Stanford University is one of the most elite universities in the country, with many distinguished alumni and — far more important — the highest applicants-to-admissions ratio, at least the last time I checked, but was a while back, admittedly.

So I imagine the medical school is at least as good, which leads me to my question:

What the hell, Stanford Medical?

The school has three notable alumni in the news at the moment: Peter Attia, Casey Means and Andrew Huberman. Peter Attia, the “longevity doctor” was tight with Jeffrey Epstein. Casey Means, the “functional medicine doctor” is Brainworm Bobby’s friend and surgeon general nominee. (Her confirmation hearing was postponed when Means went into labor, and hasn’t been rescheduled.) And Huberman, another bro-podcaster with women problems. Several women, several problems.

All three have also gotten heavily into the biohacking / supplements / functional medicine thing. Lots of people I know are into this to at least some degree; I’ve seen supplement arrays that cover half a kitchen countertop. I think what lured these docs into this space, however, is their proximity to Silicon Valley. They see all these geeks buying yachts and figure: Where’s my yacht? Or even my boat? Why suffer through residency, on-call nights, the various miseries of a fully realized medical education, which includes (ick) patients, many of them challenging, when you can just follow the medical-celebrity career arc? Write a book with your heavily retouched face on the cover. Offer a healthy life to people who are already pre-selected to have one. (In that they are young, educated, mostly white, already in pretty good health, i.e. the sort of people for whom simple, common-sense lifestyle changes are likely to have a big impact.) Start a podcast. Make your medical practice “concierge;” Attia charges $100K/year. Cozy up to the new administration. Cash checks, many of them.

I asked the smartest doctor I know what he thought of functional medicine and he said, “Some common sense. Some flam-flam,” which is about what I’d say. Yes, it’s wise to eat a balanced diet, get sufficient rest, exercise and all that. No, you probably don’t need a thousand labs to tell you you need a supplement, and isn’t it a coincidence it’s available in my online store. No, you can’t outrun your genetics, nor time itself. Enjoy your life; we’re all here for a visit.

My doctor friend forwarded this Substack essay about Attia, which I think is about right, too:

To be fair, Attia does some things exceptionally well. His discussions of healthspan, marginal decade, frailty, strength training, and metabolic disease have helped raise awareness among people who often overlook those topics. But outside his sweet spots, a different pattern emerges. Much of his output is average, derivative, or produced by a research team, and in the areas where I have deep expertise – lipoproteins, atherosclerosis, and cardiovascular disease – I hear him make basic errors, overextend mechanisms, or convert weak correlations into causal claims with confident prescriptions. If I notice these issues in the fields I know well, I have to ask what I am missing in areas I do not. Can he seriously be the authoritative voice on skin care and mental health too?

And then there is the 25 percent of his output that is genuinely extreme and, in my view, harmful: high-dose testosterone therapy with bodybuilders as expert guests and little discussion of known risks; supratherapeutic protein targets; experimentation with rapamycin; constant biometric monitoring; and quasi-clinical protocols unsupported by longitudinal human data. This is not harmless enthusiasm for fitness and can’t be written off as “bro-culture.” It is the medicalization of normal aging, which imposes physiological, psychological, and financial burdens on listeners who believe these protocols are prerequisites for a healthy life. I discuss these dynamics in detail in my JAMA Cardiology commentary.

If a practicing clinician inside a health system pushed such a regimen, oversight bodies would get involved. In traditional medicine, the doctor-patient relationship tempers certainty, forces contextualization, and ties recommendations to real consequences.

Enough about these sawbones. I watched Bad Bunny in the Bowl last night, and really liked the show. I was amazed by the logistics of it, how they were able to erect and strike such an elaborate set in the time allowed, all without tearing up the field. Then I went to bed. I gather the game improved in the second half.

What did you think?