There’s a trend you may have noticed recently.
Perhaps through Netflix’s documentary about Bryan Johnson. Perhaps through the growing number of people online sharing their blood tests, sleep scores, and elaborate morning routines.
Longevity.
At one end, picture a billionaire having young plasma infused into his veins, hoping to negotiate a few more years with death.
At the other end, someone is trying to stop smoking, sleep properly, and still be able to climb the stairs at eighty.
One wants to rewrite the rules of human existence. The other would settle for keeping their knees.
Both are expressions of the same desire: more time, preferably in a body that still works.
But beyond the expensive experiments and the slightly absurd spectacle, there is a change in demand that deserves our attention as investors.
This is more than an emerging market.
By 2030, the broader longevity economy could generate $8 trillion in annual revenue, according to UBS, a scale comparable to the $9.8 trillion the world spent on healthcare in 2022, according to the WHO.
What interests me most is the shift taking place within healthcare: more people paying to preserve their health before they feel sick.
Healthcare is finding more customers among people who do not yet feel sick.
I discussed this shift in an earlier edition of Macro Notes.
For decades, a substantial part of the healthcare business has revolved around what goes wrong with us. A disease appears. A diagnosis follows. Treatment begins.
A growing consumer segment now sells something earlier in that story: information about what might go wrong, tools to monitor it, and interventions intended to reduce the risk.
The body becomes something you maintain before the engine starts making strange noises.
Prevention itself has existed for a long time. What is changing is the accessibility of the tools, the products being developed, and the business models bringing them to consumers.
The commercial relationship can begin before symptoms appear and continue for years.
And there is a considerable problem to solve.
A study published in JAMA Network Open found that, between 2000 and 2019, global life expectancy increased by 6.5 years, while health-adjusted life expectancy increased by 5.4 years. The gap between them widened from 8.5 to 9.6 years.
We have become better at extending the journey. Keeping the vehicle in good condition has not progressed quite as quickly.
For investors, this raises a more interesting question than whether someone will eventually invent an immortality pill.
How many “Ozempic moments” could occur along the way?
I think longevity could produce several of them, each addressing a specific reason our bodies deteriorate: metabolic disease, cardiovascular risk, or a cancer discovered too late.
An “Ozempic moment” happens when a product makes a major health problem substantially more manageable—and opens a much larger commercial opportunity around it.
A company does not need to defeat ageing in its entirety to build a very large business.
It can make meaningful progress against one of the problems that shortens our lives or makes those years harder to live.
Obesity already shows what that can look like.
The WHO estimated that 890 million adults were living with obesity in 2022.
Regular readers will remember how extensively we covered the opportunity around Novo Nordisk’s Ozempic and Wegovy, and Lilly’s Mounjaro and Zepbound.
The implications extend beyond weight loss.
In the SURMOUNT-1 trial, participants with obesity and prediabetes received tirzepatide or placebo for 176 weeks. Type 2 diabetes developed in 1.3% of participants receiving tirzepatide, compared with 13.3% receiving placebo during that treatment period.
That result concerns a defined population and period of treatment. It illustrates how treating an existing condition can also reduce progression to another disease.
Now consider a few other possibilities.
A twice-yearly treatment for uncontrolled blood pressure.
According to the WHO, approximately 1.4 billion adults aged thirty to seventy-nine had hypertension in 2024. Only 23% had it under control.
Alnylam and Roche are developing zilebesiran, an investigational treatment designed for dosing twice a year. Their Phase III ZENITH programme is testing whether it can reduce cardiovascular events in patients with uncontrolled hypertension and established cardiovascular disease or high cardiovascular risk.
The commercial possibility is straightforward: sustained control between infrequent injections could offer a useful option for some patients who remain poorly controlled on existing medicines.
It still needs to demonstrate the required clinical benefit, safety, and economic value. But this is the kind of specific product that could change how a large health problem is managed.
A treatment targeting an inherited cardiovascular risk.
Elevated lipoprotein(a), or Lp(a), affects approximately one in five people worldwide. It is largely determined by genetics and can increase cardiovascular risk.
Lilly’s experimental lepodisiran reduced Lp(a) by an average of approximately 94% over days sixty to 180 at the highest tested dose in its Phase II study.
The important next step is proving that lowering the marker produces better outcomes.
That distinction has already mattered. In September 2026, Novartis reported that pelacarsen lowered Lp(a) but failed to meet its Phase III trial’s primary endpoint for reducing cardiovascular events.
A promising biological result can still leave the investment thesis unproven.
That is precisely why this opportunity requires research and selectivity.
A blood test that makes cancer screening easier to complete.
Guardant Health’s Shield blood test received FDA approval in 2024 for colorectal cancer screening in eligible adults at average risk.
In the study supporting approval, it detected approximately 83% of colorectal cancers, but only around 13% of advanced precancerous growths. Positive results require follow-up colonoscopy, and its effect on reducing cancer deaths remains an important question.
The potential commercial breakthrough is making useful screening easier to integrate into routine care, so more eligible people complete it.
A screening business can serve people before a cancer diagnosis. The test, the laboratory processing it, and the clinical pathway around it can each become part of that opportunity.
These examples are at different stages. Their commercial markets depend on clinical eligibility, pricing, reimbursement, and adoption.
But they make the investment question much more concrete.
Longevity could have several “Ozempic moments”: products that help people avoid a specific complication, identify a disease earlier, or manage a major risk more effectively.
Each could create a different set of winners.
Meanwhile, consumers are already paying for the information and monitoring that can bring them into this system:
Oura reported five million paying members at June 30, 2026, twice the number a year earlier. Membership revenue grew 121% to $240.5 million over the nine months ended June 30.
Function Health reduced its annual membership price to $365 in November 2025, including more than 160 laboratory tests per year.
Apple and Quest announced a $119 laboratory panel covering more than fifty biomarkers, planned for purchase through Apple Health later in 2026.
For the companies serving this demand, growth can come from more people paying to understand their health and trying to preserve it.
Wanting to stay alive is an unusually persistent source of demand.
Our job at Macro Notes is to identify the businesses best positioned to turn that demand into durable profits.
Over the past three years, we have developed a research approach combining global macro analysis with top-down stock selection.
We start with a structural change. We follow the spending through the industries it affects. Then we look for the companies with the products, distribution, infrastructure, or competitive advantages to capture it.
Our earlier thesis tracking includes approximately +300% for the Ozempic theme and +500% for fibre optics.
These are selected historical examples from our research, and past performance does not guarantee future results.
The work behind those themes follows the same logic: identify a major change, understand what it requires, and investigate who can become essential to delivering it.
We are looking for the ingredients that could create the next generation of mega-cap businesses: a large market, a product capable of widespread adoption, a competitive position that can endure, and economics that improve as the company grows.
Some opportunities could create new leaders. Others could give established companies another substantial source of growth.
Identifying them while the evidence is still developing is the difficult part.
The billionaire with the plasma gets the headlines.
The laboratory processing the tests, the company manufacturing the sensors, and the business supplying an essential product may have a much more interesting relationship with the money.
In the premium section of this edition, we present the first building blocks of our longevity research.
You will find:
Our initial watchlist of four listed companies, focused on testing and monitoring infrastructure with established commercial businesses.
The two businesses we would investigate first, and the reasons for that research priority.
Their potential competitive advantages, financial exposure, and valuation questions, including what could prevent growing demand from becoming attractive shareholder returns.
The upcoming results and operating signals we will monitor to test our assumptions.
Part One establishes the watchlist.
In subsequent Premium editions, we will investigate the strongest candidates in greater depth, examine additional product categories, and develop the financial and valuation models.
We will also build a dedicated index around the thesis, with defined constituents and weights, so readers can follow its performance, exposure, and concentration over time.
As the research develops, we will document any positions we decide to initiate, the reasoning behind them, and the evidence that changes our assessment.
Today, we begin with the companies that deserve a closer look. The research that follows will determine which deserve our capital.
Join Macro Notes Premium to read the initial watchlist and follow the thesis as we build it.