On Healthspan and Precision Medicine

Dr. Eric Topol has recently been promoting his new book, Longevity, and was recently interviewed by the journal Health Affairs. (1)

Dr. Topol is the Executive Vice President of the Scripps Research Institute, in La Jolla, California, and Principal Investigator of the “All of Us Research Program” - a precision medicine project funded by the National Institutes of Health (NIH).

The Cleveland Clinic’s website defines precision medicine as:

An innovative medical approach that uses information about your genes, environment and lifestyle to guide healthcare decisions. This type of medicine will allow scientists and healthcare providers to more accurately predict which prevention strategies and treatments will work with which groups of people.

Moreover:

Precision medicine differs from the one-size-fits-all approach to medicine, in which researchers and providers develop healthcare management strategies for the average person. (2)

Modern molecular biology techniques have been astoundingly effective in classifying and treating cancer and in helping understand rare genetic conditions. (3)

No knock on Dr. Topol, he’s made truly great contributions to medicine, but it’s somewhat surprising that his 7 main recommendations have neither precision nor medicine. Indeed, you’ll find them quite familiar (paraphrased):

• Strength train 3 or more times a week;

• Eat a Mediterranean diet;

• Avoid ultra-processed foods;

• Get enough sleep (7-9 hours / night), and especially deep sleep;

• Don’t take dietary supplements unless you have a known deficiency;

• Maintain social connections; and

• Go outside to recreate…and be sure to get some sun while you’re at it.

Consider the closest thing to medicine here: supplements. As far back as 1959, Ansel and Margaret Keys stated in their book in Eat Well and Stay Well that “healthy diets don’t depend on fancy preparations” . (4)

So...Dr Topol agrees (me too, completely).

I would add that women who are pregnant – or seeking to be pregnant – should take 400 µg of folate every day through the first 12 weeks of pregnancy, as this has been proven to prevent neural tube defects. That’s not really precise on an individual level, but it personalizes the recommendation to women who want to or could get pregnant.

Recent evidence in mice suggests that iron deficiency can lead to abnormal sex differentiation. This isn’t known to happen in humans, though iron deficiency can occur during pregnancy because of the large increase in blood volume and red cell mass. But iron at high levels is toxic. So a woman seeking to get pregnant should seek guidance from her physician on iron supplementation on the basis of a known deficiency. (5)

The huge problem with supplements in the United States is that they’re not regulated for content or purity, and several studies have shown that supplements purchased in stores over-the-counter have a high prevalence of contamination with:

1. Ingredients not on the label, and
2. Stimulants and compounds outlawed by the World Anti-Doping Agency (WADA).

This is why athletes who might be drug tested and want to take supplements, they should be certified clean (marked by an NSF logo). (6) That advice should give everyone else thinking about taking supplements more than a bit of pause.

My biggest amazement with Dr. Topol’s talking points is – where’s the precision medicine? Perhaps the world’s foremost authority on precision medicine writes a thoroughly researched book on living a long and healthy life and all the take-home points are about... lifestyle?

One under-appreciated point about precision medicine is that, when we are able to use molecular genetics to improve selection of a drug or drugs to treat medical conditions, it might make the treatment more effective but it almost certainly won’t make treatment cheaper. The economy of scale principle makes it so that the fewer patients there who need a particular drug, the more costly it will be to make that drug and the less likely the maker will be able to break even or make a profit. Orphan drugs – drugs that treat rare conditions – define this situation, and need subsidy in order for pharmaceutical manufacturers to sustain production of these medications.

Long before Americans jump on the precision medicine bandwagon, we should put our time, money and energy into leading a healthy lifestyle. To be explicit, in considerable agreement with Dr. Topol and with minor variation with the American College of Lifestyle Medicine's 6 Pillars and with Blue Zones principles (7,8), I mean:

• Be physically active – preferably in fun ways that get some sun (for vitamin D), convene with Nature, keep you strong and able to do extended activity,

• Eat a whole-food plant-predominant diet (the Mediterranean diet isn't required but is a great starting point),

• Get rejuvenating sleep every night (generally 7 hours, varies by individual),

• Socialize with friends and family,

• Seek spiritual strength and support, and

• Wake up every day with aspirations of achieving some dream of one’s own.

Moderate alcohol consumption remains controversial with evidence on both sides, so at most should be in moderation. But I’ve never heard of any data that use of street drugs – including tobacco and cannabis – has ever been associated with either health or longevity. During my medical career, I’ve only seen them associated with severe chronic disease and premature death. Years and even decades of life are at risk from drug abuse. (9,10) Not much medicine of any kind, much less precision, in these elements. FYI, my dermatologist disagrees with me about the sun (I do wear long sleeves and sun block).

Just imagine how much less Americans would be spending on GLP-1s if all the funds spent on precision medicine, or even half that amount, had been spent on translating lifestyle intervention research into clinical practice.

References

1. "Podcast: Eric Topol on the Science of Super-Aging and Longevity", Health Affairs Podcast, May 6, 2025 . DOI: 10.1377/hp20250505.826761
2. https://my.clevelandclinic.org/health/articles/precision-medicine
3. The Lancet. 20 years of precision medicine in oncology. Lancet 2021; 397(10287), 1781.https://doi.org/10.1016/S0140-6736(21)01099-0
4. Keys A, Keys M. Eat Well and Stay Well. Doubleday, Garden City, NY, 1959, p. 40.
5. Georgieff MK, et al. The Benefits and Risks of Iron Supplementation in Pregnancy and Childhood. Annu Rev Nutr. 2019 Aug 21;39:121-146. doi: 10.1146/annurev-nutr-082018-124213. Epub 2019 May 15.
6. https://www.nsf.org/consumer-resources/articles/certified-for-sport-program
7. https://lifestylemedicine.org/wp-content/uploads/2023/06/Pillar-Booklet.pdf
8. https://www.bluezones.com/our-values/
9. https://americanaddictioncenters.org/blog/long-term-effects-drug-abuse
10. Glei DA, Preston SH. Estimating the impact of drug use on US mortality, 1999-2016. PLoS One. 2020 Jan 15;15(1):e0226732. doi: 10.1371/journal.pone.0226732.