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

00:00:00.000 Hey everyone, welcome to a sneak peek, ask me anything or AMA episode of the drive podcast.

00:00:16.500 I'm your host, Peter Atiyah. At the end of this short episode, I'll explain how you can

00:00:20.460 access the AMA episodes in full, along with a ton of other membership benefits we've created,

00:00:25.440 or you can learn more now by going to peteratiyahmd.com forward slash subscribe.

00:00:31.140 So without further delay, here's today's sneak peek of the ask me anything episode.

00:00:39.280 Welcome to ask me anything episode 41. I'm once again joined by Nick Stenson. Today's episode is

00:00:45.860 a little different than the episodes of the past year. You've probably noticed over the past year,

00:00:51.120 we've been doing AMAs around a lot of questions that have come in around the same topics. And then

00:00:58.140 we go super deep dive on one topic, for example. Today, we do more of what we used to do traditionally

00:01:05.620 with an AMA. We just noticed we had so many questions that we hadn't been addressing.

00:01:09.740 And so we really batched them. And at the beginning of the episode, Nick is going to kind of walk you

00:01:14.280 through what the questions are. So I'm not even going to really try to repeat that here. So if

00:01:18.180 you're a subscriber and you want to watch the full video of this podcast, you can find it on the show

00:01:22.680 notes page, which are of course, where we keep all the notes for this podcast. If you're not a

00:01:26.860 subscriber, you can watch a sneak peek of the video on our YouTube page. So without further delay, I hope

00:01:31.880 you enjoy AMA number 41. Peter, welcome to another AMA. How are you doing? I'm doing well. That's good.

00:01:43.220 We got a little bit of a different vibe for this AMA. In the past handful that we've done,

00:01:48.340 we've kind of focused on a few big topics or a collection of topics under one larger topics.

00:01:54.860 And so what we've been doing in that time is just collecting a lot of questions that we think are

00:01:59.860 really good, really interesting, that maybe haven't fit in one of the past AMA topics. Also,

00:02:06.160 maybe that are as a result of one of the past AMA topics. And so what we did is we kind of flagged

00:02:11.840 them all and we're going to try and get through as many as we can get through here. So it's kind

00:02:15.940 of going to be a little more of an old school AMA on a variety of topics. And when we look at what

00:02:21.760 we're hoping to cover, it's everything from medicine, aging, longevity, questions about your

00:02:28.520 background, where it led you to where you are today. Also questions around how people should think

00:02:34.560 about prioritizing all the various things in their life. We get a lot of questions where it's,

00:02:39.320 you guys talk about ApoB, you talk about labs, you talk about screenings, you talk about sleep,

00:02:45.320 exercise, nutrition, like all these tactics, and it can get overwhelming for people.

00:02:49.520 And so we'll hopefully have a good conversation on how you think about that in your life and also

00:02:54.040 with patients as people just try and sort through everything. And then if we have time, we're going

00:02:58.420 to do an old school two minute drill, which is have a variety of questions, put two minutes on the

00:03:03.500 clock and see if you can answer it in two minutes. The last time we did this was long ago with

00:03:09.240 you and Bob, and I don't know if we answered any question in under two minutes. So we'll see if

00:03:13.460 it's any different here today. But with all that said, anything you want to add before we just get

00:03:18.880 into it? No, not at all. Let's just do it. But we're not on a two minute clock until you tell me,

00:03:23.880 right? Yeah. These first questions aren't two minute clock. That's much like football,

00:03:27.740 end of the game, two minute drill. So we have some time to ease into it. So the first question we got

00:03:33.180 is one of the phrases that people have often heard you reference throughout the podcast

00:03:37.100 in interviews with other people is this idea of medicine one to 3.0. I also know this is part of

00:03:44.040 the book you're writing. And so it's a topic and a thought experiment that you think about a lot.

00:03:49.100 And we received a lot of questions about people just saying, Hey, can you dive into that a little

00:03:52.820 more, explain more about what you mean and why it's important for people to think about as it relates

00:03:58.220 to their own medical journey. I think this would be a really good foundation for our conversation

00:04:02.840 today. So maybe you can just walk people through what is that and how you think about it.

00:04:08.860 I don't know where the idea really came from or when it came to me, but it was sometime writing the

00:04:13.680 book, which started in 2016, but I don't think it was in the first version of the book. So there's,

00:04:18.620 the book has really three versions. So I kind of wrote, there's a 2016, 2017 version that of which I

00:04:24.220 don't think anything is preserved. And then there's a second version, which is sort of 2017 to 2020 of

00:04:30.060 which some is preserved. And then there's the version of the book that ultimately will become

00:04:34.040 the book is kind of the 2020 to 2022 writing. So I'm positive or nearly positive that the medicine

00:04:40.220 1.0, 2.0, 3.0 thing came from the second version of that book. And it was, and remains this idea that

00:04:47.140 says, look, we basically exist in three different phases of medicine. One of which we're, I think not

00:04:53.840 quite into yet, but we're in the transition. So these transitions are far from discreet and they

00:04:59.820 take, in some cases, I think the transition from medicine 1.0 to 2.0 took, I don't know, I would

00:05:05.260 argue from the beginning to the end, 300 years. Okay. So what are they? So medicine 1.0 is when we

00:05:12.520 had no idea of science. Kind of keep in mind, science is what? It's such a political term at the

00:05:19.280 moment that that's really unfortunate, but science is a way of thinking. Science is not a person.

00:05:24.920 Science is not an answer. Science is a process. It's a way that we look at the natural world around

00:05:32.820 us. We formulate hypotheses about what explains them based on the physical principles of the

00:05:40.020 universe. We design experiments to test those hypotheses and we measure the results of those

00:05:47.200 experiments against the predictions of the hypotheses. And then we iterate and correct.

00:05:53.640 It's important to understand that we're not naturally wired to do that, one. So evolution

00:05:59.400 didn't prepare us to do that. It had no interest in us doing that. I've written at length about this.

00:06:05.180 I think I wrote a blog post on this seven or eight years ago called Why We're Not Wired to Think

00:06:11.040 Scientifically. I think we should link to that because I go into much more detail about the

00:06:15.640 timescale of evolution and the process of our thinking. So prior to the invention of this idea,

00:06:24.280 nothing that existed in medicine could be tethered to science. So anytime something happened,

00:06:32.520 you had to come up with an explanation. That's why we have these wonderful brains that we do. We use them

00:06:37.820 to come up with explanations for things that we see happening, but none of it could be linked

00:06:41.540 to scientific fact or verifiable or testable hypotheses. So this is where you had sort of

00:06:49.020 all sorts of crazy ideas. If you were sick, it was due to bad humors and was bad spirits and bad luck

00:06:55.440 and all these sorts of things. But there was no sort of scientific basis for that. That kind of started

00:06:59.320 to change in the late 17th century with Francis Bacon. But I would argue that the full transition to

00:07:05.120 medicine 2.0 didn't actually take place until the advent of germ theory in the late 19th century.

00:07:12.600 So that's about 300 years, if I'm doing the math right. No, no, no. I'm sorry. It was about 200 years.

00:07:18.200 So we've got about this 200-year period where Joseph Lister, all the way up to Fleming and the

00:07:24.040 discovery of penicillin and antibiotics, that to me is the breakthrough of medicine 2.0. So medicine 2.0

00:07:30.700 comes from basically three things. One is the advent and acceptance of germ theory,

00:07:37.500 the process of scientific thinking, and then really the crown jewel of medicine 2.0, which

00:07:43.560 doesn't come along until much later, is the statistical machinery to enable randomized control

00:07:49.960 trials. So again, because we're trying to be a little bit quick, I won't go into all the details

00:07:54.500 and Bernard Fisher and all of these people who played such an important role in this, but that's

00:07:59.060 basically the trifecta of medicine 2.0. And to be clear, medicine 2.0 has been an amazing

00:08:04.240 development. I don't think any of us would be sitting here today without medicine 2.0. So

00:08:09.280 I don't want to minimize it, but I want to acknowledge and just pass on, and the book

00:08:14.840 talks more about this so we don't have to get into the great detail. Medicine 2.0 has really peaked.

00:08:20.260 It's been very good at dealing with acute conditions. You get hit by a car,

00:08:25.440 you have a life-threatening infection, you suffer an MI, a cardiocardial infarction, and you want to

00:08:33.180 make sure someone doesn't die, and you want to keep somebody alive as long as possible. In that acute

00:08:38.300 phase, medicine 2.0 is amazing for those things. What I argue is that we have reached the limits of

00:08:43.600 medicine 2.0's capacity, and if longevity is something we are aspiring for, we need a new

00:08:49.940 strategy. We need a fundamentalist shift as 2.0 was from 1.0, and that is to 3.0. And 3.0 is basically

00:08:58.340 predicated on evidence-informed as opposed to evidence-based guidelines. It is predicated on

00:09:05.900 absurdly early preventative measures for chronic conditions, which are now the dominant source of

00:09:12.480 morbidity and mortality. It's no longer acute conditions, and it has to be highly personalized.

00:09:17.500 So I'll stop there because, again, I could probably spend the hour now talking about that, but I think

00:09:23.920 people now get the sense of what this is. And I'm arguing that we're not, of course, yet in medicine

00:09:28.200 3.0, but we're now in that transition. And what I'm arguing is we should be accelerating that.

00:09:33.740 And so it's interesting, right, because your medicine 3.0 isn't necessarily people are going to

00:09:38.920 live forever. It's more so just a shift to the three things, like you said, which is personalized

00:09:44.660 medicine, early prevention, and evidence-informed. Have you ever thought about what medicine 4.0 looks

00:09:53.160 like? Is that even on your radar? Or is more of the focus is how do we make this huge shift to 3.0,

00:09:58.660 which is going to create so much benefit for people? I don't think I have enough clarity as

00:10:03.800 to what medicine 4.0 would look like yet versus things that I don't think I will experience in my

00:10:09.660 lifetime that will just be a part of medicine 3.0, if that makes sense. And when you think about

00:10:14.520 that transition, which you mentioned more slowly and now, do you have an idea of how far out you

00:10:21.300 think medicine 3.0 is? Not necessarily at the individual level. So there's always a difference

00:10:27.500 when people could access it versus the standard of care. Do you have an idea or any rough idea on when

00:10:33.860 that turn to the standard of care becomes? No, I think it's too soon to say. It's really

00:10:39.020 going to depend on how quickly people adopt and sort of basically demand change. And I don't think

00:10:46.340 that's possible to predict. Let's use an example that's completely different, but I think if you

00:10:51.560 could go back in a time machine, you wouldn't know, right? So if you went back in a time machine to

00:10:56.180 1850, slavery is the law of the land. The country is completely segregated. I don't think anybody could 0.93

00:11:05.240 have reasonably predicted the events of the 1860s and the events of the 1960s, which were two very

00:11:13.720 important pillars in time as it pertained to slavery and ultimately segregation. You just couldn't have

00:11:21.540 predicted that even though those are both very social changes. Now, maybe there's a historian

00:11:26.300 that will argue, no, it was crystal clear in 1850 that we were 15 years away from a civil war and 100

00:11:31.720 years away from a civil revolution. But I don't believe that. And I certainly don't think we can

00:11:37.040 do the same here. On the book piece, I know you've been working on the book for a long time because

00:11:42.300 I've known you during that stretch, but I wasn't necessarily aware of the 2016 to 2017 initial book that

00:11:50.540 nothing made it really into the final copy. Not nothing. All of it went straight into the

00:11:56.020 wastebasket. So for everyone who's been anxious, kind of banging at the door, good thing we waited

00:12:01.160 a little bit to get that out, huh? Yeah. Love it. So the next set of questions we receive in one form

00:12:09.840 or another almost weekly, which is even people who followed you for a while and people who are kind of

00:12:15.640 newer to following you, they often will ask a variety of questions. They either might be in

00:12:21.740 school, med school, really interested in longevity, might be doctors. And they're really trying to

00:12:27.980 understand where your knowledge on this came from and how you've put into practice what you're trying

00:12:35.260 to do with your patients in medicine 3.0. Because it seems like from knowing you, a lot of what you do

00:12:42.320 with your patients didn't necessarily come from what you learned in med school and or what you did

00:12:48.860 in residency. And so I think what might be helpful to people is just if you want to give people a

00:12:54.020 walkthrough of your background and how it's led to where you are today, which is ultimately

00:12:59.020 practicing medicine 3.0 with your patients. Thank you for listening to today's sneak peek AMA episode of

00:13:05.480 The Drive. If you're interested in hearing the complete version of this AMA, you'll want to become a

00:13:10.280 member. We created the membership program to bring you more in-depth exclusive content without relying

00:13:16.060 on paid ads. Membership benefits are many and beyond the complete episodes of the AMA each month,

00:13:22.480 they include the following. Ridiculously comprehensive podcast show notes that detail

00:13:27.200 every topic, paper, person, and thing we discuss on each episode of The Drive. Access to our private

00:13:33.640 podcast feed. The Qualies, which were a super short podcast, typically less than five minutes,

00:13:38.980 released every Tuesday through Friday, which highlight the best questions, topics, and tactics

00:13:43.820 discussed on previous episodes of The Drive. This is particularly important for those of you who

00:13:49.320 haven't heard all of the back episodes. It becomes a great way to go back and filter and decide which

00:13:54.500 ones you want to listen to in detail. Really steep discount codes for products I use and believe in,

00:13:59.800 but for which I don't get paid to endorse. And benefits that we continue to add over time.

00:14:04.960 If you want to learn more and access these member-only benefits, head over to

00:14:08.800 peteratiamd.com forward slash subscribe. Lastly, if you're already a member, but you're hearing this,

00:14:15.760 it means you haven't downloaded our member-only podcast feed where you can get the full access

00:14:19.980 to the AMA and you don't have to listen to this. You can download that at peteratiamd.com

00:14:26.120 forward slash members. You can find me on Twitter, Instagram, and Facebook, all with the ID,

00:14:32.800 peteratiamd. You can also leave us a review on Apple podcasts or whatever podcast player you listen

00:14:39.000 on. This podcast is for general informational purposes only and does not constitute the

00:14:43.880 practice of medicine, nursing, or other professional healthcare services, including the giving of medical

00:14:49.600 advice. No doctor-patient relationship is formed. The use of this information and the materials

00:14:55.260 linked to this podcast is at the user's own risk. The content on this podcast is not intended to be

00:15:01.400 a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard

00:15:07.680 or delay in obtaining medical advice from any medical condition they have, and they should seek the

00:15:13.700 assistance of their healthcare professionals for any such conditions. Finally, I take conflicts of

00:15:19.440 interest very seriously. For all of my disclosures and the companies I invest in or advise,

00:15:24.720 please visit peteratiamd.com forward slash about where I keep an up-to-date and active list of such

00:15:32.480 companies.

00:15:54.720 Thank you.

00:16:03.500 Thank you.

The Peter Attia Drive - November 14, 2022

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

Episode Stats

Summary

Transcript