I find it easy to get caught up in all the positive developments in the longevity field; and people are quick to highlight their successes while they are much more reticent on the hiccups / failures / problems in the field.

So I appreciate the doses of reality you get when people reveal when things are not going to plan, because in real life I find things rarely go exactly as you had hoped.

At the most recent Longevity Clinic Roundtable conference they had a presentation by a concierge medicine doctor (runs a series of clinics around the country for the wealthiest) and he had a slightly different perspective than most of the presenters. At all of these conferences (as with any commercial conference) virtually everyone is trying to sell you something in one way or another. So you always have to be skeptical and dig into what they are not telling you. And in this specific case you might say that the doctor presenting is also selling himself and his more traditional concierge medicine clinics that are as a class of organizations are seeing their customers turn more and more to the “cutting edge” longevity clinics and groups that are pushing the envelope more (think of the stuff that Bryan Johnson is doing). So in some ways you could look at this presentation below as just a natural reaction from the more traditional doctors, to a threat to their business.

But - I think there is also something to be learned here, and its always valuable to get opinions and data from multiple perspectives, so I encourage you to review the slides and listen to the presentation (see the audio file I’ve attached).

Many of us here are pushing the envelope when it comes to longevity medicine. And its easy to be optimistic and visualize the positive outcomes of people successfully using these approaches to live longer, healthier lives. But when you push the bleeding edge of medical technology, its inevitable that some people are going to get negative results. So, I think its important to keep this in mind, and take as many actions as you can to avoid these types of outcomes.

You are never going to hear about the mistakes, the screw ups, or the bad outcomes, from the Longevity clinics or related suppliers themselves. So, its a breath of fresh air (in my mind) to hear from the people who are left holding the bag, and doing the “clean up” after something goes awry. In this case, its the regular doctors who have to help get the person back to health after something goes wrong in the longevity clinic. In this sense, as Dr. Shlain points out below, the incentives in this new era of longevity medicine are a little off, and as a result “Moral Hazard” is encountered. The stem cell clinic that sells you a service (in this case, for $100,000) incurs none of the costs associated with nursing a person back to health when things go wrong. Its the traditional medical system that bears the burden, and of course, the person who is suffering the negative results.

It also occurs to me that there is “moral hazard” in the health insurance industry in the USA, where companies like UnitedHealthcare get “paid” by refusing medical treatment to people, and the failure of treatment falls on the rest of society, to the companies who’s employees don’t get proper treatment, to the emergency rooms of hospitals that are overburdened by situations that could have easily been avoided if treated earlier, to the individuals and families that are directly impacted. Life Expectancy in the USA (Bad and Getting Worse) - #287 by RapAdmin

Anyway - for anyone who is enthusiastic about the longevity field’s progress, its a good idea to listen and learn about when things go wrong, and try to understand why, and how to avoid these types of situations for yourself in the future.

Here is the Audio File that covers most of the presentation. I’d recommend listing to it as you scroll through the slides below: (sorry for the poor quality of the audio, it’s hard to take photos and record on your phone at the same time).

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Note, in the images immediately below, the black circle on the right of the image is supposed to include the text “Doctor”












Ethics: Moral hazard occurs when one party is insulated from risk and therefore behaves differently than they would if they bore the full consequences of their actions










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@RapAdmin Thank you for sharing. I need a dose of cold, hard reality every now and then to stay out of the red zone. The more I think about my willingness to engage in wishful thinking and the limitless ability of propaganda (marketing) to twist my thinking, the more I understand the medical profession and the 1st rule: do no harm.

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I agree. I think all people who are pushing the envelope need to pause and rethink occasionally.

It also seems that as people are considering pushing the envelope a bit, they need to have contingency plans in case things go wrong. Its one thing to do these more aggressive approaches if you’re centi-millionaire or billionaire with concierge doctors on the call 24 hours a day if you have any issues. These people have a good safety net.

If the same scenario (e.g. the stem cell incident above) happened to a typical biohacker they’d have been in the typical local ER room waiting for hours or days, and then trying to explain to the front-line doctor what his stem cell treatment was, and would likely have been dead before the ER doctors could have reached the stem cell doctor on vacation (would they have even tried?).

So - a valuable question as people push the envelope, may be to ask yourself what might be the response time you could expect from your personal doctor if something bad happens, and how quickly could you see a medical expert or get help if things go seriously wrong. How knowledgeable are the medical people you would be visiting regarding the specific biohack you are trying? Always have a backup plan in mind?

Always review your planned protocol with the question in mind of how you can lower the risk. E.g. lab testing for purity any injectable, etc.

Perhaps Bryan Johnson’s follower’s motto should be: "Don’t Die (while trying some extreme new longevity hack)

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Listening to opposing perspectives is always valuable for maintaining a balanced view. I recently stumbled across “urine therapy”—yes, people actually drink urine, claiming it can cure diseases. Curious why anyone would buy into this, I looked it up. Turns out, there’s a whole pseudo-scientific system behind it, with stories from regular folks and even endorsements from people like an Indian Prime Minister or Madonna. They’ve even created “proper” methods for drinking it, and if it doesn’t work, they say you did it wrong. It’s a perfect example of how echo chambers can make the weirdest ideas seem normal.

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Should be required reading for everyone on this forum.

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I wonder if the lazy people are going to have the best outcomes.

“My lipids are suboptimal” → “Okay, I’ll take a statin and other meds”
“My blood pressure is suboptimal” → “Okay, I’ll take a BP lowering med and watch out for dizziness”
“I don’t want skin cancer, a lot of skin aging” → “Okay, I’ll use a good sun screen, and cover up a bit”
“My weight or body composition is suboptimal” → “Okay, I’ll use a GLP-1 agonist, and maybe find some exercise I like”

Then one day maybe a rejuvenation therapy or treatment is on the market.

“I’m aging and getting disease and disability” → “Okay I’ll take X drug”

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My favorite slide is the hierarchy of modern medicine showing critical thinking prism through which you evaluate longevity interventions.

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If by lazy you include not exercising, then no they won’t have the best outcome.

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Is there any one of those concierge doctors at the longevity roundtable who would be willing to give prescriptions for anti-aging drugs to someone who sees them? (Or at least, orders for rupahealth blood tests for ION blood panels? Or prescriptions for diagnostic MRI?)

Like, I met one at Zuzalu who kind of does those things but only for people in certain states.

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image

Interesting guy.

The following is from 2017. Choose your multiplier to get current year $


https://archive.fo/VJg0s

.org? Somehow I don’t think this is a 501(c)(3).

Look who’s part of their expert network!

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Like with anything, you offer a service for a price, and if people think it’s good value, you got a going business.

Everyone has to make a living. I have nothing against concierge docs. For my particular situation at this time, I don’t perceive the need. But who knows in the future. Right now, I see no value (for me) with these clinics.

What do you need, and what is the value proposition. At some point there may be a match. You pick a number you feel comfortable with, put your chips down, and the wheel spins. You might win, and you might lose. That’s life.

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I only met one doctor there who was prescribing rapamycin (and I added him to our list; Joseph Raffaele in NYC. I’m sure some of the others do the other services you mention, but I wasn’t surveying them; you’d have to check their websites and see what they offer. In many cases they are trying to get you to sign up for a yearly service with all-encompassing health reviews and testing… so I suspect they are not a good fit for your service interests. Longevity Clinics: Cleveland Clinic, Wellness and Preventive Medicine, Michael F. Roizen MD

But - I also noticed that Phil from Longevity Technology mentioned a survey they did of longevity clinics and many of them are prescribing rapamycin and/or metformin - so it seems you need to find the right ones:

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What evidence is there that exercising is required for the best outcome, and what’s defined as best?

Really - you need more evidence? Have you reviewed all in the forum?

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I think it’s okay to do decisions based on what you feel or think is right. But I wouldn’t say there was much good evidence posted in that thread: randomized trials, mendelian randomization studies, and clear mechanism of action for the former two.

So it’s more like artists debating how they should paint a painting rather than scientists arguing about what has the true impact and that’s OK.

Peter Attia is biased towards exercise as he is a former competitive athlete, which might be the reason he loves to bring up correlations for VO2Max but dislikes it for pepperoni’s.

Your bias is very strongly anti-exercise:

Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing

Conclusions and Relevance Cardiorespiratory fitness is inversely associated with long-term mortality with no observed upper limit of benefit. Extremely high aerobic fitness was associated with the greatest survival and was associated with benefit in older patients and those with hypertension. Cardiorespiratory fitness is a modifiable indicator of long-term mortality, and health care professionals should encourage patients to achieve and maintain high levels of fitness.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2707428

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Increasing VO2Max isn’t free there are costs involved (calories, effort, joints, hips, injury risk, time). I feel like going on the bike and start exercising a lot based on an association study seems a bit radical. I’d have to look at hip replacement rates and things like that.

Calories need to be burned, get rid of them. Effort is good for you, it prepares you for bad times which are sure to come. With your attitude about exercise you don 't have to worry about your joints, hips, injury risk. It’s not happening. It does not take long to exercise, do it hard and get on with life.

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