My advice to current medical students would be to develop critical thought, learn the skill of adapting (yet staying calm) during rapid change and read literature to deeply understand the human condition.
A bit different discussion today on medicine as a whole sparked by a few posts going around the past two weeks. As someone who is an ardent Munger fan, this is an ode to the legend. In recent months, discussions around the cost of medicine have evolved rapidly. The conversation around niche healthcare costs lately is reaching quite the fever pitch, particularly concerning the burgeoning fields of concierge, healthspan, and longevity medicine. We see insightful commentary, led by Dr. David Luu'sgreat piece for Longevity Docsdiving into the factors keeping costs high now and tailwinds bringing costs down in coming years.
Is Longevity Medicine Too Expensive? · Hormone Therapy-Induced Histamine Intolerance · Longevity Medicine Global Report
Your sneak peek into the world of Longevity Docs.
Discussions around executive physicals highlighted by Will Manidis,
two years later, its crazy to look back at my $5000 executive physical experience.
the three diagnoses I was given all turned out to be wrong. so why do patients flock here every year?
patients want "more healthcare", but what happens when this comes at a serious medical cost?
the three diagnoses I was given all turned out to be wrong. so why do patients flock here every year?
patients want "more healthcare", but what happens when this comes at a serious medical cost?
Last year, I paid thousands of dollars for a physical at one of the best hospitals in America
I wanted to see how different healthcare was for the ultra-rich, and what this meant for the rest of the healthcare system
Here's what I learned:
I wanted to see how different healthcare was for the ultra-rich, and what this meant for the rest of the healthcare system
Here's what I learned:
1,043
and excellent piece Eric Topol's explorations into the business of longevity, its history and a great table of current players (below).
The Business of Promoting Longevity and Healthspan
A crop of new consumer-facing companies with unconventional data collection
As can be seen, these often center on premium services offering deep investigation of biomarkers, proactive imaging, and extensive physician time – services commanding significant fees.
However, a crucial question arises: Is this value proposition, built on the medical economics of yesterday, sustainable in the face of tomorrow's technology? Meaning, can we apply the economics and business models of Medicine 2.0 to Medicine 3.0?
I believe we're on the cusp of a fundamental shift, driven not just by one breakthrough, but by a confluence of powerful technological trends.
The Great Commoditization
When Data & Basic Analysis Become Table Stakes. Historically, a significant portion of the value (and cost) in premium medical services stemmed from human capital-intensive tasks: meticulous data gathering, complex synthesis of disparate information streams (labs, imaging, history), and the diagnostic expertise honed over years by skilled physicians. And in the case of concierge medicine, add in high touch and access to that care. This required significant time and cognitive effort, justifying higher price points.
Now, a wave of technologies is automating or drastically reducing the cost and effort involved in these foundational tasks:
AI Beyond Just Language:
LLMs
As is now quite evident, Large Language Models excel at pattern recognition, synthesizing vast amounts of text-based data (research, notes), and even generating diagnostic possibilities. Let’s not spend more time here.
Computer Vision
Less discussed, but just as crucial. AI algorithms are rapidly mastering the analysis of medical images (X-rays, CTs, MRIs, pathology slides). They can screen for specific conditions like diabetic retinopathy or certain fractures, measure structures, and flag anomalies, automating parts of the initial interpretation burden previously borne by radiologists and pathologists.
Predictive Analytics
Machine learning (and subsequently quantum computing) models efficiently crunch vast datasets (EHRs, claims, genomics) to automatically stratify patients by risk for outcomes like hospital readmission or developing chronic diseases, tasks that once demanded significant clinician review time.
Result: Reduced time and cost of processing and synthesizing data.
The Sensor Revolution:
The proliferation of smartwatches, continuous glucose monitors (CGMs), connected scales, ECG patches, and other biosensors shifts data collection from episodic clinic visits to continuous, real-world monitoring.
Result: Generates immense longitudinal data streams, largely commoditizing the act of basic physiological data gathering.
Democratization of Diagnostics:
Point-of-Care Testing (POCT): Advances allow complex tests (e.g., CRP, HbA1c, infectious disease markers) to be performed quickly and cheaply outside traditional labs – in clinics, pharmacies, or even at home – reducing reliance on centralized infrastructure.
Automated labs are slowly coming live in both acquisition and processing done at home.
Plummeting Sequencing Costs:
Next-Generation Sequencing (NGS) has made obtaining raw genetic data relatively inexpensive,
The $100 Genome: Where’s the Limit? - Lindsey Fletcher
Result: commoditizing the acquisition of biomarkers detailed genomic information, even if interpretation remains complex.
Imaging Technology Advancements:
Imaging diagnostics are rapidly becoming both cheaper and more preventive thanks to automation, novel device designs, and robotics. Private AI‑enabled “body scans” now cost as little as $999 (takes only 25 minutes!) and use multi‑modal imaging combined with AI to screen asymptomatic individuals for cardiovascular disease, cancer, and other conditions in minutes—dramatically reducing per‑patient costs compared with traditional imaging pathways.
Robotics‑integrated ultrasound platforms, such as Mendaera’s AI‑guided needle system, automate and standardize procedures like biopsies, cutting reliance on specialist operators and lowering procedural expenses, thereby expanding access to early diagnostic interventions .
Meanwhile, AI‑augmented MRI and CT scanners scan patients up to three times faster, increasing throughput and reducing per‑scan costs—key advances that enable routine population‑level screening programs to catch disease at its most treatable stages
Portable, high-quality ultrasound devices connected to smartphones are democratizing basic anatomical imaging, moving it beyond specialized suites and lowering the barrier for initial assessments.
Result: reduced cost and increase efficiency allows for cheaper increased frequency of both acquisition, analysis and monitoring
Telemedicine Platforms & Remote Tools:
Sophisticated platforms streamline virtual visits, and when combined with connected digital tools (stethoscopes, otoscopes), they enable thorough remote exams and monitoring, commoditizing many routine consultations and follow-ups. A big upgrade from the manual Littmann Classic 3 we were trained on.
DTC platforms (think Hims & Hers, Ro, Hone Health) are expanding their offerings while building innovative frameworks, bundling together various aspects of both lifestyle, longevity and traditional medicine available digitally. Newer LLM-powered services provided same day care (Counsel Health,
Result: Commoditization of access to both prevention and low acuity care.
The Common Thread: Shifting the Value Equation Upstream
All these technologies share a common theme: they automate or drastically reduce the cost and manual effort involved in data acquisition, basic analysis, and routine monitoring.
This relentless technological push doesn't eliminate the need for medical expertise, but it fundamentally changes where the economic value lies. If gathering data and performing initial analyses become cheap commodities, the premium must be justified elsewhere.
The New Frontiers of Value
So, where does true value, and thus justifiable cost, reside moving forward? The shift is towards areas where human expertise, deep personalization, and uniquely human capabilities are paramount, often augmented by these powerful new tools:
Hyper-Personalized Therapeutics
The real game-changer isn't just identifying risk, but acting on it with unprecedented precision. Understanding an individual's genetic makeup to predict drug response (pharmacogenomics) is currently being used daily and is just the start.
Imagine therapies developed or selected 'just-in-time' based on evolving multi-omic risk profiles.
This level of personalization represents immense value and will likely command significant investment.
Actionable Intervention & Behavioral Modification
Data and diagnoses are useless without action. Translating AI-suggested lifestyle changes or preventative measures into sustained behavior requires human connection, coaching, and accountability. Physicians and health coaches skilled in this high-touch guidance bridge the gap between data and real-world results.
Complex Integration
Integrating insights from genomics, wearables, environment, social determinants, and patient values into a cohesive, ethical care plan requires sophisticated human judgment. As more mundane and repetitive tasks are automated by technology, physicians can spend time to become expert integrators. Translating research, response and potential new therapies for individualized use ‘co-piloted’ by AI, especially when data is ambiguous or patient preferences require nuanced decisions.
The Therapeutic Relationship
In an increasingly tech-driven world, empathy, trust, communication, and navigating uncertainty become more valuable. Patients will pay for a trusted partner who interprets the complex technological landscape with them. Not just for physical health, but also for mental health. As
Orchestration of Complex Care
Managing multi-faceted, long-term health strategies involving various specialists and therapies requires a skilled human orchestrator – the physician as a central strategist.
Access to and Guidance Through Cutting-Edge Innovations
Navigating novel diagnostics, therapeutics (many developed using AI), and clinical trials requires expert guidance only a knowledgeable physician can provide. A we are seeing novel therapies reversing aging organs, evolution of peptides and genetic modeling in-silico accelerating options, steering these will require expertise. LLMs and AI will certainly assist, but bringing those insights together in new frontiers will need original human ingenuity.
Treatment will evolve from just high touch human care to personalized cutting edge ‘just-in-time’ medications designed and synthesized for each patient guided by their biomarkers and genetics.
The Physician of the Future: Integrator, Strategist, Ethicist, Coach
For physicians, the future isn't about competing with technology on commoditized tasks; it's about leveraging these tools to enhance uniquely human skills. The focus must shift from being the sole repository of knowledge to becoming:
Expert Integrators: Weaving together AI insights, diverse data streams, and patient context.
Strategic Thinkers: Developing long-term, personalized health plans.
Ethical Guides: Navigating complexities AI cannot resolve.
Empathetic Communicators & Coaches: Building trust and facilitating action. Understand how to connect and communicate with patients, peers and people around.
Summing It Up
The existing cost structures in premium medicine, largely based on human-intensive data analysis and basic interpretation, are indeed being fundamentally challenged by a wide array of technological advancements. While costs associated with data acquisition, routine testing, basic analysis, and monitoring are likely to fall significantly, the value – and therefore, cost – will migrate upwards. It will concentrate in the realms of hyper-personalized interventions, the high-touch human guidance needed to translate insights into action, the complex ethical navigation required, and the irreplaceable therapeutic relationship.
Such a shift promises a future of medicine that is potentially more proactive, personalized, and ultimately, more valuable in delivering true healthspan and well-being. Adapting our models, skills, and expectations to align with this new, technology-infused reality is the critical task ahead. Pick up Crime and Punishment or Brothers, then dive in with some Chekhov. Enjoy!
Dr. Omar Saleem is a double board-certified physician dedicated to enhancing healthspan and longevity, especially within the South Asian community. He runs Cellspan Health, a practice specializing in healthspan and longevity protocols, and is the developer of the renowned Cellspan Protocol. For more information, visit www.cellspan.health.
