Hearings to examine optimizing longevity from research to action.

1[Senate Hearing 119-40]2[From the U.S. Government Publishing Office]34                                                        S. Hrg. 119-4056                         OPTIMIZING LONGEVITY:7                        FROM RESEARCH TO ACTION89=======================================================================1011                                HEARING1213                               BEFORE THE1415                       SPECIAL COMMITTEE ON AGING1617                          UNITED STATES SENATE1819                    ONE HUNDRED NINETEENTH CONGRESS2021                             FIRST SESSION2223                               __________2425                             WASHINGTON, DC2627                               __________2829                           FEBRUARY 12, 20253031                               __________3233                           Serial No. 119-033435         Printed for the use of the Special Committee on Aging3637[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]3839        Available via the World Wide Web: http://www.govinfo.gov4041                              __________4243                   U.S. GOVERNMENT PUBLISHING OFFICE4459-971 PDF                  WASHINGTON : 20254546-----------------------------------------------------------------------------------4748                       SPECIAL COMMITTEE ON AGING4950                     RICK SCOTT, Florida, Chairman5152DAVE McCORMICK, Pennsylvania         KIRSTEN E. GILLIBRAND, New York53JIM JUSTICE, West Virginia           ELIZABETH WARREN, Massachusetts54TOMMY TUBERVILLE, Alabama            MARK KELLY, Arizona55RON JOHNSON, Wisconsin               RAPHAEL WARNOCK, Georgia56ASHLEY MOODY, Florida                ANDY KIM, New Jersey57JON HUSTED, Ohio                     ANGELA ALSOBROOKS, Maryland58                              ----------59                McKinley Lewis, Majority Staff Director60                Claire Descamps, Minority Staff Director6162                        C  O  N  T  E  N  T  S6364                              ----------6566                                                                   Page6768Opening Statement of Senator Rick Scott, Chairman................     169Opening Statement of Senator Kirsten E. Gillibrand, Ranking70  Member.........................................................     27172                           PANEL OF WITNESSES7374Dr. Rhonda Patrick, Ph.D., Founder, FoundMyFitness, San Diego,75  California.....................................................     376Dr. Eric Verdin, MD, President, and CEO Buck Institute for77  Research on Aging, Novato, California..........................     578Dr. Sarah C. Nosal, MD, FAAFP, Physician, President-Elect,79  American Academy of Family Physicians New York, New York.......     780Dan Buettner, Founder, Blue Zones Miami, Florida.................    128182                                APPENDIX83                      Prepared Witness Statements8485Dr. Rhonda Patrick, Ph.D., Founder, FoundMyFitness, San Diego,86  California.....................................................    2987Dr. Eric Verdin, MD, President, and CEO Buck Institute for88  Research on Aging, Novato, California..........................    3189Dr. Sarah C. Nosal, MD, FAAFP, Physician, President-Elect,90  American Academy of Family Physicians New York, New York.......    3391Dan Buettner, Founder, Blue Zones Miami, Florida.................    399293                        Questions for the Record9495Dr. Eric Verdin, MD, President, and CEO Buck Institute for96  Research on Aging, Novato, California..........................    4397Dr. Sarah C. Nosal, MD, FAAFP, Physician, President-Elect,98  American Academy of Family Physicians New York, New York.......    4599100                       Statements for the Record101102James C. Appleby Testimony.......................................    49103The Alzheimer's Association & Alzheimer's Impact Movement104  Testimony......................................................    51105Dr. George C. Shapiro Testimony..................................    54106107                         OPTIMIZING LONGEVITY:108                        FROM RESEARCH TO ACTION109110                              ----------111112                      Wednesday, February 12, 2025113114                                        U.S. Senate115                                 Special Committee on Aging116                                                    Washington, DC.117    The Committee met, pursuant to notice, at 3:34 p.m., Room118106, Dirksen Senate Office Building, Hon. Rick Scott, Chairman119of the Committee, presiding.120    Present: Senator Scott, McCormick, Justice, Johnson, Moody,121Husted, Gillibrand, and Alsobrooks.122123       OPENING STATEMENT OF SENATOR RICK SCOTT, CHAIRMAN124125    The Chairman. The Senate Special Committee on Aging will126now come to order. I want to thank all of you for being here127today. Every member of this Committee is a parent, and most of128us, well, some of us are grandparents, I'm a grandparent and129living a long and healthy life is something that is very130important to me, and I'm sure to all of our members on this131Committee, but having more time with our loved ones is only132half the issue.133    My hope is your focus on today is extending not just our134lifespans, but the number of years we live but also our health135spans; the number of years we live free of disease or136disability. I'm trying to make sure I have none of those.137    It's no secret that we're facing significant health issues138in our country. Americans are plagued by preventable chronic139diseases, cancers, and other illnesses, and these are, not all140of them, but many of them are preventable. Heart disease,141cancer, diabetes are the leading causes of death and disability142in the United States. It's a massive problem. Six in ten143Americans have at least one chronic disease, and four in 10144have two or more chronic diseases according to CDC.145    Here's the good news, healthy life choices can mitigate, in146some cases, completely prevent these illnesses, and if you147start anytime in your life, you can change your life. I believe148that the American people make smart choices when they have good149information. In Florida, we see that ahead of every hurricane150season, when families understand the dangers of inaction, they151make the decision to do what is best for themselves and their152loved ones. With hurricanes, we say that preparedness saves153lives, and it does. It's no different for our health.154    Think about this way, preparedness happens when education155is met with action. Just having the information is not enough,156you got to take action with it. Unfortunately, the American157people are being underserved in both categories, education, and158action.159    Too much of the conversation around health these days is160reactive instead of preventative, we spend a lot of time161talking about how to deal with health issues and not enough162time talking about the simple ways to prevent these illnesses163in the first place.164    Even more frustrating is that there is a huge amount of165research out there showing how Americans can live longer,166healthier lives, but an inexcusable lack of action to put these167best practices in place. That's what today's hearing will be168about-turning research into action that improves the health and169wellness of Americans, so we can all enjoy living longer,170healthier lives, and spend our senior years enjoying time with171family.172    It's time to put a lot more focus and action on wellness173and prevention. As our witnesses here, will discuss, it's not174too late for anyone, even our seniors, to start making informed175choices that lead your healthier, happier, and longer lives.176That's why I'm proud to be part of the MAHA Caucus here in the177Senate. I look forward to working with RFK Jr. and Mehmet Oz to178create a healthier country.179    The issue of longevity is also something our government180should be more focused on. When Americans live healthier lives,181healthcare costs come down. The chronic diseases I mentioned182before, also leading drivers of America's $4.5 trillion in183annual healthcare costs according to CDC. We're all fiduciaries184of the American taxpayers, and we can do something that helps185people live healthier lives while saving taxpayer money.186Everybody wins.187    I look forward to an insightful discussion today on how we188can advance good research, take action that improves wellness189for American seniors today and for generations to come. Now let190me turn it over to the Ranking Member, Senator Gillibrand.191192                 OPENING STATEMENT OF SENATOR193             KIRSTEN E. GILLIBRAND, RANKING MEMBER194195    Senator Gillibrand. Thank you, Chairman Scott for calling196today's hearing. We all want to live a long and full life.197Longevity brings people so many wonderful things like198opportunities to spend time with their family, to travel, and199to continue to thrive. Ensuring that we remain healthy as we200age is our utmost importance.201    Today we'll hear from four witnesses who represent four202components of healthy aging, research, nutrition, exercise, and203medicine. We all know that we should eat a healthy diet, remain204active, seek preventive care, and avoid habits that contribute205to disease. As we'll hear from Dr. Nosal, so many Americans do206not have access to affordable healthcare, stable housing,207financial security, or even walkable communities, so we need to208address some of those impediments and some of those challenges.209    We also know that these factors, often called social210determinants of health, are often key to understanding how we211can then allow for people to make those healthier choices.212Those structural barriers often make it hard to achieve health213at any age.214    Congress has to do more to ensure that all people are able215to meet their basic needs so that they can learn how to216optimize their longevity and their health. It's why I've217introduced the strategic plan for aging in the last Congress.218This bill would provide states with critical funding to219transform their infrastructure and build communities that meet220the needs of older adults and future generations.221    It would address everything from housing to healthcare to222food insecurity, to make sure these systems are able to support223our aging population, and I'm proud that my home State of New224York is in the process of developing a strategic plan. These225are positive steps to helping older adults achieve longevity.226    We are all aging, which is not in and of itself a disease,227but a natural process, and we have a duty to ensure all228Americans can age well and age gracefully. I look forward to229hearing from today's witnesses.230    The Chairman. Thank you, Ranking Member Gillibrand. I'd231like to welcome our witnesses here today. Before we introduce232our first witness, I'd like to ask each of you to be mindful of233our limited time here today and keep everyone's opening234statements to five minutes.235    First, I'd like to introduce Dr. Rhonda Patrick. Dr.236Patrick is a scientist and health educator recognized for her237leadership and nutrition, aging, and disease prevention. Dr.238Patrick earned her Ph.D in biomedical science, conducting her239graduate research at St. Jude Children's Research Hospital.240    She completed her postdoctoral fellowship at Children's241Hospital Oakland Research Institute and has also conducted242research on aging at the Salk Institute for Biological Studies.243Dr. Patrick's goal is to challenge the status quo and encourage244the wider public to think about health and longevity using a245proactive preventive approach.246    As the founder of FoundMyFitness, she shares expert247evidence-based insights on aging and disease prevention with248her own unique brand of scientific rigor, engaging millions249through her website, podcast, and YouTube channel, where she250has a combined following of more than two million people across251the world. Dr. Patrick.252253       STATEMENT OF DR. RHONDA PATRICK, PH.D., FOUNDER,254             FOUNDMYFITNESS, SAN DIEGO, CALIFORNIA255256    Dr. Patrick. Thank you, chairman Scott. Yes, my name is257Rhonda Patrick. I'm happy to be here today, and is this just an258introduction I'm doing or is this my opening statement?259    The Chairman. We're glad you're here. If you want to do260your opening statement now. Yes.261    Dr. Patrick. Okay. We have to ask ourselves if we can call262ourselves the greatest nation in the world, while 70 percent,263nearly three out of four adults, are overweight or obese. While264we spend about 18 percent of our GDP on healthcare, more than265any other nation, and yet we rank 55th in life expectancy.266    Our children are getting type two diabetes at unheard of267rates. This is not just a health crisis; it is a cultural268crisis. Obesity is not inevitable. It is not an act of God. It269is something that can be prevented, it is a choice that has270been compounded by bad habits over time. It is reinforced by a271culture that does not foster good decisionmaking and self-272discipline.273    We have created a culture where these difficult truths have274become personal attacks, where physicians are afraid to talk275about a patient's weight because it's too taboo. If we can't276have a conversation about obesity, how can we ever solve the277obesity crisis?278    Obesity is associated with 13 different types of cancers.279It takes between three to ten years off of life expectancy. It280damages DNA, causes double stranded breaks to DNA, which is the281precursor to oncogenic mutations, and it fundamentally282accelerates the aging process, and yet, it is the principal283difference between our Nation and the longest-lived nations.284    We are overfed but undernourished. About 60 percent of285daily total calories consumed by the average American come from286ultra processed foods. These foods are caloric rich, they are287nutrient poor, they do not increase satiety so people do not288get satiated. They continue to overeat, they gain weight.289They're cheaper than whole foods, so people are economically290incentivized to eat unhealthily, and they activate the dopamine291reward pathways in our brain causing addiction.292    This trifecta of no satiety, low cost, and addiction really293kind of spiral us into this process of poor health outcomes and294runaway healthcare costs, and overconsumption of calories is295actually not the only problem, we are also micronutrient296deficient.297    The food we eat is supposed to provide us with essential298vitamins and minerals that run our entire metabolism. Omega-3-299about 80 to 90 percent of Americans have low Omega-3 levels. We300now know that low Omega-3 levels have the same mortality risk301as smoking.302    Vitamin D deficiency-easily corrected. Vitamin D gets303converted into a steroid hormone that basically runs about five304percent of our protein encoding human genome. Everything from305immune function to brain function to cancer. Very important,306easily corrected.307    Magnesium-about half the country does not get enough308magnesium from their diet. Magnesium is essential for over 300309enzymes in the body, including repairing damage to our DNA.310    DNA damage is happening every day. It's not something you311can see in the mirror; it's not something that you're going to312know about on a day-to-day basis, but it is what promotes313cancer, so decades later, it rears its ugly head.314    The real problem is simpler, we actually need to start315thinking about physical inactivity as a disease. We now know316that it carries the same mortality risk as smoking,317cardiovascular disease, and type two diabetes. Yet when the318average American reaches age 50, they lose about 10 percent of319their peak muscle mass, by the time they reach age 70, they're320losing about 40 percent of their peak muscle mass, and this321isn't just about looking strong, it's about physical322independence. It's about survival, so higher muscle mass is323associated with a 30 percent lower all-cause mortality. Grip324strength is actually a better predictor of cardiovascular325related mortality, the number one killer in United States than326high blood pressure, and yet nobody talks about it, and327strength is also associated with a 42 percent lower dementia328risk, and yet, we think of resistance training as an add-on as329a luxury. It is not, it is a fundamental pillar of aging. It330increases muscle mass, muscle strength, and bone mineral331density.332    Fractures are a death sentence between 20 to 60 percent of333Americans that have a hip fracture die within a year, and yet,334resistance training can lower fracture risk by 30 to 40335percent. This is preventable. We have the information, we have336the data we need to take action and resistance training,337exercise, getting the right foods are the most important things338that we can do to prevent disease and make a difference in our339country, so thank you.340    The Chairman. Thank you. Next, I'd like to introduce Dr.341Eric Verdin. Dr. Verdin is the president and Chief Executive342Officer of the Buck Institute for Research on Aging, the343world's only research institution singularly focused on the344biology of aging, yielding insights into age-related diseases345before they start.346    Dr. Verdin received his Doctorate of Medicine from the347University of Liege and complete additional clinical and348research training at Harvard Medical School. Dr. Verdin has349published more than 300 scientific papers and holds more than35023 patents. He has held faculty positions at the University of351Brussels, the National Institutes of Health, the Picower352Institute for Medical Research, and the Gladstone Institutes.353He's also a professor of medicine at University of California354San Francisco. Dr. Verdin.355356          STATEMENT OF DR. ERIC VERDIN, MD, PRESIDENT,357358             AND CEO BUCK INSTITUTE FOR RESEARCH ON359360                   AGING, NOVATO, CALIFORNIA361362    Dr. Verdin. Good afternoon, Chair Scott, Ranking Member363Gillibrand, and members of the Committee. Thank you for the364opportunity to speak today.365    As Chair Scott mentioned, my name is Eric Verdin. I run the366Buck Institute for Research on Aging in Northern California.367This Buck is the leading research organization in the world368focused on the biology of aging. Our mission is to eliminate369the threat of chronic disease by addressing the aging process370itself.371    Over the past century, public health advances and medical372breakthroughs have nearly doubled lifespan. This incredible373success has come with a number of challenges. We live longer,374but not healthier. The end of our long lives is now375characterized by a whole series of debilitating diseases,376including Alzheimer's, Parkinson's, heart attacks, strokes,377type two diabetes, cancer, osteoarthritis, macular378degeneration.379    By the time an American reaches age 65, most have at least380one chronic disease of aging, and 70 percent have two. We call381these conditions the chronic diseases of aging.382    Our current healthcare system is focused on treating these383conditions when they occur, not in preventing them in the first384place. This approach is expensive, inefficient, and ultimately385ineffective. The cost of managing these illnesses is actually386staggering, increasing as our population ages and places an387unsustainable financial and emotional burden on our healthcare388system, our citizens, and their families.389    In the 20th century, we dramatically reduced death from390infections, from heart disease and from cancer, extending life391expectancy in the process, but progress is slowing. Even if we392cure cancer tomorrow, the average lifespan would increase by393less than three years. The reason is simple: Aging itself and394its associated complications continue unchecked.395    Aging is the greatest risk factor and the main driver for396these chronic diseases. The good news is that we now know from397research from the past 20 years, that aging can be slowed, and398we have preliminary evidence that it can actually be somewhat399reverted in some cases, thereby extending a healthy lifespan400and delaying disease in animal model systems. There is not a401single reason why these findings should not apply to humans as402well.403    By focusing on aging and its mechanisms, we can compress404the period of illness associated with aging so that our later405years are spent in good health. The economic and public health406benefits of a shift from a reactive healthcare system to true407preventative healthcare based on our understanding of aging,408are enormous. Studies suggest that delaying aging will generate409trillions of dollars in economic gains, reduce medical costs,410and increase productivity, just as vaccines and antibiotics411revolutionized medicine in the past, aging science is the next412great frontier in preventive healthcare.413    The science is at a turning point, and as policymakers, you414will play a critical role in ensuring that we realize its415benefits. Investing in aging research must be your priority.416The NIH should increase funding on the molecular pathways of417aging, with a new emphasis on translating discoveries into418human applications.419    We also need a much greater focus on lifestyle420interventions, nutrition, exercise, sleep, stress management,421and social connections. These variables account for more than42290 percent of our health-span and our lifespan and should be an423essential part of our health policy and our research.424    We must also rethink how we allocate healthcare dollars.425Right now, we spend trillions on treating diseases after they426arise. A shift toward prevention, one that targets aging427itself, would be far more productive and effective. The FDA428needs clear guidelines for therapies targeting aging.429    Biotech and pharma companies are investing in this field,430but without a defined regulatory pathway, progress is slowed.431Finally, we need stronger public private collaborations.432Translating discoveries into real world application will433require coordinated efforts between industry, government, and434regulatory agencies.435    This is a pivotal moment. The 21st century has the436potential to witness one of the most profound medical437breakthroughs in history, not just treating age-related438diseases, but preventing them. The goal is not just to extend439lifespan, but to ensure those extra years are spent on health,440dignity, and independence.441    I applaud the Committee for recognizing the urgency of this442issue. Aging research is at an inflection point, and with the443right policies, we can transform public health for generations444to come. I look forward to working with you to make this vision445a reality. Thank you.446    The Chairman. Thank you, Dr. Verdin. I'd like to recognize447Ranking Member Gillibrand to introduce her witness. Thank you.448    Senator Gillibrand. Dr. Sarah Nosal is a family medicine449physician who practices at a federally qualified health center450in the South Bronx. She's also the President elect of the451American Academy of Family Physicians. Thank you for being452here, Dr. Nosal.453454          STATEMENT OF DR. SARAH C. NOSAL, MD, FAAFP,455456        PHYSICIAN, PRESIDENT-ELECT, AMERICAN ACADEMY OF457458              FAMILY PHYSICIANS NEW YORK, NEW YORK459460    Dr. Nosal. Thank you so much. Chairman Scott, Ranking461Member, Gillibrand, and members of the Committee. Thank you for462the opportunity to testify today. My name is Sarah Nosal and463I'm a practicing family physician in the South Bronx. As the464President-elect of the American Academy of Family Physicians,465I'm honored to be here today representing more than 130,000466physicians and student members of the AAFP.467    I currently work at the Institute for Family Health, a468network of federally qualified health centers with more than 27469locations across New York State. I am proud to be a family470physician. In my office I have the honor and privilege of471taking care of not just patients, but families and communities.472    Last month, Chairman Scott laid out his priorities, which473identified four aspects of someone to be well: having their474physical health, financial security, a safe community to live475in, and family and community support. Each of these are rooted476in the very fundamentals of family medicine.477    I have practiced for more than two decades in a community478that ranks last for health outcomes in New York. My personal479patient panel approaches nearly 90 percent Medicaid480beneficiaries. A typical patient of mine presents with cane in481hand, living with HIV, diabetes, hypertension, and chronic482kidney disease. Patient tailored counseling on diet and483exercise is something I do on every visit.484    Unfortunately, while I talk about the importance of eating485healthy whole foods, the reality is most of them are often out486of reach, financially or otherwise inaccessible to most of my487patients. This is only one of the health-related social needs488that impact them. A lack of stable housing, reliable489transportation, safe places to exercise and financial security490also make it difficult, if not impossible for my patients to491afford medications and even make it to medical visits.492    Research has consistently shown that health related social493needs can worsen health outcomes. On more than one occasion494when I've asked a patient why they were not taking their495insulin as I directed, I would learn that they did not have496electricity in their apartments for the last few weeks when497they fell behind on rent. Patients at our rural clinic have498been known to walk long distances along roadsides without499walkways.500    At our urban clinic, patients with walkers face four501flights of stairs at the subway. Many of my patients experience502food insecurity for which the USDA SNAP program is a lifeline.503Congress can strengthen to ensure it better serves those in504need. However, that alone will not solve my patients'505challenges. While diet and exercise are important to health and506wellness, we cannot ignore that many communities are designed507with them out of reach. Food and exercise can only be medicine508if they're easily accessible.509    As a family physician, I recommend a healthy diet and510working out, but it is up to you, our elected leaders, to511ensure the resources are in place to fill that prescription.512Congress must support promising innovative policies to address513health related social needs, such as expanding Medicaid514coverage for reimbursable services.515    For example, some states have used existing Medicaid516authorities to provide medically tailored meals to whole517households, not just the eligible beneficiary. This recognizes518that a food insecure parent will often give their meal to a519hungry child rather than feed themselves.520    Many of my younger middle-aged patients are caregivers for521both young children and older relatives. Any reforms that522affect their healthcare coverage may impact their employment,523their ability to help their mother make rent, to take their524grandma to the laundromat or contribute to any productive,525meaningful way in their community. Insurance does not help526patients if there is no access to care.527    Community health centers provide care to those in528underserved areas and are often the only accessible care529setting for many. CHCs have a significant economic impact and530are incredibly efficient in terms of healthcare spending.531Further, many CHCs are training the next generation of family532physicians through HRSA's Teaching Health Center Graduate533Medical Education Program.534    Thanks to THCGME, our system has multiple family medicine535residency programs. THCs have the highest success rate of any536program for retaining residents in communities of need.537Unfortunately, CHS and THCGME rely on a patchwork of538inconsistent temporary federal funding. Right now, both539programs are only funded through March 31st.540    To support and improve the quality of life for all patients541and in all communities, I urge Congress to make long-term542funding for CHCs and the THCGME a priority. In closing, thank543you again for this opportunity to testify, and I look forward544to answering your questions.545    The Chairman. Thank you. We do have one more witness546coming, but he's had some travel issues, so he'll be here in547just a few minutes, so we'll go ahead and go to questions and548I'll start.549    First off, thanks to all of you for being here. Thanks for550caring. Dr. Patrick, our healthcare system is broken. It's551reactive, not preventative. How do we get more longevity552focused care into mainstream medicine and what's standing in553the way?554    Dr. Patrick. Well, I think that the most important thing555that we can do right now for longevity medicine is actually556move more, and I think that the federal exercise guidelines are557sort of out of date, to be honest. We don't focus at all on558resistance training, it says two days a week. What does that559mean? I mean, to be honest, people might just start doing some560bicep curls, and I mean that there's not information there.561    You need to give people specific information, actionable562information. I think resistance training. OK, well, you can do,563you know, seven or eight-or fifteen workouts throughout the564week, and that's as good as doing three 45-minute workouts in565terms of gaining muscle mass and strength, so giving some more566specifics in terms of like types of exercise also, compound567lifts, like you want to basically make people be physically568independent, so you don't want biceps, you want people to be569doing squats or you want them to be doing you know, rows or,570dead lifts. Things like these that are multi-joint, right.571    I also think exercise snacks is a big one, so there's572nothing in the guidelines about how people can get exercise573benefits by doing these short bursts of physical activity. Tons574of research coming out on this, I mean, we're talking, a recent575study just showed that doing 10 body weight squats every 45576minutes over a seven-and-a-half-hour work week was better at577improving blood sugar regulation than a 30-minute walk. I mean,578that's like two and a half minutes a day.579    There are also tons of evidence coming out on these580unstructured exercise snacks, and that's also something that581can be recommended, so these are the kind of things that you582take the stairs instead of the elevator or you walk briskly583instead of, you know, taking a car to work.584    There have been studies showing that people wearing these585accelerometers are able to reduce their cancer mortality by 40586percent, their cardiovascular related mortality by 50 percent.587If they're doing nine minutes a day of these unstructured588snacks where they're just basically taking advantage of589everyday situations to get physically active.590    It doesn't cost money to do body weight squats. You don't591have to have a gym membership, so I think that's one important592way that I think information can be improved and more targeted.593    The Chairman. Thanks. Dr. Verdin, what's the most important594breakthrough in aging research that we should be paying595attention to, and how can we use it to actually help people596live healthier longer lives?597    Dr. Verdin. There's been an explosion of understanding of598the biology of aging, and in particular, the identification of599what we call molecular targets. We now understand that600targeting unique molecules can actually have profound effects601on the whole aging process and its associated diseases.602    I also want to expand on what Rhonda just talked about,603this idea of lifestyle factors. We talked about exercise, but604there's a group of lifestyle factors that we all know about:605nutrition, physical activity, sleep, human-connections that are606really the critical determinant of your longevity. Actually,607more than 90 percent of our longevity for most people is608determined by the way we live.609    What's really important is to know also each of these610variables are stackable. That is, if you are eating well,611you're going to live longer, but if you actually exercise on612top of it, you're going to live even longer, and if you have613good human connections, you're going to live longer.614    Today, most of us in this country could expect to live to61590 to 95 in good health if we were to do everything right, so616that's today, and there are communities within the U.S. who617live today close to 90 years old on average, and I can618guarantee that not all these communities are actually optimized619in terms of doing everything.620    Right now, as a Nation, as someone who studies aging, I'm621struck by the divide, the lack of knowledge of some of the622things that we know are conducive to good health are not623actually implemented, and I want to add one last point about624exercise. A 15-minute walk in the morning and at night will625lead to a reduction of heart attack, stroke, cancer, all of626these chronic diseases of aging by 40 percent, that's 30627minutes of walking every day.628    I defy anyone, no matter what their lifestyle is, to tell629me that they do not have the time to walk 15 minutes in the630morning and 15 minutes at night. This is the type of631information that people are not aware of. It could have a632profound effect on the health of our population, so I'm pretty633passionate about lifestyle.634    Next will be of course the additional interventions that635the research is pushing forward, but for me, the foundation has636to be these lifestyle factors. Drugs that target the aging637process will come in the future; we're working on them. There638are some really promising leads, but there should not be a639replacement for reestablishing a healthy lifestyle in640ourselves, in the population at large.641    The Chairman. Thanks. Let me turn over for questions to642Ranking Member Gillibrand.643    Senator Gillibrand. Thank you, Mr. Chairman. Dr. Nosal, how644do you say it?645    Dr. Nosal. You said it perfectly from the beginning.646    Senator Gillibrand. Sometimes there's barriers to the647things that we know are needed for longevity, healthy eating is648one. Obviously, there's barriers to affordability, there's649barriers like food deserts when it's not easy to get to a650grocery store. Sometimes, it's just mobility, if you're at a651fifth store building and you're not very mobile and you can't652walk to the grocery store and you don't have a car, and, and653it's hard to get on the bus, the many barriers.654    One of the barriers I want to talk about with you is the655nutritious aspect of it. A lot of people don't even know what's656nutritious. Our doctors don't really study it in medicine. It's657not common knowledge in culture. It's really, it's not well658known what's nutritious and what's good for you.659    One of the things that you talked about in your testimony,660a four-year nationwide pilot program through Medicare to661provide medically tailored meals to eligible Medicare662beneficiaries with diet impacted conditions. Now this is663innovation. We know that a medically tailored meal for somebody664with diabetes is going to be extremely healthy for them. It'll665have a lot more fruits and vegetables in it, it will have whole666grains, it will have lean proteins, it will have no processed667foods.668    Medically tailored meals really is pretty powerful. Can you669talk about that a little bit and how could we implement it as670just one of the barriers?671    Dr. Nosal. Thank you so much. As I said, I'm a practicing672family doctor. I was seeing patients this week, and I actually673saw a patient who I really wish this was one of the services I674was able to prescribe her as part of her Medicare coverage. She675gave me permission to share her story.676    This is a woman I've taken care of for quite a number of677years and has done a really great job at being physically678active to the best of her ability. She uses a rolling walker679with chair and she has really well controlled her diabetes, as680well as it can be controlled, reduced her risk of681complications, and then came in this week and saw me and her682diabetes was fully uncontrolled, and I asked her what was going683on and she said her apartment had moved.684    Previously where she lived, she knew where the local soup685kitchen was and the food pantry. She used her SNAP benefits, as686I work with my patients to use their SNAP benefits for fruits687and vegetables, use the other resources which are more likely688to give you more processed foods or carbohydrates, get those689other foods there, but save your benefits and you can get some690extra incentives.691    This is really a patient who cannot find in her community692where she is, the resources to have the healthy meal that she693needs, that it will be part of her remaining well and full, and694the idea that I could have prescribed her an appropriate low695calorie, diabetic diet full of whole plant you know, protein696and foods, would be the complete difference in her entire life.697    I agree with those speakers before me that, your ability to698move and your ability to eat healthy and have access to those699nutritious food resources, this could be groundbreaking and700life changing for our older adults, and this can be done right701through our health centers, through our community health702centers that are in the depths of the communities where we can703do this for a whole family and prevent the outcomes.704    I don't need to take care of people in a state of disease.705We are ready and willing and able in our health centers to care706for communities that we know their risk is greater, but our707ability to provide these medically tailored meals, we'll change708both cost and outcomes in that community.709    Senator Gillibrand. Along the lines of impediments to710access to nutritious meals, we have SNAP benefits. With SNAP711benefits you go to the grocery store and buy your groceries and712cook whatever you want, but for older people who aren't cooking713as much anymore, again, who can't carry the two bags of714groceries, of all those fruits and vegetables, and the whole715grains that they're going to then cook appropriately to eat.716    What do you think about the idea of being able to use SNAP717benefits for congregate meals or for organizations like Meals718on Wheels that deliver hot meals? Like is that a way to get719over some of these barriers to the nutritious or Medically720Tailored Meals that people need?721    Dr. Nosal. It would be tremendous if we could both increase722funding for SNAP benefits. I can tell you they don't meet the723needs even right now, but the kinds of creative programs I know724that we've done where I live, where we have been able to725increase funding for fruits and vegetables, but absolutely.726    My elderly patients are often only eating a hot meal if a727family member comes to help care for them and cook for them,728they often have nutritional deficiencies because they are in729fact eating things that either come in a bag or a box, which730are my top list of things I tell patients to try to not eat,731but that really isn't feasible or possible for them. It would732be astounding if they could actually use those benefits and733have that kind of food delivered at their home. It would be734life changing.735    The Chairman. Thank you. Now I'd like to recognize our last736witness. I guess he had some travel issues, so we are glad you737made it, Dan Buettner. Dan is an explorer, national Geographic738Fellow, an award-winning journalist and producer, New York739Times bestselling author and founder of Blue Zones.740    The term Blue Zones was first coined by Dan in 2004 and741refers to areas with high concentrations of centenarians?742Individuals who live to be over a hundred years old. His team743uses research to highlight and promote specific life lifestyle744habits that are tied to extended longevity and vitality. Thanks745for being here, and we are looking forward to hearing your746presentation.747748              STATEMENT OF DAN BUETTNER, FOUNDER,749                   BLUE ZONES MIAMI, FLORIDA750751    Mr. Buettner. I am honored to be here. My goal over the752next four minutes and 54 seconds is to convince you that most753of what we think works for healthy aging and longevity is754either in effective or just plain wrong.755    I know most of you know these statistics, but we're756spending $4.9 trillion on healthcare per year. About 85 percent757of that money is spent on people with chronic conditions, most758of them are avoidable chronic conditions. Another $300 billion759on exercise and diet programs, and then another 42 billion on760anti-aging industry that has failed to produce even one pill761supplement or interventions that's been shown to stop reverse762or slow aging, so if that doesn't work, what does?763    Twenty years ago, working with National Geographic and a764team of demographers, we found five areas in the world where765people are living statistically longest. Something called the766Danish Twin Study established that only about 15 percent of how767long we live is dictated by our genes, 85 percent is something768else.769    The reason we find that something else among these five770populations who are living about 10 years longer at middle age-771our age. The reason they're living 10 years longer is because772they're avoiding the diseases that foreshorten American's lives773and are kind of bankrupting us in many ways.774    What are they doing? Well, none of them are dieting or775exercising or running down to Latin America for stem cell776treatments. Every time they go to work or a friend's house or777out to eat on occasions they walk, they're getting eight to77810,000 steps per day mindlessly. The cheapest and most779accessible foods for them are peasant foods. Their whole780grains, their tubers, the cornerstone of every longevity diet781in the world is beans. They're eating about a cup of beans a782day.783    They're not spending time on Facebook, instead, they're784spending time in face-to-face conversations, living in extended785families, connecting with their neighbors. They have vocabulary786for purpose. Now, there's an idea, purpose. We know that people787have a sense of purpose live about eight years longer than788people who are rudderless. They manifest their purpose usually789in family, but also with religion.790    We know people who show up to church or temple or mosque791live about four years longer than people who don't show up at792all, so taking this insight that where people are living the793longest, it's not because they try, it's not because they794pursue longevity. We tend to think that health is a result of a795pursuit in this country, actually, it ensues. It's a result of796an environment that makes a healthy choice, the easy choice.797We're not relying on poor mothers to make the right choice, and798then sending them out into an environment where 97 out of a 100799food choices are bad.800    About 15 years ago, working with AARP and the University of801Minnesota, we set out to manufacture Blue Zones by working with802municipal governments where you can get policy done to help803them decide on policies that favor healthy food over junk food804and junk food marketing. To favor the human being over the805motorists, to favor the non-smoker over the smoker, and to806certify all the restaurants, grocery stores, workplace,807schools, and churches who agreed to optimize their designs and808their policies so that people are nudged into moving more,809eating better, and socializing more.810    The proof is in the pudding, our very first town, Albert811Lea, Minnesota, we saw a 30 percent drop in healthcare cost812among city workers, that was in 2009. In the beach cities of813California, we saw about a 25 percent drop in obesity in the 10814years we were there, and in Fort Worth Texas, they themselves815reported about a quarter of a billion dollars in healthcare816cost savings after the five-years we were there. We succeeded,817not because we came in telling people what to do, came in with818an agenda. We simply came in with policy options and place819options that made the healthy choice an easy choice.820    We set people, we set Americans up for success. Right now,821our food environment and our built environment sets people up822for failure. We have about 25 times more fast-food restaurants823than we did in 1980, when we had a third the rate of obesity824that we have right now.825    The big idea I'd ask you to think about, is shifting the826focus from changing people's behavior and individual827responsibility and setting Americans up for success by828designing our cities so the healthy choice is not only the easy829choice, but the unavoidable choice.830    The Chairman. Thank you. Yes. I live in Naples, Florida,831and they're working832    Mr. Buettner. That's right. We have Blue Zone City in833Naples and Jacksonville, Florida. I salute them.834    The Chairman. They're doing a good job. Let me turn it over835now to Senator Johnson836    Senator Johnson. Thank you, Mr. Chairman. It's very good837hearing, very interesting testimony. I held an event at the end838of September with RFK Junior, with Dr. Casey Means, who'd839written a book that interested me, "Good Energy," talking about840metabolic health. Awful lot of the testimony here relates to841that in some way, shape or form, I think to the most842significant parts of that testimony, Dr. Chris Palmer, he's a843psychiatrist that does a lot of work in terms of nutrition,844relates to mental health issues, said they don't want to know845the root cause of chronic illness.846    Dr. Casey Means talked about it in her medical education.847They didn't spend an hour talking about nutrition and Mr.848Buettner, you're talking about, you know, trying to design a849city for the right food choices, but again, what are those850right food choices? I think it's becoming pretty obvious, and I851think that's one of the questions I have for you know, Dr.852Patrick.853    We've known about this for quite some time, right? I mean,854the food pyramid was a marketing, but there's nothing855scientific about that. It was just a marketing deal. We've gone856to seed oils. Again, the problem we have as a consumer is you857have all the books out there, you have all these different858theories, who do you believe? It's a very confusing thing.859Unless you just go completely simple, all whole foods, no ultra860processed food, try and approach it that way, but Dr. Patrick,861just kind of comment on that.862    Dr. Patrick. Well, I do think that going whole Foods and863trying to reduce your ultra processed foods as much as possible864is the way to go, and I think we have a lot more information865now than we did, you know, 30, 40 years ago. We know that these866ultra processed foods are not causing satiety. That is, we know867that they're activating this addictive reward pathways in our868brain, so I think that information is a little more in depth.869    I also think that some of the information on like, why do870we eat? Okay, if we have nutrition in primary and secondary871school, definitely medical school, you're right. I mean, one872class in nutrition, it's absurd, right? I mean, if we can start873educating at an early age, children why they eat, what are they874supposed to get from their food? Why do you want to eat leafy875greens, magnesium's there? What does magnesium do? What happens876if you don't get magnesium? What is cancer?877    There's even some data out of Japan, they have that program878in Japan where they have in primary schools? Nutrition879education, and they've shown longitudinal studies that people880that were educated with nutrition in childhood are much more881likely to eat healthy, nutritious later in life.882    Senator Johnson. You know, part of the problem is just our883medical education, our medical establishment. They call it884Rockefeller medicine, all based on pharmaceuticals, and it's885awful appealing, all we have to do is get a shot, or all we886have to do is take a pill and you know, we're going to be well,887when we think probably the exact opposite is true.888    Eighty-five percent of our $4.9 trillion spend is on889chronic illness, it's about preventing that chronic illness.890Dr. Verdin, you talked about the basics, right? Nutrition,891exercise and not necessarily--and there's all kinds of892different opinions on the right type of exercise. Being active893makes sense, getting good sleep, stress management, I mean, all894those things make perfect sense.895    How do we break through, how do we reeducate our doctors?896How do we reeducate our public policy here? One thing we could897probably do is with our SNAP program not allow certain foods to898be purchased. The really highly ultra processed, the ones that899we really are pretty convinced are not good for you. I mean,900that would be a good switch, wouldn't it, Dr. Verdin?901    Dr. Verdin. Thank you for the question. I think first, let902me completely agree with you on the idea that the foundation903has to be there, the lifestyle factors, and the drugs should904only come on top or in a subset of the population that is a905increased risk of accelerated aging.906    That being said, there is something that is happening in907the aging field, which I think is going to allow us to work908through the noise that you described, which diet, paleo diet,909ketogenic diet, Atkins, I mean, there's proliferation, people910are completely confused. The same about exercise. What are you911supposed to do? Is it a strength training? Is it yoga? Is it912endurance, aerobic, anaerobic? People essentially throw up913their arms in the sky and say, I don't know what to do. The914same about sleep. Well, how much should you sleep? What is915optimal?916    The whole field of aging right now is in the process of917developing what we call these biomarkers of aging, which allow918us to measure and to predict the effect of interventions in the919long term, so instead of doing a clinical trial, where you920would take a group and have some exercise and do strength921training and another one do flexibility and follow them for 30922years to see what happened to them, these novel markers allow923us within a much shorter period within one year to actually924detect a signature.925    There is the promise that comes with further developing926these tools. I think we need support to be able to actually927test these interventions against one another so that we can928actually make the best recommendation to people in terms of929what is really the optimal way to actually live and to optimize930your health. That's where the field is.931    Again, there's a bottleneck in terms of the funding. These932are not cheap studies, but they could have massive implications933in terms of public policy recommendations in terms of what is934the optimal way to exercise. I mentioned the point of you know,935walking 30 minutes a day, that's already good. It's a 40936percent reduction. Can we get to an 80 percent reduction by937adding another modality? To what degree are these interventions938going to be in individual? That's a whole other area and field939is studying.940    Senator Johnson. Thank you, Mr. Chairman.941    The Chairman. Thank you, Senator Johnson. Senator Husted.942    Senator Husted. Thank you, Mr. Chairman. I appreciate the943testimony, the thoughts, and the conversation. I listen, you944can read, its exercise, its diet, it's lifestyle choices. If we945just made better decisions and more active on those things we946would drive down costs, we'd improve quality of life. I heard a947lot of talk about longevity, it's not just the number of years,948it's the quality of those years that also are almost949immeasurable in terms of their value of terms of your950productivity, your joy, your ability to contribute to your951family, to your community, if you have those things.952    I was also thinking when you were talking about the access953to food, I was also thinking about when you live in a high954crime neighborhood, how much harder it also is to be active and955to live a healthier life.956    I want to ask any of you that has have a thought on this,957what about this: our technologies, they seem to be driving958isolation and idleness, and has there--as we look at the959difficulty we've had as Americans of getting healthier, even960though we know all of these things, is there any evidence that961you've seen about how our technology is driving isolation or962idleness that would affect our health in a negative way versus963a positive way? I'm just interested if any of you have thoughts964on that.965    Dr. Patrick. I have thoughts on the opposite. I mean, so966most of us have an Apple Watch or a Fitbit or some sort of967wearable device where we can get to measure our heart rate,968resting heart rate or during exercise, a lot of different969health parameters, and yet I think there's a lot of regulations970there that don't allow those devices to help give us medical971advice.972    I mean, we have like AI coming out with this. AI is now973being shown to be as good as or better at predicting, disease974and illness and looking at all the variables and contribute to975that than physicians are, and yet we can't use that976information, that health information for anything, and it seems977like it's something that would be very useful for physicians978    Senator Husted. Let me challenge you a bit on that. I agree979that those things are valuable, I'm not sure that most of us980have those things, though. I read in the last couple of years981that the average prisoner spends more time outside a day than982the average child.983    I'm just wondering, when you read things like that and you984see the amount of the way that social media's affecting985particularly young people and that fewer of them are986participating in sports, it seems like from the very beginning987that we are getting children off to the wrong start as it988relates to this, so I see some heads nodding. Others might have989thoughts on that.990    Dr. Nosal. As a family physician, I take care of people in991pregnancy, newborns, small children, I get to see great992grandparents and the entire family. I think it's an interesting993perspective across technology. I'm also the Chief Medical994Information Officer at my organization, so overseeing the995rollout of our electronic health record and patient portals in996English and in Spanish.997    I am right with you. I really worry about my young people998in school. When I'm seeing the kids in my practice, I find out999what sports they're doing, how much physical activity is in1000their afterschool activity? How often do they have recess? We1001know, particularly for young people, and it's a little1002different for adults about obesity and weight for young people,1003it really, really matters that activity level that they're1004doing.1005    We have models where schools will not have cell phones for1006during the school day, and you'll get rid of your cell phone at1007the start of the day and you'll get it back later, but I'm not1008seeing paired with that, the kind of investment in making sure1009we have that funding and education, that teaching staff and the1010supervision and expertise to make that physical activity1011possible there, and that is a wonderful place for prevention.1012    I want to come to the other part of technology for our1013older adults, our rural communities that don't have broadband1014access, that can't communicate or take advantage of things like1015telehealth, which are critical when we're following up complex1016medical issues or preventing falls and trying to really make1017sure we keep our older adults safe, that it's actually really1018critical.1019    Not only that we have infrastructure that makes access1020possible, but our isolated, older adults and helping and1021teaching and finding ways both to connect with your physician1022and with your community, that there's worthy investment there1023as well.1024    Senator Husted. Yes, no doubt. We've made a lot of progress1025on telehealth and allowing particularly for elderly, others1026thought.1027    Dr. Verdin. Maybe if I can add something as a parent. I1028clearly have seen, and I think all of us who have children have1029seen the effect of portables on social isolation and inactive1030physical inactivity.1031    I do not know, as a scientist working on aging, how to1032solve this problem. Clearly there are other countries that have1033installed a number of regulations that limit the use of these1034portables and iPhones and so on by younger individuals who are1035obviously more vulnerable.1036    One thing to note is that these are the formative years1037where critical habits are formed that will last a lifetime. I1038Just wanted to amplify the point about wearables. Wearables1039are, I agree with you, today are the remit of a subset of the1040population that is generally more well to do and able to afford1041it and more interested in its health.1042    I can see the day changing though, where wearables are1043going to be part of the tools used by physicians especially in1044areas that are remote in combination with telemedicine for1045increasing the health in those populations that might be more1046isolated and not have access to everyday physicians.1047    The wearable technologies are rapidly accelerating. They1048are actually, I predict that within the next five years, they1049will be valuable, recognized, medical tools in terms of1050assessing your rates for chronic disease, simply by measuring1051your movements, looking at your blood sugar, looking at a whole1052series of variables that I see under your blood pressure and so1053on, so I think they will become important tools and with their1054democratization, we can expect the prices to go down and the1055value to go up.1056    I think this is something if I were a regulator that I1057would keep my eyes on as a potential changing factor in the1058landscape of medicine. Thank you.1059    Senator Husted. Thank you1060    The Chairman. Senator Justice.1061    Senator Justice. First of all, to our panel and our great1062witnesses, I didn't have the opportunity to hear you, but I'm1063sure that we're all singing from the choir, that's all there's1064to it. I've got to say just this, I'm from West Virginia, and1065West Virginia has surely got some really tough issues going on.1066To say the very least, we're the third oldest State in the1067country. You know, we have a life expectancy of 72.8 years,1068which is the second lowest, 20 percent of our folks in West1069Virginia are 65 and older.1070    We do have affordable housing in West Virginia, and that1071helps a bunch, but we've got risk factors like you can't1072imagine, whether they be social isolation or the risk of falls,1073you know, they could very well be food insecurity, the lack of1074broadband, transportation issues or medical care issues and1075obesity. Obesity, absolutely the worst of the worst.1076    Now, I don't look at by any stretch of the imagination, but1077I'm trying real hard, and between baby dog and I together, we1078continue to try really hard. I've lost 55 pounds, and I'm1079really proud of that, and I've got a long way to go.1080    Now, baby dog isn't subscribing to the same theory that I'm1081subscribing to, but for those of you that know her, she's a1082little brown, 62-pound watermelon, and she's a little bulldog1083and she absolutely loves everybody, but let me just tell you1084this, in West Virginia, we do have some things that are going1085on and are really, really neat stuff. We have the fact that1086we're a community, and it is so important, absolutely from the1087standpoint of family and community, it's so important to our1088seniors.1089    I just think about this beautiful little girl that's here1090and everything and if you could tell me her name, please, I1091can't--well, Addison, you are absolutely spectacularly1092beautiful, and I will promise you, if you'll look up online or1093whatever, baby dog, and look up and just know how much she1094would love you too.1095    I tell everyone, and I tell you this, just speaking from my1096heart, I tell you that in many ways, we are here for Addison.1097Not only are we here for all those of our seniors, all those of1098our aging, but we're here for Addison, because somehow, we've1099got to change the path of what we are doing today.1100    For that reason, and I don't want this to be such a1101political issue, but for that reason, that's why I will vote1102for RFK Junior because I believe he is at least trying to bring1103more awareness to all of us.1104    In all honesty, there's so many in my state that need help1105in every single way, but more than anything, we need knowledge.1106We need absolutely us to step up. I'll never forget my dad;1107I'll never forget him ever saying just this. He was trying to1108figure out where to build a road, and really and truly, he kept1109listening to engineers all around him, and finally the lead1110engineer's name was Kirby Bragg, and he looked at Kirby and1111said, "Kirby, I don't know what the right answer is, but this1112dead gum well isn't it."1113    Now, if you just think about just that, what we're doing in1114America today, isn't it. That's all there is to it, and we got1115to do better, and we got to do better for all of us, for1116myself, believe it or not, for baby dog, but more than anything1117for Addison, so Addison, thank you for being here, and thank1118you so much, Mr. Chairman. I'll yield back to you.1119    The Chairman. Thank you, Senator. Senator Moody.1120    Senator Moody. Thank you, Senator Scott. I agree with you,1121Senator Justice. I think we're all sitting up here thinking1122that we can do better, especially with us Senators who sit1123around a lot. I am only three weeks into this tenure, and I'm1124noticing that we sit around a lot.1125    Thank you for being here today, thank you, Chairman Scott1126and Ranking Member Gillibrand, for holding this important1127hearing. I think it's important not just for those of us that1128are learning more about it on the Aging Committee, but those1129who may be watching and sharing this information around the1130country.1131    I agree with Senator Justice, becoming more aware and1132making sure that others within our states are aware, it's an1133incredible first step to making America healthy again, and so,1134thank you for taking the time to be here. I know it isn't1135always easy to break away from a practice or travel from1136another State across the country. I really appreciate it. I1137know some of you are residents. I am the newest senator from1138Florida. I know some of you are my constituents, so I'm1139grateful.1140    One of the things that I think our longstanding reactive1141approach to healthcare means is we spend a lot more money than1142we probably need to, and I was most fascinated by your work,1143Mr. Buettner. I've actually watched some of the documentaries1144that you've helped on. In fact, I've recommended my own parents1145watch those, and I'm fascinated.1146    I'm from a state that is growing exponentially, and there1147are many new communities being built. There's also those that1148are going back and trying to readdress how they might rethink1149their existing communities, and I was really taken with some of1150the statistics that you included within your written testimony1151and some of the places that you've worked with reported annual1152savings.1153    Cities reported not just a drop in their physical BMI, but1154an actual drop in cost to their cities. I think it was in1155Minnesota you saw a town that saved 30 percent of their city1156worker healthcare costs since they started.1157    I was just wondering, in terms of existing communities that1158are trying to go back and reconfigure or new ones that you're1159working with to kind of build a city to highlight health and1160community and healthier options. Have you done a study that1161shows how much might be saved versus what the input of cost to1162a community or city would be?1163    Mr. Buettner. If you drop the BMI or the obesity rate in a1164city of a million people, it saves about 19,000 heart attacks1165over time. Average heart attack costs about $120,000, so you1166don't have to have a big movement to make a big difference, but1167essentially what I'm pitching to all you guys is the notion1168that we tend to think in silver bullets, there's going to be1169this one magical intervention that's going to save us.1170Meanwhile, we're surrounded by what I call silver buckshot,1171these small nudges, and defaults.1172    In all due respect to the Federal Government, it's a slow-1173moving tanker, it's hard to move, but city governments,1174municipal governments, they could move in a hurry. A mayor and1175a city council in coordination with the business community,1176they can get a lot done and simple things, and by the way,1177we've done this in Naples, Florida, and we're doing it in1178Jacksonville, something called a Complete Streets policy.1179    Do you know you can raise the physical activity level of an1180entire city by 20 percent, by just building streets? They1181invite pedestrians, they invite people to socialize, they1182invite cyclists instead of just cars. That doesn't cost any1183extra money. Once every seven years, a street needs to be1184redone, and when you redo that street, you can just as easily1185build it for humans and cars rather than just cars, so it's1186seen clearly.1187    We know there's a clear correlation between the number of1188fast-food restaurants permits and the obesity rate of a city.1189If you live in a neighborhood with more than seven fast food1190restaurants within a half mile of your home, you're about 351191percent more likely to be obese than if there are fewer than1192three. In the hands of a city council member, they may decide,1193well, our children's health is more important than another1194burger joint, and make the changes appropriately.1195    Billboard advertising: we know that two identical1196neighborhoods and one neighborhood has billboard advertising,1197the other one doesn't. The neighborhood with billboard1198advertising has about 15 percent higher BMI, so what we try to1199do is, rather than telling cities what to do, we show them the1200evidence, we give them about 30 different policies in each of1201smoking-built environment and food, things that cost them1202nothing, and we ask them, would this be effective for you?1203Would this be feasible for you? And if they say so, then we1204help them get it done.1205    The wrong thing to do is to come in and say there's a1206silver bullet. The wrong thing to do is to come in and tell1207people what to do, but when you show them the evidence,1208America's smart, it's a lot of very smart mayors and city1209council people who are tired of seeing their children grow up1210overweight and tired of seeing their neighbors die prematurely1211of heart disease and type two diabetes, and this is something1212we can act on right now.1213    I guess the pitch for Federal Government is to think about1214empowering, designing cities for health rather than continuing1215to look for just a silver bullet.1216    Senator Moody. Thank you, chairman.1217    The Chairman. Thank you, Senator. Mr. Buettner, we hear a1218lot about diet and exercise, but you've said social connections1219and purpose are just as important. What can we do without more1220government spending to encourage stronger communities and1221healthier lifestyles?1222    Mr. Buettner. My name's Buettner. This is a small detail1223for the congressional.1224    Senator Moody. I started that, I'm sorry, that was your1225fault. Well, it's my fault. I own that. I apologize.1226    Mr. Buettner. What's that?1227    Senator Moody. I said I started that. I apologize.1228    Mr. Buettner. Oh, no, no problem. You guys are important.1229Believe it or not, it is encouraging people to eat at home.1230Every time we go out to eat, we consume about 300 more calories1231than we would if we ate at home, and those calories are going1232to be more laid in with sodium, ultra processed food, and1233sugar. You can control the calories when you live at home.1234    We think about educating people. One of my fellow1235testifiers here that had a very good point about teaching1236children how to cook at home, I know it sounds so hard. I quote1237from for National Geographic, I studied a place in, in Finland1238called North Karelia, had the highest rate of cardiovascular1239disease in the world in 1972, they brought it down by 501240percent. How did they do it?1241    They did it by changing the environment, making healthy1242choices easier, and one of those was using church basements to1243teach mothers how to cook with plants rather than just with1244meat, and that's an approach that works.1245    Once again, you know, if you take a person, a couch potato1246who is getting zero physical activity and get them to walk 201247minutes a day, you raise their life expectancy by three years.1248There's no pill, no pharmaceutical in the world that'll raise1249life expectancy by 3 years.1250    If you just get people to go from zero to 20 minutes, we1251can achieve that by designing our streets and our sidewalks so1252it's easy for people to go to the grocery stores, easy for1253people to pick up their coffee, easy for kids to walk to1254school. It's a very simple solution. It's within our grasp, and1255it can potentially cost nothing.1256    The Chairman. I think now we'll turn it over to Senator1257Alsobrooks. By the way, I have to go to a budget hearing, so1258I'll turn it over to Senator Moody, and I think you had some1259more questions Senator Gillibrand. Thank you, each of you for1260being here, and I love what you're doing.1261    Senator Alsobrooks. All right, thank you so much Mr. Chair1262and Ranking Member for hosting this important hearing today,1263and thank you so much as well to our witnesses who have been1264here.1265    Advancing research on healthy aging is key to helping1266seniors live longer lives, and Congress must ensure, I believe,1267that we take action to improve the quality of life for our1268seniors, so my first question is for Dr. Verdin. As someone1269who's worked at NIH and continues to engage in aging related1270research, the question is, would you speak to the role of the1271National Institutes on Aging and advancing research on1272longevity and health span?1273    Dr. Verdin. Thank you, Senator. I came to this country 421274years ago with a suitcase and a MD degree from Belgium, and I1275was attracted at that time by what I knew about the NIH and the1276vision and the biomedical research enterprise that had been1277created in this country, and I must say that I never looked1278back and one day became an American citizen, made this country1279my home, and still at this point directing a whole institute,1280focused on the biology of aging is my dream job.1281    I think the NIH has been instrumental in creating what has1282been called the crown jewel of the American government, and1283frankly, the crown jewel of all biomedical research1284organizations in the world. The U.S., thanks to the work and1285the support of the NIH, has created the best biomedical1286research institute anywhere.1287    Remarkably, every dollar that is being invested in the NIH1288yields two of economic output, which is a remarkable outcome1289for our society. This has yielded countless cures. It has1290created millions of jobs, created a whole new industry, the1291whole biotechnology industry, and has given the U.S. a1292leadership position in the world. We still attract the very1293best to come and do research and conduct their careers here.1294    I think from a personal point of view, but also for the1295country, I think the output from the investment of Congress in1296the NIH has been nothing short of remarkable.1297    Senator Alsobrooks. I could not disagree with you, Dr.1298Verdin. I agree, especially your characterization that it's a1299crown jewel. I think it's also very important to aging research1300and to cures, so would you say that they are right now, NIH as1301you may know, is subject to a number of cuts that have been1302proposed, and would you say that cuts to NIH funding threaten1303the progress that we have made in research on the aging brain,1304on Alzheimer's disease and on dementia research?1305    Dr. Verdin. Dramatically so, and I do worry about the1306institute that I direct and I worry about this leadership1307position that we are in right now. It's a comfortable position;1308we are leading by far every other country in the world. China1309is making great strides in terms of very pushing into biology.1310    A recent JP Morgan meeting in San Francisco about a month1311ago saw very strong presence from China. I think there's a1312danger that we are going to be relinquishing this leadership1313position, that we are going to be missing out on new1314opportunities to develop new treatments, especially in the1315field of aging, and that we are going to be basically losing a1316lot of jobs.1317    There's no way around this from a personal point of view in1318terms of the institute that I direct. If these cuts actually1319come into effect the way we have seen them, we will have1320layoffs. We will have a difficult time, a difficult road ahead,1321and I think this will be replicated across the whole country,1322red and blue states.1323    Senator Alsobrooks. I agree. Thank you so much, Dr. Verdin.1324Just quickly, my time is winding. Also wanted to ask Dr. Nosal1325and the question for you is regarding research and preventative1326care, or actually the question I want to ask you about, since I1327just have a few moments, is about marginalized communities and1328Federal research funding that's helped make significant1329advances and understanding aging and age-related diseases, and1330ask you how should NIH ensure that its aging research includes1331diverse populations particularly for historically marginalized1332communities? And I know that's a longer, we don't have very1333much time, but whatever you can say to that would be helpful.1334    Dr. Nosal. It is critical that research is happening in our1335communities and my communities that have black and brown1336individuals of various backgrounds, ethnicities from around our1337world. That how they are impacted and what needs to be done to1338really prevent the heavy cost of care in the future is1339different because of the dynamics of the communities that we're1340in.1341    Research into connections with faith-based organizations,1342connection with communities and we really see that those are1343opportunities within communities like mine that aren't being1344leveraged for research, where we know trust and strength is1345already in the community and it's a real place where we could1346make those benefits to health and outcomes possible.1347    Senator Alsobrooks. Thank you so much.1348    The Chairman.Thank you, Dr. Nosal. Ranking Member1349Gillibrand, I heard you had a few more followups?1350    Senator Gillibrand. I have a couple more questions for Dr.1351Buettner. I really liked your testimony. What I really liked1352about what you talked about was that you were talking to cities1353and communities and leaders about much more of a strategic plan1354for what they could do for the health and well-being of their1355citizens.1356    What I really liked about your approach; it was no silver1357bullet; it wasn't even silver buckshot. It was, you have to do1358all these things, and you mentioned transportation, making sure1359people could walk, walkable cities, so they could ride bikes. I1360would imagine as part of that, you'd want some kind of mass1361transit or some kind of public transit, so an older person1362could actually get somewhere. Because an older person might not1363be able to walk for a mile or a long distance.1364    Did you talk to them about access to fresh fruits,1365vegetables, whole foods? Like if you go to the Bronx today,1366it's a food desert in some areas where it's just not accessible1367to get to a grocery store. You might be able to get it to a1368bodega or a corner store, but you might be charged, I don't1369know, two for an Apple. You know, it's so expensive. It's not1370accessible and affordable. Did you look into those types of1371barriers as well? Did you make recommendations? Because I have1372legislation to incentivize to build grocery stores in food1373deserts so that we can get those quick fruits and vegetables1374for a lower cost price.1375    Then did you hear my conversation with Dr. Nosal about1376using the Federal benefits that we do have better. You know, we1377made the change in SNAP, this is important for you because1378you're just new to the Committee. We made the change to SNAP to1379make it easier to use the SNAP benefit at what do we call them1380like a farm stand.1381    To go into a farm stand and to be able to buy the fruits1382and vegetables directly from the farmer, better for farming,1383better for people and using maybe the SNAP benefits to get the1384congregate meals, so instead of eating by yourself in front of1385a television as an 85-year-old, you actually can go to the1386senior center and have two meals a week that are congregate1387with community members. Do you have thoughts on that too?1388    Mr. Buettner. Yes, so we've worked in 70 cities and I've1389learned that every community thinks they're different and in1390that they're all alike, so what we've done we have boards of1391academic advisors and we've compiled, we call them policy1392menus, in food, built environment and tobacco, and these menus1393are evidence-based, and there's usually 30 different policies1394that have worked elsewhere at creating a healthier eating1395environment and more physically active community and a place1396where it's a little bit harder to smoke, so in other words,1397they've been improved health.1398    We measure with Gallup, so it's not just anecdotal. We take1399a measure, the well-being index metric at the beginning, and1400then in order for us to come in, the city council and the mayor1401have to pledge to go through this consensus process, and we go1402through every one of these menu items, every one of these1403policies, and we score it for feasibility.1404    Can we get it done in this community in five years? For1405effectiveness, do we believe it's effective? Do I believe that1406taxing sodas will lower the amount of sodas that children will1407drink? Yes, but to lead with that, you'll often be shown the1408door, but we keep it on the menu so they discuss it, so with1409each of these areas, we have 30 or so policy items. It's hard1410to mess with SNAP, but you, you can sometimes get us sell the1411idea of a pilot program, but SNAP, as you know, is a Federal1412program and it's very hard to----1413    Senator Gillibrand. We are the federal lawmakers, so when1414we are riding the farmville, we could improve that program. We1415could make it better and more accessible, more usable.1416    Mr. Buettner. Let me take you to Jacksonville, Florida and1417I'll show you some opportunities for the SNAP, but the bottom1418line is, again, trying to come in and tell people what to do1419doesn't get you far, but showing them how they can be1420successful within the parameters of what's important in their1421city, you can get a lot done and it's a different way of1422thinking about things, and SNAP, you know, my big criticism is1423it allows people to buy the same food that's making them sick.1424    Senator Gillibrand. Ideally, you'd like some nutrition1425dollars to be on education about what's nutritious?1426    Mr. Buettner. Teaching people how to cook with whole plant-1427based food.1428    Senator Gillibrand. Yes.1429    Mr. Buettner. You know, we were talking about this before,1430if you want to know what a healthy hundred-year-old ate to live1431to be a hundred, you have to know that what she was eating as a1432little girl in middle and lately, and I worked with Harvard's1433Walter Willett, and we did a meta-analysis, 155 dietary surveys1434done in five blue zones over the past a hundred years, and1435without a shadow of a doubt, they're eating mostly whole food,1436about 90 percent whole grains, garden vegetables, tubers, nuts,1437and beans.1438    Senator Gillibrand. Access to those foods is key.1439    Mr. Buettner. Yes. Showing them how to make it taste1440delicious.1441    Senator Gillibrand. Correct.1442    Mr. Buettner. You can't guilt them into eating. They have1443to want to eat that more than----1444    Senator Gillibrand. Our most successful food banks in New1445York are the ones that have cooking classes at them, so they1446can teach the whole family how to make these vegetables that1447they may never have seen, they don't own any recipes for, and1448that's been really effective.1449    Also, along the lines of our earlier conversations,1450teaching pediatricians and even prenatal doctors, providers,1451when they get the pregnant woman in to say, when you have your1452baby, this is the best nutrition for you. This is the best1453nutrition for your baby, teaching it right away. You know, this1454is not a hearing on ed reform, but again, if you had the1455benefit of exercise every day in our schools and nutrition1456education, you'd be helping the next generation for sure.1457    Well, thank you so much, all of you. This has been an1458excellent hearing. I think we've had a very lively conversation1459about ways to improve and I just appreciate you Madam1460Chairwoman for hosting us, but all of you for the contribution1461you made to today's discussion.1462    Senator Moody. All right. Thank you again for being here.1463The Committee hearing is adjourned.1464    [Whereupon, at 4:52 p.m., the hearing was adjourned.]14651466=======================================================================14671468                                APPENDIX14691470=======================================================================14711472                      Prepared Witness Statements14731474=======================================================================14751476                 U.S. Senate Special Committee on Aging14771478            "Optimizing Longevity: From Research to Action"14791480                           February 12, 202514811482                       Prepared Witness Statement14831484                           Dr. Rhonda Patrick14851486    Chairman Scott, Ranking Member Gillibrand, and Members of1487the Committee, thank you for the opportunity to speak.1488    We have to ask ourselves: Can we call ourselves the1489greatest nation in the world while 70% - nearly three in four1490American adults - are overweight or obese?1491    While we spend 18% of our GDP on healthcare-more than any1492other nation-yet rank 55th in life expectancy? While our1493children are developing type two diabetes at rates once unheard1494of?This is not just a health crisis. This is a cultural crisis.1495    Because let's be clear: obesity is not inevitable. It is1496not an act of God. It is a choice-compounded over time,1497reinforced by a system that fails to foster- even from a young1498age - self-discipline and sound decision-making.1499    We have created an environment where difficult truths are1500treated as personal attacks, where doctors feel discussing a1501patient's weight is too taboo.1502    This is a disaster. If the devastating consequences of1503obesity are too uncomfortable to discuss, how can we expect1504people to change?1505    We must foster a culture where direct conversations are1506expected, not feared.1507    Obesity alone is linked to 13 types of cancer and cuts life1508expectancy by 3-10 years, depending on severity. It promotes1509DNA damage and accelerates our fundamental aging process-often1510measured by epigenetic age. It's one of the principal1511differences between the U.S. and many of the world's longest-1512lived nations.1513    We're overfed but undernourished. 60% of all calories1514Americans consume come from ultra-processed foods that:15151516    Fail to induce proper satiety, pushing us to overeat.1517    Remain cheaper than whole foods, economically1518incentivizing the least healthy choices.1519    Hijack our dopamine reward pathways, reinforcing addictive1520eating behaviors.15211522    This trifecta-no satiety, low cost, and built-in1523addictiveness-keeps us in a cycle of poor health outcomes and1524runaway healthcare costs.1525    Caloric excess is only part of the problem-we are also1526nutrient-deficient.1527    Low omega-3 levels-affecting 80 to 90% of Americans-carry1528the same mortality risk as smoking. Vitamin D deficiency-easily1529corrected-compromises immune function, cognition, and1530longevity. Nearly half of Americans don't get enough magnesium-1531impairing DNA repair and increasing the risk of cancer.1532    We are not solving these problems-we are medicating them.1533The average American over 65 takes five or more prescription1534drugs daily-stacking interactions that compound in1535unpredictable ways.1536    Polypharmacy is a crisis. We are not buying health-we are1537buying complexity.1538    The real problem is simpler. We must start treating1539physical inactivity as a disease. It carries the same mortality1540risk as smoking, heart disease, and diabetes. Going from a low1541cardiorespiratory fitness to a low normal adds 2.1 years to1542life expectancy.1543    By age 50, many Americans have already lost 10% of their1544peak muscle mass. By 70, many have lost up to 40%.1545    This isn't just about looking strong. It's about survival.15461547    Higher muscle mass means improved insulin sensitivity - it1548means a 30% lower mortality risk.1549    Grip strength is a stronger predictor of cardiovascular1550mortality - the number one cause of death in the Unites States1551- than high blood pressure.1552    The strongest middle-aged adults have a 42% lower dementia1553risk.15541555    Yet, we treat resistance training as optional. It is not.1556It is the most powerful intervention we have against aging1557including increasing muscle mass, strength and bone density..1558    Hip fractures alone kill 20-60% of older adults within a1559year. This is a death sentence we can prevent with resistance1560training - which has been shown to lower fracture risk by 30-156140%.1562    The current RDA for protein is too low for older adults.1563    Studies have shown when it's increased by half this reduces1564frailty by 32%, while doubling it, combined with resistance1565training, increases muscle mass by 27% and strength by 10% more1566than training alone. If we want to prevent muscle loss and1567frailty, we must update our protein recommendations and1568prioritize strength training.1569    We must foster a culture of American exceptionalism built1570on daily, effortful exercise. Not as an afterthought. Not as a1571luxury, but as a non-negotiable foundation for aging, but also1572clear thinking, resilience, and even leadership.1573    We must start by holding ourselves to a higher standard.1574    We should ask: Can a doctor struggling with their own1575weight truly counsel us on ours?1576    We should ask: Can a leader who neglects their own health1577make the best decisions for the constituents they serve?1578    If we don't like the answers, we must demand better.1579    The body and brain are not separate. The consequences of1580poorly regulated blood sugar, sedentary living, and muscle loss1581are not just physical-they affect cognition, judgment, and1582resilience. If exercise enhances focus and decision-making,1583then we should expect those in power to prioritize it most of1584all.1585    A strong nation starts with strong individuals. Strength is1586not inherited-it is built. It is earned. It is trained.1587    We cannot medicate our way out of what we have behaved our1588way into.1589    If we truly want to lead the world, we must first lead1590ourselves.1591    No law, no policy, no government program can make a nation1592strong. Only its people can.1593    Strength is a choice-compounded over time and earned1594through effort.1595    Now the question is - will we have the discipline?15961597                 U.S. Senate Special Committee on Aging15981599            "Optimizing Longevity: From Research to Action"16001601                           February 12, 202516021603                       Prepared Witness Statement16041605                            Dr. Eric Verdin16061607    Good afternoon, Chair Scott, Ranking Member Gillibrand, and1608members of the Committee.1609    Thank you for the opportunity to speak today. My name is1610Eric Verdin, and I am the CEO of the Buck Institute for1611Research on Aging-the world's leading research organization on1612the biology of aging. Our mission is to eliminate the threat of1613chronic disease by addressing aging itself.1614    Over the past century, public health advances and medical1615breakthroughs have nearly doubled the human lifespan. This1616incredible success has come with challenges. We live longer but1617not healthier. The end of our long lives is now characterized1618by debilitating diseases such as Alzheimer's, Parkinson's,1619heart attacks, strokes, type two diabetes, cancer,1620osteoarthritis and macular degeneration. By the time an1621American reaches age 65, most have at least one chronic1622condition and more than half have two.\1\ We call these1623conditions the chronic diseases of aging.1624---------------------------------------------------------------------------1625    \1\ https://pmc.ncbi.nlm.nih.gov/articles/PMC68737101626---------------------------------------------------------------------------1627    Our current healthcare system is focused on treating these1628conditions when they occur, not in preventing them in the first1629place. This approach is expensive, inefficient, and ultimately1630ineffective. The cost of managing these illnesses is staggering1631- increasing as our population ages - and places an1632unsustainable financial and emotional burden on our healthcare1633system, our citizens and their families.1634    In the 20th century, we dramatically reduced deaths from1635infections, from heart disease, and from cancer, extending life1636expectancy in the process, but progress is slowing. Even if we1637cured cancer tomorrow, the average lifespan would increase by1638less than three years.\2\ The reason is simple: aging itself1639continues unchecked.1640---------------------------------------------------------------------------1641    \2\ https://www.science.org/doi/10.1126/science.22374141642---------------------------------------------------------------------------1643    Aging is the greatest risk factor and main driver for these1644chronic diseases. Research from the past 20 years clearly1645indicates that aging can be slowed, thereby extending healthy1646lifespan and delaying disease in animal models. There is not a1647single reason why these findings should not apply to humans as1648well. By focusing on aging and its mechanisms, we can compress1649the period of illness and frailty so that more of our years are1650spent in good health.1651    The economic and public health benefits of a shift from a1652reactive healthcare system to true preventative healthcare1653based on our understanding of aging are enormous. Studies1654suggest that delaying aging will generate trillions of dollars1655in economic gains, reduce medical costs and increase1656productivity.\3\ Just as vaccines and antibiotics1657revolutionized medicine in the past, aging science is the next1658great frontier in preventive healthcare.1659---------------------------------------------------------------------------1660    \3\ https://pmc.ncbi.nlm.nih.gov/articles/PMC47430671661---------------------------------------------------------------------------1662    The science is at a turning point, and as policymakers you1663will play a critical role in ensuring that we realize its1664benefits. Investing in aging research must be a priority. The1665NIH should increase funding on the molecular pathways of aging,1666with a new emphasis on translating discoveries into human1667applications. We also need a much greater focus on lifestyle1668interventions-nutrition, exercise, sleep, stress management,1669and social connections. They account for more than 90% of our1670healthspan and lifespan and should be an essential part of our1671health policy and our research.\4\1672---------------------------------------------------------------------------1673    \4\ https://pubmed.ncbi.nlm.nih.gov/30401766/1674---------------------------------------------------------------------------1675    We must also rethink how we allocate healthcare dollars.1676Right now, we spend trillions on treating diseases after they1677arise. A shift toward prevention-one that targets aging itself-1678would be far more effective. The FDA needs clear guidelines for1679aging-targeted therapies. Biotech and pharma companies are1680investing in this field, but without a defined regulatory1681pathway, progress is slowed. And finally, we need stronger1682public-private collaboration. Translating discoveries into1683real-world applications will require coordinated efforts1684between industry, government, and regulatory agencies.1685    This is a pivotal moment. The 21st century has the1686potential to witness one of the most profound medical1687breakthroughs in history-not just treating age-related1688diseases, but preventing them. The goal is not just to extend1689lifespan, but to ensure those extra years are spent in health,1690dignity, and independence.1691    I applaud the Committee for recognizing the urgency of this1692issue. Aging research is at an inflection point, and with the1693right policies, we can transform public health for generations1694to come. I look forward to working with you to make this vision1695a reality.1696    Thank you.16971698                 U.S. Senate Special Committee on Aging16991700            "Optimizing Longevity: From Research to Action"17011702                           February 12, 202517031704                       Prepared Witness Statement17051706                           Dr. Sarah C. Nosal17071708    Chairman Scott, Ranking Member Gillibrand, and1709distinguished members of the Committee, thank you for the1710opportunity to testify today. My name is Sarah Nosal, MD, FAAFP1711and I am a practicing family physician in the South Bronx. As1712the President-elect of the American Academy of Family1713Physicians (AAFP), I am honored to be here today representing1714the more than 130,000 physician and student members of the1715AAFP.1716    I currently serve as the Vice President for Innovation &1717Optimization and Chief Medical Information Officer at The1718Institute for Family Health, a federally qualified health1719center (FQHC) network with more than 27 locations in the Mid-1720Hudson Valley, Bronx, Manhattan, and Brooklyn. I am also an1721assistant professor in the Mount Sinai Department of Family1722Medicine & Community Health, where I focus on care of1723marginalized communities and the uninsured and share the role1724of medical director for Einstein Community Health Outreach, New1725York's oldest student-run free clinic.1726    While I am proud to now think of myself a New Yorker, I1727actually grew up just outside Washington, D.C. I always knew I1728wanted to be a doctor, and my journey to family medicine1729started as a grade schooler in the 80's, when I was troubled1730witnessing unhoused individuals - disproportionately veterans1731during that time in history - sleeping on sidewalks and street1732grates in the very heart of our nation's capital. I felt called1733to serve them but was not sure how. My mother, a social worker,1734told me that I could grow up to become the kind doctor who1735takes care of them. And so, I set my life's course to do just1736that.1737    While on my rotations in medical school, it became clear1738that to meet the needs of our most under-resourced patients and1739communities I needed to be the kind of physician who could do1740patient-centered, continuous, compassionate care for patients1741of all ages, across the life span, with them never aging out of1742my ability to care for them. The kind of medicine that allows1743me to do that is family medicine.1744    I am proud to be a family physician. I get to provide1745continuous, comprehensive medical care, health maintenance and1746education, and preventive services to patients across their1747entire lifespan - regardless of age, health goals, or1748challenges. Through enduring partnerships, family physicians1749lead care teams and help patients set goals; strive for1750wellness; prevent, understand, and manage acute and chronic1751illness; and navigate the complexities of the health system.1752    Last month, Chairman Scott laid out his priorities for this1753Committee which identified four key aspects for someone to be1754considered "well:" having their physical health; financial1755security; a safe community to live in; and family and community1756support. Each of these are rooted in the very fundamentals of1757family medicine, and I applaud this Committee for recognizing1758their significance in ensuring that an individual is not just1759living longer but living longer and better. That mission is one1760shared by all family physicians.1761    I have practiced for more than two decades in an extremely1762under-resourced area of the South Bronx. Health outcomes in my1763county are ranked 62 of 62 in all of New York state. My1764personal patient panel approaches nearly 90 percent Medicaid1765beneficiaries. In my office, I have the honor and privilege of1766taking care of not just patients, but families and communities.1767When I first started in my current clinic, my patients, like I1768was, were primarily younger women. As I planted my roots and1769affirmed to them I was going to stay, they started to seek care1770for their pregnancies, bringing their babies and toddlers,1771aunts and brothers, parents, grandparents, and great1772grandparents. Caring for patients across the lifespan also1773means caring for families across generations, often seeing a1774family history play out before me rather than just reading or1775documenting it.1776    Family medicine's uniqueness as a specialty means that,1777while working with patients towards wellness goals or managing1778chronic illness, we can anticipate barriers or risks due to1779social drivers of health, personal medical history, or family1780or genetic history that might be pre-disposing them to worse1781outcomes. These histories can manifest in complex needs;1782frequent among them are dietary needs for patients managing1783risks, predisposition and multiple complex diseases. A typical1784patient of mine presents with cane in hand, living with HIV,1785diabetes, hypertension, and chronic kidney disease. Patient-1786tailored counseling on diet and physical activity is something1787I do in every visit. One tool that my clinic has developed to1788help guide patients with diet-influenced conditions and help1789them visually embrace and understand healthy, plant-forward1790eating is a series called "Healthy Plates Around the World."1791These culturally appropriate plates engage my patients in a1792familiar context to best portion their meals using foods they1793are accustomed to.1794    However, no matter how well-illustrated, the unfortunate1795reality is that fresh, whole, healthy foods are out-of-reach1796financially or otherwise inaccessible to most of my patients.1797This is but one of the health-related social needs (HRSN) that1798impacts them. A lack of safe and stable housing, reliable1799transportation, safe places to exercise, financial security, in1800addition to access to nutritious foods, all make it difficult -1801if not altogether impossible - for many of my patients to1802simply afford necessary medications and reliably make it to1803medical appointments is my office.1804    Research has consistently shown that unaddressed HRSN can1805influence the onset or worsening of many health conditions,1806including chronic diseases.i On more than one occasion when I1807asked a patient why they were not taking their insulin as1808directed, I would find out they did not have electricity in1809their apartment for weeks at a time after falling behind on the1810rent. A neighbor was allowing them to store their medications1811that require refrigeration, but that also meant they did not1812have it readily accessible.1813    The empirical evidence backs this lived experience. Housing1814instability - difficulty paying rent, eviction, and living in1815overcrowded conditions - is associated with delayed medical1816care, medication nonadherence, and increased emergency1817department visits. When we screen across our patient community,1818housing is consistently the most commonly identified social1819need of our patients with the fewest resources readily1820available. Another top identified need is safe transportation,1821from our rural clinic where patients have been known to walk1822long distances along roadsides without walkways to our urban1823clinics where a patient with walker in hand faces four flights1824of stairs at the subway up and back. The lack of safe,1825accessible transportation in both rural and urban areas makes1826health and health care equally inaccessible. Unsafe,1827inconvenient transportation impacts a person's ability to1828access medical care and is also associated with higher rates of1829unemployment, poverty, and chronic illness.ii1830    The majority of the older adults I see in my practice fall1831into the group of low-income seniors who are eligible for both1832Medicaid and Medicare, known as dual eligibles, and have an1833average of 2.2 HRSN compared to 0.9 for non-dual eligibles.iii1834What that means in real life is they have a rolling walker with1835chair due to severe osteoarthritis, are unable to use public1836transportation, are forced to piece together the healthiest1837meals they can from soup kitchens, pantries and limited food1838assistance benefits, while doing laps around their daughter's1839living room as their most accessible form of exercise.1840    Medicaid serves a critical need, providing coverage for1841patients and sustaining community health centers delivering1842care to these struggling communities. Those same Medicaid1843beneficiaries with diet-related conditions experience higher1844levels of food insecurity. One study found that nearly one-1845third of Medicaid enrollees with diabetes were food insecure,1846in comparison to seven percent of those enrolled in private1847insurance.iv In another study, more than half of dual eligibles1848reported food insecurity.v1849    The U.S. Department of Agriculture's Supplemental Nutrition1850Assistance Program, otherwise known as SNAP, is a lifeline for1851those experiencing food insecurity. The program provides food1852benefits to low-income families to supplement their grocery1853budget. SNAP's healthy incentives programs (HIP) also help1854increase healthy food consumption by providing enrollees with a1855coupon, discount, gift card, bonus food item or extra funds.1856Program evaluations have shown that HIP participants consumed1857almost 1/4 cup more fruits and vegetables per day and had1858higher total household spending on fruits and vegetables than1859non-participants.vi Additionally, participants in one program1860redeemed more than $20 million dollars in nutrition incentives1861and produce prescriptions with the program generating an1862economic impact of about $41 million dollars.1863    However, there remains a gap in the nutrition needs of many1864individuals who are not enrolled in or eligible for SNAP1865benefits. An earlier cited study found that 29 percent of1866people with diabetes were not receiving SNAP benefits, and over1867two-thirds of uninsured individuals were not receiving SNAP1868benefits. Further, over 40 percent of Medicaid enrollees with1869diabetes who were receiving SNAP benefits remained food1870insecure. There is undoubtedly room for improvement to ensure1871SNAP and related programs better serve my patients who need1872them; to start, greater coordination and streamlined enrollment1873across safety-net programs such as SNAP and Medicaid, increased1874funding for benefits, improving public awareness about HIPs,1875and making it administratively easier for individuals to1876navigate and use said benefits. However, that alone will not1877solve my patient's challenges with accessing and adhering to1878healthy lifestyle choices.1879    While diet and exercise are critically important to health1880and wellness, we cannot ignore that these are not accessible1881choices for those who live in communities designed with them1882out of reach. Food and exercise can only be medicine if they1883are equitably and easily available, safe, and accessible. As a1884family physician, I can recommend working out and having a1885healthy diet - but it is up to you, our elected leaders, to1886ensure the resources and support are in place to fill that1887prescription. Congress has the opportunity to advance1888additional policies to address food insecurity, unstable1889housing, and other health-related social needs and improve1890health outcomes at the community, family, and individual level.1891For instance, policies that support free or reimbursable public1892transit or improve the safety and accessibility of sidewalks1893and bike lanes help improve transportation access and can1894influence better health outcomes for both individuals and1895communities.1896    In our free clinic, we provide free, whole, plant-forward1897food to patients on Saturday mornings. Patients will often come1898even during the weeks that they do not have a medical1899appointment. I encourage you all to explore federal investments1900such as additional grants or more sustainable funding streams1901to expand these types of community-based resources,1902particularly in communities like mine that remain food deserts.1903    Many states have utilized existing Medicaid authorities to1904begin addressing HRSN, including state plan authorities,1905section 1915 waivers, managed care in lieu of services and1906settings and section 1115 demonstrations. In December 2022, the1907Centers for Medicare and Medicaid Services announced that1908states can use section 1115 demonstrations to cover nutrition1909supports and HRSN case management, among other services, as1910reimbursable benefits under Medicaid for certain populations.1911    Nutrition support may include nutrition counseling and1912education; medically tailored meals; meals or pantry stocking1913for children under 21 or pregnant patients, including two1914months postpartum; fruit and vegetable prescriptions; and1915protein boxes. For example, under Massachusetts' section 11151916waiver, medically tailored meals may be provided to the whole1917household, not only the Medicaid beneficiary eligible for the1918service. This policy recognizes that a food-insecure parent1919will often give their nutrition supports to a hungry child,1920rather than feed themselves. Expansion of these types of1921policies would be life-changing and make wellness and longevity1922possible for my patients.1923    Some states have used other levers, such as community1924reinvestment requirements for Medicaid managed care contracts.1925Examples of community reinvestments addressing nutrition needs1926include building and maintaining community gardens, farmers1927markets, community-supported agriculture, farm partnerships, or1928grocery stores in food deserts. Federal policymakers could1929explore opportunities for expansion of these types of community1930investment requirements at the national level or ways to1931support ongoing state initiatives. To truly be successful and1932community-centric, any such policies must include appropriate1933guardrails with a clear definition of community reinvestment1934and transparency and accountability reporting requirements.1935Plans or other entities subject to community reinvestment1936requirements should also be required to solicit local input to1937ensure that the investments are culturally appropriate and1938address true community needs.1939    Much of this work in the states is just getting off the1940ground. Therefore, I strongly urge Congress and the1941Administration to support and further invest in these1942promising, innovative efforts that seek to address the root1943causes of poor health outcomes.1944    Beyond Medicaid, the AAFP has supported legislation that1945would expand Medicare coverage of nutrition services for1946seniors with certain diet-impacted chronic conditions, such as1947diabetes, HIV, and hypertension. We have also supported1948legislation that would establish a four-year nationwide1949demonstration program through Medicare to provide medically1950tailored meals to eligible Medicare beneficiaries with diet-1951impacted conditions. I strongly encourage the Committee to1952consider these policies as you continue to explore1953opportunities to improve health across the lifespan.1954    There is also an opportunity for Congress to improve uptake1955of services that are newly covered but underutilized,1956particularly chronic care management (CCM). In 2015, Medicare1957began paying physicians for delivering non-face-to-face CCM1958through separate codes. These services are fundamental to the1959delivery of patient-centered, comprehensive primary care,1960including for seniors with diet-impacted conditions.1961    Unfortunately, operational challenges such as patient cost-1962sharing requirements limit uptake by patients who would truly1963benefit from this type of additional support. A 2022 study1964found that Medicare billing codes for preventive medicine and1965care management services are being underutilized even though1966primary care physicians were providing code-appropriate1967services to many patients. The median use of the preventive and1968care coordination billing codes was 2.3 percent among eligible1969patients.vii1970    Put otherwise: patients are informed of a copay and shared1971costs as required by Medicare, so subsequently many patients1972opt out of these services because of the financial barriers. In1973my experience, it is often the ones who stand to benefit most1974from these services. This rings true for many of the other new1975codes Medicare has implemented, including G2211, social1976determinants of health risk assessments, and community health1977integration services. Patients are living on fixed incomes and1978have not anticipated paying for these services and,1979understandably, are resistant or unable to do so. If we want to1980incentivize usage of these high-value services, we must waive1981patient cost-sharing.1982    Removing cost-sharing for chronic care management and other1983primary care services increases access without increasing1984overall health care spending.viii Evidence indicates that1985reducing or removing cost barriers to primary care increases1986utilization of preventive and other recommended primary care1987services, which improves both individual and population health1988with long-term cost savings. While cost-sharing for most1989preventive services is currently waived across payers, many1990patients do not access all the preventive care recommended for1991them because they do not know what is or is not covered or they1992are concerned they might be charged for raising other health1993issues in the same visit. Therefore, the AAFP urges Congress to1994consider legislation that would waive patient cost-sharing for1995chronic care management and other primary care services.1996    As has been acknowledged by this Committee, we are all1997aging. Therefore, we must explicitly recognize the impact of1998health-related social needs across the lifespan and how they1999influence outcomes later in life. In particular, access to2000affordable health care coverage has positive long-term effects.2001Expanded Medicaid eligibility for pregnant women has been shown2002to increase their children's economic opportunity in adulthood2003through increased educational attainment and higher incomes.ix2004Children covered by Medicaid also pay more in cumulative taxes2005by age 28 compared to their peers who are not Medicaid-2006enrolled.x2007    If we want to give everyone the chance to age healthily and2008well, it is imperative Congress supports those programs which2009make it possible, regardless of a person's socioeconomic status2010or other demographics. In particular, cutting Medicaid does not2011just take away an individual's coverage and harm their health.2012It hurts entire families, has economic consequences, and2013jeopardizes community outcomes. Many of my young or middle-aged2014patients are caregivers for both children and older relatives.2015Any reforms that impede or altogether cut their health care2016coverage are likely to impact their employment, their ability2017to help their mother make rent, to take their grandma to the2018laundromat or her cardiologist appointment, or contribute in2019any productive, meaningful way to their community. If we want2020to truly improve our nation's health to optimize longevity, it2021must start with investing in Medicaid and other safety-net2022supports - not cutting them.2023    Health insurance coverage does not help patients if there2024is no access to care, however. Community health centers (CHCs),2025including FQHCs and rural health clinics, provide care to those2026in medically underserved areas and are often the only2027accessible health care setting for many individuals, including2028Medicaid beneficiaries and the uninsured. Nationally, Medicaid2029makes up 43 percent of community health center revenue.xi As a2030result, cuts to Medicaid would be a direct cut to CHCs and the2031communities they serve as well.2032    CHCs have a significant economic impact. In 2021, they2033supported more than 500,000 direct or indirect jobs nationally2034with nearly $85 billion in economic output. Both New York and2035Florida, which are proudly represented by this Committee's2036leadership, are in the top five of states that economically2037benefit from CHCs; the economic output is $6.1 billion in New2038York and $4.2 billion in Florida.xii Community health centers2039are also incredibly efficient in terms of health care spending.2040Research has consistently shown that health care costs for all2041patients served by CHCs - including Medicaid beneficiaries -2042are lower than costs for patients not served by CHCs.xiii2043    Further, many CHCs are working to combat our nation's2044primary care workforce shortage and training the next2045generation of family physicians by serving as Teaching Health2046Centers. The Health Resources and Services Administration's THC2047Graduate Medical Education (THCGME) program funds the2048development and implementation of residency programs in2049outpatient community-based settings in rural or medically2050underserved communities. Since the program's inception, it has2051trained more than 2,000 new primary care physicians and2052dentists - 61 percent of whom have been family physicians.2053Thanks to the THCGME program, our FQHC system has multiple2054family medicine residency programs across our region. Many of2055residents stay to continue serving these communities upon2056graduation.2057    Unfortunately, CHCs and THCGME are reliant upon a patchwork2058of inconsistent, temporary federal funding to stay afloat. At2059the moment, funding for both programs is only guaranteed2060through March 14. This, in addition to recent executive actions2061which have stoked confusion about what federal funding is or is2062not available, is an existential crisis for our nation's safety2063net. CHCs operate on such thin margins that even a threat to2064funding can paralyze our ability to deliver all of the care2065that is essential to meeting our patients' and community's2066needs.2067    For THCs, uncertainty about future funding for the academic2068year has led to some programs either closing their doors2069entirely or accepting fewer residents. To support and improve2070the quality of life for patients of all ages and in all2071communities, I urge this Committee and your colleagues in2072Congress to make stable, long-term funding for CHCs and THCGME2073a priority and to ensure that access to other key programs and2074community-level interventions is not disrupted. Failure to do2075so would run counter to the Committee's stated goals.2076    In closing, thank you again for the opportunity to provide2077this testimony. On behalf of the AAFP and as a family2078physician, I look forward to working with the Committee to2079advance policies that invest in the health and wellbeing of2080individuals across the lifespan at the person, family, and2081community level. We all have the same goal: to improve the2082lives of the people we serve.20832084References20852086i Heller CG, Rehm CD, Parsons AH, Chambers EC, Hollingsworth2087NH, Fiori KP. The association between social needs and chronic2088conditions in a large, urban primary care population. Prev Med.20892021 Dec;153:106752. doi: 10.1016/j.ypmed.2021.106752. Epub20902021 Aug 1. PMID: 34348133; PMCID: PMC8595547.20912092ii Centers for Disease Control and Prevention, "PLACES: Health-2093Related Social Needs." Accessed online at: https://www.cdc.gov/2094places/measure-definitions/health-related-social-needs.html.20952096iii Peikes, D. N., Swankoski, K. E., Rastegar, J. S., Franklin,2097S. M., & Pavliv, D. J. (2023). Burden of health-related social2098needs among dual- and non-dual-eligible Medicare Advantage2099beneficiaries. Health Affairs, 42(7). https://doi.org/10.1377/2100hlthaff.2022.01574.21012102iv Kirby JB, Bernard D, Liang L. The Prevalence of Food2103Insecurity Is Highest Among Americans for Whom Diet Is Most2104Critical to Health. Diabetes Care. 2021 Jun;44(6):e131-e132.2105doi: 10.2337/dc20-3116. Epub 2021 Apr 26. PMID: 33905342;2106PMCID: PMC8247495.21072108v Peikes, D. N., Swankoski, K. E., Rastegar, J. S., Franklin,2109S. M., & Pavliv, D. J. (2023). Burden of health-related social2110needs among dual- and non-dual-eligible Medicare Advantage2111beneficiaries. Health Affairs, 42(7). https://doi.org/10.1377/2112hlthaff.2022.01574.21132114vi U.S. Department of Agriculture, Food and Nutrition Service.2115(n.d.). Healthy incentives for SNAP participants. U.S.2116Department of Agriculture. Retrieved February 8, 2025, from2117https://www.fns.usda.gov/snap/healthy-incentives.21182119vii Sumit D. Agarwal, Sanjay Basu, Bruce E. Landon The Underuse2120of Medicare's Prevention and Coordination Codes in Primary2121Care: A Cross-Sectional and Modeling Study. Ann Intern2122Med.2022;175:1100-1108. [Epub 28 June 2022]. doi:10.7326/M21-2123477021242125viii Ma, Q. Sywestrzak, G. Oza, M. Garneau, L. DeVries, A.2126"Evaluation of Value-Based Insurance Design for Primary Care."2127(2019). The American Journal of Managed Care. 25: 5. https://2128www.ajmc.com/view/evaluation-of-valuebasedinsurance-design-for-2129primary-care.21302131ix Kaiser Family Foundation. (2022, December 13). Medicaid2132spending growth compared to other payers. Kaiser Family2133Foundation. Retrieved February 8, 2025, from https://2134www.kff.org/report-section/medicaid-spending-growth-compared-2135to-other-payers-issue-brief/.21362137x Ibid.21382139xi Kaiser Family Foundation. (n.d.). Community health center2140revenues by payer source. Kaiser Family Foundation. Retrieved2141February 8, 2025, from www.kff.org/other/state-indicator/2142community-health-center-revenues-by-payer-source/2143?currentTimeframe0&sortModel=%7B%22colId%22:%22Location%22sort%221442asc7D.21452146vii National Association of Community Health Centers. (2023).2147Economic impact of community health centers in the United2148States: 2023 report. National Association of Community Health2149Centers. Retrieved February 8, 2025, from https://2150www.nachc.org/wp-content/uploads/2023/06/Economic-Impact-of-2151Community-Health-Centers-US--2023--final.pdf.21522153xiii Ibid.21542155                 U.S. Senate Special Committee on Aging21562157            "Optimizing Longevity: From Research to Action"21582159                           February 12, 202521602161                       Prepared Witness Statement21622163                              Dan Buettner21642165    My goal here is to convince you that most of what Americans2166think will lead them to a long, healthy life is misguided or2167just plain wrong.2168    I've spent the past 20 years partnered with National2169Geographic to identify, verify, and understand populations2170around the world with the greatest longevity. These "blue2171zones," as they're known, are places where people live up to a2172decade longer than the rest of us with a fraction of the2173chronic diseases that eat up most of the $4.9 trillion our2174nation spends annually on healthcare.2175    The famous Danish Twin Study established years ago that2176only about 20% of how long we live is dictated by our genes.2177Another 10-15% is dictated by our health care system. That2178means at least two thirds of our longevity comes from something2179else.2180    So, with an advisory board of academics, my team and I set2181off to find the correlates and common denominators driving2182longevity.2183    On the Italian island of Sardinia, for example, our2184demographers found a cluster of six mountain villages that2185produced centenarians at a rate many times that of the U.S.2186People there ate a mostly whole-food, plant-based diet-cheap2187peasant foods like fava beans, barley, and potatoes. They2188prioritized family and friends over status and wealth. They2189prayed. (Did you know that people who go to a faith-based2190community four times a month live four years longer than people2191who don't?) And every time these villagers went to work,2192school, or to visit friends, it occasioned a walk. They got in2193their 8,000-12,000 steps a day without even thinking about it.2194    The Big Secret here-and the one we miss-is that health and2195longevity are rarely successfully pursued. They ensue.2196    We spend nearly a half trillion a year trying to chase2197health with diet, exercise, and pills. They're all great2198business plans, but they fail for almost everyone all of the2199time. If you start with 100 people on a diet, you lose more2200than 95% in two years. Exercise programs have similar drop2201offs.2202    Similarly, the $47 billion a year Americans spend on2203antiaging products has not delivered a single pill, supplement,2204or stem cell treatment that has been shown to reverse, stop, or2205even slow aging.2206    In the blue zones, longevity ensues because people live in2207an environment where the healthy choice is the easy choice. The2208cheapest, most delicious foods are the simplest foods. It's2209easier to walk places than to drive. You can't avoid face-to-2210face contact with your neighbors, your fellow worshipers, or2211the extended family that lives with you. And you have a2212vocabulary for your purpose in life, so it's easier to pursue2213it. In other words, people in the blue zones don't have to2214muster the resources, the daily discipline, and the presence of2215mind to make the healthy choice. Their environment does it for2216them.2217    If we want a healthier America, we should shift our focus2218from the folly of trying to convince 340 million people to2219follow a diet or health plan and instead we should strive to2220set them up for success. My company, Blue Zones, has helped2221more than 70 American cities shape polices that favor healthy2222foods over junk foods, to build streets for human beings, not2223just for cars, which can increase physical activity for the2224whole city by 20%, and to encourage non-smokers over smokers.2225We also offer Blue Zones certification for all schools,2226restaurants, workplaces, and places of worship that optimize2227their designs and policies to nudge people into moving more,2228socializing better, and eating healthier. The key is optimizing2229our living environments.2230    The proof is in the numbers. Using our approach, Fort2231Worth, Texas, reported a drop in obesity and a quarter of a2232billion dollars in annual healthcare savings. The Beach Cities2233of Southern California reported a 15% drop in BMI. Our first2234Blue Zones Project city, the town of Albert Lea, Minnesota, has2235saved 30% of their city worker health care costs since they2236started-and they're still making their city healthier 15 years2237later.2238    The secret to longevity does not lie in any silver bullet.2239The secret is to shift the focus of public policy from trying2240to change individual behaviors to setting up all Americans for2241success by making the healthy choice the easy one.22422243=======================================================================22442245                        Questions for the Record22462247=======================================================================22482249                 U.S. Senate Special Committee on Aging22502251            "Optimizing Longevity: From Research to Action"22522253                           February 12, 202522542255                        Questions for the Record22562257                            Dr. Eric Verdin22582259                        Senator Raphael Warnock22602261    Question:22622263    Access to affordable healthcare is essential and allows2264seniors across the country to age with dignity. Federally2265funded research, facilitated by hardworking federal workers,2266helps healthcare providers better understand aging-related2267diseases, such as Alzheimer's. In Fiscal Year 2024, Georgia2268received $782,913,345 in federal funding to support 1,557 grant2269awards through the National Institutes of Health (NIH).\1\2270Additionally, the Centers for Disease Control and Prevention2271(CDC), which is headquartered in Georgia, supports valuable2272research to combat infectious diseases and public health2273threats. However, the Trump Administration's executive orders2274and funding cuts have affected life-saving research that could2275improve the health and longevity of seniors.\2\2276---------------------------------------------------------------------------2277    \1\ NIH Awards by Location & Organization, National Institutes of2278Health, www.report.nih.gov/award/2279index.cfmot=fy=2024state=GAic=fm=orgid=distr=rfa=om=npid=view=statedetai2280l.2281    \2\ Sheryl Gay Stolberg and Christina Jewett, Judge Temporarily2282Blocks Trump Cuts to Medical Research Funding, The New York Times (Feb.22832025), https://www.nytimes.com/2025/02/10/us/politics/nih-trump-2284lawsuit-medical-research.html.2285---------------------------------------------------------------------------2286    How will cuts to the federal workforce and funding at2287research agencies, like the CDC and NIH, affect efforts to2288support research into age-related diseases?22892290    Response:22912292    At a time when we are on the verge of significant2293breakthroughs in the fight against age-related chronic disease2294- breakthroughs that could ease untold human suffering and2295achieve trillions of dollars in savings in healthcare costs -2296cuts to the NIH would be devastating.2297    On February 7, the National Institutes of Health (NIH),2298under direction from the Trump administration, announced a plan2299to cap indirect cost recovery on federally funded biomedical2300research grants at 15% of direct costs. While a federal judge2301has extended an order temporarily blocking implementation, this2302policy - which means little to the average American - could2303have devastating consequences for the future of American2304biomedical research.2305    NIH is the largest funder of biomedical research in the2306U.S., supporting thousands of projects at academic and medical2307institutions. The rationale for this proposed cut is a familiar2308one: the assumption that IDC represents unnecessary2309bureaucratic waste. That assumption is dangerously misguided.2310    Since the 1950s, NIH has divided research costs into two2311categories: direct costs-salaries, lab supplies, and equipment-2312and indirect costs, which cover essential infrastructure and2313administrative expenses necessary for conducting federally2314funded biomedical research. This includes lab space, utilities,2315security, compliance, IT support, equipment maintenance, and2316administrative staff for grants management, HR, and regulatory2317oversight. These indirect expenses are not arbitrary; they are2318calculated based on documented institutional costs and are2319subject to rigorous audits every four to five years.2320Institutions cannot simply inflate these rates at will.2321    Despite claims of excessive spending, indirect cost rates2322vary between 40% and 70%, depending on real institutional2323costs. And even that figure is often misunderstood. An indirect2324cost rate of 50% does not mean half of a grant goes to2325overhead; rather, it means that for every $100 in direct costs,2326$50 is allocated to necessary facilities and administration,2327making the actual overhead share of the grant just 33%.2328    What would slashing IDC reimbursements to 15% mean in2329practice? For most universities, research institutes, and2330medical centers, it would make large-scale research2331unsustainable. Some institutions would be forced to cut2332programs; others might abandon their research mission2333altogether. Our economy in general, and the biopharmaceutical2334sector in particular, would suffer. In FY 2023, every $1 of NIH2335funding generated approximately $2.46 of economic activity. The2336long-term damage would be profound: the U.S., which has led the2337world in biomedical innovation for decades, would see its2338scientific preeminence erode.2339    The timing could not be worse. America faces a healthcare2340crisis, with annual costs exceeding $4.9 trillion. Biomedical2341research, largely funded through NIH, forms the foundation for2342innovations that drive the pharmaceutical and healthcare2343industries. Yet the NIH budget stands at just $47 billion, a2344mere 1% of total healthcare spending. By comparison, technology2345industries routinely invest 8-12% of revenue into R&D, and the2346U.S. military spends over $143 billion annually on research-2347three times the entire NIH budget.2348    Cutting indirect cost support will not save taxpayer2349dollars; it will sabotage the very research that leads to life-2350saving treatments and drives economic growth. Policymakers must2351recognize that this change is not a bureaucratic tweak-it is an2352attack on the future of biomedical discovery. If implemented,2353it will set American science back for a generation.23542355                 U.S. Senate Special Committee on Aging23562357            "Optimizing Longevity: From Research to Action"23582359                           February 12, 202523602361                        Questions for the Record23622363                           Dr. Sarah C. Nosal23642365                        Senator Raphael Warnock23662367    Question:23682369    Access to affordable healthcare is essential and allows2370seniors across the country to age with dignity. Most older2371adults in the United States are living with at least one2372chronic health condition, and many seniors face barriers, like2373lack of access to transportation, that impede their access to2374quality health care.\1\ Medicare telehealth flexibilities have2375allowed providers to deliver quality care to seniors who might2376otherwise be unable to access certain services. I was proud to2377join my colleagues to approve an extension of telehealth2378flexibilities in the American Relief Act, 2025; however, these2379flexibilities will expire on March 31, 2025.\2\2380---------------------------------------------------------------------------2381    \1\ Social Determinants of Health and Older Adults, Office of2382Disease Prevention and Health Promotion, https://odphp.health.gov/our-2383work/national-health-initiatives/healthy-aging/social-determinants-2384health-and-older-adults.2385    \2\ Telehealth Policy Updates, Department of Health and Human2386Services, https://telehealth.hhs.gov/providers/telehealth-policy/2387telehealth-policy-updates.2388---------------------------------------------------------------------------2389    How does expanding access to health care, such as through2390extending Medicare telehealth flexibilities, optimize longevity2391for seniors?23922393    Response:23942395    Expanding access to health care across modalities, be it2396in-person, audio-only, or video telehealth, is essential to2397delivering accessible, patient-centered care and improving2398health outcomes. On many occasions my older adult patients,2399often living alone or simply alone during the day while family2400is at work, rely on visiting grandkids or the few hours a home2401attendant is present in order to connect with a video visit. On2402their own, the only successful access to telehealth may be via2403audio-only. One study of Federally Qualified Health Centers2404(FQHCs) found that, by mid-2022, one in five primary care2405visits and two in five behavioral health visits were audio-2406only, and audio-only visits were still more common than video2407visits. Yet the lack of payment parity and numerous2408restrictions placed on these visits have made them2409unsustainable post-COVID.2410    The COVID-19 pandemic shown a spotlight on what a lifeline2411telehealth and audio-only services are for keeping patients,2412including seniors, connected to care. It demonstrated that2413enabling physicians to virtually care for their patients at2414home can not only reduce patients' and clinicians' risk of2415exposure and infection but also increase access and convenience2416for patients, particularly those who may be homebound or lack2417transportation. For our patients in rural and suburban2418communities, transportation is cited as the number one reason a2419patient is unable to attend their in-person visit, canceling2420important preventive and disease management care. I remember a2421patient who had been unable to make it into the office due to2422lack of family support for transportation and physical2423disability that prevented travel on her own. On our video visit2424I had her walk about and realized she was lightly holding on to2425the furniture as she did. The patient had skipped her follow up2426eye evaluation and had had a marked decrease in vision that2427required urgent follow up. This much more timely telehealth2428visit made it possible to evaluate this patient in her home and2429observe things we normally cannot during an in-office visit.2430For this patient, both clinical deterioration and obvious home2431safety issues with her diminishing vision were observed via2432video visit and made it possible to connect her to the2433personalized specialty and community services to address her2434low vision needs and high priority care.2435    For these reasons, I urge Congress to prioritize passage of2436permanent telehealth flexibilities to provide greater certainty2437and stability to both physicians and patients and ensure that2438we can care for our communities via whatever modality is2439accessible and appropriate - not just based on arbitrary rules.2440    Question:24412442    Community Health Centers (CHCs) play a vital role in2443addressing provider shortages, especially in rural and2444underserved communities.\3\ Following President Trump's2445executive order to freeze federal funding and pause external2446communications at federal agencies, CHCs in Georgia and safety-2447net providers across the country faced delays in funding, which2448threatened access to affordable care for millions of Americans,2449including seniors, who rely on CHCs.\4\2450---------------------------------------------------------------------------2451    \3\ America's Health Centers: By the Numbers, National Association2452of Community Health Centers (Oct. 2024), https://www.nachc.org/2453resource/americas-health-centers-by-the-numbers.2454    \4\ Shannon Pettypiece and Bracey Harris, Health Clinics Face Cuts,2455Closures as Trump's Funding Fight Ripples Outside of Washington, NBC2456News (Feb. 2025), https://www.nbcnews.com/politics/donald-trump/health-2457clinics-face-cuts-closures-trumps-funding-fight-ripples-washing-2458rcna191014.2459---------------------------------------------------------------------------2460    Why are investments in federal funding for Community Health2461Centers important for seniors across the country, especially2462those living in medically underserved areas?24632464    Response:24652466    In 2023, community health centers across the country served2467nearly four million patients 65 years of age or older. This2468number has been steadily increasing over the years,2469demonstrating a growing reliance upon CHCs by our nation's2470seniors. As noted in my written and oral testimony, CHCs are2471often the only care setting available to individuals living in2472rural (caring for one in five rural residents) and medically2473underserved areas (caring for one in three people living in2474poverty) and thus play a critical role in connecting seniors2475and others to necessary primary care and other medical2476services. We take seriously our commitment to supporting2477wellness and ensuring our patients live well and longer. In the2478vein of this hearing's topic, CHCs are essential to optimizing2479longevity for seniors and other populations as we also provide2480supportive services to directly address health-related social2481needs that negatively impact an individual's ability to be2482well.2483    Nearly two-thirds (65%) of adult patients who seek care at2484CHCs reported receiving certain medical-related assistance2485services and 22% reported receiving economic-related assistance2486through their health center. Housing, transportation and food2487assistance are some of the most common medical-related2488assistance services sought at my clinic. We identify needs on2489intake screening and case managers just this week have been2490able to help my patients with medical-related assistance2491services including help arranging external medical appointments2492for critical screening care not available onsite; connecting2493patients to appropriate health education; free and discounted2494medication resources; arranging transportation to appointments;2495providing interpretation services; and conducting home visits2496to evaluate the environment and better determine health needs.2497These same patients benefited from the collocation of2498evaluation for economic-related assistance including help2499applying for government benefit programs like Medicaid or2500nutrition assistance; obtaining food; finding housing; getting2501clothing or shoes; and finding employment.2502    Unfortunately, CHCs for far too long have been reliant upon2503a patchwork of inconsistent, temporary federal funding to stay2504afloat. This approach creates an existential crisis for our2505nation's safety net and clinics like mine. CHCs are truly non-2506profit, operating on very thin margins and putting every dollar2507back into the community for which they care. The freeze that2508occurred earlier this year and the subsequent delay in2509accessing funds paralyzed our ability to deliver all of the2510care that is essential to meeting our patients' and community's2511needs. Proposals being floated to cut Medicaid are also deeply2512concerning. Nationally, Medicaid makes up 43 percent of2513community health center revenue. As a result, cuts to Medicaid2514would be a direct cut to CHCs and the communities they serve2515aswell.2516    To support and improve the quality of life for patients of2517all ages and in all communities and most impactfully our rural2518and under resourced communities, I urge Congress to make2519stable, long-term funding for CHCs a priority and to protect2520invests in Medicaid and other safety-net programs so that we2521can continue to deliver the whole-person, community-level2522interventions that are necessary to improving longevity.2523=======================================================================25242525                       Statements for the Record25262527=======================================================================25282529                 U.S. Senate Special Committee on Aging25302531            "Optimizing Longevity: From Research to Action"25322533                           February 12, 202525342535                       Statements for the Record25362537                       James C. Appleby Testimony25382539    On behalf of the Gerontological Society of America (GSA),2540thank you for a holding a hearing on longevity and healthy2541aging and the opportunity to provide the U.S. Special Committee2542on Aging this statement for the record. Since 1945, GSA members2543have been at the forefront in researching innovative2544interventions leading to greater health outcomes and more2545meaningful lives as we age. We appreciate the conversations the2546Committee and panelists had, notably discussions recognizing2547the importance of our healthspan as we live longer lives and2548our approaches to the treatment and prevention of chronic2549disease.2550    GSA seeks to serve as a resource in working with you and2551members of the Committee to inform public policy with evidence-2552based research to advance improved health outcomes. Attached to2553this letter we included a sample of resources and research2554briefly covered in the hearing. GSA publishes five peer-2555reviewed journals with research that can advance the focus on2556biomedical research, as well as more than 60 interest groups2557formed around a topic or issue that cuts across disciplines.2558    GSA has developed several resources based on evidence-based2559research for managing obesity in older people. Access to2560comprehensive obesity care can lower the severity of these2561diseases and, in some cases, cure them entirely. This includes2562a useful framework for primary care providers to help older2563people with obesity challenges recognize their condition and2564take action to maintain a healthy weight.2565    In 2023, GSA hosted a roundtable discussion in Washington,2566DC with researchers, clinicians, and advocates who were asked2567to address key questions about obesity as a disease of body2568weight regulation and how outdated paradigms and perceptions2569about obesity can be improved among health professionals,2570policymakers, and the public. That discussion produced valuable2571information on key aspects of obesity care across the lifespan2572and particularly in clinical care for older adults. The report,2573titled "Bringing Obesity Management to the Forefront of Care2574for Older Adults: Seven Strategies for Success," presents the2575roundtable s insights, which are discussed in the framework of2576seven strategies for addressing barriers to quality obesity2577care for older people.2578    In 2024, GSA submitted a letter as part of the National2579Institute of Health s Request for Information on Research2580Strategies for Addressing Obesity Heterogeneity. In this2581letter, GSA discussed our understanding of obesity2582heterogeneity and how obesity presents differently for every2583patient.2584    We know that access to comprehensive obesity care can lower2585the severity of the disease of obesity and many other diseases,2586and in some cases cure them entirely. Current federal policy2587unfairly denies coverage and access for people over the age of258865 to vitally important evidence-based treatments for obesity,2589both preventing older people from starting these treatments2590while on Medicare and disrupting treatment for those who lose2591access as they age into Medicare. GSA believes it is crucial2592that Congress and the Centers for Medicare and Medicaid2593Services (CMS) take the steps necessary to end the current2594unjust policy and ensure that Americans have access to the2595holistic and comprehensive obesity care necessary to ensure2596healthy lives. GSA supports the Center for Medicare and2597Medicaid Services (CMS) rule that would expand access to AOMs2598for Medicare and Medicaid beneficiaries. These treatments can2599prevent and treat the development of cardiovascular disease,2600type 2 diabetes, sleep apnea, and more.2601    GSA supports a comprehensive approach to treating the2602chronic disease of obesity, and this includes behavioral2603interventions. Counseling patients on nutrition, physical2604activity and behavior change at frequent clinic visits, as2605proposed by intensive behavioral therapy (IBT), is an2606effective, proven approach to treating obesity treatment and2607can reduce the risk of co-morbidities. We support this approach2608when AOMs are part of treatment for obesity.2609    The GSA KAER framework Kickstart, Assess, Evaluate, and2610Refer (KAER) supports primary care teams to better meet the2611needs of older people with obesity and overweight. Using this2612framework and the tools and resources in the GSA Toolkit for2613the Management of Obesity in Older Adults, care teams can2614kickstart the discussion of body size with older people and2615their families; assess the presence of altered body fat amount,2616distribution, and/or function; evaluate treatment options for2617older people with overweight and obesity; and refer older2618people to community resources.2619    The mission of GSA is to foster excellence, innovation, and2620collaboration to advance aging research, education, practice,2621and policy; our vision is meaningful lives as we age. GSA's26226,000 members include gerontologists, health professionals,2623behavioral and social scientists, biologists, demographers,2624economists, and many other disciplines. These experts study all2625facets of aging with a life-course orientation. The2626multidisciplinary nature of the GSA membership is a valued2627strength, enabling us to provide a 360-degree perspective on2628the issues facing our population as we age.2629    GSA wishes to be a resource to you and your staff in your2630role serving in the Senate and on the Senate Special Committee2631on Aging. We would enjoy meeting with you and/or your staff in2632the coming weeks to discuss our work. In the meantime, if you2633have any questions, please contact Patricia D'Antonio, Vice2634President of Policy and Professional Affairs.2635    We look forward to continuing to work with you on improving2636the health of all of us as we age.26372638    Sincerely,26392640    /s/2641    James C. Appleby, BSPharm, MPH, ScD (Hon), Chief Executive2642Officer26432644                 U.S. Senate Special Committee on Aging26452646            "Optimizing Longevity: From Research to Action"26472648                           February 12, 202526492650                       Statements for the Record26512652  The Alzheimer's Association & Alzheimer's Impact Movement Testimony26532654    The Alzheimer's Association and Alzheimer's Impact Movement2655(AIM) appreciate the opportunity to submit this statement for2656the record for the Senate Special Committee on Aging hearing on2657"Optimizing Longevity: From Research to Action." We thank the2658Committee for its continued leadership on issues crucial to2659individuals living with Alzheimer's and other dementias. This2660statement underscores the critical role of family caregivers2661and research on modifiable risk factors in addressing cognitive2662impairment, including the need for greater risk reduction2663strategies and awareness to improve individuals' quality of2664life and longevity.2665    Founded in 1980, the Alzheimer's Association is the world's2666leading voluntary health organization in Alzheimer's care,2667support, and research. Our mission is to eliminate Alzheimer's2668disease and other dementias through the advancement of2669research, to provide and enhance care and support for all2670affected, and to reduce the risk of dementia through the2671promotion of brain health. AIM is the Association's advocacy2672affiliate, working in a strategic partnership to make2673Alzheimer's a national priority. Together, the Alzheimer's2674Association and AIM advocate for policies to fight Alzheimer's2675disease, including increased investment in research, improved2676care and support, and the development of approaches to reduce2677the risk of developing dementia.26782679    The Impact of Family Caregivers26802681    Caregivers of individuals living with Alzheimer's or2682another dementia play an essential role in maintaining the2683quality of life for their loved ones and helping them live2684independently in their homes and communities for as long as2685possible. They are the backbone of our nation's health care2686system, providing essential care to loved ones at great2687personal, physical, and financial sacrifice. In 2023 alone,2688over 11 million dedicated caregivers provided a remarkable 18.42689billion hours of unpaid care for individuals living with2690Alzheimer's or another dementia, valued at nearly $350 billion.2691One in three dementia caregivers has been providing care for2692five or more years. In fact, of the total lifetime cost of2693caring for someone with dementia, 70 percent is borne by2694families - either through out-of-pocket health and long term2695care expenses or from the value of unpaid care. As a result of2696this financial strain, many families significantly cut back on2697savings contributions and other spending, with some reporting2698eating less due to care costs.2699    It is evident that Alzheimer's takes a devastating toll on2700caregivers. Amid these challenges, there is an urgent need to2701alleviate the overwhelming costs faced by caregivers. We2702strongly support the bipartisan Credit for Caring Act, which2703would create a new, nonrefundable federal tax credit of up to2704$5,000 for eligible working family caregivers of individuals,2705regardless of age, with certain functional or cognitive2706limitations. The tax credit would help alleviate some of the2707financial strain on these selfless caregivers nationwide and2708could be used to offset some of the costs of caregiving,2709including the costs of respite care, transportation, lost2710wages, and more. Providing these dedicated caregivers with2711financial relief would not only improve their own quality of2712life but would also allow for greater access to caregiver2713education and resources essential to ensuring adequate care and2714long-term quality of life for their loved ones. In addition,2715prioritizing home-based care through a family caregiver tax2716credit can reduce reliance on costly long term care facilities,2717saving taxpayer dollars while improving the health and well-2718being of individuals living with Alzheimer's and other2719dementias. We look forward to working with Congress and members2720of the Committee to advance the bipartisan Credit for Caring2721Act and other legislation to support caregivers, as they2722enhance longevity and quality of life for our aging population.27232724    The Science Behind Dementia Risk Reduction and Brain Health27252726    As of 2024, nearly seven million Americans are living with2727Alzheimer's, a number expected to rise to nearly 13 million by27282050. With many more at risk of developing the disease or2729another form of dementia, the need for effective dementia risk2730reduction strategies that help all communities increases by the2731day. Two-thirds of Americans have at least one major potential2732risk factor for dementia. As the prevalence of dementia2733continues to rise, addressing modifiable risk factors is2734essential not only to reduce the number of new cases but also2735to prevent current projections from worsening.2736    Population-based and epidemiologic studies show that2737certain modifiable risk factors can increase the risk of2738cognitive decline and possibly dementia. A growing body of2739evidence shows that healthy behaviors can protect and promote2740brain health. Given the growing evidence that lifestyle factors2741play a significant role in cognitive health, larger studies are2742essential to further understand how we can effectively reduce2743the risk of cognitive decline and help individuals live longer,2744happier lives. The Alzheimer's Association U.S. Study to2745Protect Brain Health Through Lifestyle Intervention to Reduce2746Risk (U.S. POINTER) is a two-year clinical trial to evaluate2747whether lifestyle interventions that simultaneously target many2748risk factors protect cognitive function in older adults who2749have an increased risk for cognitive decline. U.S. POINTER is2750the first such study to be conducted on a large group of2751Americans across the United States. Approximately 2,0002752volunteer older adults who are at increased risk for dementia2753have been enrolled and will be followed for two years. Two2754lifestyle interventions will be compared, which vary in2755intensity and format. Eligible volunteers are randomly assigned2756to these interventions to evaluate whether cognitive benefits2757from a structured program differ from a self-guided program.2758Lifestyle interventions combining multiple behavior components2759show promise as a therapeutic strategy to protect brain health.2760We look forward to sharing the results of this groundbreaking2761study soon.27622763    Alzheimer's Association Public Health Center of Excellence2764on Dementia Risk Reduction27652766    The prevention of aging-related cognitive impairment and2767dementia is a major and urgent public health priority as well2768as a priority for individuals, families, and communities.2769Because evidence for the effectiveness of specific health-2770related behaviors and practices has begun to emerge, in 2018,2771Congress passed the Building Our Largest Dementia (BOLD)2772Infrastructure for Alzheimer's Act (P.L. 115-406) to empower2773public health departments to develop and implement effective2774dementia interventions in their communities. We are deeply2775grateful for the bipartisan, bicameral support that led to the2776reauthorization of this vital law in December 2024, through the2777passage of the BOLD Reauthorization Act (P.L. 118-142),2778allowing this great work to continue for an additional five2779years.2780    Sustained funding for the BOLD Act's implementation over2781the years has allowed the CDC to award funding to three Public2782Health Centers of Excellence (PHCOE) and make 66 awards to 452783state, local, and tribal public health departments. The PHCOEs2784are working to increase the education of public health2785officials, health care professionals, and the public on public2786health strategies that promote brain health, and support people2787living with dementia and their caregivers. These investments2788are critical to advancing public health strategies that not2789only promote brain health but also support longer, healthier2790lives. The PHCOEs are working to increase the education of2791public health officials, health care professionals, and the2792public on public health strategies that promote brain health2793and longevity, while also supporting people living with2794dementia and their caregivers. We look forward to continuing2795working with Congress throughout the appropriations process to2796ensure this vital work may continue.2797    With support from the CDC, the Alzheimer's Association is2798proud to lead the PHCOE on Dementia Risk Reduction, which works2799to help state, local, and tribal public health agencies address2800risk factors for cognitive decline and dementia. Launched in28012020, the Center serves as a national resource in translating2802the latest science on dementia risk reduction into tools,2803materials, and messaging that public health agencies can use to2804reduce dementia risk for all people. More specifically, the2805Center offers one-on-one engagement with public health2806officials to encourage action in their communities; provides2807technical assistance to help public health officials design,2808implement, and evaluate risk reduction activities; and2809publishes online resources on dementia risk factors and what2810public health can do to address them. By identifying and2811mitigating key dementia risk factors, these efforts directly2812contribute to the goal of increasing a healthy lifespan.2813    The Alzheimer's Association PHCOE on Risk Reduction has2814also partnered with Wake Forest School of Medicine to convene a2815panel of nationally and internationally renowned scientists2816with expertise in specific areas of dementia and cognitive2817impairment prevention research. The panel's charge was to2818review, evaluate, and synthesize the current knowledge on2819preventing or delaying the onset of cognitive decline and2820dementia. In the report "Reducing Dementia Risk: A Summary of2821the Science and Public Health Impact," the panel ultimately2822identified eight modifiable risk factors based on the level of2823research support and strength of evidence, to inform emerging2824efforts by public health agencies throughout the United States2825to address the risk for cognitive decline and dementia:2826diabetes and obesity, physical activity, social engagement,2827diet and nutrition, vascular health, sleep, smoking and2828alcohol, and sensory impairments. Addressing these risk factors2829not only reduces the risk of dementia but also enhances overall2830longevity, enhancing the aging population's independence and2831vitality.2832    While new treatments may slow the progression of cognitive2833decline, steps can be taken now to reduce the risk of2834developing it and, in turn, optimize individuals' quality of2835life. As illustrated above, the science on dementia risk2836reduction is quickly evolving, and the evidence linking certain2837behaviors and conditions and long-term cognitive health and2838dementia is growing stronger.28392840    Conclusion28412842    By prioritizing policies that support caregivers and2843investing in risk reduction strategies, we can help the aging2844population live longer, healthier lives. The Alzheimer's2845Association and AIM deeply appreciate the Committee's continued2846commitment to advancing issues vital to the millions of2847families affected by Alzheimer's disease and other dementias.2848We look forward to working with the Committee in a bipartisan2849way to enhance longevity and improve quality of life for those2850impacted by dementia.28512852                 U.S. Senate Special Committee on Aging28532854            "Optimizing Longevity: From Research to Action"28552856                           February 12, 202528572858                       Statements for the Record28592860                    Dr. George C. Shapiro Testimony28612862    Thank you for the opportunity to submit this statement on2863behalf of Fountain Life. Our mission is to extend healthspan by2864identifying and addressing chronic disease before symptoms2865arise, using cutting-edge diagnostic technology and precision2866medicine. We fully support the Committee's efforts to ensure2867that innovative research leads to actionable solutions that2868improve the health and quality of life of older Americans.28692870    The Need for a Proactive Approach to Longevity28712872    Chronic diseases, driven by inflammation, metabolic2873dysfunction, and lifestyle factors, account for over 90% of2874healthcare costs and significantly reduce quality of life in2875aging populations. Traditional healthcare models focus on2876reactive treatment rather than early detection and prevention.2877At Fountain Life, we believe the future of medicine lies in2878proactive, data-driven care that empowers individuals to take2879control of their health before disease manifests.28802881    Fountain Life's Precision Health Model28822883    Fountain Life integrates advanced diagnostics, AI-driven2884analytics, and regenerative therapies to optimize healthspan2885and longevity. Our approach includes:2886      Whole-Body MRI & Multi-Cancer Early Detection with AI2887overlay: Non-invasive imaging technologies detect asymptomatic2888cancers and early-stage disease, allowing for timely2889intervention.2890      AI-Powered Cardiovascular Screening: AI-driven imaging2891predicts heart disease risk with unmatched accuracy, leading to2892targeted preventive strategies.2893      Epigenetic & Multi-Omic Analysis: Assessing biological2894aging markers, inflammation, and metabolic health to tailor2895personalized longevity plans.2896      Regenerative & Cellular Therapies: Utilizing precision2897interventions, such as stem cell therapies and peptide2898treatments, to reverse age-related decline.28992900    Real-World Impact: Case Studies & Data29012902    Fountain Life's model is already demonstrating significant2903outcomes:2904      A 58-year-old asymptomatic male underwent our2905comprehensive screening, revealing early-stage pancreatic2906cancer. Prompt surgical intervention led to a full recovery,2907avoiding the typically grim prognosis of late-stage diagnosis.2908      A 63-year-old woman was identified with critical2909coronary artery disease through AI-powered imaging, despite2910normal cholesterol levels and no symptoms. Early intervention2911prevented a potentially fatal heart attack.2912      In a recent internal study, 14% of asymptomatic2913individuals screened at Fountain Life had undiagnosed cancer or2914significant cardiovascular disease, highlighting the critical2915need for proactive detection.29162917    Bridging Research & Action for Better Outcomes29182919    To translate longevity research into real-world impact, we2920advocate for policies that:2921      1. Promote Preventive & Precision Healthcare:2922Incentivizing proactive diagnostics and biomarker-driven2923treatments to delay or prevent disease onset.2924      2. Expand Access to Advanced Screening: Increasing2925insurance coverage for early-detection technologies to make2926longevity-focused care widely available.2927      3. Support Data-Driven, AI-Powered Healthcare:2928Encouraging the integration of AI in diagnostics to improve2929accuracy, efficiency, and scalability.29302931    Commitment to Collaboration29322933    Fountain Life welcomes the opportunity to collaborate with2934policymakers, researchers, and healthcare leaders to advance2935longevity-focused healthcare. We look forward to participating2936in future hearings or roundtable discussions to further explore2937solutions for optimizing healthspan and reducing chronic2938disease.2939    Thank you for your leadership in this critical area. We2940appreciate the Committee's dedication to ensuring that2941longevity research translates into meaningful, actionable2942improvements for aging Americans.2943    "In addition to the insights shared here, Fountain Life has2944compiled comprehensive data demonstrating the economic impact2945of our precision medicine and longevity strategies. This data2946highlights the cost savings associated with early disease2947detection, proactive interventions, and improved healthspan. We2948would welcome the opportunity to present these findings in2949detail at your next meeting to further illustrate how our2950approach aligns with the committee's mission of translating2951research into action that enhances public health outcomes."29522953    Respectfully submitted,29542955    George C. Shapiro, MD, FACC2956    Chief Medical Innovation Officer, Fountain Life29572958                            [all]