0 evaluări0% au considerat acest document util (0 voturi)
730 vizualizări1 pagină
Longevity Escape Velocity (LEV) Medicine - A New Medical Specialty For Longevity, Undoing Aging Conference 2018, Berlin
20one Clinic
Oliver Zolman 2018
Longevity Escape Velocity (LEV) Medicine - A New Medical Specialty For Longevity, Undoing Aging Conference 2018, Berlin
20one Clinic
Oliver Zolman 2018
Longevity Escape Velocity (LEV) Medicine - A New Medical Specialty For Longevity, Undoing Aging Conference 2018, Berlin
20one Clinic
Oliver Zolman 2018
Oliver Zolman BSc, MBBS(c) (Lond)1,2 1CEO & Founder 20one Clinic Limited, 2King’s College London School of Medicine
What is “LEV”? 5 Problems LEV Medicine:
A mainstay of preventive medicine innovators and Here I present a novel paradigm of medical care: “LEV The medical specialty focused on medical futurists has been the concept of longevity Medicine”, of which can address 5 key problems that escape velocity (LEV). LEV represents the time at which are barriers towards transitioning society to one that measuring, achieving and someone is gaining greater than 1 year of predicted can provide evidence its healthcare consumers are maintaining a person’s longevity healthy life expectancy per year, essentially making his achieving and maintaining LEV: or her healthy life expectancy unlimited. escape velocity (LEV) through using 1. No current medical specialty can effectively deliver diverse measurements and Although futuristic, over the past decade, leading a maximal reduction in all-cause-mortality. Solution: innovators in the field have predicted persons reaching Creation of an LEV Medical Specialty and training of therapies to maximally reduce all- LEV soon. Human Longevity, Inc., headed by Craig healthcare professionals focused on maximally cause-mortality, all-cause Venter, Peter Diamandis, and Robert Hariri, frequently reducing all-cause-mortality. claim their goal is to make ‘‘100 the new 60’’ by 2025, morbidity, negative clinical and that LEV “will be reached” by the wealthiest of 2. No good measurement of one’s own “LEV” exists. society by 2030; the Methuselah Foundation ‘‘want to Solution: Unprecedented measurements of outcomes and aging pathology and create a world where 90-year olds can be as healthy as individuals’ LEV based on thousands of criteria. processes. 50-year olds by 2030’’; whereas Ray Kurzweil predicts that (1) LEV ‘‘will be reached’’ by 2029, (2), baby 3. The current global pool of clinical guidelines: 1) Do boomers will still be alive and healthy in 2100, and (3), that in 2017 he personally has already reached LEV. not take into account added financial spending power to improve outcomes from self-funding Integrating with RejuvMed persons; 2) Do not focus on maximally reducing all- How can LEV medicine integrate with pre-marketing cause-mortality; 3) Are not systematic, missing out authorisation/off-label rejuvenation medicine or not commenting on many topic areas; 4) Do not (RejuvMed) therapies and investigations? As part of a LEV Med. Target Outcomes LEV Med Guidelines cover many LEV Medicine related clinical areas at strategy to maximally reduce all-cause-mortality, for all; 5) Do not use the optimal evidence & critical many people it is likely optimal to implement select Implementation of this new paradigm of medical care therapies or investigations prior to them having global appraisal requirements for reaching LEV for by clinicians, stakeholders, patients and commissioners marketing authorisation and commissionability – a inclusion in the guideline; 6) Often are not adapted should be focused on achieving the following societally process which takes many decades. LEV Medicine for personalised and experimental medicine; 7) Are important goals: specialists can integrate cutting edge therapies and not formatted optimally for efficient use by clinicians (even veteran doctors frequently miss investigations into clinical practice years or decades 1. Generation of high-quality, low-risk-of-bias peer- before one would normally have access, via calculating recommendations of guidelines); 8) Are not reviewed scientific evidence showing the person specific clinical effective value thresholds (EVTs) designed for patients to understand: medicine in comparative outcomes of people receiving LEV (i.e. statistically assessing the probability and many cases is still a black box. Solution: Creation of Medicine Clinical Guideline based services, versus magnitude of benefits and risks (including financial, and hundreds of open-access, extensively peer- their existing providers, in terms of clinical time) of undertaking any given clinical action). reviewed LEV Medicine clinical guidelines focused outcomes, high-level surrogate markers of clinical Personalised EVTs can be used to guide when to initiate on addressing these sub-problems. outcomes, best-in-class risk-calculators, satisfaction cutting edge therapies and investigations and, based on and cost-effectiveness metrics (e.g. £/QALY) the individual person and intervention, this may mean 4. A major gap in most healthcare globally is the lack of appreciation of preventive & reactive emergency it is rationale to undertake such an intervention at any 2. Increase in the number of low-risk-of-bias safety stage from pre-clinical to post-Phase 0, 1, 2, 3 or 4, to medicine for maximising positive clinical outcomes. and efficacy data points for key investigations, post-establishment of Level 1 – 5 Grade Evidence from Solution: Create preventive and reactive emergency therapies and combinations of; with each data point the Oxford Levels of Evidence. medicine i.e. “emergency resilience” guidelines acquired additionally weighted by the coefficient addressing aforementioned guideline problems as multiplier of “months of early access data point was To provide such a service safely and effectively within well as other resources for clinicians and patients to acquired relative to the baseline of the expected LEV Medicine, strict peer-reviewed clinical guidelines increase focus & positive outcomes on emergency time for such data point to be acquired by the and care-quality standards, equivalent or greater to medicine. individual without such LEV Medicine services. This those of the UK Care Quality Commission (CQC) and the incentivises safe and impactful innovation UK General Medical Council (GMC) must be followed 5. Currently experimenters with “longevity protocols”, additionality. These data points apply to promising for any such investigation or therapy. For all persons as well as their physicians, do not collect and LEV technologies in the following categories : using such cutting edge therapies, to adhere to LEV distribute their methods, efficacy and safety data 1. Therapies or investigations that already hold medicine guidelines, clinical outcomes, surrogate despite being hugely valuable. Solution: Develop marketing authorisation (i.e. off label markers and other efficacy and safety data must be resources and culture to enable 100% effective therapies, e.g. rapamycin) captured and reported – with such data having to meet capture, pooling and open access of all data from all 2. Therapies or investigations that are not or only minimum steps to reduce bias, allowing for such data patients – including suitable experimental methods, loosely regulated (e.g. calorie restriction to be pooled with past, ongoing and future studies. clinical outcomes, surrogate marker and side effects optimal nutrition, class 1 devices) Furthermore, all such services should only be carried – undergoing important LEV medicine practices 3. Therapies or investigations that are post-Phase out by an LEV Medicine Certified clinician. globally. 1 clinical trials (safety established)
3. Change the mindset of medical care, as based on
number of certified LEV Medicine practitioners and Example of an LEV Medicine Service results of questionnaires & feedback from diverse A fundamental requirement of LEV Medicine services is to be able to systematically identify, prioritise & manage healthcare stakeholders, of which assess: multiple clinical problems or action points; this is key to maximally reducing all-cause-mortality. Unlike typical providers 1. Any changes in mindset about LEV and its where a person waits for symptoms or signs to occur, with the clinician then working to solve this one single problem as related aspects, such as preventive medicine first priority, an LEV Medicine practitioner would systematically assess 20 to 2000+ health components related to all- 2. Extent of improvement in implementation of cause-mortality. LEV Medicine clinicians use evidence-based statistical algorithms to identify the optimal order in which evidence based medicine practices, e.g. LEV clinical problems should be solved. Additionally, in LEV Medicine, clinicians use evidence-based OCO (optimal clinical Medicine Guidelines, versus current sub- outcomes) ranges adapted to the persons’ subpopulation, which can yield further reduction in all-cause-mortality optimally evidence based medicine practices beyond typical providers reference ranges. When managing therapies and follow on investigations, LEV Medicine Clinical done for “LEV related purposes”. Guidelines are used alongside typical gold-standard guidelines, along with aforementioned Decision Analysis algorithms.
Contact Oliver Zolman CEO | 20one Clinic Limited oliver@20one.clinic www.20one.clinic Asfand Khan, BA, CA(c), CFO Oliver Zolman, BSc, MBBS(c), CEO
Is Management Essential To Improving The Performance and Sustainability of Health Care Systems and Organizations A Systematic Review and A Roadmap For Future Studies