Overwhelmed, Bradshaw loaded his few remaining possessions into a clapped-out Jag, and boarded a ferry from Cork to Santander. He had planned to travel on to Portugal, the site of so many holidays with his wife and kids. But they no longer saw him. And where the open sea once promised escape, staring into the ship’s wake now pushed Bradshaw, 36 to despair. 

“Look at the wake of mess I’ve left behind me — look at the lies I’ve told,” Bradshaw remembers thinking. “I don’t know where the fuck I’m going. I haven’t got a house to go anymore, nor a home and I’ve fucked my kids’ lives. That’s when it really hit me. The world would look a lot better without me in it.” In the end, it was the thought of his two sons that stopped Bradshaw from jumping overboard that March night. But not everyone is so lucky. 

In the United Kingdom, this week’s front pages — dominated by reports of an election mired in a betting scandal — threaten to distract from a wider malaise: the fact that there are around 400 gambling-related suicides each year. Just like Bradshaw, young people seem particularly susceptible. Between an underdeveloped brain on the one hand, and frantic advertising from gambling companies on the other, some 55,000 British youngsters (age 11-16) are addicted to gambling. A further 85,000 also believed to be at risk of addiction. 

No wonder activists are pushing hard for change. But without more fundamental reforms — and with the gambling industry as rich and influential as ever — desperate cases like Bradshaw’s are unlikely to disappear.  

Mark thinks he knows why. The neuroscience of gambling addiction closely resembles that of drink or drug dependency. Gambling rewires the brain, flooding it with so much dopamine that the body soon learns to protect itself. That, in turn, reduces the sensitivity of so-called “bliss hormones” — which become less responsive to the high gained from that first successful flutter. As dopamine tolerance builds, punters need to raise the stakes to recreate those early peaks. “Even if it’s a 1,000-to-1 shot,” Mark says, “right down to that very last bet, you convince yourself this is the one that could change my life.” Enter fully-fledged gambling disorders: the neurological state when the brain experiences withdrawal symptoms, and demands higher bets, just to get back to its altered new normal. 

“When you’re betting, the capacity for rational thought goes out the window,” Ryan Cowley explains. “But after heavy losses you get this crushing feeling of guilt.” At his lowest point, the 30-year-old was losing almost £4,000 a day, even as he grew skilled at hiding his problem from family: “I’d start with South American football, switch to the NFL and then of course there’s always horse racing and online slots.’’ Once, he blew his wages on payday — then cancelled and destroyed his bank cards, pretending his wallet had been stolen. He needed an excuse to not pay his mum the room and board she was expecting. 

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Beyond the raw brain chemistry, there’s evidence that young people, like Cowley, are particularly vulnerable to gambling disorders. As Dr Marc Potenza, director of Yale University’s Center of Excellence in Gambling Research explains, the prefrontal cortex doesn’t fully mature until around the age of 24. He suggests that, especially for young men, this makes them less able to postpone gratification and control impulsivity — and ultimately leaves them open to the highly addictive products developed by gambling companies. 

Those products, for their part, are made vastly more dangerous by their digital nature. Consider Cowley, whose gambling problem started around 12 years ago, and coincided with the arrival of smartphones and betting apps in his late teens. Suddenly, he not only had a casino in his pocket, but also the power to bet on anything, anywhere. He’s not alone. As a survey published by the Young Gamers and Gamblers Education Trust (YGAM) in March 2024 revealed, nearly 46% of students are gambling more than they can afford, lured by promises of free bets and quick cash. 

Now 23, Robert* has been battling a gambling addiction for five years. His problems began while still a student, when betting became intertwined with watching sport with friends. Watching them celebrate occasional windfalls on their phone drew him in — and soon Robert was losing more and more. When Robert’s parents entrusted a significant amount of his grandfather’s inheritance to him, they were unaware of his problem. But Robert gambled away £15,000 over just a couple of days. “Pretty much all of it is gone,” he says. “I still haven’t been able to pluck up the courage to tell my parents.”

It deepens the problem when gambling companies use the immense power of online systems to their advantage. If you have a gambling platform on your phone, you may have noticed just how regularly you’re required to re-download the latest version of the app. For Bradshaw, that’s some indication of just how rapidly betting operators are evolving their “getting-to-know-you” data-harvesting techniques.

“Within three months of signing up with a betting app,” he explains, “they will have collected 90 key data points, which will go far beyond what your favourite team is, or the time of the day you like to bet. They’ll know exactly which offers to push at you, all tailored to make you feel really smart — too smart to miss out on this great opportunity. And all the time they’re demanding your attention with products that are incredibly addictive.”

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In theory, racking up huge losses in betting binges, like Mark, Ryan and Robert’s, was about to become more difficult, with affordability checks set to be introduced as part of the government white paper on gambling reform published a year ago. It proposed that players who lose £1,000 within 24 hours, or £2,000 over 90 days, should face financial checks. Those who have a net loss beyond £125 each month, or £500 per year, will have to go through “frictionless” checks. Alongside affordability checks, the white paper also included significant proposals for a mandatory levy on gambling operators to fund addiction treatment, education and research.

Now, of course, we have an election on our hands, which will likely delay the implementation of some of the reforms. At the same time, however, many do not require primary legislation and are due to come into force later in the year anyway. But will they make any real difference?

Many anti-gambling campaigners argue that by the time customers demonstrate problematic betting behaviours, it is already too late: they will already have a gambling disorder, and though their betting may temporarily be stopped, the underlying condition doesn’t disappear. Gambling With Lives, for example, is a charity set up in 2018 by families bereaved by gambling related suicide. While they applaud the £100 million earmarked to fund research, education and treatment around gambling addiction, activists are otherwise sceptical about the planned legislation’s overall worth. 

Bradshaw, meanwhile, believes that the law isn’t keeping pace with the technology. Just as the UK’s 2005 Gambling Act couldn’t foresee the harms of the coming smartphone era, he suggests that today’s policymakers don’t understand how AI has already transformed the industry. ‘’It doesn’t refer to algorithms or artificial intelligence at all,” he says of the Gambling Reform Bill. “It is an analogue piece of legislation in an era [when] the gambling operators are already in an AI generation. Using the power of artificial intelligence, hundreds of markets are being formed within each game using all the data they’ve got on the sport, plus all the data on you as an individual. The products are incredibly addictive and the markets are formed so fast that the smartest human being couldn’t work out if it’s a fair bet or not, which of course is precisely the point.” 

For others, the white paper’s most serious omission concerns advertising, which many attribute to the influence of the immensely powerful Betting and Gaming Council, the industry body that represents the interests of UK gambling operators. Since it was effectively deregulated in 2005, the UK gambling industry has swollen into a behemoth, one raking in revenues of £15 billion a year. As a whole, it’s estimated that the sector redirects £1.5 billion of those profits into advertising. That can have a direct impact on gamblers: research suggests that 35% of people with gambling disorders receive daily incentives to gamble, compared to just 4% of those not suffering gambling harm.

The personal impact here is just as stark. Cowley says he’s forced to go on holiday during big events like the Cheltenham Festival, just to avoid being carpet-bombed by betting ads. In April, betting giant 888.com even planted its flag in London’s underground system, with signs provocatively proclaiming that “This Carriage is now a Casino”.

In the end, an online petition forced 888.com to partly withdraw the campaign, but such brazenness can plausibly be linked to the sector’s vast wealth. 888 Holdings also owns William Hill, which was fined £19.2 million in 2023 for — among other failings — allowing customers to lose tens of thousands of pounds within minutes of opening their accounts during the pandemic. That’s still the largest fine ever meted out by the Gambling Commission, but is unlikely to deter 888 Holdings, which last year saw revenues soar by 38% to £1.7 billion.

And therein lies the problem: gambling is an industry that has grown so rich so fast that it can afford to casually treat multi-million-pound fines as simply part of doing business.

Quite apart from the individual suffering, meanwhile, there is rising evidence that gambling addiction is impacting society as a whole. The government’s own research estimates that 0.5% of the population are already problem gamblers. And while the NHS recently opened its 15th regional treatment centre in Sheffield and now has the capacity to treat 3,000 across the UK, many believe it’s unlikely to be enough. With legislation still so weak, Mark Bradshaw thinks we’re in the early days of a public health disaster: he compares it to an “avalanche” that could yet overwhelm the authorities.

But at least he got out. Five years on from his near-death experience at sea, the Yorkshireman seems happier. At 41, he’s living in Dublin with a new family, and spends his time campaigning to protect the next generation of young people from gambling disorders. Regardless, Bradshaw is under no illusions about how dangerous the modern industry can be. “If I’d come of age in an era when sports-mad young men spend half their lives on their phones,” he says, “I would be dead by now.” 

Looking incredibly young has certainly helped his case — even now, at 54, Sinclair could still pass for a 30-something. A decade ago, Time featured Sinclair on its annual list of the world’s most influential people. And by popularising the concept of “autophagy”, Sinclair has almost certainly influenced you at some point.

Autophagy, which comes from the Greek for “self-devouring”, refers to the process by which cells deprived of fresh supplies of glucose are forced to “feed off” themselves, reducing the inflammatory toxins that are so synonymous with ageing and, in theory, revitalising the mitochondria that power every cell. While Silicon Valley tech bros such as Brian Johnson, Peter Thiel and Jeff Bezos may have garnered more headlines, a lone maverick scientist, in science-fiction style, was busy working on the medical secret to substantiate their quest for eternal youth. Or so it seemed.

Nowadays, former colleagues in academia are queueing up to denounce Sinclair. In March, when he announced with his brother that their company Animal Bioscience had developed a supplement for dogs “shown to reverse the effects of age related decline”, it proved to be the final straw. A former research partner, and colleague at Harvard Medical School, labelled him “the textbook definition of snake-oil salesman”, before Sinclair resigned from his role as President of the Academy for Health and Lifespan Research on 13 March.

So where did it all go so wrong for Sinclair? After all, it’s not as though Time were wrong to cite his influence — which has become ubiquitous by stealth. With the unmasking of one of its leaders, where next for the biohacking movement? And is there more to it than billionaire daydreams and sketchy online apothecaries?

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In many ways, it simply continues to grow. Because calorie restriction has been consistently shown to increase lifespan in laboratory animals, Sinclair’s championing of autophagy to stabilise lower blood sugars has seeped into popular consciousness as a rationale for weight-loss “hacks” that might also help you live longer. Advocates of intermittent fasting, buttered coffee, ultra-low carb diets, cold-water immersion or drinking diluted vinegar invariably invoke the implied cloak of scientific legitimacy that autophagy provides. And Sinclair personally aligned himself and his clout with these sorts of trends. By taking just one meal and 1,100 calories per day, and focusing on plant-based, low-carb, low-protein, and heart-healthy high-fat foods, he promoted the “deep cleanse” cellular repair and ultimate detox that autophagy is meant to provide. In turn, autophagy is in large part responsible for the popularity of the so-called 16:8 diet, whose adherents consume their calories in an eight-hour window before fasting for the next 16 to maintain low-blood sugars.

So, when the American Heart Foundation published research last month indicating that restricted-eating-window diets of the 16:8 variety were linked to 91% higher risk of cardiovascular deaths, they rattled many of the intermittent fasting advocates. But Sinclair had already been testing the scientific establishment’s patience for years. By suggesting that non-diabetics should consider taking the diabetes drug Metformin, for longevity purposes, as he did, Sinclair had long courted controversy, and not just from outside of the biohacking community but from within it.

Because if Sinclair is the father of anti-ageing biomedicine, Oedipal forces have been massing against him for some time. On 10 March, Dr Brad Stanfield, another noted longevity influencer, launched a withering takedown of his career and record. Stanfield alleged that by setting up companies trading in anti-ageing supplements of dubious merit, Sinclair amassed a personal fortune. Initially, it was resveratrol, the much hyped “miracle” compound found in red wine. According to Stanfield, GlaxoSmithKline bought the rights to the research for $720 million dollars and spent five years trying and failing to replicate Sinclair’s findings. More recently, again without compelling clinical evidence from human trials, Sinclair has been advocating for and marketing the supplement NMN to boost NAD+ levels, in order — he said — to encourage DNA repair and enhance insulin sensitivity.

Such internal feuding demonstrates the reality of the biohacking movement. Because, while the public has a tendency to conflate longevity science with plutocrats obsessed with living forever, the movement is far from an elite project. Many biohackers are in late-middle age and have more grounded expectations. When I meet John Hemmings, a 63-year-old biohacker, he explains that by extending his “healthspan” he hopes to “compress his morbidity” and delay the onset of age-related conditions such as heart disease, diabetes, cancer and, in particular, Alzheimer’s. Hemmings is hardly your average subject matter — in an earlier political career, he was a Lib Dem MP who used parliamentary privilege to denounce Ryan Giggs’s attempts to use a super-injunction to silence press coverage of his private life. But in other ways, Hemmings’s anxieties are representative, given that, on average, senior citizens rack up five separate comorbidity diagnoses by the age of 80. It’s easy to see why some might seek more control over their exit strategy.

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Hemming’s new career as a committed biohacker began in earnest in 2020 when, at 21 stone, he realised that was a likely candidate for type 2 diabetes. He managed to lose seven stone in just nine months (a process he broadcast on social media) by making use of a device designed for diabetics. A skin sensor allowed him to perform continuous glucose monitoring (CGM) and track his blood sugar in real time through an app. For the first time he could see how levels spiked and fell in relation to different meals and activities. Preventing spikes means eliminating the crashes that inevitably follow, which reduces hunger pangs and helps weight loss. And CGM is the most prevalent biohacking trend of the moment. For many, weight loss is the primary goal, but for others, like Hemmings, it’s a gateway to biohacking through which the ultimate prize of a longer, healthier life first becomes visible. That higher glucose levels act as an ageing accelerator is the central premise of the longevity community, but Hemmings quickly realised its limitations. “It’s not as if there is just one number that matters. It requires a holistic approach.”

Today, he spends around £10,000 a year on weekly blood tests to track the effects of his various interventions on key biomarkers as a way of stalling ageing at a cellular level. And he is now a convert-turned-preacher: he publishes blogs replete with homespun microbiological research that track the impact of his treatments. More radically, these include rapamycin, which Hemmings sources from India. Although it’s a potentially harmful immunosuppressant used to prevent the rejection of kidney transplants, rapamycin has also been shown to extend lifespans in animal trials and is the longevity community’s greatest hope of a “quick win” against ageing. Hemmings believes rapamycin is likely to be a more effective method than fasting when it comes to inducing that all important state of autophagy.

He monitors his long-term progress through epigenetic tests — a type of biochemical assessment that looks at DNA to see how well cells are ageing in relation to their chronological age (he proudly tells me that one put his age at 53, and another at just 36). But with his political background, Hemmings sees his personal travails as heralding social change. He believes that our health service is out of date because it is predicated on repairing the damage caused by our afflictions, by which time it’s often already too late. “Biohacking enables people to have detailed information as to what they can do to improve how their bodies function in the short term. Hence rather than waiting to get ill and then going in and out of health care, the level of personal health can be maintained,” he says.

Despite all the money he has spent, Hemmings represents the grassroots of the biohacking movement — those seeking their own routes to longevity. And he has long been sceptical of figures like Sinclair: “The science just isn’t strong enough to support some of the claims he’s been making.” Instead, it is other leading longevity podcasters such as Dr Peter Attia and the newly emergent voice of Dr Stanfield who are likely to benefit from Sinclair’s defenestration. As a practising GP in Auckland, with clinical expertise in helping people age gracefully, Stanfield in particular has become Sinclair’s online nemesis.

Both Stanfield and Attia are physicians, and appear comparably mindful of their Hippocratic responsibility to, first, do no harm. Both tend to wait until multiple clinical studies converge around similar findings before recommending supplements. And both have identified the worrying tendency of longevity researchers such as Sinclair to conflate the evidence from animal and human trials. Looked at independently, the evidence from human trials alone often tells a very different story. And Sinclair’s entire theory of autophagy may well prove to be a classic example of this pattern. What works for laboratory rodents doesn’t necessarily apply to large mammals like human beings. Stanfield cites evidence suggesting that humans would need to fast for four days to derive the autophagy benefits that can be induced in mice in just 16 hours.

Like Attia, Stanfield regards autophagy as a dangerous distraction, and beyond short-term weight loss, he contests the idea that calorie restriction and fasting has any long-term longevity benefits, a stance now echoed by the American Heart study. What’s more, depriving your body of vital nutrients like protein for 16 hours a day is a high-risk strategy, given that human studies show that frailty is the commonest factor in all-cause mortality. As Attia argues, unless we mitigate “sarcopenia”, the age-related loss of skeletal muscle mass and strength which normally begins in our 30s, ultimately frailty will be our undoing — even if it’s not listed on our death certificates.

By advocating fasting and low-protein intake, Sinclair has been flying in the face of preventative care clinical guidelines for years. It seems that you can be a serious research scientist or an entrepreneur, but not both (and by pushing supplements for dogs, Sinclair appears to have opted for neither). But perhaps the work of more serious figures like Attia and Stanfield shows that what we currently call biohacking could ultimately become part of general medical treatment. Given that the global market for anti-ageing biomedicine is projected to be worth $93 billion by 2027, they are certainly unlikely to be the last to try and realise its immortal temptations.

Ryan acknowledges that his decision to pay £25,000 for a surgery that was pioneered to help soldiers recover from battlefield injuries might seem irrational. Now in his late 20s, he worked extra shifts as a waiter and freelance writer to help finance the operation. “A normal person would think you were crazy,” he says. “But I was at breaking point. If you lived in my head for the last five years, you’d understand.”

Despite having an outwardly confident exterior, Ryan’s height-related insecurity began at around the age of 16 while he was still at college and started to notice that younger friends were outgrowing him. “I remember feeling significantly smaller than my classmates, as if I was underdeveloped. There was a sense that I didn’t matter as much as the others and that there was that something missing.”

Although he was never bullied, Ryan found the long-term cumulative effect of occasional height-related digs corrosive enough to lead from low self-esteem to anxiety and depression. “You realise that there’s something about you that’s outside the standard deviation of people that you’d meet — and then you realise you can’t do anything to fix it. It was definitely a contributing factor to a lot of the mental-health difficulties I had during my late teens and early 20s. It sort of consumes you.” Even close friends had little sense of the extent of his despair.

Ryan remembers reading that cosmetic limb-lengthening surgery had been pioneered in the United States. But at a prohibitive cost of around £125,000, it was too remote a prospect to ever entertain seriously. And then he became aware that, by outsourcing post-operative care and physical therapy to a non-clinical setting in hotels, providers in Turkey were offering several versions of the same procedure at more affordable rates.

At around £45,000, the most expensive package there replicates the higher-tech version of operation available in the States. By implanting an extendable nail in the bone cavity, and then using magnetic sensors to lengthen it by remote control, it does away with the need for a bulky metal external fixator while also speeding up recovery and reducing the likelihood of infection, nerve damage, blood clots or the possibility of the bones not properly fusing.

However, younger patients on more limited budgets like Ryan, tend to opt for the lower-tech Lengthening Over Nail (LON) method that costs between £25,000 and £33,000 Unfortunately, LON does requires require the bulky external fixator, which is wrapped around the leg externally and attached to the bone through the skin with pins, making scarring and infections more likely. What’s more, LON patients are required to lengthen their limbs themselves, by manually twisting a key in the metal fixator on four excruciating occasions throughout the day.

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By the time Ryan was ready to outline what the LON procedure would entail to his girlfriend, he had sunk further into his depression. Although she was initially horrified at the idea, she came around when she realised that the risks of doing nothing outweighed those from the surgery itself. Therapy had been repeatedly tried and had failed to remove Ryan’s crippling insecurity.

“She could see that I was at breaking point and that I’d already made my mind up, so she supported me throughout the process,” he says. After undergoing surgery 18 months ago, Ryan remained in hospital for five days on a cocktail of strong painkillers, morphine, antibiotics and blood thinners before being transferred to the hotel.

Today, Ryan claims he was one of the lucky ones because he always found the pain manageable; he remembers mind-numbing boredom being the biggest challenge. Robert, also from the UK, is there now and has not been so fortunate. When I spoke to him, he was halfway through the three-month lengthening process and still in very obvious discomfort. On the rare occasions that the pain subsides, Robert, an IT developer in his late 30s, can work remotely. “The pain is constantly there so I’m using painkillers. It stops you from doing anything like reading or watching films, but I sometimes manage to do some work on the laptop.”

Relentlessly, every six hours without fail, Robert turns the key in the external fixator that lengthens the legs by 0.25 mm. Invariably, the pain intensifies 10 minutes later as the muscles, and nerves stretch to accommodate the adjustment. ‘’It’s a serious procedure and being trapped in a hotel with such limited movement is obviously a very unusual situation.”

When I ask him why he’s putting himself through this, Robert cites a lack of confidence and a general sense of never quite being able to live life to the full. “Being taller has always been at the back of my mind — a sort of secret wish. You do feel as if you’ve missed out on certain things. And of course women desire taller men compared to themselves.”

By the time he returns to the UK in around six weeks, Robert is hoping for 8cm of growth (from 167cm to 175cm). While he still needs a wheelchair to get around, by then he should be able to manage on crutches — although a full recovery will probably take nine months. He has no plans to broadcast where he’s been, but if close friends expressly ask him where he’s been or notice the change in his appearance, he plans to confide in them if they promise to be discreet.

Back in Istanbul, Makbulijana Haruni, the patient welfare coordinator at the Iwannabetaller clinic, remains inundated with dozens of enquiries about limb-lengthening each week. She explains that most requests are rooted in the desire to project more confidence, power and status at work. “We see a lot of businessmen who say I’m in a senior position and need to lead teams of people but with this height I’m not able to do this,” she says. People believe that if they are taller, they will be heard more or more likely to be considered for promotions because they’re taken more seriously.”

As a patient welfare coordinator, Haruni comes as part of the package. The clinic has the capacity to operate on 80 patients each year and Haruni works with her team to screen out patients with body dysmorphia — a serious mental-health condition where sufferers obsess over flaws in their appearance. She acknowledges that patients with body dysmorphia can be treated more effectively by therapy and antidepressants; surgery would be futile. Patients have to pass a pre-surgical psychological assessment to be eligible for the operation.

However, according to Haruni, not all of their competitors are quite so scrupulous. You only have to type limb-lengthening surgery into a search engine to see the proliferation of the procedure with clinics popping up in health tourist hotspots Mexico, India and even Iran. It’s an entirely unregulated global market where orthopaedic surgeons promise simple surgical solutions to complex problems with far too much gusto and entrepreneurial flair.

“Around the world, orthopaedic surgeons have clearly realised that they can make a lot of money in this way,” Haruni says, before adding that the hype is clearly fuelling unrealistic expectations. She increasingly has to reason with patients demanding growth of more than 6-8cm from the procedure, even though that escalates the risks of potentially life-changing complications.

But what is driving such international demand? When the American sociologist Saul Feldman popularised the term “heightism” in the Seventies, he identified an insidious unconscious bias that’s hiding in plain sight. “American society is a society with a heightism premise: to be tall is to be good and to be short is to be stigmatised,” he wrote. And to combat the last socially acceptable form of discrimination, he called for a “sociology of stature”. Over the past half century, researchers have been amassing an imposing body of research, with international studies showing that being tall correlates not just with enhanced educational outcomes, social mobility, romantic success, and acquisition of leadership positions, but a better quality of life in general.

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Elsewhere, anthropological studies across cultures consistently show that taller stature is linked to increased social status. Although the reason why is unclear, there is a lot of evidence to support the interpersonal dominance theory — that we’re more likely to defer to the judgement of taller people because they are more likely to win a physical confrontation. When, for instance, the journalist Malcolm Gladwell was researching how we unconsciously form erroneous first impressions for his book Blink, he found that 58% of the CEOs of Fortune 500 companies were above 6 feet even though only 14% of men in the general population were that tall.

Does this mean that heightism is hardwired into our consciousness as an insidious prejudice? Taken in the aggregate, the evidence for the existence of the so-called “height premium” is certainly compelling, to the extent that limb-lengthening surgery starts to seem like the extreme end of the cosmetic-procedure continuum: how different is it to transhumanist endeavours such anti-ageing biotech or biohacking?

Viewed in this way, Turkey’s nascent limb-lengthening industry feels like an unnerving glimpse into that biomedical brave new world where status itself is a marketable commodity. A tummy tuck or nose job might give you confidence and change the way you feel about yourself, but it can’t re-engineer the invisible power dynamics in every room that have been crafted by millions of years of evolution in the way a “height transplant” can.

Eighteen months on from his surgery, and three inches taller, Ryan has transitioned from just below average height to just above, and is perhaps uniquely placed to comment on these new power dynamics. “I just feel that I’m a default person now with my own attributes who can no longer be as easily dismissed,” he says. “It forces people to engage with me for who I really am.”