I loved the point about doctors who have a tiny, curated patient cohort. I feel like I learned so much from seeing so many patients of all types over the last 29 years since I graduated from med school. Just the sheer variety and repetition was incredibly important
Adam- a lot of your rant is true, however I do listen to Attia. While he is an exercise fanatic he is data driven and doesn’t promote crazy potions or exotic diets. I far as I can tell he only wants to live well, not live long, and stresses that to his audience
Great piece. The demand drives the supply. The overachiever who is already eating healthy, exercising, getting plenty of sleep wants to double down further, either to live longer or because of underlying health anxiety. The wealth pays for a handful of longevity doctors who are great at making a boring, irrelevant paper appear as gospel for living to 100+. Most of the other ones are just bystanding imitators who hope to land the $125K/yr client or build the 1M subscriber channel.
Once the longevity keyword starts dropping on Google Trends, the same health experts will hop on the prophylactic plasmapheresis or implantable magnets. And the same crowd will follow them.
“Only a well-designed trial tells you something works.” True, and beside the point. A trial tells you what happens on average across a population. The average describes nobody. It says nothing about what happens in one person, measured densely, over time. That isn’t a failure of rigor — it’s a category the argument never accounts for.
And the life expectancy chart. 49 to 78 wasn’t medicine extending old age. It was infant mortality, seatbelts, workplace accidents — premature death removed from the front end. The chart is run as evidence the trajectory holds. It’s evidence the easy wins are spent.
Which is the real question. Not whether the gurus are silly. Whether anything is left to measure.
It occurs to me that we may now require a two-tiered subdivision of MDs: one for caregivers, clinical scientists and those who strive to be an amalgamation of the two (with caregivers practicing at an ideally evidence-based standard of care and clinical scientists working to advance that standard of care); the other for physician entrepreneurs (cosmetic dermatologists and plastic surgeons).
To the latter group might be added these “life extenders“/longevity gurus, the Jim Bakkers of American medicine, and for this group the words emblazoned on their professional coat of arms might more appropriately read Caveat emptor rather than Primum non nocere or Medicus curat, natura sanat.
There are only 2 certainties in life: death and taxes. Those longevity wingnuts and scheisters are still gonna get both, good and hard. Well, maybe they can flee the jurisdiction and escape taxes.
1. They claim to have unique knowledge that others do not have (listen to me and only me)
2. They are unbelievably confident in their own opinions It does not occur to them that they could be wrong
We should distinguish them, however, from the many legitimate scientists who do painstaking research into the biology of aging, which, although not leading to the fountain of youth, helps in understanding how chronic illness occurs and what can be done to help. These scientists toil for years without fame and are not hawking a product
Great points. I agree that lots of the longevity discussions come out of the fear of dying. It is childish indeed, not accepting aging. 96 yo patient told me once, when I asked what is her secret to longevity that I don’t want to know. She said: my husband died, my kids died. It is very lonely to live longer than those you love. Made me think about making the best of TODAY
In Greek mythology, the goddess Eos fell in love with the mortal Tithonus. Eos asked Zeus to grant eternal life to Tithonus, which he granted. She forgot to ask for eternal youth, however, so Tithonus never died but became more and more feeble and decrepit until he finally turned into a cricket. Thus chirping forever, especially in the early morning when Eos (dawn) comes out to spread light across the land. Lesson: Be careful what you wish for...
As a nurse and nurse educator with training and practice in functional/integrative medicine, I agree with you except for the HPV vaccine (we can save that for another time :) ). A person can go broke (which definitely undermines health and longevity) trying to buy and use the next "new thing" that will somehow make you look and feel at least 20 years younger. I get particularly upset when people are diagnosed with cancer or another very serious disease/disorder and believe that the "only right thing to do" is avoid "conventional medicine" and try all the alternatives. I fully support trying alternatives AND conventional if appropriate for the disease/condition. On the flip side, "conventional" doctors need to be more supportive of patients who want to include alternatives in their treatment. In my opinion, doctors who are more "open" to alternatives enhance the patient relationship and increase the likelihood that the patient will actually tell you what they are actually doing in real life instead of hiding it for fear of ridicule.
It is very hard to convince anyone in the lay public of certain things - 1. Finding all cancers possible early is not always a good thing 2. Imaging of body parts for early detection of " problems" is not always a good thing 3. Blood tests for " cancer " are not good screening tools and actually don't really exist since cancer is not a homogeneous disease 5. The things we actually die from most often are not the things people are afraid of dying from . 6. " Preventive medicine" does not really save money for the health system . I have kind of given up - what we know to be true is so counter intuitive to the public that anyone preaching against whole body imaging, GRAIL blood tests, Ca125 testing annually , PSA testing for 75 year old men etc sounds like they just want people to get sick and die. We live in a society where " doing something" is always seen as better than not. Explaining why we spend outrageous amounts of money on the last year of life , and have terrible funding available for maternity and pediatric care .
I loved the point about doctors who have a tiny, curated patient cohort. I feel like I learned so much from seeing so many patients of all types over the last 29 years since I graduated from med school. Just the sheer variety and repetition was incredibly important
Adam- a lot of your rant is true, however I do listen to Attia. While he is an exercise fanatic he is data driven and doesn’t promote crazy potions or exotic diets. I far as I can tell he only wants to live well, not live long, and stresses that to his audience
Julian Simmons
Great piece. The demand drives the supply. The overachiever who is already eating healthy, exercising, getting plenty of sleep wants to double down further, either to live longer or because of underlying health anxiety. The wealth pays for a handful of longevity doctors who are great at making a boring, irrelevant paper appear as gospel for living to 100+. Most of the other ones are just bystanding imitators who hope to land the $125K/yr client or build the 1M subscriber channel.
Once the longevity keyword starts dropping on Google Trends, the same health experts will hop on the prophylactic plasmapheresis or implantable magnets. And the same crowd will follow them.
Mostly agreed. But two place where this is😑:
“Only a well-designed trial tells you something works.” True, and beside the point. A trial tells you what happens on average across a population. The average describes nobody. It says nothing about what happens in one person, measured densely, over time. That isn’t a failure of rigor — it’s a category the argument never accounts for.
And the life expectancy chart. 49 to 78 wasn’t medicine extending old age. It was infant mortality, seatbelts, workplace accidents — premature death removed from the front end. The chart is run as evidence the trajectory holds. It’s evidence the easy wins are spent.
Which is the real question. Not whether the gurus are silly. Whether anything is left to measure.
It occurs to me that we may now require a two-tiered subdivision of MDs: one for caregivers, clinical scientists and those who strive to be an amalgamation of the two (with caregivers practicing at an ideally evidence-based standard of care and clinical scientists working to advance that standard of care); the other for physician entrepreneurs (cosmetic dermatologists and plastic surgeons).
To the latter group might be added these “life extenders“/longevity gurus, the Jim Bakkers of American medicine, and for this group the words emblazoned on their professional coat of arms might more appropriately read Caveat emptor rather than Primum non nocere or Medicus curat, natura sanat.
non nocere, which translates to "First, do no harm."Other traditional Latin maxims and mottos used in medicine include:Medicus curat, natura sanat:
There are only 2 certainties in life: death and taxes. Those longevity wingnuts and scheisters are still gonna get both, good and hard. Well, maybe they can flee the jurisdiction and escape taxes.
Good one Adam- I might add:
1. They claim to have unique knowledge that others do not have (listen to me and only me)
2. They are unbelievably confident in their own opinions It does not occur to them that they could be wrong
We should distinguish them, however, from the many legitimate scientists who do painstaking research into the biology of aging, which, although not leading to the fountain of youth, helps in understanding how chronic illness occurs and what can be done to help. These scientists toil for years without fame and are not hawking a product
The irony that chronically unhappy people want to live longer.
I just want to live better, who cares how long that is?
What strikes me is the generalized arrogance in both medicine and longevity biohacking.
This was fun and I hadn’t considered the “childish” aspect of this. Great read!
Thanks.
Adam
perfect I bet you feel better. I know I do. the longevity space is over the top !!!!
It really helped.
I think of Peter Attia on Epstein Island and then I find it very easy to ignore the longevity experts
You are more mature than me!
Adam
Great points. I agree that lots of the longevity discussions come out of the fear of dying. It is childish indeed, not accepting aging. 96 yo patient told me once, when I asked what is her secret to longevity that I don’t want to know. She said: my husband died, my kids died. It is very lonely to live longer than those you love. Made me think about making the best of TODAY
In Greek mythology, the goddess Eos fell in love with the mortal Tithonus. Eos asked Zeus to grant eternal life to Tithonus, which he granted. She forgot to ask for eternal youth, however, so Tithonus never died but became more and more feeble and decrepit until he finally turned into a cricket. Thus chirping forever, especially in the early morning when Eos (dawn) comes out to spread light across the land. Lesson: Be careful what you wish for...
As a nurse and nurse educator with training and practice in functional/integrative medicine, I agree with you except for the HPV vaccine (we can save that for another time :) ). A person can go broke (which definitely undermines health and longevity) trying to buy and use the next "new thing" that will somehow make you look and feel at least 20 years younger. I get particularly upset when people are diagnosed with cancer or another very serious disease/disorder and believe that the "only right thing to do" is avoid "conventional medicine" and try all the alternatives. I fully support trying alternatives AND conventional if appropriate for the disease/condition. On the flip side, "conventional" doctors need to be more supportive of patients who want to include alternatives in their treatment. In my opinion, doctors who are more "open" to alternatives enhance the patient relationship and increase the likelihood that the patient will actually tell you what they are actually doing in real life instead of hiding it for fear of ridicule.
It is very hard to convince anyone in the lay public of certain things - 1. Finding all cancers possible early is not always a good thing 2. Imaging of body parts for early detection of " problems" is not always a good thing 3. Blood tests for " cancer " are not good screening tools and actually don't really exist since cancer is not a homogeneous disease 5. The things we actually die from most often are not the things people are afraid of dying from . 6. " Preventive medicine" does not really save money for the health system . I have kind of given up - what we know to be true is so counter intuitive to the public that anyone preaching against whole body imaging, GRAIL blood tests, Ca125 testing annually , PSA testing for 75 year old men etc sounds like they just want people to get sick and die. We live in a society where " doing something" is always seen as better than not. Explaining why we spend outrageous amounts of money on the last year of life , and have terrible funding available for maternity and pediatric care .
I have felt the same way ever since Orin Hatch started promoting supplements years ago
So preach it…!