It's time for your yearly checkup
Executive physicals are gaining steam—are they an answer to a sick care system?
Top of the morning, sapien. Welcome to Common Sense Medicine, where I try and keep you up to date on the latest and greatest in longevity science.
Still soaking up that UVB sunlight, so another scheduled post. In that vein, I want to cover UVB sunlight once I come back, because I saw an interesting thread about how heliotherapy might be good for you. More specifically, I wanted to dive deeper on whether I think that there’s a place for heliotherapy in medicine and how sunscreen fits into that. Additionally, one of my goals for next month is to get outside as much as possible, just like how I did an experiment on cold exposure in January.
But my analysis / thoughts about that are coming soon, so definitely subscribe if you want to get that post.
Today’s post is all about the care that’s available to you if you want to shell out a pretty penny for it, and why I think trad health and chad health enthusiasts may both rejoice that this service is available. I also wanted to cover why I think this trend is increasing, as more people become jaded of the healthcare system and their relationship with reimbursed care.
Other items on the differential:
Athletes are trying to get jacked by any means necessary to win a new type of competition—where there’s no rules on doping
Why your genetic material may be monetized by bad-faith actors pretty soon
A longevity castle in San Francisco is focused on making founders live longer
THE WEEKLY DOSE
The Doctor(s) will See You Now
Executive Health packages are multi-day, preventative screenings at top health systems (i.e., Mayo Clinic, Johns Hopkins) that bring the top-of-line care and many bundled services for thousands of dollars. They’re usually focused on Fortune 500 CEOs, but essentially you have to pay thousands of dollars out of pocket for a litany of physician’s appointments over a few days where you get poked and prodded all at once to cover the gamut of health issues that you may need to watch out for.
When doing my research about this service, I found someone on X who had been through this experience and I was intrigued for a few reasons. First, he detailed how it was very far removed from a traditional check-up where you get ushered into a drab waiting room, wait for the doctor who already seems hurried as it is, they tell you some random jibberish, and then walk out.
Second, he mentioned that this “executive health program” was a multi-day stay at a WeWork type facilty, with WiFi and a catered kitchen, and allowed him to work while waiting between doctor’s appointments. Also, it provided all these services bundled in a neat 6-page itinerary, focused on his personal wants and needs. He was allowed to add on multiple ancillary services, from spa sessions to dietitians to craft meal plans, if he wanted to.
If that wasn’t enough to sell you on the process, these visits were book-ended with two, 60-minute sessions with his new primary care provider who was patient, understanding, and is willing to walk you through your results in painstaking detail and answer any crazy question that you have (I’m talking about Bryan-Johnson-esque questions like whether injecting Botox into your private parts increases your erections).
Reading all of this, I first asked where I could sign up for something like this, and the next question I had was—is it actually worth it?
Chad Health optimizers are ecstatic that they can get the premium experience
Most people who are fans of Andrew Huberman, Peter Attia, and the folks that I cite on this newsletter are probably already familiar with “optimizing” their health—and are willing to put lots of money on the line to feel as though they are focused on living better, for longer. They probably already spend thousands of dollars for their EightSleep subscription, their Oura ring, Apple Watch, Whoop, Athletic Greens, sauna sessions, and more.
From what I’ve seen though, generally patients want this type of “executive” experience because they feel let down from the usual user experience of traditional healthcare. Nothing about the doctor’s office screams comfortable. First, you have to wait in a dingy room. Then, you might be arguing with insurance companies to make sure that the doctor’s office will accept your plan. Finally, you’re stuck with a bill which is far too high. The logistics around the appointment are extremely painful. The actual appointment is worse because patients don’t understand what’s going on and the burnt-out provider doesn’t have ample time to spend with their patient—it’s almost criminal.
Chad enthusiasts are also looking for providers which aren’t traditionally categorized as healthcare but are “instrumental” in true health—think dietitians & ancillary services like PT. I could imagine an experience like a longevity summer camp, focused on chad enthusiasts getting testosterone lab results, sleep tests, and other longevity-focused interventions in an “executive-type” stay could be popular as well for these “worried well.” This solves two issues: (1) healthcare has overlooked certain aspects which are solved using a immersive health optimization “longevity summar camp,” and (2) gives a unique and special customer service experience not provided by the current health systems.
Trad Health enthusiasts are worried about access to healthcare & necessity of care
Most of the people engaging with this service already care a lot about health, so the advice that they’re going to get is largely going to be to continue managing their chronic conditions and do a little more exercise. But, like I mentioned, the logistics of having each follow-up with a specialist take place during your stay is so convenient that the clientele is willing to pay a lot for that convenience—even if they’re just being told to eat better and exercise.
Trad Health enthusiasts who I’ve talked to about this idea with wonder if this service can scale, and whether we’re exacerbating problems already present with health equity in the U.S. by encouraging different tiers of care outside the system. If this trend continues, and people continue to opt-out of the health systems to focus on “preventative” care, then the bottom tier of care needs to be content with more medically complex patients who are paying less (through third-party payers).
The outcomes from these executive health physicals aren’t well documented in the literature, although a cursory review shows that most of the services provided are for cardiovascular disease and cancer screenings. Most of the services weren’t recommended by the USPSTF for preventative services, encouraging a higher utilization of services due to over-detection of problems via an over-sensitive screening method.
My take: A better preventative medicine product increases adoption and subsequent revenue, even if it is a novelty
While these programs may have dubious real-world evidence to support their continued use, there certainly is a business case for health systems and providers to cater to the problem of bad user experience in healthcare. I can’t say that I’m going to avail the executive health programs anytime soon due to medical school generally sapping all of my cash (and loans), but I think that it would be an interesting insight if I had a couple thousand dollars lying around. Right now, therefore, I think that it’s a novelty product best used if you’re interested in learning more about your body and getting a premium experience while doing so.
The advice that I’ve learned in medical school is that each test which you order should have a justification on how a result should change management. Unfortunately, a lot of tests which are done in the name of “preventative health,” don’t change management at all. In fact, the pre-test probability of patients who are exercising, eating well, sleeping at least 7-8 hours a night, and are voraciously consuming information on how to optimize their health for a positive cancer diagnosis is slim to none. Unfortunately, if there is a shadow on their low-dose CT which they received in an executive physical, they’re going to want to get to the bottom of it even if it is a benign nodule. This will cause further anxiety and unnecessary testing just to get to a “wait and watch” scenario, wasting resources on a nothing-burger.
If one is still planning on going the route of skipping the system entirely, I think they should use an executive health screening to get a baseline of how they should think about their health. Then, they would use a subscription-based primary care provider (also called direct primary care or DPC) to continue their care in a longitudinal manner while they are still medically simple (1-2 chronic conditions, generally healthy, longer visits with better “customer service,” and tele-health first visits to ensure convenience). If they needed further insurance, they could get it from their employer and adopt a high deductible plan to only have catastrophic care insurance for emergencies.
I think that newer DPC services are useful for patients, but they may cause access issues for more complex patients who may need to see physicians, but can’t due to shortages and receive worse care because they can’t afford to pay for the concierge experience1. Even further, while these services cost top dollar, you’re not sure whether you’re receiving care which is truly needed due to the lack of consumer protection regulation associated with DPC.
Overall, there’s a large market for these preventative care services which are offering a better consumer experience in exchange for greater out-of-pocket costs. People like to be pampered when they’re going to a doctor’s office, even if the news that they’re getting isn’t particularly actionable or warranted. It makes you feel nice when everything is convenient, and people are willing to pay more for that privilege.
There’s probably no better time for entrants to cater to this population as more and more people are going to head out and try new health products in the name of ‘longevity’ and ‘wellness.’
THE PRESCRIPTION
Cup of
JoeNope: Caffeine is best used sporadically, according to a tech-banker turned crypto newsletter writer named BowTied BullDoped to the gills: Venture capitalists led by Peter Thiel are creating an “Enhanced Games” which throw drug testing out the window, effectively creating a “Steroid Olympics.”
Live like a king: You can rent a room in a “longevity castle,” in the Pacific Heights neighborhood of San Francisco. Benefits include weekly speakers (like Bryan Johnson / Sam Altman) and all of the bells & whistles which come with the space (i.e., filtered air, filtered water, sauna, red light, eight sleep beds, catered healthy meals)
FIGURE OF THE WEEK
The upshot: 23andMe is at risk of being delisted from the NASDAQ as its’ share price drops below a dollar, creating a situation where a foreign buyer can acquire 14M American genomic sequences.
Context: 23andMe was an innovator in the D2C genetic testing space, giving more power to consumers for their health data. As a company, they received the first FDA validation of genetic tests. What impressed me about their company was their ability to put data in the hands of patients, creating greater health literacy and a more informed patient base.
However, due to a recent data breach, loss in investor trust, and lack of focus for their business strategy, 23andMe is struggling. One more potential risk includes an acquisition by a buyer, which may lay bare the treasure trove of 14M Americans to the highest bidder (as of this writing, ~$200M in market capitalization). One of my friends, Jared Dashevsky, chronicles 23andMe’s rise and fall, which provides more context around what the future holds for 23andMe. (Source)
JOURNAL CLUB
Franken-sound: Researchers used low-frequency ultrasound (LFU) to increase cell rejuvenation as measured by various biomarkers (i.e., inhibition of mTORC1, SASP creation, Sirtuin1, and ROS levels)
Tik-Tok on the Clock: Researchers found that nucleosome length from cell-free DNA (cfDNA) is increased in older adults, and created an aging clock which allowed predicting a person’s age +/- 3 years.
Longevity Escape Velocity: The LEV foundation is conducting a study to reverse aging using 4 interventions (rapamycin, senolytic, telomerase gene therapy or mTERT, and hematopoetic stem cell (HSC) therapy in mice. The most current update shows data that is directional for the interventions, but the study is complete when only 10% of the cohort is alive (not until a couple of months have passed, unfortunately)
REMEMBER, IT’S JUST COMMON SENSE.
Thanks so much for reading! Let me know what you thought by replying to this email.
See you next week,
Shree (@shree_nadkarni)
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