Dr. Peter Attia arrived at his current career as a clinician, author, and podcast host circuitously, leaving general surgery residency at Johns Hopkins University to work in consulting then returning to medicine years later. He is a fitness fanatic with a love for boxing and Formula 1 (F1) racing – Dr. Harmon never truly appreciated the athleticism required to drive F1 cars until he read this book – which is reflected in the pages of this book. His clinical practice model reflects his belief that medicine as it is currently practiced does not adequately address the core causes of poor health in our later years. Dr. Attia intervenes intensely with his patients as early as possible to maximize their healthy functionality for as long as possible. He calls this disease prevention model Medicine 3.0. He contrasts this with Medicine 2.0, which he argues was developed approximately one hundred years ago to treat infectious diseases as well as chronic diseases after they have developed.

The book explains the purpose and goals of Medicine 3.0, discusses the causes of heart disease, cancer, and neurodegenerative diseases such as Alzheimer’s, and proposes solutions to reduce our risk of such diseases.

Dr. Attia advocates for more extensive testing for cholesterol abnormalities and problems with glucose management as well as more aggressive treatment of these conditions. He feels that, by the time lab values demonstrate there is a problem with cholesterol and/or glucose management according to current guidelines it is already too late to adequately treat and prevent future complications, which can include not only heart disease but also cancer and neurodegenerative diseases. He feels that an intensive exercise regimen and a focus on building muscle mass as well as maximizing an individual’s oxygen use capacity (i.e., VO2 Max) are key to the prevention of chronic disease. He also feels that a finely measured, data-driven, individually optimized diet is also important focused on minimizing glucose spikes with meals.

He also advocates for earlier screening for cancer (e.g., colon, breast) than current guidelines recommend. He argues that survival rates for cancer are so much higher when caught early that the cost of earlier screening is justified. Dr. Attia’s arguments inspired Dr. Harmon to have a conversation with his primary care physician about advancing his screenings. It remains to be seen whether and when the medical subspecialty governing bodies and insurers will adopt new screening guidelines in the future.

The most important insight from the above sections of the book is the extent to which vascular disease as caused by high cholesterol, persistently elevated blood glucose, and high blood pressure contribute to the development of heart disease, cancer, and neurodegenerative diseases. For example, the relationship between vascular disease and neurodegenerative diseases such as Alzheimer’s Disease is gaining increasing attention in the medical literature.

Two of the most unique and valuable chapters in the book discuss the importance of sleep and maintaining good emotional health. These two areas are the most personal for Dr. Attia, and he highlights significant stories from his own life that illustrate the importance of getting good quality sleep as well as addressing problems with emotional health. Dr. Harmon agrees wholeheartedly with the importance of both and hopes patients understand the importance of emotional self-care in addition to physical self-care.

Overall, the book is a powerful argument for setting a goal of not only a long life but a healthy, functional and, therefore, fulfilling life. Dr. Attia deviates infrequently into areas that are more controversial. For example, he places patients on the immunosuppressive agent tacrolimus – a medication commonly used in patients who have undergone an organ transplant – due to his review of data that he feels makes a strong argument that it can increase our functional lifespan. This is not something most physicians would recommend. And while there are many well-argued and potentially transformative solutions to disease prevention in this book, many are dependent on involved and expensive testing and technological solutions (e.g., constant blood glucose monitor, VO2 Max testing) that are not intuitive to most people and, therefore, unlike to be adopted by most without the intense engagement of a primary care provider.