Newsletter | Overthinking Health
There is something surreal about Tad Friend’s profile of the longevity movement “How to Live Forever and Get Rich Doing It” in The New Yorker. Told from the perspective of shadowing Peter Diamandis, one of the movements best known gurus and entrepreneurs, it’s a tale starring many of today’s A-list concepts: AI, billionaires, effective altruism, colonizing space, achieving immortality through longevity “escape velocity” and/or achieving immortality by uploading our minds to the cloud. A day in Diamandis’s life sounds intense, to put it mildly:
“Diamandis rises each morning at five-thirty and assesses his overnight biometrics, gathered by an Oura ring, an Apple Watch, and a continuous glucose monitor. Then, as he meditates, he employs three red-light-therapy devices: one for healthy skin, one for lustrous hair, and one to kill oral bacteria. Along with a Ka’Chava shake, he consumes the first of five daily pill packs: this includes a GLP-1 agonist, a mitochondrial stimulant, a stress dampener, and a nootropic for cognitive enhancement. After using a toothpaste tailored to his oral microbiome, he begins his morning Zooms while pedalling a stationary bike. He also pumps iron and pins his daily protein intake at a hundred and fifty grams, one gram for each pound he weighs.”
That’s … a lot. The longevity movement is a story of optimization, maximization and – at some level – the futility of doing so given the inherent complexity of human biology and the ways in which evolution has shaped us. As Friend puts it, um, bluntly: “Our bodies, technically speaking, are just really fucking complicated.” He goes on, a little more delicately:
“Yet interventions that arrest one hallmark of aging often accelerate others. Rapamycin is popular with biohackers because it inhibits the senescent cells that cause inflammation—a condition so associated with aging that it’s often called “inflammaging.” But having too few senescent cells is dangerous, because senescence helps block tumors. Almost nothing the body does is always bad or always good: we walk a narrow footbridge between atrophy (cells failing to replicate properly) and cancer (cells replicating all too well). Caloric restriction, a “natural” alternative to rapamycin, shares some of its benefits—but it can also shrink muscle mass, lower your libido, and suppress neuronal function. Plus, you’re hungry all the time.”
Pursuit of the Fountain of Youth is of course an old story and there’s great appeal to finding the right elixirs that will slow or even reverse aging, especially if they come in the form of pills or injections and don’t require major lifestyle changes. Ironically, it’s the lifestyle changes that, for now, yield the best results. According to one physician Friend interviewed, “you can make a thirty-two-year difference in your life span by implementing the no-brainer stuff (sleep, diet, exercise, etc.), but you can gain only four years by taking supplements.” Our friend Jordan Shlain was even more direct: “Everything you do to improve your health span can improve your life span. Everything you do to improve your life span is fucking bullshit.” (Shlain recently posted a commentary on why focusing on one's social relationships is far more important than obsessing over biometrics.)
One gets the feel from Friend’s profile of health as a competitive sport. Health – and the potential resulting longevity – as an end unto itself. A goal that must be set and must be achieved. But is it best achieved with such ardor and intention? With such directness? The question makes us recall Obliquity, a wonderful book by the economist John Kay. In it, Kay argues that when dealing with complex systems, it’s often important to pursue goals indirectly. A business shouldn’t seek to maximize shareholder value, it should focus on making outstanding products and the profits will come; one shouldn’t try to optimize for happiness directly, but rather engage oneself in meaningful pursuits that can lead to a fulfilling life. Happiness manifests as a side effect. While Kay’s approach is no guarantee of success, he argues that in any case the inherent unpredictability of complex systems (e.g. the human mind and body) renders the direct approach ineffective.
So what if we could imagine good health as a side effect of living? David Shaywitz broaches this question in his piece for the Boston Globe, “The Key Insights Fitness Trackers Are Missing.” Shaywitz notes how several of the tracking platforms have pivoted to a focus on longevity, but that their narrow focus on metrics – which work better for some people than others – misses something important: “Some optimization clearly matters: lowering blood pressure, controlling cholesterol, reducing excess weight. But the pursuit of health also involves something more holistic: a sense of coherence, direction, and possibility. I’m talking about flourishing.” He means the importance of social relationships, a sense of purpose, and what he terms "soulful engagement,” which could include a trail walk with a friend or pitching in as a volunteer in one’s community.
One place where people are doubling down on the metrics is the MAHA movement, where HHS Secretary Robert F. Kennedy, Jr. wants every American to be managing their health with a wearable, much to the dismay of The Vergereporter Victoria Song, who chronicles her own struggles with health and wearables in “RFK Jr. wants a wearable on every American — that future’s not as healthy as he thinks.” Song, who was dealing with unexplained weight gain, found some value in tracking her numbers and pushing herself to meet activity goals, but found the dark side of an intense focus on metrics in its impact on her mental health. The experience wrecked her relationship with food, leading to disordered eating, and she developed anxiety around her running performance. She maintained step count streaks at the cost of missing important family time. Song’s experience isn't universal, of course – but that’s not her point: it’s that some people will benefit from engagement with wearables and the data and some will truly suffer. One size doesn’t fit all.
Another perspective on the direct pursuit of health goals, or perhaps more narrowly the framing of healthy behaviors and healthy lifestyles as “X as medicine,” comes from Dawn Teh. Writing in New Scientist, Teh notes that despite an ambitious goal by WHO to lower the global physical inactivity rate by 10% in 2025, the numbers have actually gone up, leading some to question the way that the public health community has promoted physical activity – as medicine. Song cites a number of studies that suggest that people are active for many good reasons besides health goals. As one researcher put it: “We want to play, to laugh, to explore, to dance, [and] feel proud of ourselves. Ultimately, to have fun and feel good.” Studies have also shown that people are more likely to stick with physical activity when it’s fun. That, of course, makes sense and evokes the concept of “stealth interventions,” developed by Stanford pediatrician Thomas Robinson. The idea behind stealth interventions is to create health interventions that can be motivated by the process or experience of the activity – not by the outcome the activity is designed to produce. Dancing, for example, is super healthy – but that’s not usually why people partake.
It’s nice to envision a world where we don’t need to think about health everyday. Where we live our daily lives, engaging in work, play, community, social activity, interests, and the like – and good health follows from it all. To imagine a world where we don’t need to count our calories, track our steps, or see projections for how many years we have left to live – in order to be healthy. But of course that’s easier said than done. As we discussed in our most recent newsletter:
“One argument might be that we need public health in order to give us choices. Public health gives us safe water and safe food. It gives us a variety of foods. It gives us opportunities to socialize and recreate as part of our everyday routines. Only once these basic needs are met can people actually start to take agency and take action. If the basics aren’t there, then people may not really have choices.”
We wouldn’t have to think as much about health if healthy foods were abundant, affordable and the norm (and not competing with low-cost, heavily marketed ultraprocessed foods), if we could walk, bike, or ride our wheelchairs safely to the places we needed to go, if our housing developments facilitated getting to know and trust our neighbors, if our screens didn’t constantly beckon us.
As scientists have established the connections between the modern environments our societies have created, they have had to come up with new terms like “obesogenic” and “lonelygenic” to describe the influences of these environments. The wellness and longevity movements, with their focus on wearables, data and supplements, are essentially plays to overcome these environments. Which, in the short run, one can understand. But it creates a dynamic in which individuals need resources – money, know how, access and time – to overcome what society creates. As such, it's fundamentally inequitable: those without the resources to optimize their longevity are left to themselves to scale high walls, made ever higher by the forces that shape our modern world.
We recently came across an eloquent framing of this dynamic while reading the responses to an excellent commentary, by Laura Schmidt and Luc Hagenaars, on how the emergence of Ozempic could shift the blame for obesity from individuals to society. In his response, University of Groningen economist Jochen Mierau wrote:
“It is increasingly acknowledged that the obesity pandemic stems from the commercial interests of food and beverage firms that normalize unhealthy diets, as well as automotive and fossil-fuel corporations that promote sedentary lifestyles. While these industries do not intend to make society obese, their business models depend on doing so.
“Even though the obesity pandemic is claiming lives, lowering productivity, and pushing up health care costs, health-harming industries operate within the boundaries of the law. A great paradox of our time is that while societies depend on a healthy population to function, the legal framework allows actors within society to undermine public health for private gain.”
Amen.
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