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Just four short years (and an eternity) ago, we saw the near-collapse of our healthcare system. The COVID pandemic in 2020 resulted in four-hour-long ambulance waits in NYC, reopening of mass graves such as Hart Island, and $202.6B lost by the US health system.
Fast forward to now, and a casual observer might get whiplash. Longevity is having a bit of a moment. From Peter Attia’s Outlive to a Longevity Castle in SF, we have turned 180 degrees from the crisis of the deep pandemic era to an age turned toward hope, health, and eternal youth.
Investors are excited, with VC funds dedicated to aging research and longevity startups already raising > $850M. The longevity and anti-aging therapy market is already valued at $27B, with some analysts believing the market will be worth far more - at least $600B - by 2025.
When did the Longevity Wave Begin?
As a medical doctor and startup founder, I have been puzzling over the change in the atmosphere. I was low-key obsessed with longevity even in my teens, before I (or anyone) knew much about human longevity. My first high school research project involved working with Sir2 - a family of proteins made famous by longevity scientist David Sinclair’s lifespan research at Harvard.
But throughout my medical career, I was an outlier. (I spoke about cryopreservation for my senior talk for my Stanford internal medicine residency and recalled my program director audibly exclaiming his disbelief.) The language in longevity then revolved around adaptive innovations for aging rather than a focus on slowing—even reversing—age.
The healthcare industry has tried out as many trends as a fashionista over the last couple decades. Digital health was the first attempt to bring healthcare anywhere close to the 21st century. Then there were sub-movements (or marketing buzzwords) promoting wellness, personalized medicine, value-based care, wearables, big data, and of course AI.
But in 2023 and 2024, we have seen a near explosion of interest in the field of longevity. After attending a powerhouse gathering of longevity physicians (held in NYC the past week by Longevity Docs), I’m feeling ever more curious and optimistic about the movement.
Is Longevity Medicine = Good Medicine?
One of the countless polarizing spectra of modern medicine is between population health and individual treatment. On the one end, we need to conduct large-scale studies to prove certain interventions should be guidelines for wide swaths of the population.
On the opposite end of population health is personalized, precision, concierge, executive, VIP, or now longevity healthcare. The closer one looks, the more familiar the shapes and edges of longevity medicine.
Perhaps longevity medicine is what we've all been trying to do all along. Anant Vinjamoori of Modern Age summed it up at the mastermind: “Longevity medicine is meeting a patient where they are and getting them to where they want to be.”
I’ve always thought of that as either personalized medicine or proactive medicine, which was my go-to phrase that hasn't taken off quite (yet). Isn’t this what treating an individual well means? Not everyone wants to live longer, but everyone wants to live better, according to their own values and definitions. Isn’t being a good doctor means understanding the individual patient's goals and helping shepherd their journey there?
Striking a balance - a cautionary note about VIP syndrome
The concept that longevity medicine is simply good medicine was repeated often at the longevity doctors mastermind. And I mostly agree! You want to help a patient get to their health goals. However, because longevity medicine is not covered by insurance (more on that rant another day!), longevity physicians often run concierge, or executive health, practices. But there are dangers of being too much of a concierge for one’s patients.
VIP syndrome, coined in 1964, occurs because doctors want their VIPs (billionaires, world leaders, family and friends, and other physicians) to feel well cared for. There are certainly business incentives to do so. However, this can lead to the exact outcomes you're trying to avoid (following up a mildly elevated liver function test might result in an unnecessary liver biopsy, and so forth). This is the concern many have with full-body MRIs and blood-based cancer screenings. Yet I also agree with the camp of physicians, scientists, and consumers who believe strongly that more data is generally better. The trick is how to interpret the data towards one's health goals.
Theoretically, all good doctors should already abide by evidence and best practices, so they would not need to deviate for their VIPs. But we all know this is simply not true. Perhaps the solution to human fallibility in patient care really is AI 😉.
Driving up risk tolerance
Another way of viewing longevity medicine is in terms of risk tolerance. If you assume that medicine’s broad goal is to improve health, then another axis of differentiation is how strong evidence needs to be before a physician or patient should act on it.
Towards one end, where public and population health lie, massive studies are needed to promote a specific guideline or recommendation since they will impact millions of lives. Longevity medicine, by contrast, is difficult to measure at scale. When you’re aiming to optimize health (a subjective goal in itself) or lengthening one’s life (subject to uncontrollable factors like accidents), you run into complexity of individual differences on the basis of genetics, behavior, and environment.
When you are trying to optimize health, your goal for studies is not to find the lowest common denominator for a large group. It is, instead, to find ways to improve health on an individual basis.
Therefore, longevity medicine often uses N-of-1 studies (or simply measuring an individual’s response to treatments over time) or basic lab research conducted with model organisms like yeast and mice as the theoretical basis for treatments. This necessitates a high risk tolerance, overlapping with practices like biohacking or, in some cases, pseudoscience (acting upon spurious study conclusions).
There is a balance to be made here, and it needs to be done on an individual level. While patients will never have as much knowledge or experience as a physician, we can at least strive to democratize scientific knowledge for the most informed consent in every treatment.
Breaking the psychological barrier
There was once a time when no one believed humans could run a mile in under 4 minutes. Runners for nearly a century fought against this limit with the help of the best coaches. Then, on May 6, 1954, the English Roger Bannister broke the record!
What happened next is known as the Bannister Effect. John Landy broke under 4 minutes a mile just 46 days later. Three runners in the same race broke the limit just a year later. Over a thousand runners have now broken the limit once considered a physical barrier but which is now understood to have been a psychological one.
Medicine today faces a similar psychological barrier. Scientists once considered 120 years to be the limit of the human lifespan before the French Jeanne Calment shattered the record by surviving until 122. Influencers like Bryan Johnson now inspire biohackers and Silicon Valley tech bros alike to reach for not only 120 or 130 years of life, but immortality.
Is this within the realm of possibility? I see too many factors to be able to predict readily whether people alive today will reach longevity escape velocity or the scenario when every year lived sees scientific advancement enough to extend life expectancy by more than one year. But I am certainly hopeful enough to start pushing my actions as a physician and individual toward the possibility that this could be true.
Until next time - Cheers to your health!
Hillary Lin, MD
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