Doctors are debating Peter Attia's approach to medicine

It’s interesting to watch the voices in medicine, both functional medicine and mainstream, turn so quickly on Peter Attia, someone who has achieved such fame and fortune speaking about healthspan and coining the phrase Medicine 3.0.

I won’t excuse his actions, which have been widely published. I've read many of the reports myself, and Attia's actions, in my mind, are inexcusable. Much of the criticism he is receiving is justified and will no doubt continue. 

What's interesting, however, is how the criticism of Attia has led to a broader discussion about the kind of medicine he practiced. As the NY Times put it: "What started as a rebuke of Dr. Attia has become a discussion about his credentials, longevity medicine and whom patients should trust."

So, let's discuss the approach he took in challenging the traditional practice of medicine. The general principles he followed and the information he put out on his podcast, blog, and many social media posts were helpful in comparing and contrasting where we are today and where we should focus our attention. In general, I found his interviews to be informative and helpful in questioning what needed to change about the current practice of medicine as a whole and how we approach chronic disease. 

For over 25 years, I practiced as a board-certified emergency medicine physician, treating tens of thousands of patients in large and small emergency departments on the East Coast. I witnessed the shortcomings of a system that does an exceptional job in taking care of patients near death's door in acute crises, but does a truly terrible job of preventing patients from reaching that crisis point.

The reasons are well elucidated: lack of universal health care, devaluing primary care where most chronic diseases should be addressed, a health care system driven by profit resulting in fragmentation of care, a general shifting of the financial responsibility to individual patients, and a tendency to treat all diseases with pharmaceuticals (the US population consues almost half of all pharmaceutical sales worldwide while representing less than 5% of the world’s population). 

10 years ago, I decided to take another path in addressing patients and their struggles. I went "back to school" and did a fellowship in integrative medicine through the Academy of Integrative Health and Medicine in San Diego.

This is a specialty that is not recognized by the traditional health care establishment. Some of the things I do can be criticized by national medical groups as 'not recommended’. Things like checking vitamin D and B12 levels for all my patients. This, despite the numerous studies that demonstrate the linkage between low vitamin D and a host of medical issues, including immune system dysfunction. Low normal B12 levels have also been associated with cognitive issues and increased rates of mental health conditions. Once corrected, patients feel and act remarkably better. 

I evaluate the microbiome on nearly every one of my patients despite criticism of that type of test, that it is not ‘proven’ through large randomized control trials (RCTs). However, having done it hundreds ot times and used the information to help patients rebalance their microbiomes, I have personally seen remarkable improvement in chronic gastrointestinal conditions—conditions that likely would have been dismissed by experts in the field after ‘normal’ EGD and colonoscopies. 

My point in the above examples is to clarify that doctors who practice integrative or functional medicine often do so at the edge of our current knowledge base. In my personal examples, I try to use the latest medical literature that directionally shows promise but doesn't have a randomized control trial (RCT) to back it up. Do I think some go too far, promising cures and benefits from liberal use of hormones and peptide therapies, as examples? Yes, absolutely.

Do I also believe that the current system is under-serving those patients with the most complex diseases, who are often beset by a multitude of symptoms? Yes, I emphatically do. 

Peter Attia called attention to the focus on our current system of symptom treatment rather than prevention. He spoke a lot about nutrition and exercise as fundamental to long-term health. He is not the first to state that the best drug for depression, as well as many chronic diseases, is exercise.

Should he be criticized for what he did, or for how much he charges for his services? Of course, he should be criticised for his actions. And his high fees can be questioned—whether an individual wants to pay them is their own decision, based on perceived value.

And while some of the medical treatments he suggested should be challenged, he has also popularized a willingness to try new, more holistic approaches and change the focus of our medical system to prevention. That's not wrong.