Dr Eric Topol’s new book examines the best evidence-based approaches to longevity, and seeks to challenge the “malarkey” of the bio-hacking, age-reversal and anti-science movements – all of which have found new purchase in American society amid scientific distrust stoked during the Covid pandemic.
“This book is trying to set the record straight, get rid of the pseudoscience, and paint an incredibly optimistic picture of how we are so well-positioned to prevent the three age-related diseases that compromise our health span,” says Topol, director and founder of the Scripps Research Translational Institute and a practicing cardiologist, in an interview with the Guardian.
Topol’s new book, released on Tuesday by Simon & Schuster, is called Super Agers: An Evidence-Based Approach to Longevity.
“Right now, it’s such dark times in the medical research,” says Topol. “This is a book I think burning with optimism, and we will get there. I’m confident of that.”
Topol argues that we are at a moment to prevent the big three diseases: cancer, heart disease and neurodegenerative disease. This amid the convergence of knowledge about healthy behaviors, newly available and forthcoming biometric data and the computing power of artificial intelligence.
If one stumbled at Topol’s mention of the “health span”, that’s when he says we should seek not only longevity but health in those extra years, or a “health span”. The book features Topol’s insights into the “wellderly”, a group of people he identified in a related study who are older than 80 but do not have chronic conditions like the majority of even much younger Americans.
To illustrate the kind of wellbeing Topol envisions, he describes one of his patients: Mrs LR, a 98-year-“young” patient who drove herself to Topol’s practice. Mrs LR has not suffered from chronic disease, save the edema, or swelling of the legs, for which she is currently seeing Topol.
Topol says the force of newly available and forthcoming interventions can help us live into our twilight years more like Mrs LR – not for ever, but with fewer ailments. To do that, people need medicine to help prevent years-in-the-making conditions by creating personalized plans for patients. This philosophy, known as “precision medicine”, has its own detractors.
Topol’s vision of long-term health diverges from other attention-grabbing regimes, such those of the billionaire Bryan Johnson, who seeks to defy age, and of anti-vaccine activists, who may avoid modern science. Instead, Topol’s view is one where vaccines and blockbuster drugs like GLP-1s (such as brands Wegovy and Ozempic) aid us into this future of primary prevention as uses potentially expand to prevent cancer or Alzheimer’s.
He pairs these medical interventions with an emphasis on what we know about maintaining health: eat lots of fruits, vegetables, whole grains and fish (sometimes called the Mediterranean diet), moderate caffeine and alcohol intake, exercise regularly, stay socially active and get deep and regular sleep.
“Everyone should do all these things now,” says Topol. “Here is the problem: when you have a prescription to do all these things, almost no one does them.”
Personalized and accurate medicine, he argues, could conquer the arguably biggest hurdle: human behavior. Diet and exercise habits are notoriously difficult to change, even if evidence is compelling.
“But when you say specifically, ‘You have this risk, it’s bona fide. We can confirm it on many different clocks and layers of data. We have nailed it. This is your thing. This is what you want to avoid in your life, and you can prevent it,’” he says.
Factors we cannot change as individuals but which certainly affect health are environmental exposures to pollution, the stressors of poverty and racism, and whether we live in healthy neighborhoods, often called social determinants of health. This is the “+” in Topol’s “lifestyle+” argument, and those least discussed by the “only for wealthy people” wellness and bio-hacking movements.
Topol makes the caveat that this optimistic future has changed dramatically in recent months, at least in America. In the time since he finished writing, the Trump administration successfully confirmed Robert F Kennedy Jr, arguably the nation’s leading science denialist, to head the health department.
Kennedy rejects many of the basic principles of modern medicine – from the foundational century-old principle of germ theory, the idea that individual pathogens cause disease (even in otherwise healthy people), to the more modern tenet that health is a human right – see Kennedy’s confirmation hearing, in which he questions whether smokers deserve healthcare.
The health department is the nation’s largest public health agency and largest health insurer, with a $1.8tn budget regularly accounting for a fifth of all federal spending. That powers the world’s largest public funder of biomedical and behavioral research at the National Institutes of Health (NIH), the world’s gold-standard drug approval agency at the Food and Drug Administration, and the public health insurance programs Medicaid (covering 78.5 million people) and Medicare (covering 68 million) – to name only a few.
Since taking office, Kennedy has cut 20,000 people from the health department, or about a quarter of the workforce. He has canceled hundreds of grants at the NIH, frozen funds to researchers for diseases such as Alzheimer’s, and slowed new grant-making dramatically with $2bn less injected into science in the first quarter of 2025.
He slashed programs at the Centers for Disease Control and Prevention (CDC); closed critical sexually transmitted disease labs; installed anti-vaccine advocates in positions of power; and clawed back $11bn in public health funds from localities. Scientific experts with decades of experience have been forced out. The list goes on.
However, Topol’s view is broader than the current upheaval in the US. He mentions to the Guardian how European countries banned many unhealthy substances long before the US took action – only for America to later get on board. That includes things like food additives such as trans fats (and based on American research) and ancient poisons such as lead.
“This really is to me, a unique moment, and I hope that we’ll get on it right now,” says Topol. “Of course, the prospects are not great in this country, but many other parts of the world will get on it. I’m sure of that.”
