Why are "longevity bros" so icky?
And what can real doctors learn from them?
I recently got a text from an acquaintance looking for a primary care doctor.
“Hey Mara!” he wrote. “Do you know any doctors in the area that do longevity medicine?”
I stared at his text for a minute, a little puzzled. Was he just looking for a primary care doctor? Or for something else? Isn’t longevity medicine what all primary care doctors do, by definition?
I wrote back. “I think most primary care doctors want to help their patients live long lives! What do you mean, exactly?”
He wrote back. “Basically I want someone who goes beyond the standard testing. Who really helps me understand my body.”
Hmmm. What was he getting at? And then I realized, a little embarrassed it had taken me this long to sort it out.
He was a longevity bro, and he wanted a longevity bro doctor.
What, you may ask, is a longevity bro? If you don’t know the answer: Congratulations, you probably have a healthy relationship with the internet and your own body.
Longevity bros exist both online and IRL, although the culture is fueled by social media. They sell hacks and gimmicks for living a long life. They promise, both implicitly and explicitly, that with the right combination of money and willpower, you can outrun death.
They usually start their sales pitches with phrases like this: This is what your doctor isn’t telling you.
Longevity bro culture isn’t new. It’s a longstanding Silicon Valley trend, favored by the wealthy elite. (Read this thoughtful article on Bryan Johnson, the original longevity bro, whose catchphrase is “Don’t Die.”) Their “hacks” and “proprietary algorithms” continue to surprise me with their creativity. Full body MRIs. Plasma transfusions. LED lights. Lots and lots of blood tests.
But over the last decade or so, I’ve gotten the sense that there’s an imagined democratization of longevity bro culture.
It’s no longer just for people who can afford celebrity doctor Peter Attia’s services, who reportedly charges upwards of $100K a year to serve as a personal longevity physician to the stars. (Peter Attia has been disgraced for consorting with Jeffrey Epstein, including using some vividly misogynistic terminology that I won’t type here but you can easily find online for the curious or masochistic.)
Now you, too, for a mere $399 can put your poo in a cup, get it genetically sequenced, and earn the right to buy “custom-formulated supplements!”
It can be easy to mock. But as a primary care doctor, I’m also curious about it. It speaks to our collective anxieties.
People perceive that longevity bro culture is meeting their needs. Part of the reason it’s so popular, I fear, is that in primary care, we’re failing to do just that.
What’s the difference between regular, evidence-based longevity medicine — arguably the whole point of primary care — and this aggressive, consumerist subculture?
You know it when you see it, that’s for sure. There’s something clearly different about what Peter Attia does and what I do, with my 20-minute appointments and my earnest recommendations for getting enough sleep and a mammogram.
I’ve identified a few themes that emerged as I googled “what is longevity medicine” and found myself in some dark, weird corners of the internet. Here are a few ideas I’ve been considering.
Lack of scientific rigor. This is a prerequisite. Longevity bro culture is, by definition, not based on scientific evidence. What they’re selling is that they’re cutting edge, “ahead” of the research and “ahead” of mainstream medicine. They offer you something that appears unavailable at “regular” doctors.
A mythology that human health is under voluntary control. This is another key ideology within their messaging. Without it, why would you ever buy their products? Otherwise we’d have to confront the existential crisis of the randomness of death and disease. That doesn’t sell supplements very well.
… And a mythology that the health of the individual is unrelated to the health of the community. This is the part that makes me feel the most despair. They market personal health as something you can buy online, not as something deeply interdependent with our families, our communities, and nature.
Longevity bro culture is booming, not coincidentally, as a moment when the health of the natural world feels so precarious. I’m not surprised that these wellness hacks are so popular as we’re confronted with daily reminders — both online and when we step out the front door — that the health of our planet is profoundly fragile. I know snake oil salesmen existed long before climate change did, but I can’t help but sense a connection between the vulnerability of our planetary health and the explosion of interest in optimizing our personal health.
Tests that don’t change management. This is a mantra I teach my medical students: Every test should change management. As in, there’s no point in ordering a blood test or imaging that doesn’t change something in the way we approach the patient. If you test positive for chlamydia, I’m going to prescribe you antibiotics, not just sit there and do nothing – that’s why we screen for it. But longevity bro culture is full of tests that don’t seem to really do anything. I was reflecting on the $399 poop test and really trying to give it the benefit of the doubt. If somebody got it done, maybe knowing they lacked diversity in their gut flora would help them eat more vegetables? But they — hopefully — are eating vegetables anyway. They don’t need the test to tell them veggies are good for them.
Doctors love to complain about all this wellness nonsense. We can be a little snooty and dismissive about it sometimes, to be honest. I have been known to text screenshots of wellness products to doctor pals, mocking the chumps spending money on these things.
But I’ve been challenging myself recently to get curious. Because people love this stuff. And they don’t exactly love coming to the primary care doctor.
It’s not like traditional, corporate primary care is doing a great job meeting our patients’ needs. Of course wellness culture is appealing!
The grifters are capitalizing on a lot of serious deficiencies in our traditional medical models. We doctors have left it wide open for them.
The thing is, primary care is longevity medicine.
When I diagnose you with hypertension and prescribe you a blood pressure cuff and a medication — the whole point is to help you live longer! (And live better, ideally without a heart attack or kidney disease caused by hypertension.) When I do your Pap smear, the whole point is to catch cervical cancer early enough to treat it.
There is decades and decades of good-quality research to show that both those things prolong life and — critically — prolong quality of life.
So why do people think of primary care clinic as so unsexy? Why are the poop kits winning?
Because primary care feels qualitatively different than longevity medicine.
A big part of it, I fear, is the sheer amount of administrative nonsense that it takes to engage with a primary care doctor in the U.S. health care system. The figuring out if they take your insurance. The waiting on hold at the call center. The feeling motivated to make an appointment, then being told you need to wait 3 months to be seen. The trying to figure out how much things will cost, then still getting a surprise bill. The traveling to a separate location to get your labs drawn.
“It felt like they didn’t really want me there.” That’s how a friend put it recently, reflecting on her experience establishing care with a new primary care doctor:
Then take the longevity hacks. The websites and branding are sleek, the credit card payments seamless.
But I think there’s something even deeper at play.
Coming to the doctor feels like getting scolded. Buying a supplement online feels like being welcomed into an exclusive club.
A friend sent me this hilarious TikTok video, where an OB/GYN named Dr. Fatima Daoud “rebrands” the standard medical treatments in labor and delivery as “wellness medicine.”
It’s tongue-in-cheek, but she’s on to something.
I’m not sure what this means for my practice. I can’t, with a straight face, sit there and call your cholesterol medicine an “cardio-boosting superfood made from a proprietary blend of all-natural ingredients.” I just can’t.
But I do think primary care can be less paternalistic. Sometimes it can feel like doctors are trying to bully their patients into taking certain medications rather than treating it like the autonomous decision that it is.
(The reasons for this are complex. The dynamic is emphasized in our training. We learn that we aren’t good doctors if our patients don’t do what we say. Practicing doctors are also explicitly graded and paid based on whether or not our patients take the medications we recommend and complete the tests we order.)
Might we instead treat the doctor-patient relationship as a partnership, as an invitation?
What do you think? What, exactly, is the difference between longevity bro culture and regular primary care? What could we doctors learn from them?
For sure access to health care could be improved, and doctors should continue to improve their ability to partner with patients rather than dictate to them. But they can’t compete with longevity bros any more than they can compete with churches, because longevity bros aren’t selling health care, they’re selling religion. You know, that thing that tells you if you do this or believe that, you’ll live forever (in an afterlife at least). It might look like health care because there are blood tests and pills to take, but it’s not. (There are rituals in many religions that involve blood or ingesting something that isn’t one’s typical food.)
Longevity bros live in the truthiness sphere (Stephen Colbert about 20 years ago) that has been welded onto the Dunning Krugerification of bros. They think something must be true because it feels like it might be true. And they don’t trust an expert in anything unless they’re billionaires, although multimillionaires might do. Traditional medicine feels unsexy. Anyone can do it: get enough sleep, exercise, eat a balanced diet, take appropriate medications as needed. The key is anyone can do it. But a longevity bro isn’t just anyone. They are special with unique health needs that must be addressed by special supplements identified by special tests. It’s American exceptionalism only it’s health hacks for the rich.