Medicine 3.0, practiced.

Longevity medicine is a clinical approach focused on extending healthspan — the years lived in good function — not just lifespan. Where standard primary care waits for disease and treats it (“Medicine 2.0,” in Peter Attia's framing), longevity medicine measures the predictors of the diseases most likely to shorten healthspan and intervenes decades earlier (“Medicine 3.0”). The work centers on the four horsemen — cardiovascular disease, cancer, neurodegenerative disease, type 2 diabetes — and the biomarkers, lifestyle interventions, and medications that meaningfully shift trajectory. The discipline is well-established academically (A4M Fellowship, American Academy of Anti-Aging Medicine) and increasingly mainstream clinically.

Concierge primary care is the relationship and visit model — hour-long visits, direct access, no insurance friction. Longevity medicine is what we do inside that relationship. Most concierge practices stop at “we have more time.” Mt. Baker Medical adds the A4M-trained longevity workup — the biomarkers, the four-horsemen framework, the decade-scale protocol — on top. Practically: every concierge member here gets longevity-aware primary care as part of membership. You don't have to pay extra for the longevity orientation; it's the orientation.

Lifespan is how long you live. Healthspan is how long you live well — with cognitive function, physical capacity, and quality of life intact. The gap between them is what Peter Attia calls “the marginal decade”: the years at the end of life when medicine has gotten good at extending existence but bad at preserving function. Longevity medicine targets healthspan specifically. The goal isn't to add years at the end of life when most function is gone — it's to add functional years at every age along the way.

Biological age is an estimate of how old your body is functionally, separate from how many years you've been alive (chronological age). It's measured via epigenetic methylation panels — patterns of chemical marks on DNA that change predictably with age and accumulating biological stress. The most studied measures are GrimAge (predicted age based on a composite of mortality-associated patterns) and DunedinPACE (rate of biological aging — i.e., how many “biological years” your body is aging per chronological year). They're not perfect — the science is still maturing — but they provide a quantitative way to track whether longevity interventions are actually working over time.

ApoB (apolipoprotein B) is a protein found on every cholesterol particle capable of contributing to atherosclerosis. A single ApoB measurement counts the actual number of atherogenic particles in your blood — and the particle count is what drives cardiovascular risk, not the total cholesterol number. Two people can have identical LDL cholesterol but vastly different ApoB and therefore vastly different risk. The American College of Cardiology and the European Society of Cardiology now both recognize ApoB as a superior risk marker to LDL alone. Standard primary care still mostly orders the LDL panel because that's what insurance pays for and what's been done historically. We order ApoB because it's what actually predicts events.

VO2 max is the maximum rate at which your body can use oxygen during exercise — effectively the ceiling on your cardiovascular and metabolic capacity. It's the single most predictive biomarker for all-cause mortality and healthspan in adults, more predictive than blood pressure, cholesterol, smoking, or diabetes status. The good news: it's highly modifiable. Structured aerobic training (Zone 2 work plus higher-intensity intervals) can raise VO2 max meaningfully at almost any age. Most patients walk into the first visit not knowing their VO2 max. Most leave with a number and a prescription for how to raise it.

Galleri (multi-cancer early detection) — yes, we order it for patients where the risk profile justifies it. Whole-body MRI — we don't operate the equipment ourselves; we coordinate referral to imaging partners in Seattle or Vancouver and interpret the results in context of your broader workup. DEXA — we arrange and interpret. The general principle: we order the advanced screening that meaningfully changes the protocol. We don't reflexively order every available test, because over-testing creates incidentalomas and anxiety without changing outcomes. The first visit decides what's worth running for you specifically.

The framework is evidence-informed, which is a more honest descriptor. Many interventions are backed by strong evidence (statin therapy for ApoB, strength training for sarcopenia, ApoB and Lp(a) as cardiovascular predictors, vaginal estrogen for GSM). Some are backed by reasonable evidence with active research (continuous glucose monitoring for non-diabetics, biological age clocks). A few are based on biological plausibility plus emerging signal (rapamycin, certain peptides). We tell patients which category each recommendation falls in. Nothing in the protocol relies on “it works because it should.” Every intervention has a defensible reason and a falsifiable outcome we can track.

Functionally: adults in their 30s, 40s, 50s, and 60s who want to think proactively about the next thirty years rather than reactively about disease. Patients with family histories of early heart disease, dementia, or cancer often benefit most because their risk window opens earlier. High-output professionals whose cognitive and physical capacity is central to their work tend to find the framework intuitive. There's no “wrong” age — the earlier the workup, the more leverage the protocol has, but starting at 60 still meaningfully shifts the trajectory.

No — Mt. Baker Medical doesn't bill insurance for visits or workup. Concierge membership is $300/month individually and $570/month per couple, with 10% off for annual prepay; HSA and FSA funds are eligible. Membership includes the comprehensive longevity workup, annual re-panel, and ongoing protocol adjustment. Most lab tests can be processed through your insurance (we write the order, you fill it). A few specialty markers — biological age clocks, certain advanced lipid subfractions, multi-cancer early detection — are out-of-pocket. The specific cost picture gets laid out at the consultation.