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Healthcare today is reactive, retrospective, bureaucratic, and expensive. It’s sick care, not healthcare.
But that is radically changing at an exponential rate.
Through this multi-part blog series on longevity, I’ll take a deep dive into aging, longevity, and healthcare technologies that are working together to dramatically extend the human lifespan, disrupting the $3 trillion healthcare system in the process.
I’ll begin the series by explaining the nine hallmarks of aging, as explained in this journal article. Next, I’ll break down the emerging technologies and initiatives working to combat these nine hallmarks. Finally, I’ll explore the transformative implications of dramatically extending the human health span.
In this blog I’ll cover:
Why the healthcare system is broken
Why, despite this, we live in the healthiest time in human history
The nine mechanisms of aging
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 percent more in the US than in other industrialized countries.
At current rates, by 2025, nearly 25 percent of the US 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 in 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 5-year-old had a life expectancy of 55 years. Today, a 5-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-year-old, that number became 79. Now, people of all ages can expect to live to be 81 to 86 years old.
100 years ago, 1 of 3 children would die before the age of 5. As of 2015, the child mortality rate fell to just 4.3 percent.
The cancer mortality rate has declined 27 percent over the past 25 years.
Figure: Around the globe, life expectancy has doubled since the 1800s. | Image from Life Expectancy by Max Roser – Our World in Data / CC BY SA
Figure: A dramatic reduction in child mortality in 1800 vs. in 2015. | Image from Child Mortality by Max Roser – Our World in Data / CC BY SA
The 9 Mechanisms of Aging
*This section was adapted from CB INSIGHTS: The Future Of Aging.
Longevity, healthcare, and aging are intimately linked.
With better healthcare, we can better treat some of the leading causes of death, impacting how long we live.
By investigating how to treat diseases, we’ll inevitably better understand what causes these diseases in the first place, which directly correlates to why we age.
Following are the nine hallmarks of aging. I’ll share examples of health and longevity technologies addressing each of these later in this blog series.
Genomic instability: As we age, the environment and normal cellular processes cause damage to our genes. Activities like flying at high altitude, for example, expose us to increased radiation or free radicals. This damage compounds over the course of life and is known to accelerate aging.
Telomere attrition: Each strand of DNA in the body (known as chromosomes) is capped by telomeres. These short snippets of DNA repeated thousands of times are designed to protect the bulk of the chromosome. Telomeres shorten as our DNA replicates; if a telomere reaches a certain critical shortness, a cell will stop dividing, resulting in increased incidence of disease.
Epigenetic alterations: Over time, environmental factors will change how genes are expressed, i.e., how certain sequences of DNA are read and the instruction set implemented.
Loss of proteostasis: Over time, different proteins in our body will no longer fold and function as they are supposed to, resulting in diseases ranging from cancer to neurological disorders.
Deregulated nutrient-sensing: Nutrient levels in the body can influence various metabolic pathways. Among the affected parts of these pathways are proteins like IGF-1, mTOR, sirtuins, and AMPK. Changing levels of these proteins’ pathways has implications on longevity.
Mitochondrial dysfunction: Mitochondria (our cellular power plants) begin to decline in performance as we age. Decreased performance results in excess fatigue and other symptoms of chronic illnesses associated with aging.
Cellular senescence: As cells age, they stop dividing and cannot be removed from the body. They build up and typically cause increased inflammation.
Stem cell exhaustion: As we age, our supply of stem cells begins to diminish as much as 100 to 10,000-fold in different tissues and organs. In addition, stem cells undergo genetic mutations, which reduce their quality and effectiveness at renovating and repairing the body.
Altered intercellular communication: The communication mechanisms that cells use are disrupted as cells age, resulting in decreased ability to transmit information between cells.
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.
In the next blog in this series, we will dive into how genome sequencing and editing, along with new classes of drugs, are augmenting our biology to further extend our healthy lives.
What will you be able to achieve with an extra 30 to 50 healthy years (or longer) in your lifespan? Personally, I’m excited for a near-infinite lifespan to take on moonshots.
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When you look back at 2018, do you see a good or a bad year? Chances are, your perception of the year involves fixating on all the global and personal challenges it brought. In fact, every year, we tend to look back at the previous year as “one of the most difficult” and hope that the following year is more exciting and fruitful.
But in the grander context of human history, 2018 was an extraordinarily positive year. In fact, every year has been getting progressively better.
Before we dive into some of the highlights of human progress from 2018, let’s make one thing clear. There is no doubt that there are many overwhelming global challenges facing our species. From climate change to growing wealth inequality, we are far from living in a utopia.
Yet it’s important to recognize that both our news outlets and audiences have been disproportionately fixated on negative news. This emphasis on bad news is detrimental to our sense of empowerment as a species.
So let’s take a break from all the disproportionate negativity and have a look back on how humanity pushed boundaries in 2018.
On Track to Becoming an Interplanetary Species
We often forget how far we’ve come since the very first humans left the African savanna, populated the entire planet, and developed powerful technological capabilities. Our desire to explore the unknown has shaped the course of human evolution and will continue to do so.
This year, we continued to push the boundaries of space exploration. As depicted in the enchanting short film Wanderers, humanity’s destiny is the stars. We are born to be wanderers of the cosmos and the everlasting unknown.
SpaceX had 21 successful launches in 2018 and closed the year with a successful GPS launch. The latest test flight by Virgin Galactic was also an incredible milestone, as SpaceShipTwo was welcomed into space. Richard Branson and his team expect that space tourism will be a reality within the next 18 months.
Our understanding of the cosmos is also moving forward with continuous breakthroughs in astrophysics and astronomy. One notable example is the MARS InSight Mission, which uses cutting-edge instruments to study Mars’ interior structure and has even given us the first recordings of sound on Mars.
Understanding and Tackling Disease
Thanks to advancements in science and medicine, we are currently living longer, healthier, and wealthier lives than at any other point in human history. In fact, for most of human history, life expectancy at birth was around 30. Today it is more than 70 worldwide, and in the developed parts of the world, more than 80.
Brilliant researchers around the world are pushing for even better health outcomes. This year, we saw promising treatments emerge against Alzheimers disease, rheumatoid arthritis, multiple scleroris, and even the flu.
The deadliest disease of them all, cancer, is also being tackled. According to the American Association of Cancer Research, 22 revolutionary treatments for cancer were approved in the last year, and the death rate in adults is also in decline. Advancements in immunotherapy, genetic engineering, stem cells, and nanotechnology are all powerful resources to tackle killer diseases.
Breakthrough Mental Health Therapy
While cleaner energy, access to education, and higher employment rates can improve quality of life, they do not guarantee happiness and inner peace. According to the World Economic Forum, mental health disorders affect one in four people globally, and in many places they are significantly under-reported. More people are beginning to realize that our mental health is just as important as our physical health, and that we ought to take care of our minds just as much as our bodies.
We are seeing the rise of applications that put mental well-being at their center. Breakthrough advancements in genetics are allowing us to better understand the genetic makeup of disorders like clinical depression or Schizophrenia, and paving the way for personalized medical treatment. We are also seeing the rise of increasingly effective therapeutic treatments for anxiety.
This year saw many milestones for a whole new revolutionary area in mental health: psychedelic therapy. Earlier this summer, the FDA granted breakthrough therapy designation to MDMA for the treatment of PTSD, after several phases of successful trails. Similar research has discovered that Psilocybin (also known as magic mushrooms) combined with therapy is far more effective than traditional forms of treatment for depression and anxiety.
Moral and Social Progress
Innovation is often associated with economic and technological progress. However, we also need leaps of progress in our morality, values, and policies. Throughout the 21st century, we’ve made massive strides in rights for women and children, civil rights, LGBT rights, animal rights, and beyond. However, with rising nationalism and xenophobia in many parts of the developed world, there is significant work to be done on this front.
All hope is not lost, as we saw many noteworthy milestones this year. In January 2018, Iceland introduced the equal wage law, bringing an end to the gender wage gap. On September 6th, the Indian Supreme Court decriminalized homosexuality, marking a historical moment. Earlier in December, the European Commission released a draft of ethics guidelines for trustworthy artificial intelligence. Such are just a few examples of positive progress in social justice, ethics, and policy.
We are also seeing a global rise in social impact entrepreneurship. Emerging startups are no longer valued simply based on their profits and revenue, but also on the level of positive impact they are having on the world at large. The world’s leading innovators are not asking themselves “How can I become rich?” but rather “How can I solve this global challenge?”
Intelligently Optimistic for 2019
It’s becoming more and more clear that we are living in the most exciting time in human history. Even more, we mustn’t be afraid to be optimistic about 2019.
An optimistic mindset can be grounded in rationality and evidence. Intelligent optimism is all about being excited about the future in an informed and rational way. The mindset is critical if we are to get everyone excited about the future by highlighting the rapid progress we have made and recognizing the tremendous potential humans have to find solutions to our problems.
In his latest TED talk, Steven Pinker points out, “Progress does not mean that everything becomes better for everyone everywhere all the time. That would be a miracle, and progress is not a miracle but problem-solving. Problems are inevitable and solutions create new problems which have to be solved in their turn.”
Let us not forget that in cosmic time scales, our entire species’ lifetime, including all of human history, is the equivalent of the blink of an eye. The probability of us existing both as an intelligent species and as individuals is so astoundingly low that it’s practically non-existent. We are the products of 14 billion years of cosmic evolution and extraordinarily good fortune. Let’s recognize and leverage this wondrous opportunity, and pave an exciting way forward.
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When it comes to applications for machine learning, few can be more widely hyped than medicine. This is hardly surprising: it’s a huge industry that generates a phenomenal amount of data and revenue, where technological advances can improve or save the lives of millions of people. Hardly a week passes without a study that suggests algorithms will soon be better than experts at detecting pneumonia, or Alzheimer’s—diseases in complex organs ranging from the eye to the heart.
The problems of overcrowded hospitals and overworked medical staff plague public healthcare systems like Britain’s NHS and lead to rising costs for private healthcare systems. Here, again, algorithms offer a tantalizing solution. How many of those doctor’s visits really need to happen? How many could be replaced by an interaction with an intelligent chatbot—especially if it can be combined with portable diagnostic tests, utilizing the latest in biotechnology? That way, unnecessary visits could be reduced, and patients could be diagnosed and referred to specialists more quickly without waiting for an initial consultation.
As ever with artificial intelligence algorithms, the aim is not to replace doctors, but to give them tools to reduce the mundane or repetitive parts of the job. With an AI that can examine thousands of scans in a minute, the “dull drudgery” is left to machines, and the doctors are freed to concentrate on the parts of the job that require more complex, subtle, experience-based judgement of the best treatments and the needs of the patient.
But, as ever with AI algorithms, there are risks involved with relying on them—even for tasks that are considered mundane. The problems of black-box algorithms that make inexplicable decisions are bad enough when you’re trying to understand why that automated hiring chatbot was unimpressed by your job interview performance. In a healthcare context, where the decisions made could mean life or death, the consequences of algorithmic failure could be grave.
A new paper in Science Translational Medicine, by Nicholson Price, explores some of the promises and pitfalls of using these algorithms in the data-rich medical environment.
Neural networks excel at churning through vast quantities of training data and making connections, absorbing the underlying patterns or logic for the system in hidden layers of linear algebra; whether it’s detecting skin cancer from photographs or learning to write in pseudo-Shakespearean script. They are terrible, however, at explaining the underlying logic behind the relationships that they’ve found: there is often little more than a string of numbers, the statistical “weights” between the layers. They struggle to distinguish between correlation and causation.
This raises interesting dilemmas for healthcare providers. The dream of big data in medicine is to feed a neural network on “huge troves of health data, finding complex, implicit relationships and making individualized assessments for patients.” What if, inevitably, such an algorithm proves to be unreasonably effective at diagnosing a medical condition or prescribing a treatment, but you have no scientific understanding of how this link actually works?
Too Many Threads to Unravel?
The statistical models that underlie such neural networks often assume that variables are independent of each other, but in a complex, interacting system like the human body, this is not always the case.
In some ways, this is a familiar concept in medical science—there are many phenomena and links which have been observed for decades but are still poorly understood on a biological level. Paracetamol is one of the most commonly-prescribed painkillers, but there’s still robust debate about how it actually works. Medical practitioners may be keen to deploy whatever tool is most effective, regardless of whether it’s based on a deeper scientific understanding. Fans of the Copenhagen interpretation of quantum mechanics might spin this as “Shut up and medicate!”
But as in that field, there’s a debate to be had about whether this approach risks losing sight of a deeper understanding that will ultimately prove more fruitful—for example, for drug discovery.
Away from the philosophical weeds, there are more practical problems: if you don’t understand how a black-box medical algorithm is operating, how should you approach the issues of clinical trials and regulation?
Price points out that, in the US, the “21st-Century Cures Act” allows the FDA to regulate any algorithm that analyzes images, or doesn’t allow a provider to review the basis for its conclusions: this could completely exclude “black-box” algorithms of the kind described above from use.
Transparency about how the algorithm functions—the data it looks at, and the thresholds for drawing conclusions or providing medical advice—may be required, but could also conflict with the profit motive and the desire for secrecy in healthcare startups.
One solution might be to screen algorithms that can’t explain themselves, or don’t rely on well-understood medical science, from use before they enter the healthcare market. But this could prevent people from reaping the benefits that they can provide.
New healthcare algorithms will be unable to do what physicists did with quantum mechanics, and point to a track record of success, because they will not have been deployed in the field. And, as Price notes, many algorithms will improve as they’re deployed in the field for a greater amount of time, and can harvest and learn from the performance data that’s actually used. So how can we choose between the most promising approaches?
Creating a standardized clinical trial and validation system that’s equally valid across algorithms that function in different ways, or use different input or training data, will be a difficult task. Clinical trials that rely on small sample sizes, such as for algorithms that attempt to personalize treatment to individuals, will also prove difficult. With a small sample size and little scientific understanding, it’s hard to tell whether the algorithm succeeded or failed because it’s bad at its job or by chance.
Add learning into the mix and the picture gets more complex. “Perhaps more importantly, to the extent that an ideal black-box algorithm is plastic and frequently updated, the clinical trial validation model breaks down further, because the model depends on a static product subject to stable validation.” As Price describes, the current system for testing and validation of medical products needs some adaptation to deal with this new software before it can successfully test and validate the new algorithms.
Striking a Balance
The story in healthcare reflects the AI story in so many other fields, and the complexities involved perhaps illustrate why even an illustrious company like IBM appears to be struggling to turn its famed Watson AI into a viable product in the healthcare space.
A balance must be struck, both in our rush to exploit big data and the eerie power of neural networks, and to automate thinking. We must be aware of the biases and flaws of this approach to problem-solving: to realize that it is not a foolproof panacea.
But we also need to embrace these technologies where they can be a useful complement to the skills, insights, and deeper understanding that humans can provide. Much like a neural network, our industries need to train themselves to enhance this cooperation in the future.
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A digital afterlife may soon be within reach, but it might not be for your benefit.
The reams of data we’re creating could soon make it possible to create digital avatars that live on after we die, aimed at comforting our loved ones or sharing our experience with future generations.
That may seem like a disappointing downgrade from the vision promised by the more optimistic futurists, where we upload our consciousness to the cloud and live forever in machines. But it might be a realistic possibility in the not-too-distant future—and the first steps have already been taken.
After her friend died in a car crash, Eugenia Kuyda, co-founder of Russian AI startup Luka, trained a neural network-powered chatbot on their shared message history to mimic him. Journalist and amateur coder James Vlahos took a more involved approach, carrying out extensive interviews with his terminally ill father so that he could create a digital clone of him when he died.
For those of us without the time or expertise to build our own artificial intelligence-powered avatar, startup Eternime is offering to take your social media posts and interactions as well as basic personal information to build a copy of you that could then interact with relatives once you’re gone. The service is so far only running a private beta with a handful of people, but with 40,000 on its waiting list, it’s clear there’s a market.
The whole idea may seem eerily similar to the Black Mirror episode Be Right Back, in which a woman pays a company to create a digital copy of her deceased husband and eventually a realistic robot replica. And given the show’s focus on the emotional turmoil she goes through, people might question whether the idea is a sensible one.
But it’s hard to say at this stage whether being able to interact with an approximation of a deceased loved one would be a help or a hindrance in the grieving process. The fear is that it could make it harder for people to “let go” or “move on,” but others think it could play a useful therapeutic role, reminding people that just because someone is dead it doesn’t mean they’re gone, and providing a novel way for them to express and come to terms with their feelings.
While at present most envisage these digital resurrections as a way to memorialize loved ones, there are also more ambitious plans to use the technology as a way to preserve expertise and experience. A project at MIT called Augmented Eternity is investigating whether we could use AI to trawl through someone’s digital footprints and extract both their knowledge and elements of their personality.
Project leader Hossein Rahnama says he’s already working with a CEO who wants to leave behind a digital avatar that future executives could consult with after he’s gone. And you wouldn’t necessarily have to wait until you’re dead—experts could create virtual clones of themselves that could dispense advice on demand to far more people. These clones could soon be more than simple chatbots, too. Hollywood has already started spending millions of dollars to create 3D scans of its most bankable stars so that they can keep acting beyond the grave.
It’s easy to see the appeal of the idea; imagine if we could bring back Stephen Hawking or Tim Cook to share their wisdom with us. And what if we could create a digital brain trust combining the experience and wisdom of all the world’s greatest thinkers, accessible on demand?
But there are still huge hurdles ahead before we could create truly accurate representations of people by simply trawling through their digital remains. The first problem is data. Most peoples’ digital footprints only started reaching significant proportions in the last decade or so, and cover a relatively small period of their lives. It could take many years before there’s enough data to create more than just a superficial imitation of someone.
And that’s assuming that the data we produce is truly representative of who we are. Carefully-crafted Instagram profiles and cautiously-worded work emails hardly capture the messy realities of most peoples’ lives.
Perhaps if the idea is simply to create a bank of someone’s knowledge and expertise, accurately capturing the essence of their character would be less important. But these clones would also be static. Real people continually learn and change, but a digital avatar is a snapshot of someone’s character and opinions at the point they died. An inability to adapt as the world around them changes could put a shelf life on the usefulness of these replicas.
Who’s Calling the (Digital) Shots?
It won’t stop people trying, though, and that raises a potentially more important question: Who gets to make the calls about our digital afterlife? The subjects, their families, or the companies that hold their data?
In most countries, the law is currently pretty hazy on this topic. Companies like Google and Facebook have processes to let you choose who should take control of your accounts in the event of your death. But if you’ve forgotten to do that, the fate of your virtual remains comes down to a tangle of federal law, local law, and tech company terms of service.
This lack of regulation could create incentives and opportunities for unscrupulous behavior. The voice of a deceased loved one could be a highly persuasive tool for exploitation, and digital replicas of respected experts could be powerful means of pushing a hidden agenda.
That means there’s a pressing need for clear and unambiguous rules. Researchers at Oxford University recently suggested ethical guidelines that would treat our digital remains the same way museums and archaeologists are required to treat mortal remains—with dignity and in the interest of society.
Whether those kinds of guidelines are ever enshrined in law remains to be seen, but ultimately they may decide whether the digital afterlife turns out to be heaven or hell.
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From how we get around to how we spend our time to how we manage our health, technology is changing our lives—not to mention economies, governments, and cities around the world. Tech has brought good to individuals and societies by, for example, democratizing access to information and lowering the cost of many products and services. But it’s also brought less-desirable effects we can’t ignore, like a rise in mental health problems and greater wealth inequality.
To keep pushing tech in a direction that will benefit humanity as a whole—rather than benefiting a select few—we must encourage open dialogues about these topics among leading figures in business, government, and spirituality.
To that end, SingularityU The Netherlands recently hosted a dialogue about compassion and technology with His Holiness the Dalai Lama. The event was attended by students and tech innovators, ambassadors, members of the Dutch royal family, and other political and business leaders.
The first half of the conversation focused on robotics, telepresence, and artificial intelligence. His Holiness spoke with Tilly Lockey, a British student helping tech companies create bionic limbs, Karen Dolva, CEO of telepresence company No Isolation, and Maarten Steinbuch, faculty chair of robotics at SingularityU the Netherlands and a professor of systems and control at TU Eindhoven.
When asked what big tech companies could be doing to help spread good around the world, His Holiness pointed out that while technology has changed many aspects of life in developed countries, there is still immense suffering in less-developed nations, and tech companies should pay more attention to the poorer communities around the world.
In the second half of the event, focus switched to sickness, aging, and death. Speakers included Liz Parrish, CEO of BioViva Sciences, Kris Verburgh, faculty chair of health and medicine at SingularityU the Netherlands, Jeantine Lunshof, a bio-ethicist at MIT Media Lab, and Selma Boulmalf, a religious studies student at University of Amsterdam. Among other topics, they talked with His Holiness about longevity research and the drawbacks of trying to extend our lifespans or achieve immortality.
Both sessions were moderated by Christa Meindersma, founder and chair of the Himalaya Initiative for Culture and Society. The event served as the ceremonial opening of an exhibition called The Life of the Buddha, Path to the Present, on display in Amsterdam’s 15-century De Nieuwe Kerk church through February 2019.
In the 21st century, His Holiness said, “There is real possibility to create a happier world, peaceful world. So now we need vision. A peaceful world on the basis of a sense of oneness of humanity.”
Technology’s role in that world is being developed and refined every day, and we must maintain an ongoing awareness of its positive and negative repercussions—on everyone.
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