The Hope Trade

Meet Kenneth Scott.

He is 82 years old, a former Air Force officer and real estate developer, sharp and restless and absolutely unwilling to go gently. He lives now in a mountain town in Panama, in a villa off a dirt road, where dozens of supplement bottles line his kitchen counter and an elaborate rainwater collection system runs off the roof. Every few months he drives to a clinic in Panama City, where a nurse infuses his blood with stem cells and a doctor passes a laser over his neck to guide those cells to where they're "needed most."

He pays $10,000 for the procedure. The clinical evidence for what he's receiving ranges from nonexistent to preliminary. He almost certainly knows this.

Scott is not an outlier. In my line of work, I encounter people like him regularly. Different in the particulars, recognizable in the pattern. Successful. Clear-eyed about the science. Deeply, urgently aware that time is the one resource they cannot buy more of.

And they are constitutionally incapable of accepting that without doing something about it.

These are people who have built companies, navigated crises, outlasted competitors. They have spent decades in environments that rewarded exactly the qualities now driving them toward unproven gene therapies and experimental peptides in offshore clinics: the refusal to accept unfavorable outcomes, the belief that the right information plus sufficient resources plus relentless action can solve almost any problem. 

They are scientifically literate enough to have read the animal research and to understand exactly how far it is from a proven therapy in humans. That no one has run the kind of controlled human trial they'd want to see, and that no one is likely to run it before they're dead. They are making a calculated bet with open eyes and disposable capital, the same way they've made every other bet that built their lives.

Mortality is not almost any problem. But the logic that says I'll be the guinea pig, the downside is tolerable, and I refuse to sit on the sideline waiting for permission is the logic that built everything they have. It is not stupid. It may even be admirable.

I don't know if the treatments work. Do the stem cells do what the brochure says and does the laser do what the doctor claims? Those are real questions, and the answers are largely discouraging. But what I keep returning to is the transaction underneath the transaction. What is actually being purchased, at $10,000 or $25,000 or $200,000 a round, in clinics from Panama to Próspera to the Bahamas?

I think it's something more human than follistatin.

I think it's the right to keep trying.

There is a concept in behavioral economics called the illusion of control. It describes our tendency to believe we can influence outcomes that are, in fact, determined by chance. We roll dice more carefully when we need a high number. We choose our own lottery numbers rather than accepting random ones. We feel, despite all evidence, that effort and intention bend probability.

The illusion of control is usually framed as a cognitive error. A bias to be corrected.

But spend enough time with people who have built genuinely remarkable lives, and you start to wonder whether the illusion, in their case, was ever entirely an illusion. These are people for whom relentless effort and careful preparation actually did bend probability, repeatedly, over decades. The bias got reinforced because it kept producing results. The feedback loop ran for thirty years.

There is long-standing scientific work that is at once hopeful and disillusioning: the overestimation of personal control is structural to psychological wellbeing. The non-depressed mind is, in a precise and measurable sense, wrong about its own efficacy, and that wrongness is adaptive. It sustains action in the face of uncertain outcomes. The person who sees contingencies clearly is less likely to keep going. The person who overestimates their influence keeps going, and the going itself sometimes produces the result. The illusion wasn't a flaw in the machine. For thirty years, it was the engine.

Then they turned seventy. Or they watched a friend deteriorate. Or they hauled a carry-on through JFK and had to stop, twice, to catch their breath.

And the loop started feeding back something different.

What the longevity industry grasped before almost anyone else is that this population doesn’t need hope in the passive sense. They don’t want to be comforted. They want a protocol. They want a dashboard. They want a network of fellow optimizers who are reading the same papers and comparing notes on the same interventions. They want, above all, to still be in the game.

The treatments are almost secondary. What’s being sold is the architecture of engagement. The feeling that you are still the kind of person who acts, who researches, who refuses, who flies to Panama if that’s what it takes.

Scott runs every day now. He moved to a new country. He restructured his entire life around a practice, found community, took on a role as a speaker and advisor. His days have shape and direction and the particular satisfaction of someone who believes they are working on something important.

These are not trivial outcomes. They map closely onto the variables that longitudinal research most consistently associates with extended healthspan: purpose, community, physical activity, a sense of agency over one’s life.

The follistatin may be doing nothing. The stem cells may not exist. The laser is almost certainly theater.

And Kenneth Scott may genuinely be doing better than his contemporaries.

This is where the story gets uncomfortable.

If the mechanism is fraudulent but the behavioral change is real, we are forced to ask a question that neither the longevity industry’s critics nor its enthusiasts want to sit with: what exactly are we evaluating when we evaluate these treatments? The molecule? The ritual? The community? The restructured life?

And if the answer is all of the above, always, inseparably, then what does it mean to offer something honest in this space?

There is a harder question underneath even that one.

Scott's wife Christine also receives treatments through the Panama clinic. Unlike her husband, she is not a speaker at longevity conferences or a senior business advisor. She is, by the account of the journalist who spent time with them, struggling with short-term memory loss.

Scott measures out her peptide doses in syringes in their kitchen. The vials are labeled Not for Human Use.

He believes it is helping her mood. He believes it is improving her well-being. He brings to her care the same thoroughness, the same refusal to stand idle, the same fierce love.

I recognize this. Anyone who has watched someone they love decline will recognize it. The need to do something when the situation calls for something you don't know how to give. The terror that sitting still means giving up. The way action, any action, becomes a container for love that has nowhere else to go.

But there is a version of this story that people in Scott's position rarely get to hear, because no one around them will say it. The optimizer's greatest gift, the will that builds and solves and refuses, can become a kind of interference when what the moment requires is presence rather than problem-solving. When the person you love needs you to sit with them in the uncertainty rather than try to manage it away on their behalf.

This is not a judgment of Kenneth Scott. It is a warning to everyone who recognizes themselves in him.

There is a body of research, largely from Johns Hopkins and NYU, on what happens when patients facing life-threatening cancer receive psilocybin-assisted therapy. The findings reshuffled assumptions across the field of palliative care.

The patients who found peace had something in common, and it surprised the researchers. At some point they stopped trying to manage the experience and let something larger than their will take over.

The clinical language for this is ego dissolution. What patients described afterward was simpler: it felt like coming home. Like everything was okay, even the dying. Like their life had meaning they hadn’t been able to see while they were so busy defending it.

This is not an argument for surrender. Many of these patients had fought their diagnoses with everything they had. But at a certain point something shifted. The self that had organized every resource toward survival loosened its grip, and what remained underneath all that effort turned out to be enough.

I think about Kenneth Scott in that examination room, head tilted back, the laser moving across his neck. I think about the genuine improvements he reports, the daily runs, the restructured life, the community of fellow optimizers who keep each other in the game. I think about the real and documented relationship between purpose and longevity, between agency and health, between the will to keep going and the actual length of a life.

And then I think about Christine.

The research keeps returning to the same finding: the people who made peace with what they couldn't control were not the ones who found a better protocol. They were the ones who discovered, usually to their own surprise, that they were still there when they stopped.

Kenneth Scott is not wrong to try. The trying may be the bravest thing about him. But somewhere beneath the peptides and the gene therapies and the rainwater collection system and the syringes measured out with such careful love, there is a question that no clinic in Panama or Próspera or the Bahamas has found a way to sell an answer to.

Not how do we keep going?

But who are we when we finally stop?

References

This essay was inspired by Peter Ward's March 30 piece in Slate Magazine.

The idea that overestimating our own control is a cognitive error goes back to Langer in 1975. Alloy and Abramson then showed that depressed people actually judge their own influence more accurately than non-depressed people, a finding so counterintuitive it earned the label "depressive realism." Taylor and Brown built on this to argue that positive illusions aren't a malfunction but a structural feature of psychological health. More recently, neuroimaging work by Zheng and colleagues has located the effect inside the brain's reward circuitry itself, suggesting that the tendency to overestimate personal control is something the brain actively runs, and finds rewarding.

The psilocybin research referenced in this essay comes from two landmark 2016 trials, one at Johns Hopkins led by Griffiths and colleagues, the other at NYU led by Ross and colleagues, both published simultaneously in the Journal of Psychopharmacology. Together they established that a single psilocybin session could produce rapid, sustained reductions in anxiety and depression in patients with life-threatening cancer diagnoses.

Alloy, L. B., and L. Y. Abramson. 1979. “Judgment of Contingency in Depressed and Nondepressed Students: Sadder but Wiser?” Journal of Experimental Psychology. General 108 (4): 441–85.

Griffiths, Roland R., Matthew W. Johnson, Michael A. Carducci, et al. 2016. “Psilocybin Produces Substantial and Sustained Decreases in Depression and Anxiety in Patients with Life-Threatening Cancer: A Randomized Double-Blind Trial.” Journal of Psychopharmacology 30 (12): 1181–97. 

Langer, Ellen J. 1975. “The Illusion of Control.” Journal of Personality and Social Psychology 32 (2): 311–28.

Ross, Stephen, Anthony Bossis, Jeffrey Guss, et al. 2016. “Rapid and Sustained Symptom Reduction Following Psilocybin Treatment for Anxiety and Depression in Patients with Life-Threatening Cancer: A Randomized Controlled Trial.” Journal of Psychopharmacology 30 (12): 1165–80.

Taylor, S. E., and J. D. Brown. 1988. “Illusion and Well-Being: A Social Psychological Perspective on Mental Health.” Psychological Bulletin 103 (2): 193–210. 

Ward, Peter. 2026. “Welcome to the Longevity Tourism Boom.” Medical Examiner. Slate, March 30. 

Zheng, Ya, Canming Yang, Huiping Jiang, and Bo Gao. 2024. “Neural Dynamics Underlying the Illusion of Control during Reward Processing.” Social Cognitive and Affective Neuroscience 19 (1): nsae063. 

Essays on treatment resistance, altered states, and the conditions under which change becomes possible.

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