The search to live longer is not new, but we are no longer looking for a hypothetical fountain of youth. Over the past few decades, research into metabolic health, longevity biomarkers, and more has led to longevity breakthroughs that open up new possibilities for extending lifespan and the number of years spent in good health [1].
What’s more, these breakthroughs are happening faster each year. A study published in Scientific Reports listed a 1.3-2x increase in efficiency for certain tasks in the medical research process within the last few years [2]. The study authors estimated that biomedical research in the future could accelerate to the point where it could be up to 100x faster than today.
That second number is only a prediction, but a 1.3-2x increase in efficiency is already a significant pace increase. For physicians and healthcare systems, this creates a new challenge: the implementation bottleneck.
In my own clinical practice and through teaching medical school students, I have reflected on barriers to verifying breakthroughs and implementing them in clinical practice and have identified solutions at the systemic level and for individual healthcare providers. There are also ways the companies behind longevity breakthroughs can communicate their value to relevant decision-makers.
The Implementation Gap and Current Healthcare Systems
The past few years have brought many promising longevity findings: early evidence, not yet peer reviewed, that GLP-1 drugs may lower markers of biological aging; a mouse study in which senolytic treatment with D + Q reduced kidney injury; and laboratory work supporting the STEM-PD trial of stem cell therapy for Parkinson’s disease, to name a few [3] [4] [5] [6]. While I’m optimistic biotech innovation will continue (and at faster speeds), these interventions won’t improve population health if clinicians lack the time and infrastructure to deliver them. That’s why the breakthrough I’m most excited about is addressing barriers to implementation.
Currently, a primary care provider is responsible for 2,500 patients on average in the United States [7]. Recent studies from the UK and Canada suggest similar strains on healthcare providers’ time, indicating this is an obstacle across international contexts [8] [9].
Not to mention, the shift to surrogates rather than mortality shifts a physician’s role. With surrogate endpoints, scientists use advanced tests to measure “biological age,” which means we can understand if a drug has an anti-aging effect without waiting decades [10]. Sometimes these tests can even measure the age of specific organs [11]. While a significant advancement, surrogate endpoints place an additional burden on doctors, who must closely evaluate the evidence in order to understand which biomarker changed and in which patient demographics.
There is some good news on the implementation front, however. Healthcare providers in oncology, respiratory, neurology, immunology, and cardio-metabolism are adopting new therapeutic approaches twice as fast as they were ten years ago [12]. The researchers of that study credit COVID-related fast-tracks of drug approvals, but it’s evidence that we can improve implementation.
And faster approvals aren’t the only way we can improve our healthcare systems and create more space to implement longevity medicine. Other changes might include:
- Administrative AI tools that break down information silos
- Tools that absorb prior-authorization and denial work [13]
- Workflows that protect physician time for evidence review
A Framework for Incorporating Longevity Innovation Into Practice
While systemic change is necessary to adopt longevity breakthroughs faster, shifts at the macro-level occur slowly. In the meantime, many healthcare providers might feel powerless and overwhelmed. I understand that frustration all too well, but there are steps we can take in our clinical practice to incorporate longevity innovation:
- Evaluate the endpoint: A promising biological mechanism or improvement in a biomarker is not the same as evidence that a treatment helps people live longer or healthier lives. Before incorporating a new longevity intervention, examine the quality of the supporting research, the outcomes it measures, and whether the findings are relevant to the patient in front of you. This is especially important for research where surrogates were used, since surrogates pinpoint specific biomarkers as opposed to general mortality.
- Empower the entire care team: Many of us work alongside nurse practitioners, registered dietitians, physiotherapist/physical therapists, health coaches, and other providers. Advocate for ways they can take the lead within their area of expertise, freeing up time for physicians to study new longevity breakthroughs and to reflect on how they might implement them.
- Be present with the patient: Many healthcare providers are overwhelmed by their patient load. When you’re seeing hundreds, if not thousands, of patients in a given year, it’s hard to recall everything about their medical history or previous conversations. While the best solution would be to reduce doctors’ patient panels, this is not always feasible. In previous clinical roles where I had a large patient panel, I focused on what I could control: my presence in appointments. Engaging with empathy and actively listening can help match longevity innovations to the appropriate patients [14].
- Create an implementation process: Rather than responding to every new study or product, establish a process for reviewing emerging evidence, assessing safety and clinical relevance, and deciding when an intervention merits adoption. AI can now help with evidence collation, such as the open source AI4L framework from Forever Healthy released earlier this year [15]. That said, clinicians need to review anything from AI tools for accuracy, relevance, and patient safety.
- Prioritize prevention alongside innovation: Some of the best longevity measures are preventive and not pharmacological. Healthy eating and consistent exercise, for example, are both associated with increases in healthspan [16] [17]. Promote these with patients alongside more novel drugs and therapeutic approaches.
Assessing Breakthroughs in Clinical Practice
When developing your own implementation process for longevity breakthroughs, the first step should be evaluating the clinical data. Busy healthcare providers can look at three key metrics to help determine what’s worth implementing: the dose, context, and person.
The dose refers to how much of a certain treatment was used in the study as well as the amount that the consensus of current research suggests is effective and safe. When evaluating studies, healthcare providers should also note adverse events, duration of treatment, and proposed use case, as all these factors impact clinical care too.
The context refers to the parameters and setting for the research, as well as the context in which I’m considering implementing the findings.
Person is the trickiest evaluation metric. It encompasses both the participants of a study, as well as our patients. With recent advancements, we can now assess a patient’s reference range via their trajectory across proteomic, metabolic, and functional measures over time. An organ-age score, for example, can be determined from the patient’s own data as opposed to population wide information [18].
How Longevity Companies Can Support Clinical Adoption
Healthcare providers don’t have to work alone to assess and implement breakthroughs. Companies developing longevity interventions and technologies can make adoption easier. This starts with taking the time to understand how healthcare providers make decisions. From there, companies can offer resources that help providers make informed decisions.
Those resources should be transparent. Companies should clearly communicate study design, participant characteristics, the surrogate-to-evidence chain, limitations, and known safety concerns. They should also distinguish between evidence of a biological effect and of improvement in health.
Practical considerations matter as well. Before promoting a new breakthrough or therapeutic approach to healthcare providers, ask yourself:
- Does a diagnostic tool provide information that can change a clinical decision?
- Can its results be interpreted reliably?
- Will it integrate with existing records and workflows?
- What training and ongoing support will clinicians need?
Of course, the answers to these questions and barriers healthcare providers face will vary from country to country. In the United States, regulatory status, insurance coverage, reimbursement, and the structure of primary care can all affect whether an innovation reaches patients [13]. In the UK, NHS pathways, commissioning arrangements, and relevant regulatory and evidence-assessment requirements shape adoption differently [19].
Across international settings, collaboration is still key. Biotech companies across the globe can engage clinicians early, address practical barriers, and demonstrate how their products can support safe, effective care.
Final Thoughts
Longevity science will continue to generate new possibilities, but its value depends on what happens after a discovery is made. Healthcare systems must cultivate environments where physicians can adequately evaluate and implement new longevity treatments as well as track patient biomarkers which will be essential to quickly implement ongoing research, such as the studies on early senolytic efficacy signals.
Clinicians need the time, tools, and framework to evaluate evidence. Companies can aid implementation by offering resources that align with the realities of care. The next breakthrough may not be a new longevity treatment, but a better way to ensure that proven interventions reach the people who can benefit from them.
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