Weekly I/O: What living longer truly means, Longevity strategy beyond randomized control trial, Eulogy virtues not resume virtues
#77: Healthspan not Lifespan, RCT and Evidence-informed Medicine, Eulogy and Resume Virtues, Money is Gasoline, Reward of Good Work
Hi friends,
Greetings from San Francisco!
This week I’m mainly reading the book Outlive by Peter Attia about the complex subject of longevity. It takes some time to digest, and I probably will write more on that in the later weekly or as an article.
Anyway, I hope you enjoy this week’s I/O!
Input
Here's a list of what I'm exploring and pondering on this week.
1. Prioritize enhancing healthspan, not just extending lifespan. Focus on preventive measures for physical, cognitive, and emotional health because it is better to get cancer later in life than to live longer with cancer.
Book: Outlive
People say they want to live longer. But what does the goal of living longer truly mean?
Longevity comprises two components: lifespan, how long you live, and healthspan, the time spent free from illness and disability. While lifespan is binary, whether you are dead or alive, healthspan considers the quality of physical, cognitive, and emotional health.
Interestingly, focusing on healthspan also extends lifespan. Statistical data shows that for those over 40 who don't smoke, about 80 percent of the causes of death will be cancer, cardiovascular, neurodegenerative, or metabolic diseases. We can live longer with or without a chronic disease. The data unambiguously shows that you will live longer if you can extend the time without a chronic disease rather than with a chronic disease.
In other words, it's better to get cancer later in life than to live longer with cancer. Therefore, though there's less evidence-based strategy, we should focus on preventing chronic diseases.
Moreover, emotional health is a crucial yet often overlooked aspect of health. As psychotherapist Esther Perel puts it, "Why would you want to live longer if you're so unhappy?" An infinite lifespan is worthless if lived miserably.
2. Because randomized controlled trials have limitations in studying longevity, we should shift from evidence-based to evidence-informed medicine and adopt probabilistic strategies to live longer.
Book: Outlive
Randomized controlled trial(RCT) is a scientific method commonly used to determine cause and effect in simple, short-term studies. These trials form the basis of evidence-based medicine and advanced treatments like vaccines and cholesterol-lowering drugs, where studies involve relatively simple interventions and can be observed within a shorter period.
However, RCTs are of limited use in longevity research. Short-term studies can't reveal the full picture of diseases that take decades to unfold. Worse, beyond pharmacology, interventions involving exercise, nutrition, and sleep are very complex.
For example, an RCT can never map out a heart disease prevention plan using exercise for a healthy 40-year-old. It's simply unfeasible to monitor 10,000 people over their entire lifetimes with varying lifestyle interventions. Studying longevity itself in this way is almost impossible.
Therefore, a more practical option is to synthesize various existing data sources to form a strategy triangulating between them. Though these data sources aren't strong enough to be definitive when viewed separately, they can point us in a promising direction when taken together. The five data sources mentioned in the book are:
Studies of centenarians, people who have lived to the age of one hundred and beyond
Lifespan data from animals such as laboratory mice
Human studies of the major diseases
Molecular study of aging in both humans and animal
Without long-term RCTs to answer our questions with certainty, we must navigate health based on probabilities and risks. We shift from exclusively evidence-based to evidence-informed, risk-adjusted medicine.
Due to the uncertain nature, evidence-informed medicine is like charting an investment strategy. Based on what we know and our individual tolerance for risk at a given time, we adopt tactics to earn a better-than-average return of longevity. In other words, we utilize information to pursue a higher expected value of healthspan (aka longevity alpha).
3. Eulogy virtues and résumé virtues: Should you care more about what people will say at your funeral or what is listed on your resume?
Book: The Road to Character
From David Brooks on the distinction between résumé virtues and the eulogy virtues:
"The résumé virtues are the ones you list on your résumé, the skills that you bring to the job market and that contribute to external success."
"The eulogy virtues are deeper. They’re the virtues that get talked about at your funeral, the ones that exist at the core of your being — whether you are kind, brave, honest or faithful; what kind of relationships you formed."
"Most of us would say that the eulogy virtues are more important than the résumé virtues, but I confess that for long stretches of my life I’ve spent more time thinking about the latter than the former. Our education system is certainly oriented around the résumé virtues more than the eulogy ones. Public conversation is, too — the self-help tips in magazines, the nonfiction bestsellers. Most of us have clearer strategies for how to achieve career success than we do for how to develop a profound character."
4. The reward for good work is more work. Therefore, find the work you will enjoy spending more time doing rather than focusing on reducing the time spent on your work.
Book: Excellent Advice for Living: Wisdom I Wish I'd Known Earlier
Many productivity-focused people always try to minimize the time spent on every task. They research and adopt various methods and tools to be more efficient.
However, the real goal should be to find work that we want to spend as much time as possible working on. Because the reward for good work is usually more work, we must find things we enjoy, even if the result of doing well on it means we need to spend more time doing it.
Remember, productivity is often a distraction. Don't aim for better ways to finish your tasks as quickly as possible. Instead, aim for better tasks that you never want to stop doing.
This also reminds me that meaningful things are usually inefficient.
5. "Money is like gasoline during a road trip. You don’t want to run out of gas on your trip, but you’re not doing a tour of gas stations." - Tim O'Reilly
Quote
Money serves as a means, not the end goal. We need gasoline to drive around, not to tour the gas stations to see how much extra gas we can get.
This quote echoes two anecdotes from Kevin Kelly in this podcast:
On Crypto, Kevin used to say to people,
"I'm willing to have a conversation about Crypto, but here's one caveat: you can't mention the word money. You can't talk about making money, saving money, whatever it is. Let's talk about Crypto without talking about money."
Those conversations usually become very short. Kevin found it boring because it was only a single dimension about money, which is not the case with the Internet and AI where we don't have to only talk about money.
Though I found some concepts behind Crypto fascinating, such as incentive design of Cryptoeconomics, Zero-knowledge proof, and encryption, conversations about Crypto often bore me for the same reason as Kelly mentioned.
On wealth, Kevin has some advice:
"You should try as hard as possible to never have $1 billion."
For many billionaires he knows, many 0s are an incredible burden that distorts their kids and families. The weight of it becomes something they always have to attend to. The responsibility of managing such wealth overshadows its utility, turning it into an overwhelming task.
He argues that, for most aspirations, a fraction of that wealth is enough. You don't need to join Wall Street for a few years to do a motorcycle trip across China because six months working at McDonald's should save you enough money. In most cases, money is not the gating factor for what most people want to do.
Photo of the Week
That's it. Thanks for reading. Please share which input you found the most helpful or intriguing. Just reply to this email with a number—it's quick and easy!
And as always, feel free to send me any interesting ideas you came across recently!
Looking forward to learning from you.
Cheers,
Cheng-Wei