jamesrichman.health Load · Recovery · Signals · Frontier Journal
James Richman / HealthCEO, OTLEN · Singapore

Run the body like critical infrastructure.

James Richman standing with arms crossed in an office, beside a laptop marked OTLEN.
At OTLEN, 2026. Photograph via USA Wire.

A journal on performance under executive load, from a technologist who works inside healthcare and biotech.

I lead OTLEN, where we build AI infrastructure for revenue operations in healthcare and biotech. The role comes with long weeks, decisions that carry weight, and a remote team and client base spread across London, New York, San Francisco, Dubai, Riyadh and Singapore, so the working day never closes. Here I apply the discipline we bring to hospital systems to the one system I am responsible for around the clock: measure the load, protect recovery, and read the frontier of biotech by its evidence rather than its marketing.

Start with the load
24/24 h

Hours a day when at least one of our cities is at work: London, New York, San Francisco, Dubai, Riyadh, Singapore. Live, with daylight saving.

01 The load
−20%

Major cardiovascular events with semaglutide in the SELECT trial. Peptide medicine now has outcome data.

04 The frontier
1,614

AI-enabled medical devices on the FDA’s public list, decisions through June 2026.

03 Instruments
01The executive load

Pressure is a load, and load has a physiology.

Responsibility does not stay at the office. The stress mediators that help in a crisis wear the body down when they never switch off, and the cumulative cost has a name in the literature: allostatic load.

For an executive the inputs are predictable. Long weeks, compressed sleep, travel across time zones, and decisions that cannot wait for a better night. I treat them as engineering constraints to design around, not as personality traits to push through.

NEJM 1998
The operating day, in Singapore timeLive
24/24hours when at least one of six cities is at work
7/7hours of a seven-hour night that fall inside someone’s working day
SGT
Cities open
Sleep 23–06
Overlap

Each city works 09:00 to 18:00 local time, shifted live for daylight saving. The brighter the cell, the more cities are open in that hour. The sleep window is an example of the seven-hour minimum for adults.

The last finding matters most in a boardroom. The impairment arrives before the feeling does, so I measure it instead of trusting how I feel.

02The base layer

Frontier tools sit on top of the basics, never instead of them.

A strong body is not built from one perfect routine. It comes from a stack of basics done consistently: resistance training, conditioning, sufficient protein, useful sleep, recovery and sensible progression. The interesting work starts when those basics become a system you can observe and improve.

Programs are tools, not religions. Three questions decide any of them.

  1. 1What stimulus am I trying to create?
  2. 2What can I recover from?
  3. 3What evidence will tell me to change course?
Base layerSix parts, dosed weekly
Public referenceOwn baseline
WHO · ISSN · IOM · AASM
  1. BL-01
    WHO 2020

    Resistance training

    2+days a week

    Minimum 2 of 7 daysAll major muscle groups

    Muscle-strengthening work at moderate or greater intensity.

  2. BL-02
    WHO 2020

    Conditioning

    150–300minutes a week, moderate

    Moderate
    Vigorous

    Or 75 to 150 minutes of vigorous activity, or an equivalent mix of the two.

  3. BL-03
    ISSN 2017IOM 2005

    Protein

    1.4–2.0g per kg a day

    g / kg

    For most people who train. The general adult baseline, the RDA, is 0.8 g per kg a day.

  4. BL-04
    AASM 2015HBR 2018

    Sleep

    7+hours a night

    Hours
    CEO average 6.9

    The adult minimum, on a regular basis. The 27 CEOs in the Harvard study averaged 6.9 hours, just under it.

  5. BL-05
    Own baseline

    Recovery

    No fixed number

    Rest HR
    HRV

    Band: your own baselineSchematic

    Resting heart rate and HRV are read against your own trend, not against someone else’s.

  6. BL-06
    Own log

    Progression

    No fixed number

    Weeks: load rises, then steps backSchematic

    Load or volume rises gradually when recovery allows. The training log is the evidence.

Frontier tools sit on top of this layer, never instead of itWeekly

Doses summarize public guidelines for healthy adults. They are a reference point, not personal medical advice. Panels marked schematic show a shape, not data.

03Instrumentation

A number earns its place when it changes a decision.

Health technology has moved from step counts toward clinical-grade signals. More data is not the goal. Heart rate, HRV, blood pressure, glucose, sleep and laboratory results become valuable only when they change a decision, early enough to act on.

Some signals have public thresholds. The rest are read against your own baseline, and the tags say which is which.

Blood pressure, where the categories change

ACC/AHA 2017
Systolic, mmHg
Diastolic, mmHg

  1. Normal

    <120 and <80

    Keep the habits that got you here, and recheck yearly.

  2. Elevated

    120–129 and <80

    Lifestyle changes, and a recheck in 3 to 6 months.

  3. Stage 1

    130–139 or 80–89

    Lifestyle changes. A clinician weighs medication against overall cardiovascular risk.

  4. Stage 2

    ≥140 or ≥90

    Lifestyle changes, and usually medication, managed with a clinician.

For adults. When the two readings fall in different categories, the higher category applies. Sustained stress is one of the reasons this is the first signal I watch. A summary of the guideline, not medical advice.
04Biotech frontier

Peptides, read by evidence tier.

Peptides are where metabolic medicine is moving fastest, and where marketing runs furthest ahead of data. In a few years the incretin drugs went from diabetes, to obesity, to proven reductions in heart attack and stroke. At the other end, injectable “research peptides” are sold online with almost no human evidence behind them.

Working in biotech, I read the field the way a pipeline is read: by phase, by endpoint, and by who did the measuring.

Head to head, 72 weeksNEJM 2025
Tirzepatide
−20.2%
Semaglutide
−13.7%

Mean change in body weight in adults with obesity and without diabetes, the two drugs compared directly in one randomized trial (SURMOUNT-5).

Compound
Pre-clinicalPhase 1Phase 2Phase 3ApprovedOutcomes
Evidence

Semaglutide

GLP-1 receptor agonistApproved, with outcome data

Cut major cardiovascular events by 20% (hazard ratio 0.80) in people with overweight or obesity and heart disease, without diabetes.

NEJM 2023

Tirzepatide

GIP and GLP-1 receptor agonistApproved

Approved for chronic weight management in November 2023. Beat semaglutide on weight in a direct comparison.

FDA 2023NEJM 2025

Retatrutide

GIP, GLP-1 and glucagon receptor agonistPhase 3

Phase 3 topline, May 2026: −28.3% at 80 weeks on the top dose. Company-reported and not yet peer reviewed; a US filing is planned for 2027.

Topline 2026

BPC-157

Sold as a “research peptide”Pre-clinical only

Animal studies only. The FDA lists it among compounding substances that may carry significant safety risks, with little or no human safety data.

FDA 2023

This is how I read a field, not a recommendation. Prescription medicines need a prescriber who knows your history. Unapproved peptides come with no verified dose, purity or safety.

05Experiments, not identity

Change one variable. Then decide.

Nutrition phases, training changes, recovery practices and new tools can be treated like experiments. Define the question. Change one meaningful variable. Track a few outcomes. Decide what the result means. Then move on.

It is the same discipline we use when we put a new model into a hospital’s revenue cycle, and it makes health less emotional and more empirical.

Protocol

Example
  1. 1

    Define the question

    Does a fixed wake time protect my sleep through weeks of late calls with London and New York?

  2. 2

    Change one variable

    The same wake time every day, travel and weekends included. Nothing else changes.

  3. 3

    Track a few outcomes

    Sleep duration, resting heart rate, HRV trend, and a 1 to 5 rested score each morning.

  4. 4

    Decide what it means

    After three weeks against a two-week baseline, keep it if the outcomes improve and nothing else slips.

  5. 5

    Move on

    Write the result down, then pick the next question.

06The long game

Keep more capability for longer.

Longevity is not an excuse to avoid living. It is the attempt to keep more capability for longer: strength, mobility, cardiovascular capacity, cognition, independence, and the freedom to do demanding things.

Longevity science is a frontier of its own. Until it has outcome data, capability is the measure I trust. The objective is not a perfect body. It is a body that keeps up with the ambitions of the person using it.

  1. L1Strength400.00 m
  2. L2Mobility407.04 m
  3. L3Cardiovascular capacity414.70 m
  4. L4Cognition422.37 m
  5. L5Independence430.03 m
  6. L6Freedom to do demanding things437.70 m

Lap length per lane on a standard 400 m track: 36.50 m bend radius, 84.39 m straights, 1.22 m lanes. The outer lanes run further, which is the point. Track standard

The objective is not to optimize everything. It is to keep increasing what the body is capable of doing.

This is an editorial starting point, designed to grow with original articles, projects, research, tools, examples and case studies specific to this property.

Figures summarize public guidelines, peer-reviewed trials and regulatory records. They are not personal medical advice, and nothing here describes my own treatment.

  1. HBR 2018Porter ME, Nohria N. How CEOs manage time. Harvard Business Review, July–August 2018. hbr.org
  2. Track standardWorld Athletics, Track and Field Facilities Manual: 400 m standard track geometry, summarized in Running track.
  3. NEJM 1998McEwen BS. Protective and damaging effects of stress mediators. N Engl J Med. 1998;338:171–179. doi:10.1056/NEJM199801153380307
  4. OEM 2000Williamson AM, Feyer AM. Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication. Occup Environ Med. 2000;57:649–655. doi:10.1136/oem.57.10.649
  5. Sleep 2003Van Dongen HPA et al. The cumulative cost of additional wakefulness. Sleep. 2003;26(2):117–126. doi:10.1093/sleep/26.2.117
  6. WHO 2020World Health Organization. WHO guidelines on physical activity and sedentary behaviour. Geneva, 2020. who.int
  7. AASM 2015Watson NF et al. Recommended amount of sleep for a healthy adult. J Clin Sleep Med. 2015;11(6):591–592. doi:10.5664/jcsm.4758
  8. ISSN 2017Jäger R et al. International Society of Sports Nutrition position stand: protein and exercise. J Int Soc Sports Nutr. 2017;14:20. doi:10.1186/s12970-017-0177-8
  9. IOM 2005Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. 2005. doi:10.17226/10490
  10. ACC/AHA 2017Whelton PK et al. 2017 ACC/AHA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension. 2018;71:e13–e115. doi:10.1161/HYP.0000000000000065
  11. FDA 2024FDA. FDA clears first over-the-counter continuous glucose monitor. 5 March 2024. fda.gov
  12. FDA listFDA. Artificial Intelligence-Enabled Medical Devices. 1,614 entries, latest decision 29 June 2026. fda.gov
  13. NHGRINational Human Genome Research Institute. DNA sequencing costs: data. genome.gov
  14. eLife 2022Belsky DW et al. DunedinPACE, a DNA methylation biomarker of the pace of aging. eLife. 2022;11:e73420. doi:10.7554/eLife.73420
  15. NEJM 2023Lincoff AM et al. Semaglutide and cardiovascular outcomes in obesity without diabetes (SELECT). N Engl J Med. 2023;389:2221–2232. doi:10.1056/NEJMoa2307563
  16. FDA 2023FDA. FDA approves new medication for chronic weight management. November 2023. fda.gov
  17. NEJM 2025Aronne LJ et al. Tirzepatide as compared with semaglutide for the treatment of obesity (SURMOUNT-5). N Engl J Med. 2025. doi:10.1056/NEJMoa2416394
  18. Topline 2026Retatrutide TRIUMPH-1 phase 3 topline results, reported by AJMC, 21 May 2026. Company-reported, not yet peer reviewed. ajmc.com
  19. FDA 2023FDA. Certain bulk drug substances for use in compounding that may present significant safety risks (BPC-157 entry). fda.gov