By Bobby Stroup

If you want to read a book about how to guarantee a 100-year lifespan, Peter Atta’s Outlive is going to disappoint you. But if you want to learn about Medicine 3.0, the four horsemen diseases, and how you might increase your healthspan, then you should get a copy of the book today. 

Outlive is not a book on public health policy so much as it is an exploration of personal health policy. Even so, the text — existing somewhere between the genres of autobiography and medical journal anthology — offers insights relevant to any health care aficionado.

Though Outlive discusses a large range of health care concerns and does not shy away from scientific terms, even a casual reader can walk away with memorable lessons. Attia breaks down the science just enough to explain why his advice is important. Furthermore, Attia’s emotional tales of his own and his patients’ struggles makes the science all the more engaging. 

Modern Medicine

Medicine 1.0 & 2.0

Attia begins Part I by defining “Medicine 1.0,” the pre-scientific-method era where doctors were slightly more advanced than cavemen, but not much better than random guessing. The next phase, one beginning in the 17th Century, he names “Medicine 2.0.” In 2.0, we see the formation of the scientific method, germ theory, and randomized controlled trials.

Although there have been drastic improvements from 1.0 to 2.0, Attia claims Medicine 2.0 has reached its upper limit of effectiveness. In recounting his early years as a medical practitioner, he writes, “The problem is that we treated both sets of patients, trauma victims and chronic-disease sufferers, with the same basic script. Our job was to stop the patient from dying, no matter what.” In summary, Medicine 2.0 is an effective hammer, but not every problem is a nail. We need more variety in our toolkit.

Medicine 3.0

The second chapter of the book begins by quoting another passionate advocate for elder health, John F. Kennedy. The line comes from JFK’s 1962 State of the Union address in which he said, “The time to repair the roof is when the sun is shining.” Although the speech was on anti-recession protections, Attia leverages the famous metaphor to explain what’s necessary to promote human health. We need to start mitigating risk for diseases like Type 2 diabetes not when someone becomes pre-diabetic, but decades beforehand. This strategy, Attia claims, is Medicine 3.0.

Medicine 3.0 represents a shift from reactive to proactive. 3.0-thinking also includes “healthspan,” “the period of life spent in good health, free from the chronic diseases and disabilities of aging.” Yet, more prominent than any of these effects is a shift from “evidence-based” to “evidence-informed” medicine. In other words, Medicine 3.0 incorporates data at an individual level to create custom-tailored plans of attack to address health matters.

The Most Feared Disease

In Part II, Attia gives scientific descriptions of the four horsemen diseases — heart disease, cancer, neurodegenerative disease, and type 2 diabetes with associated metabolic dysfunction. Of all these diseases, he claims there is one feared more than all the rest. He writes, because there’s no definite way to treat the disease and because it is debatably impossible to reverse, “without exception, [his] patients fear dementia, more than any other type of aging. They would rather die from cancer or heart disease than lose their minds, their very selves.”

The sense of self is a powerful driver behind much of what Attia is promoting in the book. He wants the reader to become aware of their own bodies and what indicators to look for to identify health problems. The goal is that identifying these signs early can protect the self through earlier risk mitigation by delaying or preventing the diseases’ progression.

In regards to neurodegenerative disease, one indicator he mentions is impaired visual tracking. He references science seen in a study by the Journal of Alzheimers’ Disease, which shows that impaired eye movements can be an early sign of cognitive decline. Attia also explains how grip strength is directly correlated with long-term health. He writes, “Exercise is full stop and hands down the best tool we have in the neurodegeneration prevention toolkit.” The scientific literature supports this claim.

The Finale

Limitations

Part III of the book takes the problems defined in Parts I and II and begins to apply tactical solutions. Unfortunately, these solutions have their limitations. To his credit, Attia regularly qualifies his advice by encouraging the reader to talk about options with their personal doctor. He also doesn’t claim to have a cure-all, nor does he reduce people’s problems to mere lack of willpower (as others sometimes do).

So how does Attia’s book fall short? If you are an individual with more unique health needs, such as a disability, or you’re immunocompromised, this book might not have the nuance you want. Additionally,  Attia’s medical advice generally proves much more useful for someone in their 30s than someone in their 80s. Even for the ‘optimal’ crowd, Attia’s discussion of centenarians makes it unclear whether even a youthful reader has much control over whether they can make it to one hundred years old.

Takeaways

Though the book has its limitations, it is, nonetheless, a valuable resource for health care practitioners and laypeople alike. Outlive provides an accessible narrative explaining some of the weaknesses of modern medicine and describes some practical steps someone might take to improve their own life. For issues as important as these, we cannot afford to forego the use of our most powerful tool to call people to action — storytelling.

Ultimately, much of the beauty of Outlive is in the storytelling, Attia’s personal narrative. Attia shares decades-worth of life stories from being a child to studying as a medical school student to practicing medicine in the modern day. It’s these personal touches that change the text from a cold medical journal into a compelling story. It is this skillful storytelling that inspires the reader to continue the learning journey long after reading the final page.