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Weekly dose of optimism #195

Packy McCormick's latest dispatch doesn't just catalogue scientific progress; it constructs a compelling narrative that the trajectory of human capability is accelerating faster than our institutional imagination can track. While the headlines often fixate on setbacks, McCormick argues that a convergence of breakthroughs in gene editing, oncology, aerospace, and nanotechnology suggests we are on the precipice of solving problems once deemed permanent. This is not mere cheerleading; it is a data-driven assertion that the constraints of biology and physics are being systematically dismantled.

The End of Chronic Disease as We Know It

McCormick anchors his optimism in the rapid evolution of cardiovascular medicine, specifically highlighting Eli Lilly's recent phase 1 results for VERVE-102, a gene therapy targeting PCSK9. The stakes are immense: McCormick notes that high LDL cholesterol is responsible for roughly 4.4 million deaths annually, accounting for a quarter of all cardiovascular fatalities. The potential to eliminate this risk factor with a single dose represents a paradigm shift from lifelong management to a one-and-done cure.

Weekly dose of optimism #195

"Now, if Lily's early results hold, they will get all of the benefits in a one-and-done shot," McCormick writes, contrasting this with current treatments that require indefinite adherence. The author draws a powerful parallel to natural human genetics, explaining that the drug essentially mimics a rare mutation found in a small population that naturally confers massive protection against heart disease. This reframes the drug not as an invention, but as an emulation of a biological advantage that already exists in the wild.

"Medicine keeps getting better and better."

The argument extends beyond LDL to its genetic cousin, Lp(a), a particle that diet and exercise cannot lower and for which no approved therapy currently exists. McCormick points out that while previous attempts to lower Lp(a) failed to reduce clinical events, new technologies from major pharmaceutical players are now poised to cut these levels dramatically. A counterargument worth considering is the timeline; phase 1 trials are merely the first step, and the gap between early efficacy and widespread, safe market availability remains significant. However, the sheer volume of capital and research now directed at these specific genetic targets suggests the window for a breakthrough is closing rapidly.

The Unexpected Weapon Against Cancer

The piece pivots to a surprising secondary benefit of the weight-loss drug class known as GLP-1s. McCormick synthesizes four new studies indicating that these drugs may do more than regulate weight; they appear to stall cancer progression. The data is striking: in lung cancer patients, the rate of progression to advanced disease was cut roughly in half for GLP-1 users compared to the control group. Breast cancer showed a similar pattern, with progression rates dropping from 20% to 10%.

"A suite of four new studies suggest that people taking so-called GLP-1 drugs like Novo Nordisk's Ozempic and Eli Lilly's Mounjaro saw reductions in tumor progression, lower overall chance of death and less risk of developing breast cancer," McCormick summarizes. The author admits that the biological mechanism remains a mystery, yet the statistical correlation is too strong to ignore. This reframes the conversation around these drugs from a niche obesity treatment to a potential cornerstone of oncology.

Critics might note that observational studies can be confounded by lifestyle factors or other variables, and that the mechanism needs to be understood before these drugs can be prescribed specifically for cancer prevention. Yet, as McCormick puts it, the research points to "yet another miracle for this miracle drug," suggesting that the therapeutic utility of these compounds may be far broader than initially conceived.

Breaking the Sound Barrier and the Atom

McCormick then expands the scope from biology to physics, celebrating Hermeus's successful test of the Quarterhorse Mk 2.1, which became the world's first privately developed, unmanned supersonic jet. The flight reached Mach 1.21, a milestone that has significant implications for logistics and defense. The author connects this to a broader vision of the future, quoting their own previous writing: "I would like to live in the future in which we have spaceships and abundant energy and supersonic planes, the future in which car crashes and cancer are a thing of the past."

The commentary then dives into the most theoretically ambitious topic: nanotechnology. McCormick revisits the decades-old debate between K. Eric Drexler and Richard Smalley regarding the feasibility of atomically precise manufacturing. For forty years, the idea of building objects atom-by-atom was dismissed as science fiction due to the "fat fingers" problem—the inability to manipulate individual atoms with precision. McCormick highlights a new paper that demonstrates "simultaneous spatial and chemical control over the mechanosynthetic fabrication of carbon structures," effectively proving the skeptics wrong.

"This thing that people said was impossible was just demonstrated to be possible!"

The author is careful to distinguish between this primitive demonstration and the full vision of a self-replicating nanofactory. The current technology is slow and serial, lacking the massive parallelism required for industrial-scale production. However, the existence of a working primitive changes the philosophical landscape. As McCormick notes, this establishes "controlled mechanosynthetic donation as a foundational capability for programmable atomically precise fabrication." The implication is that the cost of physical goods could eventually collapse, much like the cost of computation did with semiconductors.

The Lunar Infrastructure Play

Finally, the piece turns its gaze to the Moon, detailing NASA's updated roadmap for a sustained lunar presence under the Artemis program. The plan involves a series of missions starting in 2026, utilizing landers from Blue Origin and Astrobotic to establish a base at the lunar South Pole. McCormick frames this not just as exploration, but as the creation of essential infrastructure.

"Then, eventually, we'll have people living on the Moon, which is a harsh mistress but a potentially perfect launchpad for humanity's mission to Mars," the author concludes. The inclusion of a dedicated website and timeline signals a shift from abstract goals to concrete engineering milestones. While the execution of such a complex, multi-agency, and multi-company effort is fraught with risk, the momentum appears undeniable.

Bottom Line

McCormick's strongest argument lies in the synthesis of disparate fields—biology, aerospace, and materials science—to show a coherent trend of accelerating capability. The piece's greatest vulnerability is its inherent optimism, which risks underestimating the regulatory, ethical, and engineering bottlenecks that often stall transformative technologies. However, by grounding the narrative in specific, recent data points rather than vague speculation, the commentary successfully makes the case that the future is not just arriving, but is already being built.

"This thing that people said was impossible was just demonstrated to be possible!"

Deep Dives

Explore these related deep dives:

  • The End of Illness Amazon · Better World Books by David B. Agus

  • PCSK9

    Understanding the specific enzymatic function of this protein explains why a single gene therapy dose can permanently lower cholesterol, contrasting sharply with the lifelong daily injections required by previous treatments.

  • Hermeus

    This private aerospace company is developing the specific hybrid-engine technology needed to achieve the Mach 5+ speeds mentioned in the supersonic flight breakthrough, moving beyond theoretical concepts to active flight testing.

  • K. Eric Drexler

    As the author of 'Engines of Creation' and a central figure in the nanotechnology movement referenced via 'The Diamond Age,' his work provides the historical and technical context for the article's optimism regarding molecular manufacturing.

Sources

Weekly dose of optimism #195

by Packy McCormick · Not Boring · Read full article

Hi friends,

Happy Friday, and welcome to our 195th Weekly Dose of Optimism.

Man, just when I thought it was going to be hard to top last week’s Dose, we have an LDL cholesterol-fighting gene therapy, evidence that GLP-1s slow cancer, supersonic flight, and nanotech, and a Moon Base. We also have the coolest Science Breakthroughs roundup yet. Even a massive Blue Origin explosion can’t slow us down.

If you get through this and want even more optimism injected into your veins, check out this week’s essay:

Let’s get to it.

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(1) Eli Lily Does it Again, Now with LDL Cholesterol Gene Therapy.

For those keeping score at home, this is the second week in a row that we’ve led off with Eli Lily. Last week, their Reta Phase 3 trials showed astonishingly good results, and this week, they published the results of a phase 1, open-label, single-ascending-dose study on the VERVE-102 gene therapy targeting PCSK9, which is responsible for LDL cholesterol, which is in turn responsible for a lot of heart disease and deaths.

Now this is just a phase 1, and there were only 35 people involved, but a single dose gene therapy reduced PCSK9 levels “from 51% at the 0.3-mg-per-kilogram dose to 88% at the 1.0-mg-per-kilogram dose,” and showed corresponding reductions in the LDL cholesterol level “from 9% at the 0.3-mg-per-kilogram dose to 62% at the 1.0-mg-per-kilogram dose.”

This is a big deal! Globally, about 4.4 million deaths a year are attributable to high LDL cholesterol, roughly 7.8% of all deaths. Cardiovascular disease causes roughly 18.6 million deaths a year worldwide, so high LDL accounts for somewhere around a quarter of those.

Now, we might be able to knock out 4.4 million deaths a year with a shot.

PCSK9 inhibitors are not new. On a recent Invest Like the Best episode, Braidwell Managing Partner Alex Karnal called PCSK9 medicines “pretty much a free lunch”:

The headline here is PCSK9 medicines are amazing, because what they do is they today can ...