5HT #116: preventing dementia, screaming about health premiums, and 3 more

It looks like we’re starting to beat dementia. 

I’ve written about dementia prevention at length before and now a recent Cell review shows off all the remarkable advances we’ve made since, including things like blood tests detecting signs of Alzheimer’s before symptoms appear, anti-amyloid drugs (with some asterisks) slowing its progression, and a 2024 Lancet commission estimated addressing 14 modifiable risk factors could prevent or delay nearly 45% (!) of dementia cases. 

All this is especially exciting for people with a predisposition to Alzheimer’s—like me. My mom has early-onset Alzheimer’s, and I carry one copy of APOE4, which roughly doubles or triples my risk of developing the disease.

Knowing that is scary, but I’ve always tried to let it fuel me rather than paralyze me. And science is finally getting to a place where people like me may be able to do something with that knowledge. This, to me, illustrates where healthcare is going next—and why I’m so excited about the future for builders in it. 

Take NeuroAge Therapeutics, where I recently completed a full workup with its brilliant founder and CEO, Dr. Christin Glorioso. The workup included the works: a brain MRI, genetic testing, Alzheimer’s blood biomarkers, and cognitive testing.

The most interesting result wasn’t my brain-age score, which came in juuust above their ideal target of 5 years. It was the specificity.

I know I don’t have dementia. I did this in order to create a baseline I can revisit every five to 10 years and, most importantly, to get a clearer plan for what to do now. 

(An aside: I recognize not everyone wants this type of information. Earlier this month, there was a powerful piece in The Washington Post about a woman agreeing to an Alzheimer’s blood test and then panicking over what the results could mean. I want to know, but I respect not everyone’s wired that way.)

Knowledge is only useful when you know what to do about it. And now, thanks to all that progress we’ve made—we can get BOTH. What’s exciting is this evolution is true not only in dementia, but in many other areas: cancer, heart disease, and many more common concerns to boot.

So what? Well, five years ago, I believed the future of health would be won by companies owning one current condition really deeply. Allara with PCOS, NOCD with OCD, Midi with menopause, and Oshi with GI issues are examples of that model. They’re all focused interventions for an existing, diagnosable condition.

I think the next wave will look different, shaped around states medicine historically didn’t treat aggressively because nobody was measuring them early,

It will be built around known concerns and sold to people decades before there’s anything technically wrong with them. A completely different category, built off a future with commoditized diagnostics, constant wearable data, accessible genetic testing, and continued learnings from clinical studies. 

Knowing your risk will become table stakes. The business opportunity will be everything after it: intervention, adherence, engagement, and personalization. Potentially community, too. It’ll be built for people staring down a family history wondering, what now?

Because now, after my NeuroAge workup, I have real steps to take—and those recommendations are only going to get better. (Another example worth shouting out is Michelle Zimmerman’s Previvor Edge, focused on early detection and cancer prevention for high-risk individuals.)

Ultimately, call me crazy, but I don’t want to get Alzheimer’s. My Mom getting early-onset Alzheimer’s is the saddest thing that has ever happened to me. This has been on my mind especially as she enters hospice this week after not really being a part of my life for 5+ years and a shell of herself for at least 10.

I don’t want that future (for me or, worse, for my family), and I’ll do whatever I reasonably can to avoid it. I suspect many other people will, too—especially if taking action continues to become clearer, more personalized, and more frictionless.

Bottom line: The future of preventative medicine is a world where awareness meets action—and companies built around this will win the next era.

It’s almost like last year’s healthcare premiums saw gas and egg prices go up and said: “hold my beer.” ACA Marketplace insurers announced they’re proposing a median 14% premium increase for 2027, aka the second straight year of double-digit growth. 😫

Employer plans are no safe harbor, either. The 2026 Milliman Medical Index (MMI) estimates U.S. healthcare costs per person at $8,460—an increase of nearly 8% and the steepest non-COVID jump in a decade. And a hypothetical family of four? $37,824. 😳

While there’s no one obvious reason to point fingers at, it seems pharmacy costs are a major factor (yes, increasing 14.8% thanks in part to GLP-1s). MMI also flagged AI as a factor in healthcare cost trends (awkward) with hospitals using AI to upcode and payers using AI to optimize claims. (Hat tip to prescient friend Will Young from Sana Benefits, who totally called this.) 

Hospitology’s Blake Madden also wrote a must-read State of the Union newsletter on this, including some potential ways to fix this (“direct contracting, price transparency, and consumerism, supercharged by AI-enabled navigation, will shape the next decade of benefit design”). But yeesh, it’s a mess, and it makes alternative ideas like health shares that much more intriguing.

Point is: Health premiums are too damn high, and history will reward the builders who rethink the system. (And if you’re working on something like this, I want to hear about it.)

I increasingly believe psychedelics 🍄 have the potential to move the needle on our country’s growing mental health crisis.

I first wrote about psychedelics being studied for depression back in April, and now we have fresh evidence about their potential benefits. 

A large-scale phase IIb trial found 50% of participants experienced remission from generalized anxiety disorder (GAD) after a single dose (100 μg) of LSD. A single dose! Owen Muir calls it “the best depression drug results ever.” There was also another phase III trial—this one on a psilocybin—that also demonstrated rapid, lasting benefits for at least six months in people with treatment-resistant depression (TRD).

That’s huuuge. ❗

And it’s about to get bigger. 

Eli Lilly just announced it’s buying psychedelics maker AtaiBeckley for $2.8 billion today, too. ‼️

The FDA also recently finalized its formal guidance for clinical trials involving psychedelic drugs and announced a public hearing on future therapeutic use, happening September 14. My guess is we’ll see expanded access very, very soon—and clinics offering this (like Radial, where I’m actively very involved) are going to be at the forefront of psychiatry's brain-medicine era.

Here’s a thing that’s super working at many health co’s for you to adopt at yours.

At Healthyish Content, we’re the best at publishing high-quality health content (I’m very biased) for our clients. But, to truly compete in a YMYL (Your Money or Your Life) category, brands need to prove their expertise beyond their own site—and never more so than in today’s AI search-driven world.

So, we’ve built what we call a credibility engine, which essentially takes a client’s clinicians and experts and weaponizes them to earn citations, links, and mentions on other sites to signal authority to Google and LLMs.

Basically, we do constant reactive and proactive outreach to journalists—identifying timely and relevant angles (this is sometimes referred to as, sigh, “newsjacking”), pitching clinicians as expert sources, and responding quickly to ongoing media opportunities from places like HARO, Qwoted, and ProfNet.

It usually starts slowly. First you have to get the stories right (it helps to have expert journalists driving this). Then, each placement strengthens the next. Journalists begin to recognize the clinician. Their quotes get cited elsewhere. Over time, both the clinician’s and the brand’s credibility compound. Bada bing, bada boom.

Because, speaking of Radial, they’re one of our best success stories so far. By turning clinical expertise (shout out Owen Muir, MaryEllen Eller MD, and Steve Harvey MD among others) into scalable authority signals, Radial’s increased organic traffic by 1,556% (!) and earned placements in pubs like Self, Everyday Health, and Prevention 👍. 

Yes, your PR agency probably claims they do this (but are they really?). And yes, you can totally do this yourself. But know it works—and it’s how many health co’s are separating themselves from their competition to drive AI visibility and search rankings today.

Longtime 5HTers know my back suuuucks and that I’ve been working toward doubling my restorative sleep. I’ve been using a buckwheat pillow for 2+ years now, and it’s made a huge difference. There are many, but the one I’ve got is the Hullo Buckwheat Pillow (I’ve also met one of the founders, and he’s great).

It’s small (but mighty) and made with American-grown buckwheat—basicallyyy like nature's memory foam. Plus, it keeps me cool (I tend to run hot). I now struggle to sleep without it… whichhh is why I even have a li’l one that I take with me when I travel 😆.

Highly recommend it for anyone looking for a new pillow to rest their head on (or to scream into about healthcare premiums).

Most clicked last week: My updated protein bar challenge 😋.

👋 Who are you again? I’m Derek Flanzraich, and I’m in the business of healthyish. I founded two venture-backed startups–Greatist (👍) and Ness (👎)—and helped dozens of brands you know grow including Ro, GoodRx, Midi, BetterHelp, and LMNT. I now run Healthyish Content, plus a few other healthyish things (like Fixie Dust, launching this fall).

Every Thursday, I share what’s hot, what’s not, and what’s next in consumer health. (Disclosure: I invest in and advise companies in this space—when I cover one, I'll say so.) I sometimes add affiliate links, but they influence my picks zero.

See something smart, strange, or seriously overhyped? Hit reply, I respond to every email.