Why We Reinvented the Annual Exam

Humans evolved between 200,000 years ago. Our physical environment today shares little with the environment in which we first evolved, yet our biological systems are 99% the same.

The foundations of our modern healthcare system arose around 170 years ago. When we first evolved our healthcare system, life expectancy was 38 years. The most common ways to die were tuberculosis, dysentery, cholera, malaria, typhoid fever, pneumonia, diphtheria, or scarlet fever. Meaning, acute infections. This list is substantially different today. While the average life expectancy for someone born in 1990 is 75 years old, the most common causes of death are heart disease, cancer, accidents, chronic lower respiratory infections (includes asthma), stroke, Alzheimer's, and diabetes. We’ve all but stricken acute infections from the leading causes of death.

In 1850, when our modern medical system really started to take shape, we were focused on solving these acute diseases. We developed a medical system to eradicate these diseases, and the tools were blunt (read: leg amputations, full lobotomies, annexation of thyroids). Surgical interventions are popularized as one of the most effective tools to stop the spread of infection and disease throughout the body.

As we have consistently eradicated acute infections, we’ve failed to update our healthcare system’s focus, and really evolve our tactics to ensure longevity and fight disease. The most prevalent, deadly, and costly diseases of today are not typically (aside from Covid) infections, they are autoimmune-based. They’re diseases of physical degradation and of aging (eg. diabetes, heart disease, Alzheimer's, IBS & Crohns, depression/anxiety, rheumatoid arthritis).

The aging process is, in the most simplistic manner, triggered by oxidative or chronic stress. Enduring periods of stress distract our bodies from critical periods of repair, and without these periods of repair, we start to age or lose optimal performance in our body, typically due to failures in our DNA to properly copy itself. Unlike the lifestyles we are adapted to experience (with short-lived acute stressors) we lead lives that consistently levy psychological burden upon us. Our bodies don’t recognize this manner of stress differently than stress due to starvation or intertribal genocide. So, our bodies start to exhibit features of a chronic stress state, that would make sense evolutionarily but do not benefit us given how we are living today.

At Tia we are fixated on this topic of chronic stress, longevity medicine is another term for it. We believe that this is the equivalent of the realm of antibiotics over a ½ century ago. Our approach to medicine through this lens is what will enable us to unlock the antidotes to the new cadre of disease that humanity is facing: the internally born disease promulgated by us literally eating ourselves from the inside out.

Our focus is on how to modulate the stress response, or even, at times reverse the implications of aging. While there are certain areas of research in this arena that are showing medical interventions can be useful (metformin, resveratrol, stem cell therapy, NAD+ /NMN), what is fascinating and truly uplifting is that the most effective research in this field shows that lifestyle adjustments are just as, if not more, effective than many of the leading medical interventions on the market.

Tia is not an “integrative medicine practice,” meaning our mission is not to combine alternative and “traditional” modalities. First, we aren’t even sure what qualifies as “traditional.” For example, ashwagandha, an Indian herb, has been used in medical practices for centuries. Is it an alternative? What is the purpose of these distinctions, and more importantly, what is the purpose of putting these methods into arbitrarily (in)distinct little boxes? While we certainly are interested in many of the same interventions these practices use, our purpose for using them is perhaps different.

Somatically, performance degradation is imputed through symptoms: PMS, migraines, PCOS, anxiety. From our perspective, all of these issues come down to a single root: an overactive stress response, which could likely be wreaking havoc on proper cell functioning, and that could ultimately lead to multifactorial disease promotion. Our mission is to say: what could be off-kilter in your proper functioning? Is it the lack of carbs in your diet? Is it a lifelong attenuated stress pathway due to premature birth? Is it that your grandmother experienced periods of famine, and this was passed down through her and your mother’s epigenome?

This approach does require a “precision medicine” approach, as each and every person, due to their genetic composition and epigenetic display, is different. It is far more complex than administering an antibiotic for tuberculosis. While we, over time, hope to consistently layer in more and more data resources that can help us methodologically and empirically assess your cellular age, we are starting with one of the most reliable and important sources for this information: the health record. While ours is long (over 250 questions, in fact) — it asks questions that get to the core of your personal vulnerabilities.

The annual well-woman has historically been a preventive exam that women (should) get every year. Preventive is an interesting phrase in this case; while yes, the exam & screens are intended to detect diseases preventively (eg. cervical cancer via Pap smears, breast exams/mammograms for breast cancer), the typical well-woman does not revolve around a provider digging into your biology to understand how you tick. Nor is it the norm for your provider to assess the ways in which you may already be, or are predisposed to be, rendered “off-kilter." In this way, the typical well-woman operates in the world of “old medicine.” It’s focused on detecting infections and disease *after* onset. It does not assess your vulnerability to developing a disease in the first place. To exemplify the difference here, consider this: cervical cancer is highly correlated with bacterial vaginosis (BV). BV is typically a chronic condition of a dysbiotic vaginal microbiome. Detecting a dysbiotic vaginal microbiome is actually relatively simple, and only requires a swab test, yet we must understand the baseline in each woman to detect abnormalities (and each woman’s vaginal microbiome is different). Sequencing a woman’s vaginal microbiome regularly could enable us to detect aberrations. Most providers do not consider sampling a woman’s vaginal microbiome to assess for general health, nor do they consider counseling patients who have a high sugar/alcohol intake that this could put their vaginal microbiome more at risk. This is what we mean by preventative. Assessing and considering lifestyle factors that could put a patient more at risk.

Tia’s annual Whole Health Exam is anchored on the goal of extending patients' lifespans, mitigating the effects of our chronically stressed environments, and promoting longevity in our cellular function. Tia’s approach is anchored on ensuring truly optimal health. While of course, we will treat disease, we take the view that if we’re treating a patient's disease, we’ve failed. We should’ve set her up for better success from square one.

At Tia, in your Whole Health Exam, we will assess your vulnerabilities (lifestyle, genetic, current condition-based, world views), and craft a Care Plan with you. This Care Plan will not be a “one and done.” This Care Plan will include daily, weekly and monthly activities to promote your health. And, as a part of your Care Plan, your care team will meet with you frequently to assess your progress and ongoing needs.

Sources:

Infoplease. (n.d.). Life Expectancy by Age, 1850?2011. Infoplease. https://www.infoplease.com/us/health-statistics/life-expectancy-age-1850-2011.

Life Expectancy: progress from 1990 to 2013. Life Expectancy: progress from 1990 to 2013 | Health Intelligence. (n.d.). http://publichealthintelligence.org/content/life-expectancy-progress-1990-2013.

Oshinsky, D. M. (2017). Bellevue: three centuries of medicine and mayhem at America's most storied hospital. Anchor Books.

Sinclair, D., & LaPlante, M. D. (2021). Lifespan: why we age and why we don't have to. Harper Thorsons.