What is the difference between longevity medicine and preventive care?

Longevity medicine is preventive care reframed around healthspan as the primary endpoint, rather than the absence of disease. In practice they overlap heavily. The longevity framing adds explicit attention to body composition, fitness biomarkers (VO2 max, grip strength), and trajectory measurements that most preventive practices do not run.

Do you prescribe rapamycin, peptides, or NAD precursors?

We do not prescribe off-label longevity protocols (rapamycin, peptides) outside of research contexts. We are honest about why: the evidence base is still developing and the long-term safety profile is not established. We track the literature and revisit this position annually.

Do you do whole-body MRI screening?

Not as a routine longevity tool. We will order targeted imaging when there is a specific reason. Whole-body MRI in asymptomatic low-risk patients has a high false-positive rate and frequently generates anxiety and downstream procedures that hurt more than they help.

What is the most useful single longevity test for someone over 40?

For most patients with any cardiovascular risk factor, a coronary artery calcium (CAC) scan is the single highest-yield test. About $100 at most Philadelphia imaging centers. A score of 0 substantially de-risks the next decade. A score above 100 reroutes the prevention plan toward assertive lipid lowering.

How is this different from concierge medicine?

Concierge medicine is enhanced access on top of insurance-billed visits (you pay a membership fee AND insurance still bills per visit). Direct primary care, our model, replaces insurance for primary care, so the membership covers all visits. Longevity medicine can be delivered through either model. We use the DPC structure because the math works better for the patient.

Can I just see my regular doctor and ask for these tests?

Sometimes, yes. If your primary care physician will order ApoB, Lp(a), fasting insulin, and a CAC scan and has time to act on the results, you can get most of the value through your existing relationship. The challenge is the time and the framing. Most insurance-based practices cannot sustain the 60-minute longevity conversation that is the point.

What is the difference between longevity medicine and preventive care?

Longevity medicine is preventive care reframed around healthspan as the primary endpoint, rather than the absence of disease. In practice they overlap heavily. The longevity framing adds explicit attention to body composition, fitness biomarkers (VO2 max, grip strength), and trajectory measurements that most preventive practices do not run.

Do you prescribe rapamycin, peptides, or NAD precursors?

We do not prescribe off-label longevity protocols (rapamycin, peptides) outside of research contexts. We are honest about why: the evidence base is still developing and the long-term safety profile is not established. We track the literature and revisit this position annually.

Do you do whole-body MRI screening?

Not as a routine longevity tool. We will order targeted imaging when there is a specific reason. Whole-body MRI in asymptomatic low-risk patients has a high false-positive rate and frequently generates anxiety and downstream procedures that hurt more than they help.

What is the most useful single longevity test for someone over 40?

For most patients with any cardiovascular risk factor, a coronary artery calcium (CAC) scan is the single highest-yield test. About $100 at most Philadelphia imaging centers. A score of 0 substantially de-risks the next decade. A score above 100 reroutes the prevention plan toward assertive lipid lowering.

How is this different from concierge medicine?

Concierge medicine is enhanced access on top of insurance-billed visits (you pay a membership fee AND insurance still bills per visit). Direct primary care, our model, replaces insurance for primary care, so the membership covers all visits. Longevity medicine can be delivered through either model. We use the DPC structure because the math works better for the patient.

Can I just see my regular doctor and ask for these tests?

Sometimes, yes. If your primary care physician will order ApoB, Lp(a), fasting insulin, and a CAC scan and has time to act on the results, you can get most of the value through your existing relationship. The challenge is the time and the framing. Most insurance-based practices cannot sustain the 60-minute longevity conversation that is the point.

Longevity Medicine in Philadelphia: Testing & a Plan

TL;DR30-second take

Longevity medicine in Philadelphia is primary care reorganized around healthspan: the years you stay healthy and functional, rather than the years you are simply alive. At Fishtown Medicine that means advanced cardiovascular biomarkers (ApoB, Lp(a), fasting insulin), early cancer screening calibrated to family history, VO2 max and DEXA as the 2 most useful trajectory markers, a serious sleep and stress conversation, and a longitudinal relationship that updates the plan as your biology changes. The membership model is built around having time to do this well instead of spending it on insurance paperwork.

There are 2 versions of longevity medicine being sold in 2026.

One is theater. It runs on celebrity podcast peptides, stacks of compounds prescribed off-label with no follow-up, cold plunges and brain stim devices marketed in a way that conflates correlation with causation, and enormous quarterly bills for monitoring that does not change clinical decisions. It is shiny, and it has a marketing budget.

The other one is quieter. It is mostly the same medicine that has been the basis of internal medicine for decades, applied earlier and with more time and better biomarkers: cardiovascular risk reduction, metabolic health, bone density, VO2 max, sleep, strength, and a thorough cancer-screening conversation. The tests that change care are the ones that have changed care for a long time, and the longevity layer is the consistency of doing them.

This page is about that second version, what Fishtown Medicine does, and where we land on the more speculative material.

What longevity medicine looks like in practice at Fishtown Medicine

A new patient's first longevity visit at Fishtown Medicine is 90 minutes. We build a full history, family tree, training and sleep profile, and stress and substance picture. Most of the value comes from the conversation. The labs we run after the visit follow from what we learn, but the baseline panel usually includes:

Full lipid panel with ApoB. ApoB is a better predictor of cardiovascular risk than LDL-C, full stop. The European cardiology guidelines have already moved here. We use ApoB targets, not LDL targets, for risk-stratified prevention.
Lp(a), once in a lifetime. It is genetically set, rarely measured, and it changes the prevention plan when it is elevated. Worth running on every adult at least once.
Fasting insulin and HbA1c. Fasting insulin catches insulin resistance years before HbA1c moves. The HOMA-IR calculation from those two values is a high-yield metabolic snapshot.
CBC, comprehensive metabolic panel, thyroid (TSH and free T4), vitamin D, hsCRP. Standard but done with attention.
Sometimes a coronary artery calcium (CAC) scan. Single most underused test in cardiology, $100 cash at most Philadelphia imaging centers, settles the cardiovascular risk question for the next decade.
DEXA scan for body composition and bone density. Body composition is more honest than BMI; bone density at baseline is useful for everyone over 40, women particularly.
VO2 max testing. Best independent predictor of all-cause mortality after age. If yours is poor for your age, that is the single most actionable data point in the visit.

Beyond labs, we go through sleep, training, nutrition (protein floor, fiber, alcohol), stress, social connection, and screening cadence. The patient leaves with a written plan that fits on a single page.

What the data supports

There is a substantial body of evidence behind longevity medicine, and there is also a lot of speculation. Here is an honest triage.

Strong data, do this:

Assertive cardiovascular risk reduction. ApoB-driven lipid management, blood pressure control, low-dose aspirin if indicated. The single largest contribution to extending healthspan.
Resistance training, 2 or 3 sessions a week. Sarcopenia is the silent driver of late-life dependency. Lifting is the single best intervention against it.
Zone 2 cardio, 3 to 4 hours a week. Builds mitochondrial density, raises VO2 max, lowers all-cause mortality.
Protein floor of around 1.6 g per kg per day for active adults. The default American diet is protein-low for an aging population.
Sleep duration in the 7 to 8.5 hour band. Sleep is upstream of almost every other longevity metric.
Smoking cessation and alcohol moderation. The evidence has only gotten stronger.
Vaccination on cadence. RSV, shingles, pneumococcal, annual flu, tetanus. Prevented disease is healthspan.
Cancer screening calibrated to family history. Earlier than guidelines if family history is meaningful.

Promising, watching, sometimes using:

GLP-1 medications (Ozempic, Mounjaro) for cardiometabolic risk reduction in patients with metabolic disease or significant weight to lose. The trial data on cardiovascular outcomes has become harder to argue with. We prescribe these thoughtfully when indicated.
Continuous glucose monitors (CGMs) for short diagnostic windows. Useful for catching insulin resistance early and behavior change; not a forever device for most patients.
Senolytic and rapalog protocols (rapamycin off-label). Early human data exists, long-term safety data does not. We do not prescribe off-label for longevity outside research settings, but we watch the literature closely.
NAD-precursor supplementation (NMN, NR). Promising mechanistic data, mixed clinical data, very mixed product quality. We do not push these.
Most peptide protocols sold by longevity clinics. Highly variable evidence base, often-uncertain product quality, serious safety questions. We do not prescribe peptides off-label.

Hype, mostly skip:

Stem cell injections for general anti-aging. Unproven.
Most expensive supplement stacks. Magnesium, omega-3, vitamin D, sometimes creatine and a multi - those are the core. Most of the rest is noise.
Whole-body imaging programs (like full-body MRI screening) for asymptomatic patients without family history. High false-positive rate, downstream procedures that hurt more than they help. We will order whole-body imaging when there is a reason; we do not recommend it as a routine longevity tool.
Most "biological age" tests. Interesting to track for motivation. Do not change clinical decisions.

ℹ IMPORTANT

Most "longevity clinics" run on a parallel financial model: high cash fees, recurring lab subscriptions, branded peptide and supplement sales, and a sales funnel that scales by adding services. A direct primary care practice can offer the substantive longevity workup as part of standard primary care, with no incentive to upsell. That is worth thinking about when comparing options.

Who longevity medicine fits at Fishtown Medicine

Fishtown Medicine

A 90-minute conversation with Dr. Ash. A written plan you can actually follow.

Start your intake

Here is who it fits:

Adults in their 30s, 40s, and 50s who want a plan written for the next 20 or 30 years.
People with a family history of cardiovascular disease, cancer, or dementia who want to measure earlier and act earlier.
Driven professionals and athletes who want training-informed primary care.
Patients in remission from a serious illness who want a strong prevention plan moving forward.
People who have had bloodwork done before and never had a useful conversation about it.

It is also fine if this is not for you. Some patients want a regular doctor who runs a standard panel and renews their prescriptions. That is a perfectly reasonable model. Longevity medicine is for the patients who want a different relationship with their own data.

How longevity medicine works inside the Fishtown Medicine membership

The membership covers all visits and direct access. The first longevity visit is 90 minutes. Follow-ups are typically 30 to 60 minutes depending on what we are doing. We coordinate labs (cheapest of insurance or cash), refer for CAC, DEXA, and VO2 max as indicated, and update the longevity plan annually or whenever your situation changes.

There is no separate "longevity package" required. Longevity medicine is just how preventive care works at the practice.

If you are not ready to join, the Strategic Roadmap package covers most of the same depth as a one-time engagement and is a good way to test whether the model is a fit.

What it costs

Membership covers all visits with no per-visit copays and no initiation fee; see pricing for current rates.

Strategic Roadmap one-time package: see packages (5 visits, full workup).

Labs and imaging: separate. We route to the cheapest of insurance or cash before ordering.

The honest comparison: a dedicated "longevity clinic" in Philadelphia will charge $5,000 to $25,000 per year, often with separate fees for each lab panel and supplement subscription. The substantive components of that workup are deliverable inside a primary care membership.

Key Takeaways

Substantive longevity medicine is primary care done with more time, better biomarkers, and a healthspan endpoint.
The high-yield workup is ApoB, Lp(a), fasting insulin, HbA1c, CAC scan, DEXA, VO2 max, and a full sleep and training conversation.
Most of the "longevity" content marketed online (peptides, NAD, off-label rapamycin, whole-body MRI for everyone) is either too early or hype.
Fishtown Medicine runs the substantive workup as part of standard preventive care inside the membership, without separate "longevity" upsells.
A direct primary care model lets a Philadelphia patient get this depth for a fraction of what dedicated longevity clinics charge.

Healthspan Optimization - the deeper framing of the longevity arc.
Preventive Care in Philadelphia - the operational structure.
Executive Physical in Philadelphia - the one-time deep look.
Direct Primary Care in Philadelphia - how the membership model works.
ApoB and Heart Health - why ApoB is the right cardiovascular marker.
Lp(a) Cholesterol - the once-in-a-lifetime genetic test.
VO2 Max - the mortality predictor that is also the most actionable training target.
Biological Age - what we make of the new generation of clocks.
Annual Physical - what a comprehensive annual physical includes
Functional Medicine - what functional medicine offers and where it overlaps with internal medicine

Fishtown Medicine | Services

2418 E York St, Philadelphia, PA 19125(267) 360-7927 hello@fishtownmedicine.comHSA/FSA Eligible

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Frequently Asked Questions

Common Questions

Deep-Dive Questions

Biological age tests (epigenetic clocks like GrimAge, telomere panels) are scientifically interesting and useful for personal motivation. They do not currently change clinical decisions for us in the way that ApoB, Lp(a), VO2 max, or DEXA do. We will run them when patients are curious, but we do not include them in the standard panel because the cost-per-decision-changed is high relative to other tests.

Philadelphia is dominated by Penn, Jefferson, and Temple. Each has world-class specialty programs and middling primary care from the patient's standpoint. The doctors are good; the appointment structure cannot support the longer visit. Longevity medicine works best at the primary care level because the physician sees the whole picture and writes the long-term plan. A DPC practice between you and the hospital systems gets the best of both - depth at the primary care level, specialist access when you need it.

The cardiovascular outcomes data on GLP-1s has become compelling: meaningful reductions in major adverse cardiac events in patients with cardiometabolic disease, independent of weight loss. The case for using them in the right patients is strong. The case against routine use in metabolically healthy patients is also strong: they carry side effects, they do not address the upstream lifestyle drivers, and the long-term safety data on use over decades does not exist yet. Our practice approach is: prescribe thoughtfully when the indication is clear, avoid using them as a universal longevity tool.

We ask 2 questions of each candidate intervention. The first is whether the evidence base supports a meaningful effect on a clinically important outcome (cardiovascular events, cancer mortality, all-cause mortality, function in late life). The second is whether the cost-per-quality-adjusted-life-year is reasonable relative to the patient's other options. Things that pass both tests get into the plan, things that pass only the first get watched, and things that pass neither get a polite no.

Ready when you are

Start your intake

Dr. Ash reads every intake himself, and answers questions personally - usually within a few hours.

TL;DR30-second take

There are 2 versions of longevity medicine being sold in 2026.

This page is about that second version, what Fishtown Medicine does, and where we land on the more speculative material.

What longevity medicine looks like in practice at Fishtown Medicine

Full lipid panel with ApoB. ApoB is a better predictor of cardiovascular risk than LDL-C, full stop. The European cardiology guidelines have already moved here. We use ApoB targets, not LDL targets, for risk-stratified prevention.
Lp(a), once in a lifetime. It is genetically set, rarely measured, and it changes the prevention plan when it is elevated. Worth running on every adult at least once.
Fasting insulin and HbA1c. Fasting insulin catches insulin resistance years before HbA1c moves. The HOMA-IR calculation from those two values is a high-yield metabolic snapshot.
CBC, comprehensive metabolic panel, thyroid (TSH and free T4), vitamin D, hsCRP. Standard but done with attention.
Sometimes a coronary artery calcium (CAC) scan. Single most underused test in cardiology, $100 cash at most Philadelphia imaging centers, settles the cardiovascular risk question for the next decade.
DEXA scan for body composition and bone density. Body composition is more honest than BMI; bone density at baseline is useful for everyone over 40, women particularly.
VO2 max testing. Best independent predictor of all-cause mortality after age. If yours is poor for your age, that is the single most actionable data point in the visit.

What the data supports

There is a substantial body of evidence behind longevity medicine, and there is also a lot of speculation. Here is an honest triage.

Strong data, do this:

Assertive cardiovascular risk reduction. ApoB-driven lipid management, blood pressure control, low-dose aspirin if indicated. The single largest contribution to extending healthspan.
Resistance training, 2 or 3 sessions a week. Sarcopenia is the silent driver of late-life dependency. Lifting is the single best intervention against it.
Zone 2 cardio, 3 to 4 hours a week. Builds mitochondrial density, raises VO2 max, lowers all-cause mortality.
Protein floor of around 1.6 g per kg per day for active adults. The default American diet is protein-low for an aging population.
Sleep duration in the 7 to 8.5 hour band. Sleep is upstream of almost every other longevity metric.
Smoking cessation and alcohol moderation. The evidence has only gotten stronger.
Vaccination on cadence. RSV, shingles, pneumococcal, annual flu, tetanus. Prevented disease is healthspan.
Cancer screening calibrated to family history. Earlier than guidelines if family history is meaningful.

Promising, watching, sometimes using:

GLP-1 medications (Ozempic, Mounjaro) for cardiometabolic risk reduction in patients with metabolic disease or significant weight to lose. The trial data on cardiovascular outcomes has become harder to argue with. We prescribe these thoughtfully when indicated.
Continuous glucose monitors (CGMs) for short diagnostic windows. Useful for catching insulin resistance early and behavior change; not a forever device for most patients.
Senolytic and rapalog protocols (rapamycin off-label). Early human data exists, long-term safety data does not. We do not prescribe off-label for longevity outside research settings, but we watch the literature closely.
NAD-precursor supplementation (NMN, NR). Promising mechanistic data, mixed clinical data, very mixed product quality. We do not push these.
Most peptide protocols sold by longevity clinics. Highly variable evidence base, often-uncertain product quality, serious safety questions. We do not prescribe peptides off-label.

Hype, mostly skip:

Stem cell injections for general anti-aging. Unproven.
Most expensive supplement stacks. Magnesium, omega-3, vitamin D, sometimes creatine and a multi - those are the core. Most of the rest is noise.
Whole-body imaging programs (like full-body MRI screening) for asymptomatic patients without family history. High false-positive rate, downstream procedures that hurt more than they help. We will order whole-body imaging when there is a reason; we do not recommend it as a routine longevity tool.
Most "biological age" tests. Interesting to track for motivation. Do not change clinical decisions.

ℹ IMPORTANT

Who longevity medicine fits at Fishtown Medicine

Fishtown Medicine

A 90-minute conversation with Dr. Ash. A written plan you can actually follow.

Start your intake

Here is who it fits:

Adults in their 30s, 40s, and 50s who want a plan written for the next 20 or 30 years.
People with a family history of cardiovascular disease, cancer, or dementia who want to measure earlier and act earlier.
Driven professionals and athletes who want training-informed primary care.
Patients in remission from a serious illness who want a strong prevention plan moving forward.
People who have had bloodwork done before and never had a useful conversation about it.

How longevity medicine works inside the Fishtown Medicine membership

There is no separate "longevity package" required. Longevity medicine is just how preventive care works at the practice.

If you are not ready to join, the Strategic Roadmap package covers most of the same depth as a one-time engagement and is a good way to test whether the model is a fit.

What it costs

Membership covers all visits with no per-visit copays and no initiation fee; see pricing for current rates.

Strategic Roadmap one-time package: see packages (5 visits, full workup).

Labs and imaging: separate. We route to the cheapest of insurance or cash before ordering.