What will be the mission of family medicine in Quebec, or more generally, in North America, in the coming years? Biogerontology has made great strides and the pace of discovery is accelerating. Digital technologies and scientific advances are advancing at an incredible speed, in view of the increasingly rapid exchange of information in real time. We are therefore entitled to question the future of medicine, both preventively and curatively. Advances in diagnostics, including imaging and digital technologies, raise questions about the impact that medicine may have on human longevity. And as a corollary, what impact could have increased longevity within the practice of medicine?

Are we entitled to think that the ultimate prevention in medicine could be to slow down aging or senescence, so as to decelerate so-called degenerative diseases, and live longer in better health. We have long considered “old age” as an inevitable reality, to which are grafted to many morbid conditions which lead inexorably to death. However, theoretically, it seems to us that we could reduce the speed of senescence, and thus favor the conservation of the functions specific to young tissues much longer, or even to regenerate them.

The Discovery show on February 10, 2019 described the progress of the Mayo Clinic, a world-renowned medical institution. In particular, the work of Dr. James Kirkland, researcher in biogerontology, reported the capacity of certain substances already available for clinical trials on humans to reduce the aging of exposed cells. Similarly, Idunn Technologies, a Quebec company, in collaboration with Concordia University, announced very significant results on March 5, 2019 (see here). This is a very high-level scientific publication describing the pooling of different cellular mechanisms in order to slow down the primary aging of the organism.

What could be the role of the doctor in the face of a new approach targeting longevity? In so-called primary prevention, that is to say before the disease occurs, the doctor must be able to intervene upstream. They will be able to identify the “grounds” predisposing the appearance of the problems of the individual who consults them. In secondary prevention, that is to say when the disease or dysfunction occurs, they must be able to intervene to bring back the lost balance, as much as possible: we are aiming here for proper “healing”. For tertiary prevention, they will participate in “limiting the damage” and helping the individual by developing adaptation scenarios allowing them to live better with their disease(s), without claiming to cure them. Here, of course, we are targeting so-called degenerative diseases that have evolved over several years and produce irreversible sequelae.

The doctor’s work, in all of these three preventive spheres, is first and foremost in the establishment of diagnostics, using all the means at his disposal. This diagnosis will take into account lifestyle, personal, medical and surgical history, and possibly genetics. Family factors are also important in targeting the areas of vulnerability of the person during a consultation.

Once the diagnoses have been made, as well as the areas of predilection established, the doctors will be able to suggest preventive or curative approaches targeting interventions capable of shortening the so-called degenerative diseases having an impact on the quality and duration of life.

In a second step, the doctor will have to stabilize or treat the patient in order to restore the compromised balance. The third action will be to establish a follow-up and treatment plan capable of preserving any deterioration in physiological functions, whether at the physical, psychological or social level, because these three dimensions are interrelated and fundamental to the maintenance of optimal health.

How can the doctor include the longevity component in the elements mentioned above? We are increasingly aware of the metabolic pathways of aging and it is already possible to intervene on them and delay the onset of degenerative diseases. The doctor can thus identify the specific areas for certain diseases that their patient could develop, but also act in a non-specific way on cellular aging. This latter function could prove to be highly preventive in terms of its ability to preserve the integrity of cellular function. This may well be the ultimate prevention. Thus, as an example, a patient with a predilection for osteoarthritis could receive for example extracts of olive polyphenols (overall action), at the same time as agents acting specifically on inflammation, such as devil’s claw or turmeric. The basic premise here is to harm other essential functions as little as possible, first by using products free of side effects that would diminish their interest. As the old adage put by Hippocrates states: “Primum non nocere“: first, do no harm. Certain natural products have undeniable advantages and well described by science, by their harmlessness in comparison with heavier molecules, with more undesirable effects. Initial solutions should include more strategies with no potential for detrimental patient harm. In case of failure, we can consider more “hard” molecules, while minimizing their negative impact.

 

– Jacques Lambert, MD