The missing ingredient in modern healthcare: ethics
Why an ethics-first model is the only serious way to build longevity
When my “dirty secret of longevity” piece took off, a lot of people thought I’d written an attack on drips and gadgets.
I hadn’t.
What I was really attacking was this: in most of healthcare, nobody is structurally paid to ask the only question that matters.
Does this person actually need what we’re selling – and will it have a net positive effect on their health?
Modern medicine is not failing for lack of data or technology.
It’s failing because ethics is optional in the business model.
This is an educational and strategic perspective, not personal medical advice.
What kind of market are we really in?
On the macro chart, health and wellness look like a dream.
OECD countries spend around 9–10% of GDP on health and the trend is up, not down.
The global wellness economy has crossed multiple trillions in value and is growing faster than global GDP, roughly twice the pace in recent years. It is now larger than many “sexy” sectors we obsess over, including parts of IT, sports and recreation, and close in scale to the green economy.
Within that, anti-aging, aesthetic, and “longevity” segments are growing mid to high single digits annually, with IV therapy, hydration and drip clinics hitting high single to low double-digit CAGRs in many markets.
So from a distance, the story is:
Big market.
Strong growth.
Emotionally inelastic demand (everyone ages, everyone fears decline).
If this were any other industry, the rational next question would be: where is growth mispriced?
In longevity, the mispricing is obvious once you look at evidence:
We have very strong data that controlling blood pressure, improving cardiorespiratory fitness, keeping people moving, and running guideline-level screening programmes reduce cardiovascular events, disability, and premature death. The effect sizes are large and repeatable.
We have much weaker or absent data that IV vitamin drips, many peptides, and a lot of “optimization” protocols do anything meaningful for otherwise healthy people beyond placebo and transient feelings – while they carry non-trivial risks and costs.
Yet capital flows the other way:
Billions into aesthetics, drips, aggressive screening, and data-heavy experiences.
Far less into unglamorous, behaviour-heavy prevention built to guideline evidence.
That’s not because investors are stupid. It’s because health, as a market, has the exact structure in which mispricing thrives:
It’s a credence good: you can’t easily verify whether what you bought did anything.
Information is asymmetric: the seller looks like they know more than you.
Externalities are massive: the real benefits of prevention spill into the public system, employers, and families, not just the person paying.
In that environment, selling anything that sounds plausible is easy.
Selling only what actually works is expensive.
The longevity boom as a misaligned growth story
Compare longevity to other fast-growing sectors.
You’ve seen versions of this pattern before:
Adtech: optimising clicks and time-on-site instead of long-term welfare.
Subprime credit: optimising yield today instead of solvency tomorrow.
Green finance: speculative carbon products growing faster than actual decarbonisation.
On a slide, the verticals look great. Underneath, the growth is partly built on exploiting information gaps and pushing risk into the future.
Longevity is drifting the same way:
Chain IV clinics, wellness hotels, and “full-body scan” memberships are easy to understand, easy to franchise, and easy to sell.
Prevention and evidence-led risk architecture are more complex to explain, slower to monetise, and harder to scale in a pitch deck.
From an economist’s point of view, the sector is over-investing in:
High-margin, low-evidence private goods (drips, vanity diagnostics, annual “executive” packages),
and under-investing in:
Lower-margin, high-evidence goods with huge externalities (blood pressure control, fitness, guideline prevention, sleep, mental health).
We’re pouring capital into the theatre, not the engine.
Three structural failures (without the moralising)
I want to challenge the industry without just moralising. So let me put this in system terms.
1. Informed consent is a thin patch over asymmetric information
In theory, informed consent is how we square the information gap: we disclose risks and benefits, the person decides.
In reality, in many “premium” longevity settings, three things go wrong:
Complexity: full-body MRIs, genomics, “omics” panels, peptide stacks. Even clinicians struggle to keep up with the evidence. Clients don’t stand a chance.
Narrative demand: people paying €8–20k/year for a membership rarely want to hear, “You mostly need to sleep, walk, lift, and take a statin.” They want a complex story that feels proportional to the spend.
Sales overlay: the consult is half clinical, half sales process.
We’ve imported DTC playbooks into clinical contexts. The real question in the room is not:
“Is this needed and net positive for you?”
It’s:
“How do we frame this so you feel good about buying it?”
The formalities are respected. The economic logic underneath is not.
2. Conflicts of interest live in the revenue mix
We already know from multiple health-econ studies that:
When physicians own imaging equipment, imaging rates go up.
Fee-for-service models tend to increase volume without necessarily improving outcomes.
We accept this as textbook principal–agent behaviour.
Longevity clinics have quietly built the same pattern:
Margin sits in drips, injectables, niche diagnostics, and high-ticket packages.
KPIs focus on revenue per square metre, device utilisation, and “conversion”.
Staff are rewarded more for upgrades than for preventing unnecessary interventions.
I’m not pointing fingers from the outside. In an early Atlas Cove financial model, we had a line that read (in plain language):
“X% of new guests should leave day one with at least one IV or injection booked.”
On a spreadsheet, that looks rational. The fixed cost is high; the margin lives in certain services; guests “expect something”.
Read it as an economist and it’s exactly what you’d criticise in any other sector: a strong financial incentive to oversell a credence good.
Every time a clinician tells a guest, “You don’t need that,” they reduce contribution margin. Ethics becomes negative carry.
3. No one owns the decade
Most health businesses own a tiny slice of someone’s health trajectory:
Hospitals: 30-day readmissions and acute complications.
Longevity clinics: monthly revenue, annual membership renewal, NPS.
But the real value of strong-evidence interventions is long-horizon:
Well-controlled blood pressure, properly managed lipids, sustained physical activity, appropriate cancer screening – these move hard endpoints over 5–20 years, not 5–20 days.
From a system perspective, that’s a horizon mismatch:
We optimise for quarterly metrics that are easy to measure and sell.
We neglect ten-year risk that is hard to attribute and hard to monetise.
This is how you end up with:
Double-digit growth in aggressive screening and “total body” check-ups,
While epidemiologists warn that a lot of general population screening, outside defined risk groups, leads to overdiagnosis and unnecessary interventions, not improved mortality.
We are de facto paying businesses to create data and anxiety, not to reduce strokes and amputations.
Health is one of the few products you can feel
Here’s the part that doesn’t get discussed enough in investment memos.
Most products can hide behind perception and brand. Health can’t, not indefinitely.
If your sleep improves, you notice.
If your blood pressure is controlled and your fitness goes up, you feel it.
If your baseline anxiety about your body drops because things actually are better, your behaviour changes.
That makes health unusual: it’s a multi-trillion market where the “utility function” is literally embodied.
A business that truly delivers:
more energy,
fewer symptoms,
better function,
and lower risk,
should have stickier economics than a business that delivers only experiences and dashboards.
In theory, an ethics-first, evidence-first longevity model should behave like a great B2B SaaS product:
Retention is high because churn feels bad.
Expansion is organic because satisfied clients bring spouses, friends, and colleagues.
Acquisition costs trend down as reputation compounds.
In practice, the industry behaves like fashion retail:
constant new protocols,
constant new devices,
constant movement between providers.
Churn is reframed as “people trying different things”.
That’s the opportunity: to build the first layer of longevity that monetises felt, durable health, not novelty.
Atlas Cove: ethics as a design constraint, not a slogan
Atlas Cove exists because I didn’t want to criticise the market while quietly reproducing it in nicer stone.
We started exactly where everyone starts:
advanced imaging on the whiteboard,
complex panels,
an exciting list of frontier tools.
Then we put the stack through three filters:
Evidence tier
Strong human outcome data?
Early but promising human data?
Mechanistic/animal only?
Speculation?
Net benefit by profile
For whom, exactly, does this materially change long-term risk or function?
At what stage?
Sequence
Does this belong before or only after we’ve done the boring work: sleep, blood pressure, lipids, weight where appropriate, fitness, mental health, and guideline screening?
A lot of pretty lines died on that whiteboard.
What survived for Atlas Cove is essentially the Atlas Labs stack in real life:
1. Foundations (non-negotiable)
Every member goes through a structured foundations phase:
movement and strength,
VO₂max-oriented cardio in practical form,
sleep and circadian hygiene,
nutrition and metabolic basics,
mental load, relationships, and work patterns.
These levers have the largest and clearest impact on morbidity and mortality in the literature. Skipping them to jump into frontier tools makes no sense if you care about outcomes rather than optics.
2. Medical & prevention layer (evidence-aligned)
On top of that:
basic labs through a quality partner lab: lipids, glucose/HbA1c, organ function, sometimes inflammatory markers;
vitals and functional metrics: blood pressure, resting HR, strength, simple cardio tests;
guideline-aligned decisions on medication and screening, with specialist input where needed.
Interpretation is done by prevention-oriented physicians, under clear regulation, with explicit evidence tiers.
3. Frontier layer (tightly gated)
Only after 1 and 2 are mapped and under active management do we even consider:
advanced imaging,
targeted pharmacology,
or more experimental protocols.
Each of those is:
tagged by evidence level,
anchored to specific profiles,
and offered only if it has a plausible net positive effect beyond doing more of the basics.
The operative rule we wrote into the operating model is blunt:
Nobody gets access to the shiny stuff until we’ve done the work on the boring stuff.
This is not about being paternalistic. It’s about aligning the business with what an honest long-horizon risk model would recommend.
It also changes the economics:
We cannot hit our numbers by pushing drips on day one to exhausted, hypertensive executives.
We must make prevention design, interpretation, and behaviour architecture themselves into billable, high-value products.
Retention becomes a function of how people feel and function six months in, not how impressed they are on day one.
Ethics, in this model, isn’t a brand value. It’s a constraint that shapes the P&L.
Ethical debt: the line item nobody models
As an operator or investor, you’re used to thinking about:
leverage,
regulatory risk,
reputational risk.
I think longevity needs one more category: ethical debt.
Ethical debt is the cumulative gap between:
what you know would be an ethically defensible, net-positive product set and sequence, and
what you actually sell because it’s profitable and the market is currently willing.
You accumulate ethical debt when you:
add a “performance drip” primarily because it photographs well,
keep a rainmaker clinician whose numbers depend on overselling,
push general health check-ups or scans outside evidence-based indications,
treat prevention as a thin layer of marketing rather than the core engine.
Like technical debt, ethical debt:
makes later course correction expensive,
compounds quietly,
eventually crystallises as scandal, regulatory action, or talent flight.
Unlike technical debt, it plays out in human bodies.
From a seasoned economist’s perspective, ethical debt is a mispriced liability in a sector where the scarcest assets are trust and long-horizon outcomes. Running high ethical leverage in a credence market is not just morally dubious; it’s financially naive.
A simple filter for serious capital
So here’s the line I now use on myself, and I’d invite you to use it on any longevity asset:
Would this business still be viable if every clinician told every client the whole truth about what they actually need – including “you don’t need most of this”?
If the honest answer is no:
you don’t own a healthcare company;
you own an extraction scheme sitting on top of information asymmetry.
That can make money. Plenty of things do.
But in a world where:
wellness is already a multi-trillion sector,
prevention has clear, measurable ROI,
health is a product people literally feel in their bodies,
the compounding opportunity is elsewhere:
In the layer that allocates this growing river of spend into interventions that actually extend healthy, capable years.
Atlas Cove is my attempt to build that layer in one geography.
Not as an ethics performance.
But as the only version of the longevity business that makes sense if I treat my own time and capital the way I treat health: as something to allocate carefully, over decades, with reality – not narrative – as the benchmark.
I like your 3 layered system approach. Excited for what you have in store in the future. Rooting for you !