Outlive: The Science and Art of Longevity

According to Attia, medical history comprises two distinct eras. He calls the first era “Medicine 1.0.” Medicine 1.0 began with the Greek physician Hippocrates (c. 450-c. 380 BCE) and lasted 2,000 years, until the late 1800s. In Medicine 1.0, observations and guesswork served as the basis for medical conclusions rather than science. A major component of Medicine 1.0 was that bad air (also called “miasmas”) or evil spirits spread disease.

The groundwork for the shift from Medicine 1.0 to Medicine 2.0 began with English philosopher and statesman Sir Francis Bacon in 1628, who was the first to set-up experiments to test hypotheses. Attia notes that “this represented a major philosophical shift, from observing and guessing to observing, and then forming a hypothesis” (27). Three centuries elapsed, however, before experiments and hypothesis testing became widespread in the medical field.

Medicine 1.0 shifts to Medicine 2.0 with German physician and microbiologist Heinrich Hermann Robert Koch’s discovery of the germ theory of disease in the late 19th century. Koch discovered that microscopic organisms (such as germs) caused specific diseases. New technology (e.g., the microscope) and a new way of thinking prompted this shift. The importance of Medicine 2.0 cannot be understated: Medicine 2.0 represents a “defining feature of our civilization, a scientific war machine that has eradicated deadly diseases such as polio and smallpox” (27).

While Medicine 2.0 was transformational to human society, Attia underscores that the transition between Medicine 1.0 and Medicine 2.0 was not smooth. Instead, the shift “was a long bloody slog that took centuries, meeting trench-warfare resistance from the establishment at many points along the way” (26). A particularly poignant example is that of Hungarian obstetrician Ignaz Semmelweis. Semmelweis worked in a maternity clinic at the General Hospital in Vienna. At this clinic, there were two maternity wards: one staffed by all-female midwives, and the other by all-male doctors and students. The ward staffed by all men had higher maternal death rates than the ward staffed by all women.

Semmelweis began to investigate this difference. He found that the male doctors and medical students went to the maternity ward after conducting autopsies, in contrast to the midwives. Furthermore, many of these doctors and medical students did not wash their hands between conducting autopsies and delivering children. Semmelweis hypothesized that there was a link between the autopsies and high maternal death rate (germs had not yet been discovered). As a result, he demanded that his staff clean their hands and tools with a chlorine solution. The maternal death rate dropped. Despite this, Semmelweis’s colleagues ostracized him. He died in a psychiatric hospital.

While Medicine 2.0 has obliterated almost all infectious diseases and doubled chronological lifespan, it has been less successful at eradicating chronic diseases of aging, especially the “Four Horsemen”: metabolic dysfunction, heart disease, cancer, and neurogenerative diseases. According to Attia, the reason for this failure is because Medicine 2.0 fails to acknowledge and understand risk. The Four Horsemen do not suddenly appear overnight. Instead, they are the result of minor risk factors (e.g., smoking, eating too much, etc.) that compound over time “into an unstoppable, asymmetric catastrophe” (29). Treatment in Medicine 2.0 occurs when the chronic disease is already embedded in a person’s body. Thus, the treatment comes too late.

Attia argues for a new way of thinking about medicine, which he calls “Medicine 3.0.” Medicine 3.0 comprises four key parts. First, prevention is more important than treatment. Second, it respects patients’ individualism. Prevention plans focus on individual needs and circumstances. Third, it accepts risk, “including the risk of doing nothing” (32). Finally, Medicine 3.0 focuses on healthspan, or quality of living, as well as chronological lifespan, or how long someone lives. Medicine 2.0 emphasizes lifespan whereas Medicine 3.0 focuses on maximizing both healthspan and lifespan.According to Attia, medical history comprises two distinct eras. He calls the first era “Medicine 1.0.” Medicine 1.0 began with the Greek physician Hippocrates (c. 450-c. 380 BCE) and lasted 2,000 years, until the late 1800s. In Medicine 1.0, observations and guesswork served as the basis for medical conclusions rather than science. A major component of Medicine 1.0 was that bad air (also called “miasmas”) or evil spirits spread disease.

The groundwork for the shift from Medicine 1.0 to Medicine 2.0 began with English philosopher and statesman Sir Francis Bacon in 1628, who was the first to set-up experiments to test hypotheses. Attia notes that “this represented a major philosophical shift, from observing and guessing to observing, and then forming a hypothesis” (27). Three centuries elapsed, however, before experiments and hypothesis testing became widespread in the medical field.

Medicine 1.0 shifts to Medicine 2.0 with German physician and microbiologist Heinrich Hermann Robert Koch’s discovery of the germ theory of disease in the late 19th century. Koch discovered that microscopic organisms (such as germs) caused specific diseases. New technology (e.g., the microscope) and a new way of thinking prompted this shift. The importance of Medicine 2.0 cannot be understated: Medicine 2.0 represents a “defining feature of our civilization, a scientific war machine that has eradicated deadly diseases such as polio and smallpox” (27).

While Medicine 2.0 was transformational to human society, Attia underscores that the transition between Medicine 1.0 and Medicine 2.0 was not smooth. Instead, the shift “was a long bloody slog that took centuries, meeting trench-warfare resistance from the establishment at many points along the way” (26). A particularly poignant example is that of Hungarian obstetrician Ignaz Semmelweis. Semmelweis worked in a maternity clinic at the General Hospital in Vienna. At this clinic, there were two maternity wards: one staffed by all-female midwives, and the other by all-male doctors and students. The ward staffed by all men had higher maternal death rates than the ward staffed by all women.

Semmelweis began to investigate this difference. He found that the male doctors and medical students went to the maternity ward after conducting autopsies, in contrast to the midwives. Furthermore, many of these doctors and medical students did not wash their hands between conducting autopsies and delivering children. Semmelweis hypothesized that there was a link between the autopsies and high maternal death rate (germs had not yet been discovered). As a result, he demanded that his staff clean their hands and tools with a chlorine solution. The maternal death rate dropped. Despite this, Semmelweis’s colleagues ostracized him. He died in a psychiatric hospital.

While Medicine 2.0 has obliterated almost all infectious diseases and doubled chronological lifespan, it has been less successful at eradicating chronic diseases of aging, especially the “Four Horsemen”: metabolic dysfunction, heart disease, cancer, and neurogenerative diseases. According to Attia, the reason for this failure is because Medicine 2.0 fails to acknowledge and understand risk. The Four Horsemen do not suddenly appear overnight. Instead, they are the result of minor risk factors (e.g., smoking, eating too much, etc.) that compound over time “into an unstoppable, asymmetric catastrophe” (29). Treatment in Medicine 2.0 occurs when the chronic disease is already embedded in a person’s body. Thus, the treatment comes too late.

Attia argues for a new way of thinking about medicine, which he calls “Medicine 3.0.” Medicine 3.0 comprises four key parts. First, prevention is more important than treatment. Second, it respects patients’ individualism. Prevention plans focus on individual needs and circumstances. Third, it accepts risk, “including the risk of doing nothing” (32). Finally, Medicine 3.0 focuses on healthspan, or quality of living, as well as chronological lifespan, or how long someone lives. Medicine 2.0 emphasizes lifespan whereas Medicine 3.0 focuses on maximizing both healthspan and lifespan.