We are Keeping People Sick Longer - We Need Medicine 4.0
Author and physician Peter Attia popularized the concept of "Medicine 3.0", the third in a series of distinct phases—Medicine 1.0 and Medicine 2.0 included—that describe the evolution of medicine as we know it.
In this episode, Matt takes us through these phases and proposes a "Medicine 4.0" as the best next step beyond Peter's Medicine 3.0. He discusses the reactive disease care approach of Medicine 2.0, noting that while it has done a stellar of job of increasing life expectancy through developments such as widespread antibiotic use, sanitation improvements, and childhood mortality reductions, it has not been quite as useful at improving healthspan. People may stay alive for longer than they used to, but many of them spend this extra time alive suffering from at least one significant chronic disease or disability that significantly impedes their vitality and quality of life. Matt suggests several approaches we should take to kick off Medicine 4.0 and also presents an even longer-range version of the future: Medicine 5.0.
Check out the links below for further information and/or reading about some of the things we discussed in this podcast episode. Note that we do not necessarily endorse or agree with the content of these readings, but present them as supplementary material that may deepen your understanding of the topic after you listen to our podcast. This list is in no way exhaustive, but it’s a good start!
The concept of Medicine 3.0 comes from author and physician Peter Attia. In this "Ask Me Anything" episode of the Peter Attia Drive podcast, Peter discusses medicine's trajectory through Medicine 1.0, 2.0, and 3.0. He describes each phase thoroughly and argues that while Medicine 2.0 has served us well in some ways, we have reached the limits of its capacity and need to create another fundamental shift to Medicine 3.0 if we want to meaningfully extend human longevity.
If you're pressed for time, here's the CliffsNotes version of Medicine 3.0 from Peter Attia.
How healthy is the healthspan concept?
In 2018, Matt published this article exploring the concept of healthspan and the lack of clarity in the usage of the term. He notes that while a common definition of healthspan is “the period of life spent in good health, free from the chronic diseases and disabilities of aging”, there are many issues with this definition—for example, are all diseases equal in heralding the end of healthspan? If you are simply frail and get sick more often, has your healthspan ended? He discusses the implications of imprecise definitions of healthspan for interpreting new findings in the geroscience field.
In Search of Methuselah: Estimating the Upper Limits to Human Longevity
Published in 1990, this paper argues that major life expectancy gains past 83 years at birth are unlikely to happen absent truly transformative discoveries in modulating biological aging. The paper includes data that highlights the ineffectiveness of a one-by-one approach to curing disease in significantly extending human lifespan: for example, curing all forms of cancer would increase life expectancy at birth by only 3.17 and 3.2 years for females and males respectively, while curing all ischemic heart disease would increase life expectancy at birth by only 3.0 and 3.5 years for females and males respectively.
Articulating the Case for the Longevity Dividend
This paper, whose author S. Jay Olshansky is the lead author on the previous paper in this list, argues that making progress on major individual diseases such as cardiovascular disease and cancer will have diminishing returns on enhancing longevity. As Matt does in this episode, the paper makes the case for tackling the biology of aging as more effective armor against multiple chronic diseases than any intervention currently available.
