November 14, 2022

Science of Aging

#231 – AMA #41: Medicine 3.0, developments in the field of aging, healthy habits in times of stress, and more

“We have reached the limits of medicine 2.0 capacity, and if longevity is something we are aspiring for, we need a new strategy.” —Peter Attia

Read Time 26 minutes

In this “Ask Me Anything” (AMA) episode, Peter answers a wide variety of questions, starting with a discussion on the evolution of medicine and the hopeful transition to “Medicine 3.0.” Peter recounts his unique career path and explains how he assesses risk and utilizes frameworks for decision-making. He also describes how he prioritizes his health while navigating the stresses of life, and he reviews the most exciting developments in the aging and longevity space. He finishes with some rapid-fire questions on cold plunging, strategies for lowering apoB levels, designing an exercise program for beginners, and more.

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We discuss:

  • The evolution of medicine and the transition to “Medicine 3.0” [3:00];
  • Peter’s unorthodox career arc and what led him to this point [11:45];
  • What does Peter consider to be his superpowers? [22:15];
  • How Peter thinks about risk and explains it to his patients when making medical decisions [26:45];
  • The advantage of using frameworks for decision-making [37:00];
  • What advice would Peter give his 30-year old self? [42:15];
  • Why longevity is such a hard problem to solve [42:30];
  • The most impactful developments in the field of longevity and aging in the last 5 to 10 years [46:15];
  • What is Peter most excited to see develop in the health and longevity space in the next few years? [51:30];
  • Prioritizing healthy habits while navigating the stresses of life and time constraints [53:45];
  • How Peter navigates periods of high stress [58:00];
  • What fitness watch did Peter recently purchase? [1:03:45];
  • Potential benefits of cold plunging [1:05:15];
  • Advice for someone beginning an exercise program [1:07:30];
  • Strategies and tactics to lower apoB levels [1:09:00];
  • Interesting studies and books Peter has recently read [1:11:30]; and
  • More.

§

The evolution of medicine and the transition to “Medicine 3.0” [3:00]

Evolution of medicine from Medicine 1.0 to 2.0 to 3.0

Medicine 1.0 is when we had no idea of science

  • Science is a way of thinking—not a person, not an answer—science is a process
  • It’s a way that we look at the natural world around us and formulate hypotheses about what explains them based on the physical principles of the universe
  • We design experiments to test those hypotheses and we measure the results of those experiments against the predictions of the hypotheses
  • and then we iterate and correct
  • However, evolutionarily, we’re not naturally wired to do that 
  • Prior to the invention of this idea, nothing that existed in medicine could be tethered to science
  • Any time something happened, you had to come up with an explanation
  • But none of it could be linked to scientific fact or verifiable or testable hypotheses
  • This is where you had all sorts of crazy ideas

Medicine 2.0

  • Medicine started to change in the late 17th century with Francis Bacon
  • Peter would argue that the full transition to medicine 2.0 didn’t actually take place until the advent of germ theory in the late 19th century
  • So that’s about a 200 year period where Joseph Lister all the way up to Alexander Fleming and the discovery of penicillin and antibiotics
  • This was the breakthrough of medicine 2.0 which basically comes from three things:
    • 1 – the advent and acceptance of germ theory
    • 2 – the process of scientific thinking
    • 3 – The statistical machinery to enable randomized control trials (the “crown jewel of medicine 2.0”) 
  • But Peter believes we’ve reached a plateau with medicine 2.0: “Medicine 2.0 has been an amazing development. I don’t want to minimize it, but I want to acknowledge [that] Medicine 2.0 has really peaked.” 
  • It’s been very good at dealing with acute conditions
    • I.e., You get hit by a car, you have a life threatening infection, you suffer an MI, myocardial infarction and you want to make sure someone doesn’t die and you want to keep somebody alive as long as possible in that acute phase

“We have reached the limits of medicine 2.0 capacity, and if longevity is something we are aspiring for, we need a new strategy.” —Peter Attia

Medicine 3.0

  • We need a fundamental shift just like 1.0 to 2.0, we need to go from 2.0 to 3.0
  • Medicine 3.0 is basically predicated on evidence informed as opposed to evidence based guidelines
  • It is predicated on absurdly early preventative measures for chronic conditions (not acute conditions), which are now the dominant source of morbidity and mortality
  • Medicine 3.0 has to be highly personalized
  • We’re not yet in medicine 3.0, but we’re in that transition and Peter thinks we should be accelerating that

When you think about that transition, do you have an idea of how far out you think medicine 3.0 is?

  • Too soon to say as it’s going to depend on how quickly people adopt and demand change

 

Peter’s unorthodox career arc and what led him to this point [11:45];

Peter has an interesting career path with many different experiences that has shaped his thinking and brought him to where he is today with his medical practice

A lot of what Peter does your patients didn’t necessarily come from what he learned in med school or residency

So how did he get to where he is today?

{end of show notes preview}

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  1. Peter’s next career – learn guitar and tour around impersonating Tom Morello.

    Also, more seriously, reducing LDL-C (or ldl-p/apoB) is a main principal repeated. It seems of methods to do this, pcsk9 would be the best option since it is closest to the switch you are trying flip. Since statins start upstream of that switch, what is Peter’s thoughts on the known and unknown side effects that come along for the ride? Is there a trade off trying to take LDL down that low with statins since it’s not just flipping off the switch to a room but an entire floor? Or is the risk/reward so skewed it is worth it?

  2. Awesome pod. Loved hearing more about Peter’s history and that the book is…almost done! Are you willing to share Peter’s 8 question framework?

  3. I have Coros Pace2 watch, very accurate HR compared to chest strap, some trouble when sweating heavily

  4. Great AMA. Could you share the “card” that Peter carries with him showing the lipid level by percentile by age? Or the reference to that data? Thanks!

    Also- Peter mentioned that many would not agree with his desired level of Apo B. How low does he like it?

  5. Appreciate the recent podcasts with some of the focus on woman’s health and what needs to be done, if anything, differently to prevent the onslaught of chronic disease. Also appreciate comments that highlight how therapies might change for different age groups.

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