With a two-month summer break, I had the chance to close my medical school textbooks and read for leisure. While I initially experienced a Pavlovian aversion to books related to science or medicine, I eventually found myself reading Outlive: The Science and Art of Longevity by Peter Attia.
Attia’s thesis rests on the distinction between the current approach of Western medicine, “Medicine 2.0,” and an updated framework, “Medicine 3.0.” In his telling, Medicine 2.0 focuses on the treatment, rather than prevention, of the “four horsemen” of chronic diseases:
- Cardiovascular disease
- Cancer
- Neurodegenerative disease (including Alzheimer’s and other forms of dementia)
- Metabolic disease (such as type 2 diabetes)
In contrast, Medicine 3.0 would proactively intervene to delay the onset of these conditions, lengthening lifespan (the number of years a person lives) and improving healthspan (a person’s overall quality of life).
To better understand why the ostensibly obvious strategies of Medicine 3.0 have yet to be implemented at scale, let’s explore some proposed preventive interventions for the “Four Horsemen” diseases.
Example 1: Early statin treatment for cardiovascular disease risk reduction
More aggressive statin use is discussed as a proactive strategy to lower low-density lipoprotein (LDL) cholesterol, a major risk factor for cardiovascular disease. While effective, statin prescriptions for younger individuals (less than 40 years old) may not be covered under current insurance guidelines, making their cost prohibitive for some at-risk patient populations.
Example 2: Early cancer detection through liquid biopsies and increased screening
Noninvasive liquid biopsies and increased cancer screening can lead to earlier detection, enabling timely treatment and potentially improving survival rates. However, false positives from increased screening could lead to overdiagnosis, resulting in unnecessary invasive procedures or treatment regimens that negatively impact quality of life.
Example 3: APOE E4 allele genetic testing for Alzheimer’s disease
Apolipoprotein (APOE) E4 allele testing can identify genetic susceptibility to late-onset Alzheimer’s disease, allowing for informed lifestyle choices and potential early interventions. Since a positive result does not guarantee disease development, these types of genetic testing results could cause anxiety and psychological distress in patients.
Example 4: Proactive nutritional interventions to prevent metabolic disease
Attia emphasizes personalized approaches that incorporate dietary restriction (what a person eats), time restriction (when a person eats) and caloric restriction (how much a person eats). Implementing one or more of these strategies can be effective in managing blood sugar levels and improving insulin sensitivity. But in practice, these sustained dietary changes can be challenging to maintain, especially for patients living in “food deserts” with limited access to unprocessed, nutrient-rich foods.
Medicine 3.0, as advocated by Attia, envisions a future where health care goes beyond treating diseases to promoting longevity through evidence-based interventions. However, the adoption of these practices might be slowed by concerns of health equity and limited accessibility within our current health care infrastructure. As Medicine 3.0 evolves, striking a balance between science, ethics and individual empowerment will be crucial in realizing its potential.
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