#46: 🩺 Med3

The evolution of medicine & predicting the future of healthcare

Hey Friends,

I personally narrate the audio for every Nina’s Note.

It’s not an auto-generated robot voice. 

It’s me.

Now that you know I’m the voice behind that play button. Take a second to answer this poll & give this Note a listen.

Click the Play button at the top of the article called “Audio Voiceover” and relax as I teach you about science and medicine.

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💬 In this note:

• 🩺 Med3

• 📚 Outlive

• ⚡️ Take Your Vacation, Please

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🩺 Med3

Photo by National Cancer Institute on Unsplash

In Peter Attia’s latest book Outlive, he coined the term Medicine 3.0. To make it catchier, let’s call it Med3. 

So, what is Med3?

Similar to the evolution of the web, medicine has evolved as well. The web evolved from writing to reading to owning.

Web1 → Web2 → Web3

Read → Write → Own

In the last 500 years of medicine, we went from understanding to treating. 

Peter Attia suggests we are now in a transition from treatment to prevention with Med3.

Med1 → Med2 → Med3

Understand → Treat → Prevent

Let’s take a look at the evolution of medicine.

Med1 = When we had no idea about science. 

Med1 refers to the old world of medicine when doctors didn’t have much in the way of effective treatments and their knowledge of disease and conditions was rudimentary compared to today.

Beliefs about health were that you were unlucky if you fell ill or sickness was the result of bad humors or spirits.

Basically the concept of health had no scientific basis at this time. The relationship between doctors and patients was close however, with typically one doctor treating all the members of a family for decades.

That all changed in 1620 at the height of the Scientific Revolution when Sir Francis Bacon introduced the scientific method to European thinkers in his published treatise, Novum Organum.

Bacon introduced a systematic approach to establish scientific knowledge. Where one makes an observation, asks a question, researches the question, proposes a hypothesis, tests the hypothesis with an experiment and draws a conclusion based on the results. Then one iterates the experiment based on the outcome.

This method allowed a systematic way to investigate the world. Outside of medicine, Sir Francis Bacon influenced the likes of Galileo and Isaac Newton who used the method in their practices of physics, math and astronomy, which further catalyzed the Scientific Revolution.

The scientific method started to evolve Med1 at the end of the 17th century, but the transition to Med2 did not begin until we discovered germ theory.  This theory, discovered by Louis Pasteur, states that pathogens or “germs” cause disease. 

Pasteur was the inventor of the first vaccines and the method of pasteurization we use to preserve foods, but the notion of the immune system was still undiscovered at this time. 

Med2 = Breakthrough medical tech & pharmaceuticals

Joseph Lister, a surgeon, medical scientist and experimental pathologist, was the first to apply the science of Germ Theory to surgery, building on its discovery. He was the pioneer of antisepsis surgery and his antisepsis system is the basis of modern infection control. 

The full transition to Med2 occurred with the discovery of antibiotics.

In 1928, Dr. Alexander Fleming returned from holiday to find a mold growing on a Petri dish of Staphylococcus bacteria. He noticed the mold seemed to be preventing the bacteria around it from growing. He found that the mold produced a self-defense chemical that could kill the bacteria. That chemical was penicillin.

This discovery changed the course of medicine and transitioned the world from Med1 to Med2. It lead us into the 20th century which can be described as the era of antibiotics.

Med2 also has had a boom in medical technology with the crown jewel being the invention of  statistical machinery to enable randomized control trials. Thus allowing scientists and physicians to test new drugs for a variety of conditions. 

Med2 is great for acute conditions. Doctors now have powerful tools at their disposal such as MRI machines, advanced surgical techniques and new pharmaceuticals. These tools can tackle most acute conditions like heart attacks, car accidents and life threatening infections.

Med2 patients sometimes feel a lack of trust or depth in their doctor-patient relationship, feeling that they are just another number. Doctors on the other hand, are under more pressure due to increasing demands of the system which prioritizes procedures and prescriptions over holistic patient care.

If you want to keep someone alive as long as possible with acute conditions, Med2 is the answer. Instead of dying young from infections, as in the past, people typically succumb at a mature age from chronic, non transmittable conditions.

In summary, the transition from Med1 to Med2 was fast, less than a century, and vaccines along with notable antibacterial agents have changed the profile of world public health.

However, if longevity is what we are aspiring to, we have reached the limits of Med2’s capacity and we need a new strategy. 

We need a fundamental shift to Med3.

Med3 = Focus on prevention above treatment

While previous versions of medicine reacted to diseases, Med3 will focus on their prevention. A core element of this is identifying risk factors early, promoting healthy lifestyles and early interventions to prevent disease progression.

In the Med3 era we are starting to see certain physicians taking a larger look at the body. 

In the majority of Med2, physicians studied an individual organ and became a specialist. For example a brain surgeon or a nephrologist (kidney expert). These physicians would treat the symptoms causing a patient’s problems but not look at the root cause of disease. 

In the transition to Med3, instead of viewing patients as a collection of symptoms, we look at the whole individual. Med3 considers physical health, mental well-being, social factors and environmental impacts on the body.

Dr. Attia suggests an accelerated transition to Med3, which is predicated on “evidence-informed” as opposed to “evidence-based” guidelines. 

Med2 is an “evidence-based” practice. “Evidence-based” decisions are made based on the best available current and scientific evidence. This means relying on well-conducted studies such as randomized clinical trials, systematic reviews and meta-analyses.

“Evidence-informed” practice recognizes the value of research evidence but also considers other forms of evidence such as expert opinion, patient preferences, clinical or contextual experience and available resources.

Strong research evidence may be lacking in the care of preventative interventions, as human clinical trials are nearly impossible to conduct. These trials require a long time scale, thus reinforcing the need for an “evidence-informed” approach.

Overall, Med3 will promote human healthspans. 

Healthspan is the part of a person’s life in which they are generally in good health and without chronic disease. Lifespan, or how long one lives, is what previous versions of medicine focused on.

Med3 will emphasize lengthening the period during which a person is healthy and free from chronic diseases. The goal is to extend, not just overall age, but the time people enjoy a high quality of life.

Lastly, this type of care needs to be highly personalized. There has been the promise of personalized medicine for decades but we are not there yet. If Med3 can succeed in prevention of disease, then I see Med4 as the era of personalization.

Med4 = The era of personalized care

If I were to predict what Med4 could look like, it would represent a truly integrated, holistic approach to health and well-being. It would use the latest technologies with a profound respect for the individual, the environment and the complex interplay of those factors which influence and determine someone’s health.

The heart of Med4 would be an unparalleled degree of personalization. More than a genetic understanding, it would be a holistic understanding of the individual at every level.

Med4 will have an advanced digital integration with wearable and implantable devices to monitor our health in real time. This integration will leverage AI to provide data,  predicting health issues before they occur, by diagnosing disease at the earliest stages in complex data sets that are beyond the human capacity for analysis.

Regenerative care using advanced stem cell therapies can move us beyond transplants and give doctors the ability to repair and replace damaged organs.

Telemedicine and remote care would be the gold standard, along with a fully decentralized healthcare system. Increased advanced home-based care and mobile clinics will provide easily accessible care.

Education and empowerment will be a core pillar of Med4. We will trust patients to be an active participant in their healthcare and make informed decisions with their doctors. 

We will accept and recognize the influences of the environment and social structures on health. Med4, in turn, will incorporate strategies to improve societal and environmental determinants of health to ensure a healthier global population. This will also lead to new disciplines focusing on medical ethics, as gene editing progresses and we develop longevity interventions. 

The transition from Med1 to Med2 took 300 years and we are in the transition to Med3 now. A full integration to Med3 may take another half a century but with all the rapid advances in technology, I still hope to see Med4 become a reality in my lifetime.

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📚 Book of the Week

Outlive by Peter Attia

5 / 5 Stars

Being a longevity enthusiast, I was recommended Peter Attia’s new book Outlive by a few colleagues. I was apprehensive at first because I worry about “celebrity scientists” diluting their content in order to bring the science mainstream. However, Peter Attia does a great job explaining the mechanisms behind what is driving many of the chronic diseases that cause mortality globally. 

Attia makes a strong case for the need to start preventative measures decades earlier than what is currently recommended by standard clinical practice guidelines. He emphasizes that many chronic diseases, such as diabetes and heart disease, can be prevented and improved with an emphasis on lifestyle changes and available diagnostic tests which one can request from their primary care physician.

I really enjoyed the read and suggest everyone pick up a copy.  

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⚡️ Check This Out

According to the U.S. Bureau of Labor Statistics, the percentage of the U.S. workforce taking vacation in a given week has fallen from 3.3% in 1980 to 1.7% today. 

Americans aren’t taking their vacation often out of fear for their job security or appearing expendable. Since paid time off is often combined with sick days, employees don’t take their PTO in case they need it in an emergency.

I write this newsletter from sunny Portugal, where we have a federal vacation policy of a minimum of 22 vacation days per year. Right now is the slow season and setting meetings is largely impossible because everyone is OOO enjoying this policy.

Let’s throw it back to this 2021 tweet which is still relevant today, and having worked both in the U.S. and Europe, I can tell you this tweet hits my soul.

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