The next frontier of longevity (part one)
In conversation with Dr. Cory Goldberg, Co-Founder and Chief Medical Officer of Healthspan Digital
Dr. Cory Goldberg is the former Head of Plastic Surgery at Trillium Health Partners. He trained in Plastic and Craniofacial surgery and has a Biomedical Engineering degree in stem cell science. Dr. Goldberg is passionate about Longevity Medicine and aims to maximize healthspan for all. He founded Healthspan Digital, which offers a proprietary Healthspan-as-a-Service (H-a-a-S) program for preventative, predictive, and personalized healthcare.
Superbeing sat down with Dr. Cory to discuss his journey into medicine, his passion for longevity, Canada’s healthcare system, the importance of community and social connectivity in promoting healthy longevity, and his company, Healthspan Digital. We explored the future of personalized healthcare using data analysis, health-centric home features, stem cell therapies, and the potential of aesthetic treatments in holistic health.
Below are excerpts from the interview. You can listen to the full audio below.
SUPERBEING: How did you get into longevity medicine?
DR. CORY: You enter medicine to help people through your training. I love being a plastic surgeon, interacting with people, and the benefits of surgery, but I've recognized there's more. It's not just about the aesthetic or surgical treatment.
It relates to people being healthy at a root cause level and maintaining that health for a beautiful appearance and confident outlook. My colleagues and I can help by empowering individuals with personal healthcare and a forward-looking approach to optimize their health. That's what led me into longevity medicine.
I have a master's degree in biomedical engineering and stem cell science. As these tools have developed, I have grown a passion for evolving the industry. Within the Canadian healthcare framework, I have noticed limitations in what a healthcare system can provide.
The current model in Canada and the US is a sick care system that waits for someone to become sick and then tries to fix it, when the issue could have been prevented or identified early.
In Canada, our healthcare system is in crisis, and people can’t get expected care from the public system. They will have to take care of themselves more.
This has led me to my passion for developing this industry, which will significantly impact public health globally.
SUPERBEING: What is longevity versus healthspan to you?
DR. CORY: As this healthcare develops, we need to define terminology and understand what we're discussing. In the healthy longevity community, there's a project to define 'healthspan'. Initial research found over 200 definitions of the term, making it challenging to discuss, define, and set an objective. You need to know what defines healthspan, and there's no consensus. Our community efforts aim to achieve that consensus and appropriate definitions for what these things are so that we know what we're developing. Fundamentally, the concept of longevity is about how long you would live – your lifespan.
Historically, people viewed aging through the lens of lifespan as the goal for longevity. The implicit assumption was that extending it was desirable. There was a firm belief that aging diseases were natural – blood pressure problems, arthritis, and all of these things.
The key differentiator from longevity to 'healthy longevity' or 'healthspan' is promoting extended life durations with extended health durations.
That leads to the term healthspan. The simplest definition is how long you're alive until you develop one significant chronic disease.
Some see healthspan simply, but I view it as a mathematical formula. In our sick-care model, health is binary: you're healthy or sick. Labeling someone sick because of a disease like diabetes is too simplistic. It is a spectrum. Healthspan is the total health a person has over their lifetime, added up over the duration of their life – and that will change over time. Disorders or infections will vary the amount of health you have at a given moment. Healthspan is the sum of health moments—like a calculus problem, it's the area under the health curve from birth to death. That is healthspan.
SUPERBEING: This next frontier of longevity is about targeting the biology of aging to slow it down and live our later lives healthier.
DR. CORY: When I introduce this concept to my colleagues, or during operations with my nurses or students, there’s an automatic reflex when I mention healthy longevity or health span. The immediate reaction is, “I don’t want to live longer. Why would I want to live longer?” The concept of living longer means living longer with diseases, being immobile, and being in a nursing home.
That's not the case at all. The premise is about improving health and increasing healthy longevity, so living a longer period of time and being vital and energetic enough to go dancing. We're trying to enhance people's quality of life and extend the duration.
SUPERBEING: We need to adjust to longevity, but we have this aging society narrative and see more old people as a burden. If we need to age differently, how do we change this conversation? What else do we prioritize for our health? It's not just about living healthy longer, but what do we change in our financial institutions and education system? How long will I work? How much more money do I need to save?
DR. CORY: I'll try to shift that narrative a bit because you should be excited about it. I'll start with the focus of living longer. Let's assume that healthy living is possible. Let's say you could be perfectly healthy from zero to 100. On your 100th birthday, if you chose to end your life, that would be it. 100 years of perfect health, running a mile daily, dancing, and enjoying intimacy with your partner. All of that until you're 100. From a financial point of view, that really changes things.
You work until you're 65, then stop, and the rest of your life you're taken care of. That doesn't fit anymore. It doesn't work for people saving for retirement. It doesn't work to think if we're supporting individuals from 65 to 100 and everybody lived that long in nursing or retirement homes, it would be an overwhelming and unmanageable burden. But that's not the point. We're talking about people being productive for longer.
People envision living to 65 and retiring, a very American phenomenon – middle class and the US pioneered the premise of golden years and then retirement. The AARP in the US is fixed to that model. That will need to change.
For healthy longevity and living longer, it's not about the drugs or therapies. The most important factor is your motivation and purpose: waking up with a sense of purpose.
A big part of that is your social network, partner, friends, and family. Those things motivate you to want to live longer, and that's a main driving factor for keeping you healthy and alive longer.
The idea of working until 65, then stopping to sit on a beach with margaritas... I've never viewed retirement that way. It's foolish, because then you stop having a purpose in life. Without purpose, your motivation for being alive and getting up, your cognition, all of it suffers. The existing model of work until 65 and then stop is not financially feasible, and it's not healthy. It's good for people to have a reason to get up. Work is not a bad thing; it's a way of being productive and contributing to society.
I'd look at it this way. We have a significant crisis. We lack enough people to handle the workload. Very few are actually labouring – it's a huge issue. It would be amazing to tap into our elderly population who are experienced, knowledgeable, and vital, energetic, and healthy – not the diseased, hospital-ridden individuals we've been conditioned to think of.
When you hit 60, you don't retire. You get another degree, go back to school. Why not become a professional, learn a new trade, and maybe you don't need to work anymore? You've saved enough to live off the savings, and at that moment, you can enter a new career. You could do something else with your life in another part of the world. This opens the door for people to enjoy and be productive longer. That means they are contributing to society. Your GDP will go up, social supports will increase – it's a benefit for everybody.
We take healthcare costs for granted. They're highest in Canada and the U.S., for different reasons. In the U.S., it's immense inefficiency due to the interplay between caregivers and insurance companies. In Canada, it's inefficiency due to unfortunate structuring and conflict between government and provincial health ministries. Overall, we spend a huge sum of money in every province, and the U.S. spends a lot on every person, regardless of state. And what's the outcome? Poor health.
In the past few years, U.S. life expectancy has decreased and infant mortality has increased. Healthcare spending doesn't reflect population health.
Now, we're looking at healthy longevity, and we go back to that person living to 100 with perfect health to that last moment. That individual is productive. What's their healthcare cost? It's next to nothing. It's about maintenance and prevention, with some cost and aftercare, but the per capita healthcare expense will drop dramatically.
The healthy longevity industry is key for societal productivity and reducing healthcare costs.
SUPERBEING: I'm thinking about the blue zones worldwide. I think about community structure and how people engage, and the things we're doing in society leading to chronic diseases and unhealthy habits. There's a big gap between how they live in these blue zones and here. What are your thoughts?
DR. CORY: You got it exactly right. As I mentioned earlier, the most important component of healthy longevity is social connectivity and the purpose, satisfaction, and connection it brings. That exists in the blue zones, and it doesn't exist much here.
Reflecting on our last conversation about the aging population and elderly, we've established a model where after 65, you can't work, you're too sick, and you should retire. Eventually, you go to a retirement home, then a nursing home, and then, it's the end. We view old people as unhealthy and separate from ourselves.
The model of multi-generation families living together or in the same community doesn't exist. As our parents age, they can't care for themselves. The next generation is too busy working and managing an accelerating lifestyle to provide care. The distances these families live apart make it impossible to be supportive.
We see our old people as needing to be put away somewhere and not living with us. I'd change that perspective. We should live close to our families and friends for that network. In Singapore, a Blue Zone 2.0, they give a financial bonus to families living within two kilometers. Parents and children aren't together but are close. Singapore has public transit and walking, so driving isn't necessary. That distance lets them interrelate. Grandchildren have babysitters, and you have multi-generational families and communities working together. That's healthy longevity.
Our technology, devices, and work-from-home model (popular post-pandemic) offer benefits but are extremely isolating. People working remotely or in a hybrid model are disconnected, spending time on devices away from others, leading to unhealthy isolation. We need to encourage work and home environments that foster social interconnectivity.
This will come down to real estate and community developments – building homes and communities around public spaces that encourage physical activity and modes of transportation like walking and biking.
This needs to be instituted at the level of our homes and communities. The future of real estate in terms of healthy longevity and wellness will be communities that do that.
At Healthspan Digital, which I've helped co-found, we're pioneering the development of communities around healthy longevity, not just having a basement gym. It requires more than that to make people social and enjoy the outdoors, which comes from a development level.
When I first got involved in the healthy longevity space, I expected the consumers would be those later in life, approaching their later years, wanting to be healthy. I was surprised that the younger population – mid 20s to early 40s – are the most in tune with their health and desire to be healthy. This comes from a sense of self and wanting to care for oneself, which past generations lacked. People were conditioned to think they weren’t important and that looking after yourself or trying to look good was vain. It was a strange mentality.
Young people are looking after themselves and their parents. They see their parents facing health issues. They want to do better and be healthy. The gateway to older people is through their children, who will bring technologies and knowledge to their parents, helping expand this field.
SUPERBEING: Do younger generations feel traditional medicine practices failed them? What's changed since you started in your medical practice? What do you wish we could do differently in healthcare today? What's missing?
DR. CORY: I compare our public healthcare system to the Titanic. It's too massive and cumbersome to turn or too damaged to be saved. We could debate whether the iceberg is ahead or behind us – it doesn't matter. It has long passed.
Our system can't change for our population, and it's beyond repair. People need to find alternatives and ways to care for themselves. A fix is not coming.
Our tax base shrank in the nineties. Canada's healthcare system is 50 years old. Initially, universal healthcare was solid, but now it can't operate the same way. We're expecting it to, despite a decreased tax base. For every person over 65, there were 7.7 workers; now it's 3.4. In the nineties, we had enough workers and tax revenue. Now, 25-30 years later, we have fewer workers and resources.
The pandemic worsened the situation. Anyone who could escape did. Any physician who could retire or find alternative income did. Any nurse who could leave the hospital system did too. There's a huge nursing shortage, but many have left. They don't want to be in hospitals. We're facing a world with insufficient revenue, workers, and increased healthcare delivery costs. There are more tools and costs. There's also more liability, necessitating hospital and infrastructure adaptation, leading to additional expenses.
The last issue is hospital inefficiencies. The cost of care in the public system is far too high. I'm a surgeon, and I can tell you the cost to run an operating room in a hospital is $2,500 to $4,000 an hour. In a private center, that would be less than $1,000. By private center, I mean privately delivered, publicly funded, like x-ray or blood work at a lab paid for by OHIP. A private operating room would be a third to a quarter the cost of the public systems, and they have high turnover time, over an hour between cases.
Due to huge inefficiencies in operations and management, the output is much less. One of Canada's largest hospitals has more administrators than physicians. Our system hasn't adapted.
Your question: what's the public healthcare system and what's the solution?
The solution is a personal healthcare system that supports people in obtaining, managing, and monitoring their own health and that of their family, avoiding the public healthcare system.
Our public healthcare system is past crisis. It may not be fixed in my lifetime. It's up to us in this industry to help democratize and bring these tools to people to take care of their own health and be aware of what’s going on in the public system, and where we can and can’t depend on it.
Stay tuned for part two of ‘The Next Frontier of Longevity’ with Dr. Cory Goldberg, coming next week.
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