Here’s what keeps longevity doctors up at night: A lack of standards pitting serious clinicians up against snake oil salesmen — a problem DOC’s Dr. Jordan Shlain satirized in a parody video for a dubious longevity treatment called Longevex. That concern, how to balance undeniable progress in cutting-edge research while still protecting patients, led to a provocative conversation about aging and longevity among Dr. Shlain, Dr. Nicole Sirotin, and Dr. Eric Verdin during DOC 2025’s first session, “Longevity: Signal, Noise and Snake Oil,” led by DOC co-founder John Battelle.
As Dr. Shlain, Founder and Chair of Private Medical, put it, “Everyone’s trying to sell you longevity.” That’s why, he insists, we all need to develop what he calls a good “B.S. meter” — and keep it finely tuned.
The Real Cost of Unregulated Practice
Here’s what the unregulated Wild West of science looks like on the ground: Dr. Sirotin, CEO of the Institute for Healthier Living, Abu Dhabi, had a thorough checkup at a longevity clinic, where a nurse took her EKG four times. The doctor — visibly concerned — recommended she go to the emergency room immediately. She calmly explained she had a normal variant on her EKG and asked what kind of training he had. The answer? Urology.
As she later reflected: “I walked out of that visit and I just thought, we have a problem. We have people who are not qualified to do the things that they’re doing.”
Yet the panelists noted this isn’t a theoretical danger; this practice is happening right now, in real clinics, to real people who want to live longer, healthier lives. Their call? Standards ensuring every intervention we put into a human body clears a high bar, knowing treatments are safe — and work.
The Impossible Choice Facing Responsible Practitioners
Major pharmaceutical companies are now investigating drugs like GLP-1 agonists (you know them as Ozempic and similar medications) and rapamycin — drugs already approved for other uses — because they show remarkable protective effects against multiple age-related diseases simultaneously.
Traditional medicine says: Wait for the 20-year studies, the massive clinical trials, the FDA approval for a longevity indication. That’s the textbook answer. But patients walk into clinics informed, educated, and determined. They’ve read the research. They know these drugs exist. They want access now.
As Dr. Verdin, President and CEO of The Buck Institute for Research on Aging, noted, “Many of these patients go first to the serious clinics. If they’re turned down, they’re going to go to the less [regulated clinics]… where you can buy rapamycin online or GLP-1.”
This is the paradox panelists say keeps them up at night: How do we balance appropriate caution with the reality that doing nothing may actually cause more harm?
Building a System That Actually Works
All three noted that today’s healthcare system is built on a foundation that rewards providers when patients are sick — not when they remain healthy. As Dr. Verdin pointed out, in medicine we have “…an economic system that works very well if you are in it. It works for the hospitals, it works for the doctors. It doesn’t really work so well for the patients.”
Longevity medicine represents that fundamental shift. Instead of waiting for people to get sick and then treating them, keep them healthy in the first place. But that requires formal standards for what longevity clinics can and cannot do, accredited training programs that separate evidence-based practice from wishful thinking, and transparent governance so patients know who’s actually qualified.
So, where does this leave longevity clinicians and scientists today? All three noted, we’re standing at a crossroads. The question isn’t whether this field will grow, but how we’ll build the systems to do it right.
We invite you to watch the entire session, or read through the transcript to catch every word of this engaging exchange below.
TRANSCRIPT:
Dr. Jordan Shlain
We’re going to give a brief presentation. I’m represent the Snake Oil side. Eric represents the research side. Nicole represents the highly pragmatic clinical side. Let me get started here. This is if you ever emailed me, this is my signature on my email. Take a quick look at it.
This is a written over 2000 years ago, and I’m constantly reminded that we should do these things as part of our life. But one of the things in here about alcohol, is always a question. Drink. Don’t drink. According to this guy, don’t drink. You know what? I agree with them. You should never drink But you should drink with friends. That’s social nutrition. I put this up last year, and I’ll go over it real briefly again. The things that we care about in clinical medicine, as a doctor at Private Medical, when I’m out seeing patients, is it safe and is it effective?
When anybody shows you, a supplement, a peptide or whatever it is, the question is, is it safe? Isn’t it effective? And can you prove it? Can you show me the evidence? If it’s safe and effective, it’s probably FDA approved. If it’s, safe and not effective. There’s a lot of things that fall into that category.
Great. Do them. You’re just losing some money. But if it’s effective or not safe, like taking high doses of, you know, a lot of things, you can feel great. But it really wears down your body. And I’m going to tell you some stories about that. Obviously, being safe, not effective. You’re an idiot. So this is a case study of a friend of mine, who called me up, in great health, three kids, nothing going on with them.” He called me. He said, “I’ve got a problem I need you to help me with.” I said, “What’s the problem?” He said, “Right, I have a brain tumor.” I was like, “Oh my God, that’s awful.” I said, “Well, let me dig into, what’s going on with you?”
So he said, “I went to see this longevity doctor, and she put me on some supplements.” Were you taking anything before? No. This is what he was taking. Okay. So if you look at the top from the top, like third of it or more, half is all the supplements in the morning. And then in the middle of is the before the workout supplements and then the evening supplements and then the bedtime supplements.
I’m going to point to two of these in particular. He had a brain tumor. It was a meningioma not a glioblastoma, which can kill you. This is his brain tumor, where that arrow is. As I was researching his brain tumor, I come up with some research that showed that, certain hormones can make gliomas grow bigger, blow like a balloon.
I put up in the upper left the hormones that this person had put him on. We immediately stopped all of his supplements. The tumor stopped growing. He is stable and fine. Years later, it was a benign tumor that blew up like a balloon and started compressing his optic nerve. So, things that seem fine, even though that list is not defined, come with consequences.
This is a member of the practice who said, I want to do some L-carnitine. For those of doctors in the room, you probably heard of this company. And, he said, My wellness longevity fitness guy said, I need to be injecting this. Will you buy this for me? And I said, well, why would you want to inject something in your body if you didn’t know really what it did?
The same safety and efficacy questions. So I asked him another question which like stimulated him to think a little harder. I said, how do you know what’s in there? And he said, well, it says so right there. I mean, it must be in there. It says so. And it’s a reputable company. He did the homework on it.
And I said, well, you know what? There’s a guy that I know called David Light from a company called Valisure in New York that does this testing on all sorts of medications and that come into the United States to make sure they’re pure. But he does it for huge pharmaceutical companies. And I called him I said, hey, can you run a sample for me on this vial?
And he goes, Jordan, I, we don’t really do small one off things like this. He said, but for you I’ll do it. So we sent it into his lab and, as he did as a favor, cost some money. But we paid for it, and I got an email from him saying, Jordan, you got to call me. So I’m going to show you what was in this vial here. Do you want to see what’s in this vial? Okay. So this is what’s in the vial. So at the top you can see that there is L-carnitine in there, but underneath there there’s five, two amino purple two three, one hydrogen ending, which is an MDMA derivative. It is a psychoactive substance. You will feel promotes, promotes weight loss and improves overall well-being. But there’s also of course, you’re going to feel good and go on Instagram and tell me how great you’re feeling. But there’s also an herbicide in there, an herbicide, things that kill weeds. Then there’s also a fatty acid capsaicin product, which is a contaminant.
There is another MDMA-derivative psychoactive substance, and there’s another random Tetro metal. This is a dirty vial and people are putting stuff in their bodies all the time. Why would you do that? Then I’m sure a lot of you read about this. There was a big peptide conference in Las Vegas last month or two months ago.
Two people went to the hospital. I don’t know really how they’re doing, but it’s dangerous. All this stuff is dangerous. We have all these things that are being promoted on Instagram and all over the place, but it’s really important that we ask these critical questions. My job is to have a good B.S. meter, all the time.
If you if you walk away from one thing here, everyone should have a great BS meter because everyone’s trying to sell you, longevity and there are real things. What is longevity? My definition of longevity is to maintain your optimal mental, physical health for as long as possible with the fewest interactions with the health care system. Because people get sick in hospitals, and in the health care system is not the more money, the sicker you get, the more money they make. That’s just the sad truth of the system. The question is I will leave you with is what is your health and longevity strategy? Not your tactics, but your overarching strategy.
Who are your trusted advisors? In the same way you have advisors for everything else. Who do you really trust to, like, be in your corner for these things and why do you make the decisions that you do? I think it’s a really important question to ask yourself when you decide to do something. Because ultimately we all want to live like the bottom line here and not the top line, which is, you know, health span that we’re going to talk about a lot.
William Osler said, “Medicine is the science of uncertainty and the art of probability.” So that’s just how it goes. Remember that what you spend time doing now, you might not be able to ever get back. On that note, I’m going to hand it over to thank you.
John Battelle
Thank you Jordan. Nicole, come on up. Thank you, thank you.
Dr. Nicole Sirotin
Good morning everyone. I loved the commercial, and it really was, a spontaneous idea from Jordan that I wholeheartedly encouraged. It came out fabulously. I am going to start us off with a story that I think helped me really crystallize what our problem is right now. This is a true story. Like many of you, I’m sure, are extremely curious about what people are doing in these clinics, not just what their say they’re doing, but what’s actually happening.
So I went, I’m often mystery shopping, but I do it. Full disclosure I’m a physician. I work at Cleveland Clinic Abu Dhabi. I am also leading a healthier living, health care company. I feel like that’s the only fair thing to do in these, in these interactions. I went in and I had a full checkup through this clinic, and it was I thought, well done.
The physician spent a lot of time with me, asked me a lot of questions. We went through a series of tests. One of those tests was an electrocardiogram, and the nurse took my test. Four times. She printed out four EKGs, and I said, Okay, we’re going to have a conversation now. The doctor comes in and he says, very seriously, I think you need to go to the emergency room.
I’m sitting there perfectly healthy and also, not having any chest pain, no symptoms. And I just politely said, I understand I have a normal variant on my ACG. Would you feel comfortable if I just talked to my cardiology friend and he gave you the reassurance? We did that. He was reassured. We went on with our visit, and then I realized I didn’t know what kind of doctor he was.
At the end of the visit, I asked him, What kind of training do you have? He told me he was a urologist. Now I love urologists. I have many urology friends, but I think they would all agree they’re not the first one to read an ECG. They have a role in this kind of medicine. How do you keep us healthy? There’s a clear role for urologists, but it’s not reading my ECG. So I walked out of that visit and I thought, we have a problem. We have people who are not qualified to do the things that they’re doing.
In addition, we have the testing and the supplements and, and many things that are just not proven. So why would we lower our standards? Why would we have a different approach to keeping you healthy as we do to when we take care of you being sick? I very clearly had this thought that we need to make a different approach.
What we did in the Institute and what we’re really encouraging at this conference is for us to think about how do we make sure that we have what is necessary in order to practice this kind of medicine. We don’t yet have a name for what we’re doing. We’re keeping people healthy. We’re expanding health span.
There is a movement to call this, precision medicine. We’ve had many conversations around how do we get people to understand what that is. And the concepts here are let’s put standards in place and let’s think about how is it that we can really think about what happens inside the health care, inside the health care system, what happens outside.
We know that this is really what our health system is, at the moment. We have this tap that is flowing and it’s overwhelming. We’re mopping up the floor, and we really don’t have anyone who’s turning off that tap. Part of our goal here is to think about how do we turn off that tap and how do we empower people with information that’s actually accurate, that they can use.
What we have been discussing is, number one, everyone does not do everything. We have to have standards. We’ve written the first standards with the Department of Health Abu Dhabi and the Healthy Longevity Medicine Society to try to take a stab at this. We now have standards published by a government that say, this is longevity medicine, this isn’t longevity medicine.
We used healthy longevity medicine as the name of it at that time, which again, is still part of the debate. But what we would love to think about and talk about together is, what is it? What are we talking about? How do we make sure that that is at the level of the standards that you would expect when you or your loved one goes to see a rheumatologist or a cardiologist or a general surgeon.
I think our message here is why would we lower our standards when everyone’s lives depend on them? We actually are trying to help people stay healthy. We should be thinking about, all the levels of science and knowledge that we need in order to do that. So I’m going to leave you with this, and will pass over to Eric.
Battelle
Thank you. Nicole.
Dr. Eric Verdin
Morning, everyone. Just to be sure that the commercial has nothing to do with the Buck Institute. It’s called the Atkins. It’s the Yuck Institute. Anyway, delighted to be here and see you all. I just wanted to give you the perspective from the basic science, in some way trying to answer the question, why are we here today talking about longevity in medicine?
And the reason is that about 25 years ago, actually 30 years ago, a whole series of labs, three major labs, Tom Johnson, Gary Rifkin, Leonard Guarente identified mutations that could control the aging process. Those were, at the time, completely unexpected. The idea that you can make a single point mutation in an animal model and in some cases, double its lifespan, just went against everything that people had postulated aging was made of.
But it also highlighted the possibility that if you can modify a single gene and increase lifespan, that you could actually identify a drug in the future that would do the same thing. That really is why we are here today, 30 years later. That also speaks about the speed at which, basic discoveries get to be translated into the clinic.
What was thought initially to be an anomaly or an aberration, distrusted by many people actually in the field has really been validated. They are now, in some animal species, more than 700 genes that you can target that will result in an increase in lifespan. And obviously, the this brings the question, what does this mean for humanity, for us, for our own lifespan?
Are these applications going to be, translatable to the clinic? In some way, this meeting is a representation of that conflict, that, tension between the pace of discovery, what we can do in the laboratory setting and its relevance to the clinic. It’s actually getting pretty extraordinary. I know many of you who know me know that I’ve positioned the Buck Institute as a sort of the voice of reason, as an organization that really stands by the principles that have led us to where we are today, which is an evidence based, reproducible, safe, and so on. But it’s hard when working in this field not to become truly excited. I’m going to play a little bit of the advocate of what’s to come and why this debate is actually incredibly important.
If I can have my first slide, several of us here in this audience attended a meeting, which is the merge is one of the biggest meeting in the longevity space that integrates the clinic, the laboratories, the pharma and so on. And this is called ARDD. It takes place in Copenhagen. And for the first time, there was a heavy big pharma presence.
Typically big pharma stayed away from the field for a number of reasons. They view it as sort of hyperbol. But this year, pretty much every big pharma was there and as you can see from the title, two of them embraced GLP-1 agonist, Ozempic. Many of these drugs that we hear nonstop, they embraced them as longevity drugs.
I think this was truly extraordinary to watch. The two who gave the very visible talks were from Novo Nordisk. She’s one of the key architects of that whole program, Semaglutide as a proven longevity medicine.
Dr. Andrew Adams, who’s the CSO at Eli Lilly, asked the question, are GLP-1s the first longevity, drugs. And I think if you look at the data, there is a lot of evidence that points to the fact that these drugs are globally protective. They have not been globally protective against kidney aging, heart aging, Alzheimer’s. There are now clinical trials looking at the prevention of Alzheimer’s disease by these drugs.
Obviously, this is not all proven, but we also live in a world where these drugs are available, approved. What are you supposed to do as a longevity physician? If someone comes to see you and says, I have a heavy family history, the risks are minimal. Should I take the drug according to the most rigorous standards, you would say, no, you should not go on this drugs.
But frankly, many people are not waiting for our advice. They’re finding doctors who will prescribe these drugs. And I think we’re going to be living at that, interface where the informed patients and the educated patients are coming and they’re demanding these drugs. Rapamycin is another really good example approved drug that you can go on today. How are we supposed to be positioned?
Frankly, the fear from my standpoint is that many of these patients go first to the serious clinics. If they’re turned down, they’re going to go where you can buy actually rapamycin online or GLP-1. So we see a proliferation of all these companies.
My recommendation would be that the longevity is serious. Longevity clinics should adopt a sort of a a different stance from the traditional medicine, which is to only approve it things that have been proven and to be open to a company, to patients. There are self-experimentations if this was not enough.
I just want to give you a hint of what’s to come.There’s a program run by the NIH called ITP Intervention Testing Program, where any scientist can nominate a drug to be tested in a cohort of mice for lifespan extension. This tested close to 70 different drugs, 11 of them increased lifespan. I’ve highlighted here in red all of the ones that are actually approved drugs that are available today. I can tell you that a lot of people are not waiting their funding their doctors to prescribe these drugs and experiment again, the same tension. If this was not bad enough or not exciting enough, three days ago, a paper came out in Cell that documented for the first time its five year rejuvenation of all the macaques using, stem cell, preparation.
They published in the top journal showing five year of rejuvenation, and using human cells transplanted. It’s heart to see these types of results without being incredibly excited. I can guarantee you some of the clinicians are going to have people knocking on your door within the next two weeks with that paper and saying, what do I do about this? I just wanted to throw in the excitement from the basic science, but also all the important questions that this brings to us as a field. Thank you.
Battelle
Thank you Eric. I think that what I’m taking from the three perspectives that you have, you all share a common sense of principle and integrity. You’re a bit more cautious. You’re clinical and you want to see this move forward. You see really exciting research. And you don’t want you don’t want to lose the optimism that has driven this in this enterprise of better health. But I think the question then becomes you use the term Eric, it’s bad and exciting, which is a little bit of an oxymoron. But I understand it. And that is informing the problem that you’ve all identified. People will get what they want, whether or not they go through traditional medicine. So I think the first question really is, given this somewhat Wild West environment that that we’re in right now, how do we define what is a longevity doctor?
Shlain
I’d turn it over to Nicole. The goal of primary care is prevention, and managing issues as they are to prevent you from falling into a ditch in the future. Just doing that is a kind of a definition of longevity. Then there’s the extension and the reversing and the rejuvenation, which I think is another part. In my field, what I just heard just now from Eric, was how will I incorporate that? I don’t know, but I think it’s an interesting question. There are people going to see ophthalmologists who are longevity doctors. Doctors are becoming longevity doctors. So I do think going back to Nicole’s point, it is important that when you want something, you understand the substrate of who’s giving it to you, and are they just trying to make money? What’s the motivation and B, to my other slides is what’s in it? We’re going to hear from some stem cell researchers later. But if you’re going to do stem cells, how do you know what’s in it?
Sirotin
Absolutely. We have to approach this like we have in other parts of medicine, in my opinion. This means we need standards for what the clinic does and doesn’t do. What does the doctor need to have as a training, which, by the way, we don’t yet have a certification set up. So there are now, groups that are calling themselves board certification. You can get board certified in longevity medicine, but what does that mean?
There was a conference that one of these groups was running, and I was sitting with Nir Barzilai, and we were chatting about the field. I raised my hand and asked one simple question. If you have a board certification, normally that’s issued by a board and it’s accredited by a third party. I asked very simply, who is accrediting this board certification? And the answer was, Well, we are okay. Of course, Nir also had his hand up. Then they didn’t call on him because he was having to be sitting next to me.
Battelle
That’s not the spirit of spicy debate that we wish for.
Sirotin
Yeah. We have a process where we understand now, can a urologist or a plastic surgeon train themselves on another part of medicine? Absolutely. But there should be a process that you go through to say that this is now where your expertise lies. Until we get there, we have to be extremely careful consumers of this kind of medicine. The conflict of interest piece that Jordan raised is absolutely at the heart of this. Is this person selling you something, and do they have a financial interest in you saying, yes, I want to take that treatment. You have to be able to separate those things out. We have to be very smart consumers and get to how do I know that this person’s incentive is to keep me healthy?
Then I think we need to have the standards. We’re working on developing educational materials for people that have been validated and verified. But that takes that takes time.
Battelle
I’m curious. Eric, what would you see as the next steps that could be taken to get towards that structure? Or as many in the world I come from of tech might say those structures are old and stupid and can’t deal with the reality of what’s coming, so we need new structures.
Verdin
I completely agree, and I used to when I started this, I argued that we had to reform medicine based on some new principles, that the idea that health is a continuum. The aging process starts at 30, that there are lifestyle interventions that can be done. Just to be sure, there are other doctors who already have applied lifestyle medicine is a specialization for lifestyle medicine. But I think longevity medicine goes one step further and I also think that, we’re at this critical juncture where we have to establish a formal recognition of what it is. I think this is what the field should be working on.
There are other forms of medicine that have focused on primary care, functional medicine, integrative medicine. All of them have acquired an aura of trying unproven interventions. But they had one very important aspect, which is they looked at the individual as an integrated biological person. They really accompanied people throughout their, their whole life. I think longevity medicine has to be anchored in science, and it has to be anchored in proven therapies.
We’ve argued that, when you talk to people who are running longevity clinics, many of them express the frustration that the hardest problem is to recruit physicians who are actually properly trained.I’ll give you really one example that actually applied to me. I’m in my late 60s. At age 60, my blood sugar was 98. I showed this to my physician and he told me that you’re in the normal range. I say I’m in the normal range, but when I hit 100, I’m pre-diabetic. That doesn’t sound really good. And we know blood sugar keeps increasing, during lifespan.
That whole approach of a normal range. The same for your blood pressure. If your blood pressure is 130 or 125 with, over 90, your doctor is going to say you are in the normal range. Longevity medicine looks at this in a completely different way. This is normal, but it’s not optimal. And so this idea that our whole biological process, our health is a process that can be optimized throughout life for me is one of the foundation of longevity medicine.
Just to continue my story, not accepting this blood sugar of 98, I started Metformin and I tried a whole series of interventions, again, an unproven drug, but but lo and behold, my blood sugar now is 84, and I feel a lot better knowing that I’m walking around with a blood sugar of 84 than 98. That for me really sort of epitomizes some of the challenges that traditional medicine deals with, and that where longevity could bring a whole new dimension.
The whole idea is also the whole prevention studies, whole body MRI and liquid biopsies. There’s a whole series of interventions, technologies that are coming online that will change the way we do medicine to make it much more proactive.
To finish what I the way I started, I said we had to reform medicine. I don’t think we can reform medicine. I’ve become convinced by talking to a lot of colleagues and physicians that medicine, I would call it a self-fulfilling prophecy. This is an economic system that works very well if you are in it. It works for the hospitals, it works for the doctors. It doesn’t really work so well for the patients. The question is we need to invent a new form of medicine, and that medicine hopefully will put traditional medicine a little bit out of business by preventing a lot of the diseases on which medicine is relying today.
This whole idea of replacing sicker from true health care, accompanying people throughout their lives to make them healthier and at the end, happier.
Shlain
I’ll just jump in, on the business model question, which I think is interesting, Private medical where we work. 25 years ago when I started this, it was because I was being asked by the HMO to see a patient from every ten minutes and every seven minutes. I just felt like my soul was being sucked out. And I said, if I leave this insurance model and, you know, charge the actual person money, then my incentive now is to keep you healthy. I don’t make money, the sicker you get. The more visits I have, the more money I make. That’s the old model.
I do think that’s why the concierge medicine whole realm has exploded. Because it’s a market failure. The hospitals make more money with specialists than they do with primary care doctors. So they just make us do more for less. We just get crushed and we say, okay, we’re leaving. So, 10,000, primary care doctors, every quarter are leaving, the insurance model or they’re or they’re joining pharma or they’re retiring. I do think if there’s a model that exists where if I do an intervention, it’s bad for you, I lose. I don’t know how to structure that.
Battelle
Nicole, I’m going to let you have the last word because unfortunately, we’re running late, and I promised I’d keep everyone on time.
Sirotin
This idea of the incentives having to be aligned is really at the crux of how this is actually going to roll out across the world. Someone has to pay to keep you healthy. If the insurance companies are only going to pay when they keep you sick, then we have a problem. It’s going to have to come out of your own pocket. Then we get into the consumer realm. One of the things we’re doing in Abu Dhabi, which I think is one of the first governments to really commit to this, is actually doing a randomized clinical trial within the public health system comparing our model of care, which is almost 100% lifestyle medicine at this point, because we don’t have these drugs out there, but that you can compare that to standard of care to show clinical and cost effectiveness, and it’s being paid for by the National Health Insurance. At the end of the day, if we walk out with a blueprint that says this model of care keeps people healthy and saves you money as a system, then we have at least put the foundation in place for the structure for it to be paid for, and then we have to work on the education to make sure that whatever the new therapies are coming out, how people are dealing with the new technologies, we can have them studied.
One of the way to do this is actually self-funded studies. One of the things we’re doing is setting up a structure where a patient can come in and say, I want to try this stem cell therapy. They can self-fund it just because they’d have to go funded themselves in the consumer world, but that they can do it under a research arm. It’s in a trusted environment where you can come in and pay your 25 grand, no problem, but you do it in a monitored setting. Those are also sprouting up all over in different clinics. If we get the incentives aligned and if we can really think about the experimentation that people are wanting and wanting to do under a monitored setting, then I think we’ll get there faster.
Battelle
As much as I want to have Q&A, this session is meant to be a provocation to get everyone thinking about the bigger framing issues that are going to inform everything we’re going to talk about all day today and throughout the most of tomorrow. So please join me in thanking the provokers.