Silicon Valley thinks our bodies need a reboot. PayPal founder and Donald Trump booster Peter Thiel, who plans to live for 120 years, has publicly discussed taking human-growth hormone (and expressed interest in blood transplants from young people). Google spun off Calico in 2013 to defeat the inevitability of aging. Software engineers fast for days and order custom “stacks” of nootropics, or brain-enhancing substances, to gain a cognitive edge. One venture capitalist, requesting anonymity, said at a dinner he recently attended several people opened up boxes to pop nootropic pills before the first course.
There’s no end to the experimentation people will undertake in pursuit of productivity, even if most treatments and supplements don’t yet have strong evidence or FDA approval. That hasn’t phased the patients that Dr. Molly Maloof sees in her Silicon Valley practice. “This is a place where people don’t give a flying fuck what they do with their minds and bodies,” she said.
The general practitioner wants to see real medical rigor behind people trying to hack their health. Her concierge medicine practice in San Francisco serves a small number of patients for anywhere from $5,000 for an initial assessment to upwards of $40,000 per year for comprehensive care (every patient has a second, primary care physician as well). Her clients are often engineers and executives looking to hit peak performance, or recover from an over-stressed work-life. Maloof, who earned her medical degree from the University in Illinois in 2011, sees part of her work as ensuring they they are doing it safely, backed up by the maximum amount of evidence.
Too often, she says, executives and entrepreneurs place performance above health. “All these people are not stupid … but what used to be domain expertise is now everyone claiming to be the expert,” she says.
Maloof’s data-heavy approach begins with a battery of tests—measuring thousands of biomarkers in all—to understand her patients at the cellular level. By analyzing the results, she can prescribe food and lifestyle tailored to every individual, alongside standard western therapies. Only then does she consider pharmaceutical-grade supplements. If needed, she helps patients practice harm reduction with ”performance-enhancing” substances from nootropics to micro-dosing LSD. Her philosophy, she says, is to do more than cure sickness, but to enhance health.
Investors are betting this approach—optimizing one’s health through deep analysis of their genetics, physiology, and psychology—becomes the standard of care. Technology, they argue, will ultimately bring down prices so it’s affordable for almost everyone. Today, Maloof estimates less the 1% of private medical practices take this approach, but companies like Color Genomics, Forward, Nootrobox, Arivale, Metabolic Code, Habit, and Viome are already aiming to go mainstream.
Maloof is surprised at the cavalier acceptance of DIY health at the intersection of technology and personalized medicine. “People will spend months researching which computer they will buy and then two minutes researching the nootropic brand they’re about to put into their body,” she says.
Maloof sat down with Quartz to talk about her work and the future of personalized medicine. The interview was condensed and edited for clarity.
Can you describe your practice?
My practice has basically been an emergent phenomena: What if a doctor decided to optimize health instead of just fixing illness? The first thing I’ve done differently is I’ve positioned myself as a doctor who is aiming to improve the human condition rather than just get you from sick to not-sick.
There’s this spectrum of disease. Most people are in the sick-to-average part of that spectrum. The athletes and movie stars of the world are at the opposite end at the optimal part of the spectrum.
There’s this space between average and optimal that is a very grey area. It’s been sort of commandeered by the wellness industry: the people who perpetuate mindfulness, fitness, and nutrition, but maybe don’t have any rigorous medical training. And, as such, haven’t actually learned the basic science of the human body and how biology, physics, and chemistry works.
How did your practice begin?
I thought, if I was in a perfect world, “What would I want my health experience to look like?” I basically decided I would want a doctor to listen to me, and listen for a long time. In an ideal situation, it takes about two hours to ask all the questions I would want.
The second thing is that, typically when you get blood drawn from a doctor, you might get 10 biomarkers or lab [tests]. That’s just not very much information. And they don’t usually tell you there’s something wrong with you unless it’s really wrong. In my practice, I’m looking at 170 chemical biomarkers. Instead of normal or abnormal, I’m looking at a range of what’s good.
Instead of just looking at blood, I’m looking at blood, urine, stool and saliva. Instead of just chemistry markers, I’m looking at chemistry, metabolomics (chemical fingerprints of cellular processes), genomics, microbiome (microorganisms), hormone tests, and I’m starting to look at immunology markers.
That’s a very different experience. In a perfect world, your body is like the airplane and I’m the co-pilot and we’re using all these tools to identify if there are issues going wrong with the engine.
How does your typical day go? How would a patient’s visit to your office be different?
A typical patient is first going to have a meeting with me to go through all these questions, I’ll gather all the data and then send a phlebotomist to their house [to draw blood].
I get all the information back and then I sit back down with the patient and we will go over all of the report together. And that will take up to an hour and a half.
At the end of that, we edit the decision together. So we decide what we we want to do. I come up with a summary, a one- to two-page summary, and then create a schedule for all their supplements and their nutrition, and then basically hand off the recommendations to any staff they have to help implement it, or just to them.
Then I’ll check in with them in a couple weeks via text or via email or the phone and then we’ll repeat the process. We’ll take some of the labs that we did and then we’ll repeat that on a quarterly basis. And then we’ll go over the changes we see over time.
Q: How long would a typical patient be with you?
The real benefit comes after working for a year. Six months to a year is the minimum amount of time that we should be working together. And the patients who tend to go off the program, they come back to me eventually and they’re like, “Yeah, I fell off the wagon and I want to jump back on.” But it takes some commitment because you want to optimize health.
The first and foremost thing you need to do is recognize that this is not an overnight fix. You’re not just going to feel amazing overnight. It’s actually about building these changes over time, and it makes a lot of difference if you recognize it’s like compounding interest.
And the thing about it is that it’s not rocket science, but a lot of it is actually knowing what is right for your body and your lifestyle. And that’s going to be different for different people.
Q: That’s tough what you’re describing. How many stick with it?
I work with mostly entrepreneurs, investors, and executives. So I tend to work with people who, when I first evaluate whether or not they’re a fit for my practice, I can assess “how willing are they to do the things that I’m asking them to do?” If they’re a six out of 10, then I’m not going to ask them to do that.
The patients that don’t do the best are the ones that think that everything is about the supplements, and everything is about the right supplements. Supplements are like the last mile of optimization. They can make a really big difference. But fundamentally, if your lifestyle is a disaster, for those people it’s about actually showing them what’s happening in their lifestyle and showing them how food is affecting them, giving them continuous glucose monitors, getting them heart-rate variability monitors, so they can glean some real insight around what’s happening day-to-day.
Q: What are some of the more dangerous things patients come in doing?
A big problem I see people buying everything they read on Bulletproof Coffee. I’m just like, ‘Guys, [Bulletproof’s founder] Dave Asprey has not figured everything out. First and foremost he’s a salesman and a marketer. And secondly he is a bio-hacker, and so let’s get real.’
Everything he’s recommending! Bulletproof Coffee [which has as much as 4 tablespoons of fat or oil per cup) is probably the worst idea that a person can do in terms of their health. The problem is there’s a large number of people that will have much higher rates of cholesterol, and some people will be fine on it. And people do it wrong: they add sugar to it, or eat sugary things, or don’t have the right genetics for that level of fat consumption.
I’ve seen three patients now with really, really high cholesterol levels. Way, way above normal. I’m like, ‘What are you drinking in the morning? What does your routine look like?’ They say, ‘You know, I start my day with Bulletproof Coffee…’ And I’m like, ‘Are you? Oh no.’
Is what you’re doing scalable?
What I’m doing right now is not scalable at all. I’ve been doing this practice in order to figure out what does scale. Because if you look at all this information, you’ll start to see things that make sense for larger populations of people, and I think this is where medicine could go if we had more convenience.
Can this become a standard of care for most people, or will it be concierge medicine forever?
Here are few things that have to happen.
The health care system needs to recognize that what they are doing isn’t working for chronic disease, first and foremost. Second of all, we need large-scale studies on this kind of medicine.
I’m looking at interventions from the perspective of what is the most sound, evidence-based recommendation I can make for this individual. If it doesn’t have evidence, why doesn’t it. Chinese medicine may not have much evidence in the western model but it has thousand of years of people using it. The question is, ‘Is it totally bullshit?’ Well, probably not. There’s probably some truth in it.
Then we need doctors who want to learn how to do this. We have to be able to train them how to do this. When I was in med school, I thought there was a lot missing from my education: what about lifestyle, what about what happens after the patient goes home after the visit to the hospital?
I saw this giant problem in my education, and I actually designed a course called, “Physician Heal Thyself, Evidence-based lifestyle.” I brought in all these doctors who are experts in sleep medicine, sleep, fitness nutrition, food as medicine, functional medicine, integrative medicine, osteopathy and acupuncture. I got them all in a room and said I want you to teach students what we’re missing. We need to make this medical school education and have to implement this into the board certification programs as well as board exams. If it’s not required, it’s not going to be taught.
Finally, we need to be able to prescribe these things. We need food companies to do the research to show their food has outcomes that can improve human health. If we believe it’s medicine, then we need to study food as medicine. And we have to put it through the same rigor that we put drugs through. That’s going to happen. We’re not that far way, but one of the biggest things that needs to happen is a culture shift.
Where do you think a practice like yours will be in five years?
The way to explain this question is actually to look to the past. When I was trying to figure out if what I was doing was special, I started doing some research on doctors in antiquity. I found an interesting pattern.
Most people in Greek and Roman times considered their kitchen to be their medicine cabinet. The women of the world were responsible for managing a lot of illness through food. So food as medicine was fairly widespread, but the wealthy and the gladiators and the kings, all of these people had special doctors.
There’s always been doctors working with the elite and working with the athletes of the world. But the difference between now and then, is that the kitchen is no longer the medicine cabinet. The kitchen is now the place of ultra-toxicity and disease.
I think in five years, I’m going to be, hopefully, speaking to the entire country through media and through public health campaigns (I’m going to build a platform around this) trying to bring back what we knew for thousands of years about how food can treat our disease and how plants are a source of healing and how the way that we are living our lives in modern times is antithetical to optimal health.