Authors: Peter Attia with Bill Gifford
Great Britain: Vermillion, part of Penguin Random House UK, 2023
Paperback ISBN 9781785044557
Peter Attia discusses his perspective on healthy living through a series of personal anecdotes. The book has become the centrepiece for conversations around healthspan and longevity since its release in 2023.
Peter started out as a surgical oncology trainee working long hours in a large tertiary hospital. He describes this experience in an analogy of trying to ‘catch eggs that someone was throwing off a roof’. The health system operates on the principles of treating the sick patients, prioritising the severe conditions such as cancer and heart disease, which he termed as ‘Medicine 2.0’. Disillusioned and burnt out, in what he perceived as a failing system, he left clinical practice and spent the next few years working as a management consultant. It was this work that he attributes to broadening his world view.
He finds his way back to medicine after some personal setbacks where he changed his focus to longevity medicine. As a result, he advocates to his patients the concept of a healthspan rather than a lifespan, a term he coined ‘Medicine 3.0’. The book explains that the primary conditions that contribute to chronic disease are heart disease, cancer, dementia (specifically Alzheimer’s disease) and metabolic disease, naming them as the ‘Four Horsemen’ of chronic disease. The book goes in to detail on how each of these conditions combine and amplify their effects.
He uses unconventional practices that are derived from his clinical experience and encourages proactive screening. One such example is the use of regular full body magnetic resonance imaging (MRI) for screening his patients. This is resource intensive and carries its own risks, such as incidental findings that may lead to requiring invasive procedures and treatments and cause anxiety.1 The book does not discuss the potential risks of such investigations. Furthermore, his very detailed patient centric approach is accessible to very few affluent individuals.
From a general practice point of view, the book provides a fresh approach to the core principles of exercise, nutrition, sleep and emotional health. It proposes stricter regimes in these crucial areas to promote a longer period of healthy living. It goes on to introduce the ‘centenarian decathlon’, a concept that encourages individuals to envision their lives in their later decades and prepare for them through a set of structured exercises. It is a compelling perspective and could be a unique way to refocus priorities for lifestyle changes.
The critique of evidence-based medicine (referred to in the book as Medicine 2.0) is well founded, but reflects the decade that he was first practising in. However, much has changed in medicine since his early experiences and in that time preventive medicine has taken forefront in most of the developed world.2,3 By the time this book was published, in 2023, we now have a much more comprehensive understanding of lifestyle interventions. General practitioners and an increasing number of patients are already well-informed regarding aspects of preventive medicine.4,5
In the concluding chapters of the book, he touches on emotional health and his difficulty with his mental illness. These are real struggles that doctors go through: struggling without insight into our own mental health. Having the medical knowledge to manage mental health is both a boon and a curse. His words on his struggle to accept help from those around him resonated strongly with me.
His narrative style is engaging and he explains his reasoning in a direct, easily digestible way. The science is presented in an easy-to-read manner, but the research behind it is superficial. Despite this, I found it to be a thought-provoking book that forces you to revisit some of the core tenets of preventive medicine.