When Dr. Peter Attia introduces his patients to his approach to medicine, he talks about icebergs.
“Specifically, the ones that ended the first and final voyage of the Titanic,” he writes in his terrific book Outlive.
At 9:30 p.m. on that fatal night, the immense ocean liner received an urgent message from another ship that it was sailing into an ice field.
The message was ignored.
“More than an hour later, another ship telegraphed a warning of icebergs in the ship’s path,” Peter writes. “The Titanic’s wireless operator, busy trying to communicate with Newfoundland’s overcrowded airwaves, replied (via Morse code): ‘Keep out; shut up.'”
There were other challenges. The Titanic was traveling too fast on a foggy night with poor visibility. The water was also unusually tranquil, giving the crew a false sense of security.
There was a set of binoculars on board the ship. However, they were not being used as the ship’s lookout depended on his eyesight alone.
“Forty-five minutes after that last radio call,” he notes, “the lookout spotted the fatal iceberg just five hundred yards ahead. Everyone knows how that ended.”
If it were fifteen years later, the ship would have had radar and sonar. But it didn’t.
Today, ships rely upon GPS and satellite imaging. “Rather than trying to dodge through the maze of deadly icebergs, hoping for the best, the captain could have made a slight course correction a day or two before and steered clear of the entire mess.”
2: Which is what modern-day captains do.
“Thanks to improved technology that has made Titanic-style sinkings largely a thing of the past,” Peter writes, “relegated to sappy, nostalgic movies with overwrought soundtracks.”
Today’s medicine is similar to seafaring in 1912 when the Titanic sank.
“The problem is that in medicine our tools do not allow us to see very far over the horizon,” Peter observes. “Our ‘radar,’ if you will, is not powerful enough. The longest randomized clinical trials of statin drugs for primary prevention of heart disease, for example, might last five to seven years. Our longest risk prediction time frame is ten years.
“But cardiovascular disease can take decades to develop.”
3: There is an emerging approach to medicine that uses a longer lens. Peter calls it “Medicine 3.0.”
“A forty-year-old should be concerned with her thirty- or forty-year cardiovascular risk profile, not merely her ten-year risk,” he writes. “We therefore need tools with a much longer reach than relatively brief clinical trials.
“We need long-range radar and GPS, and satellite imaging, and all the rest. Not just a snapshot.”
Peter tells his patients he wants to be the navigator of their ship.
“My job, as I see it, is to steer you through the icefield,” he notes. “I’m on iceberg duty, 24-7. How many icebergs are out there? Which ones are closest? If we steer away from those, will that bring us into the path of other hazards?
“Are there bigger, more dangerous icebergs lurking over the horizon, out of sight?”
That’s what Medicine 3.0 promises.
More tomorrow!
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Reflection: What are my assumptions about aging? What was my parents’ or grandparents’ experience of getting older? Will that be my fate as well?
Action: Journal about my answers to the questions above.
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