Peter Attia· MD
you have to have objective outcomes that are ideally uh hard uh so a hard outcome would be mortality that would be the ultimate hard outcome does intervention X alter the course of a person's life does it increase the duration of a person's life does it alter the course of a disease so in cardiovascular disease we often look at what's called mace major adverse cardiac events and this would be a heart attack a stroke cardiac death uh you know re uh the need for revascularization something like that so if you put all of these together you realize boy there's a lot that can't be done in fact you could you could address all one two three and five but not four if you're trying to do a study for primary prevention in low-risk individuals right so if you took the perfect intervention the perfect pill the perfect drug and you said I believe this is going to delay the onset of cardiovascular death and we want to test this in 30 years olds it's not going to work why because you're going to have to wait 30 or 40 years to get your answer it's simply impossible so I say all of this not to suggest that the randomized control trial is not valuable it is imperative I simply say it to argue that we have to be able to go beyond randomized control trials in humans that are at the gold standard if we want to get past medicine 2.0 and one of the ideas in medicine 3.0 is the idea that we have to be able to rely on not just evidence-based medicine which falls into this but also evidence informed medicine we have to be able to extrapolate intelligently from what we know from rcts we have to be able to also maybe include what we've learned in cross species experiments we have to be able to impute intelligently What We Gather from biomarkers or indications around specific diseases and what we know about that disease relative to all cause mortality so for example we might look at an intervention that lowers apob significantly and say