#231 - AMA #41: Medicine 3.0, developments in the field of aging, healthy habits in times of stress, and more

Hey, everyone. Welcome to a Sneak Peek, Ask Me Anything or AMA episode of the Drive podcast. I'm your host, Peter Attia. At the end of this short episode, I'll explain how you can access the AMA episodes in full, along with a ton of other membership benefits we've created. Or you can learn more now by going to peterattiamd.com subscribe. So, without further delay, here's today's sneak peek of the Ask Me Anything episode.

Welcome to Ask me anything episode 41. I'm once again joined by Nick Stenson. Today's episode's a little different than the episodes of the past year. You've probably noticed over the past year we've been doing AMAs around a lot of questions that have come in around the same topics. And then we go super deep dive on one topic. For example, today we do more of what we used to do traditionally with an ama. We just noticed we had so many questions that we hadn't been addressing, and so we really batched them. And at the beginning of the episode, Nick is going to kind of walk you through what the questions are. So I'm not even going to really try to repeat that here. So if you're a subscriber and you want to watch the full video of this podcast, you can find it on the Show Notes page, which of course where we keep all the notes for this podcast. If you're not a subscriber, you can watch a sneak peek of the video on our YouTube page. So without further delay, I hope you enjoy AMA number 41.

Peter, welcome to another ama. How you doing?

I'm doing well.

That's good. We got a little bit of a different vibe for this ama. You know, in the past handful that we've done, we've kind of focused on a few big topics or a collection of topics under one on larger topics. And so what we've been doing is in that time is just collecting a lot of questions that we think are really good, really interesting, that maybe haven't fit in one of the past AMA topics, also maybe that are as a result of one of the past AMA topics. And so what we did is we kind of flagged them all, and we're going to try and get through as many as we can get through here. So it's kind of going to be a little more of an old school AMA on a variety of topics. And when we look at what we're hoping to cover, it's, it's everything from medicine, aging, longevity, questions about your background, where it led you to where you are today. Also questions around how people should think about prioritizing all the various things in their life. We get a lot of questions where it's you guys talk about apob, you talk about labs, you talk about screenings, you talk about sleep, exercise, nutrition, like all these tactics and it can get overwhelming for people. And so we'll hopefully have a good conversation on how you think about that in your life and also with patients as people just try and sort through everything. And then if we have time, we're going to do an old school two minute drill which is have a variety of questions, put two minutes on the clock and see if you can answer it in two minutes. The last time we did this was long ago with you and Bob, and I don't know if we answered any question under two minutes. So we'll see if it's any different here today. But with all that said, anything you want to add before we just get into it?

No, not at all. Let's just do it. But we're not on a two minute clock until you tell me, right?

Yep. These first questions aren't two minute clock. That's much like football, end of the game, two minute drill. So we have some time to ease into it. So the first question we got is one of the phrases that people have often heard you reference throughout the podcast in interviews with other people is this idea of medicine 1.2, 3.0. I also know this is part of the book you're writing. And so it's a topic and a thought experiment that you think about a lot. And we received a lot of questions about people just saying, hey, can you dive into that a little more, Explain more about what you mean and why it's important for people to think about as it relates to their own medical journey. I think this would be a really good foundation for our conversation today. So maybe you can just walk people through what is that and how you think about it.

I don't know where the idea really came from or when it came to me, but it was sometime writing the book, which started in 2016, but I don't think it was in the first version of the book. So the book has really three versions. So I kind of wrote there's a 2016, 2017 version, that of which I don't think anything is preserved. And then there's the second version which is sort of 2017-2020, of which some is preserved. And then there's the version of the book that ultimately will become the book is kind of the 2020-2022 writing. So I'm positive or nearly positive that the medicine 1.0, 2.0, 3.0 thing came from the second version of that book. And it was and remains this idea that says, look, we basically exist in three different phases of medicine, one of which we're, I think, not quite into yet. But we're in the transition. So these transitions are far from discrete. And they take, in some cases, I think the transition from medicine 1.0 to 2.0 took, I don't know, I would argue, from the beginning to the end, 300 years. Okay, so what are they? So medicine 1.0 is when we had no idea of science. Kind of keep in mind science is what. It's such a political term at the moment that that's really unfortunate. But science is a way of thinking. Science is not a person. Science is not an answer. Science is a process. It's a way that we look at the natural world around us. We formulate hypotheses about what explains them based on the physical principles of the universe. We design experiments to test those hypotheses, and we measure the results of those experiments against the predictions of the hypotheses, and then we iterate and correct. It's important to understand like, that we're not naturally wired to do that one. So evolution didn't prepare us to do that. It had no interest in us doing that. I've written at length about this. I think I wrote a blog post on this seven or eight years ago called why We're Not Wired to Think Scientifically. I think we should link to that because I go into much more detail about the timescale of evolution and the process of our thinking. So prior to the invention of this idea, nothing that existed in medicine could be tethered to science. So anytime something happened, you had to come up with an explanation. That's why we have these wonderful brains that we do. We use them to come up with explanations for things that we see happening. But none of it could be linked to. To scientific fact or verifiable or testable hypotheses. So this is where you had sort of all sorts of crazy ideas. You know, if you were sick, it was due to bad humors and was bad spirits and bad luck and all these sorts of things. But there was no sort of scientific basis for that. That kind of started to change in the late 17th century with Francis Bacon. But I would argue that the full transition to medicine 2.0 didn't actually take place until the advent of germ theory in the late 19th century. So that's about 300 years if I'm doing the math right. No, no, no, I'm sorry, it's about 200 years. So we've got about this 200 year period where Joseph Lister all the way up to Fleming and the discovery of penicillin and antibiotics. That to me is the breakthrough of medicine 2.0. So medicine 2.0 comes from basically three things. One is the advent and acceptance of germ theory, the process of scientific thinking. And then really the crown jewel of medicine 2.0, which doesn't come along until much later, is the statistical machinery to enable randomized control trials. So again, because we're trying to be a little bit quick, I won't go into all the details and Bernard Fisher and all of these people who played such an important role in this, but that's basically the trifecta of medicine 2.0. And to be clear, medicine 2.0 has been an amazing, amazing development. I don't think any of us would be sitting here today without medicine 2.0. So I don't want to minimize it, but I want to acknowledge and just pass on. And the book talks more about this so we don't have to get into the great detail. Medicine 2.0 has really peaked. It's been very good at dealing with acute conditions. You get hit by a car, you have a life threatening infection, you suffer an mi, a myocardial infarction, and you want to make sure someone doesn't die and you want to keep somebody alive as long as possible in that acute phase. Medicine 2.0 is amazing for those things. What I argue is that we have reached the limits of Medicine 2.0's capacity. And if longevity is something we are aspiring for, we need a new strategy. We need a fundamentalist shift as 2.0 was from 1.0 and that is to 3.0. And 3.0 is basically predicated on evidence informed as opposed to evidence based guidelines. It is predicated on absurdly early preventative measures for chronic conditions which are now the dominant source of morbidity and mortality. It's no longer acute conditions and it has to be highly personalized. So I'll stop there because again, I could probably spend the hour now talking about that, but I think people now get the sense of what this is. And I'm arguing that we're not, of course yet in medicine 3.0, but we're now in that transition. And what I'm arguing is we should be accelerating that.

And so it's interesting, right, because your medicine 3.0 isn't necessarily people are going to live forever. It's more so just a shift to the three things like you said, which is personalized medicine, early prevention, and evidence informed. Have you ever thought about what medicine 4.0 looks like? Is that even on your radar or is more of the focus is how do we make this huge shift to 3.0 which is going to creates so much benefit for people?

I don't think I have enough clarity as to what medicine 4.0 would look like yet versus things that I don't think I will experience in my lifetime that will just be a part of medicine 3.0, if that makes sense.

And when you think about that transition, which you mentioned more slowly and now do you have an idea of how far out you think medicine 3.0 is not necessarily at the individual level. So you know, there's always a difference when people could access it versus the standard of care. Do you have an idea or any rough idea on when that turn to the standard of care becomes.

No, I think it's too soon to say. It's really going to depend on how quickly people adopt and sort of basically demand change. And I don't think that's possible to predict. Let's use an example that's completely different. But I think if you could go back in a time machine, you wouldn't know, right? So if you went back in a time machine to 18, slavery is the law of the land. The country is completely segregated. I don't think anybody could have reasonably predicted the events of the 1860s and the events of the 1960s, which were two very important pillars in time as it pertained to slavery and ultimately segregation. You just couldn't have predicted that, even though those are both very social changes. Now, maybe there's a historian that will argue no, it was crystal clear in 1850 that we were 15 years away from a civil war and 100 years away from a civil revolution. But I don't believe that and I certainly don't think we can do the.

Same here on the book piece. I know you've been working on the book for a long time because I've known you during that stretch, but I wasn't necessarily aware of the 2016-2017 initial book that nothing made it really into the final copy.

Nothing. All of it went straight into the wastebasket.

So for everyone who's been anxious, kind of banging at the door, good thing we waited a little bit to get that out huh?

Yep.

Love it. So the next set of questions we receive in one form or another almost weekly, which is even people who followed you for a while and people who are kind of newer to following you, they, they often will ask a variety of questions. They either might be in school, med school, really interested in longevity might be doctors, and they're really trying to understand where your knowledge on this came from and how you've put into practice what you're trying to do with your patients in medicine 3.0. Because it seems like from knowing you, a lot of what you do with your patients and didn't necessarily come from what you learned in med school and or what you did in residency. And so I think what might be helpful to people is just if you want to give people a walkthrough of your background and how it's led to where you are today, which is ultimately practicing medicine 3.0 with your patients.

Thank you for listening to today's Sneak Peek AMA episode of the Drive. If you're interested in hearing the complete version of this ama, you'll want to become a member. We created the membership program to bring you more in depth exclusive content without relying on paid ads.

Membership benefits are many and beyond the.

Complete episodes of the AMA each month. They include the ridiculously comprehensive podcast show notes that detail every topic, paper, person and thing we discuss on each episode of the Drive, access to our private podcast feed, the Qualys, which are a super short podcast, typically less than five minutes, released every Tuesday through Friday, which.

Highlight the best questions, topics and tactics.

Discussed on previous episodes of the Drive.

This is particularly important for those of.

You who haven't heard all of the.

Back episodes becomes a great way to.

Go back and filter and decide which ones you want to listen to in detail.

Really steep discount codes for products I.

Use and believe in but for which I don't get paid to endorse, and benefits that we continue to add over time. If you want to learn more and access these member only benefits, head over to peterattiamd.com subscribe lastly, if you're already a member but you're hearing this, it means you haven't downloaded our member only podcast feed where you can get the full access to the AMA and you don't have to listen to this. You can Download that@peterattiamd.com members.

You can find me on Twitter, Instagram and Facebook, all with the ID peteratti amd. You can also leave us a review on Apple Podcasts or whatever podcast player you listen on this podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice. No doctor patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice from any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. Finally, I take conflicts of interest very seriously. For all of my disclosures and the companies I invest in or Advise, please visit PeterAttiamD.com about where I keep an up to date and active list of such companies.

Sam.