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Science-based Longevity Medicine

Much nonsense has been written in the guise of longevity medicine. In Fantastic Voyage, Ray Kurzweil explains why he takes 250 pills every day and spends one day a week at a clinic getting IV vitamins, chelation, and acupuncture. He is convinced this regimen will keep him alive long enough for science to figure out how to keep him alive forever. In Healthy Aging, Andrew Weil chips in with his own mixture of science and magic. I pointed out the flaws in their reasoning in a review for Skeptic magazine – available online. There are many other popular books that promise to tell you how to live longer. Most of them amount to little more than speculation based on extrapolations from animal studies, in vitro studies, and odd non-clinical facts.

There simply is no evidence that any intervention will extend the human life span. The most promising idea from animal studies, severe calorie restriction, is not practical or palatable and would make adequate nutrition difficult. We don’t know how to prolong human life to, say, 130 years; but we do know how to prevent a number of diseases from causing premature demise at 60 or 70. That’s what real “longevity medicine” means.

To counteract all the belief-based and speculation-based “longevity medicine,” we needed a science-based longevity book. And now we have it. Carl Bartecchi, MD and Robert W. Schrier, MD have written a book entitled Living Healthier and Longer – What Works, What Doesn’t. The price is right – it is available online for free download.

This book is based firmly on science. It covers major diseases, risk factors, and the interventions that have been tested and shown to improve outcome. It doesn’t promise survival beyond the expected life span, but it shows you how to minimize the risk of avoidable diseases and live as long as possible given the constraints of genetic inheritance and the accidents of chance.

For those who think modern medicine doesn’t focus on prevention, here’s a whole book of refutation. It stresses appropriate screening tests, immunizations, smoking cessation, weight control, healthy diet, exercise, and proven interventions like low-dose aspirin. It even includes guidelines for the responsibilities of doctors and the responsibilities of patients so they can work together optimally.

I have a few quibbles with details: they recommend breast self-exam, which has recently been shown not to improve survival from breast cancer, and they recommend limiting egg consumption because of the cholesterol in eggs, outdated advice that most science-based doctors would disagree with based on more recent evidence. But most of what they say is solid mainstream science backed up by good quality evidence.

They cover vitamins in detail. They discuss the failures of antioxidants in clinical studies and the recent changes in recommendations for vitamin D. They dispel many popular myths:

Studies do not show that a healthy person who takes extra nutrients has increased energy, reduced fatigue, or added disease protection. .

The title of one chapter is particularly refreshing:

“Alternative Medicine – Alternative to What????”

They quote R. Barker Bausell’s Snake Oil Science and Edzard Ernst’s review of the evidence for acupuncture. They cover many of the things we have covered on this blog, including the failure of the NCCAM, the problems with the DSHEA, the dangers of chelation, the “natural” fallacy, the vagueness of claims to “support immune function,” herbal side effects, and contaminated products. They call homeopathy the ultimate hoax. They discuss the reasons things may seem to work when they do not. They conclude:

In spite of the many promises, alternative medicine practices are not short-cuts to living longer and healthier lives. In fact, according to Professor Bausell, “There is no compelling, credible scientific evidence to suggest that any CAM therapy benefits any medical condition or reduces any medical symptom (pain or otherwise) better than a placebo.” Of course, should any of these CAM therapies be found to be effective, that therapy becomes part of conventional medicine.

The book was reviewed favorably in the New England Journal of Medicine I hope the word will spread and this excellent resource will become the go-to reference for accurate information about science-based preventive medicine and “what really works” to live a long and healthy life. And I hope its on-line format will include constant updates as new information becomes available.

Posted in: Book & movie reviews, Science and Medicine

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21 thoughts on “Science-based Longevity Medicine

  1. caoimh says:

    What a wonderful and timely gesture they have made by making it available online for free. We just have to wait until the journals catch up with this sort of progressive thinking!

  2. DevoutCatalyst says:

    The alternative lifestyle luminaries don’t seem to live any longer than the rest of us. Harbhajan Singh Yogi, Paavo Airola, TC Fry, and so on, all nice guys I’m sure, all died relatively young. CAM proponents often project their promises off into the future as yet another dodge from reality.

    If we do find a way to extend lifespan dramatically, imagine the enhanced sense of tragedy of that inconsiderate boob driving whilst on the cell phone that just hit you and wiped out 800 years of life expectancy. ;*)

    An arbitrarily long life — I’m all for it — would be interesting to witness in terms of the unexpected consequences, whether quirky or dire.

  3. gerryfromktown says:

    There is a TED talk on this topic by Aubrey de Grey:

    http://uk.youtube.com/watch?v=8iYpxRXlboQ

    Claims to be entirely science-based, but takes the view that research on longevity is both potentially fruitful and ethically responsible.

    He seems to be a walking counter-example to your assertion that “… severe calorie restriction, is not practical or palatable and would make adequate nutrition difficult” (Although I’ll grant that his appearance makes me wonder about his nutrition levels).

  4. Fifi says:

    What I always find entertaining is that it’s the people who preach about life after death and how amazing it will be to be “pure spirit” that also want to delay death!

  5. Fredeliot2 says:

    It appears that you have to leave off www to get to the book web site.

  6. jonny_eh says:

    Finally, something I can send my grandparents! Can’t wait until a print version is available. Thanks for pointing out yet another awesome book Dr. Hall!

  7. daedalus2u says:

    Aubrey de Grey is a pseudoscientist (in my opinion). Much of what he proposes in what he calls SENS is non-physiologic and can’t work the way he suggests (and which success in SENS requires).

    I see virtually all of the “symptoms” he aims to eliminate by SENS as being “features” of physiology, not pathology per se. For example, I see the accumulation of undegraded protein aggregates (as in Alzheimer’s, Lewy body neuropathies and amyloidosis) as the consequence of the activation of ATP conserving mechanisms, not because they are somehow not degradable by existing lytic enzymes (which he proposes to fix by genetic engineering even more powerful lytic enzymes into humans). This is simply wrong thinking. If those compounds were not degradable, they would accumulate at every age and in every individual not just at old age and not just in some individuals.

    The linked to book is pretty good.

  8. timely16 says:

    Nice book, but this is complete nonsense:

    “Ecstasy, along with Rohypnol and Ketamine, belong to a group known as date rape drugs. They are colorless, odorless and tasteless, which allows them to be slipped into a victim’s drink. They can cause a victim to pass out, unable to resist what is being done to them, and leaving them unable to recall what happened to them. Chronic use of these drugs can cause changes in brain function, coma and seizures. Ecstasy can interfere with the body’s ability to regulate one’s temperature, causing severe temperature elevations and organ damage. These drugs, used mostly by teens and young adults who are part of a nightclub, bar, rave, or trance scene, can be deadly.”

    I can tell you that Ecstasy is not tasteless, in fact it has a very strong bitter taste and would be easily detectable if slipped into a drink. Second, it doesn’t cause victims to pass out. In fact, MDMA is an amphetamine derivative and has stimulant properties.

    These authors willy-nilly grouped Ecstasy with rohypnol (a benzo) and ketamine (an anesthetic). They do not go together, chemically or physiologically.

  9. khan says:

    Personally I don’t want to extend my longevity, unless someone can come up with a ‘cure’ for arthritis.

  10. Ex-drone says:

    Page 85:
    “Use of marijuana appears to facilitate one’s progression to even more dangerous drugs.”

    What? Is that a medical opinion? What scientific evidence is it based on?

  11. Fifi says:

    Ex-drone – Thanks for pointing out the misrepresentation of recreational drugs! It does make me wonder about the accuracy of the rest of the info when combined with the misinformation about eggs and breast self exams.

  12. marilynmann says:

    Sanjay Gupta wrote a book called “Chasing Life: New Discoveries in the Search for Immortality to Help You Age Less Today.” I haven’t read it, but the title and amazon.com page, containing blurbs by Andrew Weil, Deepak Chopra, and Mehmet Oz, make me a little suspicious.

    http://www.amazon.com/Chasing-Life-Discoveries-Search-Immortality/dp/0446698180/ref=sr_1_1?ie=UTF8&s=books&qid=1232505578&sr=1-1

  13. Prometheus says:

    I have just one word for Ray Kurzweil: telomeres!

    [with apologies to The Graduate]

    Even if Ray manages to avoid coronary artery disease, small-vessel disease, cancer, Alzheimer’s disease, etc., he still has to face the fact that most of his tissues have “switched off” the enzyme that prevents their telomeres from shortening with every cycle of cell division.

    Eventually, after enough cell divisions, the telomeres will be gone and the coding regions of the chromosomes will start to erode, leading to either cell death or malignant transformation.

    Switching the telomerase back on is not without its problems, either. A feature of numerous cancers is that their telomerase (which was supposed to be off) has been switched on. Turning off the telomerase appears to be a backup safeguard to prevent out-of-control cell replication which could lead to cancer.

    There have been a lot of studies in mice, fruit flies and other animals that show some promise in extending the lifespan of humans. However, there hasn’t yet been any solid explanation why humans live so much longer than other primates of similar size.

    In captivity, chimpanzees and gorillas live – at most – into their fifties. Their lives are even shorter in the wild, where disease, starvation and predation kill them much earlier.

    Humans (in captivity – e.g. office workers in Manhattan) live an average of 70 – 75 years, with some “specimens” reaching well past 100 years. (Those who argue that humans don’t live in captivity should look around their cubicles and ask themselves if they might not live longer – or at least happier – in a zoo-like setting.)

    Before we start thinking that we can extend our lives, perhaps we ought to understand why we already live longer than we should expect.

    Prometheus

  14. Fifi says:

    Prometheus – I think your point about understanding why we live long lives is extremely valid and on point. Our longevity may (that’s a big “may”) be an evolutionary feature in that post-menopausal women play a social function (helping with childcare).

    Fortunately I work for myself (even if I must climb trees and negotiate to get bananas) but if I didn’t I’d be asking for more tire swings for my cubicle to compensate for having to dodge the poo being flung!

  15. Harriet Hall wrote:
    “I have a few quibbles with details: … they recommend limiting egg consumption because of the cholesterol in eggs, outdated advice that most science-based doctors would disagree with based on more recent evidence.”

    Wha, waitaminute– what’s this? I can haz eggs?

    My internist said I could only have egg whites, because of my high LDL. If that information is outdated, I’d love to see the more recent research, so I can discuss with him further my pitiful lusting after egg yolks!

  16. Harriet Hall says:

    While a limited cholesterol intake is still recommended by many authorities for people with high blood cholesterol levels, there is little convincing evidence to support that advice. We have learned that total fat, saturated fat and particularly trans-fats, are more important than cholesterol in the diet. In fact, here is a study that says eggs are GOOD for your blood cholesterol:

    http://www.ncbi.nlm.nih.gov/pubmed/18575296?ordinalpos=17&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

    In patients with high LDL cholesterol levels, diet usually can only lower it by a small percentage. Weight loss and diet are the first steps, but statins are frequently needed to make a real difference.

    Eggs have gotten a bad rap. They are an excellent, inexpensive source of protein.

  17. Thank you VERY much for the link, Harriet! :) This is good to know. I’ll discuss it with him at my next appointment!

    I’m in the process of trying to drop a total of 24 lbs (ten down already!), and in doing so I’ve changed my diet and exercise regimen for the better. Plus, my doc has me on a fiber supplement. My whole goal here was to eliminate any need for statins altogether, because I wasn’t sure if they would interact badly with my mood stabilizer (oxcarbazepine). But actually, it seems they’re not too bad together: https://online.epocrates.com/u/10a2284/oxcarbazepine — and I did find one source that suggests (right at the end) they might even play well together– http://findarticles.com/p/articles/mi_hb4365/is_/ai_n29173328 — So, the prognosis looks encouraging, whatever the outcome! :)

  18. Carl Bartecchi says:

    We appreciate the mention of and comments about our book – LIVING HEALTHIER AND LONGER – WHAT WORKS, WHAT DOESN’T in this blog. We apologize for errors that were duly noted in the “responses” as well as by the New England Journal of Medicine reviewer. Of course we will correct those errors in the next “update”. Update #1 was already added in November, after the May 2008 publication. The advantage of such a publication, besides being FREE, is the fact that it can be corrected in a timely fashion (every 6 months), and we can benefit from the knowledge of the vast readership that such a publication will reach. We have had over 4,500 downloads from 94 countries, and have granted requests for translations in Chinese, Japanese and Vietnamese. The real benefit of such a book is the fact that information can be updated, on a regular basis, and downloaded, at no cost, from the Web site healthierlongerlife.org While appreciating that our text is not perfect, it can be made better by the input of so many of you out there with expertise in the different subjects that we have chosen to cover. We welcome your comments, which can be sent to ckbartecchi@comcast.net This book is also an experiment. Our goal is to see what difference it will make to give a free hard copy of up-to-date health information (not supported by the pharmaceutical industry, the health care or insurance industry, HMOs, government, foundations with a health care agenda, etc., where the authors receive absolutely no financial reward, in any way, from sales, distribution, downloads, etc.) to each of the 60,000 households in a Colorado county. Possibly, an approach such as this will provide the best of what evidence based, scientific medicine has to offer to the vast number of our citizens in need of such information.
    Carl E. Bartecchi, M.D. and Robert W. Schrier, M.D.

  19. daedalus2u says:

    I had been eating 4 eggs per day every day for some months (because they are a good and cheap source of protein) and a blood test said my cholesterol was too high.

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