwide. However, without a large pool of willing donors, these resources alone are insufficient.
But building a bigger pool of donors is difficult, partly because becoming a living donor is difficult.
Living liver donors often have to travel to their recipients, pay for associated lodging, and take weeks off work for both the operation and the recovery. The cost of donor screenings and transplant surgeries is usually taken on by the recipient’s insurance, but many programs recommend that the donor plan for any additional expenses, including follow-up appointments, continued medications, and caregiver expenses.
Any healthy person over the age of 18 can be a living liver donor. The first step of the process is to contact a transplant center that has a living donor program. If you are donating to someone you know, you can ask them to put you in touch with their care team but you can also contact their hospital directly and let the transplant staff know if you prefer to get tested for a match before telling your intended recipient.
If you wish to donate to a stranger, the new non-directed living donor network started by the American Liver Foundation is a good starting point. They can help connect you with a transplant center for further testing if you pass their initial online health questionnaire.
Nonprofits like the National Living Donor Assistance Center (NLDAC) can help living liver donors subsidize costs, but only if the recipient’s household income is 350 percent below the federal poverty guidelines. For a household of two in the 48 contiguous states, that is an annual income of $75,740. Some states also provide income protection for living donors who have to take time off work, but others don’t. In the absence of more universal protections and other forms of support, building the donor pool may be a bottleneck for also building out broader living liver donation infrastructure.
“Donors should never have a penalty to be a donor. They are definitely the national heroes, and they should have all the protections that they deserve. Nobody should have to go into debt to be a donor, for goodness sakes,” said Dr. Julie Heimbach, director of the Transplant Center at Mayo Clinic. The center performed its first paired living liver transplant in 2024.
One major roadblock in establishing national collaborative programs for living liver transplants comes down to what’s called the organ’s cold ischemia time. This is the time between organ procurement and transplantation, during which the organ is kept cool, and no blood flows through it.
Kidneys can hold on for longer than livers, which means that they can be transported across significant distances without the quality of the organ deteriorating. With livers, it becomes all the more important to quickly procure and transplant them because they can’t stay on ice too long.
This limits how far a liver can be transported. A liver from a living donor across the country might not be viable by the time it reaches the recipient and is transplanted — and even if it could be, a transplant surgeon may not be willing to take a risk on it.
In 2023, when United Network for Organ Sharing (UNOS) Labs, the innovation arm of the private non-profit that manages the organ transplant system in the US, attempted to pilot a nationwide liver paired donation program, this proved to be one of the biggest stumbling blocks. The program was anonymously funded by a private benefactor and involved 15 transplant centers across the US. However, the program shut down less than a year later. Even though one recipient-donor pair was enrolled for a liver paired exchange, the transplant surgeries were ultimately not executed. Many of those I spoke to for this story — transplant surgeons from centers that participated in the pilot — said that the funding dried up before the challenges of a collaborative liver paired exchange surgery could be resolved.
“One of our key learnings was that moving donors, rather than organs, created major barriers. Donors are connected to their care teams and support systems, and asking someone to relocate for surgery and recovery is difficult,” Dr. Benjamin Samstein, the lead on this pilot and chief of liver transplantation at NewYork-Presbyterian and Weill Cornell Medicine, said in an email.
He believes that there is still potential to revisit the concept, this time with a focus on moving organs instead of donors and exploring regional hub models.
As Vox reported earlier this year, some transplant surgeons now rely on a new method of organ preservation where an external pump is used to circulate oxygenated blood or other fluids through an organ after it is procured from the donor. This keeps the donated organ viable for much longer and has been shown to outperform standard “icebox” preservation where the organs are cooled on ice. That could, transplant surgeons say, spare living donors the obligation of traveling to their recipients.
While this technology, which is also revolutionizing the use of organs from deceased donors, may eventually reduce the pressure to recruit living donors, Dr. Jason Hawksworth, Director of the Robotic Liver Surgery Program at New York-Presbyterian/Columbia University Irving Medical Center, doesn’t think that it will diminish their importance.
The MELD score used to prioritize patients on the liver transplant waiting list does not capture all clinical symptoms. Patients with low MELD scores can also face life-threatening complications of liver failure such as abnormal buildup of fluid in the abdomen. Such patients benefit most from living liver donations because they don’t have access to machine-perfusable organs usually reserved for those higher on the waitlist, said Hawksworth.
To meet at least some of the need, the American Liver Foundation launched the first-ever non-directed living liver donation network to connect those who would like to donate to a stranger to transplant centers who can access this network free of charge. While the network has already saved two lives as of June this year, it remains to be seen if the program will run into the same issues as its more ambitious UNOS counterpart.
Ultimately, optimizing the field of organ procurement and transplant is both a medical problem and an infrastructural one. OPTN data shows that 95 percent of those on the organ waitlist are in need of a kidney or a liver — the two organs a living person could give. Kidney donation has already been transformed by a combination of smarter algorithms, better standards, and trained surgeons. While living liver donation presents more challenges, there’s a real possibility to revolutionize the process and save lives.
“If these particular barriers were not an issue,” Kaplan said. “I think everyone would be interested in it.”
Miranda Luby was only 36 years old when her tinnitus arrived in the middle of the night, without warning and for no clear reason
One night two years ago, I was lying in bed when I began to hear a high-pitched, electronic hum. The scene that followed would be comical if it wasn’t so traumatic. I roamed around the house in my PJs, frantically pressing my ears against various electrical appliances. It took half an hour to realise the sound was coming from inside my own head.
I’d heard ringing in my ears before, rising then falling, like a one-note crescendo of an orchestra. As a kid, I used to believe the myth it was the sound of dying ear cells, playing a swan song for a frequency I’d never hear again. This was different. This time, it didn’t stop.
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© Photograph: Carol Yepes/Getty Images
© Photograph: Carol Yepes/Getty Images
© Photograph: Carol Yepes/Getty Images
A few things are certain in life: death, taxes, LeBron James playing professional basketball — and Americans’ belief that crime is getting worse. Since Gallup began asking about national crime in 1989, a majority of respondents said they thought crime in the US was higher than the year before in every survey year except 2000, 2001, and 2025. Even in that last year, 49 percent still said more crime was happening. It’s perhaps the archetypal example of negativity bias, the mental habit of giving more weight to bad news than good.
Last week, the FBI put some numbers on just how big that bias is. The American murder rate — which peaked in 1980 at 10.2 per 100,000 — fell to an estimated 4.1 per 100,000 people in 2025, matching the rates recorded in 1955 and 1956 for the lowest ever measured in the country. The violent crime rate (murder, rape, robbery and aggravated assault) fell 9.7 percent, the largest single drop since J. Edgar Hoover was running the bureau in 1936.
That much is known. But what’s not known for sure about the crime drop is almost everything else. Adam Gelb, who runs the Council on Criminal Justice, says that there is no single or easy explanation for the historic lows, while Jeff Asher, the analyst who spotted this decline before nearly everyone else, agrees. For every leading candidate — federal pandemic spending, some normalization after the 2020 social collapse, better violence prevention, even the decline of drinking — there is a corresponding hole.
But there is one American city where researchers can point to a specific program, measure what it did, and put real numbers on it. And it just happens to be the city that spent 50 years — and five award-winning seasons on HBO — as America’s shorthand for murder.
Baltimore recorded more than 300 homicides a year for most of the last decade, and more than 200 for most of the past half-century. In one month, July 2015, 45 people were killed — an astounding figure for a city of just around 600,000 people at the time.
But Baltimore finished 2025 with 133 homicides, the fewest since 1977 and about 60 percent fewer than in 2020. Through the first eight months of this year, the city has seen 60 murders, and the police commissioner’s target is to stay under 100.
What caused this? Three things at once.
Baltimore Mayor Brandon Scott’s Group Violence Reduction Strategy identifies the few people most likely to shoot or be shot — two groups that heavily overlap — and sends people to their doors with two messages: you are on our radar, and here is housing and job training. Separately, the longer-running Safe Streets program puts outreach workers with real street credibility between disputes, aiming to interrupt them before they become shootings.
That’s the harm reduction element. There’s also a tough-on-crime component. The state’s attorney office says it has secured 2,129 convictions since 2023 across several gun-related violent-crime categories, with over 1,700 of those defendants incarcerated.
Meanwhile, Baltimore’s homicide clearance rate reached 60 percent by mid-2026. Its nonfatal-shooting clearance rate was 54 percent, up more than 12 percentage points from a year earlier. Criminologists have long held that the certainty of being caught deters criminals more than the severity of the sentence, and more successful shooting investigations are a common thread where violence is falling around the country.
How do you tell whether a program worked, or whether a city just got lucky? Drug trials get a control group; cities don’t. Baltimore got one almost by accident: the strategy launched in the city’s Western District in 2022 and nowhere else, which left the rest of the city as a comparison.
That’s what a team of economists and criminologists used. They measured the Western District against Baltimore neighborhoods that hadn’t started the program yet, and over 18 months the number of people shot there, fatally or not, ran about 30 percent below that stand-in. Killings alone fell by a similar share, but deaths are rare enough that chance couldn’t be ruled out. Police made no more arrests than before. Arrests for serious violent crime rose 81 percent.
A second, looser test set the whole city against a composite of other big American cities and put Baltimore’s murder rate about 25 percent below it. The authors are careful with that one: too much changed in Baltimore at once to say how much it the strategy was responsible for.
Baltimore’s success is built on two ideas, and they came from two very different places.
The first came from a doctor named Gary Slutkin, who spent the 1980s and early 1990s fighting tuberculosis in San Francisco, cholera in Somali refugee camps, and AIDS across Africa. He came home to Chicago in 1995, a year the city recorded over 800 homicides.
When Slutkin examined the city’s shooting maps, they looked familiar. Clustered in space, clustered in time, and spreading case to case — murder resembled the outbreaks he used to fight. Slutkin reasoned that the way to treat violence was to treat it like cholera: find the people most likely to transmit. Interrupt the transmission. Change the conditions that let it spread. Slutkin built the model into a program called CeaseFire, now Cure Violence Global, and its Baltimore descendant is Safe Streets.
The second idea came from a criminologist. David Kennedy, working in Boston in the 1990s, found that 61 gangs with about 1,300 members — under 1 percent of the city’s young people — were tied to at least 60 percent of its youth homicides. Get those people in a room with police, prosecutors, and community elders, tell them plainly what comes next, and the shooting slows down.
That approach is called focused deterrence. Baltimore’s Group Violence Reduction Strategy is a version of it. To see how it works over a longer period of time, take a trip across the Atlantic to Glasgow in Scotland, which in the early 2000s was considered the murder capital of Europe.
In 2005, in the midst of that wave of violence, Glasgow’s Strathclyde Police established a Violence Reduction Unit that operated with a basic thesis: evidence shows that violence can be prevented. Among other interventions, the unit sent trauma surgeons into schools to describe what a blade does to a face and stationed outreach workers at hospital bedsides to reach victims in the vital hours after an attack, the moment when retaliation can still be stopped.
In 2024-25, Scotland recorded 45 homicide victims, the fewest since comparable records began in 1976 and down from 96 two decades earlier. Every case was solved.
So we have clues to why crime has dropped so much, but not clear conclusions. As successful as Baltimore’s group violence strategy has proved, a 2023 study of a similar street-outreach effort in Boston found no effect whatsoever. And the latest evaluation of Baltimore’s own Safe Streets — 11 sites, each measured against a stand-in version of the same neighborhood without the program — produced numbers that sound terrific but settle very little: youth homicides down 42 percent and youth shootings down 21 percent, but neither is strong enough to rule out chance. And while some sites saw youth homicide fall by as much as 100 percent, two sites saw it rise by 42 and 89 percent.
Some experts, like the UC Irvine criminologist Emily Owens, argue the crime decline has been so widespread and similar — big cities and small, red and blue governments — that the true cause is some larger social change rather than what any one city is doing. Nor can we be sure the fall will continue. Billions in federal pandemic relief money has supported many of the programs that have worked well in places like Baltimore, and that money is already running out. But we can identify one reason why it happened, and learn from that success.
As it happens, Gary Slutkin was not the first doctor to look at a map of the dead and see a pattern in it. In September 1854, a cholera outbreak was killing hundreds of people in London’s Soho district. A doctor named John Snow had mapped the outbreak and saw the dead were clustered disproportionately close to the district’s Broad Street water pump. Snow had a theory that water was connected to the disease and convinced a Soho parish board to remove the handle of the pump.
Nobody in Soho at that moment could have told you what caused cholera. It would only be 29 years later that someone would definitely identify the responsible pathogen, and in doing so, explain why Snow’s intervention worked. But the explanation could wait. The dying stopped that month in Soho, just as it is stopping in Baltimore and around the US today. And that’s what counts.
A version of this story originally appeared in the Good News newsletter. Sign up here!
Jamie Justice admits she has no poker face. As executive director of XPrize Healthspan, a philanthropic and corporate sponsored competition, Justice oversees one of the most buzz-worthy science competitions today. The contest, launched in 2023, attracted nearly 200 applicants from groups around the world who think they can help people to live not just longer lives, but healthier ones.
When the 15-member judging panel met in early summer to pick the top 10 teams who would continue on in the seven-year competition, Justice excused herself. “I couldn’t be in the room because my face shows everything,” she says, since she became familiar with each of the teams and their various approaches to extending human life.
Read more: TIME's 2026 Longevity Leaders
Both in the scientific community and the commercial market, there is no shortage of ideas—from legitimate, rigorously developed approaches to more fantastical schemes—for a fountain of youth. XPrize Healthspan exists to bring some order to that chaos, and legitimacy to the process of developing and, most importantly, testing ideas in longevity. Applicants for the prize, which has a total purse of $101 million, allocated in segments throughout the seven-year competition, included teams from academic research institutes as well as biotech and startup groups. All had to follow a few basic rules; they had to show early promise in human studies that their approach could improve health in three critical areas: muscle function, brain function, and immune function. All teams were judged based on standard measurements of these three functions that XPrize committees of experts had specified, to ensure that all projects were evaluated using the same metrics. The judges announced the top 10 projects on Aug. 11.
“This is where I get the most excited, when things get really sort of dirty and ugly,” says Justice, who spent time researching geroscience at Wake Forest University before coming to XPrize. “You’ve got biohackers selling you this, and you have a bro guy over here that wants you to take so much protein that you’re going to die. What we need to do is have a strainer, a filter where everybody is held to the same standard. There may be something really worthwhile and useful out of some of these things that seem harebrained. What XPrize does well is invite everyone in, teach them how to do the science to get to a level of super credibility. It’s an alliance that comes together to set the frameworks for the start line, a finish line, and how to get there.”
The projects are as varied as you might expect approaches to longevity to be—ranging from the latest anti-aging trends in Asia involving extracellular vesicles, to stem cells and more traditional, well-established programs that include exercise and supplements. Two of the teams are from Japan, one from South Korea, one from China and six from the U.S. Two of the groups are studying repurposed drugs for their potential in extending life, while the Korean team is investigating a novel longevity drug. Four projects involve supplements and five rely on biologic compounds including extracellular vesicles, peptides, and antibodies.
Both teams from Japan are working with the vesicles, which carry a wide menu of molecules in the body, from enzymes to peptides, fats and genetic material. But the teams are taking very different approaches to optimizing what these vesicles can do to improve health.
Time Traveler Corp., a biotech startup launched in 2024 by Rieko Akiyama to bring ideas from her father's research in tumor biology and cancer research at University of Tokyo to longevity is one of the teams focusing on this approach. Tomoatsu Hayashi, a project assistant professor at the University of Tokyo and co-CEO, started by studying human cells to find ways to make the vesicles at scale. Smaller versions of these vesicles, called exosomes, which are made when cell membranes fold inward, and pinch off tiny bubbles, are an increasingly popular component of anti-aging beauty products in Japan and Asia, but they remain untested from a longevity perspective, and Hayashi and his team were eager to study them in a more rigorous fashion.
Akiyama gave the team what turned out to be its XPrize-leading idea. She noted that during the COVID pandemic, there were more discussions about turning away from animal-derived materials in science, which are heavily regulated to ensure safety before they develop into products used in people, to plant-based sources, including for food products like mayonnaise. “I wondered whether human-derived exosomes could also be replaced by plant-derived exosomes, which might offer advantages in terms of safety, scalability, and ethical considerations,” she says through a digital translator during a recent interview near Hayashi’s labs at the University of Tokyo. “I brought this idea to my father and asked whether plant-derived extracellular vesicles could become a new approach for promoting healthy longevity. That conversation became the starting point of our plant-derived exosome business.”
Hayashi and his team started with edible plants and algae, assuming that those would have the strongest safety profile for eventual human use, and screened more than 140 species, including 95% of those that grow in Japan. While human exosomes were widely studied, those from plants were still a mystery, and “we didn’t know if plant exosomes would have the same effect in human cells,” he says. But starting first with mice and then with human cells, they showed that in fact, plant exosomes worked in very similar ways to human-derived exosomes, proving Rieko’s initial hunch correct. And of the species, it turned out exosomes from parsley showed the strongest effects.
In mice, the parsley-derived exosomes lowered inflammatory factors that are responsible for many aging processes in cells. Animals who were fed the exosomes in their water were able to maintain muscle strength, as measured by the longer time that these mice could hang from a wire cage compared to similarly-aged mice that didn’t get the supplement.
The team saw similar benefits in lowering inflammation in a small group of 40 people who started taking the supplement pill once a day. Anecdotally, the people reported sleeping more consistently and deeply and feeling more energy during the day. The animal and human data were enough to give the team a chance at testing their product further in more people in the next phase of the XPrize competition. That trial will evaluate volunteers on muscle function, walking, leg presses, cognitive tests, and tests looking at inflammatory markers in their blood.
The other Japanese team, also from University of Tokyo, is likewise banking on exosomes. But to address supply issues, instead of plants, they turned to stem cells. Keisuke Goda, professor of chemistry at University of Tokyo, decided to tackle the problem of getting exosomes to the cells where they are needed most. Relying on his chemistry and engineering background, he designed so-called super exosomes with specific molecules on their surface that can draw them to aging cells like a magnet. Because they are revved up to target aging cells, they can deliver the lipids, genetic material, and other compounds cells need to keep them acting like younger versions of themselves. “We knew from previous studies that exosomes secrete a range of molecules including growth factors, metabolic enzymes, lipids, and DNA and RNA, and previous reports showed that injecting young exosomes into aged mice rejuvenated the aged mice,” says Goda. “But there is a delivery problem.”
As part of the XPrize, Goda and his team will start testing the super exosomes in more than 100 people in a formal trial see how they affect muscle, brain, and immune cells.
He is confident that they will see similarly encouraging results as they saw in their mouse and human cells studies, which showed that older human cells in the lab treated with the exosomes had reduced markers of aging and appeared rejuvenated. “We know they work,” says Goda. “It’s exciting. When we saw the results, we doubted it was true. But the cells were rejuvenated, they were not dying.” About 25 months after they started studying the super exosomes in mice, the untreated animals are starting to die, he says, but the treated ones are not. “We of course want to see the actual effect in humans, assuming it’s safe,” he says.
Not all of the top 10 teams involve innovative or cutting edge scientific approaches. The group from Mount Sinai earned its spot by combining three, more familiar strategies: exercise and two supplements, one that’s been bandied about the aging community for a few decades now—rapamycin—and another, spermidine, that came out of work from one of the Mount Sinai scientists as a factor to control inflammation associated with aging. During the COVID pandemic, Dr. Miriam Merad, director of the precision immunology institute at the Icahn School of Medicine at Mount Sinai, and her team noticed a strong connection between age and inflammation that made older people more susceptible to the effects of a COVID infection. That led to a hypotheses about the role that inflammation might play in a range of age-related diseases, including heart disease, respiratory conditions, and muscle loss. “What we realized was that the inflammatory response was contributing to age associated diseases,” she says. “It’s very established what happens with age when organs decline—they acquire somatic mutations from the exposures we have, and at the same time as all of our organs age, our immune system is also declining, and producing more inflammatory molecules. Age-associated diseases are aggravated, or precipitated by chronic inflammation.”
Addressing inflammation, then, might be a powerful way to control the aging process, and in further studies in mice and with human cells in the lab, Merad and her team zeroed-in on a compound that older cells weren’t making as robustly as younger ones—a polyamine called spermidine. By giving older mice the supplement spermidine, they saw improvements in the animals’ immune responses that tipped the balance away from the chronic state of inflammation associated with accelerated aging. “Once we saw the data in the lab, we all started taking it ourselves because [the data] looked so good,” says Dr. Thomas Marron, professor of immunology and immunotherapy at the Icahn School of Medicine at Mount Sinai and the principal investigator of the team’s study of the compound.
The researchers also included rapamycin, a drug approved by the U.S. Food and Drug Administration to treat rejection in kidney transplants, as well as certain types of cancer, in the study as well. Because some, but not all, studies showed rapamycin extended the life of animals, it’s been a controversial product in the longevity field, with some in the health community using the drug off-label in the hopes of a longer and healthier life, despite the lack of solid evidence in human studies that it can have this effect.
That’s one of the reasons the Mount Sinai team is eager to put it to the test, in combination with an exercise regimen and spermidine. Their rationale in combining the two supplements and physical activity lies in the fact that aging isn’t likely directed by a single compound or process, but the net result of a multitude of body processes, so slowing aging will likewise require a multi-pronged strategy. Marron also expects that given the biological differences among people, some may respond more to one supplement, while others respond to the other, and still others may respond best to the exercise regimen. Studying them together could provide the first hints about which components are contributing to slowing aging, and by how much. The researchers will be taking blood samples throughout the coming year, and looking at certain markers of inflammation and as well as conducting tests of hand grip and leg strength, respiratory function and evaluations of changes in fat composition with MRI images. The participants will also take standard cognitive tests to monitor changes in their processing speed and executive function skills such as planning, memory, attention, and impulse control.
“The goal of XPrize is to improve health span by 10 years, and ultimately by 20 years,” says Marron. “But that’s hard because there is no validated way to measure health span, or aging. So the real goal is to inject more science into this process.”
The top 10 teams earned $1 million each to test their ideas in a larger group of people over the next year, and hopefully show improvements in the three areas targeted by the XPrize: muscle, brain, and immune function. “I love to have a front seat and watch the next phase of this go from hype cycle to durable evidence if there is any,” says Justice. But she also acknowledges that aging is a varied process, and no single, uniform solution that applies to the widely diverse human species will likely emerge. “We age at different rates, we have different constellations of diseases and functional decline, so a one-size-fits-all is probably unlikely,” she says. “I expect a lot of failure, but the question is whether you can take that failure and make something useful out of it. Does it become compost to build something better? There needs to be a lot more work from the field within geroscience to really lean on learnings. This is what gets me excited.”
If ‘lifespan’ is the time you’re alive and ‘healthspan’ the years you’re disease-free, then ‘hotspan’ is the period you’re attractive and vibrant. Want to increase yours? Experts share their tips
Forget 12-step skincare routines, red light therapy and injectables – the single most important thing you can do for your skin is wear UV protection. “Not just sun protection, but UV protection, every single day, regardless of weather or season,” says Dr Jennifer Owens, resident aesthetic expert at the Reborne Longevity clinic in London. “Up to 90% of visible skin ageing is caused by UV exposure – nothing else comes close in terms of impact.”
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© Composite: Reuters & Getty Images
© Composite: Reuters & Getty Images
© Composite: Reuters & Getty Images
Americans continue to drink less alcohol than ever before, according to a new Gallup poll.
Only 54% of U.S. adults surveyed by the analytics firm in July said they ever drink alcohol—the same share as last year and the lowest recorded since Gallup began surveying Americans on this topic in 1939, says Lydia Saad, Gallup’s director of U.S. social research.
“We saw a significant decline in people’s use of alcohol last year, but whether that was a one-time reaction or a trend, we had to wait and see,” Saad says. “This year’s result tells us that whatever is happening out there is a sustained change. Drinking has gone down across all age groups.”
More public awareness of alcohol’s health risks could be prompting Americans to drink less, the poll results suggest. A little more than half of Americans surveyed this year said that alcohol is “bad for health,” compared to the less than 30% of people who said that a decade ago; and 86% of people polled said they had heard of recent studies about the long-term health effects of alcohol—a 7% increase from 2024. Drinking alcohol has been linked to several forms of cancer, as well as higher risks of liver and heart disease, among other health effects.
“The decline in alcohol use coincides with a sharp increase in concern about the health risks of drinking,” Saad says.
https://x.com/Gallup/status/2090452609316335964?ref_src=twsrc%5Etfw
But researchers who study alcohol say the poll results don’t provide a complete picture of alcohol use in America. While drinking might be declining overall, alcohol remains the country’s second-deadliest drug, behind tobacco. Alcohol kills about 178,000 people yearly, and harmful drinking remains a challenge for many people.
“Many people are changing their attitudes towards drinking and intoxication for health reasons, which means that the number of people who say they drink may be declining because lighter drinkers who are more health conscious and more capable of changing their drinking are maybe choosing to cut back or not drink at all,” says Thomas Babor, a professor emeritus at the University of Connecticut School of Medicine who studies alcohol and alcohol addiction.
“But the rates of drinking and drinking problems remain unacceptably high” among some groups, including college students and older people, Babor says. “The big picture is: alcohol consumption is one of the biggest risk factors for chronic diseases and many other health conditions.”
According to the 2025 National Survey on Drug Use and Health (NSDUH), 44% of U.S. teenagers and adults who drank alcohol said they had engaged in binge drinking in the past month, and about 10%—about 14.5 million people—said they engaged in heavy drinking, defined as binge drinking on 5 or more days in the past 30 days.
NSDUH results show that the numbers of binge and heavy drinkers declined overall since 2021. But percentages for binge and heavy alcohol use among underage drinkers didn’t change from 2021 to 2025. Among people aged 65 and older, about 10% in 2025 said they engaged in binge drinking, compared to about 12% in 2021.
In the new Gallup poll, people were asked if they “sometimes drink more alcoholic beverages than you think you should.” Some 13% of respondents said yes to that question, another record low, according to Gallup.
More research is needed to better understand why people are drinking less, says Traci Toomey, a public health policy expert at the University of Minnesota who studies alcohol and cannabis. Health concerns are likely a factor, but there may be other reasons too, she says.
It isn’t clear if an increase in cannabis use, for example, is driving some of the decline. “We don’t know if it’s a substitution, but that’s a question we need to answer,” Toomey says.
Use of GLP-1 drugs, which studies suggest may help reduce alcohol consumption and craving in people with alcohol abuse disorder, along with higher alcohol prices and policies to curb harmful and underage drinking, may also be playing a role, she says.
Saad, of Gallup, says there could be political factors at play too. According to the new Gallup poll, alcohol use has declined significantly among Republicans and Independents, while Democrats’ alcohol consumption has remained virtually unchanged since 2023.
“It could be worth looking into what kind of political messaging is going on, and if it’s more effective among Republicans and Independents than Democrats,” Saad says.
She notes, however, that “we haven’t seen strong anti-alcohol messages out of the [Trump] Administration.” In January, the administration released updated dietary guidelines that no longer specified a daily limit for alcohol consumption.
Dr. Mehmet Oz, who leads the Centers for Medicare & Medicaid Services, said at the time that alcohol is a “social lubricant that brings people together.”
“In the best-case scenario, I don’t think you should drink alcohol, but it does allow people an excuse to bond and socialize, and there’s probably nothing healthier than having a good time with friends in a safe way,” he said. The World Health Organization, supported by emerging research, has asserted that no amount of alcohol is safe for health.
In the town of Nipomo on the central coast of California, in Bill Waycott's fields, lettuces of the future are taking root. Red-furled or dark-leaved, these rosettes of crunchy goodness might someday make it to a store near you.
Waycott is an independent plant breeder, one of the small community of dedicated folks who devote their time and effort to the reproduction of a given plant or plants. For decades, he's focused mainly on breeding better lettuces, and he spoke to TIME about what could be in America's salad bowls in coming years and just how damaging the recent Cyclospora outbreak, traced to a farm run by greens behemoth Taylor Farms in Mexico, has been for lettuce growers.
TIME: How did you intertwine your fate with that of lettuce?
Waycott: My introduction to agriculture occurred as a Peace Corps volunteer in India in the ‘70s. When I came back from that assignment, I wanted to dedicate myself to agriculture. It was the most amazing thing that could ever have happened to me—a California surfer goes to India and learns how to survive in a language, in a culture, in a food system that I had no clue about. I got a job at the [U.S. Department of Agriculture] and the first year and a half it was a sugar beet breeding project. When the lettuce position opened up, I jumped on it.
We were trying to slow down the process of early flowering in lettuce. You probably know that it doesn't last very long in a garden during warm temperatures. It goes to seed pretty quickly. But then we had George Bush Senior come across and clear the deck. I was laid off at that point with a lot of my colleagues back in the '90s, and that's when I went to work for a private breeding company.
In your decades of making lettuce better, what’s been the main focus?
Well, you know it's 96% water to start with, so you don't have a lot to work with. My focus has been as much as possible on disease resistance—developing lettuces that can stand up to plant diseases that can wipe out a crop—and improved nutrition. Since so many people eat salads these days, even if we were able to improve the nutrition by 5 or 10%, that's a huge impact on the North American diet.
At Nipomo Seeds, which is a company my wife and I started in 2014, we’re working on a lettuce we have nicknamed “Spinach Lettuce,” because it resembles spinach both in the way it grows and also its taste (a softer, spongier, and slightly bitter eating experience). The nutritional values for most of the important nutritional components in lettuce are high in the Spinach Lettuce, especially when compared to iceberg; there’s a lot more fiber, protein, calcium, iron, vitamin C, and vitamin A.
There are others; we have some new lettuces that we're hoping growers will take an interest in. We've been growing field trials, and Chef Dan Barber from Row 7 Seeds has come out to California and looked at them. I think in September we're going to have somebody from Whole Foods come over and have a look.
What’s the biggest challenge facing lettuce breeders these days?
I have to say, I am just flabbergasted by the number of diseases that have come in in the last five to 10 years, and the rapidity with which they're mutating and forming new races. Example: I have been testing for plants that can resist Fusarium oxysporum, which is a fungus of the roots and vascular tissue. The plant's growing along, it's getting close to harvest, and then it just sort of wilts. Pull up the roots, and you see this discoloration. I really did my best to come up with resistance to that issue over the last five or so years. But in the last two years, the disease has changed and formed a new what we call variant race. So all the seed that I produced for that particular issue is no longer interesting to my customers because it doesn't have the brand-new race resistance.
Right now we have three fungi, one bacterium, and one virus here in California lettuce that are wreaking havoc and making life very difficult. In the past, there was one major issue at a time that we could hopefully solve in five years of breeding. Now I'm working on five issues, six issues in tandem.
How has the Cyclospora outbreak, linked to Taylor Farms’ operations in Mexico, affected the lettuce industry?
Oh, it's disastrous. I've heard sales are at least 30% down, and not just in lettuce. Anything that's green is suspect to some people. If you can't cook it, or buy it out of a can, it’s not on the list. There are fields of mature lettuces being plowed under constantly now that have no value because they can't sell.
But this isn’t the first time. In 2006, there was a big E. coli outbreak with spinach. That started the whole system of trying to evaluate the product before it was cut. Nowadays, at least north of the border, there are companies that go into every field and sample methodically across the field. Maybe every 30th row or every 50th row, they sample and send these samples into a lab, and it's checked for pathogens.
Is there a safer way to grow lettuce? Hydroponically, with filtered water?
The hydroponic systems are so expensive—if they were really going to change things, it would have happened by now.
But there isn't really that much difference; the plant is exposed to the atmosphere, and whatever's in the atmosphere is going to somehow affect the plant. Open field production is the cheapest way to go. Using water, either from wells or from canals, is really the only system available. And when you're looking at production the size of what North America requires, there's nowhere [big enough where] you can filter that water and create a sterile environment for the plant to grow in. It's impossible. But you can at least sample all those components that are going into it, and try your best to avoid any major contamination.
What are you looking forward to in the future of lettuce?
I hope that we can slowly get to the point where we're improving nutrition. The world right now is pretty chaotic. How does diet fit into all that? How do people make decisions about what they're going to eat? What is the ratio of home cooking to restaurant dining, and financial stability—how does that influence the diet that they choose to use? It is tough. So working on making things more nutritious is an important factor. Hopefully, the growers and the shippers and the marketers agree, and we will bring healthier food into the system, so that people don't even have to decide at the moment of purchase if they should or not, because it's already more nutritious.
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