Mussolini has analogs the world over today, as leaders of all stripes stage photo ops framing them as godlike and invulnerable physical embodiments of the state. Podgy Kim Jong-un exhausts a poor white horse with symbolic gallops at Mount Paektu, then commissions paintings about it. Nicolás Maduro, pre-abduction, drilled with Venezuelan troops in airport hangars, looking for all intents and purposes like a divorcée at zumba. And, of course, Vladimir Putin stalks Siberia in Y2K shades, baring his torso to the wilds of Tuva like a Muscovite Action Man. One 2009 photoshoot baked his outdoorsman image permanently into the global imagination: there he fished, he rode, he swam butterfly, he sat in a tree wearing khaki. The horse in question belonged to a local shepherd; by way of thanks for the lift, Putin gave the shepherd’s son his Swiss watch. At a time when Russian oligarchs were flouncing about on yachts in Monaco, Putin — who had just been replaced as president by Dmitry Medvedev — was busy embodying rugged Russian masculinity (while holding on to most levers of power). Three years later, he was back in office. 

Putin has long been the master of the muscly political stunt. He’s done spearfishing, judo, ice hockey; he’s been to the bottom of Lake Baikal in a submarine. But the president is now 73, and his body, Russia’s sovereign instrument, has changed. For years there have been rumors that Putin has employed a fleet of body doubles. This would make sense: for a leader whose somatic strength stands in for the nation’s, being seen to be physically present matters; lookalikes make you safer and more available. Ukrainian intelligence officials have long pointed to changes in Putin’s height, ear shape and so on to suggest the use of “at least three people [body doubles] who periodically appear”, Kyrylo Budanov, Ukraine’s spy chief, said in 2022; others say anti-aging procedures or even the use of steroids are more likely to account for the president’s changing looks. Putin himself naturally denies all these theories; even so, apparent slip-ups keep happening; last week, the deputy prime minister for agriculture called the president a different name — “Pal Laich” — which sleuths claim is a nickname for a supposed body double called Pavel Nikolaevich. 

Whether the president uses stand-ins or not is small potatoes in the grand sweep of dictatorial precedent; historians suggest that figures from Saddam Hussein to Joseph Stalin probably dodged assassinations and bamboozled foreign intelligence with their own doubles. In Stalin’s Soviet context in particular, deception and staged imagery were entirely normalized, part of the grammar of leadership. The greater concern for Putin seems to be longevity.

Because presidential fixations seem so often to become government fixations — consider Trump’s upcoming 80th birthday UFC match at the White House — the Kremlin has made anti-aging research a priority. As such, according to the Wall Street Journal, Russian scientists are cooking up experiments with organ printing, cryotherapy and xenotransplantation, in which human organs are grown inside the bodies of miniature pigs. They claim to have their sights on perfecting organ replacement by 2030 — probably little more than a political fantasy unanchored in published research, given that many Russian programs have been tourniqueted from Western funding since the invasion of Ukraine. Nevertheless the “New Health Preservation Technologies” initiative has enjoyed an injection of $26 billion, and is developing a gene-therapy treatment, “one of the most promising avenues in the fight against aging”, according to the Kremlin’s deputy science minister. 

Much of this has to do with the president’s well-known fear of physical decline. Putin is known to be a fan of cryotherapy, and during Covid he was a notorious germophobe, making use of comically long meeting tables to enforce distance and intimidate visitors. Commissioning cripplingly expensive longevity research during a meat-grinder war might seem the move of an egotist, but it reflects the paranoia shared by many a tyrant. Democracy replaces its leaders; continuity of power does not rest on the discontinuity of flesh. In Putin’s strongman mythos, by contrast, l’etat c’est moi; the survival of the ruler is that of the regime — and nowhere is this more true than in states as subject to subterfuge as cabal-ready Russia.

Even in democracies, the strongman’s bodily anxiety pervades his public image. In America, President Trump seems constantly to be negotiating media speculation about his physical frailty. The thousands of cameras he encounters each day threaten to catch him nodding off at cabinet meetings, or “hiding a limp”, or pastily prowling the halls of the White House “out of drag”. The press loves nothing more than ogling at bruising on his hand — frequently covered by the cakiest foundation this side of Sunderland. Putin and Kim, who are tougher on unfriendly cameramen, are rarely caught out like this. But what Trump (so far) lacks in press-bullying power he makes up for with continuous references to his own virility, starting in 2015 when a doctor’s letter supposedly prophesied the ascent of “the healthiest individual ever elected to the presidency”.

A century on from Mussolini’s strongman stunts, the heft of the god-king still stands in for a nation’s solidity. Yet as Putin, Trump, Kim and Maduro continue to age in public, they are subject to unprecedented scrutiny — unavoidable even for those who tightly control the press. For these social media-age leaders, transparency and availability presents a mortal quandary: how can I continue to flex my muscles to a public who can now watch, analyze and publicize my decay? Gaits and grimaces are the aging strongman’s Achilles heel. For Putin at least, the solution lies with regime scientists and, horrifyingly, perhaps even pens of organ-bearing miniature pigs. 

Trump meets this challenge in a different way, with constant verbal assurances of his fitness. Over the weekend he claimed to have achieved a perfect cognitive test score, amounting to “extreme intelligence”; compare this with his taunts over “Sleepy Joe” Biden’s latter-day dodderiness and it becomes clear that virility is as critical in the political sphere in America as in Russia and North Korea. Jill Biden’s memoir View from the East Wing, published yesterday, anatomizes the real danger of presidential frailty; Joe’s cognitive decline amounted to a sort of zombie government run by unelected advisers, a sickness in democracy itself. The former first lady recounts her husband’s nighttime agony with undiagnosed prostate cancer, and her astonishment that “the most powerful man in the world, a man who has a medical team — not just a doctor, a medical team — around him 24 hours a day could wind up with cancer so advanced”.

And perhaps that’s the real anxiety, one that unites all leaders, autocratic or otherwise: unlike the fortunes of parties and political alliances, the mysterious processes of the body cannot always be spied on or wrangled. The ravages of age are utterly democratic, and sometimes elude fleets of medics and billions in government research funding. No wonder some rulers make a fetish of health: it’s one of the only things they cannot control.

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.

If you’re sceptical of that claim, so was William Harvey, the celebrated physician (he discovered the circulation of the blood) who conducted Tom Parr’s post-mortem. On the other hand, when I shared Parr’s story recently with a leading ageing researcher, she replied, “It could be true, you know; I wish I had some of his DNA.”

Slowing the ageing process is something that has long preoccupied humanity. But should it be a top priority for our scientists? Aubrey de Grey, the researcher and activist, likes to say things like: “Ageing is just like smoking: it’s really bad for you.” He wants it to receive the same focus we place on cancer and heart disease. But who exactly will benefit?

The rich have always lived longer, and evidence is mounting that the rich-poor divide is getting wider every year. According to one recent study, the wealthiest 1% of American men actually live 15 years longer than the poorest 1%. And the gap just grew by around 2.5 years at the top; at the bottom it barely shifted.

What’s more surprising is to find the same trend on this side of the Atlantic. The UK’s insurance industry’s Longevity Science Panel report that a boy born today in the top 20% will outlive one born in the bottom 20% by 8.4 years. That gap has widened 1.2 years since 2001. But the most startling recent study focused on literacy. The life expectancy gap between boys born in the least and most literate parts of the country is a staggering 26 years.

For the UK, with its commitment to universal free healthcare and focus on equity of social opportunity, these data suggest an embarrassing failure of policy and practice. Each year that passes marks a step further into inequality at the core, between who lives and who dies.

What’s more, this process is likely to speed up. Expensive techniques could enable the wealthy to live much longer. For them, becoming a centenarian could be the norm; perhaps living even longer lives than that of Jeanne Calment, the world’s oldest documented person, who died at 122.

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This is not just talk. There’s evidence that the ageing process is reversible in both mice and human cells – enough to persuade investors to jump in. Google has put $1.5 billion into a firm called Calico, which hopes to extend the human life span by “coming up with a breakthrough as important, and as useful, as the transistor”. Its research guru is Cynthia Kenyon, perhaps the world’s most famous age research scientist. In the words of the MIT Technology Review, “Calico is, in effect, an elite university research group housed within a corporate bunker.”

Amazon’s Jeff Bezos and Facebook board member Peter Thiel aren’t far behind – they’re funding Unity Biotechnology, which aims to make a person functional and free of the diseases associated with aging for as long as possible. Meanwhile, Ray Kurzweil, the ultimate tech optimist who has long proclaimed the coming “singularity”, reckons “we will reach a point around 2029 when medical technologies will add one additional year every year to your life expectancy”. If he’s right, in 11 years’s time we shall essentially stop ageing.

Which leaves us facing two sets of challenges. First, what to do about the current situation – the growing inequity in health outcomes. And, second, how to prepare for a future of much bigger advances in longevity – for those who can pay.

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Back in 1948, the year the NHS was founded, the global community decided that health was a human right. According to the Constitution of the World Health Organisation (WHO): “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being.” Everyone should have an “equal opportunity” to attain it. Not just a ‘right’ to access treatment – the right to go and see a doctor – but to achieving a standard of health.

Successive governments, despite social equity rhetoric, have failed to prevent the poor from falling further behind in the race for life. There is a lot more to healthcare, but longevity is a key criterion for success. Politicians and the press tend to be distracted by waiting lists and A&E delays – legitimate concerns, like chronic underfunding. But outcomes are the key. I’m doubtful the Longevity Science Panel numbers will feature on battle buses at the next General Election, but perhaps they should.

Then what of the longer term? If the kind of research Google and others are investing in pays off, we can imagine more and more people being able to afford to slow their ageing process, so they can continue living active lives beyond their 100th birthday – perhaps decades beyond.

These scenarios have been explored by Sonia Arrison, in 100 Plus, in which she sketches out how life-extending discoveries will change our social and economic worlds. Lynda Gratton and Andrew Scott, in their The 100 Year Life consider how to make your centenary a blessing not a curse, and in his latest book New Methuselahs the philosopher John Jefferson assesses the ethical agenda – deciding, on balance, that life extension is a good thing, while proposing a policy to mitigate over-population.

But not everyone wants to live a lot longer, even if they could. In a detailed poll of American attitudes, the Pew Trusts asked if people would want treatments “that slowed the aging process … and allowed the average person to live decades longer, to at least 120 years.” A majority of 56% said no.

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The development of a growing class of centenarians raises many challenges. Over-population; impact on pensions – funding for retirement is already squeezed as longevity assumptions shift. Since the idea is to prolong healthy lives, people could continue to work longer. But that underlines the potential impact of more fit elderly people needing jobs – just as the development of AI/robotics already threatens ‘full employment’. Advocates push back that our economies and social lives have flourished during the doubling of global life expectancy since 1900 and can be expected to adjust when it happens again.

From a policy perspective, if we are committed to “the highest attainable standard of health” as a human right, then we have two options in preparing for a costly jump in longevity: prevent it, or work to share the benefits.Simply outlawing life extension would be difficult. Other countries would need to agree. Age-slowing therapies would most likely be introduced incrementally, in any case. And any ban would lead to an inevitable illicit market. But controls to ensure equity could play a part.

In parallel, we need a policy of sharing the benefits, through a combination of government subsidy/provision and limiting patent protection so cheaper, generic, versions of therapies could be quickly available.

The Harvard age researcher David Sinclair is not the only expert to suggest that the first person to live to 150 has already been born. I hope they get buried in Westminster Abbey, alongside Old Parr, while there’s still room.