100 Is The New 60: The Transformation Of Healthcare
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Healthcare is reactive, retrospective, bureaucratic, and expensive. It's sick care, not healthcare. But that is radically changing at an exponential rate.
Last year alone, we saw nearly US$800 million invested in longevity startups- over double the approximate $400 million invested in 2017.
In this month’s column, I’ll take a deep dive into the broken healthcare system we’re dealing with now, how longevity and healthcare technologies are working together to dramatically extend the human lifespan, disrupting the $3 trillion healthcare system in the process.
Finally, I’ll explore the transformative implications of dramatically extending the human health span. In the Middle East, where diabetes and heart disease are major causes of death, this is bound to have a game-changing impact.
In this article, I’ll cover:
- Why the healthcare system is broken;
- Why, despite this, we live in the healthiest time in human history;
- Exponential technologies are changing the game;
- Genome sequencing and editing;
- Senolytics, nutraceuticals, and pharmaceuticals.
Let’s dive in.
The system is broken
Here’s the data: doctors spend $210 billion per year on procedures that aren’t based on patient need, but fear of liability.
Americans spend, on average, $8,915 per person on healthcare- more than any other country on earth. Prescription drugs cost around 50% more in the U.S. than in other industrialized countries. At current rates, by 2025, nearly 25% of the U.S. GDP will be spent on healthcare. It takes 12 years and $359 million, on average, to take a new drug from the lab to a patient. Only 5 in 5,000 of these new drugs proceed to human testing. From there, only 1 of those 5 is actually approved for human use.
And yet, we live in the healthiest time of human history
Consider these insights, which I adapted from Max Roser’s excellent database, Our World In Data:
Right now, the countries with the lowest life expectancy in the world still have higher life expectancies than the countries with the highest life expectancy did in 1800.In 1841, a five-year-old had a life expectancy of 55 years. Today, a five-year old can expect to live 82 years- an increase of 27 years.We’re seeing a dramatic increase in healthspan. In 1845, a newborn would expect to live to 40 years old. For a 70-yearold, that number became 79. Now, people of all ages can expect to live to be 81 to 86 years old.
100 years ago, one of three children would die before the age of 5. As of 2015, the child mortality rate fell to just 4.3%. The cancer mortality rate has declined 27% over the past 25 years.
Over the past 200 years, we have seen an abundance of healthcare technologies enable a massive lifespan boom. Now, exponential technologies like artificial intelligence, 3D printing, and sensors, as well as tremendous advancements in genomics, stem cell research, chemistry, and many other fields, are beginning to tackle the fundamental issues of why we age. And so, while the causes of ageing are complex and unclear, with longevity clinical trials nearly doubling, from 73 in 2012 to over 145 in 2018, more answers -and questions- are emerging than ever before.
With the dramatic demonetization of genome reading and editing over the past decade, and Big Pharma, startups, and the FDA starting to face aging as a disease, we are starting to turn those answers into practical ways to extend our healthspan.
Below, I explore how genome sequencing and editing, along with new classes of anti-aging drugs, are augmenting our biology to further extend our healthy lives.
Genome sequencing and editing
Your genome is the software that runs your body. A sequence of 3.2 billion letters makes you “you.” These base pairs of A’s, T’s, C’s, and G’s determine your hair color, your height, your personality, your propensity to disease, your lifespan, and so on. Until recently, it's been very difficult to rapidly and cheaply "read" these letters- and even more difficult to understand what they mean.
Since 2001, the cost to sequence a whole human genome has plummeted exponentially, outpacing Moore's Law threefold.From an initial cost of $3.7 billion, it dropped to $10 million in 2006, and to $5,000 in 2012.Today, the cost of genome sequencing has dropped below $500, and according to Ilumina, the world’s leading sequencing company, the process will soon cost about $100, and take about an hour to complete.
This represents one of the most powerful and transformative technology revolutions in healthcare.When we understand your genome, we'll be able to understand how to optimize "you."
We'll know the perfect foods, the perfect drugs, the perfect exercise regimen, and the perfect supplements, just for you. We'll understand what microbiome types, or gut flora, are ideal for you.We’ll accurately predict how specific sedatives and medicines will impact you.We’ll learn which diseases and illnesses you’re most likely to develop, and, more importantly, how to best prevent them from developing in the first place (rather than trying to cure them after the fact).
In addition, to reading the human genome, scientists can now edit a genome using a naturally occurring biological system discovered in 1987 called CRISPR/Cas9. Here’s how it works: the bacteria capture snippets of DNA from invading viruses (or bacteriophage) and use them to create DNA segments known as CRISPR arrays. The CRISPR arrays allow the bacteria to "remember" the viruses (or closely related ones), and defend against future invasions. If the viruses attack again, the bacteria produce RNA segments from the CRISPR arrays to target the viruses' DNA. The bacteria then use Cas9 to cut the DNA apart, which disables the virus.
Most importantly, CRISPR is cheap, quick, easy to use, and more accurate than all previous gene editing methods. As a result, CRISPR/Cas9 has swept through labs around the world as the way to edit a genome. Early results are impressive. Researchers from the University of Chicago recently used CRISPR to genetically engineer cocaine resistance into mice.
Researchers at the University of Texas Southwestern Medical Center used CRISPR to reverse the gene defect causing Duchenne muscular dystrophy (DMD) in dogs. (DMD is the most common fatal genetic disease in children.)
With great power comes great responsibility, and the opportunity for moral and ethical dilemmas.
In 2015, Chinese scientists sparked global controversy when they first edited human embryo cells in the lab with the goal of modifying genes that would make the child resistant to smallpox, HIV, and cholera. Three years later, in November 2018, researcher He Jiankui informed the world that the first set of CRISPR engineered female twins had been delivered.
To accomplish his goal, Jiankui deleted a region of a receptor on the surface of white blood cells known as CCR5, introducing a rare, natural genetic variation that makes it more difficult for HIV to infect its favorite target, white blood cells. Setting aside the significant ethical conversations, CRISPR will soon provide us the tools to eliminate diseases, create hardier offspring, produce new environmentally resistant crops, and even wipe out pathogens.
Senolytics, Nutraceuticals, and Pharmaceutcials
Over the arc of your life, the cells in your body divide until they reach what is known as the Hayflick limit, or the number of times a normal human cell population will divide before cell division stops, which is typically about 50 divisions. What normally follows next is programmed cell death, or destruction by the immune system. A very small fraction of cells, however, become senescent cells, and evade this fate to linger indefinitely.
These lingering cells secrete a potent mix of molecules that triggers chronic inflammation, damages the surrounding tissue structures, and changes the behavior of nearby cells for the worse. Senescent cells appear to be one of the root causes of aging, causing everything from fibrosis and blood vessel calcification, to localized inflammatory conditions such as osteoarthritis to diminished lung function.
Fortunately, both the scientific and entrepreneurial communities have begun to work on senolytic therapies, moving the technology for selectively destroying senescent cells out of the laboratory, and into a half-dozen startup companies. In recent years, researchers have identified or designed a handful of senolytic compounds that can curb aging by regulating senescent cells. Two of these drugs that have gained mainstay research traction are rapamycin and metformin.
Originally extracted from bacteria found on Easter Island, rapamycin acts on the m-TOR (mechanistic target of rapamycin) pathway to selectively block a key protein that facilitates cell division. Currently, rapamycin derivatives are widely used as immunosuppression in organ and bone marrow transplants. Research now suggests that use results in prolonged lifespan, enhanced cognitive and immune function. Results of the drug’s recent clinical trial include decreased incidence of infection, improved influenza vaccination response, and a 30.6% decrease in respiratory tract infection.
Impressive, to say the least. Metformin is a widely used generic drug for mitigating liver sugar production in Type 2 diabetes patients. Researchers have found that Metformin also reduces oxidative stress and inflammation, which otherwise increase as we age. There is strong evidence that Metformin can augment cellular regeneration, and dramatically mitigate cellular senescence by reducing both oxidative stress and inflammation.
Over 100 studies registered on ClinicalTrials.gov are currently following up on strong evidence of metformin’s protective effect against cancer. Beyond cellular senescence, certain critical nutrients and proteins tend to decline as a function of age. Nutraceuticals combat aging by supplementing and replenishing these declining nutrient levels. NAD+ exists in every cell, participating in every process from DNA repair to creating the energy vital for cellular processes. It’s been shown that NAD+ levels decline as we age. A few supplement companies are now offering products that increase NAD+ levels consistently by a sustained 40%.
These are just a taste of the tremendous momentum that longevity and aging technology has right now. As artificial intelligence and quantum computing transform how we decode our DNA and how we discover drugs, genetics and pharmaceuticals will become truly personalized. Each year at Abundance 360, I host a panel of world-class longevity researchers and CEOs to update our members on the current state and near future of these technologies. In our forthcoming inaugural Abundance 360 Summit being held in Dubai, I’ll have three rock star CEOs leading the discussion on how some of these longevity technologies. We are edging closer toward a dramatically extended healthspan, where 100 is the new 60. What will you create, where will you explore, and how will you spend your time, if you are able to add an additional 40 healthy years to your life? Personally, I’m excited for a near-infinite lifespan to take on moonshots, and in a region like the Middle East, with a very young population, that additional 40-50 years promises to make the youth from the region the rock star entrepreneurs and change-makers of tomorrow.