Humans have — presumably — always aspired to living longer, healthier lives. Now that might be more possible than ever before — especially if you have enough money.
Think about the Fountain of Youth. Versions of the promise of a life-giving spring date to Ancient Greek philosophers, with variations through the centuries. But the basic concept was: Find the spring, drink its waters, and you’re young and spry again.
Today, people seem more inclined than ever to believe there is a path to better health, increased longevity and an improved healthspan — a term from the 1980s meaning that the quality and quantity of life can more closely align.
To meet this desire is a growing longevity and wellness industry.
Typically on the science side, in addition to doctors in traditional practices are the growing number of concierge medical practices across the country that offer a wide range of services to those who can afford them. Begun in the 1990s and expanding ever since, they eschew insurance in favor of annual retainers that can range from $4,000 to $45,000 or more.
The internal medicine or family medicine doctors who have started these practices are not necessarily better trained than the doctors who have stayed in the traditional insurance-model practices. But they have chosen to see fewer patients, spend more time with them, and offer in-house services — like scans, for example — that otherwise would have to be outsourced.
According to the Private Physicians Alliance, a membership group of concierge doctors, somewhere from 7,000 to 22,000 concierge medical practices operate in the United States today. That’s compared with nearly 400,000 insurance-based medical practices, according to the Bureau of Health Workforce.
Typically, a concierge doctor sees about 20 percent (or less) of the patients that an insurance-based doctor sees. That patient has the doctor’s cellphone and greater access to the doctor’s time.
The growing and expanding wellness industry doesn’t have criteria for entry. So aside from trained doctors, it also leaves room for those in the lucrative vitamin and supplement business, which has grown rapidly on the promise of enhancing health and longer life. In 2024, it was valued at $192 billion. Supplements can include tablets, capsules, powders and gummies.
Medications undergo stringent Food and Drug Administration review and are prescribed by doctors. Vitamins like D, B-12 and iron can be prescribed as well to address specific deficiencies that are identified in blood tests. Supplements, however — like collagen, creatine and fish oils — undergo less rigorous testing and are usually taken voluntarily, rather than prescribed by a doctor.
The F.D.A. puts more of the responsibility for their efficacy on the manufacturers. The American Medical Association has cautioned people from putting too much stock in supplements, which the F.D.A. treats as food and not medicine. Supplements often are sold in monthly subscriptions and frequently promoted by prominent podcasters and influencers, who often generate income through the sale of them.
Steve Mister, president and chief executive of the Council for Responsible Nutrition, a trade group for supplements, said the average person spent $50 a month on supplements and is more likely focused on longstanding ones that had proven benefits, like vitamin D, Omega 3 and calcium.
While he is concerned with influencers who make promises that aren’t backed up by science, he also pushed back against doctors who dismiss less-well-known supplements without understanding them. “They’re suspicious of these products because they’re not taught about them in medical school,” Mr. Mister said.
Combining standard drugs and supplements can be tricky — both for patients and for doctors.
“I had a patient who was on a statin but decided to add red yeast rice as a supplement to lower her LDL cholesterol,” said Dr. Cari Dawson, who runs the Colorado Center for Medical Excellence, a concierge practice in Denver. “The problem was she decided to take her statin every other day, and she took a supplement that you don’t know what’s in it all the time. She picked red yeast rice over a statin that we’ve studied for 30 years.”
Dr. Dawson said she often debunked what people had seen online about statins and supplements, contending that the information had no scientific support.
“There’s a lot of noise about statins online,” she said. “Yes, about 5 percent of people will get achy muscles with them. We know that’s real. But 95 percent of people do fine on this drug. And there’s an argument that everyone over the age of 50 should be on a statin to lower their cholesterol.” (She ultimately persuaded the patient to stick with the statin, she said.)
“The F.D.A. does not allow supplement companies to market their products as a substitution for prescription drugs,” Mr. Mister said. “I worry about misinformation all the time.”
Dr. Dawson said she understood, though, where this searching came from. “If you have anyone who has any distrust of the medical system, they’re always seeking out alternative treatments,” she said.
Dr. Anton Titov, founder of Diagnostic Detectives Network, is a supplement opponent, contending that their advocates are driven by financial gains — and playing on the distrust people have in institutions far beyond medicine.
“You can sell gazillions of supplements and vitamins. You have to see the patient to prescribe the statin. You can’t make money telling people to get on the maximum dose of statins to improve their cardiovascular health,” he said, about the supplement business. His practice finds experts in specialty areas to help clients solve their often complex medical issues. He said he charged a flat fee of around $6,000, which escalates if more experts were needed or he had to do more to connect patients and doctors.
To sort through the various approaches to longevity, a key question might be: What’s the best way to invest money in my health so I live well for decades to come?
Dr. Jordan Shlain, the co-founder of Private Medical who is considered one of the earliest concierge doctors, said the focus for everyone, regardless of wealth, was similar. Putting aside fatal accidents, there are four major causes of death: cardiovascular, neurological, cancerous and metabolic, he said.
“Your genetics are critical, and they account for 50 to 70 percent of your longevity,” Dr. Shlain said. “Then you get to these foundation things: sleep, exercise, diet and social nutrition. Sleep and social interactions are the most important things to focus on.”
To manage care through nontraditional medical practices, patients should expect different things at different price points. While the concierge practices generally have smaller patient loads, the offerings can become even more personalized.
Dr. Ramon Jacobs-Shaw, a Harvard-trained doctor who is board-certified in internal medicine and pediatrics, is a private doctor, generally defined as one who operates in a self-owned practice outside a larger medical system. He makes old-fashioned house calls from his base in Fairfield County, Conn., and does not see patients in an office. The cost for him to focus on you is $25,000 a year.
“The hallmark of patient care is that doctor-patient relationship,” he said. “Right now, it feels transactional. Health care should not be that way. It requires a relationship, and that requires time.”
Some concierge doctors are part of practice groups. MD2, which first opened in Seattle in 1996 and now has offices around the country, limits its doctors to 50 patients and charges $30,000 a year. Private Medical, which Dr. Shain co-founded, charges $45,000 a year for each patient and sees just 1,500 families in six locations in California, Florida and New York. The Atria Health and Research Institute costs $60,000. Its two locations, New York and Palm Beach, have in-house specialists, including cardiology, neurology and women’s health.
“What’s different about our approach is we focus holistically on the prevention of disease,” said Alan Tisch, Atria Health’s co-founder and chief executive. “We’re primary care plus 15 other specialties. We’re also lifestyle and psychology. We integrate all the most cutting-edge technology in-house so we don’t have to send you out for it. And we’re here to keep you healthy, but we’re also responsible for giving the best care for you and your family when you get sick.”
Meantime, regardless of the medical practices one chooses, Dr. Titov said the two things anyone could do to promote their longevity was to focus on their cardiac health and weight. “G.L.P.s [not inexpensive injectable drugs for weight management] are showing that all these other ailments go away when people lose weight. So, get to your ideal weight, and then do exercise.”
Dr. Aaron Wenzel, a former emergency room physician and weight-loss doctor, runs a concierge practice in Nashville that is focused on overall wellness. He charges $10,900 a year. “When I was doing E.R. medicine, I had this epiphany that the only people I ever saw improve their health removed excess fat from their body,” he said.
While G.L.P.s make it easier today, he said his practice focuses on helping people optimize their metabolism. It’s hard work, which is why he has sympathy for people who seek supplements as an easier route.
“I’m seeing a lot of people, regardless of economic firepower, be drawn to the noise of the new thing. But their diet, their fitness, their relationships are fragile.”
Those, he said, are what people need to spend their time and money on the most.
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