417: Hospitals' next lucrative bet — longevity clinics

0:06Welcome to The Read Out Loud, a weekly biotech podcast from STAT. I'm Alison DeAngelis. I'm Adam Feuerstein. And I'm Bilene Chen. In this episode, we dive into the longevity industry, a growing field of medicine aimed at extending human life. Longevity was once thought of as a fringe movement, but today it's in the mainstream. But first, a word from our sponsor.

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1:21Before we get to the longevity conversation, we have a sad note to share. Stat lost one of its cornerstone reporters, Helen Branswell. Helen died Tuesday after a recurrence of breast cancer with her loved ones around her.

1:39Helen was a cherished member of the Stad family, a giant in public health journalism, and a regular presence on this podcast. Helen was someone we turned to time and time again to explain infectious disease outbreaks and public health policy. She was one of the first journalists to spot a concerning virus brewing in China at the end of 2019. And we all know that that led to the COVID pandemic. Here at Statt, she led the charge in our COVID reporting, writing important stories about life-altering information that educated readers and listeners. It feels especially cruel to lose Helen when the public health sector, and actually the country needs her reporting more than ever.

2:25Helen would honestly hate us paying tribute to her so publicly. She kept news of her cancer recurrence private and she was working right up until the end. You'll hear more about Helen next week from the people who knew her and how incomparable she was.

2:41Sarah Todd: The first time I ever heard of Helen was when I had first become director of the CDC and there was a press conference about influenza and a very astute press officer said to me, you are not ready for this press conference until you are ready for the questions from Helen Branswell. We just wanted to say thank you, Helen. We will miss you.

3:10In Helen's spirit, we're going to jump into the news. We know that's what she would do.

3:30People want to live longer, and they are paying lots of money for it. Longevity medicine is now estimated to be a multi-trillion dollar industry. Imagine having the tools, the knowledge, and the support to stay ahead of illness rather than reacting after it strikes. That's the vision of Weill Cornell Medicine's Longevity Program, a 12-month journey that is designed to help you take control of your health now and for the future. Our evidence-based approach merges the clinical precision of modern medicine with data-driven guidance on the daily behaviors that profoundly shape long-term health. Our colleague Sarah Todd recently subjected herself to a barrage of tests and treatments at one of the many longevity clinics popping up in major hospitals across the country.

4:16Sarah, welcome to the podcast. Hi, thanks for having me. Sarah, so you're writing a series of stories at STAT called Selling Longevity. Tell us why you decided to start this series and what are the big ideas and themes you hope to cover? So, you know, I think we've all seen tons of longevity in the media, especially at the sort of like billionaire level. And it's perpetuating this idea that I think is largely been true of longevity as something that's for the rich and all of these types of really fringy treatments like stem cell infusions and peptides and things like that. But with this series, with Selling Longevity, I was thinking like as it continues to penetrate public consciousness, we're seeing longevity move to another space where it's becoming increasingly not necessarily within reach of an average person, but less only for billionaires and more mainstream adoption of certain longevity treatments and ideas.

5:16So I wanted to look at how it's being marketed and sold to the general public. Some of the themes that I'm going to be exploring, this first story that was about hospitals getting into the longevity space. And then coming up, I will also have stories looking at women in longevity and cognitive longevity. It's interesting because when you think of longevity medicine, it seems like it's kind of been on the fringes of health care. But here you have these really established hospitals, you know, brand name hospitals that we all know launching these longevity clinics. Why are they doing that? Right.

5:50So we're seeing a few hospitals jump onto this. There's Northwestern Medicine, Weill Cornell, and Mayo Clinic are some of the biggest names, all really prestigious hospitals. And in many cases, these are cash pay programs. Financially, there's a big upside for hospitals in offering these longevity clinics. They can get around having to deal with insurers. They can also charge thousands of dollars to patients that helps go to their bottom line. And one thing that all of the clinic directors that I spoke with were upfront about is they know that there's big demand for these services. People are increasingly interested in longevity medicine, and I think they just thought if we build it, they will come.

6:33So why are they doing this now? And then also, what are we talking about in terms of cost for these services? Yeah. So in terms of the why now, I think the broader trend is happening because there's growing publicity around longevity. There are more and more private longevity clinics popping up where people can experiment with things like peptide infusions. And hospitals say, OK, we can offer treatments and tests that are safe and that are more evidence backed than what's being offered at some of these private clinics. So they're thinking, oh, there's a market niche that we can carve out. In terms of the cost, at Northwestern, it's$5 ,500 for a year.

7:12While Cornell, it's anywhere between$7 ,500 and$12 ,000, depending on which membership you might choose. And then at Mayo's Jacksonville Clinic, it's$45 ,000 for a year. So Sarah, what do you get for this kind of money? You actually went to one of these clinics as a patient. Tell us about that. I'll start off just by talking about Northwestern specifically. So at Northwestern, you go through a battery of tests. All in all, it takes three or four hours. And they're looking at everything from your heart health to your lung health to your brain health. So some of the tests that I did included the VO2 max, which is a test that is clinically validated, but it's typically used for people who are having heart or lung problems.

7:55Basically, you get on a treadmill and you run faster and faster at steeper and steeper inclines until you can't possibly run anymore. That's a test of your cardiorespiratory fitness overall. I did a scratch and sniff smell test where I had to pick from multiple choice answers. Oh, does this smell like lemons or strawberries or smoke? They explained to me that that is because often losing your sense of smell can be a sign of early onset dementia or other cognitive problems. Some of the less evidence-backed types of tests that they have there included the biological age tests that use your blood biomarkers, DNA methylation tests.

8:35And then they also did a retinal scan where they look at your vasculature in the back of your eye. That's to measure your heart health. And then they also did an AI-based algorithm based on my electrocardiogram to measure heart health as well. So they don't just give you one biological age number, you get a range of different numbers. Those are more controversial simply because these aren't recommended by any major medical associations or medical guidelines. And there's also a lot of questions about, you know, once you get this number, what do you do with it? Is it proven to any helpful health outcomes?

9:08I feel like with any kind of tests or screening in medicine, like certain cancer screening, there's the concern about, you know, is this test really necessary? Are we over-diagnosing or inaccurately diagnosing that will then lead patients to get procedures that they don't need, like biopsies, et cetera. How do people feel about these kinds of tests that you just described that one could get at a longevity clinic? So this is something that I think is really interesting. So at Weill Cornell and at Mayo, they do offer the early cancer detection tests, and they also both offer the whole body MRIs.

9:44Another controversial test. In both cases, there are concerns about finding what they call incidentals, which are really common findings where you discover maybe be a mask, something else pops up that you weren't looking for, but it may or may not have actually ever become a problem for you down the line. And we know that biopsies can come with their own potential risks and downsides, as well as being quite expensive. So basically what the clinics say, they're thinking about this is they know that there's a demand for it, which is true. These are also available privately and people will seek them out.

10:18And they say, you know, at the very least we're in a position like, you know, we're Weill Cornell, we have radiologists who can interpret these results for people and help them understand what to do next and refer them out to specialists as needed. But that said, they're also upfront about the idea that they know that these aren't things that have substantial evidence backing them yet. And they say, okay, that's maybe something that we can offer too. So at WAL Cornell, they're saying, well, we're going to be using de-identified patient data. We're going to be tracking to see whether doing these whole body MRIs actually improve health outcomes down the line.

10:55And if so, maybe they publish studies on it and that helps lead to them eventually being covered by insurance. I wonder going into this, Sarah, like how are you feeling about it? Were you skeptical about this? You went through this experience, you took all these tests. And so coming out of it, do you feel like people who pay for these services, are they getting their money's worth? Going into it, I was skeptical. I think that's the reporter's default mode. And coming out of it, what I found was that I don't think that I needed tests worth thousands of dollars in order to come out on the other side.

11:30They were basically just confirming that I was pretty healthy. I think for some people, they might think that's worthwhile because it gives them peace of mind. I know that that's one reason why people seek out longevity clinics. And they also do offer suggestions about modifications that you can make to your diet, to exercise, all those different lifestyle factors to improve the areas that you need improving in. And I did find to my surprise that the visit to the longevity clinic has helped tip me towards some healthier habits. I usually don't exercise after I drop off my kid at daycare in the morning.

12:05Now I'm making a little more time for that before I start work, that kind of thing. But I think that that's less about the longevity part of it and more about the experience in our healthcare system, it's quite rare to have that kind of time and attention just sort of lavished on you as a patient where I was spending so much time thinking about all of my body's different functions being made to appreciate it, getting to sit down with a doctor for an hour and have him walk me through all of these results and answer any questions that I might have. So I think that really what people are paying for in part is also having that kind of superior healthcare experience.

12:44Well, I read a little bit more on that because, look, we all have experience going to the doctor where, you know, you're there for like 15, 20 minutes and then, you know, you're out the door. You know, you spent a luxurious afternoon at this longevity clinic and obviously you have to pay a lot for that. How does all of this fit into America's health care system? Is this always going to be something just for folks who can pay for this out of pocket? Or is there anyone thinking about how to incorporate this stuff into the kind of health care that 99 % of Americans get? Yeah, I think that this is a criticism that a lot of the people I spoke with for this story mentioned.

13:24And one that the medical directors of the clinics readily acknowledge that there's already this perception that longevity is for rich. And then charging people thousands of dollars for this clinic experience is certainly confirming that perception. And it's also a problem when you think about it from an inequality point where we know that lifespan is correlated with your income level. So the people who are in the top 1 % by income live on average to age 84. People who are in the bottom 50 % die seven years earlier. So really, if we're thinking about who's most in need of longevity services, it's really people who are in that lower income bracket.

14:05it. There are some things that the clinics are looking at and that people are thinking about doing to sort of bring some of this level of care on a broader sphere. So at Northwestern, for example, their longevity clinic is connected to a research lab that does have a focus on people from marginalized backgrounds, including a particular study they're running on people with HIV and longevity. So that's one piece of it, you know, the connection with the research at these clinics. And then at Mayo Rochester, they do as much as they can, they say, to make sure these tests are covered by insurance. They also have a slightly different model in that the people who are at their longevity clinic are people who are already coming to the Rochester campus for something else.

14:48So maybe you're there because you're dealing with cancer or a heart problem, and you're also being sent to the longevity clinic in the process. So that's an interesting potential model and alternative. But in the short term, I think that what these longevity clinics reflect is that there is this increasing divide in healthcare where people will pay for concierge health services, executive health services, longevity clinics that give you this kind of access. I think that nobody, including the people who I spoke with at these clinics would deny that's a problem. Yeah, what really struck me in your story was how luxurious the experience was.

15:25You talk about how there was spa music, There was Aesop soap in the bathroom, organic cocoa nibs after the visit. So it's interesting that they talk about, you know, wanting to make this more accessible. But the experience itself feels very much like a spa visit. Did they give you a robe and did you get to keep it? So they did offer a robe. And I wrote down the brand because I was curious about, like, how fancy is this robe? But then I didn't include it in the story because when I looked up the price of the robe, I was like, it's not that fancy. But wait, the Mayo Clinic Longevity Clinic in Florida, you said, costs$45 ,000?

16:01Yes,$45 ,000. What do you get for 45K? They're one of the ones that do offer the whole body MRIs, the early cancer detection, a bunch of other types of options, too. That's not one of the ones that I visited, so I didn't personally get a chance to experience it. It must be near Mar-a-Lago. Maybe. Yeah. And the woman who's the medical director of that clinic, she came from a background in concierge health. So I think that she was probably bringing some of her experience with that to the longevity clinic as well. What to the average patient, what do these longevity clinics say they're selling you or what you could get out of this experience?

16:40So beyond the particulars of what tests are offered, I think that they are united in offering two things. One is a more detailed overview of your current health and your aging trajectory than you would get at a typical primary care or specialist doctor's visits. You know, you get this in-depth look at what's going on. And then the other piece of it is the follow-up where you get the consult, not just with the main physician, but also with a registered dietitian, with an exercise physiologist, and they're helping you figure out how to tailor your actions based on the results of your longevity testing.

17:18And then there's usually a follow-up appointment in six months where the idea is like, you'll hopefully see improvements and you'll be like, hooray, I'm helping myself live a longer, healthier life. What was the biological age or ages they gave you? I got back a couple different results. So one of them put me at age 39. Another one put me at age 34. My actual age is 43. So, you know, it was nice that I was coming in younger than my actual age, But I also wasn't totally clear, like, how real is any of this is one question. And then two is how significant is the difference between 39 and 43? It's not huge.

17:57I guess it would be really a bummer if you got that back and said you were like, you know, 60 and you're only 41. It would. Yeah. But, you know, I talked to the medical assistant who was guiding me through the Northwestern experience. She said that she had gotten results that were older than her age. And she said, well, it didn't feel great. She wasn't surprised either. She had kind of been expecting that because she knew that she had been stressed out lately. And she said that that had motivated her to do more on the lifestyle front, to get things more in order. And that's one of the things that Northwestern says is a reason why they think that there's a purpose to the biological age test.

18:33They say, like, you know, it can be motivating for people if they do get a bad result. Sarah, what are your overall takeaways from this experience? I would say, you know, I don't think that I needed this. It made me think about the problems with the current healthcare experience that the average patient has and how I think that if aspects of it were made to be more like this, not the ASAP soap necessarily, not the whole body MRI, but attention and care that I got, I think is something that is worthwhile. And that's probably what made the difference for me. Sarah, you don't look a day over 30. Thanks for joining us.

19:16Thanks so much, guys. That does it for another episode of The Read Out Loud. Our podcast is produced by Rachel Gottbaum. Our senior producer is Delissa Ambrose. Our executive producer is Rick Burke. And our theme music is by Brian Joel. And we'd love to hear from you. Tell us what you like about this week's episode, what you didn't like, and send us a memory of Helen Branswell. You can do all that by sending us an email at readoutloud at statnews.com. And if you like what we do, leave a review or rating on Apple Podcasts or wherever you get your podcasts. See you next week, folks.