Longevity Escape Velocity (LEV) Medicine: A New
Medical Specialty for Longevity?
Oliver Zolman BSc, MBBS(c)
1CEO & Founder 20one Clinic Limited, 2King’s College London School of Medicine
What is “LEV”?
A mainstay of preventive medicine innovators and
medical futurists has been the concept of longevity
escape velocity (LEV). LEV represents the time at which
someone is gaining greater than 1 year of predicted
healthy life expectancy per year, essentially making his
or her healthy life expectancy unlimited.
Although futuristic, over the past decade, leading
innovators in the field have predicted persons reaching
LEV soon. Human Longevity, Inc., headed by Craig
Venter, Peter Diamandis, and Robert Hariri, frequently
claim their goal is to make ‘‘100 the new 60’’ by 2025,
and that LEV “will be reached” by the wealthiest of
society by 2030; the Methuselah Foundation ‘‘want to
create a world where 90-year olds can be as healthy as
50-year olds by 2030’’; whereas Ray Kurzweil predicts
that (1) LEV ‘‘will be reached’’ by 2029, (2), baby
boomers will still be alive and healthy in 2100, and (3),
that in 2017 he personally has already reached LEV.
LEV Med. Target Outcomes
Implementation of this new paradigm of medical care
by clinicians, stakeholders, patients and commissioners
should be focused on achieving the following societally
important goals:
1. Generation of high-quality, low-risk-of-bias peer-
reviewed scientific evidence showing the
comparative outcomes of people receiving LEV
Medicine Clinical Guideline based services, versus
their existing providers, in terms of clinical
outcomes, high-level surrogate markers of clinical
outcomes, best-in-class risk-calculators, satisfaction
and cost-effectiveness metrics (e.g. £/QALY)
2. Increase in the number of low-risk-of-bias safety
and efficacy data points for key investigations,
therapies and combinations of; with each data point
acquired additionally weighted by the coefficient
multiplier of “months of early access data point was
acquired relative to the baseline of the expected
time for such data point to be acquired by the
individual without such LEV Medicine services. This
incentivises safe and impactful innovation
additionality. These data points apply to promising
LEV technologies in the following categories :
1. Therapies or investigations that already hold
marketing authorisation (i.e. off label
therapies, e.g. rapamycin)
2. Therapies or investigations that are not or only
loosely regulated (e.g. calorie restriction
optimal nutrition, class 1 devices)
3. Therapies or investigations that are post-Phase
1 clinical trials (safety established)
3. Change the mindset of medical care, as based on
number of certified LEV Medicine practitioners and
results of questionnaires & feedback from diverse
healthcare stakeholders, of which assess:
1. Any changes in mindset about LEV and its
related aspects, such as preventive medicine
2. Extent of improvement in implementation of
evidence based medicine practices, e.g. LEV
Medicine Guidelines, versus current sub-
optimally evidence based medicine practices
done for “LEV related purposes”.
Contact
Oliver Zolman
CEO | 20one Clinic Limited
oliver@20one.clinic
www.20one.clinic
Asfand Khan, BA, CA(c), CFO
(Lond)1,2
5 Problems LEV Medicine:
Here I present a novel paradigm of medical care: “LEV The medical specialty focused on
Medicine”, of which can address 5 key problems that
are barriers towards transitioning society to one that
measuring, achieving and
can provide evidence its healthcare consumers are maintaining a person’s longevity
achieving and maintaining LEV:
escape velocity (LEV) through using
1. No current medical specialty can effectively deliver diverse measurements and
a maximal reduction in all-cause-mortality. Solution:
Creation of an LEV Medical Specialty and training of therapies to maximally reduce all-
healthcare professionals focused on maximally cause-mortality, all-cause
reducing all-cause-mortality.
morbidity, negative clinical
2. No good measurement of one’s own “LEV” exists.
Solution: Unprecedented measurements of
outcomes and aging pathology and
individuals’ LEV based on thousands of criteria. processes.
3. The current global pool of clinical guidelines: 1) Do
not take into account added financial spending
power to improve outcomes from self-funding
Integrating with RejuvMed
persons; 2) Do not focus on maximally reducing all- How can LEV medicine integrate with pre-marketing
cause-mortality; 3) Are not systematic, missing out authorisation/off-label rejuvenation medicine
or not commenting on many topic areas; 4) Do not (RejuvMed) therapies and investigations? As part of a
LEV Med Guidelines
cover many LEV Medicine related clinical areas at strategy to maximally reduce all-cause-mortality, for
all; 5) Do not use the optimal evidence & critical many people it is likely optimal to implement select
therapies or investigations prior to them having global
appraisal requirements for reaching LEV for
marketing authorisation and commissionability – a
inclusion in the guideline; 6) Often are not adapted
process which takes many decades. LEV Medicine
for personalised and experimental medicine; 7) Are
specialists can integrate cutting edge therapies and
not formatted optimally for efficient use by
clinicians (even veteran doctors frequently miss investigations into clinical practice years or decades
before one would normally have access, via calculating
recommendations of guidelines); 8) Are not
person specific clinical effective value thresholds (EVTs)
designed for patients to understand: medicine in
(i.e. statistically assessing the probability and
many cases is still a black box. Solution: Creation of
magnitude of benefits and risks (including financial, and
hundreds of open-access, extensively peer-
time) of undertaking any given clinical action).
reviewed LEV Medicine clinical guidelines focused
Personalised EVTs can be used to guide when to initiate
on addressing these sub-problems.
cutting edge therapies and investigations and, based on
the individual person and intervention, this may mean
4. A major gap in most healthcare globally is the lack
of appreciation of preventive & reactive emergency it is rationale to undertake such an intervention at any
stage from pre-clinical to post-Phase 0, 1, 2, 3 or 4, to
medicine for maximising positive clinical outcomes.
post-establishment of Level 1 – 5 Grade Evidence from
Solution: Create preventive and reactive emergency
the Oxford Levels of Evidence.
medicine i.e. “emergency resilience” guidelines
addressing aforementioned guideline problems as
To provide such a service safely and effectively within
well as other resources for clinicians and patients to
LEV Medicine, strict peer-reviewed clinical guidelines
increase focus & positive outcomes on emergency
and care-quality standards, equivalent or greater to
medicine.
those of the UK Care Quality Commission (CQC) and the
UK General Medical Council (GMC) must be followed
5. Currently experimenters with “longevity protocols”,
for any such investigation or therapy. For all persons
as well as their physicians, do not collect and
using such cutting edge therapies, to adhere to LEV
distribute their methods, efficacy and safety data
medicine guidelines, clinical outcomes, surrogate
despite being hugely valuable. Solution: Develop
markers and other efficacy and safety data must be
resources and culture to enable 100% effective
captured and reported – with such data having to meet
capture, pooling and open access of all data from all
minimum steps to reduce bias, allowing for such data
patients – including suitable experimental methods,
to be pooled with past, ongoing and future studies.
clinical outcomes, surrogate marker and side effects
Furthermore, all such services should only be carried
– undergoing important LEV medicine practices
out by an LEV Medicine Certified clinician.
globally.
Example of an LEV Medicine Service
A fundamental requirement of LEV Medicine services is to be able to systematically identify, prioritise & manage
multiple clinical problems or action points; this is key to maximally reducing all-cause-mortality. Unlike typical providers
where a person waits for symptoms or signs to occur, with the clinician then working to solve this one single problem as
first priority, an LEV Medicine practitioner would systematically assess 20 to 2000+ health components related to all-
cause-mortality. LEV Medicine clinicians use evidence-based statistical algorithms to identify the optimal order in which
clinical problems should be solved. Additionally, in LEV Medicine, clinicians use evidence-based OCO (optimal clinical
outcomes) ranges adapted to the persons’ subpopulation, which can yield further reduction in all-cause-mortality
beyond typical providers reference ranges. When managing therapies and follow on investigations, LEV Medicine Clinical
Guidelines are used alongside typical gold-standard guidelines, along with aforementioned Decision Analysis algorithms.
Oliver Zolman, BSc, MBBS(c), CEO