Peter Attia: Our conversation about his hit book OUTLIVE, Medicine 3.0, promoting healthspan, GLP-1 drugs and more

In July, I reviewed Peter’s Outlive book here in Ground Truths and hoped I’d be able to interview him about my concerns. Here’s that conversation, recorded October 16th. I hope you’ll find it informative and stimulating!

The AI generated transcript (unedited) below with links to the audio recording

Eric Topol (00:01):

Peter, it's really great to see you. I haven't been chance to visit since early 2020, and you introduced me to Topo Chico as a great way to get carbonated water. Are you still into those?

Peter Attia (00:15):

Very much so, yeah. Although I have a different drink today because, well, I don't know why I grabbed for different drinks.

Eric Topol (00:22):

Yeah, well it's kind of amazing. Distinct from the rest of the waters, fizzy waters. At any rate, since that time, that memorable visit we had, you published an incredible book Outlive, and I think it sold more than a million, well over a million copies, which is amazing. So congratulations.

Peter Attia (00:41):

Thank you so much.

Eric Topol (00:42):

It's a great book. And you may have written my review, which I really thought it offers just a great information resource and it must've taken so many years to put it all together.

Peter Attia (00:54):

Yeah, I think it probably took seven years in total.

Eric Topol (00:57):

Well, I think it was well worth, and I think it's helping a lot of people. And in fact, I first became aware of it just because these patients were coming into me and saying, well, that's not what Dr. Attia says, or What do you think of Dr. Attia’s book ? So that's prompted me to give it a really close read, and I learned a lot from all your work. I thought what we'd start off with, I think you framed it really well with this Medicine, 1.0, 2.0, 3.0 and the shift to the right. So maybe you could explain the concept on that. Sure.

Peter Attia (01:34):

So Medicine 1.0 is kind of a placeholder for a time before there really was medicine, or at least before, there was sort of a scientific method and an understanding of science and the natural world around us. But of course, from a timescale perspective, it's what dominated all of our civilization. So humans have been around for 250,000 years and until very, very, very recently on that timescale, we didn't really have the tools intellectually to understand science. So we couldn't understand cause and effect. We didn't have a scientific method, let alone capacity to do experiments. And so most of what we did as far as medicine was based on things that we look back at today and think are completely ridiculous. Illness was brought on by the gods or bad humors or things like that. And really then when we start to think about medicine in the way we think about it today, we're really thinking about Medicine 2.0.

(02:33):

And this is something that was obviously a many, many year transition. Technically I would argue it took place over hundreds of years, beginning with Francis Bacon in the late 17th century or the mid 17th century, but really accelerating in the latter part of the 19th century with germ theory. So we can think about lister, I wrote a little bit about them, and ultimately really a more concrete set of tools including physical tools such as the light microscope, ssid, Muer G writes very elegantly about the importance of the light microscope in the understanding of the cell. And of course a big part of understanding the cell was understanding bacteria, their role in disease. And then we have the advent of antimicrobial agents. So it's this sort of collective set of tools that allow us to basically double without exaggeration human lifespan in a matter of three generations.

(03:31):

So this is kind of a remarkable trajectory. I think it would be surprising for most people to learn, however, that in this doubling of human lifespan about, well, I would say virtually all of it has come through the reduction of and or elimination of infectious diseases and communicable diseases. And none of that has really come, or very little of that has come by addressing chronic diseases. And so as we've now lived longer by not dying due to the sort of usual infant mortality and infectious disease route, we're instead dying of these chronic diseases. And I think Medicine 2.0 has been largely unsuccessful in that arena with perhaps one exception and that exception is vaccination. So vaccination is in some ways a medicine 3.0 tool because it's a tool of prevention, meaning you treat before a person is sick, whereas most of the success of medicine 2.0 is treat once the patient is ill.

(04:39):

And that tool doesn't work for cancer, for dementia, and for atherosclerosis for those diseases, you actually have to treat if you will, long before the patient is sick to prevent or at least delay the onset of. So in some ways that is one of the most important pillars of Medicine 3.0, there are several others. So another very important pillar of it is an equal if not greater focus on health span over lifespan where the description and definition of health span are much more rigorous. So the Medicine 2.0 definition of health span is the period of time in which you are free of disability and disease. I kind of reject that definition is not very helpful because I'm as free of disability and disease today at 50 as I was when I was 20, I'm clearly not in as good a shape, I'm not as strong, I'm not as cardio respiratory fit, I'm not as cognitively sharp. So my health span has already declined.