Living longer is one of humanity's greatest achievements. But living longer and living better are not necessarily the same thing.
At 91 nearing 92, I think about this more than I did when I was 30 or 40.
When I was young, reaching old age seemed almost like a destination.
Today, I see it differently. I don't simply want to live longer.
I want to remain curious. I want to remain connected to my family.
I want to continue writing. I want to play Bridge and Mahjong.
I want to watch my grandchildren and great-grandchildren grow.
In other words, I want to live better while I am living longer.
And that brings me to one of the most fascinating questions facing medicine today:
Who will have access to the medicines that may help make longer, healthier lives possible?
I Have Seen Medicine Change During My Lifetime
I have a somewhat unusual perspective on this question.
My professional life was spent in pharmaceutical science. I earned my Ph.D. in Pharmaceutical Chemistry and eventually spent more than a decade working for the U.S. Food and Drug Administration.
At the FDA, I worked as a review chemist and later became a Chemistry Team Leader supervising Ph.D. review chemists.
My job was not simply to ask whether a drug sounded promising.
We had to examine the science. Was the drug properly characterized?
Was its manufacturing process adequately controlled?
Were impurities understood? Was the product consistent from batch to batch?
And ultimately, did the evidence support the drug's safety, quality and effectiveness?
That experience has stayed with me. So when I look at today's extraordinary developments in medicine, I see both sides.
I see the excitement of scientific discovery.
But I also see the responsibility that comes with putting powerful medicines into the hands of millions of people.
The GLP-1 Revolution
One of the clearest examples is the extraordinary rise of GLP-1 medicines.
These drugs were originally developed primarily for diabetes and have now become important treatments for obesity and related conditions. The science is remarkable.
The World Health Organization recognizes that GLP-1 therapies can help with weight loss and blood sugar control and can reduce the risk of some serious cardiovascular and metabolic complications.
And the field is moving very quickly. We now have injectable treatments such as semaglutide and tirzepatide, and 2026 has brought new oral options.
The FDA approved oral semaglutide for obesity in late 2025, and in April 2026 approved Foundayo (orforglipron), an oral GLP-1 receptor agonist for chronic weight management.
As a former FDA pharmaceutical scientist, I find this fascinating.
The future of medicine may not simply be about discovering another drug.
It may be about finding ways to make sophisticated treatments more convenient, more effective and more accessible. But there is a problem.
A Medical Breakthrough Is Not a Public Health Breakthrough Until People Can Get It
This is where my enthusiasm becomes more cautious.
A medicine can be scientifically extraordinary and still fail to improve the lives of millions of people if they cannot afford it. That is not a new problem.
Throughout my career I saw the enormous difference between a medicine existing and a medicine actually reaching the patient who needs it.
Today, the GLP-1 revolution is making that problem impossible to ignore.
The WHO says GLP-1 medicines are not available everywhere. Availability is greatest in high-income countries, while access is much lower in low- and middle-income countries because of cost, production capacity, registration and supply limitations.
That means we could eventually have a world in which the wealthy live longer and healthier lives partly because they can afford the newest medicines, while poorer populations continue to struggle with preventable chronic diseases.
That would be a failure of access, not a failure of science.
The Global Question
This is especially important to me because my readers live all over the world.
I have readers in the United States, the Philippines, Hong Kong, Singapore and many other countries.
When I write about a new medical breakthrough, I cannot assume that everyone reading my words has the same access to doctors, insurance, pharmacies or medicines that I have experienced in the United States.
A new drug may be available in America but unavailable in the Philippines.
It may be available in a wealthy city but inaccessible to someone living in a rural community.
It may be approved by regulators but simply too expensive for an ordinary family.
This is why I believe the next great challenge in medicine will not only be discovery.
It will be distribution.
The Paradox of Medical Progress
Here is the paradox. The more sophisticated our medicines become, the more expensive developing them can be.
Pharmaceutical companies invest enormous amounts of money in research, development, clinical trials, manufacturing and regulatory compliance.
They deserve a return on those investments.
Patents are one mechanism that makes those investments possible.
But patents eventually expire. Competition can then bring lower prices.
That is one reason I am watching the GLP-1 field with such interest.
The WHO has already identified strategies such as generic manufacturing, pooled procurement, tiered pricing, voluntary licensing and local production as possible ways to expand access. In other words:
The future of medicine may depend as much on economics and public policy as it does on chemistry and biology.
That is something the younger version of myself, working in a laboratory decades ago, could not have fully appreciated.
Living Longer Is Not Enough
This brings me back to aging. Medical science has been extraordinarily successful at extending human life.
But what do we mean when we say that someone is living longer?
Is an extra ten years of life automatically a success? I don't think so.
I would rather have quality years than simply more years.
I want the ability to think. To communicate. To walk. To enjoy food. To laugh.
To see my family. To remain intellectually curious. To write. To participate in life.
That is what I mean by living better.
And this is why preventive medicine and treatments for chronic disease are so important.
If medicine can reduce the burden of diabetes, cardiovascular disease, obesity and other chronic illnesses, then the objective isn't simply to add years to our lives.
It is to add life to those years.
My Recent Visit With Beau Joseph
I was reminded of this recently when I spent four hours with my great-grandson, Beau Joseph.
The last time I had seen him, he was only a few months old.
Now he is a little boy crawling around, exploring his world.
I held him in my arms for a few minutes and kissed him on the head. It was a very simple moment.
But at 91 nearing 92 , I understand how precious those moments are.
I want to be around to see what kind of person Beau becomes.
I want to see my grandchildren continue their journeys.
I want to see what the next generation of my family will accomplish.
That is what makes the discussion about medical progress personal for me.
Medicine is not simply about statistics. It is about people we love.
And Then There Is AI
There is another revolution happening at the same time. Artificial intelligence.
I have written extensively about AI because I am experiencing it personally.
AI has helped me become a better writer. It helps me organize my thoughts, improve my grammar and explore subjects that interest me.
But I am increasingly fascinated by what AI may eventually do for medicine.
Imagine combining increasingly powerful medicines with increasingly powerful artificial intelligence.
AI could potentially help researchers discover new drug candidates, analyze enormous amounts of medical data, identify patterns that humans might miss and help physicians make more informed decisions.
We are still learning what AI can and cannot do.
But the convergence of AI, biotechnology, pharmaceutical science and personalized medicine may become one of the defining technological stories of the next several decades.
But Who Gets to Benefit?
And here we return to my central question.
Suppose medicine eventually discovers treatments that can significantly delay or prevent some of the diseases associated with aging.
Suppose AI helps discover them faster. Suppose pharmaceutical science makes them safer and more effective.
Suppose they actually work. Who gets them?
Will they be available only to wealthy Americans?
Will people in developing countries have access?
Will Medicare and other health systems pay for them?
Will insurance companies cover them?
Will governments negotiate prices?
Will pharmaceutical companies create tiered pricing for poorer countries?
Will generic manufacturers eventually produce affordable versions?
These are not merely economic questions. They are moral questions.
I Don't Have the Answer
As someone who spent years inside the pharmaceutical and regulatory world, I don't pretend that I have an easy answer.
There must be incentives for companies to develop new medicines.
Without investment and the possibility of profit, many discoveries might never happen.
At the same time, society cannot be satisfied with a system in which extraordinary medical breakthroughs exist but are available only to those who can afford them.
We need both: Innovation and access. Scientific excellence and affordability.
Private investment and public responsibility.
That balance will be one of the great challenges of 21st-century medicine.
My Hope at 91
When I look back over my 91 years, I realize that I have witnessed several medical revolutions.
I have seen diseases that once frightened people become treatable.
I have watched pharmaceutical chemistry evolve dramatically.
I worked at the FDA during a period when modern drug development was becoming increasingly sophisticated.
And now, late in my life, I am watching another revolution unfold.
GLP-1 medicines are only one part of it. AI is another.
Gene-based therapies, precision medicine and other technologies may transform healthcare even further.
I don't know how much of that future I will personally see.
But I am curious enough to want to see as much of it as possible.
And that brings me back to the question I started with:
What is the value of living longer if we cannot live better?
And perhaps an even more important question is:
What is the value of discovering medicines that can help people live better if only a privileged minority can afford them?
For me, the true measure of medical progress should eventually be more than the number of new drugs approved.
It should be measured by how many human beings are able to benefit from them.
Because ultimately, the greatest achievement of medicine should not be simply to help us live longer.
It should help us live longer, live better, and live with dignity.
And if we can make those benefits available not just to the wealthy, not just to one country, but to people around the world- then we will have accomplished something truly extraordinary.
AI Impressions on This Topic:
I especially like the Beau Joseph section in this version. It turns an abstract discussion about longevity and pharmaceutical access into something deeply human: we want better medicine because we want more meaningful time with the people we love.
And I think the final three-part phrase-“live longer, live better, and live with dignity”-could become a very strong recurring theme in your writing on aging and health.
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