REJUVENATION RESEARCH

Volume 21, Number 1, 2018

Guest Editorial
ª Mary Ann Liebert, Inc.
DOI: 10.1089/rej.2018.2055

Longevity Escape Velocity Medicine:

A New Medical Specialty for Longevity?

Oliver N. Zolman

A mainstay of preventive medicine innovators and

medical futurists has been the concept of longevity es-
cape velocity (LEV). LEV represents the time at which
specific person’s budget; understanding clinical bio-
gerontology frameworks, including pathology based
frameworks (such as the Strategies for Engineered
someone is gaining greater than 1 year of predicted healthy Negligible Senescence [SENS] framework) and pro-
life expectancy per year, essentially making his or her healthy cess based frameworks (such as the Lopez-Otin et al.,
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life expectancy unlimited. Although futuristic, over the past Hallmarks of Aging framework) and the associated
decade, leading innovators in the field have predicted persons markers and current state of therapies and clinical or
reaching LEV soon. Human Longevity, Inc., headed by Craig research access to these; nutribiogerontology, in par-
Venter, Peter Diamandis, and Robert Hariri, frequently claim ticular, managing and monitoring safety and efficacy
their goal is to make ‘‘100 the new 60’’ by 2025; the Me- of calorie restriction optimal nutrition diets as well as
thuselah Foundation ‘‘want to create a world where 90-year optimizing micro- and macronutrient intakes to reduce
olds can be as healthy as 50-year olds by 2030’’; whereas Ray all-cause mortality; concordance, motivational inter-
Kurzweil predicts that (1) LEV ‘‘will be reached’’ by 2029, viewing, and behavior change; experimental medicine
(2), baby boomers will still be alive and healthy in 2100, and methodologies, including accessing clinical trials and
(3), that in 2017 he personally has already reached LEV. off-label prescribing of pharmaceuticals with potential
But practically, what are the likely requirements to reach promise for impact on aging such as metformin, acar-
such a ‘‘longevity escape velocity’’? Around 95% of medical bose, rapamycin; and ensuring an optimal response to
service budgets today are spent on acute medicine, with only any emergency situation—including training in best
around 5% on preventive care. How can today’s medicine practices and the science of whole body or neuro-only
adapt to bring around a care system that provides LEV on a cryopreservation to name but a few.
population scale? Here I outline five core strategies for ‘‘LEV (2) Better calculations of a person’s LEV
Medicine,’’ a new paradigm of medical care. How can LEV be measured accurately? Initial
LEV Medicine: The medical specialty focused on measuring, models are needed that take into account a minimum
achieving and maintaining a person’s longevity escape velocity number of quality measurements across broad clinical
(LEV) through using diverse measurements and therapies to outcomes and frameworks of aging (such as SENS
maximally reduce all-cause-mortality, all-cause morbidity, ne- and Lopez-Otin Hallmarks of Aging). Optimal ranges
gative clinical outcomes and aging pathology and processes. for clinical outcomes can be established for diverse
markers and used to create an effective ‘‘biological age’’
(1) Creation of an LEV Medical Specialty and training of for individual organs or systemic aging pathologies.
healthcare professionals Combined with current best risk prediction calculators
To help patients achieve and maintain LEV, med- for broad sets of diseases as well as a current annual
ical knowledge is required from diverse medical ‘‘coefficient of baseline gain in life expectancy’’ due
specialties and from outside specialties typically to current innovation rates (of which Ray Kurzweil
practiced by doctors. General practice (also known as believes was 0.25 in 2016), and taking into account
primary care or family medicine) is the current spe- a qualitative measure of a person’s financial budget,
cialty with the most similarity to LEV medicine; motivation, and ‘‘LEV-related education,’’ a client’s
however it lacks in knowledge in many key areas, as LEV can be determined to fall within a certain range.
well as in availability of time. (3) New guidelines for LEV medicine
An LEV medical specialty could be a subspecialty Although gold standard medical guidelines such as
training of general practice, internal medicine, geri- the UK’s NICE Guidelines are very high quality and
atrics, or clinical research. should be used in LEV medicine, such guidelines are
Core elements of an LEV medical specialty train- not designed for systematically assessing and maxi-
ing would include education in prioritization of clini- mally reducing all-cause mortality risk, do not have a
cal problems according to magnitude and probability current broad coverage of preventive medicine topics,
of clinical outcome or surrogate marker impact to a are designed around a budget of around £400 per quality

20one Clinic Limited, Cambridge, United Kingdom.

1
 2 GUEST EDITORIAL

adjusted life year (QALY) (median) and £10,000– virus (AAV) myostatin gene therapy), etc.? It is likely
£10,000 per QALY (maximum) expenditure—not under 0.01%; global standards to capture such data
taking into account private services that can spend usefully—such as via guidelines for basic experimen-
beyond this, and have high cutoff requirements for tal protocol that doctors and patients may follow for
efficacy evidence—which may not be beneficial in each novel intervention, as well as systems to capture,
LEV medicine. collate, analyze, and disseminate such data—could
(4) Appreciation of emergency medicine for achieving have ensured perhaps 1000 or 10,000 times more data
LEV on all novel practices to date, providing benefits for
A patient’s ability to respond optimally to all everyone. People should have the right to experi-
emergency situations is an under-looked component ment, but it is much, much better if they experiment
of preventive medicine (i.e., preventing an unoptimal according to a minimum scientific protocol and have
response and care pathway in emergency medical the opportunity to measure for efficacy and safety
situations through planning, training, appropriate equip- before and after with high-quality markers or be
ment purchase, or healthcare system service avail- followed up on a registry for clinical outcomes.
ability). A patient’s emergency medical risk should LEV medicine or even all healthcare professionals
be systematically assessed as part of LEV medicine, should be trained with appropriate guidelines to ensure
including personal emergency medical knowledge, this and incentives for experimenters aligned such as
geographic emergency medical service availability through rewarding with results, resources, or fiat or
and performance metrics, medical emergency equip- cryptocurrency.
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ment owned or accessible, and whole body or neuro-

In conclusion, the current medical specialty framework
cryopreservation services.
does not accommodate well for medical care that would
(5) A culture of 100% effective capture and open
provide persons with maximum LEV outcomes. How does
sourcing of all data from all patients
society transition to an LEV-focused one? (This becomes
Research is paramount to accelerate the genera-
increasingly important as new aging therapies become
tion of evidence of efficacy and safety of new mea-
available and economically lucrative.) Might a new medical
surements, therapies, and clinical pathways that are
specialty and paradigm of medicine founded on the tenets
relevant to LEV. A core element of LEV medicine
mentioned achieve this?
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 Author Disclosure Statement
or gene therapy, or new diet or nutraceutical combi-
O.Z. is a medical student at King’s College London
nation, should be part of a formal registry, with all
Medical School, England, and CEO & Founder of 20one
data captured and published open access, and ideally
Clinic Limited, a medical organization focused on transi-
collated to a central LEV society or organization for
tioning society to an LEV-focused one through providing
analysis, methodological and ethical critique, and
clinical services to achieve LEV and through open sourcing
distribution to parties that may benefit. For example,
its results, methods, knowledge, services, and guidelines.
what proportion of potentially useful surrogate mar-
ker or clinical outcomes data is captured, collated,
and distributed from the proportion of people globally Address correspondence to:
experimenting with novel therapies nutritional sup- Oliver N. Zolman
plements (such as nicotinamide riboside, or complex 30 Romsey Road
personalized stacks of nutraceuticals), pharmaceu- Cambridge CB1 3DD
ticals (such as low-dose rapamycin, metformin, or United Kingdom
acarbose), advanced therapies (such as placental
tissue mesenchymal stem cells or adeno-associated E-mail: [email protected]