QAIAx (AIhealth4U) – AI Public Health Central: Microcity-A (re Quantum AI Agency Aka AI City Hall Project, UPSTO App Nos. 64/074,526, 64/063,557, 63/903,181, 63/729,428

Conditions: Asperger’s Disorder; Asperger Disorder; Autism Disorder; Autism; ADHD – Attention Deficit Disorder With Hyperactivity; ADHD; ASD; Alcohol Abuse/Dependence; Alcohol Addiction; Alcohol and Other Drug Use Disorders; Alcohol and Other Substance Use Prevention; Gambling Addiction; Gambling Disorder; Sex Abuse; Sex Behavior; Sex Crimes; Sex Disorder; Sex Disorders; Gender Dysphoria, Adult; Eating Behavior Disorders; Narcotic-Related Disorders; Narcotic Addiction; Narcissism; Psychiatric Disorder; Psychedelic Effects in Healthy Volunteers; Psychedelic Experiences; Psychedelic Drug Dependence; Marijuana Use Disorder; Marijuana Abuse and Dependence; Smoking (Tobacco) Addiction; Smoking Among Youth; Smoking Abstinence; Abstinence, Sex; Opiate Substitution Treatment; Opioid Abuse (Disorder); Opioid Abuse and Addiction; Cocaine Abuse; MDMA (‘Ecstasy’); Addiction Disorders; Homeless and Low Incomes People, Refugees; Homelessness; Reliability and Validity; Anger Problems; Child Abuse, Sexual

Interventions: Behavioral: AI City Hall Project (AIhealth4u – Public Health Central); Behavioral: AI City Hall Project (QAIAx Microcity A – AI Public Health Central)

Sponsors: Veterans Recovery Network Inc.; U.S. Special Operations Command; Central Virginia VA Health Care System; AI-119 Vulcan Project Research & Educational Technology Company (fka Henry Nanpei Academy Project)

Not yet recruiting

The Download: AI bottleneck debates, and BCI trials take off

This is today’s edition of The Download, our weekday newsletter that provides a daily dose of what’s going on in the world of technology.

A startup claims it broke through a bottleneck that’s holding back LLMs

AI startup Subquadratic came out of stealth last month with a huge claim: it had solved a mathematical bottleneck that had held back large language models for almost a decade.

The purported breakthrough comes from slashing the number of computations transformers need to carry out to generate answers. The result is a faster and cheaper LLM that uses far less energy than any other model on the market.

Many experts remained skeptical—but Subquadratic has started to share the receipts. They suggest that their approach might be worth paying attention to.

Here’s how the system works—and why some researchers still aren’t convinced.

—Will Douglas Heaven

Brain-computer interface trials are taking off

—Jessica Hamzelou

This week, I covered the story of Casey Harrell—a man with ALS who is “the first power user” of a brain implant. The device has enabled him to maintain an income, reconnect with friends and family, and read to his daughter. He told me that it’s “nothing short of revolutionary.” 

Over the past couple of years, the number of BCI trial volunteers has soared. This year, China became the first country to approve a BCI for medical use. Advances in technology are allowing engineers to provide more features than ever. BCI research is properly taking off.

Find out how the technology is edging from the lab towards the market.

This story is from The Checkup, our weekly newsletter giving you the inside track on all things biotech. Sign up to receive it in your inbox every Thursday.

The must-reads

I’ve combed the internet to find you today’s most fun/important/scary/fascinating stories about technology.

1 Amazon workers who backed data center limits may face termination
The engineers say they’re under investigation by the company. (NYT $)
+ And could face discipline, including potential termination. (The Verge)
+They had testified at meetings about pausing data centers. (CNBC)
+ They’ve filed a joint complaint to Seattle’s Office for Civil Rights. (Wired $)

2 A new fossil discovery has rewritten 150 years of evolutionary theory
It suggests early land vertebrates skipped the tadpole stage. (New Scientist $)
+ And raises questions about how vertebrates adapted to land. (404 Media)
+ Sponges may have been the first animals. (MIT Technology Review)
 
3 Bernie Sanders plans to give the public direct ownership of AI firms
He’s unveiled new legislation to create an AI sovereign wealth fund. (AP News)
+ It would be funded through a one-time tax on AI companies’ stock. (Quartz)
+ And make annual payments directly to Americans. (Washington Post $) 
 
4 Investors in China secretly acquired stakes in SpaceX before its IPO
One had ties to Chinese military contractors. (ProPublica)
+ The US fears China has got one of ASML’s top machines. (Reuters $)
 
5 Researchers have figured out Russia’s nuclear-powered missile
They call it “a terrible idea”—but not an impossible one. (NPR)
+ NASA is building a nuclear reactor-powered spacecraft. (MIT Technology Review)
 
6 Longevity medicine faces a do-or-die moment in a landmark trial
It will test whether cellular aging can be safely reversed in humans. (Axios)
+ The next step is “chemical reprogramming.” (MIT Technology Review)
 
7 Studies suggest AI may already be deskilling professionals
Over-reliance appears to weaken doctors’ and engineers’ abilities. (Nature)
 
8 Tech workers who maxed out their AI use are now trying to minimize it
Spiralling costs mean “tokenminning” has replaced “tokenmaxxing.” (NYT $)
 
9 Scientists say the human genome’s structure may confound AI models
Which would constrain AI-based models of biology and disease. (Quanta)

10 A new robotic self-driving toilet brings the bathroom to you
The Xiaoban also cleans up and empties itself all on its own. (The Verge)

Quote of the day

“They hated me. They were doing everything they could to knock me down. And look at them now.” 

—Donald Trump mocks Mark Zuckerberg and Jeff Bezos in a conversation with Elon Musk that’s recounted in a new book, Wired reports

One More Thing

chicken network

PABLO DELCAN


Technology can help us feed the world, if we look beyond profit

The pandemic exposed the weak spots in our interconnected food system. They’re the result of decades’ worth of technological advances, from globe-spanning shipping to refrigeration networks. But technology is not inherently opposed to sustainable and resilient food systems.

Powerful technologies like genetic modification can create stronger local agriculture and a healthier food system—but they normally aren’t. The challenge is ensuring they serve food security and human well-being, rather than simply maximizing profits.

Dive into our food system’s problems and the solutions that technology can provide.

—Fabio Parasecoli

We can still have nice things

A place for comfort, fun, and distraction to brighten up your day. (Got any ideas? Drop me a line.)

+ This intriguing video tracks the covert reality of Japan’s shinobi.
+ Dive into this admirably obsessive archive covering over 100 different ways to tie your shoes.
+ One of the world’s largest digital collections of plants and fungi is now available for free to everyone.
+ A grand orchestra has beautifully covered Michael Jackson’s “Human Nature” at Abbey Road Studios.

A startup claims it broke through a bottleneck that’s holding back LLMs

The Miami-based AI startup Subquadratic came out of stealth mode last month with a huge claim. It announced that it had solved a mathematical bottleneck that had been holding back large language models for almost a decade.

The details were thin, and many people were unconvinced. But Subquadratic has started to bring the receipts, sharing the results of an independent evaluation of its new tech. The results suggest that the company’s claims might be worth paying attention to.

According to Subquadratic, it has developed a new kind of LLM, called SubQ, that is faster and cheaper and uses a lot less energy than any other model on the market. The company also claims that SubQ is able to process up to 12 times as much text at once as most other models, allowing it to carry out a range of data-heavy tasks, such as analyzing hundreds of documents or entire code bases.

What’s more, Subquadratic says, SubQ does this while more or less matching the performance of the best models put out by Google DeepMind, OpenAI, and Anthropic on key tasks like coding.

The problem was that the company at first provided little evidence for its claims beyond a handful of self-published test scores. And it has yet to make SubQ widely available for people to try out themselves.

So it’s no surprise that Subquadratic’s claims were met with skepticism. Dan McAteer, an artificial-intelligence engineer, captured the overall response on X: “SubQ is either the biggest breakthrough since the Transformer … or it’s AI Theranos.”

A month on, the company has published more information about its model, including the results of additional independent tests run by the third-party firm Appen.

“We expected healthy skepticism,” says Subquadratic cofounder and chief technology officer Alex Whedon. “In hindsight, releasing the third-party benchmarks alongside the initial announcement would have preempted much of the skepticism, which is why we’re taking the time to make sure any future results are fully verified before putting them out.”

Subquadratic asked Appen, which evaluates other companies’ models, to run its tests on SubQ. The results seem to back up a lot of Subquadratic’s claims. “That was really exciting to me, it validated their architecture,” says Jeanine Sinanan-Singh, Appen’s director of generative AI research.

“I was like, ‘Wow, this could be a game changer,’ because models struggle with speed and inefficiency,” she adds. “But when you have kind of shocking results, it’s really not as credible when you say it yourself.”

SubQ won’t replace existing top models across the board, but it could offer huge increases in speed at a fraction of the typical cost for certain tasks. Subquadratic insists that in the long run, though, its breakthrough could change how LLMs are built. “We hope we’re kicking off a new age of efficiency,” says Justin Dangel, the firm’s cofounder and CEO. “We don’t think anybody will be building on transformers in a few years.”

Attention!

To understand why Subquadratic’s claims are a big deal, let’s dig into how most LLMs work. The key mechanism inside an LLM is a type of neural network called a transformer, which runs a process known as dense attention. Today’s LLMs typically chain together multiple transformers. (The foundational paper of the LLM era, published by researchers at Google in 2017, was titled “Attention Is All You Need.”)

Dense attention works like this: When a transformer processes a chunk of text, it first encodes each word (or part of a word, known as a token) with a number. To capture the meaning of the full text, it then multiplies each of those numbers with every other number for that text. For example, a piece of text 10,000 words long would kick off almost 50 million individual multiplications. That’s a lot of computation and the main reason that LLMs are notorious power hogs.

“If you want to summarize The Great Gatsby, you have to look at the first word and the last word together, and then you have to look at every other combination,” says Dangel.

As the length of the text increases, the number of computations skyrockets. That’s because each additional number must be multiplied by all other previous numbers. Double the number of words, and you roughly quadruple the number of computations, a rate of increase known as a quadratic expansion.

(You can picture this yourself: Draw a circle and mark dots around its edge. Each dot is a token. Then draw lines between pairs of dots to represent the multiplication of those two tokens. A circle with five dots will have 10 lines crossing it. Make it 10 dots and you will have 45 lines, 20 dots and you will have 190 lines, and so on.)

Slashing costs

Subquadratic’s solution is to ditch dense attention, the core operation of a transformer, in favor of what’s known as sparse attention, which slashes the number of computations needed. Instead of multiplying the number assigned to each token by every other number, sparse attention selects just some of the numbers to multiply. The idea is that not all relationships between words in a piece of text matter.

“Sparse attention says not all of those relationships are important, because they’re not,” says Whedon. “If you’re reading a book, you’re not going to look at the first and second words, first and third—that’s insane.”

It’s a simple approach, and Subquadratic is not the first to try it. “Pretty much everything under the sun has been attempted,” says Will Depue, an independent AI researcher who previously worked at OpenAI. “It’s not impossible, but it’s akin to running a four-minute mile.”

Previous techniques for selecting which numbers to multiply and which to ignore have not produced a mechanism that can capture the meaning of a document as well as dense attention can.

Subquadratic claims to have cracked the problem at last. It pitches SubQ as the first sparse-attention LLM that rivals mainstream dense-attention models in performance.

“Historically, most mechanisms have used fixed patterns, like always comparing the first word to the fifth,” says Whedon. “That’s pretty limiting. Language is too sophisticated for that. And so, one of the things that makes our mechanism unique is that we dynamically select which ones are important.”

The firm won’t say exactly how SubQ chooses which words to focus on, but the selection is calculated on the fly and differs for each piece of text the model is given. “That’s kind of where the secret sauce is,” says Whedon.

Testing, testing

The upshot is that for certain tasks, SubQ may be faster and cheaper to run than most other models. Appen evaluated SubQ on a handful of standard tests. In a straight-up speed test, which sets a baseline for how fast a model can operate in theory rather than assessing what a model can actually do, Appen found that SubQ was 56 times faster than models using FlashAttention, a previous sparse-attention technique. 

On LiveCodeBench, a test that looks at how well models perform on competitive coding problems taken from real contests, SubQ scored 89.7%, putting it in the same ballpark as other top coding models. “This model continues to provide frontier-level performance in coding,” says Appen’s Sinanan-Singh.

Subquadratic’s claims about cost are harder to verify because SubQ is not yet widely available. According to Dangel, it costs $2,600 to run Anthropic’s LLM Opus 4.6 through RULER 128, a test developed by Nvidia to assess a model’s ability to retrieve information from large data sets. And SubQ? “It cost us eight dollars,” he says.

SubQ does seem to be able to handle a lot of text at once. The model has a context window (roughly akin to a working memory) up to 12 million tokens long. Most top models today have context windows one million tokens long. In a demo that Whedon ran for me, he asked SubQ to perform a task that required it to reason about information contained in 400 documents. It responded in seconds. When he gave Perplexity—a popular LLM-powered search engine—the same task, it failed to load all 400 documents. 

Appen put SubQ through the Needle-in-a-Haystack test, which, like RULER, assesses how well a model retrieves specific information buried in a large data set. In its report, Appen states that Subquadratic’s model scored 98% with context windows six million and 12 million tokens long, “sustaining near-perfect long-context retrieval at scales few models are tested at.”

Too good to be true?

Despite the high scores, benchmarks paint an incomplete picture of what a model can and cannot do. Testing under very specific conditions is not a substitute for running a model on a wide range of real tasks.

Subquadratic is offering SubQ as a model tailored to coding and to searching very large data sets. It says that tens of thousands of potential users have already signed up for early access, including more than 500 enterprise customers. But there’s a long waitlist, and the firm has given very few people access so far. Subquadratic’s response is that it is a new, small company with limited resources and cannot serve too many people at once.

Until more people get their hands on the model and try it out for themselves, some skepticism is justified. One nagging issue is that Subquadratic reused the weights (values set within a model during training that determine how it will behave) from a version of the Chinese open-source model Qwen to bootstrap SubQ, rather than training it from scratch. That’s a common approach for model makers to take, but it cuts across Subquadratic’s claim that it has fully reinvented how LLMs work.  

“They may have built something real and useful,” says Depue. “But the public evidence does not yet justify the stronger claim that they have solved the quadratic attention bottleneck.”

In the meantime, Subquadratic cofounder Whedon insists that making something different was his only option. If you want to build a competitive model, you have to have new ideas, he says: “We’re more up against it than OpenAI is.”

Videos on Bilibili, TikTok, and Xiaohongshu as Sources of Medical Information on Adenoid Hypertrophy: Cross-Sectional Content Analysis

Background: The clinical diagnosis rate of adenoid hypertrophy (AH) in children has increased in recent years, drawing growing attention from parents. Short-video platforms such as Bilibili, TikTok, and Xiaohongshu host a large volume of educational content on this condition. However, the quality and reliability of this information remain unclear. Objective: This study aimed to evaluate the completeness, understandability, actionability, reliability, and overall quality of short videos on AH across Bilibili, TikTok, and Xiaohongshu and to explore factors associated with these quality metrics, including uploader characteristics and engagement indicators. Methods: We collected 220 videos (Bilibili: n=90, 40.9%; TikTok: n=63, 28.6%; and Xiaohongshu: n=67, 30.5%) using newly registered accounts. Two independent reviewers evaluated video quality using a 6-item content completeness scale (score range 0-12), the Patient Education Materials Assessment Tool for Audiovisual Materials, the modified DISCERN instrument, and the Global Quality Scale (GQS). Interrater reliability was high (Cohen κ=0.77-0.993). Completeness assessed essential informational components of AH. As data were nonnormally distributed, results are presented as median (IQR). Cross-platform comparisons were conducted using the Kruskal-Wallis test with post hoc Mann-Whitney tests (with Bonferroni correction). Spearman correlation was used to explore associations between video characteristics (ie, duration and engagement metrics) and quality outcomes. Stepwise linear regression identified independent predictors of overall quality (GQS). Results: Video duration differed significantly across platforms (Bilibili: median 113.5, IQR 66.5-271.5 seconds; TikTok: median 73, IQR 44-100 seconds; and Xiaohongshu: median 63, IQR 41-127.5 seconds; <.001). Bilibili videos demonstrated higher completeness than videos on the other 2 platforms (Bilibili: median 2, IQR 1.5‐4.0; TikTok: median 1.5, IQR 0.5‐2.0; and Xiaohongshu: median 1.5, IQR 0.5-2.8; <.001); overall differences were observed for understandability and reliability, but pairwise comparisons did not reach statistical significance after Bonferroni correction. Xiaohongshu videos showed greater actionability than TikTok videos (=.011). Medical professionals (n=158, 71.8%) had higher understandability than nonprofessionals (n=158, 81.8% vs n=62, 66.7%; =.001). Video duration positively correlated with completeness (ρ=0.64, 95% CI 0.56-0.71; <.001). Shares showed weak positive correlations with completeness and actionability. Stepwise regression identified understandability (using the Patient Education Materials Assessment Tool–Understandability) as the strongest independent predictor of overall quality (GQS), followed by actionability, video duration, and uploader type; engagement metrics and platform did not enter the final model. Conclusions: The quality of AH-related videos on Chinese short-video platforms is generally suboptimal. Bilibili offers higher completeness, while Xiaohongshu excels in actionability and interactivity. Understandability is the strongest predictor of overall quality, surpassing uploader type and engagement metrics. To improve online health information, platforms should move beyond engagement-based algorithms, and health care professionals should prioritize clear, actionable content.

Have Microbubbles Burst Through the Barriers of Genetic Medicine Delivery?

After more than 20 years working on viral and nonviral delivery modalities, Kenneth Greenberg, PhD, thought he had seen it all in genetic medicine delivery—until he met Steve Feinstein, MD, and Michael Davidson, MD, in 2021. Feinstein, a clinical cardiologist, had been working with ultrasound and contrast ultrasound for decades.

“Steve was scratching his head in the 90s trying to better diagnose heart disease patients, wondering why there’s a contrast agent for every other imaging modality except ultrasound,” Greenberg told Inside Precision Medicine.

Feinstein’s solution was microbubbles. These tiny gas-filled spheres (1-10 μm) with lipid, protein, or polymer shells can safely circulate through capillaries and resonate in response to ultrasound waves when injected intravenously, improving blood flow and tissue perfusion visualization before being cleared by the lungs and liver.

It was Feinstein that got the FDA to approve the first two ultrasound contrast imaging agents. Beyond diagnostics, he found new uses for microbubbles. Certain acoustic conditions could allow them to deliver therapeutic payloads directly into tissues.

Together with Davidson, a lipidologist and preventive cardiology specialist, Feinstein formed a long-term research partnership in Chicago’s academic medical community that resulted in the founding of SonoGene in 2000 to translate and commercialize ultrasound-mediated gene delivery.

kenneth greenberg sonothera
Kenneth Greenberg, PhD, co-founder and CEO of SonoThera [SonoThera]

Though SonoGene never made a splash, Feinstein and Davidson were able to generate preclinical data, which Greenberg found “mindblowing.”

“It showed me that you could use ultrasound and nonviral DNA payloads to achieve delivery and gene expression,” said Greenberg. “This is in rodents, but it was enough to persuade me that if it worked in humans anywhere near as well as it does in rodents, it could completely change the landscape of gene delivery. I thought it was just such an elegant idea. These components have been available for years, and we can repurpose them in a creative way to accomplish things that you could never do with existing modalities.”

In 2022, Greenberg, Feinstein, and Davidson joined forces to launch SonoThera, backed by a $60.75 million Series A financing with the goal of developing a nonviral, ultrasound-mediated gene delivery platform capable of producing safe, targeted, redosable, and cost-effective genetic medicines.

Four years later, investors are reaffirming that vision. SonoThera closed an oversubscribed $125 million Series B financing to advance its lead programs to the clinic and develop its ultrasound-enabled delivery platform. The funding comes at a crucial time for genetic medicine, where delivery challenges continue to temper therapeutic innovation.

RIPPLE effect

The genetic medicine revolution has produced transformative therapies across rare diseases, oncology, and metabolic disorders. Yet despite the success of viral vectors such as adeno-associated virus (AAV) and nonviral systems such as lipid nanoparticles (LNPs), researchers continue to grapple with payload-size constraints, limited tissue targeting, inability to redose, manufacturing complexity, and immune-related toxicities.

For Kenneth Greenberg, PhD, those challenges create an opening for a fundamentally different delivery strategy. “The field and investors recognize that this is a big problem, and no one has yet been able to solve it,” he said. “Coming up from a very different angle, I think it is getting people excited that this could ever come.”

Rather than engineering new viral capsids or nanoparticle chemistries, SonoThera has built its platform around two technologies already widely used in medicine: ultrasound systems and microbubble contrast agents. The company’s innovation lies in combining them with naked DNA payloads and proprietary ultrasound waveforms, called RIPPLE, to drive gene transfer into tissues.

“Our strategy has been to use the existing infrastructure as much as possible and not to develop bespoke hardware or novel microbubbles,” Greenberg said. “We want this to be widely utilized and have great patient access and clinicians to be familiar with the systems and the components.”

Unlike AAVs or LNPs, SonoThera does not package DNA inside a carrier. Instead, naked DNA and microbubbles circulate independently in the bloodstream until ultrasound is applied to a target organ. “There are some common misconceptions about the mechanism,” Greenberg said. “The mechanism basically involves taking the genetic payload, which is naked DNA. It’s not encapsulated in anything.”

The ultrasound activates circulating microbubbles in a multi-step process. First, acoustic energy creates temporary gaps in the endothelial lining of blood vessels, allowing DNA to access target tissues. The microbubbles are then collapsed, creating transient pores in cell membranes that permit intracellular entry of the payload. Finally, ultrasound-driven modulation of the nuclear pore complex facilitates transport of DNA into the nucleus for transcription and protein production. “The ultrasound can basically do everything in one single profile,” Greenberg said. “We can modulate the waveform in ways to drive this mechanism of delivery. We don’t need receptors, endosomes, or anything like that, which gives the platform a huge advantage in versatility to target different organs.”

That receptor-independent mechanism may offer one of the platform’s biggest advantages. Existing delivery systems typically depend on receptor-mediated cellular uptake, which can activate innate immune pathways and restrict tissue tropism. According to Greenberg, microbubbles largely avoid those limitations. “It’s also key to how we avoid the immune system, the innate immune system’s response that typically gets triggered by viruses and LNPs,” Greenberg said.

Because microbubbles are micron-sized rather than nanosized, they never enter the cell and are destroyed extracellularly after ultrasound activation. The DNA itself enters cells independently. While naked DNA degrades relatively quickly in circulation, Greenberg said its half-life of roughly 30 to 60 minutes is sufficient because infusion and ultrasound delivery occur simultaneously.

In contrast, LNPs enter cells through endocytosis, carrying lipids and genetic cargo that can activate innate immune sensors such as cGAS-STING and TLR9. AAVs similarly rely on receptor-mediated uptake pathways that can provoke immune responses and limit redosing.

From sonoporation to clinical translation

The platform’s flexibility has become increasingly apparent as SonoThera expanded beyond its initial liver studies. The company subsequently evaluated delivery to kidney, skeletal muscle, heart, brain, and adipose tissue. “What we’ve found is that the delivery technology works in all organs in the body, as far as we can tell,” Greenberg said. The notable exception is the lung, where air attenuates ultrasound energy.

Perhaps most striking is the company’s work in the brain. The SonoThera platform can temporarily open the blood-brain barrier and deliver payloads using the same mechanism as other tissues. “A common misconception is that the bone can attenuate the ultrasound energy. But that’s not the case,” Greenberg said. “The frequencies are such that they can penetrate easily through the skull and get into the brain.”

If that capability translates clinically, it could represent a significant advantage over delivery technologies that remain largely confined to the liver or a limited set of tissues.

SonoThera’s initial pipeline targets diseases where current delivery systems struggle. In Duchenne muscular dystrophy (DMD), the full-length dystrophin gene is too large for AAV vectors. The company’s ADPKD program has a larger payload.

“The overarching strategy when we’ve approached indications is that it’s challenging to get access to large payloads that are prohibitively large for AAVs,” Greenberg said. “With our ADPKD program, the payloads are even larger. That’s about a 22 KB payload, while the DMD payload is about 13 kb.”

Redosing is also important. Many genetic diseases require long-term treatment, especially in children whose tissues grow. AAV therapies are rarely administered again due to immune responses, making therapeutic expression difficult. “There are indications where the disease really requires redosing over time,” Greenberg said. “DMD is a good example because we’re treating really young boys as their bodies grow.”

SonoThera delivers mutation-agnostic full-length dystrophin with redoseability. The company also targets skeletal muscle, heart, and diaphragm simultaneously to address cardiopulmonary complications that kill many DMD patients.

The platform uses episomal DNA rather than genome editing. Greenberg believes the DNA behaves like AAV-delivered episomes, becoming chromatinized in the nucleus and maintaining expression. “We’ve got durability data out to a year so far with a single treatment,” he said.

Target tissue will determine redosing frequency: rapidly dividing cells may dilute episomal DNA, but quiescent tissues may maintain expression longer. Despite its focus on gene replacement, SonoThera has shown compatibility with gene editing and targeted integration methods. “For us, it’s really about using the right tool for the right job,” Greenberg said. “We don’t want to do gene editing just because it’s sexy.”

The scientific foundation for SonoThera’s platform is rooted in sonoporation, a concept that has been explored academically for decades but has never successfully reached the clinic. Greenberg believes the field historically struggled with two major hurdles: achieving sufficient transfection efficiency and broad biodistribution. “In the first two years of the company, we basically focused on solving those problems and really innovating to achieve extremely high delivery efficiency and broad organ biodistribution,” he said.

Those advances have now positioned the company to enter clinical development. SonoThera is conducting IND-enabling studies, manufacturing activities, and GLP toxicology work while refining clinical trial designs with physician and disease-area experts. The initial studies will focus primarily on safety while also evaluating biomarkers and early signs of efficacy. In DMD, the company has already generated preclinical biopsies showing expression of full-length dystrophin protein in muscle tissue.

Although SonoThera’s internal pipeline currently focuses on rare diseases, Greenberg sees broader opportunities ahead. Pharmaceutical companies have increasingly shifted attention toward common diseases with larger commercial potential, and many are searching for delivery platforms that can overcome the limitations of AAV-based therapies.

Investor confidence—but can it scale?

Greenberg says industry interest in nonviral, redosable systems may be better for common diseases, especially when manufacturing costs and reimbursement issues make one-time treatments unsustainable. SonoThera will advance its pipeline and partner with larger companies seeking platform access to capitalize on those opportunities. “Our strategy as a small biotech company has been to have our internal pipeline but, in parallel, be able to have licensing deals and partnerships that allow us to expand the reach of the technology and the much larger patient populations.”

The oversubscribed $125 million Series B financing suggests investors increasingly view delivery as the next major frontier in genetic medicine. As SonoThera approaches the clinic, it faces many of the same questions every new gene-delivery platform has faced for creating a paradigm-shifting delivery modality: safety, durability, and scale.

Because SonoThera’s platform relies on ultrasound-driven physical mechanisms rather than biological targeting, factors such as organ size, anatomy, blood flow, and patient variability could provide challenges to translatability.

Delivering DNA to a mouse liver or muscle is very different from delivering therapeutic amounts of genetic cargo throughout the muscles, heart, and diaphragm of a growing child with Duchenne muscular dystrophy. While microbubbles have a decades-long track record as imaging agents, repeated therapeutic delivery tools are a different proposition.

While the company argues that naked DNA and ultrasound avoid many of AAV’s payload limitations, questions remain about the doses required for large organs and whether manufacturing and administration can scale efficiently. Relatedly, SonoThera has reported preclinical expression lasting up to a year after a single treatment, but long-term persistence remains unknown. If repeat dosing is required, the company will need to demonstrate that repeated ultrasound exposure and cycles of vascular permeabilization can be performed safely over time.

SonoThera’s appeal reflects a broader reality: despite decades of innovation, delivery remains genetic medicine’s biggest unsolved problem. The company’s platform is scientifically elegant and potentially transformative, but only clinical data will determine whether ultrasound-mediated gene transfer represents a true breakthrough—or simply the latest attempt to solve one of biotechnology’s most stubborn challenges.

The post Have Microbubbles Burst Through the Barriers of Genetic Medicine Delivery? appeared first on Inside Precision Medicine.

Smartphone-based Intervention for Young Adults With ADHD

Conditions: Attention Deficit/Hyperactivity Disorder(ADHD); Alcohol Use

Interventions: Device: Ecological Momentary Assessment for ADHD and Substance Use – Intervention Group; Device: Ecological Momentary Assessment for ADHD & Substance Use – Control Group

Sponsors: Traci Kennedy; National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Recruiting

Digital Technologies for Children With Hearing Impairments to Support Language Learning: Scoping Review

Background: Children with hearing impairments (HIs) have traditionally faced difficulties with language acquisition due to various factors, such as difficulties in accessing early intervention and therapy, among others. There is an opportunity for digital technology to address this problem; however, how different technologies can facilitate language acquisition, as well as the level of evidence, is not well understood. Objective: This study aimed to explore the types, roles, and outcomes of different digital technologies in supporting language development in children with HIs. Methods: Following Arksey and O’Malley’s framework for conducting a scoping review and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews), we systematically searched 6 online databases from 2014 to September 2024 for relevant studies on the role of digital technologies in supporting language learning among children with HIs (aged <18 years). Results: A total of 45 studies met the inclusion criteria. Mobile apps were the most frequently reported technologies, followed by digital books, extended reality, computer-based programs, and tangible or robotic tools. The most commonly used signed-language apps focus on vocabulary development and visual communication. Spoken language tools were less common but included augmentative and alternative communication (AAC) systems and auditory training apps. The efficacy outcomes of 12 studies included in this review showed that AAC-based apps had stronger effects on expressive language, pragmatic communication skills, and vocabulary development. These outcomes occurred when AAC-based apps were used in structured contexts with a therapist or parent. In contrast, signed language apps often reported narrower, word-level outcomes. Notably, relatively few interventions targeted early spoken language development, despite early childhood being a critical period for language acquisition. In addition, limited attention was given to visual design considerations related to user comfort, cultural relevance, and contextual adaptation. Conclusions: The evidence base reveals 3 structural patterns: the dominance of accessibility-driven mobile technologies; an imbalance between signed and spoken-language interventions, characterized by a greater number of signed-language tools but stronger and more consistent evidence for spoken-language outcomes, particularly in AAC-based interventions; and limited integration of digital technologies across home, school, and clinical contexts. Future research should prioritize the co-design and evaluation of culturally responsive, integrated, developmentally appropriate digital systems that support early spoken-language development and sustained, family-mediated language learning across contexts.

The “steroid olympics” were a circus—and a window into our culture

Testosterone. Methenolone. Nandrolone. Human growth hormone and EPO. Meldonium, modafinil, and mixed amphetamine salts. Clomiphene, anastrozole, levothyroxine, and liothyronine. Patches and capsules, creams and pills. A whole galaxy of steroids, metabolic modulators, and synthetic hormones coursing through the blood of a few dozen swimmers, sprinters, and weightlifters. And millions of dollars up for grabs for athletes who could break world records and usher in the age of superhumanity.

On Sunday, May 24, at a $50 million arena built in a casino parking lot in Las Vegas, I witnessed a libertarian thought experiment come to life. The inaugural Enhanced Games were the first sporting competition where participants were encouraged to take performance-enhancing drugs. The founders say they’re challenging dated sporting norms and helping to build a world where we can all live better, longer lives. Critics say the event is an embarrassment, that it glamorizes the use of dangerous substances and puts lives at risk. 

The open-air venue was compact and decked out in bright blue, with a six-lane, 100-meter track down one side, a four-lane Olympic-length swimming pool down the other, and a weightlifting platform and stage at the front. You could see the golden façade of the Trump Hotel looming in the background. The scene had all the trappings of an NFL game, with the too-loud music and crowd work on the big screen—a “flex cam”  gave the well-muscled an excuse to unveil their biceps. Between events, adverts flashed up for the line of performance products sold by Enhanced, the company behind the event: injectable peptides that supposedly support cellular energy and skin elasticity, daily supplement powders with names like “Stronger” and “Longer.”

James Magnussen, wearing his race goggles and cap, stretches his arms above him

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the Enhanced Games stadium from an elevated viewing angle

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Australian swimmer James Magnussen was the first athlete to sign up with Enhanced but hasn’t broken any world records. He finished last in his two events in Las Vegas.

The day started with the weightlifters, under the blazing sun. But by 4 p.m., only one of them had even attempted a world-record lift. Two had pulled out injured. Some athletes were competing without taking drugs because of the money on offer, and as the competition went on, they had the better of their enhanced peers: Hunter Amstrong, a 25-year-old American swimmer and triple Olympic medalist, won the backstroke by more than a second. In the men’s 100-meter sprint, the non-enhanced US athlete Fred Kerley romped to an easy victory. “Man, they gotta do better than that,” he said of his doped opponents in his post-race interview. “They need to train a little harder, get on that shit a little bit more.”

At the bar, bodybuilders swapped before-and-after pictures and talked about their stacks, and VCs and finance bros traded LinkedIn details. Lukas Lakutsin, a 6-foot-10, 354-pound Russian bodybuilder who was milling around the entrance to the VIP suites, initially told me he didn’t use any performance-enhancing drugs. Except testosterone replacement therapy, of course. But he didn’t think that really counted. “I’m almost 34 years old,” he said. “I need to do this to stay strong.”

close up shot of a man's muscled chest
The “protocol” for Enhanced athletes only includes FDA-approved drugs. While Enhanced’s team might make recommendations, individuals have the final say on what they want to take, if anything.
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Jeremy Sigal, an influencer and author, wore a USA tank top that showed off hugely muscled arms adorned with prison tattoos. He told me he was proudly natural, in both his health and his personal life. “I’ve got an exceptional credit score,” he said. He has written 12 books on marketing and leadership. Later, I looked up his most recent book online. It’s called Simp to Pimp: 10 Steps to Fix Why She’s Not Banging You and lists AI as a coauthor.

What I saw in Las Vegas probably wasn’t the future of sport. But it was a perfect encapsulation of our present moment, as Silicon Valley biohackers, alt-right looksmaxxers, Make America Healthy Again boosters, and longevity-obsessed scientists all vie to remake reality in their own image. For them, the Enhanced Games offered a glimpse of a future where medical advances push the human race to new heights, and where they never have to get old. 

I’ve tracked Enhanced’s journey from a crazy idea scribbled on a napkin to a public company valued at $1.2 billion. Behind the scenes, there have been power struggles, life-changing victories, and moments of total farce. As I recently, finally, watched the games unfold, two questions bounced around my head: Were they right? And what does that mean for the rest of us?


In December 2022, the Australian entrepreneur Aron D’Souza flew to Miami to spend New Year’s Eve with his friend and mentor Peter Thiel. A decade earlier, D’Souza had helped Thiel orchestrate the lawsuit that bankrupted Gawker—a stunning revenge against the gossipy New York media blog that had outed him as gay. Now he was armed with a disruptive idea that he thought Thiel, the billionaire cofounder of PayPal and Palantir, would love. It was inspired by the buff bodies he’d been seeing at the gym, highlighting a disconnect between a workout culture where the use of steroids was an open secret and a sporting establishment where it was, at least on paper, an inviolable taboo.

His initial pitch was provocative and confrontational: a grand sporting event to rival the Olympic Games, where competitors could take any substance they wanted—their body, their choice. The first time I met D’Souza, in the spring of 2024, he had founded the company and attracted some initial investment but seemed obsessed with taking on the fat cats at the International Olympic Committee and reinventing sports (even though he didn’t seem to be a huge sports fan himself). On Enhanced’s Discord server, I found a folder full of memes with names like IOC Clowns.jpg. The whole thing felt very unserious.

That would change. 

D’Souza told me that Thiel had previously introduced him to Christian Angermayer, a German biotech billionaire, who would come onboard at Enhanced. He’s funded clinical trials of psychedelics through his company Atai Life Sciences and is helping bring them into the medical mainstream as a treatment for depression and anxiety. Angermayer says he spotted an opportunity to do the same thing for steroids. What he really wants is to redefine medicine, he told me. Its focus has already changed from treating disease to trying to prevent it; actively enhancing people’s health, he says, is just the next logical step.

By early 2024, Angermayer had brought his own people into key roles. The team included Michael Sagner, an anti-aging expert and private doctor who works with many of Hollywood’s leading men, and Max Martin, who has the jawline and cheekbones of an Instagram looksmaxxing influencer and the boundless enthusiasm of a puppy. (He started his own enhancement program a few years ago, when he was just 27.) Sagner would head up Enhanced’s medical commission, making sure the games were safe for the athletes. It was Martin’s job to make sure they actually happened. 

a group of men in business suits posing at the desk of the NYSE
In early May, Enhanced began trading on the New York Stock Exchange with an initial value of $1.2 billion. Christian Angermayer stands far right with Max Martin to his left (front row), and Aron D’Souza next to him.
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Tensions sparked as D’Souza’s freewheeling style clashed with the more sensible image that Sagner and others were now keen to present. “It was not just his personality and his abrasive way of talking,” Sagner told me recently. “Even when he was briefed on a scientific fact, he would just completely ignore it and say something outrageous.”

But the more outrageous D’Souza got, the more attention his idea received. In February 2024, James Magnussen, a retired Australian swimmer, became the organization’s first official athlete, and Enhanced promised to pay a million dollars to him, or anyone else, who could break the world record in the 50-meter freestyle.

The notion of a “steroid olympics,” as many have dubbed the Enhanced Games, had been kicking around for decades—for instance, in a Wired article from the early 2000s and an SNL sketch from the 1980s. Two things helped finally make the Enhanced Games a reality. First, in November 2024, Donald Trump was again elected president of the United States. The Biden administration had been actively hostile to the games, but the founders saw a more receptive political environment in Trump world. Not long after the election, Enhanced announced a new tranche of funding led by 1789 Capital, a venture capital firm whose partners include Donald Trump Jr.

And second, in February 2025, an enhanced swimmer finished the 50-meter freestyle faster than anyone in human history. It wasn’t Magnussen, though. He had been injecting himself with testosterone to grow muscle, plus a cocktail of peptides that aimed to speed up recovery—but his journey hadn’t quite worked the way he’d planned.

A combination of reputational issues (no pools wanted to host his training) and physical complications (the regimen did help him get stronger, but he packed on so much muscle that it slowed him down in the water) meant he watched from the sidelines as the Bulgarian-Greek swimmer Kristian Gkolomeev—who had finished fifth at the Paris Olympics in 2024—came in two-hundredths of a second under the record and won a million-dollar payout from Enhanced. The idea has always been that breaking records would effectively prove the legitimacy of this enhancement project: Look what we can do now

Over the shoulders of Shane Ryan (left) and James Magnussen (right) as they sit and talk poolside
Enhanced swimmers like Magnussen (right) wore supersuits to compete, though they’ve been banned by World Aquatics since 2010.
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Gkolomeev, though, had a different motivation for participating: “One successful year in the Enhanced Games and I could make as much as I would in almost 10 careers,” he told me not long after setting the new record (notably, wearing a kind of “supersuit” that’s been banned by World Aquatics since 2010). Enhanced was paying its athletes a regular salary, on top of any potential bonus. And he had a young family to support and feared that the four-year stretch to the next Olympics would be long and precarious. 

In May 2025, with a world record in the bag and a friendly administration in the White House, Enhanced was ready to announce its first games: They’d take place in May 2026 at Resorts World in Las Vegas. 

At the same time, D’Souza made another big reveal: Enhanced Performance Products, a line of supplements available for a monthly subscription. The Enhanced Games now seemed less like a sporting event and more like a loss leader for selling testosterone injections, GLP-1s, or a range of peptides that are claimed, with little scientific evidence, to improve sleep or skin elasticity. Perhaps it was all a brilliantly executed marketing stunt.

“The games themselves now seem almost secondary to what appears to be an online marketplace for hormones, peptides, and other performance-enhancing compounds,” says Astrid Kristine Bjørnebekk, a steroids expert at Oslo University Hospital. “From my perspective, this significantly changes the nature of the project. It is one thing to organize a closed sporting event built around controversial principles, but openly marketing and commercializing substances such as testosterone, hGH, GLP-1 drugs, peptides, and other pharmacological compounds is something else entirely.”


As the games approached, more athletes joined. Some were genuinely elite. The US sprinter Kerley—who is serving a two-year ban for missing three drug tests—had won silver in the 100 meters in the Tokyo Olympics and a bronze in Paris. Ben Proud, a British swimmer, had won silver at the Paris Olympics and dozens of medals at world and European championships and the Commonwealth Games. He had been mulling over joining the Enhanced Games ever since the idea first emerged, but the tipping point seemed to come when Gkolomeev’s record was announced. 

Some participants, like Magnussen and another swimmer, Megan Romano, had been tempted out of retirement. Romano hadn’t swum competitively for almost a decade. Others were at the start of their careers but ready to cash in their chips and bid goodbye to Olympic dreams for a potential six-figure payday. The $1 million payouts were reserved for records in the two flagship events—the 50-meter freestyle and the 100-meter sprint—but winning any other event would mean a prize of $250,000, with an additional $250,000 bonus for setting a world record.

Athletes would get paid even if they just showed up and finished last—as much as $50,000. This is all on top of the salaries that stretched into six figures in some cases, making the payout from the games more than many athletes make in a year.

Sport’s governing bodies reacted to each new athlete announcement with fury. World Aquatics threatened to ban for life any athlete who participated in the games, even if they didn’t take any drugs. Enhanced responded with an $800 million antitrust lawsuit against the global swimming organization, the World Anti-Doping Agency, and USA Swimming, alleging misuse of monopoly power.

Emmanuel Matadi (left) and Fred Kerley (right) running on the track
American Fred Kerley (right) won the 100-meter sprint without performance enhancing drugs.
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In November 2025, a court in New York dismissed the case. Three days later, D’Souza, the mind behind the entire project, was out. A notice on Enhanced’s website said he had “transitioned out of the company’s day-to-day operations.” Martin would take over as CEO. “The investors basically said we need someone a bit more serious,” Sagner told me. In conversations, execs at Enhanced played down any suggestion of a feud—D’Souza was simply the ideas man, with little interest in the day-to-day dreariness of actually running a company. (Enhanced spokesperson Chris Jones wrote in a statement that “there is no tension between Aron and Enhanced that I’m aware of.” D’Souza did not respond to a request for comment.)

I got the sense that Enhanced, in its new iteration as a pharmaceutical subscription company, was almost embarrassed by the games. When I visited enhanced.com a couple of months before the event, they had been relegated to a sub-heading on the home page. D’Souza’s showmanship had helped get attention for what was becoming a run-of-the-mill telehealth business like Hims & Hers—albeit one well timed to take advantage of a shifting regulatory landscape around peptides, which Robert F. Kennedy Jr., the US secretary of health and human services, has been pushing the FDA to approve despite a lack of evidence that they’re actually effective. 

Sagner is still loosely involved with Enhanced, but he says the medical commission was not consulted before it launched its line of performance products. (Jones did not respond to a question regarding this claim.) Sagner is scathing about what he sees as the “hype” around peptides. “I can tell you already, peptides do nothing,” he says—with the exception of human growth hormone and GLP-1. “The peptides that people use, black-market peptides that they buy online—they do nothing. We have tested them; 80% of them contain nothing. It’s saline solution, salt water, and some of them are contaminated.”


At the end of January 2026, a group of around 40 swimmers, weightlifters, and sprinters arrived in Abu Dhabi to start their individualized enhancement “protocol,” as Enhanced calls it. Officially, they would be taking part in a clinical trial, pending approval by the Abu Dhabi government and overseen by Guido Pieles, a Qatar-based cardiologist who has taken over the reins of Enhanced’s medical commission from Sagner.

Canadian weightlifter Boady Santavy strains to lift a barbell which is currently level with his hips
The day started with the weightlifters, but by late afternoon, only one of them had even attempted a world-record lift.
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They would be allowed to choose only from a menu  of specific FDA-approved drugs. Pieles broke them down into five categories: testosterone variants and growth hormones, which can both boost muscle mass; metabolic modulators that can tweak how the body burns fat; stimulants like Adderall to improve focus; and EPO, which can increase the amount of oxygen the blood is able to carry. While Enhanced’s team might recommend particular things, the athletes would have the final say on what they wanted to take, if anything. (As Oslo University’s Bjørnebekk points out, FDA approval “does not mean the substances are inherently safe, particularly not when used for enhancement purposes.”) 

There would be regular blood tests, heart scans, and brain scans and access to the best training facilities money could buy. Pieles and others say the clinical trial will help inform the line of supplements Enhanced is offering consumers, but there’s actually very little overlap between the drugs the athletes were taking and the substances the company is currently selling.  

Not long after they arrived in the Middle East, the athletes were awakened by the sound of explosions at a military base near their hotel. The US and Israel had struck Iran, and the Iranian regime was responding by peppering the region with missiles. “It wasn’t a pleasant situation,” says Andrii Govorov, the world record holder in the 50-meter butterfly, who a year earlier had become one of the first swimmers to join Enhanced. Govorov had some experience in these matters—back in Ukraine, he’d had a business selling cars that helped fund his swimming career, but he’d lost it after the Russian invasion.

Cody Miller standing by the pool in profile

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attendees sitting in the bleachers

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close-up of the calloused and powdered hands of a weightlifter with remnants and marks left by the tape.

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Swimming, sprinting, and weightlifting were the focus of the first Enhanced Games but in many ways the sports were the sideshow.

The conflict exacerbated delays in getting approval for the clinical trial and sourcing the drugs, and as a result, what was supposed to be a 12-week enhancement protocol got cut down to eight weeks. The athletes didn’t actually start taking the drugs until toward the end of March. For those who had always been clean, that represented the irreversible crossing of a line. “The first injection was very emotional, very tricky to navigate,” says Proud. “For me, that was the day I went from the Ben Proud that I always knew to a new person.”

Proud was joined in the enhancement program by his girlfriend, Emily Barclay, who had swum at college level without ever appearing at a major international event; she was working as a swimming teacher at a school in England. After that first injection, they left Abu Dhabi and spent a few days in Dubai as they reckoned with what they had done. “I just couldn’t be around the team,” Proud says. “I wanted to be by myself and feel those feelings, because it is a big deal to make that step, and I felt it.”

Those feelings were soon forgotten, though, as the drugs kicked in. Proud says he had incredible energy, and a drive to train that he hadn’t experienced before. Shania Collins, an American sprinter, says she had “increased strength, increased recovery, and increased mental clarity at practice.” Sagner and several athletes admitted there were some side effects: acne and some swelling around the joints; unwanted hair growth for the women, unwanted hair loss for the men.

close-up of runner Tristan Evelyn in profile
Like Kerley, sprinter Tristan Evelyn from Barbados competed without taking any drugs. She too won big in Vegas, besting her Enhanced peers in two events.
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One thing the athletes wouldn’t talk about, though, is what drugs they were actually taking. They all had the same reason: not wanting to encourage copycats who might take enhancements without a doctor on hand to tailor programs to their needs. 

The one exception was Thor Björnsson (testosterone, deca-durabolin, anastrozole, halotestin), a hulking Icelandic deadlifter and former World’s Strongest Man who played The Mountain on Game of Thrones. Björnsson first heard about the games on Joe Rogan’s podcast and was immediately interested. The rules for strongman competitions are somewhat less stringent than those for Olympic sports, though, and he actually had to reduce the number of substances he was taking to meet Enhanced’s FDA requirements.

Hafþór Júlíus Björnsson holding a barbell at mid thigh
Icelandic strongman Thor Björnsson actually had to reduce the number of substances he was taking to meet Enhanced’s FDA requirements.
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There is some debate over how much doping some of the athletes were actually doing. In a conversation last year, Gkolomeev told me he’d only really been “microdosing,” and he confirmed that his 2026 enhancement program was largely the same. Sagner says the doses the athletes were taking were a fraction of the amounts some Olympic athletes had been caught using in the past. I heard that a few athletes had decided not to take steroids or growth hormones and were only using modafinil, a narcolepsy medication that’s thought to improve focus.

The day before the games, I asked Angermayer what it would mean if clean athletes like Kerley and Armstrong won their events—what impact it would have on Enhanced’s business model of using sports as a showcase for its line of performance products if the people using those products didn’t actually win anything. “I know what you mean, but mostly our business model is headlines to drive attention,” he said. “Any debate is good for us.” 

In early May, Enhanced began trading on the New York Stock Exchange with an initial value of $1.2 billion.


That same week, it was finally go time. The athletes and coaches left Abu Dhabi and flew to Las Vegas, where they were put up in five-star luxury at the Conrad hotel inside Resorts World while they made their final preparations. 

When I got there a few weeks later, toward the end of May, I found it jarring to see these hulking presences walking around the casino in their Enhanced sportswear, weaving their way through packs of half-drunk tourists, with slot machines flashing in the background and cigarette smoke hanging in the air. I had expected the games to be a bigger deal within the city itself, but they were just one of a thousand things happening in Vegas that weekend—drowned out by a series of BTS shows at the football stadium, by the Golden Knights in the NHL playoffs, by No Doubt’s residency at the Sphere.

If this was a sporting earthquake, it was one whose tremors were mainly being felt online, where bodybuilding influencers livestreamed to their followers on Kick and Twitch, and where thousands watched on YouTube and Rumble. (D’Souza once told me he’d had “every major sports broadcaster” vying for the rights; in the end, Enhanced struck an exclusive streaming deal with Roku in the US.) 

A group of well-heeled guests in the VIP area face left to pose for a photographer
No tickets were sold, so the crowd was a mix of invited guests, investors, and influencers, some of whom had reportedly been flown in on a chartered jet.
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On the morning of the games, Enhanced held a medical symposium that was supposed to provide a taste of the company’s long-term objectives. The first speaker was Bryan Johnson, the longevity-obsessed entrepreneur famous for plowing his personal fortune into wild attempts to reverse his aging: receiving transfusions of his teenage son’s plasma, measuring his nighttime erections, taking more than 100 supplement pills a day. He spends $2 million per year on all this, but he looked pale and vampiric as he delivered the slightly off-brand message that, really, the most important thing was getting a good night’s sleep: “You don’t need to chase IV infusions; you don’t need to chase crystals. You don’t really need to do much of anything.”

At 2 p.m., I took two escalators from the conference room down to the arena, where spectators were filtering in. Though it had cost $50 million, it had been constructed in just three and a half weeks, and it showed; on the media tour the previous day, there were still loose screws on the floor of the bleachers. 

There were a few thousand seats in an open grandstand down one side, and two rows of VIP suites on the other. No tickets were sold, so it was a strange mix of invited guests, investors, and influencers, some of whom had reportedly been flown in from Los Angeles on a chartered jet. The rapper Tyga was the biggest name to grace the “blue carpet,” although I did also spot Fabio James, a Michael Jackson look-alike who has had surgery to make the resemblance even stronger. Rumors swirled that Peter Thiel might show up; they proved unfounded.

looking up at a balcony of excited attendees including a person at center who is dressed to resemble Michael Jackson.
In attendance was Fabio James, a Michael Jackson look-alike who has had surgery to make the resemblance even stronger.
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A few hours before the doors opened, journalists got a stern message from the organizers trying to bar us from interviewing guests. Still, I talked to a Cambridge professor who wanted to use Enhanced as a case study in innovation for his MBA students, a retired Brazilian swimmer with the Olympic rings tattooed on his forearm, and a biotech investor wearing an Enron hat. Proud’s family and friends were sheltered from the blazing sun in the shadow of the big screen. 

D’Souza was nowhere to be seen. Nor was he really mentioned at all—not during the introductory press conference, where Martin was introduced as the “founder of the Enhanced Games,” nor during the event itself, where the athletes showered praise on Angermayer and Martin. But the tens of millions D’Souza had banked from the stock listing likely softened any blow. Plus, he’s already moved on to his next provocative venture: an AI-powered arbitration platform designed to scrutinize the work of journalists on behalf of the rich and powerful.


As the sun set behind the hills, casting the arena in soft gold light, there were still no world records. That and the wins for clean athletes seemed to put the whole Enhanced project in jeopardy—the knives were already being sharpened online. I asked the organizers whether this threatened the legitimacy of the project. 

A wet Marius Kusch lays on the ground grimacing as though his eyes are stinging
German swimmer Marius Kusch was among the dozen or so athletes who hit personal bests in Vegas.
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“Our response is that enhancements help athletes improve and, in some cases, break records. And yes, some non-enhanced athletes also won—because talent and ability also matter,” Enhanced’s Jones emailed last week. “Breaking world records is incredibly hard as the margin is infinitesimal, as we witnessed. Ignoring that 13 athletes some of whom 10 years later broke personal bests is disingenuous and selective reporting.” 

Megan Romano was one of them, swimming faster in the 50-meter freestyle at 35 than she had at 22. And Emily Barclay knocked two seconds off her fastest time in the 100-meter freestyle, coming in second in that event and winning the 50-meter freestyle; she went home with a check for $375,000. “No one’s ever heard of this girl,” said Enhanced swim coach Brett Hawke afterwards. “She’s retired; she’s a nobody. She comes out tonight and swims a time that would have got a bronze medal in Paris.” For all the talk of “superhumanity” and pushing the boundaries of performance, making a 35-year-old feel 22 again is probably the perfect marketing message for the products Enhanced wants to sell. 

Megan Romano stands on the winners area, holding aloft her trophy while Christian Angermeyer and other Enhanced Game participants clap for her.
Angermayer cheers on swimmer Megan Romano, who swam faster in the 50-meter freestyle at 35 than she did at 22.
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Enhanced’s executives say people should take enhancements only with medical supervision, but price could be a barrier to heeding that advice. The battery of health tests the company was giving its athletes in the run-up to the games cost $25,000 per athlete per month. The drugs themselves start at $75 a month and go up toward $200. While Jones says the products “are in line with industry price points,” there were almost certainly people watching who saw the drug-altered physiques of athletes like Gkolomeev or Magnussen and decided to find cheaper, less safe alternatives on unlicensed websites.

“Many of these substances require medical supervision and prescriptions, and several are associated with potentially serious long-term health consequences,” says Bjørnebekk. “Presenting them in this lifestyle-oriented and commercial format risks normalizing use while downplaying the medical risks and uncertainties.”

Kristian Gkolomeev with his arm raised
Although his world record-breaking time won’t stand as the official record, swimmer Kristian Gkolomeev will walk away from the Enhanced Games with a million dollar prize in the 50-meter freestyle.
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Before the night was over,  Gkolomeev again had the chance to right the Enhanced ship. The final event of the night was the men’s 50-meter freestyle swim. His 2025 time had been surpassed by the Australian swimmer Cam McEvoy (without a supersuit) at the China Swimming Open a couple of months before, so he needed to lose another two-hundredths of a second to beat the new record of 20.88 seconds. 

Gkolomeev was wearing the same supersuit he’d used the previous year, and he’d shaved off his mustache for a little extra streamlining. But he messed up his start—doing four kicks instead of five—and was trailing Proud at the halfway mark. His long arms levered him forward, though, and he reached the wall in 20.81. The spectators were on their feet as “WORLD RECORD” flashed red on the big screen. Martin vaulted over the glass partition from the VIP suites, beaming, to embrace Gkolomeev. They had their record.

Or did they? Online, people shared screenshots from the video feed, purporting to show that the clock had stopped before Gkolomeev’s hand touched the pressure sensor at the end of the pool. An Enhanced spokesperson gave a statement to the Guardian dismissing this as “completely unfounded internet drivel.” But hey—live by the sword, die by the sword. It’s quite possible Gkolomeev didn’t care. He had another million in the bank. 

It remains to be seen if it’ll work out so well for the other athletes. Enhanced organizers recently announced a prize of $10 million for anyone who can break Usain Bolt’s 100-meter world record in 2027. They are adamant that the games will happen again next year. If they don’t, dozens of sporting careers will be over, and the athletes will join the long list of victims of VC-backed disruption.

My personal prediction is that Enhanced will pivot away from the risk and uncertainty of a flagship event—the company’s valuation plunged by almost $800 million when markets opened after what was perceived as an underwhelming set of results in Vegas. I expect you’ll see individual stunts and challenges, tightly controlled and filmed for virality and probably featuring your favorite YouTubers—think Björnsson bench-pressing Jake Paul.

D’Souza’s initial idea has served its purpose by capturing the world’s attention. But that won’t necessarily translate into success either. Though the company has had plenty of hype over the last 12 months, SEC filings published as part of its stock exchange listing reveal that it generated only $2,755 in revenue from its enhancements business in the first three months of 2026. Would what happened in Vegas be enough to juice sales?

Max Martin with his mouth open wide to cheer from the VIP stands
Martin, Enhanced’s CEO, cheers on athletes from the stands. Company leadership insists the competition will take place again next year.
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As the athletes gathered on the stage to receive their prizes, Martin took the microphone and addressed the crowd. “Enhanced is culture,” he said. “We are at the pulse of where the world is going.” On this, at least, he’s probably right. Testosterone replacement therapy is rapidly moving into the mainstream, and while the science may still not be there on peptides, they have certainly exploded in popularity in the two years since Enhanced launched. And there are undoubtedly more substances yet to be discovered that will promise to improve people’s lives, or at least hold their appearance in stasis. The enhanced age is upon us, whether we want it or not. 

As the fireworks went off and the Killers closed out the event with “When You Were Young” (“Congratulations to … whoever deserves it,” said frontman Brandon Flowers), I wondered what that might mean for us mere mortals. Invoking Hunter S. Thompson’s Fear and Loathing in Las Vegas in a story about drugs and Las Vegas may be a cliché, but it struck me that fear played a big part in all of this. Fear of missing out. Fear of getting old. Fear of never making a dime on your life’s pursuit. Fear of waking up one morning and seeing your flabby, sunken face in the mirror while everyone around you shines and grins and thrives with white-toothed, alien smiles.

Megan Romano in cap and goggles with her dry robe stands backlit by pink event lighting and stage fog
Before joining Enhanced, Romano had not swum competitively in almost a decade.
SAEED RAHBARAN

But the big problem with Enhanced’s vision of superhumanity is the question of who gets to join in. “People will be able to enhance themselves if they have enough money,” Sagner had told me the night before the games. The rest of us, I fear, will just have to function as normal human beings.

Amit Katwala is a journalist and author covering science, culture, and where they collide. His latest book is Tremors in the Blood: Murder, Obsession and the Birth of the Lie Detector. He is based in London.