In this episode of Beyond Longevity, Daphna speaks with Dr Peter Scriven, Co-Founder and Clinical & Scientific Director of LONGEVITY, about what longevity medicine should actually look like: moving from reactive, disease-led healthcare towards preventative, personalised medicine that tracks biomarkers, cardiovascular risk and health trajectory over time.

Dr Peter describes much of conventional healthcare as ‘failure-based medicine’ — a system designed to respond once something has gone wrong. He questions the reliance on population-based ‘normal’ laboratory ranges, which can obscure meaningful changes within an individual, and makes the case for longitudinal ‘human telemetry’: following biomarkers and other health data over time rather than relying on isolated snapshots.

They discuss what responsible longevity testing should look like, including a core panel of around 50–80 blood biomarkers, more targeted diagnostics according to age, sex, symptoms and individual goals, and the importance of having a clear clinical reason for every test. Dr Peter also explains why more testing is not necessarily better, and why interpretation, clinical oversight and sensible testing intervals matter.

The conversation examines the realities of longevity medicine and preventative health screening, from several hundred pounds for more focused assessments to several thousand when extensive diagnostics and medical imaging are included, and where he believes people should prioritise their spending.

Dr Peter explains how his father’s missed cardiovascular risk and inadequate lipid testing helped shape his approach to preventative medicine. He also discusses the largely unregulated ‘Wild West’ of longevity, including peptides and other interventions promoted ahead of strong clinical evidence, and the checks patients can make when assessing a longevity clinic or practitioner.

And beneath the diagnostics, biological-age testing and emerging technologies, he returns to the foundations of healthspan: movement, nutrition, sleep and purpose.

For those working with a limited budget, he identifies three areas he believes are worth considering first: a proper cardiovascular risk assessment, omega-3 to omega-6 balance, and GlycanAge testing.

https://longevityclinics.life/

https://www.linkedin.com/in/drpscriven/

00:00 Why Prevention Matters

03:12 Failure-Based Medicine

04:34 Human Telemetry Monitoring

06:28 Testing Without Overtesting

09:53 Core vs Targeted Panels

13:13 Cost and ROI of Diagnostics

17:54 Healthspan Intervention Pyramid

20:53 Normal Ranges vs Trajectories

24:36 Missed Risks Real Stories

28:46 Breaking Medical Silos

33:49 Renaissance Medic Mindset

36:05 Training Beyond Silos

36:49 Regulating Longevity Medicine

37:43 Patients or Permanent Clients

41:01 Too Much Testing Ethics

44:08 Peptides and Amateur Hype

45:42 How to Vet a Clinic

49:01 Budget Biomarkers That Matter

52:13 Foundations and Wearables

55:19 Future of Cellular Medicine

58:30 Long-Term Clinic Journey

01:00:00 Rapid Fire and Wrap Up

Welcome to Beyond Longevity, the podcast that explores not just how we age, but how we can build a longer, healthier future for ourselves.

For more than a century, healthcare has been built around diagnosing and treating disease. We wait until something goes wrong, give it a name and then try to fix it. But what if the real opportunity lies much earlier?

What if we could identify the biological changes that lead to disease years before they cross the threshold of a diagnosis? My Guest today is Dr Peter Scriven, founder and medical director of Longevity, a UK clinic dedicated to personalized longevity medicine.

After careers in surgery, cancer research and general practice, he now helps patients understand and optimize their long term health through detailed diagnostics, continuous monitoring and highly personalized prevention. In this conversation, we explore why he believes modern healthcare still practices what he calls failure based medicine.

Why normal is often very different from optimal, and how to think about testing without falling into the trap of over testing. And where longevity medicine genuinely offers something new beyond conventional healthcare.

Hi Dr. Peter, thank you so much for joining me on Beyond Longevity today. You've worked in surgery, cancer research, general practice, and now longevity medicine.

You spent your career watching people arrive at your door once something had already gone wrong. Looking back, what made you realize that treating disease wasn't enough and that prevention deserved far more attention?

Thanks Daphne, for having me on.

This is a really good question and I think one of the bits for me that really stands out is the mindset shift from disease as a threshold diagnosis and moving towards looking at health as a trajectory over time. So it's a shift from a point assessment deal with a problem to how do we maintain function over time.

And if we look at what we know about biology, if we look at what we know about how we change as we age, we are now much better able to describe that than we were when I was at medical school nearly 30 years ago. And that for me is a profound shift in how I look at my patients. The question is not now, when have they crossed a disease threshold?

The question is, how do I keep my high performing 50 year olds physically closer to how they were at 30? And for me, that's the most profound shift. And in the uk, certainly the NHS is not configured to do that.

No, many people have voiced the same thought. Now, you've described much of modern healthcare as practicing what you call failure based medicine. I have to say I've never heard that phrase before.

I find it pretty striking. So let's start here. Explain to us, what do you mean by it?

We're set up in the UK to detect disease, which is usually a failure of a biological system.

So it might be hormonal failure when a woman reaches a certain age, it might be failure of thyroid axis hormones, it might be failure of renal function, it might be failure of vascular elasticity delivering hypertension. So we're set up to make the diagnosis once a threshold has been crossed into the failure of a system.

And that's really not where much of the rest of the world is going. The focus is now is. Is tracking the trajectory of change in those systems and intervening. That's the prevention piece.

We're not talking population health prevention for longevity, we're talking precision, personalised prevention and supporting those systems before they cross the failure threshold.

And that, again, is a fundamentally different approach to how we've been used to thinking about healthcare, how we've been used to teaching healthcare in the uk. And that's quite exciting.

At what point does the patient, or the doctor, for that matter, not be doing preventative medicine or treating a disease?

Because, if I understand it correctly, you sit in the middle of that, you're not doing just preventative medicine in case of what happens, but you're also not sort of getting to it when it's probably too late.

The ideal is to be monitoring those systems and intervening before they get even close to a failure threshold. So for me, it's about the longitudinal monitoring. Some of the work that we do with racing drivers, the analogy is about the racing car itself.

Those cars are wired up with various telemetry systems.

Every system is monitored, deviations from the norm are identified and when the car's back in the pit, the mechanics and engineers are trying to put that deviation back. Now we have a similar approach to our patients.

We call it human telemetry is the continuous longitudinal monitoring that enables us to spot things far earlier than waiting for vague headaches and a bit of fatigue, which is a hallmark of hypertension. This is about spotting drift from the optimal early and then intervening in a targeted fashion to restore that individual to their optimum. So it's.

The approach is very much more longitudinal, it's a very much deeper approach. We need to be looking at things that conventional medicine frequently doesn't look at.

And by conventional medicine, I mean what most of us experience from the NNHS in the UK. But the key is that longitudinal approach.

It's the data monitoring, it's the collation of that data, the interpretation of that data, and always bringing it back to where's optimal for that person at that point in time for them to do what they want to do so in.

Order to create a baseline, does that not involve hundreds and thousands of tests? Because if you're not looking for something in particular and you're just trying to see what is the norm and when are we off for the norm?

How do you know? How do I know what sort of tests are needed and what are superfluous to getting to that baseline?

So that's a really good question. And I think we need to be cautious of over testing.

We need to be mindful of the statistics that say if you look at enough things, you will find something that might be associated with a decline. But there is a balance and the NHS is not very good at doing broad spectrum tests. There are a whole variety of tests.

Even if we just look cardiovascular risk in the uk, we don't really do the lipoprotein profiles. My American and European colleagues just laugh when I say that it's not an expensive test, but the UK doesn't do it.

So it's about having the wisdom and experience to bring in a sensible baseline panel and that denotes your, your biological terrain. And that's going to differ for each of us. Once you've got that baseline, you can then look at the areas where things can be improved.

And I think the other really key message, and this goes back to the failure based issue, is normal isn't optimal.

A normal range is a statistical construct and within that statistical construct, you've got people who are unwell, you've got people who are very fit, you've got people with undiagnosed disease, you've got an age difference and we are beginning to understand that age does bring differences to those. So simply to go it's in the normal range, that's satisfactory, is not adequate, that's not precision healthcare.

And yet that's what the NHS is very good at, because it's set up for threshold and failure based care. So it's a very different approach. And yes, our clients get an awful lot of tests as a baseline. Not necessarily all of those need to be repeated.

It's about the precision around the individual. But we do need to be mindful that a test is a clinical process.

There has to be a rationale for doing that test, there has to be ownership of those results, there has to be the wisdom within the organization to actually manage that test end to end. If a cancer biomarker comes back as elevated, you have to, in my view, be able to manage that with an appropriate onward referral.

Nobody's claiming you should be able to do the chemo Radiotherapy and the surgery. That's absurd. But what you should be able to do is make the correct onward referral to the right service, be that private or in the nhs.

What's not appropriate is to just offload that responsibility into the NHS or whatever else. So I think there's clinical ownership of tests is really key.

How you deliver those tests is really key and understanding how to interpret them is important.

And again from 30 or nearly 30 years in the NHS, the mindset shift from it's in the normal range that'll do to what is optimal for this patient within their goals and expectations is really important. That's bringing the precision around the patient back to the fore, which I think is really, really important.

Oh, absolutely. You've touched on quite a number of things that I really want to delve into further.

But I want to start at something you really said right at the beginning. It's these tests that you do for your patients. Now, a twofolded question here. If I come to your clinic, what tests would you do with me?

Would they be the same as a 20 year old male? And do you base them on the way I live, if I'm an athlete or if I'm obese or those kind of things?

Or are they as a baseline standard test that you do just to sort of COVID the basis?

So there's a couple of buckets of tests, if you like, Daphne. So there's the core tests which are appropriate for everybody. There's a slight gender difference in there in terms of what hormones you look at.

But there's a core test that probably covers about 150 to 180 different blood based biomarkers which are appropriate for every individual. It gives us that core intelligence around their biological system.

So hormone axes, peripheral thyroid conversion, insulin resistance, renal function, cardiac function, proper cardiovascular risk assessment. So bucket one is a common set of tests. Then it's about what's the detail for the patient? Are we dealing with a lady of a certain age?

Are we dealing with an athlete? Are we dealing with somebody who's got already some pre existing metabolic issues?

And that's where the second bucket of tests comes along and that's much more targeted. So that's fishing out the information that we need that's more relevant to that individual. So the example I give is mitochondrial function testing.

I mean there's an entire rabbit hole about reproducibility and everything else there. But there is a commercially available test. I tend to reserve that for my patients who are living with fatigue, dominant symptom complexes.

We could do it on everybody. It's an expensive test and some people may want it, but the value it would give us for the more average individual is pretty limited.

So for me it's about the intelligent targeting of what you've got.

So I mean, we don't have a patient that's had every single test in the book because there's no value, it doesn't add anything to the outcome for that patient. So you've got your core set of tests, then you've got a menu of tests which are selected on the basis of appropriateness for that patient.

And that may change over time. You know, we have a couple of patients who've, they want to prepare for crazy things like Ironman triathlons and things.

They then get a slightly different work. When they initially came and said, you know, I'm a stressed 50 something year old businessman with a bit of a belly, what can you do?

So the other bit about that trajectory is your pathway through the testing process isn't fixed, it's dynamic and I think there's not enough dynamism in medicine. It's become very rigid, very pathway based. It shouldn't be like that.

It needs to reflect the change in expectations and what we're doing that everybody goes through. So the dynamic aspect of it is really important.

Definitely has to be sort of tailored to the person. All this, I have to be honest, sounds rather expensive and rather exclusive. What price range are we talking about? Just a range.

If I were to come in with no specific issues, just saying, hi, here I am, you know, I'm whatever, X, Y, Z years old and I just want to stay healthy and fit for as long as I can.

So diagnostics is something that in the UK we are completely divorced from. We have no clue what the cost of getting those tests are.

We roll into our hospital department, they're done, we go to our gp, boxes are ticked, vials are filled. Diagnostics is expensive, so a very simple basic set of screens might run you. And this is purely diagnostic costs, nothing else.

Four to five hundred pounds. It's very easy with the more advanced tests to end up in the low thousands.

Now some of those tests you may not need to repeat again, but it's really easy to end up with quite a large diagnostics bill and once you bring imaging into it as well, that bill can climb significantly. And it is interesting. That's the biggest disconnect I see in my clients. They have no clue about the cost of diagnostics.

In contrast to other parts of the world where the diagnostics have always carried that fee. That can be challenging. But I frame this for patients. This is your return on investment for you.

A lot of my clients are used to running their own businesses or they're running businesses. They're used to due diligence, they're used to risk registers, they're used to roi. And I simply ask them to apply that knowledge to themselves.

If you were going to do a corporate takeover on you, what would you want to know? Well, I'd want to know that my key talent isn't going to drop dead from an MI in 12 months or have a missed cancer.

And I'd want to know that they can keep functioning like they used to when they were 40, now that they're 55. So framing that can be interesting and get people to understand that this is an investment in themselves.

This isn't there just for ticking the wellness box or just because this is a serious investment in yourself. And that can change that perspective on, well, I'm going to invest X thousands in me. Well, what's the ROI?

The ROI is you can function as you could at 40 because let's be honest, you wake up in your 30s and what you got away with at 20, just a bit harder. And then you wake up in your 40s and what you got away within your 20s you can't get away with any longer. And then you cross 50. It's just a dream.

We recognize our biology changes, but if we can genuinely turn back the clock to a small degree, for many of us, that's the roi. But I've worked with people who have said that's fab.

I'm going to build my next business twice as fast because I've got 30 years of experience and I now feel like I've got the energy of a 40 year old. And I've heard clients who said, that's great. I'm going to really enjoy what I've built and I'm going to keep skiing with the grandchildren.

Where you choose to measure your ROI is variable, but the commonality is everybody's got a dream of where they want to be able to function at.

I agree with all of what you've said, but I want to play a little bit devil's advocate here.

Of course what you're doing helps people and all that, but even the examples you've given, they all sound very white collar, not terribly blue collar, which I understand. This, unfortunately, is how the system is at the moment. If you want to look after yourself, it does require a certain amount of Money.

Let's just call a spade a spade. So I do understand that, and we don't need to go on about how unfair that in itself is.

But do you think there could be a adequate intermediate level where people can maybe not in their 50s, go back to how they were in their 20s, but at least in their 50s, prevent getting sick? So maybe not turning back the clock, but at least not fast forwarding it by having a disease that isn't recognized early enough?

So what I'm trying to ask is, is, is there anything the NHS can do that makes economical sense in covering all these perspectives?

Well, let's take it back a layer from the nhs. Why reliant on the NHS to do it?

If we think about the pyramid of interventions, naturally I tend to sit at the top of that because that's where my interest is, that's where my science background is. But the fundamentals of living well and staying well are things that are within the gift for all of us to control.

It's how we move, it's how we eat, it's how we sleep, it's having hope, meaning and purpose. Those are the foundational aspects as far as all the information we have on aging well and health Spanish.

Those fundamentals are within the gift for all of us to control.

Layered on top of that, you've then got things like nutraceuticals and supplements, repurposed medications, and then we're firmly into the exotics, where commercial enthusiasm currently exceeds the data. So peptides, exosomes, stem cells, some novel therapies.

But the pyramid approach to healthspan is something that we can all work on at the foundational level.

Some of what the NHS is trying to do with its focus on population health is help broader sections of the population put some good foundations in place and that's highly relevant. That will probably have some benefit on a population level. We've got some difficult things in society, though.

Night shift workers is probably the worst thing that you can do. So how do we get around that?

We've become accustomed to a 247 society in both doctors, nursing staff, the guys can go off and keep the railways operational, maintenance is at night, airports. So we've become 24, 7 as a genius, but our biology really is not set up to do that.

So there's some wider societal questions about how do we mitigate the impacts of than that. But ultimately a lot of the foundational bits come back to our choices.

And those foundations are probably far more powerful than things that the exotic quantities of the pyramid, you know, I have the occasional conversation where people are not putting the foundations in place, but want to talk to me themselves. But you can't peptide yourself out of poor foundations. You just flat out can't.

So some of it is about understanding that pyramid of intervention and where you sit on it. We have some clients who really want to be at the tip of that and they are dedicated to maximizing their own biology. Grand.

But you don't have to come and see me and have 150plus biomarkers done to sort your foundations out. So I think just changing that framing in terms of what's longevity medicine about? At one level, it's public health 100%.

Pretty much every guest that comes on says the most important things are sleep and movement to really narrow it down. Do you think we've been asking the wrong question as a society by focusing on whether results are normal instead of where someone is heading?

I know you've touched upon it already, but is there a simple way that that can be changed?

I think that's going to be a struggle for the NHS, because there is not the time, there is not the training, there's not necessarily the understanding, and there is a focus on throughput rather than thoroughness in the nhs which works against it. So in primary care, it's very easy. It's two button clicks to see where a trend goes.

But what I see very frequently is trends that are being ignored because the values sit within that normal range. And this is about what is the NHS there to do? Where does the threshold sit?

If it's outside a normal range, which doesn't always mean disease is there, that usually triggers something within the nhs. The difficulty is when you've got three readings, maybe on a decline, that's obvious on the chart, but it's still within the normal range.

I'm going to stick my neck out and go, 99 times out of 100, primary care will just go, that's normal. Off you go.

But for somebody who's got fatigue, brain fog, not feeling quite right, that could be the end result of declining peripheral conversion of thyroid hormones. So this is the bit about where does the precision sit? The nhs, in my view, is not set up to deal with precision and it's absol.

Absolutely not set up to deal with trajectory medicine.

So you think the main issue is the fact that the range of what is normal is wrong, rather than the actual tests that are done through the NHS or most GPs.

The NHS cheapskates out on some tests. Let's be honest, it doesn't do Thyroid properly, in my view. It doesn't do cardiovascular risk properly in my view.

I've got the stories to back those up.

The issue with the normal range is it's a statistical construct and people don't really fully understand where that's constructed from and what that actually means. The other difficulty is it's quite involved to work out what's optimal for an individual.

So I have the luxury of time, I have the luxury of specialist tests, I have the luxury of a generally motivated client base. So we work really hard to go, okay, what's your optimal? So where do we want your peripheral thyroid conversion to be?

We want it to be in an optimal ratio. Is that good enough? What are the performance indices are which are angulating to go that's optimal.

There is nothing, as far as I'm aware, that can go, well, this is optimal for you, yet it's based on clinical judgment and feedback and repeated measurement. There is no capacity to do that in the nhs and I think that's the big problem. So you have a lack of understanding of what a normal range means.

You have inadequate time and other resources to do the longitudinal trajectory based piece and to understand where optimum comes for an individual. So we don't have an optimal range, really, that could be easily referenced and I think that's one of the challenges.

So I can't see a way in which NHS primary care or even hospital based outpatients can come to that optimal range for an individual. We're not settled to do it. And I think in fairness to the nhs, the workload demand is such that I can't see how it could do it.

You've mentioned thyroid testing and I have actually a personal story on that because my daughter, I was being told my daughter's in the normal range with her thyroid. She wasn't. She almost ended up getting Hashimoto's because they kept telling me, it's fine, it's fine, it's fine.

And I kept saying, no, it's not, no, it's not, it's not. They didn't test the tha3, tha's 4. So they only test what you're right, what they are trained to test.

Now, do you have a story of a patient that was wrongly tested until they came to you?

I don't have a story about a patient that was wrongly tested till they came to me.

What I have is the story about why I sat down a few years ago with my wife, who's also a doctor, and we decided what a blank sheet of paper, top quality Care looks like. So my father, mid-60s, annoyingly fit, climbed mountains at the weekend, was running half marathons faster than I can run them now.

So he went and did a half marathon and he did it in a decent time. Two weeks later, he was in a hospital having had a massive MI and a really horrible distribution of atheroma within his cardiac vasculature.

About a month before he ran that marathon, he'd had the NHS health check and told everything was fine because they'd only checked his headline, cholesterol the cheap part. Population test that the NHS does. His apolyte protein profile was horrific. Mine isn't great because those are hereditary factors.

So that was the trigger for me for thinking there has to be a better way. What are we missing?

So we know that we are disadvantaging many patients in the NHS because we don't do the tests the rest of the world is doing, because we're not focused on where is the change for that patient, Some of which is not a. You know, this isn't a dig at NHS doctors. I've worked NHS gp, it's busy. You don't always have the time to spend with your patients.

We have a patient who, similar to your story, Daphna, she's just not right. Been to see her NHS GP, told Everything's fine, she's not converting her T4 to T3 peripherally. Why?

Probably because she was deficient in selenium and her HRT wasn't managed optimally. And she's borderline Hashimoto's. We've done the detailed tests, we've calculated the ratios, we've optimised her hrt.

Those numbers are improving, she's improving with them. Technically, all of the tests that the NHS done are normal, but they're not adequate for that individual.

And this is the bit that really triggers in me the desire to provide. And I'll be honest, I've got a vested interest in this.

I'm the wrong side of 50, I've carried too much weight, I've had high blood pressure, I've had af. I fixed all of those things without input from the nhs.

I want to be able to provide the kind of health care that I want and that I wish my father had been able to have. And that's a really powerful story for me.

That's why I'm passionate about what we do and that's why I don't tell my patients they're normal, even if they're in the normal range. The question is, is that optimal for you have we missed anything? What are we optimizing?

We've been, I don't want to say bashing the NHS quite a bit and they deserve to be bashed for certain things, definitely. But you know, it's not just a problem in the nhs.

I think most cardiologists and most private doctors know what to test for and what questions to ask because they have been trained in the same, let's call it, old fashioned system, and they do not know what to look for and even if they have the time and all the resources. So do you not think it's a bigger problem than just the constraints of time and money that the NHS has?

Do you not think it's a fundamental, fundamental sort of issue for the clinicians in general?

I think that's interesting.

So longevity medicine is probably the first specialty to emerge in the full glare of social media and it is struggling to maintain its authority within that.

And I think we are guilty of having broken up the glorious biology of a human being into silos based on structural definitions that were generated 200, 300 years ago. And we perpetuated that throughout medical training, which has been done in locked citadels of education by predominantly white men.

Now, whether that contributes to silo formation is another rabbit hole to go down.

But the upshot is we have structurally defined specialisms with minimal acceptance that the body is a complicated system of systems and it isn't mechanistic, it is biological. So we're seeing some changes and some cross pollination.

And I think that's where longevity medicine has its advantage because one of the key tenets is to recognize that a change in one system will inevitably have a change in another system. So we're not, I don't feel silo based clinicians in the longevity medicine sphere.

And there is a recognition that cellular biology is probably the key to almost everything.

But I do think the training that, particularly in the UK that we do is underemphasizes cellular biology, under emphasizes system of systems thinking and it still propagates the structural silos for various specialisms.

And the net result of that is you come out and you are a cardiologist, an endocrinologist, an upper GI surgeon, a patio biliary surgeon, an orthopaedic surgeon, whatever, with limited opportunity for crosstalk. Now, if you are running something like the NHS and you're failure based and you're there to fix disease, you can probably get away with it.

But if we're running a different model that says we want to intervene earlier in that trajectory, and maintain that quality of life, that resilience, that vitality. Those silos don't work so well. So it's a different means to an end.

The NHS is unique globally really because it is the biggest government backed healthcare provider. But demand exceeds supply and we're at a point where we probably can't put any more money into it. So what's its mission?

Those are big questions that nobody's able to answer. But the underlying training within that, you get clinicians who are very siloed, who will follow pathways slavishly without critical thinking.

And for me, I think that's one of the big challenges is where do we bring critical thinking back into medicine? And we have to accept doctors are a diverse set of people.

There are some people who just don't want to think that they're happy doing their little niche and they have a role.

But then there are the broader thinkers who probably end up walking away from the nhs, because to practice medicine in the way that you want to be able to practice it, you can't really do in the nhs.

Okay, I just want to push back a little bit on this because you are right. Within the nhs, it is what it is. But unfortunately it is like that also with, I don't want to give a percentage, but the majority of private doctors.

And that is why a lot of private doctors like yourself, you could have just become in your own siloed speciality, you could have continued, but you instead decided to take a different route and become a longevity doctor.

And I also believe that that is sometimes why we call it longevity is because, for a lack of better phrasing, I think there are two types of doctors that are looking at the person as a whole. They're either called longevity doctors or functional doctors. Functional medicine doctors.

And I do agree that not everybody can look at the whole system and you know, it is excellent to have a cardiologist who all he does is specialize in the heart. That's wonderful.

But even those doctors do not always do the necessary tests and use all the resources that are available even within their siloed field. So how can we wake up the whole field in saying that, look, we've moved on, we are, you know, in the 21st century, there are more tests available.

You need to help your patients help themselves by empowering them and giving them more facts and even yourself giving yourself more facts in order to help your patients. So it's not just an NHS problem, I think. What are your thoughts on that?

I think there's certainly some attitudinal bits. And a couple of years ago I had a good exchange on LinkedIn with a Scottish poet and yogi and we came up with the term Renaissance medic.

Thinking back to the Renaissance, that brought together a confluence of scientific thinking from different domains. And I think that's the attitude that we need more of in medicine.

We need more Renaissance medics, people with the open mind and the ability to bring together multi domain thinking. And I think that's what's emerging in longevity medicine. And I love your approach that we've called it that because it hasn't got a better name.

And I think that's there's an element of truth in that. You know, a lot of the interventions we do are functional. A lot of the interventions that we do are cellular based rather than systems based.

But I think not everybody approaches life with that open mind. And sometimes it's a journey.

I'll be honest, 15 years ago, if somebody had said to me that mitochondrial dysfunction was the principal driver of most conditions of aging, I'd have sort of blue screened out a little bit because we, we were taught about mitochondria 30 odd years ago in medical school and we were taught that there's a few obscure mitochondrial diseases. Everybody who gets them is dead by the age of 20. And you know, that was it. We now know that's not true.

And it's really difficult to keep an eye on where the literature is going just in your field, let alone the wider field. So it is a challenge. And I think we have to accept some people just want to be the very best surgeon for the biliary system and nothing else.

We need a few of those people.

But I think for the rest of us we need to be a bit more open minded and understand that human biology is that system of systems and you need to be aware of all of those systems and the interaction. So it's about having that Renaissance mindset bring together different domains and try and synthesize an output.

You know, I think it's really notable that in Star Trek they don't have surgeons, they've got doctors and bones is there doing stuff at the cellular level. And I suspect that's broadly where we will end up. It is about bringing all of that together.

And we don't do that because we still teach in domains, we still teach in silos, we practice in silos.

Primary care is probably in the uk the broadest experience now the specialist will be jumping up and down and go, well, you don't teach GPS the details and that's right, we don't. But to be successful in primary care, you do have to have a system of systems head on.

But most GPs don't understand some of the complexities around the thyroid access. Many surgeons don't. So it's, how do we change how we train our medics at undergraduate level and a postgraduate level and how.

Perhaps that wider bit, you know, longevity medicine in some senses is up for grabs. How do we define it in the uk? To be a longevity in the uk, to claim to be a specialist, you have to be registered with a Royal College.

We don't have a Royal College of Longevity Medicine. How can we. It's an emerging specialty. The standards are not there. How do you determine the level of knowledge? We're way behind in the uk.

In Switzerland, you've got Healthy Longevity Medicine Society, in America, you've got longevity docs. So people, encouragingly are trying to set the bar for those standards.

But it's still a little bit Wild west, which is exciting, but it makes it difficult. As a patient, how do you know the person you're going to is actually able to do what they say, that they're properly regulated?

The Wild west vibe is still there around longevity medicine.

Do you think that there's a danger that parts of longevity medicine are turning healthy people into permanent patience?

That's a tricky one. So if you've got a sensible longevity practice, what you're not doing is creating a burden of perceived ill health.

What you're doing is trying to optimize your patients. So it's back to that, squaring the curve.

We know that there's a decline with age and what you're trying to do is move people away from that to support function for as long as possible. That's subtly different to collecting patients diagnoses, which is what currently happens.

You age then, so you'll get hypertension, then you'll get some incipient renal failure, then you get a little bit of cardiac dysfunction and you're. You're then bundling patients with multiple diagnoses. So I think there's a conceptual difference there.

And we constantly have a back and forth in, in longevity about do we have clients or patients?

Because patience implies that historically that you've got somebody who's ill. Well, most of our patients are actually tolerably well and we're trying to make them weller. I don't think we're making our patients carry a greater illness burden, which is what can easily happen in conventional medicine.

More diagnoses, more pills, downward spiral what we're doing is saying, okay, what do we need to sensibly measure what's in your domain to control? Where are you on the intervention pyramid and where do you want to be and how do we keep track of that trajectory?

So it's back to the racing car analogy. You monitor that car every time it goes out on the circuit. Same with our patients.

You know, we monitor them at sensible intervals, at sensible rates to enable us to optimize them. The emotional intellectual burden is very different because we're not talking about illness, we're talking about vitality.

We're talking about improved biological resilience.

We're talking about improved biological and physical and mental capacity over the next 20 years, which is a much more uplifting conversation than being hauled in to see your GP once a year for your annual check, where they'll tell you your hypertension is not well controlled, your renal function's borderline, and all the rest of it. But the emotional burden is very, very different.

The mindset of many patients or clients is quite different, which is another beautiful advantage that we have of working in this space.

Let's presume there's somebody who goes to a longevity doctor.

Not you, not as reputable as you, but certainly not someone completely dodgy and just out to get their money, of which there are plenty of, but someone with a medical, but also a business acumen. At what point does a patient know, or do they know at all? This is too much testing. I don't really need this because it becomes very addictive.

Also, even if the doctor isn't pushing so much, because, you know, you have people that are addicted to their wearables. They get a bad reading and their whole day is ruined. So how do you manage that? And what do you say to a patient that doesn't come to you?

When do they know? Okay, that's maybe pushing the envelope.

Wow. Okay. So it's tricky. And this is a conflict that is in all private medicine, all over the planet.

Where does the doctor or clinician decide that this is enough?

So for us, we have a really robust governance around our program definitions, our package definitions, and our testing intervals for almost all tests. And some of it comes down to personal integrity. In the uk, you're GMC registered doctor, your business is CQC registered.

You have a duty of care to evidence that you're not, as I alluded to earlier, getting everybody to spend a lot of money on a mitochondrial function test. But there is no law that says you can't do that.

And this is the Difficulty as a patient, you might go, I'd like to know what my mitochondria are doing. As the doctor, I think you have a moral obligation to go, okay, why? It might be clinically indicated, it might not be.

Now, some people are not fussed, the money is not relevant, they want the data, fine, very happy. But it would be quite easy to go, well, this would be worth doing. And I think that's the moral bit that affects every clinician in private practice.

I worry about open access to tests because as I spoke about earlier, a test is a clinical intervention, it's not a consumer item and who owns it and all the rest of it. So I worry about entities that have effectively infinite drop down menus and all the rest of it. I worry about single handers.

So in the GP world in the uk, being a single handed GP has largely been frowned upon for a number of years. How can an individual provide that range of services? So longevity is doctor led. I am not the only doctor.

We have PhD level clinical specialists in other domains and we have a multidisciplinary team. We have an expert advisory scientific panel as well. There are many entities that seem to be broadly single handed.

So where's your internal governance? But again, as a patient, as a consumer, you don't see that. And in the uk, all you can do is go, well, is that provider CQC registered?

And there's a third rabbit hole about CQC registering and sheltering and all the rest of it. So I think we do struggle in the UK to clearly articulate to consumers, how do you know that your clinic is valid?

How do you know it's run to good medical practice standards? It's quite tricky to do. And in other parts of the world the regulation is even lighter touch.

So you can set up with no regulatory approval and basically it's on you to comply with perhaps what the Medical Board registrant's ethics policy is. But that's broadly it. So I think we need to decide, are we going to be unregulated completely and let the market deal with it?

Most times that doesn't go well or are we going to be properly regulated, in which case possibly need to do a little bit more than we already are. But as a consumer it's really difficult, isn't it? We've got this bit about now, the loudest and brightest are perceived as the expert.

We've totally gone down the avenue of the cult of the amateur. And this constantly gets my goat. You know, you see people on social media take this Peptide stack. And it's like you dig back into their background.

Many of them have never done even so much as an undergraduate biology degree and yet now here they are recommending peptide stacks. You know, I love peptides, I think they are the pointy tip of the spear. But they are complicated, they are not properly regulated.

Research grade does not mean fit for human use, it means research grade. And the evidence is lacking now.

It's lacking because they probably don't really suit RCTs randomized controlled trials in the way that conventional drugs do. So there are two I'm not anti peptide.

What I am anti is amateurs making recommendations for potent agents that we don't have good scientific background for. But as a consumer, what floods your feed? It's PTS pushing stuff, it's people on popular podcasts, it's people who write in social media.

Dig into their background. If they've never done anything biological, if they've never been accredited, why are you listening to them?

And if they've got a link at the end of it that says 10% discount here, I think you should run for the hills.

Couldn't agree with you more, but let's be really practical here. If I'm a consumer, a patient, I'm aware of all that you've said and yet I do want to help myself better myself.

How can I realistically find someone who's reputable?

You've got to do your homework. And it comes back to that due diligence bit. You have to go to the clinic website, you have to look at the doctors that are on there.

You can see whether those doctors are registered with the GMC in the uk. That's one of our really helpful things. You can go to the GMC website and you can search that doctor's name.

Many doctors will put their GMC number on public facing information. So is that doctor registered with the gmc? If they're not legally, they shouldn't be practicing in the uk. Is that clinic CQC registered?

Have they got the CQC registration number somewhere on their website? And remember, CQC isn't approval as such, it's regulatory registration. But at least it shows that that clinic is registered with the cqc.

Look into the background of the individuals that you might potentially be going to see. What have they done? I have an interesting career, I've done an awful lot of stuff.

But if you are dealing with somebody who maybe has five years of primary care experience and nothing else, medicine takes a long time to learn the pattern recognition and the crystalline Intelligence and all the rest of it. So you need to have your questioning head on when you are making a decision. Look at the clinic, have they got regulatory approval?

Can you find the doctors on the GMC register? Does their background seem to make sense with what they're doing?

It's really easy to be overwhelmed, you know, oh, this doctor's got five years of that. Well, for many medical training programs, five years is nothing. You can leave medical school, train and be qualified as a GP in five years.

Now, the reality is you are not experienced, so to then be claiming that you're a longevity doctor is, in my view, pushing it. There are mornings when I wake up and I read comments from other colleagues and I think, my word, that's another paper I'm going to need to read.

I don't know enough and I have no problem in going, I don't know enough. We're uncertain about a lot of things and, and that's fine because, you know, that's part of medicine.

That's the robust conversation with the patient. What about this? If we're going to do it, we do it for these reasons.

This is how we monitor it and this might be the outcome, but we have to be honest. Again, there may not be a huge amount of evidence for it, but as a consumer, it's really difficult.

We need to, I think, to get back to the understanding that confidence does not equal competence and that quiet confidence is probably a positive flag rather than who's got the loudest, brightest social media, who's recommending X and Y, who's got their own branded this, that and the other. Those are the little things I would encourage people to go and have a look at because it is the Wild west. Still.

While the UK is probably not so bad as other parts of the world, but you've got to have your wits about you and that's tricky.

Now, if someone is coming to you with a very limited budget, but they really want to help themselves, are there any tests or biomarkers that you say, look, these five tests or these limited amount of tests, they will really already tell you a lot, or does it always need to be the big, you know, hundred biomarkers?

I think if you were very limited, Daphne, then I would do a proper Cardiovascular risk assessment. Omega 3, 6 ratios and then probably a glycomic profile.

And that's probably going to be in the region of just doing some quick maths, about 350 to 450 pounds. Your biggest silent killers are your adverse lipid profiles, your inability to get your 3:6 ratios correct. And then the glycomic test.

And here I'm talking about glycan age, which many people listening to this will have come across. I think that's a fabulous test. I think that's frontier biology done right. I have tremendous admiration for Gordon, the founder.

I think that's a really, really useful test. Now, the interpretation of it is challenging in some ways, but if you had a limited budget, then those are the three that I would go for.

If you were on an ultra limited budget, I would say get your cardiovascular markers done first because that's probably the biggest silent killer. You can have normal cholesterol and a really adverse risk profile that you need your apolipoproteins to fully understand.

They would be sort of the absolute ultra minimum that I would suggest would give you most value.

You know, we've had Professor Gordon's daughter on talking about the glycanate test and all that it involves in.

Actually, I'm really happy that you mentioned them and all the other tests that are reasonable and that really give you an insight because it shows that even though the longevity market is so diverse and everybody has their own thoughts and opinion on it, there are some basic and fundamental tests and obvious signs that we can't ignore. There are a lot of icing on the cake things that you do that other people do, but the basics are the basics.

And I think it's really important for listeners who just can't afford to do all the tests that one should do that there are some basic tests that still tell you a lot. And I think that's really important to hear. You know, we can always do better in life with anything.

We can have a good diet, we can have a better diet, we can do, you know, sports, we can do more. But I think it's really important to stress the fact that, that the basics can already tell us a lot, especially coming from you, whose.

I don't want to say whose business it is to sell tests, but it kind of is, you know, and in a good way, because these tests do tell us a lot of things.

But it's very important, I think, to make it clear that there's a baseline that can be achieved by most people, surely not everyone, but by most people. And I think that's really important. Just put out there.

Yeah. And it's back to the foundations of the pyramid, the things that are within our gift that you don't need to pay people to do.

There's enough information out there, open source, about how to optimize your sleep, optimizing your nutrition, having that hope, meaning and purpose is really, really important. And that's for you as an individual to discover movement. You know, leave the car at home.

If you're walking down to the shops, there's bits that we can control that don't cost us. And I think that's really, really important. Those are the positive changes that anybody can choose to make.

If you want that minimal layer of information over the top of it, then some of the cheaper wearables can be useful. But again, that shouldn't become obsessional data, that's telemetry, to guide you in.

Okay, this week have I done a bit more movement than I did last week? Because that's the trajectory that you're wanting to follow on.

I have some patients that I steer away from wearables, particularly for sleep, because it just creates more anxiety. But a simple wearable can be really helpful.

Forty years ago, a wearable was called a pedometer and the fancy ones would tell you in miles how far you've walked. I remember walking the sandstone trail in Cheshire, Waring 1, it's a mechanical counter. We've always had wearables.

They've just been a super niche interest, not a digital thing. Everybody's oh, well, like my school is this, and there are always folk, bit like myself, who love the data. I want to know more.

And we show our human telemetry to the race engineers and they laugh, they go, well, what's your sampling rate on that? Well, once a minute, because I don't need to know any more than that.

You know, they're used to sensors, you know, they measure the sampling rate in hertz. It's hundreds of times a minute that they're pulling the data.

So there are some people for whom that data is really hugely motivating and it gets them to think and it reinforces the, I'm going to do the change because I want to see my numbers change. And then there's the people. We have one lovely client who said, well, I'll wear the wearable, but I don't want to interact with it.

So we worked with her to set it up and the data comes to us, that's fine. Those simple things sort the foundations out.

Minimal data, understand your cardiovascular risk for relatively low amounts of money is a fundamental basis that anybody can do. And if you're fixing those, you've already taken huge steps to optimizing your health span. And that's the really important bit.

It's where do you want your function to be? In 20 or 25 years time, what are you going to do with another 25 years of healthy life? So I'm the wrong side of 50. I have no intention of retiring.

I have no intention of seeing the physical decline that my parents underwent or even my grandparents underwent. I anticipate being broadly as fit as I AM now in 10 years time, in 15 years, in 25 years time.

Now, to achieve that, I've got to go up that pyramid of interventions, but I have to get the foundations right because that's where you build everything else off. And that, I suppose, is the simplest message.

Daphne, so you've mentioned 10 to 25 years into the future. Where do you see your clinic being different in 20 to 25 years?

That's all the really exciting, just over the horizon stuff. So I want it to be like Bones Clinic on the Starship Enterprise. So I think we're going to be much more focused on cellular medicine.

I think our interventions are going to be at the cellular mechanism level. They're not going to be crude drugs that simply suppress whole systems.

I think we're going to see much more targeted optimization of cell based mechanisms. Mitochondria are fascinating. I think they are going to be the next big diagnostic and therapeutic intervention.

They are not simply the batteries in the cell. They are so much more absolutely fascinating. I think orally, 10 to 15 to 20 years out, mitochondrial medicine.

I think we're going to be measuring things to do with the vascular system in a different way. So vascular elasticity is really important. The glycated substances that sit around on the inside of the vascular tree are really, really important.

That's potentially a really interesting therapeutic place to go. I'm not entirely convinced that our current lipid hypothesis is entirely correct.

Probably the best model that we had and statins have worked at a population basis, but very crudely. So I think we're going to see more and more cellular based interventions.

I think we're going to see more and more use of tests like Glycan age that give us some predictor. We're almost into that sort of predictive state. And I hope we see a profound shift into trajectory based medicine, because for me that's the key.

It, it's moving that curve of decline away from that decline. So, you know, my clinic, in 20 years time, I anticipate that we will have a full array of peptide, I'm going to call them messenger based therapies.

So currently it's exosomes, which is a little bit crude. You know, I'm thinking About a much more targeted version.

So messenger based therapies, so peptides and exosomes being refined, mitochondrial therapy I think will become real and I think how we measure interaction between systems will change. We will inevitably have more biomarkers. So things like the senescent associated secreto. We're only just beginning to tease out what that is.

What are the cellular messengers involved with that, how do we target it, how do we sensibly use senolytics? Because I'll give you a blue now, it's not a tiny dose in a magical blue powder you take every day. That's not going to work.

This is going to have to be based on pulsatile biology. So I think that's where we're going. But we have to do that with appropriate regulation. Neither too much nor too little.

And my concern is the regulators are way behind the curve. So how do we get them up to the curve?

Well, you better stay in business for another 20 to 25 years in order to make sure this all goes according to plan.

We are architected to stay in business for a long time. You know, I love companies like Clinic La Prairie and Lanzerhof. They have been going on for decades and I think that's really important.

We ask our clients to stay with us for decades. So we need to be architected in order to do that. And that's what we are. That affects how we structure ourselves at longevity.

We're not saying to our clients, well come and spend a year with us or two years with us or a week with us. What we're saying is let's be on that journey throughout life together.

Yeah, it's like going to the gym. It has to be a regular habit. It's not just a one off pill.

Absolutely.

Listen, Dr. Fieta, thank you so much. It's a shame really and I really mean that. It's a shame that not all longevity clinics are as serious and as fact based as yours.

They should really all be like yours because you're really dealing with literally people's lives, but also their concerns and worries and health. So I think you really do an invaluable service. Thank you for being on Beyond Longevity is all I can say.

Thank you for sharing your wisdom and thank you for being so on the ball and honest. Think it's lacking in the field.

Thanks Daphne, I appreciate that. I'm very much grateful for the invitation and yeah, I think honesty in the field is really, really important.

As promised, Dr. Peter, here are the five rapid fire questions. The first one, what is the single best piece of advice you would give your younger self.

Move more.

Name one habit everyone should adopt for a longer, healthier life.

Prioritize your sleep.

If you weren't in longevity science, what career would you have chosen?

I would probably go into farming.

What microdose habits? Sort of five minute routine or small daily action yields outsized longevity benefits?

Journaling and what's the craziest longevity myth you've encountered? And is there any truth to it?

Blue zones. Because statistically they probably don't exist.

But we can take the lessons about community and hope, meaning and purpose from those zones which do have a credible benefit for longevity.

Whether longevity medicine becomes a recognized medical speciality or remains an evolution of existing healthcare but as Dr. Peter Scriven argues, one thing is becoming increasingly difficult to ignore. Waiting for disease to appear is unlikely to be the best way of preserving health.

His challenge to conventional medicine is not simply to do more testing or adopt the latest technology.

It is to rethink when we intervene, to pay attention to how our health is is changing over time rather than waiting for it to fail, and to recognize that normal is not always the same as optimal.

Whether you agree with every aspect of that approach or not, it is a conversation worth having because it asks a fundamental should medicine be judged primarily by how well it treats disease or by how effectively it helps us over avoid becoming patients in the first place? If you enjoyed this episode of Beyond Longevity, please rate, review and subscribe. Thank you. Sa.