[Aurornis]

This holds true for many things. It’s easier to stay in shape and maintain a healthy weight than it is to recover from getting out of shape or overweight. The longer someone spends out of shape or overweight, the harder it becomes to escape the cycle. There’s no better time to start than now.

As for preventative medical treatment: This one is a difficult topic. There’s a popular misconception that getting a lot of different blood tests and imaging scans is a good idea to identify conditions early, but most people don’t understand that these tests (including imagine) are prone to a lot of false positives. Excessive testing has been shown time and time again to lead to unnecessary interventions, leading to worse outcomes on average. A number of previously routine medical tests are now not recommended until later age or until other symptoms appear because routine testing was producing too many unnecessary interventions, producing a net negative benefit.

It’s a hard concept to wrap our heads around when we’re so attached to the idea that more testing means better information. It’s a huge problem in the alternative medicine community where podcast grifters will encourage people to get various tests like organic acid tests or various “levels” testing, then prescribe complex treatment programs with dozens of supplements. The people chasing these tests then throw themselves far out of balance with excess supplements while sinking thousands of dollars into repeat testing

[FabHK]

Any opinion on Outlive: The Science and Art of Longevity by Peter Attia? He seems fairly fact-based, but does recommend several diagnostics.

[timr]

He’s better than most, in that he puts disclaimers on things that aren’t rigorously proven. That said, he talks a lot in that book about things that aren’t actionable, even if they were rigorously proven - such as the coronary calcium scan.

If you get a high score on that test, what are you going to do? Eat better, lose weight and exercise. So skip the test and just do that instead.

[nradov]

A high coronary calcium score factors into the decision about whether to apply more aggressive pharmacologic interventions. Those have risks and side effects so unlike the lifestyle factors you mentioned they aren't appropriate for everyone.

[timr]

I didn’t say the tests have no use, but trust me: if you’re otherwise well and don’t have symptoms, nobody is making aggressive pharmacological interventions based on the calcium scan.

This is why, historically, they were rarely used.

[nradov]

I am aware that is the current standard clinical practice. Dr. Attia's argument is that we could cut death rates in such patients by starting aggressive pharmacological intervention much earlier in the disease progression. From a physiological perspective that makes some sense, although there haven't been any studies to show whether that cuts all-cause mortality.

[timr]

Yeah, I get it. I read the book. I think his argument is wrong.

The point I am making is that for the “worried well” (aka “longevity enthusiasts”) you aren’t going to do anything differently based on the result. It's largely a waste of money for the sake of people who want to feel like they're Doing Something (tm).

If you really think about it, you're talking about the extremely marginal case where a) the patient had no prior symptom of an illness; b) the calcium scan is so bad that you'd put the person on a medication to manage a hypothetical future problem; and c) you weren't going to do it anyway based on other tests.

The three things together are vanishingly unlikely. The better argument, mayyyyybe, is that maybe the test is one of those things that motivates a certain type of person (again, the "longevity enthusiast") to do something they otherwise wouldn't do, but that kind of person seems like...the kind of person who wants to do things. So what is the goal?

See also: Vo2max, DEXA scans, and most of the other tests mentioned in the book. Great for nerding out on metrics, but...you aren't going to do anything you weren't already doing if you're the type of person to be getting the test in the first place.

[vismit2000]

Chapter-level summary: https://www.booksummary.pro/Outlive_summary.html

[the__alchemist]

This sounds like an example of a fault in how to take action based on results vice a fault in getting too much data. Perhaps the conclusion you state about the better approach being to forego tests is true. For example, if emotional and legal factors prevent patients and providers from acting rationally here. Optimistically, we can do better.