I’ve been a trader and investor for 44 years. I left Wall Street long ago—-once I understood that their obsolete advice is designed to profit them, not you.
Today, my firm manages around $5 billion in ETFs, and I don’t answer to anybody. I tell the truth because trying to fool investors doesn’t help them, or me.
In Daily H.E.A.T. , I show you how to Hedge against disaster, find your Edge, exploit Asymmetric opportunities, and ride major Themes before Wall Street catches on.
Table of Contents
H.E.A.T.
15 Years Avg. American spent in poor health | >$250B Longevity TAM (Tier 1 + 2) | $80/mo Consumer wellness spend (survey avg.) |
Consider the math the healthcare industry has quietly relied on for decades: the average American dies at 79 but lives in full health only through roughly age 64. (Those figures come from different reporting vintages — CDC life expectancy data for 2024, WHO healthy life expectancy estimates from 2021 — but the gap they describe is consistent across sources and growing.) Fifteen years of decline — chronic disease management, prescription cascades, hospital readmissions — is not a tragedy to the incumbents who profit from it. It is a revenue model.
That model is cracking.
A proprietary survey of 2,500 consumers conducted in May 2026 reveals something that should unsettle every traditional pharmaceutical and hospital executive: people are no longer waiting for a diagnosis to take their health seriously. They are monitoring, supplementing, screening, and optimizing before anything goes wrong. They are spending roughly $80 per month on it today — and they are increasingly willing to spend more. The $250 billion total addressable market this creates sits almost entirely outside of insurance reimbursement. It is self-pay. It is sticky. And Wall Street has barely begun to map it.
This is the longevity economy. And it is not a wellness trend. It is a structural shift in how Americans think about the relationship between time and health.
KEY DATA POINT 76% of Americans have at least one chronic disease. 51% have multiple. Cardiometabolic conditions — heart disease, stroke, diabetes — account for 31% of all U.S. deaths. Cancer adds another 19%. The single largest investment opportunity in the longevity economy is therefore not treatment of these conditions. It is their prevention. Source: CDC, WHO, TD Cowen Thematic Research, June 2026 |
The Shift From Lifespan to Health Span
For most of Wall Street's history, the healthcare investment thesis has been simple: more sick people means more revenue. But the most lucrative opportunity in the next decade is not treating sickness. It is extending the window of health — what researchers and now investors call 'health span.'
The mechanism driving this shift has three legs: technology, biology, and policy. All three are moving in the same direction simultaneously.
On the technology side, AI and wearable devices have done something previously impossible: they have given consumers continuous visibility into their own physiology. A consumer wearing an OTC continuous glucose monitor can see glucose patterns that were previously invisible between annual physicals — patterns that may prompt behavioral changes or appropriate clinical follow-up. That same consumer, using direct-to-consumer genetic screening, can surface selected risk signals that warrant further evaluation. These tools are not niche. The survey shows 21% of adults have already purchased a wearable fitness device, with adoption highest among 18-to-34-year-olds at 25%.
On the biology side, the cost of genome sequencing has fallen so precipitously that consumer-grade genetic screening is now accessible at price points below $500 — though the survey data reveals a meaningful wrinkle: 88% of high-income respondents ($150K+) are unwilling to pay more than $500 for a multi-cancer early detection test. Demand is real. Price sensitivity is real. This tension defines the near-term go-to-market challenge for screening companies.
On the policy side, the Trump Administration's drug price focus is accelerating the shift to direct-to-consumer platforms, while the FDA's steady movement of prescription medicines to over-the-counter status is handing consumers more agency than they have ever had. The MAHA movement — Make America Healthy Again — has provided political tailwind that would have seemed implausible five years ago.
"The biggest investment opportunity sits exactly where luxury wellness overlaps with traditional healthcare." |
The Three-Tier Framework: Who Is Actually Spending
Not all longevity consumers are equal, and investors who treat the market as monolithic will misprice it. The most useful framework divides the market into three tiers.
Tier 1 is the health optimizer — average age 44-45, income skewed above $150K. This is longevity as a luxury. These consumers use the full suite of products: continuous glucose monitoring, concierge medicine, genetic screening, advanced sleep tech, high-end supplements. Their spending is discretionary in form but psychologically protected. They are buying an extended premium life. Tier 1 represents 29% of the market.
Tier 2 is the budget-conscious wellness seeker — average age 44, income broadly distributed. This consumer picks and chooses: one supplement stack, a gym membership, an annual blood panel. They are not optimizing comprehensively; they are making incremental health investments that fit their wallet. Tier 2 represents 34% of the market.
Tier 3 is the already-ill patient — average age 50, income weighted toward lower bands. This consumer is not preventing disease; they are managing it. The TAM for treatment and intervention here is vast, but the investment opportunity profile is different from the prevention-and-optimization trade.
The investable core of the longevity trade is Tier 1 and Tier 2 combined: a $250 billion estimated spending pool (per TD Cowen survey-derived analysis, Tier 1+2 respondents, May 2026) organized around the premise that prevention is worth more than treatment.
Four Pillars, One Macro Trade
The longevity market organizes itself around four pillars, each representing a distinct investment sub-theme.
Screening and monitoring is the pillar most directly tied to AI. Blood-based testing, multi-cancer early detection, concierge medicine, and continuous glucose monitoring all sit here. The market's adoption curve looks like early smartphones: low penetration today, explosive compounding as costs fall and clinical validation expands. The 83% of survey respondents who said they would take a multi-cancer early detection test if priced under $500 is a powerful demand signal — but consumer interest is not clinical proof. The NHS-Galleri randomized controlled trial, presented at ASCO in 2026, missed its predefined primary endpoint: no statistically significant reduction in combined Stage III/IV cancers in the 12 prespecified cancer types. There were encouraging secondary findings — a 14% reduction in Stage IV cancers overall, 22% and 26% reductions in subsequent screening rounds — and GRAIL submitted its PMA to the FDA in January. The category direction is right. The evidence is still accumulating. That tension, not false certainty, is what makes MCED the most interesting investment debate in the longevity space.
Nutrition and diet is the pillar where consumer spending is already concentrated. The supplement market reached $14.7 billion in fiscal year 2025, growing 6% year-over-year. General health supplements led at $3.2 billion, growing 10%. Mental performance supplements grew 8%. These are not vanity purchases — they are functional interventions. GLP-1 drugs sit adjacent here: approved for obesity and Type 2 diabetes management, they are increasingly being adopted by longevity-conscious Tier 1 consumers as metabolic tools, a trend that is driving off-label and DTC demand well beyond their clinical indication footprint.
Mobility and fitness encompasses wearables, the fastest-growing consumer hardware category for health data capture. The 35-to-54-year-old cohort is the highest adopter, suggesting that peak spending on fitness wearables tracks income maturity.
Lifestyle — sleep, alcohol reduction, stress — is the most underappreciated pillar from an investment standpoint. Sleep tech alone is projected to grow to $154 billion by 2035. The non-alcoholic beer market has delivered three consecutive years of plus-15% growth. Full-service restaurant chains are watching alcohol's share of sales decline steadily from 19% in 2017 toward 15% today — a structural margin headwind that is not reversing.
PILLAR-LEVEL SIZING SUMMARY Screening/Monitoring: Market adoption early-stage; MCED demand signal strong at 83% stated interest below $500. Nutrition/Diet: $14.7B supplement market growing 6% YoY; general health and mental performance outpacing category. Sleep Tech: $154B projected TAM by 2035. Fitness Wearables: 21% current adult penetration, highest among 18-34 cohort. Non-Alcoholic Beverage: Three consecutive years of 15%+ growth. Sources: NielsenIQ, Eight Sleep/Precedenceresearch.com, TD Cowen Consumer Survey, May 2026 (N=2,511) |
Categories Are Lying
Here is the mispricing that creates opportunity: Wall Street still indexes the longevity trade under healthcare. But many of the most compelling exposures are in consumer discretionary. A continuous glucose monitor worn by a healthy 42-year-old optimizing metabolic performance is not a medical device in the traditional insurance-reimbursed sense — it is a consumer wellness product. A non-alcoholic beer company is not a beverage company; it is a lifestyle modification business operating at the intersection of consumer and health. An AI platform that interprets genomic data and generates personalized health protocols is not a SaaS company; it is precision medicine infrastructure.
The index labels lag the cash flows by years. That lag is where alpha lives.
The Hidden Conversion Lever: Qualified HSA Spending
U.S. HSA assets reached nearly $174 billion at year-end 2025, according to Devenir. That does not make every wellness product eligible for HSA spending — IRS rules generally exclude products merely beneficial to general health, and nutritional supplements typically qualify only when recommended to treat a specific diagnosed condition. Ordinary fitness wearables and generalized wellness purchases often do not qualify. But the opportunity is still real and underappreciated: it is narrower than a $174 billion wellness wallet, and more credible. Diagnostic testing, eligible medical devices, and clinician-directed interventions can qualify. Companies that establish clear medical necessity positioning, support reimbursement documentation, and build seamless HSA payment into their checkout flow are reducing friction at the exact moment of purchase decision for the Tier 2 consumer. The conversion advantage is not theoretical — it is measurable. The companies that own it will win repeat purchasing.
Tiered Winners
Tier | Category | Companies | Why It Wins | Signal |
Clinically De-Risked — Core | CRC Blood Screening / Oncology Detection | GH | Guardant's Shield blood test has FDA approval for colorectal cancer screening and is now included in American Cancer Society and NCCN guidelines. This is an existing commercial franchise, not MCED optionality. The Shield approval is the strongest regulatory anchor in the longevity screening category right now. | Shield volume uptake; Medicare LCD for blood-based CRC screening |
Clinically De-Risked — Core | MRD / Treatment Guidance | NTRA | Natera's Signatera received the first FDA approval for a blood-based minimal residual disease companion diagnostic (May 2026). This is treatment monitoring, not MCED. It is the most clinically validated name in the liquid biopsy space and belongs in a different conversation than speculative multi-cancer detection. | Signatera companion diagnostic label expansions; payer coverage |
Clinically De-Risked — Core | Continuous Glucose Monitoring | DXCM, ABT | CGM is the wearable with the strongest clinical evidence base. DexCom's consumer positioning and Abbott's Lingo (OTC) and Libre Rio platforms are competing for the enormous non-diabetic wellness market. Abbott's omission from most longevity coverage is a significant category oversight. | Non-diabetic CGM prescribing; OTC CGM sell-through at retail |
Emerging / Higher Upside | AI Precision Oncology Platform | TEM | Tempus AI is a precision oncology data and clinical AI platform with longevity infrastructure optionality. It is not yet a longevity operating system — but it is the most credible candidate for that role if the clinical data layer consolidates. Enterprise health system adoption is the watch variable. | Data licensing revenue growth; health system enterprise contract wins |
Emerging / Higher Upside | Diagnostics Infrastructure | ALMR, CAI, BFLY | Proteomics (Alamar), molecular profiling (Caris), and portable ultrasound (Butterfly) represent the infrastructure layer under the screening pillar. These names have longer adoption curves but are building the tools that will power Tier 1 longevity medicine at scale. | Commercial lab adoption; DTC channel revenue mix |
Speculative / Binary Events | MCED — FDA Review Pending | GRAL | GRAIL submitted its Galleri PMA in January. The NHS-Galleri trial missed its primary endpoint but showed encouraging secondary results (14% Stage IV reduction; improving in rounds 2-3). This is a binary regulatory event, not a validated commercial product. The upside is enormous; the evidence base is still contested. Position size accordingly. | FDA PMA decision; Medicare coverage determination; Galleri trial follow-up data |
Speculative / Binary Events | DTC Telehealth | HIMS | Hims & Hers has the distribution and brand to own the Tier 2 consumer. But FDA explicitly named Hims & Hers in its February enforcement statement against non-approved compounded GLP-1 products. This is structural regulatory risk, not a near-term headwind. The platform breadth is real; the GLP-1 exposure is an overhang until resolved. | FDA compounding enforcement actions; GLP-1 revenue disclosure in earnings |
Speculative / Binary Events | Hormone Optimization | BTMD | Biote operates in the compounded hormone pellet market. ACOG recommends against routine use of compounded hormone therapies when approved alternatives exist and specifically flags testosterone pellets given limited safety data and inability to remove the pellet. The longevity thesis is directionally sound; the evidence and regulatory backdrop for this specific modality are weaker than the category suggests. | FDA compounding guidance for hormone pellets; ACOG evidence updates |
Pressure Points | Full-Service Restaurants | High-alcohol-mix chains | Alcohol's share of full-service restaurant sales has declined from 19% to ~15% since 2017 and is still falling. Three consecutive years of 15%+ growth in non-alcoholic beer confirms this is generational, not cyclical. Alcohol is the highest-margin revenue line at these chains. The sober-curious consumer is a structural margin headwind. | Alcohol mix disclosure in same-store sales; mocktail menu expansion |
Pressure Points | Undifferentiated Supplements / DTC Wellness | Generic supplement brands; claim-dependent platforms | Consumer demand for supplements is real ($14.7B market, 6% growth). But platforms dependent on unsubstantiated health claims face compounding risk: FTC enforcement, retailer delistings, and the arrival of AI-personalized nutrition that will make generic SKUs obsolete. The category grows; the generic middle gets hollowed out. | FTC enforcement actions; CGM-linked nutrition platform launches |
Pressure Points
Sector | Pressure Point | Mechanism | Watch For |
Full-Service Restaurants | Alcohol mix decline | 3-year trend: alcohol's revenue share falling steadily from 19% to ~15%. Mocktails partially offset but at lower margins. | Q3 comp reports; alcohol line-item disclosure |
Traditional Pharma | OTC migration | FDA actively pushing Rx-to-OTC conversions. DTC brands capture downstream consumer relationship and margin. | FDA OTC user fee pipeline; new OTC approvals |
Supplement Incumbents | AI-personalized nutrition | Platforms that personalize supplement stacks using biometric data displace generic vitamin retail. Shelf velocity at mass-market retailers plateaus. | CGM-linked nutrition platform launches; GenAI diet app penetration |
Insurance / Managed Care | HSA/FSA channel leakage | As longevity products become HSA-eligible, consumer health dollars bypass traditional insurance infrastructure and flow to DTC. | IRS HSA eligible product list expansions |
Credibility Firewall
What the data says vs. what we think it means.
Company-Disclosed | Model-Derived | Editorial View |
83% of survey respondents said they would take a multi-cancer early detection test if priced under $500. Source: TD Cowen Consumer Survey, May 2026, N=656. NHS-Galleri RCT primary endpoint: no statistically significant reduction in combined Stage III/IV cancers across 12 prespecified types. Secondary: 14% Stage IV reduction overall. GRAIL PMA submitted January 2026. Source: ASCO 2026 / Journal of Clinical Oncology. | Consumer interest is not clinical proof of mortality benefit. 88% of high-income respondents still cap willingness-to-pay at $500. What we know: demand is strong. What we do not know: how many will pay, repeat annually, complete follow-up, or achieve better outcomes. The trial evidence is mixed, not validating. | Bullish on MCED direction. Cautious on near-term revenue. GH's Shield (CRC-specific, FDA-approved) is the most credible near-term commercial franchise. GRAL is a binary FDA/reimbursement event. NTRA is MRD/treatment guidance, not MCED. Do not conflate them. |
U.S. HSA assets: ~$174B at year-end 2025 (Devenir 2025 Year-End HSA Research Report). Supplement market: $14.69B FY25, +6% YoY. Source: NielsenIQ via TD Cowen. | IRS Pub. 502 rules generally exclude products merely beneficial to general health. Supplements qualify only when treating a diagnosed condition. Ordinary fitness wearables generally do not qualify. The HSA opportunity is real but narrower than the $174B headline implies. | The supplement market is bifurcating: commodity SKUs face margin compression; clinically-positioned premium brands gain. HSA-checkout integration is a Tier 2 conversion lever for companies with clear medical necessity framing — not a blanket wellness subsidy. |
Non-alcoholic beer: 15%+ YoY growth for three consecutive years. Alcohol share of full-service restaurant sales: ~15% in 2024 vs. 19% in 2017. Source: NielsenIQ, company reports. | Three consecutive years of trend data through a post-pandemic recovery period is not cyclical normalization. Mocktails partially offset volume but at structurally lower margins. Alcohol is the highest-margin line at full-service chains. | This is a structural margin headwind at full-service restaurant chains that consensus models have not fully discounted. Position it as a durable secular trend, not a macro call. |
Bear Case: This Is Wellness, Not Medicine
The Bear Case The single most credible objection to the longevity investment thesis is that most of this market is self-pay luxury spending — and luxury spending compresses when economic conditions tighten. Unlike statins or chemotherapy, a $300 monthly concierge medicine subscription or a $200 sleep optimization device is genuinely discretionary. When unemployment ticks up or consumer sentiment deteriorates, Tier 1 and Tier 2 longevity spending is the first line item that gets cut. The survey data was collected in May 2026 under relatively benign consumer conditions. We do not know how this cohort behaves in a recession. Second: the clinical evidence base is thinner than the enthusiasm implies. The NHS-Galleri randomized controlled trial — the most rigorous test yet of multi-cancer early detection — missed its predefined primary endpoint. The secondary results were encouraging, but missing a primary endpoint in the pivotal trial is not validation. The MCED category may still produce enormous shareholder value. But the path runs through FDA approval, reimbursement, and a follow-up trial that shows mortality benefit. That is years away, not quarters. Third: the regulatory environment could shift in ways that are hard to model. FDA explicitly named Hims & Hers in its February 2026 enforcement statement against non-approved compounded GLP-1 products. ACOG has recommended against routine compounded hormone pellet use. The gray zone between wellness and medicine is narrowing. Platforms built on regulatory ambiguity are running out of runway. Fourth: clinical validation for many longevity interventions remains thin. The gap between 'consumers believe this works' and 'randomized controlled trials confirm this works' is wide. A series of high-profile negative studies — or, worse, adverse event reports on a widely-used supplement or wearable protocol — could reprice the entire category. Our response: We hold the structural thesis. But position sizing should reflect the self-pay risk and the evidence gap. The purest way to play this trade with downside protection is through the diagnostics and screening infrastructure layer — where clinical evidence is strongest and reimbursement pathways are real — rather than through consumer-facing DTC platforms with high sentiment exposure and regulatory overhang. |
Five Takeaways
1. The longevity market is a $250B+ structural shift, not a wellness cycle. Americans spending 15 of their 79 years in poor health represents a systemic failure that technology, biology, and policy are now combining to correct. The investment opportunity lies in owning the correction.
2. Categories are lying. The most investable longevity plays are mislabeled by Wall Street indexes — filed under consumer discretionary, healthcare IT, or medical devices when they should carry a 'longevity infrastructure' designation. That mislabeling creates mispricing.
3. MCED is the highest-upside category in the longevity trade — and the highest-evidence-risk category. Consumer demand is strong (83% stated interest below $500). Clinical proof of mortality benefit is still accumulating. The NHS-Galleri trial missed its primary endpoint. GH's Shield (CRC-specific, FDA-approved) is the most de-risked screening position today. GRAL is a binary event.
4. Full-service restaurants have a structural problem that is not in the consensus model. Alcohol mix is falling from a generational shift toward sobriety — not a pandemic artifact. Every 100 basis points of alcohol mix lost represents a permanent margin haircut. Model it before Q3 earnings season.
5. HSA checkout is a Tier 2 conversion lever, not a $174B wellness wallet. IRS rules limit HSA eligibility to qualified medical expenses — most supplements and fitness wearables don't qualify. But companies with diagnostic positioning and clear medical necessity framing that build HSA payment natively will win repeat purchasing. The opportunity is real; it is narrower than the headline number implies.
The AI Buildout Has a Physical Layer
Many of today’s data centers are still using copper wiring. The same metal we’ve been using for a hundred years.
At the speeds AI demands with data moving between thousands of GPUs, billions of times a second, copper doesn’t just slow down.
It turns that data into heat. The more you push through it, the worse it gets. There’s no software for fix for that.
So what’s the answer?
Explore the Photonics Layer…..
Tuttle Capital Pure Play Photonics ETF (FOTO)
Distributor: Foreside Fund Services | Investing involves risk including possible loss of principle.
News vs. Noise: What’s Moving Markets Today
The news. Three things matter. Warsh’s first FOMC removed forward guidance, withheld the chair’s dot and launched five task forces. Nine of the 18 participants who submitted rate projections see at least one hike by year-end. But the rates market has already moved: Monday futures implied roughly 38 basis points of tightening by December. The disconnect is no longer the Fed versus bonds. It is bonds versus risk assets.
Iran’s Lake Lucerne agreement is a 60-day negotiating framework, not a settlement; the machinery exists, but final nuclear, sanctions and Lebanon terms remain unresolved.
And AI capex is now a credit story. One estimate puts combined capex at Amazon, Alphabet, Microsoft and Meta near $750 billion this year, much of it for AI infrastructure. Amazon’s trailing free cash flow is down to $1.2 billion, and SpaceX is preparing at least $20 billion of bonds to refinance the bridge loan tied to its xAI acquisition. AI investors are about to learn that capex has a cost of capital.
The noise. Brent fell below $80 Monday and the market treated the roadmap as resolution. Iran had reclosed Hormuz before the talks began, traffic fell after the closure, and the hard terms remain unresolved. Lower oil is a rational response to less near-term tail risk. It is not proof that production, shipping or insurance have normalized. David Roche’s inventory point is the one worth watching: supply can appear abundant while stored crude and oil sitting on tankers are being drawn down. A framework tested by another closure before its first negotiating session is not a settlement.
The dumb advice. Bob Michele called the bond market “inviting.” Maybe. Which bond market? T-bills, mortgages, high yield and 30-year Treasuries are not the same trade. With the 10-year near 4.5%, long duration can rally if a tougher Fed crushes inflation; it can also lose money if term premium or Treasury supply pushes yields higher. T-bills can reduce volatility. Long bonds are a macro position. The dumb advice is not buying bonds. It is pretending the word bond tells you the risk.
Where Does the Money Go When AI Hits a Wall?
When capital chases a tech theme, it tends to pile into the most obvious
layer and miss the one underneath. AI spending is now bumping hard
against memory. Hyperscalers — the big cloud builders like Amazon,
Google, and Microsoft — have shifted memory from 8% of their build
budgets to an estimated 30% in a single cycle. That capital has to go
somewhere. If the constraint is memory, and the build can't move without
it, shouldn't an investor own the layer AI runs on?
View HBMX fund holdings →
Distributor: Foreside Fund Services | Investing involves risk including
possible loss of principal.
<Link = http://www.hbmxetf.com/>
ETF News
A Stock I’m Watching
Seven weeks ago, Bleecker Street—disclosed short—called SharonAI a neocloud built on “phantom contracts and questionable financing.” Since then, the company has done something more useful than argue with the report. Its previously announced $350 million Oaktree-led convertible closed. SharonAI signed a six-year NVIDIA agreement with a stated value of up to $4.88 billion, covering as many as 40,000 GB300 GPUs and 72MW of new Australian capacity. It expanded its VAST Data deployment to 600 petabytes. And this week it announced what it described as an oversubscribed $1.6 billion financing, expected to close June 22, anchored by Leopold Aschenbrenner’s Situational Awareness and Oaktree. That does not kill the short thesis. It does make the “they cannot finance this build” portion much harder to defend.
But financing is not revenue, and this capital is not free. The $900 million equity-and-warrant leg alone creates roughly 13.1 million new share equivalents, before potential dilution from the new $700 million convertible and the earlier $350 million convertible. SharonAI generated just $294,000 of first-quarter revenue, and its own filing spells out how much still has to go right before the NVIDIA agreement becomes revenue. The stock closed Thursday at $92.70 versus a $30 February IPO. The bears were too quick to assume the money would never show up. The bulls may be too quick to count money raised as revenue earned. The capital is real. So are the dilution and execution risk. That is why I’m watching it—not chasing it.
Watch for any sort of move into moving average support, or better yet, an undercut and rally.
In Case You Missed It
Great conversation on wide ranging topics with Kenny Polcari…
The H.E.A.T. (Hedge, Edge, Asymmetry and Theme) Formula is designed to empower investors to spot opportunities, think independently, make smarter (often contrarian) moves, and build real wealth.
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