1: “Many pundits have been predicting a glorious new era of ‘personalized’ or ‘precision’ medicine, where our care will be tailored to our exact needs, down to our very genes,” Dr. Peter Attia writes in his book Outlive: The Science and Art of Longevity.
Which is a clearly a worthy goal.
The only problem with this approach?
Peter likens it to building a self-driving car in the 1950’s.
Our “best option might have been to strap a brick to the accelerator,”
The vehicle would be able to go forward. But it would not be able to slow down, stop, or avoid obstacles.
Not ideal!
“But does that mean the entire concept of the self-driving car is not worth pursuing?” Peter asks.
Not at all. It simply means we lacked the necessary tools at that time.
2: Peter believes this metaphor applies to medicine as well.
“Two decades ago, we were still taping bricks to gas pedals, metaphorically speaking,” he writes. “Today, we are approaching the point where we can begin to bring some appropriate technology to bear in ways that advance our understanding of patients as unique individuals.”
Still, “our idea of personalized or precision medicine remains some distance ahead of the technology necessary to realize its full promise.”
There is, however, an innovative, new approach to medicine, which is very much here today. It requires not technology but a change in our mindset.
Peter calls it Medicine 3.0.
Medicine 1.0 began with the ancient Greeks and lasted until the middle of the nineteenth century. Its conclusions were on direct observation and mainly were guesswork.
Medicine 2.0 kicked in around the mid 1800s with the discovery of germ theory and later antibiotics. It emphasized the scientific method of experimentation and eradicated many deadly diseases.
Medicine 2.0, however, has proven much less effective in combating what Peter calls the Four Horsemen: Cancer, heart disease, neurodegenerative disease, and type 2 diabetes.
3: Medicine 3.0 takes a different approach:
First, “Medicine 3.0 places a far greater emphasis on prevention than treatment,” he writes.
When did Noah build his ark? Way before it started to rain.
“Medicine 2.0 tries to figure out how to get dry after it starts raining,” he notes. “Medicine 3.0 studies meteorology and tries to determine whether we need to build a better roof, or a boat.”
Second, “Medicine 3.0 considers the patient as a unique individual,” Peter observes. “Medicine 2.0 treats everyone as basically the same, obeying the findings of clinical trials.”
In reality, there are no “average” patients.
Medicine 3.0 looks carefully at the data “to determine how our patient is similar or different from the ‘average’ subject in the study, and how its findings might or might not be applicable to them.”
Third, Medicine 3.0 involves a shift in our perception of risk.
“Our starting point is the honest assessment, and acceptance, of risk—including the risk of doing nothing. . . At the level of the individual patient, we should be willing to ask deeper questions of risk versus reward versus cost for this therapy–and for almost anything else we might do.”
“The fourth and perhaps largest shift is that where Medicine 2.0 focuses largely on lifespan, and is almost entirely geared toward staving off death, Medicine 3.0 pays far more attention to maintaining healthspan, the quality of life.”
Creating more years where we are free from disability and disease was not a topic that was discussed when Peter was in medical school.
“My professors said little to nothing about how to help our patients maintain their physical and cognitive capacity as they aged,” he writes.
“The word exercise was almost never uttered. Sleep was totally ignored, both in class and in residency, as we routinely worked twenty-four hours at a stretch. Our instruction in nutrition was also minimal to nonexistent.”
The bottom line?
The goal of Medicine 3.0 is to thrive “in every way, throughout the latter half of our lives,” he notes.
More tomorrow.
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Reflection: How might I change my mindset regarding my health to focus more on prevention than treatment?
Action: Discuss with a colleague, friend, or family member.