The Fountain of Youth

What if I told you that you could reverse aging and live forever? What if I promised you the fountain of youth.

Then, I’d be lying to you.

In my last post, I talked about ethical enterprise from the lens of an interventional cardiologist & cofounder of Lylah. Let’s continue that theme.

Some of you may have heard of Bryan Johnson of Braintree fame. He sold Braintree to Paypal after acquiring Venmo & is worth nearly half a billion dollars. He also spends roughly ~$2M a year on supplements & efforts to “reverse aging” & prolong his lifespan.

I’ve seen this trend not only among the insanely wealthy but among regular consumers as well. The longevity fad has convinced folks that they can somehow increase their lifespan in a data-driven or evidence-based way.

Let’s embark on a thought experiment:

If you wanted to see if an intervention increases lifespan, how would you prove that? Let’s say the goal is to live for 200 years, as Bryan Johnson purportedly aims for.

Can a Clinical Trial Prove Longevity?

The gold standard to rigorously show this is to conduct a randomized controlled trial with 2 groups, one tested on the miracle intervention & one living life normally. However, you’d need a lifespan to prove anything.

That’s impractical.

What are the other options?

Can We Study People Later in Life?

What if you take 70 year olds or even 90 year olds & replicate the study design in that demographic? Well, the average life expectancy in the US is ~79 years. If you make it to 65, you can expect on average to live an additional 19.7 years. See the math problem yet? If you live to 65, you can expect on average to live to ~85. That’s higher than average life expectancy by 6 years. If you’ve lived long enough, other factors are at play that increase your chances of living longer than average. The study is flawed from the get go.

What about cellular mechanisms?

Can Cellular Mechanisms Prove Longevity?

Mechanistic data is hypothesis generating, not evidence of proof. The dusty shelves of useless interventions are filled with “it should have worked” ideas. The reason is simple. There are so many variables involved in human biochemistry, even without environmental exposures, that you can’t extrapolate mechanisms & call them proof.

It’s like trying to predict the stock market. To paraphrase Michael Berry & Nassim Taleb in ‘The Black Swan,’ if you take a pool table & assume its frictionless, the path after the first strike of the ball is easy to predict. By the 9th strike, you’d have to take into account the gravitational pull of people near the table for an accurate model. By strike #56, every elementary particle in the universe needs to be factored into your assumptions for an accurate model, including an electron 10 billion light-years away.

Chase Better Years, Not Immortality

Let’s go where the data leads us. The last 10-15 years of an American’s life are spent dealing with chronic illness with the associated financial, emotional, & psychological cost. Instead of chasing immortality, let’s chase prevention of shitty twilight years.