Longevity Medicine at a Crossroads: Education, Evidence, and the Risk of Acting Too Fast

A recent Biogerontology perspective by Thor and colleagues makes a timely and important argument: the greatest limitation in longevity medicine today is not a lack of science or technology, but a lack of structured medical education. As discoveries in ageing biology accelerate, many clinicians are left without the training needed to translate these insights into coherent, ethical, and clinically meaningful care.

On this core point, the authors are absolutely right.

But the paper also exposes a deeper challenge facing modern medicine—one that extends beyond longevity care and echoes familiar problems in psychiatry, neurodevelopment, and chronic disease management.

What the paper gets right

Thor et al. argue that longevity medicine should not become a new medical specialty, but rather function as an upskilling layer integrated into existing clinical pathways. This is a crucial and pragmatic insight.

They emphasize:

• structured education and accreditation

• protection against commercialization ahead of evidence

• integration with current healthcare systems

• a shift from reactive “sick care” to proactive, healthspan-oriented care

They also warn that, without proper training, longevity medicine risks fragmentation and misuse.

In reality, this fragmentation is already widespread—which makes their proposal not theoretical, but urgently corrective.

Where the tension begins

The paper proposes that future longevity training should include tools such as:

• biological age diagnostics

• digital phenotyping

• advanced biomarker platforms

These approaches are scientifically interesting, but they also repeat a familiar medical pattern: measurement and labeling advancing faster than clinical actionability.

We have seen this before.

Diagnosis without mechanism: a recurring problem

In neurodevelopmental care, a child is labeled with ASD—yet the underlying brain bioenergetic strain, mitochondrial stress, or neuroimmune activation is often left unaddressed.

In psychiatry, depression or anxiety is diagnosed—while the energetic and metabolic constraints shaping brain function remain invisible.

In longevity medicine, a person is assigned a “biological age”—without clarifying whether their body still has the capacity to adapt, recover, and resolve stress.

In each case, the label becomes the endpoint rather than the entry point.

The other side of the same problem: premature treatment adoption

Alongside the explosion of advanced diagnostics, we are also witnessing the widespread premature adoption of interventions that lack robust clinical evidence. This is now common across longevity and functional medicine landscapes.

Examples include:

• off-label use of compounds promoted as “geroprotective”

• aggressive supplementation driven by weak surrogate markers

• experimental metabolic, hormonal, or immune-modulating strategies introduced as routine care

• protocol-based treatments justified primarily by mechanistic plausibility

In many cases, sophisticated testing creates a false sense of certainty, making early or speculative interventions appear justified.

This is not a problem of bad intentions. It is a structural failure.

When clinicians are given complex data without a clear framework for interpretation, they are implicitly pushed toward action—even when the most appropriate response might be to stabilize physiology, restore recovery capacity, or simply observe longitudinal patterns.

Action becomes a substitute for understanding.

What the ERM framework adds

The Exposure-Related Malnutrition (ERM) framework approaches this problem differently.

ERM does not reject diagnosis, technology, or innovation.

It reframes diagnosis as phenotype, not cause.

Rather than asking:

How old does this biology look?

ERM asks:

Is adaptation resolving—or failing?

ERM focuses on:

• energy availability and substrate sufficiency

• bioenergetic congestion and recovery failure

• longitudinal biomarker patterns rather than single scores

Crucially, ERM relies on clinically available, interpretable biomarkers, used over time, rather than opaque composite indices or proprietary algorithms.

This keeps medicine:

• explainable

• affordable

• scalable

• directly linked to clinical decisions

ERM as a brake, not a barrier

One of the underappreciated strengths of the ERM framework is that it introduces restraint where restraint is needed.

ERM does not ask:

What should we add next?

It asks:

Is this system capable of responding to intervention at all?

As a result, ERM often leads to:

• de-escalation rather than escalation

• fewer but better-timed interventions

• clearer stopping rules

• restoration of foundational capacity (sleep, nutrition, recovery, stress resolution) before advanced therapies

This protects patients from the cumulative burden of well-intentioned but poorly sequenced treatments.

Alignment and misalignment—at the same time

It is important to be clear: The ERM framework aligns strongly with the intent of Thor et al.’s paper.

Both emphasize:

• education over hype

• physiology over marketing

• prevention over late-stage rescue

• governance over enthusiasm

Where they diverge is not in values, but in translation strategy.

ERM argues that:

• biological age should not replace adaptive staging

• digital phenotyping should not substitute for clinical reasoning

• more data does not automatically mean better care

How we should move forward

The future of longevity medicine should not be built on ever more complex measurements or increasingly aggressive interventions alone.

It should be built on:

1. Education that prioritizes adaptive physiology

2. Longitudinal, clinically interpretable biomarkers

3. Clear links between measurement and intervention

4. Early identification of reversible maladaptation

5. Restraint in adopting treatments ahead of evidence

6. Respect for timing, recovery, and physiological readiness

Advanced diagnostics and novel therapies may one day earn a central role.

But today, restoring energy balance, adaptive capacity, and recovery matters more than assigning new labels or deploying speculative protocols.

A necessary reframing

Longevity medicine should move from asking:

How old does this system appear?

To asking:

Is this system still capable of adapting—and if not, why?

Thor et al. are right: the path from sick care to healthspan begins with education.

The next step is ensuring that what we teach keeps biology actionable, evidence-based, and humane.

Because people are not broken.

They are often exhausted—and exhaustion is reversible when we understand the system.

Thor, D., Barzilai, D., Lyu, Y.-X., & Spiru, L. (2026). From sick care to healthspan: Educating the longevity physician for health maintenance and health promotion. Biogerontology, 27, Article 22. https://doi.org/10.1007/s10522-025-10371-3