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.
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.
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.
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.
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.
I'm not sure I disagree with your general argument but it's worth noting that aerobic sport forums are replete with examples of people who were considered extremely fit, right up until the moment they were in an ambulance due to an undetected issue that could have been anticipated with a scan.
Testing in general gets out of control but we as a medical community also have a problem I think of not identifying certain problems until it's too late. Some preventative testing could be done more, some less.
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.