Just want to make sure this video from @DrFraser gets the audience it deserves. Very important information.
Let’s hit the like button to give his channel more reach.
9 Likes
You are too kind - I’m trying to get the one up of the panel discussion I did with the other 2 physicians on Rapamycin - that was a great talk. Just trying to get the source video from Vitalist Bay.
The video I think is useful in giving the construct to how to approach longevity medicine. We see so many people focusing on the minutia while missing the elephant in the room.
I’ve had a number of patients on rapamycin come to join my practice, who have had domains 1/2/3 completely unevaluated, and several have critical disease, completely undiagnosed, while pursuing all the clever things.
It isn’t clever to be on sirolimus and dasatinib/quercetin while having severe coronary artery disease, lots of white matter change in one’s brain, and a malignancy undiagnosed. I’ve seen this multiple times. People have to properly evaluate the things that are most likely to kill or disable them and manage those … THEN have a go at all the clever stuff.
8 Likes
Great talk! I think it would be better if we could see more of the slides and less of the couch though. Just an idea for the next time you do this!
I don’t think that’s how the YouTube algorithm works.
Primarily I think it’s
(1) CTR, click through rate.
If you don’t cover topics that people click on then people won’t watch the video. So the title and thumbnail needs to be accurate and interesting, and topics need to be designed with that in mind “What topic do people want to click on?” Clickbait doesn’t work because of
(2) Watch time
If people stop watching in the beginning of the video, then YouTube won’t recommend it to others as people want to watch something else. If they don’t stop watching in the beginning naturally more people will continue to watch.
(3) Continuing watching on YouTube
If people quit watching YouTube after they’ve seen your video maybe they weren’t satisfied with youtube, the last moments of the video if they keep watching need to keep them on youtube.
(4) Long term watching
If people don’t come back for the long term and want to watch your videos over time maybe they weren’t as satisfied they could be, more creators for long term watching keep more people on youtube.
Veritasium changed his approach and explicitly looked at similar youtubers when he did so after tips from MrBeast, categorized with the two videos(https://www.youtube.com/watch?v=fHsa9DqmId8 / https://www.youtube.com/watch?v=S2xHZPH5Sng). There’s a PDF by MrBeast used in his production companies (leaked?) that bring up many of these things: How To Succeed In Mr Beast Production : MrBeast : Free Download, Borrow, and Streaming : Internet Archive
If you look at the same google trend now after his change the effect is clear:
Some speculative non-expert feedback if I’m going to guess for the algorithm: There’s plenty of ways of grabbing attention in the beginning of a video. I don’t think the title or the disclaimer at the beginning of this one helps, it’s better to get straight to the talk, for example, I’m not a lawyer but maybe the disclaimer can be somewhere else, how do other medical info youtubers do it?
Maybe it’s important to be aligned with other aspects of work. How would a personalized medicine business for example reflect that personal nature? What type of videos and in what way, how are they filmed (scripted, if at all), for example? It’s probably important to not overthink it but still align with the overall principles in the two veritasium above and the MrBeast document would be my best bet, and it looks like it works, but I’m not an expert and I don’t personally know if it works. It’s hard and takes a long time regardless even with “best practices”, if there is such a thing.
But if someone else has a good idea. RapAdmin is the king of SEO it seems which is kind of like YouTube but for text and they probably have similar principles.
2 Likes
I agree. The disclaimer should be buried at least a minute into the video, not at the beginning. Probably include a few key clips at the beginning. Similar to how ModernHealthspan and Optispan produce their videos.
I would also cut that carbon monoxide audience question part out. It detracts from the value of the video (and makes it needlessly longer).
Overall, I enjoyed watching the video! It reminded me to get a CAC test for my wife in a couple weeks!
The word Vitalism has a somewhat checkered history. Maybe it is due for a reboot.
Nice to see a nod to Numberphile, one of my favorite YouTube sites.
Beautiful talk. A little fast for me, I would’ve liked more detail on some parts (neurological health!), but within a limited time frame a lot of territory was covered. One of those videos one should watch more than once.
2 Likes
I wish I had a local doctor this informed. Good job Dr Fraser.
1 Like
O3:
1 Curriculum Vitae — Dr Grant E. Fraser, MD, ABAARM, DABFM, FRACGP, FACRRM, GEM
| Section | Details |
|---|---|
| Current Roles | • Founder & Chief Physician, Grant E Fraser MD, PLLC – tele‑medicine longevity & regenerative‑medicine practice (AZ, CA, FL, KY, PA, TN, TX, WA, WI) (grantfrasermd.com) • Emergency‑Medicine Staff Physician, multiple hospitals in the Chattanooga–Nashville corridor (per‑diem) (doximity.com) |
| Clinical Interests | Longevity medicine • Preventive cardiometabolic care • Neuro‑cognitive risk modification (APOE ε4 focus) • Hormone optimisation • Point‑of‑care ultrasound • Acute & rural emergency care |
| Education | MD, University of California San Diego School of Medicine, 1994 (doximity.com) Residency (Family Medicine), Kaiser Permanente Southern California, 1994‑1997 (doximity.com) Advanced Specialty Training, Generalist Emergency Medicine (GEM), Australian College of Rural & Remote Medicine, 2011‑2016 (doximity.com) |
| Board Certifications & Fellowships | • American Board of Family Medicine (ABFM) (doximity.com) • American Board of Anti‑Aging & Regenerative Medicine (ABAARM) (a4m.com) • Fellow, Royal Australian College of General Practitioners (FRACGP) (doximity.com) • Fellow, Australian College of Rural & Remote Medicine (FACRRM) (a4m.com) • Generalist Emergency Medicine (post‑fellowship credential, ACRRM) (doximity.com) |
| Licensure (active) | CA (1995‑2027) • TX (1997‑2026) • TN (2016‑2026) • KY (2019‑2026) • AZ, AL, FL, WA, WI, PA (varying expiry) (doximity.com) |
| Awards | • Emergency Department Director of the Year – American Physician Partners, 2018 (doximity.com) • Critical‑Care Faculty of the Year – University of Queensland (visiting faculty), 2014 (doximity.com) |
| Media & Outreach | Creator, DrApoE4 YouTube channel – short evidence‑based briefings on APOE4 and brain health; >50 episodes planned (Rapamycin News) Author, longevity‑medicine blog posts and patient newsletters (grantfrasermd.com) |
| Professional Memberships | American Academy of Anti‑Aging Medicine (A4M) • American College of Lifestyle Medicine • Australian Medical Association |
2 Tidied Transcript (14‑minute talk)
Note: Filler words have been removed, and sentences have been punctuated for clarity. Time‑stamps are approximate anchors.
00:11 – 00:55
“Good morning. It’s my first time lecturing in this hall, so let’s see how it goes. We have an overwhelming amount of longevity data; the challenge is to compress it into a practical initial consultation. Weird and wonderful interventions can come later, but first we need a structured approach.
A quick reminder about me: I’ve spent decades in acute care and now focus primarily on longevity medicine.”
00:55 – 02:35
“My consultation starts with a morbid question: What will kill or disable this patient? Leading causes of death: vascular disease, cancer, accidents, infection, stroke, lung disease, Alzheimer’s, diabetes, renal and hepatic failure. Leading causes of disability mirror that list. Our job is to mitigate these predictable risks and extend both health‑span and life‑span.”
02:35 – 05:00
“I collapse three big domains—vascular events, metabolism, and malignancy—into one prevention bundle because the interventions overlap: optimise lipids, homocysteine, omega‑3 index, blood pressure, insulin sensitivity, diet, exercise, visceral fat, and keep the patient away from cigarettes.
Genetics matter, but they explain only ~15 % of outcomes, so we check them without being distracted. For example, 9p21 basically guarantees symptomatic coronary disease by age 50 in men and 60 in women. If the family history is strong, I image early.”
05:00 – 06:10
“Screening reality check: only 30 % of cancers even have a screening test, and those tests catch just a fraction of cases. Mammography modestly reduces breast‑cancer mortality; colonoscopy is better but still misses plenty. Hence I use CT coronary angiography and, for cancer, a 3‑tesla whole‑body MRI (SimonONE is US $1,250 for head‑to‑toe with MRA). If we find coronary plaque or white‑matter disease, patients suddenly care about treating their lipids.”
06:10 – 08:05
“Infection kills more older adults than most realise; frailty is the amplifier. Maintain muscle. Same logic with trauma: sarcopenia plus osteoporosis turns a ladder fall into the beginning of the end.
Neuro‑cognitive decline is a personal interest—my YouTube channel is ‘Dr ApoE4’. I run inexpensive online neuro‑psych testing (CNS Vital Signs, about $50) and aim to start interventions 20 years before expected symptom onset. Forty‑two percent of today’s over‑55s are projected to develop dementia.”
08:05 – 09:45
“I normalise hormones lifelong unless a clear contraindication exists—sex steroids, thyroid, adrenal, sometimes GH analogues when IGF‑1 is low. Lifestyle pillars—exercise, sleep, stress, community—still underpin everything. Environmental exposures (moulds, metals, plastics) and chronic infections are routinely screened. Periodontal disease strongly correlates with dementia and coronary disease; we treat it aggressively.”
09:45 – 11:05
“We tune nitric‑oxide pathways for cardiovascular and men’s‑health benefits, address mitochondrial health (methylene blue, NAC‑glycine, etc.), and use senolytics judiciously—I’m not sold on dasatinib + quercetin for every patient. Supplement lists are kept tight; a hundred pills can cancel each other out.”
11:05 – 12:05
“Pharma corner: SGLT‑2 inhibitors plus GLP‑1 agonists show roughly a 70 % lower incidence of dementia in community datasets. Telmisartan is my first‑line antihypertensive and the only one I push to max dose because of PPAR‑γ effects. Rapamycin plus acarbose appears synergistic in animal work. Metformin’s pros are tempered by possible sarcopenia.”
12:05 – 14:00
“In a typical 60‑minute new‑patient consult I get through about 70 % of that list and mop up the rest in follow‑ups.”
(Q&A excerpt)
Q: Routine screenings rarely cut mortality—why would a full‑body MRI be different?
A: Stage‑4 cancers are lethal; stage‑1 are almost always curable. MRI picks things up small. We lack outcome trials, but waiting for RCTs means we’re both dead before publication.
Q: How often should scans be repeated?
A: If we see an abnormality, that region gets rescanned in a year. For low‑risk patients with clean scans: whole‑body annually and head‑and‑neck every 3 years between 50‑60, every 2 years after 60.
(Minor discussion on carbon‑monoxide and radon monitoring concludes the session.)
3 Executive Summary
Dr Fraser outlines a risk‑first framework for longevity consultations:
- Start with the killers. Vascular disease, cancer, accidents, infection, and neuro‑degeneration account for most mortality and disability; prevention should target them first.
- Bundled mitigation. Because lifestyle and metabolic levers (lipids, BP, insulin, smoking cessation, exercise) influence cardiovascular, metabolic, and oncologic risk simultaneously, he treats them as a single package.
- Early imaging & genetics. CT coronary angiography and low‑cost whole‑body 3 T MRI are advocated to reveal silent disease; high‑penetrance genes (e.g., 9p21) flag who needs imaging even earlier.
- Frailty defence. Maintain muscle and bone to avoid the domino of falls, infections, and hospital complications.
- Cognition window. Begin dementia‑prevention 20 years before anticipated onset, especially in APOE‑ε4 carriers, using lifestyle, hormone optimisation, and selected pharmaceuticals (rapamycin, GLP‑1s ± SGLT‑2s).
- Lifestyle & environment. Sleep, stress, community, periodontal care, toxin avoidance, and chronic‑infection control are non‑negotiable foundations.
- Targeted pharmacology. Telmisartan, rapamycin, acarbose, SGLT‑2s, GLP‑1s, and curated supplements form the therapeutics stack; blanket senolytics and mega‑supplement regimens are discouraged.
4 Critical Appraisal
Strengths
- Risk‑oriented structure. Leading with actuarial causes of death keeps consultations focused on interventions with the largest absolute return.
- Emphasis on modifiable factors. Lifestyle and metabolic optimisation receive priority over less tractable genetics.
- Nuanced hormone view. He endorses replacement yet acknowledges contraindications and the need for personalised dosing.
- Real‑world pragmatism. The talk resonates with clinicians who have seen the downstream cost of “incidental” findings in the ER and wish to move upstream.
Limitations & Caveats
| Issue | Commentary |
|---|---|
| Evidence gap for routine whole‑body MRI. Early‑stage detection logic is compelling, but outcome data are absent; professional societies currently discourage screening MRIs outside research because of cost, incidentalomas, and unclear mortality benefit (ClearHealthCosts, Agency One). | |
| Radiation trade‑offs. CT coronary angiography delivers non‑trivial radiation; repeated scans may negate benefit in low‑risk patients. Risk‑stratified intervals are mentioned but not quantified. | |
| Over‑extension of pharmacology. Citing observational dementia reductions with GLP‑1 + SGLT‑2 combo risks post hoc fallacy; RCT confirmation is pending. | |
| Patient‑centred economics. Annual MRI plus genomics and advanced panels can run >US $3k/year—unaffordable for many. Cost‑effectiveness is not addressed. | |
| Generalisability. The framework is rooted in a North‑American private‑pay context; applicability to population health or publicly funded systems is limited. |
Overall Verdict
Dr Fraser delivers an engaging, clinically grounded blueprint that bridges emergency‑medicine scepticism (“avoid medical misadventure”) with proactive longevity care. The strategy excels at identifying actionable risks and motivating patient engagement. Its weak point is reliance on screening technologies whose net‑harm vs net‑benefit balance remains unproven. Clinicians adopting this model should incorporate shared decision‑making, disclose uncertainties, and stay alert to forthcoming evidence—especially around advanced imaging and pharmaceutical geroprotectors.
5 Likes
Is this using ChatGPT? Prompt?