Aging Better

Peter Attia on “fixing the system” to improve our later years


Through his popular podcast, The Drive, and his new book, Outlive: The Science and Art of Longevity (Penguin Random House 2023), Peter Attia challenges the conventional medical thinking on aging and offers a new approach to preventing chronic disease and extending long-term health. Attia, 51, who completed surgical training at Johns Hopkins (2001–06), lives in Austin, Texas, with his wife, Jill (RN ’00, NP ’04), and three children. When the family isn’t working out together on the weekends, Attia gravitates to the local Formula 1 racetrack to pursue his passion for car racing.

Interview by Elizabeth Darrell

You posit that American medicine ("Medicine 2.0") treats patients too late and focuses on prolonging their lifespan at the expense of their “health span,” or quality of life. Could you explain? 

With “Medicine 2.0,” the focus is on lifespan, which is binary. You’re alive or you’re dead. So it’s very easy to focus on mortality as the metric to care about. It gets much more difficult when you want to start talking about cognitive health, physical health and all the details that make that up — strength, stamina, movement, balance, freedom from pain, emotional health. We have to be able to understand how to scientifically apply nutrition, exercise, sleep physiology, and tools around emotional and mental health. That’s a huge expansion of scope [for clinicians].

What must change to make “Medicine 3.0” a reality? 

You have to change your view of risk — to view risk through a much longer time horizon. So instead of thinking about what’s the five-year risk, or even the 10-year risk of something, you have to consider lifetime risk.

Then you have to realize that every time you look at a study, even the best study, it’s taking individual data and homogenizing the data and giving you average outputs. And that’s valuable at the population level. But doctors don’t treat populations; they treat people. So you have to think about customizing [study findings] into a risk-adjusted strategy for each patient.

Medicine 3.0 requires learning a lot of new science. It also requires a system that allows [nutrition, exercise, sleep physiology, and emotional and mental health care] to be implemented, because as any doctor knows, you’re not going to be compensated for those things the way you’ll be compensated for prescribing medications based on a diagnosis and/or doing a procedure. So you have to fix the system to allow the providers within the system to give the care that’s aligned with it.

Could you talk a bit about the origins of your podcast?

I trained in surgery. And what I do today is not surgery. About 12 years ago, I realized I needed to learn everything all over again. It’s basically like I was now a medical student, starting from scratch. So how do you do that? Well, I think that’s probably my superpower — I know how to find people who are exceptional. And I know how to learn from them … through really lengthy conversations and asking a lot of questions.

Over the years, I was doing this constantly. And I kept saying to myself at the end of every one of these discussions, “Boy, that was such an interesting discussion. It’s a shame nobody else got to hear it.” And finally, I kind of had an “aha” moment — maybe that could be the theme of a podcast. The Drive is me having the discussions that I have where I learn, but now I get to share it with a million people.