THE NEW YORK TIMES: What, exactly, is longevity medicine?

Longevity medicine is a confusing brew of noble intentions, cutting-edge care and expensive snake oil.

That’s partly because there is currently no board certification, nor official guidelines, for practising longevity medicine (also called geromedicine) in the United States.

Virtually anyone with a medical degree can call themselves a longevity doctor; witness all the doctor-influencer types positioning themselves as experts on social media.

And while there are practitioners working in good faith to help people live longer, healthier lives, and scientists pursuing treatments to potentially slow the ageing process, there are also clinics and companies marketing anything and everything in the name of longevity.

That includes supplements, scans and infusions that have little evidence to support their use.

Longevity medicine “requires a lot of scrutiny,” said Dr. Bobby Mukkamala, the president of the American Medical Association.

Are the treatments clinics are offering “based on something that’s totally justified to work, or is it something that hasn’t yet been proven?”

We asked longevity doctors and other health experts about the most promising ways longevity medicine can help people, and where the hype has gotten ahead of the science — and may be doing more harm than good.

Longevity medicine done right?

The experts said the best version can currently accomplish a few things: give people more time and attention than the typical primary care system allows for, offer more personalised care plans, and shift the priority to preventing disease rather than treating it after it appears.

“I think in the best-case scenario, longevity medicine is what really good medicine has always aspired to be, but rarely had the tools to deliver,” said Dr Jordan Shlain, the founder of the concierge medical practice, Private Medical.

A typical first step at many longevity clinics is to undergo a comprehensive work-up, which often includes things such as a fitness assessment, blood panel, genome sequencing and body scans.

Some of these, such as a metabolic panel, are standard and regularly used in primary care practices. Others have historically been used in specialty care but are becoming more mainstream, such as tests for lipoprotein (a) and apolipoprotein B, two biomarkers related to cardiovascular health.

To the field’s proponents, these tests are a way to gather data about a person’s risk of various medical conditions and come up with a plan to intervene earlier.

“When we think about primary care right now, we are still reacting to information that is, quote, ‘after the fact,’” said Dr Nicole Sirotin, the CEO of the Institute for Healthier Living Abu Dhabi.

(While there are many longevity clinics based in the United States, much of the work to grow and standardise the field is taking place in other countries.)

Dr Sirotin cited blood sugar management as an example. In traditional primary care, a doctor likely would not prescribe medication or lifestyle changes until after a person’s glucose levels qualified them as prediabetic.

With a longevity medicine approach, a provider might recommend similar treatments if a patient’s blood sugar was trending high, even if they didn’t reach the prediabetes threshold.

That means a normal test result, often seen as an indication of health in traditional care, might not be deemed good enough in a longevity clinic.

Dr Andrea Maier, the co-director of the Academy for Healthy Longevity at the National University of Singapore, said she treats normal bloodwork as something that she can work with a patient to improve on.

“We want the normal people to become optimal,” Dr Maier said. Because for people with borderline results, “in 10 years’ time it’s very likely that you are abnormal, so why would we wait?”

Longevity medicine care can cost you — and is very rarely covered by insurance.

Some clinics in the United States operate on a fee-for-service model, and tests and treatments must be paid for out of pocket. At other practices, an annual membership can run five or six figures.

Dr James Kirkland, the director of the Center for Advanced Gerotherapeutics at Cedars-Sinai in California, agreed that there isn’t “much yet” in terms of health outcomes a patient can get from a longevity clinic that they can’t receive from good primary care.

He added that he is excited about the potential for geromedicine (his preferred term) over the next five to 10 years, but right now, he said, “there’s a lot that’s being done that is somewhat risky and is poorly evidence based.”

Unproven treatments with a ‘veneer of rigor’

The lack of standardisation in longevity medicine has left a lot of room for false promises and pseudoscience.

Clinics have been known to offer all sorts of unproven and potentially dangerous treatments, including peptides, stem cell therapy and plasma exchange therapy.

“We have, at this point of time, people who died from stem cells, people who had very severe toxic reactions through infusions of different peptides,” said Dr Evelyne Bischof, the medical director of the Sheba Longevity Center in Israel.

“So there are risks, there are harms,” she said.

Then there are the subtler ways that longevity clinics stray from the science. For example, several of the experts took issue with some of the tests offered, including biological age tests, saying they aren’t accurate enough to be used on an individual level.

“They are useful at population levels,” Dr Kirkland said. “But there’s tremendous interindividual and day-to-day variation in their readouts.”

Other treatments, such as supplements or off-label prescription drugs, are being studied in clinical trials and there is some evidence — mostly from animals — to support their use. But many of the experts still urged caution.

“Longevity medicine can be kind of a bit of quackery, rebranded,” Dr Shlain said: “Biomarkers give a veneer of rigor, and the supplements give it revenue, and the patient gets neither longevity nor honest conversations about things.”

While the experts were concerned about the snake oil on offer, they were also optimistic about the future.

There are nascent global efforts to legitimise longevity medicine by creating government-issued licensing standards for clinics.

And there are ongoing clinical trials that might one day lead to medications that can influence the root causes of ageing — the field’s ultimate goal.

“In some way, geromedicine right now is a field without specific medicines, but they will come,” said Dr Eric Verdin, the president and chief executive of the Buck Institute for Research on Ageing.

But right now, he added, we may be “a little bit ahead of our skis in terms of vision.”

This article originally appeared in The New York Times.

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