Longevity Escape Velocity Medicine: A New Medical Specialty for Longevity?

(1) Creation of an LEV Medical Specialty and training of healthcare professionals

To help patients achieve and maintain LEV, medical knowledge is required from diverse medical specialties and from outside specialties typically practiced by doctors. General practice (also known as primary care or family medicine) is the current specialty with the most similarity to LEV medicine; however it lacks in knowledge in many key areas, as well as in availability of time.

An LEV medical specialty could be a subspecialty training of general practice, internal medicine, geriatrics, or clinical research.

Core elements of an LEV medical specialty training would include education in prioritization of clinical problems according to magnitude and probability of clinical outcome or surrogate marker impact to a specific person's budget; understanding clinical biogerontology frameworks, including pathology based frameworks (such as the Strategies for Engineered Negligible Senescence [SENS] framework) and process based frameworks (such as the Lopez-Otin et al., Hallmarks of Aging framework) and the associated markers and current state of therapies and clinical or research access to these; nutribiogerontology, in particular, managing and monitoring safety and efficacy of calorie restriction optimal nutrition diets as well as optimizing micro- and macronutrient intakes to reduce all-cause mortality; concordance, motivational interviewing, and behavior change; experimental medicine methodologies, including accessing clinical trials and off-label prescribing of pharmaceuticals with potential promise for impact on aging such as metformin, acarbose, rapamycin; and ensuring an optimal response to any emergency situation—including training in best practices and the science of whole body or neuro-only cryopreservation to name but a few.

(2) Better calculations of a person's LEV

How can LEV be measured accurately? Initial models are needed that take into account a minimum number of quality measurements across broad clinical outcomes and frameworks of aging (such as SENS and Lopez-Otin Hallmarks of Aging). Optimal ranges for clinical outcomes can be established for diverse markers and used to create an effective “biological age” for individual organs or systemic aging pathologies. Combined with current best risk prediction calculators for broad sets of diseases as well as a current annual “coefficient of baseline gain in life expectancy” due to current innovation rates (of which Ray Kurzweil believes was 0.25 in 2016), and taking into account a qualitative measure of a person's financial budget, motivation, and “LEV-related education,” a client's LEV can be determined to fall within a certain range.

(3) New guidelines for LEV medicine

Although gold standard medical guidelines such as the UK's NICE Guidelines are very high quality and should be used in LEV medicine, such guidelines are not designed for systematically assessing and maximally reducing all-cause mortality risk, do not have a current broad coverage of preventive medicine topics, are designed around a budget of around £400 per quality adjusted life year (QALY) (median) and £10,000–£10,000 per QALY (maximum) expenditure—not taking into account private services that can spend beyond this, and have high cutoff requirements for efficacy evidence—which may not be beneficial in LEV medicine.

(4) Appreciation of emergency medicine for achieving LEV

A patient's ability to respond optimally to all emergency situations is an under-looked component of preventive medicine (i.e., preventing an unoptimal response and care pathway in emergency medical situations through planning, training, appropriate equipment purchase, or healthcare system service availability). A patient's emergency medical risk should be systematically assessed as part of LEV medicine, including personal emergency medical knowledge, geographic emergency medical service availability and performance metrics, medical emergency equipment owned or accessible, and whole body or neurocryopreservation services.

(5) A culture of 100% effective capture and open sourcing of all data from all patients

Research is paramount to accelerate the generation of evidence of efficacy and safety of new measurements, therapies, and clinical pathways that are relevant to LEV. A core element of LEV medicine should be that any novel practice across any aspect of LEV medicine, be it a new annual screening panel, an off label pharmaceutical, an experimental stem cell or gene therapy, or new diet or nutraceutical combination, should be part of a formal registry, with all data captured and published open access, and ideally collated to a central LEV society or organization for analysis, methodological and ethical critique, and distribution to parties that may benefit. For example, what proportion of potentially useful surrogate marker or clinical outcomes data is captured, collated, and distributed from the proportion of people globally experimenting with novel therapies nutritional supplements (such as nicotinamide riboside, or complex personalized stacks of nutraceuticals), pharmaceuticals (such as low-dose rapamycin, metformin, or acarbose), advanced therapies (such as placental tissue mesenchymal stem cells or adeno-associated virus (AAV) myostatin gene therapy), etc.? It is likely under 0.01%; global standards to capture such data usefully—such as via guidelines for basic experimental protocol that doctors and patients may follow for each novel intervention, as well as systems to capture, collate, analyze, and disseminate such data—could have ensured perhaps 1000 or 10,000 times more data on all novel practices to date, providing benefits for everyone. People should have the right to experiment, but it is much, much better if they experiment according to a minimum scientific protocol and have the opportunity to measure for efficacy and safety before and after with high-quality markers or be followed up on a registry for clinical outcomes. LEV medicine or even all healthcare professionals should be trained with appropriate guidelines to ensure this and incentives for experimenters aligned such as through rewarding with results, resources, or fiat or cryptocurrency.