The biotech industry faces significant challenges, with declining returns on R&D investments leading to a diminishing number of new drug approvals. Strategies such as focusing on human genetics, drug repurposing, and AI have not yielded a trillion-dollar biotech, particularly in the context of age-related diseases, which present unique hurdles. Despite some successes in rare diseases, the overall trend suggests that the traditional models of drug development may be unsustainable without innovative approaches to circumvent the inherent economic challenges.