You Read Outlive. Here Is How It Becomes Your Medical Care.

TL;DR: The book you read is a way of thinking. Care is a way of doing. If Outlive convinced you that waiting for disease is the wrong plan, the next step is a doctor who works that way: measure the right things early, train for the decades ahead, and treat risk before it becomes diagnosis. That is how this practice works, as a flat monthly membership, in Philadelphia and by telehealth in 40 states. Start by telling us your story and we will build the plan around it.

Plenty of people finish Outlive in a weekend and then sit with an odd feeling: the book handed them a better map, and their annual physical does not follow it. The 15-minute visit, the basic panel, the "everything looks normal" letter, none of it matches what they just read. If that is where you are, this page is for you. It walks through what the book's ideas look like when a physician runs them as your care, week over week and year over year.

What does Outlive ask of a medical practice?

The book's central move is a change in tense. Medicine as most of us have received it responds to disease that has already announced itself. The approach Attia calls Medicine 3.0 works on the 4 big killers, heart disease, cancer, neurodegenerative disease, and metabolic disease, during the long years when they are still building and still bendable.

That sounds abstract until you list what it demands from a practice:

• Time. You cannot work decades ahead of disease in 15-minute slots. The practice has to know your story, your family, your goals, and your data, and hold all of it across years.
• Better measurement. The standard panel misses the numbers that matter most for early risk. ApoB says more about heart risk than standard cholesterol reporting. A single Lp(a) test identifies a lifelong inherited risk most people have never heard of. A fasting insulin catches metabolic disease 10 or 15 years before glucose moves.
• Training, not just advice. Strength and cardiorespiratory fitness are 2 of the strongest predictors of how long and how well you live. A practice working this way treats them like vital signs and builds a plan to raise them.
• Follow-through. One ambitious visit changes nothing. The value comes from the loop: measure, act, remeasure, adjust, for years.

Our Medicine 3.0 guide covers the philosophy in depth. This page is about the practical half.

What do the labs look like in practice?

When a new member joins, we pull their history and run bloodwork that goes well past the standard annual panel. The additions the book made famous are the ones we lean on:

• ApoB, the particle count behind cholesterol, which tracks heart risk more directly than LDL alone.
• Lp(a) once in your life, because it is inherited, stable, and missed by every routine panel.
• Fasting insulin alongside glucose and A1c, because insulin rises years before glucose does, and catching that drift early is the whole game in metabolic health.
• hs-CRP for inflammation, homocysteine for methylation and vascular risk, and a full thyroid picture rather than TSH alone.

Numbers alone are not a plan. Each result gets read against preventive targets rather than the wide "normal" ranges built to catch established disease, and the ones that matter for you get a job: a change to make, a medicine to consider, a date to retest. Our lab and biomarker guides explain how we read each one.

Where do strength and fitness fit?

The book's chapters on exercise land hardest for most readers, and they translate directly into care. We ask every member about their week of movement in specifics: days of resistance work, days that leave you breathing harder, what you could carry up a flight of stairs today. When a DEXA scan is available, we read lean muscle mass and visceral fat against percentile targets and let those numbers steer the plan.

Then the plan gets small on purpose. A member starting from zero gets a 10-minute walk attached to something they already do daily, not a 6-day program. A member who lifts twice a week gets a progression. The aim is the same one the book argues for: build the reserve of strength and fitness now that the last decade of your life will spend.

What about cancer screening and the newer tests?

Attia pushes screening earlier and harder than many guidelines do, and this is where a thoughtful practice has to be honest rather than enthusiastic. We keep standard screening current first, because colonoscopy, mammography, and low-dose CT for the right smokers carry the strongest evidence there is. For members who are up to date and want to go further, we talk through whole-body MRI with diffusion-weighted imaging and multi-cancer blood tests with the honest numbers: what each can find, how often they raise alarms that turn out to be nothing, and what they cannot rule out. Our early cancer detection guide carries the details.

The point is that "more screening" is a conversation with trade-offs, not a menu. A practice that knows your history, your exposures, and your family tree can have that conversation properly.

Do I need a $60,000 concierge program for this?

The programs built around this philosophy often price it as a luxury. Concierge longevity practices commonly run from several thousand to tens of thousands of dollars a year, and at the top end past $60,000. The medicine inside them, the labs, the reading, the training plan, the follow-through, does not require that price. It requires a physician with time, and a practice built to give it.

Fishtown Medicine is a direct primary care membership with a flat monthly fee, and the details live on our membership page. You get a doctor who reads your whole story, orders and interprets the advanced labs, builds the training and nutrition plan with you, and answers your messages. That is the same work, without the velvet rope.

Can you do this if I do not live in Philadelphia?

Yes. The practice is based in Philadelphia's Fishtown neighborhood, and members here get in-person visits, including home visits. Dr. Ash is also licensed in 40 states, so members who live elsewhere, or who split the year between cities, do the same work by telehealth: the labs are drawn at a Quest or Labcorp near you, the DEXA happens at a center near you, and the reading, planning, and follow-through happen wherever you are. The current list of states lives at AL, AZ, CO, CT, DC, DE, FL, GA, GU, HI, IA, ID, IL, IN, KY, LA, ME, MD, MN, MO, MS, MT, NE, NH, NJ, NV, NY, ND, OH, OK, PA, SD, TN, TX, UT, VT, WA, WI, WV, WY.

book and a standard physical is time, measurement, training, and follow-through. - The load-bearing labs are ApoB, Lp(a) once, fasting insulin, and hs-CRP, read against preventive targets rather than disease-range "normals." - Strength and cardiorespiratory fitness are treated like vital signs, with a plan sized to where you are starting. - Standard cancer screening comes first; the newer tools are honest conversations for people already up to date. - This work does not require a concierge price. It requires a physician with time, in person in Philadelphia or by telehealth in 40 states.

Scientific References

1. Attia P. Outlive: The Science and Art of Longevity. Harmony; 2023.
2. Sniderman AD, et al. Apolipoprotein B particles and cardiovascular disease: a narrative review. JAMA Cardiol. 2019;4(12):1287-1295.
3. Tsimikas S. A test in context: lipoprotein(a). J Am Coll Cardiol. 2017;69(6):692-711.
4. DeFronzo RA, Tripathy D. Skeletal muscle insulin resistance is the primary defect in type 2 diabetes. Diabetes Care. 2009;32(Suppl 2):S157-S163.
5. Mandsager K, et al. Association of cardiorespiratory fitness with long-term mortality among adults undergoing exercise treadmill testing. JAMA Netw Open. 2018;1(6):e183605.
6. Srikanthan P, Karlamangla AS. Muscle mass index as a predictor of longevity in older adults. Am J Med. 2014;127(6):547-553.

Medical Disclaimer

This article is for educational purposes and is not a substitute for personalized medical advice, diagnosis, or treatment. Talk with your physician about your own history and risks before changing your testing, training, or medications.