I. We wallow in “sickcare.”
Are you sick to death of being sick and dying?
Today, we have “sickcare.” You get sick. You get treatments. Some are useful, others not. Your choices are limited by the U.S. Food and Drug Administration (FDA) and other government agencies and regulations.
You fight about how to pay the bills: indirectly, through your tax dollars or choices determined by your employers, directly out of your pocket, or some mix.
As you age, you’ll likely fall ill more often. You’ll find that the FDA, which must certify the safety and efficacy of all drugs, medical devices and treatments before patients can access them, generally will not consider treatments for the processes that constitute aging. Your physical deterioration will continue to your inevitable end.
But it need not now be this way!
The information and communications revolutions, with the emergence of artificial intelligence and a plethora of other exponential technologies and applications, is disrupting this sad situation. These technologies are making it possible for researchers and entrepreneurs, if they have liberty to innovate, to create a true healthcare system, a system that ministers to you as a unique individual and prevents you from falling ill to begin with.
And innovators could unleash the greatest revolution in history: ending human aging.
II. Five techno-hacks to healthcare.
Consider how exponential technological breakthroughs can be harnessed to replace “sickcare” with healthcare:
First, the cost of sequencing human genomes has dropped from some $100 million in 2001 (not including initial capital costs) to $10 million in 2007, to well under $1,000 today. Ultima Genome is
working to bring that cost down to $100. Our genomes are the detailed blueprints of our biological makeups as individuals. With other data garnered about our biology and epigenomes, we’ll have the basis for individualized healthcare.
Second, researchers continue to improve analytic tools for understanding in our sequenced genomes and other bio-data what long-term risks and propensities for certain ailments we are subject to as individuals.
For example, in a Nature Science Report article on “Interpreting models interpreting brain dynamics,” researchers explained how they created an AI program they “trained” by having it review over 10,000 functional magnetic resonance imaging (fMRI) scans of brains so it could understand aspects of brain biology.
Researchers then had the AI review over 1,000 fMRIs that included scans of brains afflicted with Alzheimer’s disease, schizophrenia, and autism. The result was that the AI “learned” to discern in scans of apparently healthy brains patterns that could predict those ailments years before symptoms manifest themselves. The AI is a scientist making discoveries!
Recently, researchers identified an enzyme the lack of which seems associated with Sudden Infant Death Syndrome. Now we might save babies from death and parents from needless heartbreak.
Third, wearable diagnostics continue to improve. We currently have Apple Watches, Fitbits, Oura rings, and glucose readers that monitor temperature, heartbeat, blood oxygen, pressure and saturation, sleep patterns, and other biomarkers. In the future, improved diagnostics routinely will
be able to measure your electrolytes, blood platelets, enzyme balances, and much more. Some of these diagnostics will be nano-bots circulating in your system, always on guard for unwanted ailments.
Fourth, your real-time, real-world health in the future could be monitored by an AI, referencing your individually sequenced genome and other bio-data. Potential serious ailments could be detected before symptoms manifest themselves. If factors suggest you’re on the verge of a heart attack or some other devasting health emergency, medics could be at your door before you know it.
Fifth, future technology could mean you rarely face such emergencies to begin with. The CRISPR-Cas9 genetic editing tool has been used to remove dangerous DNA from human genomes, treating certain cancers. It was recently used experimentally to turn off the production of tau proteins in brain neurons.Clumping of such proteins is associated with Alzheimer’s. Gene therapy is poised to cure sickle cell disease, which principally afflicts African-Americans. CAR-T treatments can be used against acute lymphoblastic leukemia, which principally afflicts children. Nanobots, regenerated replacement organs, and a plethora of emerging technologies will treat even more ailments. And now that the processes that constitute aging are better understood, researchers are working to stave off our otherwise inevitable fate.
This is true healthcare!
III. Three reforms to open the way.
The biotech revolution today is at a stage similar to the infotech revolution in the 1980s. At that time, entrepreneurs like Steve Jobs and Bill Gates had pioneered the hardware and software that would put computers in every home, business, school, scientific establishment—in other words, everywhere. The exponential improvements in the quality of those technologies and dramatic drops in cost, combined with emerging world wide web, put infotech on a trajectory to create today’s incredible techno-world, linking everyone to one another and to all the information in the world.
But there’s a difference between that revolution and the emerging biotech revolution. Entrepreneurs like Bill Hewlett, David Packard, Jobs, Larry Page, Sergey Brin and many others were under few or no restrictions; they could literally work out of their garages. But biotech pioneers face regulatory and institutional barriers that stifle innovation.
The creation of a true healthcare system will require some fundamental reforms.
First, your bio-data. Keeping you alive and well will more and more depend on monitoring your genome and bio-data in detail, overseen by an AI. And the AI will be comparing your data to the data of others (with everyone’s actual identities scrubbed) to discover new, underlying bio-patterns in order to diagnose ailments and develop treatments. Massive real-world data will be necessary.
But you will want assurance that neither governments nor unscrupulous private parties can use your data for nefarious purposes or to control you. Thus, it will be necessary for both strong privacy protections to be in place, allowing you to determine where and when your data is used, but also allowing or offering incentives for legitimate use of your data.
Second, your insurance vs. boutique treatment. Current health insurance is a dysfunctional hybrid. In part it is traditional pooling of resources to cover costs of unpredictable ailments. We know, for example, that a certain percentage of adults in the U.S. will suffer heart attacks but, at least at this time, we can’t predict exactly who. So we all chip in a little and the unfortunate few who suffer will have their bills covered.
But health insurance today also includes costly mandates, with each state involved in regulations as well as the federal government. Because government controls pricing for the largest portion of “sickcare” through Medicare, Medicaid and other programs, pricing of medications especially is an incomprehensible and contradictory spaghetti-tangled mess. Add to this the severe restrictions on when you can purchase insurance and you have the current dysfunctional system.
Currently, insurers offer only a few incentives for individuals to remain healthy: free annual checkups, lower rates for non-smokers. Of course, we can give ourselves the best chance for long, healthy lives with good diets, regular exercise, and other lifestyle choices. These choices, of course, could not be mandated by insurance companies. And it is only now that technology will offer ways to monitor and treat threats to health beyond our individual control.
A true healthcare system can emerge in the future if insurance companies themselves and Health Maintenance Organizations are free to offer access to technologies that will diagnose and head off our serious ailments before they occur. This does pose a challenge. Will insurers, monitoring our bio-data, insist we go light on holiday feasts or require we increase our daily exercise to keep our premiums low? Will governments mandate such measures? Recalling the opening of George Orwell’s novel 1984, with Winston Smith and all subjects of Big Brother forced to work out before the telescreen, such lifestyle control will meet strong public resistance.
But if individuals are freer to control their own healthcare dollars, for example, with tax-deductible Health Savings Accounts, we will likely see the growth and expansion of what are currently boutique individualized healthcare providers. Today, for example, Fountain Life advertises its mission “to revolutionize the current healthcare system by switching the primary focus to proactive and preventative care. Thanks to advancements in technology and artificial intelligence (AI), we can detect illnesses earlier than ever before so you not only can live to 100 and beyond, but you can feel and look as great as a centurion as you did when you were 60.”
With individuals free to choose their levels of health protection, competition between providers, and falling costs of cutting-edge technology and ever-increasing quality, we can expect the biotech revolution to follow the same path as the infotech revolution, with better, less-costly healthcare for all.
Third, regulatory reform. The first COVID-19 vaccine was developed in April 2020, but it wasn’t until December of that year—300,000 deaths later—that the FDA gave it provisional approval for Americans. This made clear the desperate need for FDA reform.
Before patients can access a new treatment for serious ailments, it must pass FDA-mandated Phase I safety tests and Phase II and III clinical trials for efficacy. In spite of reforms since 1962 when it was created in its current form, this 18,000-employee-strong unwieldy federal agency has not been able to keep up with changes in medical technology.
A Tufts study found it takes on average 10-12 years at a cost of nearly $3 billion to bring a new treatment from research lab to patient. Much of that cost is generated by the FDA certification process. Thousands of individuals each year suffer and die because of unnecessary FDA delays. Smaller, innovative research labs cannot afford such costs and time, so many promising treatments never make their way to patients.
One significant FDA reform would be “Free To Choose Medicine” (FTCM). (A version of this approach, the Promising Pathway Act, is currently before Congress.) This approach is based on the 1992 FDA reform that offered AIDS suffers access to a safe treatment still in clinical trials years ahead of final approval, saying as many as 12,000 lives. FTCM would create a parallel track on which sponsors could offer a proposed treatments that had passed FDA safety tests and a least one Phase II efficacy trial to patients, with informed consent.
Patient experiences with treatments, with privacy protected, would be logged in a database. This real-world data would allow promising treatments to receive final approval more quickly, cutting costs.
Thousands of patients who could not participate in FDA-mandated clinical trials would not have to suffer or die waiting safe, promising treatments that would come too late for them.
Also, this approach would open the way not only for innovation in medical treatments but also for innovations in how the treatments themselves are tested, for example, through Ais applications.
Such a reform, no doubt, would need to be augmented by many others. But FDA reform is crucial for a biotech revolution.
IV. Ending Aging and Celebrating your 200th birthday!
Most serious ailments occur when we are older. Yet FDA usually refused to even consider treatments that don’t target particular diseases but could treat the underlying biological conditions that give rise to those ailments as we age. But researchers like Aubrey De Grey, David Sinclair, Bill Andrews and others are coming to understand both the genetic and epigenetic factors—mitochondrial mutations, telomere shortening, cell atrophy—that constitute the aging process. De Grey observes that aging is really a “treatable condition.” Therefore, the most important FDA reform ever would be to allow certification of treatments targeting the “processes that constitute aging.”
Throughout human history, aging has been seen by most as the inevitable fate with which you can rage against or make your peace with, but from which you can never escape.
All the science now suggests that this is not so, that we can at least push back the dates of our demise, possibly to the indefinite future.
Anti-aging pioneers point to two new realities they are creating. First is longevity: you get to celebrate your 200th birthday! Second is health: you celebrate it not in a hospital bed, hooked up to machines and tubes keeping your age-ravaged body alive, but with a brisk swim, walk, or jog and then party with friends and family!
This possible future is no longer science fiction. If researchers and innovators are free to develop and utilize the exponential technologies, if we have an education system that trains and nurtures innovative minds, and if we have a culture of optimism, purpose, joy in achievement and benevolence that tells us that anything’s possible, then “sickcare” will be part of a darker past and healthcare will be our shining future!
Edward Hudgins, Ph.D., is founder of the Human Achievement Alliance and an expert on technology policy. His career includes stints at the Heritage Foundation, Joint Economic Committee of Congress, the Cato Institute, the Atlas Society, and the Heartland Institute. He can be contacted at [email protected]