A much better focus on primary prevention would certainly be a good thing. As I am sure you know all too well, best use of these advances will require investing much more in our primary care providers and the support and information systems they need for optimal patient care. Unfortunately, the investments made in medical care appear to turn that marvelous pyramid you show upside down. I would welcome learning what it would take for hospital and health care systems to see it as in their interest (profitable) to align their resources with the pyramid as you show it.
I love to read your Substack. I think without general practitioners who are willing to spend more than 15-20 minutes, it is very difficult to utilize and of the technology as a lay person. I do ask Chat about my lab tests etc… and subscribe to Function Health for lab work. I even wear CGM. But alone I’m unable to figure out what this means for me and how to proceed. We need doctors or health advocates!
So much hopeful news, thank you. Any tips for getting involved in trials? I have invested time in enrollment but I don't get much response and give up. My sense is that researchers and staff are stretched. Maybe there are points of entry or resources you can recommend?
I'm shocked by this comment, even if it doesn't define who "we" are:
"..we’ve yet to achieve any substantive primary prevention with the notable exception of vaccinations that prevent infectious diseases. Of the 3 major age-related diseases that I focused on in SUPER AGERS—cardiovascular, cancer, and neurodegenerative—we have not prevented the latter two."
In fact, WE have made huge strides in primary prevention. In 1965 more than 40% of adults smoked; today about 10% do. That fall in smoking has reduced rates of many cancers, heart disease, and many other health problems. While most of the credit goes to policy-makers, anti-smoking advocates, and public health workers, clinical physicians played a role in recommending that their patients quit and prescribing cessation treatments.
In recent decades, public health actions have also achieved primary prevention in lead poisoning, injuries from motor vehicle crashes, and many other areas. And if you go to earlier decades, public health actions have succeeded in primary prevention (indeed revolutionized health) with sanitation.
I suggest you think more broadly about the actions that you consider important to health. It's not all about individual patients, and not all about pills and shots.
I was not writing about public health measures such as reduced smoking which obviously have had marked effects. I wrote about disease-specific, individualized primary prevention and reviewed what we do now and what we can do in the future (last Figure). Since you didn't read Super Agers, you've taken my work out of context.
AI as analysis and prediction seems to be making great progress - very happy about that. Far less convinced about "generative AI" - creating reports, etc.. Maybe, but generative consistently has hallucination issues - which puts the clinician in the "reverse-centaur" position of spending time figuring out whether the AI got it right or not. (similar to the issue with coding where actual tests show developers wasting time to see if AI got it right or not)
Dr. Topol, Enlightening article along with your earlier piece on peptides (the good, bad and ugly). I'd love to bend your ear or talk about what this ideal preventative medicine world might actually might look like if you could "build" it from scratch. Let me know.
A much better focus on primary prevention would certainly be a good thing. As I am sure you know all too well, best use of these advances will require investing much more in our primary care providers and the support and information systems they need for optimal patient care. Unfortunately, the investments made in medical care appear to turn that marvelous pyramid you show upside down. I would welcome learning what it would take for hospital and health care systems to see it as in their interest (profitable) to align their resources with the pyramid as you show it.
I love to read your Substack. I think without general practitioners who are willing to spend more than 15-20 minutes, it is very difficult to utilize and of the technology as a lay person. I do ask Chat about my lab tests etc… and subscribe to Function Health for lab work. I even wear CGM. But alone I’m unable to figure out what this means for me and how to proceed. We need doctors or health advocates!
So much hopeful news, thank you. Any tips for getting involved in trials? I have invested time in enrollment but I don't get much response and give up. My sense is that researchers and staff are stretched. Maybe there are points of entry or resources you can recommend?
Thanks. We'll be starting a prevention of Alzheimer's trial in January..stay tuned. Hopefully many more to come.
I'm shocked by this comment, even if it doesn't define who "we" are:
"..we’ve yet to achieve any substantive primary prevention with the notable exception of vaccinations that prevent infectious diseases. Of the 3 major age-related diseases that I focused on in SUPER AGERS—cardiovascular, cancer, and neurodegenerative—we have not prevented the latter two."
In fact, WE have made huge strides in primary prevention. In 1965 more than 40% of adults smoked; today about 10% do. That fall in smoking has reduced rates of many cancers, heart disease, and many other health problems. While most of the credit goes to policy-makers, anti-smoking advocates, and public health workers, clinical physicians played a role in recommending that their patients quit and prescribing cessation treatments.
In recent decades, public health actions have also achieved primary prevention in lead poisoning, injuries from motor vehicle crashes, and many other areas. And if you go to earlier decades, public health actions have succeeded in primary prevention (indeed revolutionized health) with sanitation.
I suggest you think more broadly about the actions that you consider important to health. It's not all about individual patients, and not all about pills and shots.
I was not writing about public health measures such as reduced smoking which obviously have had marked effects. I wrote about disease-specific, individualized primary prevention and reviewed what we do now and what we can do in the future (last Figure). Since you didn't read Super Agers, you've taken my work out of context.
AI as analysis and prediction seems to be making great progress - very happy about that. Far less convinced about "generative AI" - creating reports, etc.. Maybe, but generative consistently has hallucination issues - which puts the clinician in the "reverse-centaur" position of spending time figuring out whether the AI got it right or not. (similar to the issue with coding where actual tests show developers wasting time to see if AI got it right or not)
Dr. Topol, Enlightening article along with your earlier piece on peptides (the good, bad and ugly). I'd love to bend your ear or talk about what this ideal preventative medicine world might actually might look like if you could "build" it from scratch. Let me know.
All the best,
Sanders