The present day organization of medical practice and its regulation is built atop the infectious disease model, even where it engages with age-related diseases. Prevention is a comparatively thin thread in an industry largely focused on the strategy of waiting until there is a problem, then attacking the symptoms of that problem with every available tool, as aggressively as possible. This isn't all that useful for age-related disease to start with, but it simply doesn't work for a world in which rejuvenation therapies that can repair the damage that causes aging initially arrive in a prototype form and then grow more capable over time. In that world - our world! - prevention quickly becomes enormously important and effective, and should be prioritized accordingly. This will require major change in a large number of conservative, hidebound organizations and communities, and will no doubt proceed only slowly and reluctantly.
A mainstay of preventive medicine innovators and medical futurists has been the concept of longevity escape velocity (LEV). LEV represents the time at which someone is gaining greater than 1 year of predicted healthy life expectancy per year, essentially making his or her healthy life expectancy unlimited. But practically, what are the likely requirements to reach such a "longevity escape velocity"? Around 95% of medical service budgets today are spent on acute medicine, with only around 5% on preventive care. How can today's medicine adapt to bring around a care system that provides LEV on a population scale?
To help patients achieve and maintain LEV, medical knowledge is required from diverse medical specialties and from outside specialties typically practiced by doctors. General practice (also known as primary care or family medicine) is the current specialty with the most similarity to LEV medicine; however it lacks in knowledge in many key areas, as well as in availability of time. An LEV medical specialty could be a subspecialty training of general practice, internal medicine, geriatrics, or clinical research. Core elements of an LEV medical specialty training would include education in prioritization of clinical problems according to magnitude and probability of clinical outcome or surrogate marker impact to a specific person's budget; understanding clinical biogerontology frameworks, including pathology based frameworks (such as the Strategies for Engineered Negligible Senescence [SENS] framework) and process based frameworks (such as the Hallmarks of Aging framework) and the associated markers and current state of therapies and clinical or research access to these.
How can LEV be measured accurately? Initial models are needed that take into account a minimum number of quality measurements across broad clinical outcomes and frameworks of aging (such as SENS and Hallmarks of Aging). Optimal ranges for clinical outcomes can be established for diverse markers and used to create an effective "biological age" for individual organs or systemic aging pathologies. Combined with current best risk prediction calculators for broad sets of diseases as well as a current annual "coefficient of baseline gain in life expectancy" due to current innovation rates, and taking into account a qualitative measure of a person's financial budget, motivation, and "LEV-related education," a client's LEV might be be determined to fall within a certain range.
Research is paramount to accelerate the generation of evidence of efficacy and safety of new measurements, therapies, and clinical pathways that are relevant to LEV. A core element of LEV medicine should be that any novel practice across any aspect of LEV medicine, be it a new annual screening panel, an off label pharmaceutical, an experimental stem cell or gene therapy, should be part of a formal registry, with all data captured and published open access, and ideally collated to a central LEV society or organization for analysis, methodological and ethical critique, and distribution to parties that may benefit. For example, what proportion of potentially useful surrogate marker or clinical outcomes data is captured, collated, and distributed from the proportion of people globally experimenting with novel therapies? It is likely under 0.01%; global standards to capture such data usefully - such as via guidelines for basic experimental protocol that doctors and patients may follow for each novel intervention, as well as systems to capture, collate, analyze, and disseminate such data - could have ensured perhaps 1000 or 10,000 times more data on all novel practices to date, providing benefits for everyone.
Link: https://doi.org/10.1089/rej.2018.2055
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