Living Six Productive Years Longer

David Drew Longevity was founded in 1997 to determine whether comprehensive ongoing disease surveillance and risk factor management can prolong productive life and, if so, to develop a model program that could be replicated by others. Specifically, this longitudinal and ongoing study seeks to prevent early deaths by using medical technology to (1) identify and correct disease-promoting conditions and (2) detect early any occult and life-threatening problems in time for cure.

Analysis of the first 24 years of David Drew research shows that program participants live at least 6 more years of productive life, on average, when compared to traditional US health care, which itself has some proactive features but is largely reactive. Additional productive life is gained from the outset and continues during participation, averaging 2.4 months gained each year, or about 1 year added for every 5 years of participation. The average cost to gain a productive year of life is about $20,000 and 20 hours of participant time, spread over five years.

The design of the David Drew Longevity study, how gains in productive longevity are measured, and results after 24 years are briefly described here.

Design Principles

The David Drew Longevity program was designed with four important principles in mind. First, our goal is to extend the productive years of life, not the total length of life. Surveillance methods and interventions are chosen to maximize those productive years, and results are expressed in productive years added. Because individual productivity varies and can be difficult to quantify, we chose to define a productive year of life as one that occurs before the age of average life expectancy based on current age. For example, the average 50-year-old man in America lives to about 82. By definition, half die earlier, losing productive years. In short, the goal of the David Drew program is to minimize the loss of productive years caused by those early deaths.

Second, the program seeks to avoid all early deaths but focuses upon intercepting the commonest causes. For American adults over 40 years of age, a large majority (more than 80%) of productive years lost are lost about equally to two causes: cardiovascular diseases and cancer. Any longevity program seeking to maximize productive years must aggressively seek out and mitigate both processes. For cancer survival, this means detecting cancer and precancerous conditions early, while they remain curable. When genetic or other cancer risk factors are identified, the program must adjust to intensify surveillance in areas of increased risk. Cardiovascular death prevention must include risk identification and mitigation, periodic inspection of the state of critical arteries, and functional testing when risk is elevated.

Third, the surveillance program is flexible, incorporating emerging medical technology. The David Drew Longevity study began not long after the development of new tools, such as cross-sectional imaging and genomic analysis. Over the program’s life, the ability to detect problems and risks has been augmented by the incorporation of many new procedures that have replaced obsolete tests or added to the process of collecting useful medical data.

Fourth, the program is affordable and practical. For a model program to be implemented broadly, the monetary cost must be reasonable in absolute terms and in proportion to gains achieved. It must also be no more than a modest logistical encumbrance to the participant. At the outset of the study, the annual cost of the program was limited to $2,500 and is now about $4,000. The average commitment of time by a participant is less than 4 hours per year.

Methods

Study group. Participants are recruited via conventional advertising methods in the Washington, DC, metropolitan area and from referrals from physicians and existing participants. For the years 1997-2021, data from all participants were included if they completed two or more consecutive years of evaluation.

Each participant undergoes an annual, in-clinic evaluation that is typically completed in three hours. It includes a comprehensive physician interview and examination, laboratory testing, body fluid cancer markers, medical body imaging, cardiovascular imaging, functional cardiac testing, body composition measurement, and genetic evaluation. All tests are commercially available.

Medical testing and follow-up. The type and frequency of administration of medical tests are individualized, based upon age, medical and family history, personal medical history, and results of prior testing. For a new participant, tests are prioritized and administered progressively over the first three years.

Participants are counseled regarding the results of their evaluations. Interventions are made as necessary to address current issues or risk factors for future medical problems. Immediately important findings are pursued and may result in referral to local or national specialists.

Most participants undergo additional biochemical screening at the midpoint of their evaluation year via collection at a convenient remote laboratory.

Data analysis. Death data for all qualified David Drew Longevity study participants during the years 1997-2021 were included. They were compared to death data for the entire US population for 2016 as reported by the US Social Security Administration. Average remaining years of life by age was also ascertained from this source. Reference data and David Drew study data are available for male and female gender.

For any given year of participation, the incremental productive years gained by a David Drew participant can be calculated as the difference between death rates for that exact age in the US population and in the David Drew study sample; times the average years of life remaining at that exact age; times the probability of having survived from the start of participation. The sum of these incremental values over the period of participation yields the average productive years of life gained during that time.

Results

During the study period, data for 18,327 patient-years were collected, of which 68% were men, 32% were women.

The results of this study have been computer-modeled. For any combination of gender and start/end ages, the model calculates the number of productive years gained, the total cost of participation, and the cost per productive year of life gained. For the specified interval, the model calculates and generates a graph depicting survival curves for David Drew Longevity study participants and for the general US population. The model also displays a graph depicting the incremental gain in productive life expectancy for each year of participation.

For any interval, the average David Drew Longevity participant achieves a greater number of productive years than their counterpart receiving usual health care. The increment can be substantial. Presented in the graph below is the predicted outcome for a man participating in David Drew’s longevity program for 35 years, beginning at age 50. He is almost certain to survive until age 65, by which time 15% of men in the general US population have died. The advantage widens thereafter. By age 82, when half of the male US population has died, he has an 80% chance of remaining alive.

Based on the annual cost of David Drew participation, each year of added productive life will have cost $19,800 and about 20 hours of examination time, spread over a five-year period.

Comment

The David Drew Longevity program achieves superior protection of productive years of life when compared to average US medical care. This is due in large part to the comprehensive nature of its surveillance and resulting health optimization. Whereas traditional medical care attempts to intercept some diseases proactively (such as breast and colon cancer), the list is not extensive. And in many cases, the best detection tests are not used because of cost constraints and delays in adoption.

David Drew’s Longevity program functions remarkably consistently as a function of age. Lethal diseases are less common in younger individuals, but discovery and cure preserves more productive years. Risk mitigation efforts instituted early are more likely to be disease-sparing later in life. In later life, fewer productive years remain to be rescued, but the likelihood of avoiding serious disease increases.

The David Drew Longevity program achieves greater preservation of productive years than predicted, based upon the track records of individual tests. In fact, for many tests that reduce the death rate from the cause detected, it is not possible to demonstrate an impact on all-cause mortality. This dichotomy arises from the fact that individuals have simultaneous susceptibility to multiple threats. It underlies the fallacy of evaluating individual test performance in isolation. More importantly, it underscores the critical importance of deterring all threats to productive years to maximize the value of a longevity program. This concept deserves elaboration; thus, the following example.

Imagine a population in which every person reaches the age of 65, but during the subsequent year will be diagnosed with end stage heart disease and incurable cancer, each expected to cause death before their 66th birthday. Then, with great fanfare, a universal cure for cancer is announced, and the death rate from cancer drops to zero. What happens to the all-cause death rate? It is unchanged, because now everyone dies of heart disease before age 66. This scenario exemplifies the importance of surveillance for, and prevention of, death from all causes to maximize productive years saved. Looking only for vascular disease, or only scanning for cancer, are incomplete strategies that fail progressively as a population ages.

The cost of an additional productive year of life is about $20,000 at David Drew Longevity. But what is a year of life worth? For the recipient and family and friends, it’s often priceless. In macroeconomic terms, the average American accounts for about $85,000 of gross national income annually. In public health parlance, a quality-adjusted life year (QALY) is one year of perfect health. For medical interventions that may prolong life, decisions about drug approvals and insurance coverage determinations are often based in part on the cost per QALY added. For drugs used to treat lethal diseases such as cancer, QALY values of $100,000 to $150,000 are usually found to be acceptable. In these contexts, the cost of extra years obtained at David Drew Longevity is modest. And at scale, that cost would be substantially lower.

Conclusion

This study demonstrates that the David Drew Longevity surveillance and health optimization program is highly effective in extending the productive years of life in American adults. It demonstrates that, between the years of 40 and 85, one additional year accrues for every five years of participation. Among advanced “longevity” programs, including executive health evaluations, cancer scans and stem cell facilities, David Drew Longevity is the only program to have established and quantified a substantial survival advantage. The program’s success and cost effectiveness render it an ideal model for replication and broad application.