"Is longevity medicine just functional medicine x precision medicine plus some scans?”
~A primary care physician genuinely confused about the longevity movement
Is longevity medicine supposed to be a modern, concierge version of primary care? Or is it supposed to be an addition to primary care services? What even is primary care?? (A loaded question for another piece.)
The new longevity clinical care platforms look like a hybrid of functional and precision medicine with an added dab of cash and consumerism. With VC backing and flashy branding, I can understand why it perhaps feels like a marketing reframe for conventional physicians.
Because it kind of is. But, marketing is another way of defining meaning for people, and meaning is everything.
Ground Rules. What is Longevity Medicine?
The emerging field of longevity medicine might be just Wellness 2.0 with doctors. Or it could be the field that unlocks immortality. Everyone from tech bros to academics debate on the actual definition of what constitutes longevity medicine, with each player claiming a piece of the industry (while it's hot, anyways).
In my view, longevity medicine is the pinnacle of functional, integrative, precision, preventive, and personalized healthcare. But while functional or precision medicine takes a paragraph to describe, longevity medicine is instantaneously something anybody could get behind.
Whether it includes regenerative interventions like peptides and stem cells, or is simply optimized evidence-based healthcare, the common ground definition of longevity medicine is its mission to extend not just lifespan but healthspan—the period of life spent in good health, free from the chronic diseases and disabilities of aging. It integrates advancements in biotechnology, personalized medicine, and preventive health strategies to delay (or even prevent!) the onset of age-related decline.
The most dastardly attribute of longevity medicine is its defiance of our current "sickcare" system, aiming instead at promoting health to eliminate disease before it occurs.
Integrating Complementary Therapies
A colleague of mine once had a patient who was lost to follow up after her leukemia diagnosis. She finally turned up a few weeks later, still very much sick with leukemia, but also with a septic infection from injecting home-brewed kombucha into her veins.
Experiences like this have turned physicians against "alternative medicines," which by definition, are interventions outside conventional medicine.
However, conditions like cancers and autoimmune diseases teach us that conventional medicine doesn't have all the answers. I myself practiced in the "gray area" when there are no conventional answers, for example allowing cancer patients to consume their own medicinal marijuana to assuage their pain and nausea while hospitalized. (Marijuana is on no hospital pharmacy's formulary, as far as I'm aware.)
The compromise approach is that of integrative health, which is conventional medicine with the addition of complementary therapies. What are complementary therapies? Well, they're sort of like alternative therapies but the phrasing is different because they're used in addition to, rather in place of, conventional treatments. Acupuncture, medicinal marijuana, psychedelics, meditation, and massage are all deemed safe enough to recommend but not quite evidence-based enough to fall within the boundaries conventional medicine.
The field of longevity, even more so than oncology or immunology, is one without clear answers from conventional medicine. The addition of complementary or integrative therapies that have a non-zero chance of being helpful and a smaller chance of being harmful can sometimes reveal surprising, and hopefully positive, results.
Finally, integrative medicine treats the whole person—mind, body, and spirit—rather than just addressing isolated symptoms. This is a welcome approach in a healthcare system that tends to reduce humans to billable diagnoses and interventions (it all comes back to the money $$).
Where Does Functional Medicine Come In?
Synonymous with root-cause medicine, functional medicine seeks to focus on getting the patient healthy, with beneficial side effects being weight loss, pain resolution, and all the symptoms conventional medicine tackles more directly.
Functional medicine, like integrative health, is often seen as somewhat "outside" conventional medicine. It also has a more holistic (another loaded term!) approach, much like integrative health, treating the body as an interconnected system. Where conventional medicine might give a chronic fatigue patient stimulants to mask symptoms, functional medicine would dig deeper, looking at potential underlying causes such as gut dysbiosis, nutrient deficiencies, or hormonal imbalances.
Longevity medicine benefits from functional approaches because if you're seeking to live longer, you want to solve illness at its root (rather than bandage the symptoms with pills forever). The two fields also overlap heavily in their somewhat obsessive (over)analysis of nutrition, physical activity, and environmental toxins.
Due to a lack of clarity and studies when it comes to root-cause medicine, both longevity and functional medicine suffer from a decent exposure to hocus pocus, or pseudomedicine. Such practices have little to no verifiable scientific evidence to back them, but a ton of astrology and narrative pull.
If anything, there's simply an attitude difference between the two medicines. Longevity enthusiasts are rather more ambitious (see below) in their approach - fasting longer, taking more medications, and exercising harder.
A Core of Precision Medicine
Steve Jobs, whose innovations transformed our world forever, sadly died in 2011 of pancreatic cancer.
What most people don't realize is that he did not die of the more well-known pancreatic adenocarcinoma, but rather from a pancreatic neuroendocrine tumor (NET). My research at Stanford with my mentor Dr. Pamela Kunz focused on this rare type of cancer. Specifically, we were doing the rather tedious work of mapping the myriad of ways NETs were described in pathology reports.
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128,000 Americans suffer harm annually due to delayed cancer diagnosis or incorrect cancer diagnosis. (Imagine how integration of LLMs with advanced semantic search might be able to assist here!) For this reason, oncologists started defining types of cancer by their biological features rather than their location in the body (which has far less import for the type of treatment). Because of this, we can now design custom treatments based on the specific genetic mutations present in a patient’s cancer.
Similarly, precision medicine aims to treat a patient as a unique combination of genetics and biology rather than a template based on a generalized population. Longevity medicine utilizes the techniques of precision medicine to collect data at the minute level, continuously if possible. This allows for what is commonly referred to as "N of 1" studies, referring to the concept of experimentation and iterating interventions according to measurable results.
Why don't all doctors do this? Corporate medicine has turned clinics into 15-minute assembly line engines, forcing most conventional physicians to practice algorithmic care. This also explains why longevity medicine utilizes, by necessity, a cash-pay model. Insurance would never allow for the cost and time spent on precision-level medical care.
Side note: The advent of AI-assisted medicine may help, and is necessary if we ever hope to practice precision medicine at a population level.
The Key Addition of Hope
Longevity medicine also represents the hope for a day when we reach longevity escape velocity. This is the concept referring to the point at which our rate of medical progress outpaces the rate of aging, essentially rendering age-related decline meaningless. This differentiates longevity medicine from optimized primary care, evidence-based preventive medicine, functional health, or precision medicine.
99.9999999% of doctors scoff at this perceived delusional optimism, because it's easy to be a cynic. It's also almost always more correct to be pessimistic. After all, every human in history has aged and died, so why should we be any different?
But now we live in a world where the status quo of healthcare is so incredibly broken that some of us are daring to dream. Technological progress is now proceeding at a rate that is beyond imagination. What would artificial general intelligence (AGI) make of our health problems today?
Higher Standard, Intensity, and Focus
Longevity Escape Velocity is a (near) impossible goal for most of us living today. But for those of us who are delusional and competent enough, we may be able to achieve this goal with adequate determination and a heavy dose of luck.
Longevity medicine demands a higher standard of care, greater intensity, and a laser focus on results. It’s akin to the precision and determination demonstrated by my singularly favorite fictional characters - John Wick. In his world, every action is deliberate, every move calculated, and the end goal unwavering. This relentless pursuit of excellence drives innovation and pushes the boundaries of what we can achieve in health and longevity.
Where We Stand Today
While it might seem like a rebranding of existing medical disciplines, I believe that it's the concept of longevity medicine which represents a seismic paradigm shift. By integrating the best of functional, precision, and integrative health with disciplined focus, we have the opportunity to create a type of healthcare that not only prevents and treats disease better, but also fosters hope and empowerment.
There is valid skepticism and criticism given the hype, including concerns about hype, inequity, and unproven interventions. As the field evolves, it must be held to rigorous standards of evidence and ethics, striving to be accessible to all.
Despite the challenges, the potential impact of longevity medicine is too significant to ignore. If successful, it could transform individuals, societies, and economies, ushering in a future where the majority of people live to 100 and beyond, free from the diseases and disabilities of aging.
Delusional much? Challenge accepted.
Until next time - Cheers to your health!
Hillary Lin, MD
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