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There is a lot of “longevity” around at the moment.
Longevity clinics.
Longevity supplements.
Longevity blood tests.
Longevity IV drips.
Red-light beds.
Saunas.
Cold plunges.
NAD+.
Peptides.
Biological-age tests.
If you spend enough time on social media, it can start to feel as though living longer requires a very expensive morning routine and approximately 47 supplements.
I don’t think that is what longevity medicine should be.
In fact, the more I study healthy longevity medicine, the more I find myself coming back to something surprisingly unexciting:
Good longevity medicine looks remarkably like good medicine.
It means understanding the person in front of us.
Identifying disease and risk factors early.
Treating what needs to be treated.
Preventing what can reasonably be prevented.
Preserving muscle, bone, cognition and metabolic health.
Maintaining function.
And increasingly, understanding whether the biological processes of ageing themselves can eventually become legitimate targets for medical intervention.
That last part is where the science becomes particularly exciting.
But it is also where we need to be especially careful not to let marketing run ahead of medicine.
When people hear the word “longevity”, they understandably think:
living longer.
But simply extending lifespan is not the objective I find particularly interesting.
Imagine living to 100 but spending the final 20 years increasingly frail, dependent and burdened by multiple chronic diseases.
Now imagine living to 90 but remaining physically capable, cognitively engaged and independent for almost all of those years.
The second outcome is much closer to what I mean when I talk about healthy longevity.
The important concept is healthspan: the period of life spent in relatively good health and function.
So the question isn’t simply:
“How do I live longer?”
It is:
“How do I remain healthy and functional for as much of my life as possible?”
That changes the conversation completely.
This is where we need to distinguish several terms that are increasingly being used interchangeably.
Geroscience is the scientific field studying the relationship between the biological processes of ageing and the diseases and functional decline that become more common as we grow older.
The central idea is remarkably logical.
Age is one of the strongest risk factors for many chronic diseases.
Cardiovascular disease.
Diabetes.
Cancer.
Dementia.
Frailty.
Rather than studying every age-related disease entirely in isolation, geroscience asks whether some of them share underlying biological processes related to ageing.
These include processes involving cellular senescence, chronic inflammation, mitochondrial dysfunction, altered nutrient sensing, genomic instability, epigenetic changes, loss of proteostasis, and stem-cell exhaustion, among others.
This leads to what is known as the geroscience hypothesis:
If we can safely influence some of the biological processes that contribute to ageing, could we potentially delay several age-related diseases and functional decline at the same time?
That is a very different proposition from treating wrinkles.
And importantly:
it is still an evolving scientific field.
Many interventions that produce remarkable lifespan effects in worms, flies or mice have not yet been shown to produce meaningful longevity benefits in humans.
Geromedicine is the clinical translation of this idea.
One contemporary definition describes geromedicine as medicine concerned with optimising health and preventing disease by targeting the underlying ageing process.
I find that definition fascinating.
But in clinical practice, I think we need to be humble about where the science currently is.
Because geromedicine does not mean that I suddenly have a drug that stops ageing.
We don’t.
Instead, I think of geromedicine as combining two things.
First:
Manage blood pressure.
Identify diabetes and metabolic disease.
Treat abnormal lipids when clinically indicated.
Don’t smoke.
Exercise.
Maintain muscle.
Protect bone.
Sleep properly.
Eat adequately.
Vaccinate appropriately.
Screen for disease according to evidence and individual risk.
Manage menopause appropriately.
Treat mental health.
Address hearing and vision.
Maintain social connection and cognitive engagement.
These things are not particularly futuristic.
But collectively, they can have enormous consequences for how we age.
And then there is the second part:
That is where geroscience is taking us.
But until an intervention has crossed the enormous gap between an interesting biological mechanism and a meaningful human clinical outcome, I think we should describe it honestly.
Promising.
Experimental.
Under investigation.
Not proven.
I actually find this reassuring.
People sometimes ask what they need to add to their lives to achieve longevity.
My first instinct is often to ask what we have already neglected.
Have we checked the blood pressure?
How is the cholesterol?
Is there diabetes?
Are you smoking?
Are you exercising?
How much muscle do you have?
Are you getting stronger or weaker?
How are you sleeping?
How is your bone health?
Are you going through perimenopause?
Are you up to date with appropriate health screening?
How much alcohol are you drinking?
What does your nutrition actually look like?
These questions sound almost disappointingly ordinary.
But ordinary does not mean unimportant.
One of the dangers of the longevity industry is that we become so fascinated by what might work that we neglect what we already know does.
This distinction is particularly important to me.
Wellness is an extremely broad concept.
It can include things that genuinely contribute to health:
exercise,
healthy food,
sleep,
stress management,
social connection,
mindfulness,
massage,
saunas,
and simply doing things that make us feel good.
There is nothing wrong with wellness.
I enjoy wellness too.
But wellness and medicine are not interchangeable.
Medicine requires us to ask different questions.
What is the indication?
What is the evidence?
What are the risks?
Who should not have this intervention?
What dose?
What outcome are we trying to change?
Has it been compared with placebo or standard care?
Are we changing a biomarker—or actually improving someone’s health?
And perhaps most importantly:
What happens if we’re wrong?
That is the responsibility that comes with calling something medicine.
This is another distinction we need.
Suppose you go to a sauna.
You relax.
You sleep beautifully that evening.
Your muscles feel wonderful.
You feel fantastic.
That has value.
But it does not automatically mean:
“The sauna has slowed my biological ageing.”
Those are two entirely different scientific claims.
Similarly, something may improve a biomarker without proving that it reduces disease, disability or mortality.
Or something may improve how you feel without altering the biological processes of ageing at all.
All of these outcomes can still be worthwhile.
We simply need to call them what they are.
Saunas are a wonderful example.
Interesting observational studies—particularly from Finnish cohorts—associate more frequent sauna bathing with lower cardiovascular and all-cause mortality.
That is genuinely interesting research.
But observational evidence cannot prove that sauna use itself caused people to live longer.
People who use saunas frequently may differ from those who don’t in many other ways.
There are also physiological studies examining cardiovascular effects of heat exposure.
So I wouldn’t dismiss sauna as nonsense.
I would say:
Interesting. Biologically plausible. Potentially beneficial. Not equivalent to proven longevity therapy.
And if you enjoy it?
Wonderful.
Just don’t imagine that twenty minutes in a sauna cancels out smoking, uncontrolled hypertension, and never exercising.
Photobiomodulation—often marketed simply as “red-light therapy”—is another perfect example of why language matters.
Photobiomodulation is a legitimate area of medical research.
There is clinical evidence supporting certain applications, including some dermatological, wound-healing, hair, and pain-related indications.
But this does not mean:
red light = longevity.
Different devices use different wavelengths.
Different irradiances.
Different doses.
Different treatment durations.
Different tissue targets.
And different indications.
The evidence for treating a particular medical condition with a particular photobiomodulation protocol cannot automatically be extrapolated to:
“Stand in this red-light bed three times a week and you will age more slowly.”
That leap is where science becomes marketing.
NAD+ is probably one of the best examples of the difference between exciting biology and established clinical medicine.
Nicotinamide adenine dinucleotide—NAD+—is an essential molecule involved in cellular energy metabolism, redox reactions and numerous signalling pathways.
NAD biology is fascinating.
And alterations in NAD metabolism have been studied extensively in relation to ageing.
This has created an enormous commercial market around:
NAD supplements,
NMN,
NR,
and intravenous NAD+ infusions.
The marketing logic sounds compelling:
NAD changes with ageing → restore NAD → reverse ageing.
Unfortunately, there are several enormous scientific steps hidden inside that arrow.
Human studies of oral NAD precursors such as NR and NMN demonstrate that we can alter NAD-related metabolites.
But demonstrating biochemical target engagement is not the same as demonstrating improved healthspan.
Human trials looking at functional, metabolic and vascular outcomes have produced heterogeneous and often null or endpoint-specific results.
And intravenous NAD+ is even further ahead of its evidence.
A recent systematic review found no eligible human outcomes trials evaluating intravenous or intramuscular NAD+ itself for anti-ageing or wellness indications.
Think about that for a moment.
IV NAD+ is already commercially available as a “longevity treatment”.
Yet we still lack robust clinical outcomes evidence demonstrating that giving NAD+ intravenously to otherwise healthy people improves healthspan or slows ageing.
That doesn’t mean NAD biology is wrong.
It means:
The marketing has arrived before the clinical evidence.
The biology of ageing is extraordinarily exciting.
But there is a predictable pathway that I see repeatedly.
A biological mechanism is discovered.
↓
It works in cells.
↓
Something interesting happens in mice.
↓
A small human study demonstrates a change in a biomarker.
↓
A company develops a product.
↓
Instagram announces:
“This reverses ageing.”
Several scientific steps have just disappeared.
This is why understanding the hierarchy of evidence becomes so important in longevity medicine.
This deserves its own discussion.
Longevity medicine is increasingly filled with measurements.
Biological age.
Epigenetic clocks.
Inflammatory markers.
Metabolomics.
Proteomics.
Telomeres.
Continuous glucose monitoring.
Wearables.
Some of these technologies are scientifically fascinating and may eventually become clinically valuable.
But measuring something does not automatically mean we know what to do with the number.
And changing a number does not necessarily mean we changed the outcome that matters.
If an intervention makes someone’s “biological age” three years younger on a particular algorithm, I want to know:
Does that person develop less cardiovascular disease?
Less dementia?
Less frailty?
Do they remain independent longer?
Do they live longer?
Until we establish those relationships, we need to be very careful about confusing surrogate biomarkers with clinical outcomes.
Another trend I see is extremely extensive testing in healthy people.
Hundreds of biomarkers.
Whole panels of hormones.
Tumour markers.
Micronutrients.
Inflammatory markers.
Genetics.
Biological-age tests.
More information sounds inherently better.
But medicine doesn’t work like that.
Every test has false positives.
Every reference range has context.
And once we test enough things in a healthy person, eventually something will come back outside the reference range simply by chance.
Then we need another test.
Perhaps a scan.
Perhaps a specialist.
Perhaps a biopsy.
Good medicine isn’t about ordering the largest blood panel.
It is about asking the right clinical question and choosing a test that helps answer it.
The same principle applies to supplements.
More is not necessarily better.
A supplement being “natural” doesn’t make it harmless.
A molecule participating in an important biological pathway does not automatically mean taking more of that molecule improves the pathway.
And an association between low levels of something and disease does not automatically mean supplementation prevents the disease.
This sounds obvious when I write it.
It becomes surprisingly easy to forget when the bottle says ANTI-AGEING.
At this stage of my learning, I think about it in layers.
Prevent disease where possible.
Vaccination.
Smoking cessation.
Appropriate screening.
Blood pressure control.
Cardiovascular risk assessment.
Metabolic health.
Bone health.
Women’s health.
Mental health.
Sleep disorders.
Maintain muscle.
Strength.
Cardiorespiratory fitness.
Balance.
Mobility.
Cognition.
Social connection.
Independence.
Family history.
Existing disease.
Medications.
Hormonal transition.
Nutrition.
Sleep.
Stress.
Body composition.
Individual goals.
Not everyone needs the same intervention.
Treat deficiencies when they exist.
Treat disease when it exists.
Address meaningful risk factors.
Don’t manufacture diagnoses simply because we have a test available.
This is where it becomes exciting.
Senescence.
Epigenetic regulation.
Nutrient sensing.
Mitochondrial biology.
Proteostasis.
Chronic inflammation.
Potential geroprotective drugs.
Biomarkers of biological ageing.
There is extraordinary research happening.
But our enthusiasm should rise in proportion to the evidence.
This is perhaps the least commercially exciting conclusion possible.
If you ask me whether I would rather have someone:
exercise regularly,
maintain muscle,
not smoke,
control their blood pressure,
sleep adequately,
maintain metabolic health,
eat reasonably well,
and participate in appropriate preventive healthcare,
or
live badly but receive a weekly longevity IV drip…
I know which one I would choose.
Every time.
That doesn’t mean future gerotherapeutics won’t change medicine.
I think some of them eventually will.
But longevity medicine should add emerging science to good medicine—not replace good medicine with emerging science.
Not at all.
I’m fascinated by them.
That is precisely why I am studying this field.
I want to understand what is real.
What is promising.
What is premature.
And what is simply excellent marketing.
I am perfectly comfortable saying:
“We don’t know yet.”
Medicine needs more of that sentence.
If compelling evidence eventually shows that a particular drug, supplement, device or intervention meaningfully improves human healthspan with acceptable risks, then it deserves to become part of medicine.
And I will happily change my practice accordingly.
But the burden should be on us to demonstrate that something works.
Not on the patient to prove that it doesn’t.
After studying all the complicated pathways, biomarkers, and hallmarks of ageing, I keep coming back to this.
Perhaps good geromedicine is simply:
good medicine, practised with a longer horizon.
Instead of waiting for disease to appear, we think about risk.
Instead of caring only about survival, we think about function.
Instead of treating each organ completely independently, we recognise shared biology.
Instead of celebrating weight loss while ignoring muscle loss, we ask what happened to body composition.
Instead of accepting declining strength as inevitable, we work to preserve it.
Instead of asking only how long someone might live, we ask:
What do we want those additional years to look like?
And while we remain excited about emerging interventions that may eventually influence the biology of ageing, we don’t abandon the principles that medicine has spent decades establishing.
Evidence.
Diagnosis.
Risk and benefit.
Prevention.
Treatment.
Follow-up.
And humility about what we do not yet know.
I think there is room for both.
Take the sauna because you enjoy it.
Use red light for an indication where there is reasonable evidence—or simply because you enjoy the ritual, provided it is safe for you.
Meditate.
Have a massage.
Go on a retreat.
Do things that make you feel restored.
Wellbeing matters.
But we shouldn’t need to call every enjoyable or potentially beneficial activity a longevity treatment.
For me, the distinction is quite simple:
Wellness asks: “What might help me feel well?”
Longevity medicine asks: “What can we reasonably do, based on evidence, to preserve health and function as I age?”
And geroscience asks an even deeper scientific question:
“Can we understand and eventually modify the biology of ageing itself?”
Those three conversations overlap.
But they are not the same.
At VIDASKIN, as we begin incorporating healthy longevity thinking into the way we care for our patients, that distinction is extremely important to me.
I don’t want longevity to become another aesthetic trend.
I want it to remain medicine.
And perhaps the most important principle is this:
Don’t let the excitement of what might work distract us from doing exceptionally well what we already know works.
Founded in 2015, Dr Vicki has grown with the clinic, to become one of the leading aesthetic clinicians in Singapore. She is an appointed key opinion leader and trains other aesthetic doctors on how to best use prestigious brands and treatments.
