That sounds like an operational detail. It is actually the foundation of everything on this site. The biggest problem in longevity medicine is not a knowledge problem. It is an incentive problem. When a physician profits from the protocol they prescribe, every recommendation becomes ambiguous. Is this supplement stack medicine, or margin? Is this 100-biomarker panel clinical judgment, or merchandising? Patients can rarely tell the difference, and much of the industry is built on that ambiguity.
I structured my practice so the question never comes up. At PrimaryMD, the only thing I sell is judgment: my time, my attention, and twenty-five years of clinical training applied to one patient at a time. When I recommend a test, it is because the result will change a decision. When I recommend against one, nothing was lost but the markup someone else would have charged you.
Two failures
I spent more than two decades in emergency departments and hospital wards watching the same story end the same way. A heart attack at 54. A stroke at 61. A cancer found late because of back pain. Almost none of it was sudden. The disease had been building quietly for twenty years while the system waited for it to declare itself. Conventional medicine is superb at rescue and negligent at prevention. That is the first failure.
The second failure is the industry that grew up in the gap. The longevity world correctly diagnosed that traditional care waits too long, then filled the space with supplement stacks, unvalidated biological age scores, and protocols sold with a confidence the evidence cannot support. I trained as an epidemiologist at Harvard specifically to learn how we know whether a treatment works. Most of what is marketed as longevity medicine would not survive that scrutiny.
Evidence-based longevity medicine has to reject both failures at once. That is the work.
What I do instead
At PrimaryMD, my co-founders and I built the practice we could not find anywhere else: small physician panels, advanced diagnostics used when they are decision-linked, unhurried visits, and continuity measured in decades rather than billing cycles. We test thoroughly. The difference is what happens next: interpretation in clinical context, by a physician who knows you, with no financial stake in the answer. The test is not the care. The judgment is.
Background
I grew up in Hilmar, a small dairy town in California's Central Valley, and earned my B.S. in biology, magna cum laude, at California State University, Stanislaus. I completed my M.D. at the Medical College of Wisconsin, where I was elected to Alpha Omega Alpha, and then spent the better part of a decade at UCLA: residency in internal medicine, residency in emergency medicine, fellowship in infectious disease. I am board-certified in all three, and I have kept all three current for a reason. Prevention, acute care, and infection sit at three corners of the same clinical map, and most of medicine happens in between.
In 2010 I joined the faculty of Harvard Medical School and the Brigham and Women's Hospital, where I practiced both emergency medicine and internal medicine for seven years, directed the residency journal club, and taught clinical reasoning to some of the best trainees in the country. They voted me Outstanding Attending twice and Mentor of the Year. While there, I completed an SM in Epidemiology at the Harvard School of Public Health, studying causal inference: the formal discipline of separating what works from what merely appears to work. That training is the backbone of how I read evidence today.
I have authored more than 30 peer-reviewed publications and more than 20 textbook chapters, including chapters in both Tintinalli's and Rosen's, the two standard textbooks of emergency medicine. I have served as a section editor, a DynaMed topic editor, and a reviewer for journals including JAMA and Annals of Internal Medicine. Since 2020, I have been an event physician and consultant to the National Basketball Association.
Writing and research
I write Mixed Medical Arts, a publication about evidence, judgment, and the fight against optimization theater. PrimaryMD is also building a clinical research capability, because a practice that critiques weak evidence should be willing to generate strong evidence.
Off the clock
I was a three-sport varsity athlete and a league champion wrestler, which taught me most of what I know about discipline and losing well. These days the obsessions are Formula 1, history, and travel. I live in the Bay Area and see patients in San Mateo and New York.