Peter Attia: Life and Career

Table of Contents

1. Engineering and Mathematics at Queen’s University
2. Medical School at Stanford
3. Surgical Training at Johns Hopkins
4. Melanoma Immunotherapy Research at the National Cancer Institute
5. The Regulatory T-Cell Experiments
6. Swimming the Catalina Channel
7. Consulting and the Nutrition Science Initiative
8. A Longevity-Focused Medical Practice
9. Outlive: The Science and Art of Longevity
10. The Drive Podcast and Recognition
11. Timeline
12. Key Research Papers
13. Connections
14. Featured Videos

1. Engineering and Mathematics at Queen’s University

Before medicine, Attia trained as an engineer. According to the French-American Foundation’s 2012 biography, he earned a bachelor’s degree in mechanical engineering and applied mathematics at Queen’s University in Kingston, Ontario, Canada. The same biography says he also taught at Queen’s and helped revamp the university’s calculus curriculum.

An engineer’s vocabulary runs through his later writing. The third chapter of Outlive is titled “Objective, strategy, tactics: a road map for reading this book”, and the tenth “Thinking tactically: building a framework of principles that work for you”. His framework is set out on the companion page Medicine 3.0: Peter Attia’s Framework for Longevity.

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2. Medical School at Stanford

Attia then moved to California and studied medicine at the Stanford University School of Medicine. His own website, his publisher and the French-American Foundation all list the Stanford medical degree; Stanford Magazine identifies him as a member of the medical class of 2001.

His first published research paper also dates from 2001. It came not from Stanford but from the Surgery Branch of the National Cancer Institute in Bethesda, Maryland, where he was a co-author of a review of 374 consecutive patients with metastatic melanoma treated with high-dose interleukin-2, an immune-signalling protein used as a cancer drug. That paper found an overall response rate of 15.5%; 53.6% of patients whose melanoma had spread only to the skin or the tissue just under it responded, compared with 12.4% of patients with disease in other places. Patients who developed vitiligo (patches of skin that lose their colour) after treatment were more likely to have responded. The early date of this paper is one reason his research years at the National Cancer Institute appear to overlap with his surgical training rather than simply follow it.

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3. Surgical Training at Johns Hopkins

After medical school Attia went to Baltimore. His website and the French-American Foundation biography both describe five years of training in general surgery at the Johns Hopkins Hospital. Stanford Magazine described him in October 2005 as “a surgical resident at Johns Hopkins”.

Alongside the surgical training came research in cancer immunology at the National Institutes of Health in nearby Bethesda, described in the next two sections. No primary source gives the exact years of each; the dates of his papers suggest the two periods overlapped.

The first chapter of Outlive is titled “The long game: from fast death to slow death”, and his later work centres on the slow chronic diseases rather than sudden events. The four chronic diseases he groups together are covered on The Four Horsemen: Peter Attia on Chronic Disease.

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4. Melanoma Immunotherapy Research at the National Cancer Institute

Attia spent two years at the National Institutes of Health as a surgical oncology fellow at the National Cancer Institute, working under Dr. Steven Rosenberg in the institute’s Surgery Branch. His website and his publisher describe the work as research on the role of regulatory T cells in cancer regression and on immune-based therapies for melanoma, the most dangerous form of skin cancer.

The idea behind this work was that the immune system can recognise and destroy cancer cells, but is held back by built-in “brakes” that normally stop it from attacking the body’s own tissues. One of those brakes is a molecule on the surface of T cells called cytotoxic T-lymphocyte antigen-4 (CTLA-4). Blocking it with an antibody releases the brake.

The Surgery Branch had already reported, in 2003, that blocking this molecule in 14 patients with metastatic melanoma produced tumour shrinkage in three patients (21%; two complete and one partial response), along with serious autoimmune side effects in six (43%) — inflammation of the skin, gut, liver and pituitary gland. Attia was not an author of that first report, but he was the first author of the larger follow-up.

That 2005 paper in the Journal of Clinical Oncology treated 56 patients with progressive stage IV melanoma with the antibody against cytotoxic T-lymphocyte antigen-4 plus a peptide vaccine, on two different dose schedules. Two patients had a complete response and five a partial response, an overall response rate of 13%, with tumours shrinking in the lungs, liver, brain, lymph nodes and under the skin. The central finding was in its title: autoimmunity went together with tumour regression. Of 14 patients who developed severe (grade 3 or 4) autoimmune side effects, five (36%) responded, compared with two of the 42 patients (5%) who had no autoimmune side effects.

A companion phase I/II study, on which Attia was third author, combined the same antibody with high-dose interleukin-2 in 36 patients. Eight (22%) had objective tumour responses, and five (14%) developed severe autoimmune side effects, mostly inflammation of the bowel. The authors concluded that the combination did not show a synergistic effect, since 22% is what the two treatments would be expected to achieve separately, although some of the regressions were durable. A laboratory analysis by the same group, with Attia as second author, found that the antibody worked by increasing T-cell activation rather than by removing or switching off regulatory T cells. He was also one of 14 authors of a study that raised the antibody dose within individual patients.

Later research carried this line of work into routine cancer care. In 2010 a phase 3 randomised trial of 676 patients with previously treated metastatic melanoma reported a median overall survival of 10.0 months with the antibody ipilimumab plus a vaccine and 10.1 months with ipilimumab alone, compared with 6.4 months with the vaccine alone. In 2012 a study of an antibody against a second immune brake, programmed death 1, reported responses in 28% of evaluable patients with melanoma, 18% with non-small-cell lung cancer and 27% with kidney cancer. Attia was not an author of either paper. The melanoma side of this story is told on Melanoma Immunotherapy: The Long-Term Trial Results.

From the same years comes a first-author case report and review, published in 2003, on a hormone-like protein that can drive dangerously high blood calcium in melanoma. Among 1,146 consecutive patients treated for metastatic melanoma at the Surgery Branch between 1988 and 2000, 4.9% had high blood calcium.

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5. The Regulatory T-Cell Experiments

Regulatory T cells are a small group of immune cells whose job is to calm other immune cells down. In animal tumour models they can blunt the effect of cancer immunotherapy, so the National Cancer Institute group tried to remove them in patients before treatment. Attia led or co-authored three studies on the question, and each reported its results plainly, including the negative ones.

• Denileukin diftitox (2005). Attia was first author of a study of a drug that fuses interleukin-2 to diphtheria toxin, meant to kill cells that carry high-affinity interleukin-2 receptors. Thirteen patients (12 with metastatic melanoma, one with metastatic kidney cancer) received one of the two approved doses. None had an objective clinical response; a marker of regulatory T cells did not fall significantly overall, and the suppressive ability of the cells in the laboratory was unchanged. The authors concluded that the drug did not appear to eliminate regulatory T cells or shrink melanoma.
• A recombinant immunotoxin in cell studies (2006). As first author, Attia tested an antibody fragment fused to a bacterial toxin on human blood cells in laboratory dishes. It reduced the number of regulatory T cells without impairing the remaining lymphocytes. This was an in-vitro result, not a treatment in patients; the authors proposed testing it before vaccine or cell-transfer therapy.
• A second immunotoxin in patients (2008). In his last paper from the National Cancer Institute years, on which he was second author, a different toxin-linked antibody given to six patients with metastatic melanoma cut the number of cells most strongly carrying the targeted receptor by a mean of 97.5% at the lowest point, but the regulatory T-cell population as a whole fell by only 71.3%, and no patient had an objective tumour response. The authors concluded that fully removing these cells would require targeting them more broadly.

Together, these papers record a period in which the field learned that releasing the immune system’s brakes could shrink some advanced melanomas, at the price of autoimmune side effects, and that simply removing regulatory T cells was harder than expected.

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6. Swimming the Catalina Channel

Outside the hospital, Attia was an endurance athlete. Stanford Magazine reported in its January/February 2006 issue that on 11 October 2005, while a surgical resident at Johns Hopkins, he swam the Catalina Channel off Southern California — from Santa Catalina Island to the mainland below the Point Vicente Lighthouse — a distance of about 22 miles, in about ten and a half hours.

Exercise remained central to his later work. In Outlive he titles one chapter “Exercise: the most powerful longevity drug” and another “Training 101: how to prepare for the centenarian decathlon”. His framework for training is described on Exercise, VO2 Max and the Centenarian Decathlon.

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7. Consulting and the Nutrition Science Initiative

After his surgical and research years Attia left clinical medicine for a time. The French-American Foundation biography records that he worked as a consultant at a management-consulting firm, in its corporate-risk and health-care practices.

In the early 2010s he turned to nutrition science. He co-founded, with the science writer Gary Taubes, the Nutrition Science Initiative (NuSI), a non-profit organisation set up to fund carefully controlled nutrition experiments, and served as its president; the 2012 biography describes him as “president and co-founder”. The organisation was supported by a philanthropic foundation. Accounts by people involved with it state that Attia left the Nutrition Science Initiative at the end of 2015.

His interest in what he later called “nutritional biochemistry” carried into Outlive, which has a chapter titled “Nutrition 3.0: you say potato, I say ‘nutritional biochemistry’”. His views on food and sleep are set out on Nutrition and Sleep in Peter Attia’s Outlive.

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8. A Longevity-Focused Medical Practice

Attia returned to patient care as a physician focused on preventing chronic disease and extending healthy life. In research papers from 2018 to 2020 his affiliation is his own medical practice in San Diego and New York. His website now describes him as the founder of a medical practice “that applies the principles of Medicine 3.0 to patients”. The same site lists medical licences in Texas, California and New York, and his publisher notes that he serves on the editorial board of the journal Aging.

From this practice he co-authored clinical research with university groups:

• Alzheimer’s prevention (2018). With Richard Isaacson’s group at Weill Cornell Medicine in New York, Attia was second author of a review of six mechanisms involved in Alzheimer’s disease — disordered glucose metabolism, inflammation, oxidative stress, growth-factor release, amyloid build-up and calcium toxicity — that the authors saw as targets for risk reduction, with a blueprint for a clinical risk-reduction programme. The review notes that Alzheimer’s disease affects nearly 50 million people worldwide.
• Individualised Alzheimer’s risk management (2019). He was one of 28 authors of a study in which 174 people aged 25 to 86 were given individually tailored interventions. After 18 months, patients in the prevention group improved more on a cognitive test composite than matched historical comparison groups; the comparison was with historical cohorts, not a randomised control group.
• Sleep and hardened arteries (2020). With Matthew Walker’s sleep laboratory at the University of California, Berkeley, Attia co-authored “Broken sleep predicts hardened blood vessels”. In more than 1,600 people, fragmented sleep was linked to higher counts of inflammatory white blood cells and, through them, to more severe atherosclerosis, even after other common risk factors were taken into account. This was an observational study.

These subjects — dementia, sleep and the hardening of the arteries — are among the main themes of Outlive. His view of heart disease is covered on Apolipoprotein B and Heart Disease: Peter Attia’s View.

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9. Outlive: The Science and Art of Longevity

Outlive: The Science and Art of Longevity, written by Peter Attia with Bill Gifford, was published in the United States by Harmony, an imprint of Penguin Random House, on 28 March 2023 (400 pages). A British edition appeared the same year from Vermilion in London, with the cover line “Rethinking medicine to live better longer”. Gifford is a journalist and the author of an earlier book on aging, Spring Chicken. Attia’s website describes Outlive as a number-one New York Times bestseller and as “a new approach to preventing chronic disease and extending long-term health”.

The book’s seventeen chapters move from ideas to practice. In order, they cover:

1. The long game: from fast death to slow death
2. Medicine 3.0: rethinking medicine for the age of chronic disease
3. Objective, strategy, tactics: a road map for reading this book
4. Centenarians: the older you get, the healthier you have been
5. Eat less, live longer: the science of hunger and health
6. The crisis of abundance: can our ancient genes cope with our modern diet?
7. The ticker: confronting and preventing heart disease, the deadliest killer on the planet
8. The runaway cell: new ways to address the killer that is cancer
9. Chasing memory: understanding Alzheimer’s disease and other neurodegenerative diseases
10. Thinking tactically: building a framework of principles that work for you
11. Exercise: the most powerful longevity drug
12. Training 101: how to prepare for the centenarian decathlon
13. The gospel of stability: relearning how to move to prevent injury
14. Nutrition 3.0: you say potato, I say “nutritional biochemistry”
15. Putting nutritional biochemistry into practice: how to find the right eating pattern for you
16. The awakening: how to learn to love sleep, the best medicine for your brain
17. Work in progress: the high price of ignoring emotional health

The final chapter turns to emotional health, which Attia treats as part of longevity alongside the physical diseases, drawing on his own experience.

At the centre of the book is his statement that “longevity is a balance of lifespan (living longer) and healthspan (living better)”, and his call for what he names Medicine 3.0 — medicine built on “evidence informed” rather than “evidence based” guidelines, with very early prevention of chronic disease.

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10. The Drive Podcast and Recognition

Attia’s podcast, first called The Peter Attia Drive and now The Drive, released its trailer on 19 June 2018; the first numbered episode, a conversation with the author Tim Ferriss, followed in early July 2018. His website and his publisher describe it as “one of the most popular podcasts covering the topics of health, medicine, and longevity”. The episodes are long-form interviews with researchers and clinicians, and question-and-answer episodes in which he explains his own framework — including the November 2022 episode in which he set out Medicine 1.0, 2.0 and 3.0. Video versions appear on his YouTube channel, Peter Attia MD (@PeterAttiaMD).

In 2024 TIME magazine named him to its TIME100 Health list of influential people in health.

According to his website, Attia lives in Austin, Texas, with his wife and three children.

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11. Timeline

• Before medical school — Bachelor’s degree in mechanical engineering and applied mathematics, Queen’s University, Kingston, Ontario; teaches there and helps revamp the calculus curriculum.
• 2001 — Medical degree, Stanford University School of Medicine; first research paper, on interleukin-2 treatment of metastatic melanoma, with the Surgery Branch of the National Cancer Institute.
• Five years — General surgery training at the Johns Hopkins Hospital, Baltimore.
• Two years — Surgical oncology fellowship at the National Cancer Institute under Dr. Steven Rosenberg.
• 2003 — First-author case report and review on high blood calcium in metastatic melanoma.
• 2005 — First-author paper linking autoimmunity to tumour regression after blocking cytotoxic T-lymphocyte antigen-4; first-author study of denileukin diftitox. On 11 October he swims the Catalina Channel, about 22 miles in about ten and a half hours.
• 2006 — First-author cell study of a recombinant immunotoxin against regulatory T cells.
• 2008 — Last paper from the National Cancer Institute years.
• After surgery — Consultant at a management-consulting firm.
• Early 2010s — Co-founds the Nutrition Science Initiative with Gary Taubes and serves as its president; leaves at the end of 2015.
• 2018 — Alzheimer’s risk-reduction review with Weill Cornell Medicine; trailer of The Peter Attia Drive released 19 June.
• 2019 — Co-author of the individualised Alzheimer’s risk-management study.
• 2020 — Co-author of “Broken sleep predicts hardened blood vessels” with the University of California, Berkeley.
• 2022 — November podcast episode setting out Medicine 1.0, 2.0 and 3.0.
• 28 March 2023 — Outlive: The Science and Art of Longevity published in the United States.
• 2024 — Named to the TIME100 Health list.

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Key Research Papers

1. Phan GQ, Attia P, Steinberg SM, White DE, Rosenberg SA. Factors associated with response to high-dose interleukin-2 in patients with metastatic melanoma. J Clin Oncol. 2001;19(15):3477-82. — PubMed PMID: 11481353
2. Attia P, Phan GQ, Duray PH, Rosenberg SA. Parathyroid hormone-related protein and hypercalcemia in patients with metastatic melanoma: case report and review. Am J Clin Oncol. 2003;26(1):42-5. — PubMed PMID: 12576923
3. Phan GQ, Yang JC, Sherry RM, Hwu P, Topalian SL, Schwartzentruber DJ, et al. Cancer regression and autoimmunity induced by cytotoxic T lymphocyte-associated antigen 4 blockade in patients with metastatic melanoma. Proc Natl Acad Sci U S A. 2003;100(14):8372-7. — PubMed PMID: 12826605
4. Attia P, Phan GQ, Maker AV, Robinson MR, Quezado MM, Yang JC, et al. Autoimmunity correlates with tumor regression in patients with metastatic melanoma treated with anti-cytotoxic T-lymphocyte antigen-4. J Clin Oncol. 2005;23(25):6043-53. — PubMed PMID: 16087944
5. Attia P, Maker AV, Haworth LR, Rogers-Freezer L, Rosenberg SA. Inability of a fusion protein of IL-2 and diphtheria toxin (Denileukin Diftitox, DAB389IL-2, ONTAK) to eliminate regulatory T lymphocytes in patients with melanoma. J Immunother. 2005;28(6):582-92. — PubMed PMID: 16224276
6. Maker AV, Phan GQ, Attia P, Yang JC, Sherry RM, Topalian SL, et al. Tumor regression and autoimmunity in patients treated with cytotoxic T lymphocyte-associated antigen 4 blockade and interleukin 2: a phase I/II study. Ann Surg Oncol. 2005;12(12):1005-16. — PubMed PMID: 16283570
7. Maker AV, Attia P, Rosenberg SA. Analysis of the cellular mechanism of antitumor responses and autoimmunity in patients treated with CTLA-4 blockade. J Immunol. 2005;175(11):7746-54. — PubMed PMID: 16301685
8. Attia P, Powell DJ Jr, Maker AV, Kreitman RJ, Pastan I, Rosenberg SA. Selective elimination of human regulatory T lymphocytes in vitro with the recombinant immunotoxin LMB-2. J Immunother. 2006;29(2):208-14. — PubMed PMID: 16531821
9. Maker AV, Yang JC, Sherry RM, Topalian SL, Kammula US, Royal RE, et al. Intrapatient dose escalation of anti-CTLA-4 antibody in patients with metastatic melanoma. J Immunother. 2006;29(4):455-63. — PubMed PMID: 16799341
10. Powell DJ Jr, Attia P, Ghetie V, Schindler J, Vitetta ES, Rosenberg SA. Partial reduction of human FOXP3+ CD4 T cells in vivo after CD25-directed recombinant immunotoxin administration. J Immunother. 2008;31(2):189-98. — PubMed PMID: 18481388
11. Hodi FS, O’Day SJ, McDermott DF, Weber RW, Sosman JA, Haanen JB, et al. Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med. 2010;363(8):711-23. — PubMed PMID: 20525992
12. Topalian SL, Hodi FS, Brahmer JR, Gettinger SN, Smith DC, McDermott DF, et al. Safety, activity, and immune correlates of anti-PD-1 antibody in cancer. N Engl J Med. 2012;366(26):2443-54. — PubMed PMID: 22658127
13. Schelke MW, Attia P, Palenchar DJ, Kaplan B, Mureb M, Ganzer CA, et al. Mechanisms of Risk Reduction in the Clinical Practice of Alzheimer’s Disease Prevention. Front Aging Neurosci. 2018;10:96. — PubMed PMID: 29706884
14. Isaacson RS, Hristov H, Saif N, Hackett K, Hendrix S, Melendez J, et al. Individualized clinical management of patients at risk for Alzheimer’s dementia. Alzheimers Dement. 2019;15(12):1588-1602. — PubMed PMID: 31677936
15. Vallat R, Shah VD, Redline S, Attia P, Walker MP. Broken sleep predicts hardened blood vessels. PLoS Biol. 2020;18(6):e3000726. — PubMed PMID: 32497046

PubMed Topic Searches

1. Attia and Rosenberg: National Cancer Institute papers
2. Blocking cytotoxic T-lymphocyte antigen-4: autoimmunity and tumour regression in melanoma
3. Removing regulatory T cells with immunotoxins in melanoma
4. High-dose interleukin-2 in metastatic melanoma

Further Reading

• Peter Attia — About (his own website)
• Outlive — book page on his website
• Penguin Random House — author page
• French-American Foundation — biography (2012)
• Stanford Magazine (2006) — “Surgeon swims Catalina Channel”
• Wellcome Collection — catalogue record of Outlive with chapter list
• TIME100 Health 2024 — Peter Attia

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Connections

• Dr. Peter Attia: Outlive and the Science of Longevity
• Medicine 3.0: Peter Attia’s Framework for Longevity
• The Four Horsemen: Peter Attia on Chronic Disease
• Exercise, VO2 Max and the Centenarian Decathlon
• Apolipoprotein B and Heart Disease: Peter Attia’s View
• Nutrition and Sleep in Peter Attia’s Outlive
• Contemporary Practitioners
• Melanoma
• Melanoma Immunotherapy: The Long-Term Trial Results
• Longevity and Healthy Aging
• Alzheimer’s Disease
• Sleep Hygiene

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