Longevity, or Prevention 2.0

Hello from the U.K., where I’ve been catching up with old friends and new this week. There’s a very human tendency to believe the grass is always greener, so it’s been eye opening talking to Londoners about their views of their own healthcare system. Unsurprisingly, the NHS is a source of immense concern for locals. But they don’t view the U.S. as a panacea either.

One of my goals for the next few years is to do what I can to help increase the connectivity between the innovators in both countries. The U.K. also has private insurance, as well as the NHS, and an openness to new ideas, particularly in areas like behavioral health, genetics, digital and tech.

More relevant to the topic of this week’s edition - longevity - I have an appointment booked tomorrow in Stockholm for a long-awaited Neko scan. Neko recently raised a $260 million series B and has locations in the UK and Sweden. It offers a series of tests, including a scan and bloodwork, plus access to health practitioners to interpret the results. Spotify CEO Daniel Ek is closely connected to the initiative, as a cofounder, alongside Swedish entrepreneur Hjalmar Nilsonne. I’m planning to spend some time wtih Nilsonne and will report back on the experience! Stay tuned for a possible U.S. expansion.

Thank you to Annalisa Merelli for the writeup - below - of a recent conversation I had with Heartbeat Health’s Dr. Jeff Wessler on the difference between longevity and prevention.

By Annalisa Merelli

Tech entrepreneurs — they are just like us. They age. The once twenty-something startup founders are now middle-aged individuals who once saw lost sleep and unhealthy habits as a point of pride but are now coming to understand them as a health issue. 

So how do they deal with it? Enter the longevity space: health-tech companies and concierge services offering tests and scans, looking for early indicators and proxies for disease, and offering patients insights into their health. Though those aren’t entirely new, they are particularly hot right now: after all, once young tech consumers are also aging, and as they approach or pass their 40s, their risk for health issues increases. 

But isn’t longevity, well, the whole point of medicine? Is this anything truly new? Can it have a real impact or does it just end up sending worried healthy people to the doctor with Apple Watch Syndrome? 

On the Second Opinion podcast, our editor-in-chief Christina Farr discussed with Dr. Jeff Wessler, a cardiologist and the CEO of Heartbeat Health, a virtual cardiology practice focused on identifying and managing moderate and high-risk cardiovascular issues. Christina has known Jeff for more than a decade, and he’s been on the forefront of making prevention accessible - particularly when it comes to heart health. This conversation focused on the question posed by Sunita Mohanty, a health-tech entrepreneur, who mused that longevity is essentially a more accessible version of prevention. Many of the recommendations are the same — eat well, sleep well, drink less alcohol — but patients have the opportunity to reach those conclusions via their own Nof1 experiments, typically guided by a clinician or health coach.

This conversation focused on the question posed by Sunita Mohanty, a health-tech entrepreneur, who mused that longevity is essentially a more accessible version of prevention. Many of the recommendations are the same — eat well, sleep well, drink less alcohol — but patients have the opportunity to reach those conclusions via their own Nof1 experiments, typically guided by a clinician or health coach. When he thinks about longevity tech, Dr. Wessler’s mind immediately goes to a fact that may be surprising for some: heart attacks are almost entirely predictable. Though most people, including well-informed ones working in the medical field, think heart attacks are sudden, without any warning signs, we have enough understanding of how a heart attack happens and how the risk factors will develop in its lead-up. (As Christina joked on the podcast, it may be time to give heart attack a rebrand?) So how can longevity play a role in heart health? And what makes it different from prevention? For Second Opinion subscribers, we dug in.

So how can longevity play a role in heart health? Is longevity a clever rebranding of prevention? And what makes it different? For Second Opinion subscribers, we dug in.

The reason the predictability of heart attacks isn’t necessarily translating to their prevention is our human fallibility: habits are hard to change, and even if we know that a certain behavior is going to help our cardiovascular health, it’s not easy to adopt it, especially when we are trying to do some of what’s known as “primordial prevention.” That’s where longevity comes in. 

There are three types of prevention when it comes to heart health:

Where do all these longevity companies, whether it be Function Health, Ezra, or Superpower, fit in? Well, Wessler believes it’s really with the first: Primordial prevention. Where he sees these companies be less successful is in helping people who have already experienced heart attacks and other cardiovascular events reduce their risk. Those patients may require the support of a cardiologist and medical team — and even then, behavior change is a challenge.

“Not a day goes by when all of us as individuals face the fact that we're trying to alter, change, modify a behavior and we have trouble doing that,” says Dr Wessler. “When you take that at the population level and you're talking about things like serious cardiovascular disease, the stakes are higher, but it doesn't make it any less difficult to get to behavioral change.”

The reason? “There is no feedback loop,” says Dr. Wessler. There is no way to see the changes and impact that a certain behavioral change has, and all that is left is to trust that it will matter in many, many years. But what if you could see the impact? This is where some of the longevity products can help: they give you (the patient) data showing how your behavioral change affects the now, encouraging you to keep up the effort. It’s prevention 2.0, so to speak. For cardiovascular health, but other domains, too.

There’s something to that Nof1 care may be less evidence-based, because it pertains to the experience of an individual versus a population. But the value it brings is that it allows patients to reach a certain insight on their own. We might be told by a physician that alcohol wreaks havoc on our sleep, but it might hit differently if a device like an Eight Sleep or Oura Ring shows the user that their REM sleep quality has plummeted after a night out with friends.

Of course, this is a bit of an ideal scenario. To be effective on a relevant scale, longevity tech should be available to a lot more people, in particular people at higher risk for health issues. These aren’t typically in the socioeconomic groups of early longevity tech adopters; so for now, a lot of the full-body MRIs and other testing will continue to result in many healthy people going down rabbit holes of testing, concerned about conditions they don’t actually have. That’s what cardiologists affectionately refer to as the Apple Watch Syndrome: your wearable tells you your heartbeat is off, so you rush to the doctor to check your heart, but the problem is in the wearable, not the wearer. 

Which continues to be the paradoxical risk of longevity tech: it can end up adding unnecessary stress and worry to today’s life while trying to extend tomorrow’s. Perhaps worse, it ends up taking away scarce resources — i.e. doctor’s appointments — for those who really need them — the individuals in the secondary and tertiary categories.

But when done effectively and via the companies with the best clinical programs, it offers an opportunity to bring forms of prevention to populations that have historically ignored the medical system, and to those that are still young and healthy enough to truly impact their health trajectory in the long-term.

What needs to change from here to maximize longevity’s impact?

Some of the most well-known longevity influencers, for instance, are men like Bryan Johnson. These individuals are clearly reaching other men, particularly those in their forties and fifties, who are suddenly taking a keen interest in their health – it’s not uncommon now to see men giving up alcohol, eating less sugar, going to the gym and even taking trips to the spa for relaxation. All of this could have an impact when it comes to primordial prevention – and that could be a very good thing, particularly given that men have historically avoided going to the doctor.

Still, there’s a major opportunity for more influencers to emerge that target women. Over 60 million women in the United States are living with some form of heart disease, and many experienced delayed diagnoses as their symptoms may have shown up differently. Longevity poses a path for there to be more women influencers, educating other women about health and prevention. There’s already early signs that this is on the horizon.

For those interested in tuning into the full episode, the links are below. We’d love to hear from you about whether you’ve been impacted by trends in the longevity space, and how you’ve changed your habits as a result. 

Check out these links below to listen to the full podcast