Category Archives: complex adaptive systems

Google’s Calico – extending health life years

  • Calico is about extending healthy life years, not just life
  • Larry Page’s view is that ageing is the cause and diseases are the consequence of this ageing
  • Google will use all data it has access to – from search terms, to location data and including genomic data when it becomes more readily available
  • Curing cancer is not as big an advance as you might think” saying it would only add about three years to average life expectancy.

Source: http://mashable.com/2013/10/24/google-calico/
S
ource: http://www.technologyreview.com/view/519456/google-to-try-to-solve-death-lol/

Google Wants You to Live 170 Years

BY DANI FANKHAUSER

Along the lines of self-driving cars and smart glasses, Google‘s newest venture promises to wow the tech scene. Only, it’s not quite tech, at least in the traditional sense. The venture is called California Life Company, or Calico for short, and its goal is to extend human life by 20 to 100 years.It sounds surreal, until consider that we already extended human life by 20 years over the past century. The average girl born today will live to be 100, a once outlying achievement.

Other research outlets have made relevant discoveries over the years, including worms thatdivide stem cells without aging and that resveratrol, found in red wine, seems to defend against diseases related to aging and could be manufactured as a more potent synthetic drug.

Meanwhile, companies such as Elixir Pharmaceuticals, Sirtris Pharma and Halcyon Molecular set out to extend human life, only to shut down (or be acquired, then shuttered by the buyer), many times running out of money before bringing a product to market.

Don’t be quick to assume Google’s involvement is strictly to benefit the common good, however. CEO Larry Page is pushing to spend on long term rather than incremental R&D. There’s money to be made here. The regenerative medicine industry is valued at $1.6 billion, and anti-aging products are virtually resistant to economic cycles. Therapies available today may be expensive,untrustworthy and could produce horrific results.

But one thing is true: The quest to live just a bit longer is in demand.

But living longer comes with its own challenges. One imagines doubling our elderly population and the strain that would put on their families and on resources in general. On the other hand, by allowing people to age slower, it’s possible a solution could extend our productive years, rather than the elderly years — so, an extra decade of being 30, rather than an extra decade of being 90 — a more attractive option for both individuals and culture as a whole.

Mashable spoke with experts in the space, who predict Calico will indeed approach the latter (Google declined to comment for this story). It won’t likely be one magic bullet solution, but rather, a group of solutions — a suite of products that will catch our imagination just as Google Glass and self-driving cars have.

The Problem With Aging

In a TIME profile, Larry Page said that solving individual diseases, even ones as pervasive as cancer, would not increase life expectancy by much. To reframe, cancer is the symptom; the true disease is aging itself. As we age and our cells wear down, it causes other old-age diseases.

Currently, much of our technology that extends life actually extends life in poor health, while thenumber of years lived in good health remains unchanged.

Our retirement age of 65 was originally set because hardly anyone ever reached that age.

“Today we spend an incredible amount [of money] out of keeping people alive in a bad state of health,”

“Today we spend an incredible amount [of money] out of keeping people alive in a bad state of health,” says Aubrey de Grey, chief science officer of the SENS Research Foundation, who presented a TED Talk on anti-aging.

This might explain why many people have no interest in living longer.A Pew study shows 56% of Americans would not choose to slow the aging process, even if such medical treatments were available.You may have read about the suicide of 60-year-old sports blogger Martin Manley. His website reveals his distaste for the physical and mental limitations of old age.But de Grey doesn’t expect a solution from Google to follow this trend, adding length to the “unwell” years of life while the number of healthy years remains the same.

“We will not be able to extend life without extending health,” he says. “Longevity is a side effect.”

Why Google?

For most of us, Google’s investment into longevity was a surprise (but note, Google will not be operating Calico, only backing it). Others already in the space were able to see the connection.

What Google brings to the table is data. “Not just one set of data, multiple forms,” says Harry Glorikian, founder of life sciences consulting firm Scientia Advisors. “Search data, GPS data, all sorts of other pieces, electronic breadcrumbs that you produce all out there to get a picture of you.”

This data could be paired with each person’s genome — a partial genome can be mapped today for $99 via 23andMe (another Google investment), but many are hoping a full genome will cost as much in the next few years.

Daniel Kraft, medicine and neuroscience chair of Singularity University, affirms that this will require people to relinquish some privacy, in hopes of helping others and themselves, but predicts it to be something many will do.

“Lot of folks will be happy to share elements of health history,”

“Lot of folks will be happy to share elements of health history,” he says.

For an example of how data can impact health, just look to Google’s Flu Trends, which predicted flu outbreaks based on search data, although it turned out to be accurate only in certain cases.

Finally, note that Google isn’t entirely new to this space. Singularity University has had a lot of cross-pollination with Google, Kraft says, and Ray Kurzweil, director of engineering at Google, is an advisor to Maximum Life Foundation, says founder David Kekich.

Glorikian notes that, much like how Google’s development of Glass inspired developers to create uses for it, the Calico announcement will bring further attention and energy to life extension.

“When one of these behemoths points to a certain place, everyone has to believe that there’s something there,” Glorikian says.

The Solution Won’t Be a Magic Pill

We won’t see an anti-aging product from Calico come to market in a year — it’s a long-term venture. The company is likely assembling a team (the announcement only mentioned leadership of Art Levinson, who is former CEO of biotech company Genentech) and deciding what kind of research to do. Of course, there are several types.

First, there is the idea of the engaged patient. You have the “ability to manage your prevention if you know the risk of certain diseases,” says Kraft. Again, think genome mapping.

Second, de Grey maintains that a medical solution will be discovered before a solution involving nanotechnology — and the medical solution will allow some of us to live long enough to also benefit from future solutions. A medical solution might involve cell therapy, gene therapy or injections. Nanotechnology could include tiny robots that repair our cells or assist organs.

Who Will Pay for It?

An early criticism of Calico was that it sounded like something that would increase the split between the rich and the poor, leaving millionaires to live as long as they like (a few extra years to spend all that money doesn’t hurt), while less privileged people would settle for traditional lifespans or shorter (many children in developing countries continue to die without lack of access to clean water).

The rich already have the option of cryonics, preserving their bodies after death in hopes future technology will revive them. It costs $200,000.

It is possible individuals will not need to cover costs of anti-aging treatments themselves? Much like health care today, it makes for a convincing job perk.

De Grey expects these solutions to be paid for by neither the individual or the employer, but rather, the government. Between social security and Medicaid, the government spends billions on treatment for old-age illnesses and providing for the aging population. Perhaps a product that slows aging will be seen as preventative care — over time, it may prove cheaper and could save government money down the road.

“These therapies will pay for themselves so quickly,” de Grey says.

Further Questions

An extra 100 years to live that you didn’t expect is a daunting idea. But because many of these solutions will piggyback over time, it’s not likely to be a sudden burden. As any technology comes to market, we as a culture must learn to use it both safely and with respect for others.

But still, asking the ethical questions is an important step. With an extra set of productive years, should people have second careers (or second marriages)? If you’ll be in this world for longer, does it reduce the drive to have children? Will a larger population mean more competition for resources?

A popular Steve Jobs quote communicates life’s brevity as a benefit to the human race:

“Death is very likely the single best invention of life. It’s life’s change agent.”

But even with increased lifespan, death is never too far away. When asked about the difference between solving death and solving aging, de Grey was quick to point out the obvious: “I’m not working on a solution to stop people from getting hit by cars.”

Thesis: Food composition is not as important as physical structure in determining satiety, and therefore overweight and obesity

vanishing caloric density: energy dense foods that meltdown rapidly in the mouth, often lack satiety (Dr. Drewnowski)

the problem with sugared soft drinks: energy consumed as fluid calories are not counted by the body as contributing to satiety, in the same way that energy consumed in solids.

Putting these two data points together, It would therefore seem that non-solid foods don’t satiate.

It makes sense that industry includes these forms of food in our diet, as the less satiety we experience, the more food we eat.

This also explains why fruit juice, but not solid fruit, leads to weight gain. It’s nothing to do with fibre slowing the absorption of calories in the gut, it’s to do with the satiating effects of calories derived from solids vs liquids.

This thesis makes sense in evolutionary terms, as the only pre-agricultural sources of liquid calories would have been honey – water being the mainstay.

NYT: The Challenge of Diabetes for Doctor and Patient

..or why managing diabetes doesn’t fit with how doctors have been taught, and therefore generally like, to treat patients >>> we need a radically new approach not involving doctors, busy doing other things – see Iora Health post re. health coaches.

The good news: lifestyle change for the obese or those with prediabetes may have lower progression to diabetes
http://archinte.jamanetwork.com/article.aspx?articleid=1485081

The average news: childhood obesity is plateauing [PN: ??from a scandalously high base]
http://www.nytimes.com/2012/12/11/health/childhood-obesity-drops-in-new-york-and-philadelphia.html?_r=0

The bad news: Intensive lifestyle change for diabetics did not reduce the risk of stroke or heart attack, even though these patients were able to lose weight, improve their overall quality of life, take fewer medications and even decrease costs.

Lifestyle changes — diet and exercise — require huge and ongoing investment efforts for patients; we’d like to think it pays off for the big-ticket clinical outcomes. Hopefully future studies will show benefits.

 

OCTOBER 17, 2013, 3:43 PM

The Challenge of Diabetes for Doctor and Patient

By DANIELLE OFRI, M.D.

My patient was miserable — parched with thirst, exhausted and jumping up to go to the bathroom every few minutes. His vision was blurry and he’d been losing weight the last few weeks, despite eating voraciously. I’d only just met him, but I was able to diagnose diabetes in about a minute. What was unusual was that this was a scheduled office visit; usually, patients with such overwhelming symptoms are the provenance of emergency departments and urgent care centers.

A quick shot of insulin and five glasses of water and my patient felt like a new man, with no need to go to the E.R. But now, of course, the hard work would begin. A new diagnosis of diabetes is an enormous undertaking — lots to explain, major life changes to contemplate, myths to dispel, consultations with a nutritionist and a diabetes nurse.

Two days later I had another new patient for a scheduled visit — thirsty, tired, losing weight, eating and drinking like mad, eyes so blurred he could hardly see. We’d barely gotten past the introductions before I’d made another new diagnosis of diabetes. Another shot of insulin, another five glasses of water, and then the plunge into the thicket of diabetes education.

Most of my regular office visits with diabetic patients — even newly diagnosed patients — don’t involve such dramatic presentations. More often the disease is found when we screen patients who have risk factors like obesity or a family history of the disease, or who have commonly co-occurring illnesses like hypertension, heart disease or elevated cholesterol.

These two patients highlighted the outsized role that diabetes plays in the primary care setting. The tidal wave of diabetes over the last two decades has made it one of the most common diseases that internists and family doctors treat. Right now feels like a good-news-bad-news time on the diabetes front, which in a general medical clinic can sometimes feel like the only front there is.

The good news is that childhood obesity rates have begun to inch downward in some cities, including among poor children, the first positive sign in the obesity epidemic in years. Obese children are potential future diabetic patients, so even incremental progress is a public health victory to celebrate.

Also good news is a study in which adults with obesity and pre-diabetes were able to lose weight with sensible lifestyle changes and coaching. This took place in a primary care setting, not a research setting, so this also suggests that we might be able to bend the curve of new diagnoses of diabetes.

But there’s also bad news. Intensive lifestyle changes for patients with diabetes, disappointingly, did not reduce the risk of stroke or heart attack, even though these patients were able to lose weight, improve their overall quality of life, take fewer medications and even decrease costs. Lifestyle changes — diet and exercise — require huge and ongoing investment efforts for patients; we’d like to think it pays off for the big-ticket clinical outcomes. Hopefully future studies will show benefits.

Even with all the research and new treatments available, combating diabetes can feel like a Sisyphean task. The bizarre contradiction of junk food being cheaper than healthy food, combined with a bombardment of advertising — especially toward children — make it a challenge even for motivated people to eat healthfully. Sugary drinks in monster-size containers abound. And our fixation with screens large and small keeps us increasingly sedentary.

But even with all the uphill challenges, there are successes, even if not perfect ones. Both of my patients who came to my office with florid diabetes that week have improved. Perhaps it was the concreteness of their symptoms that motivated them, but they have both made steady progress getting their diabetes under control.

Over the past few months they’ve been eating more moderately, and exercising more regularly. We’ve been calibrating their medications so that their blood sugars have left the stratospheric levels and are now only moderately elevated. Medication side effects, cost of glucose meter supplies, real-life logistics, and concomitant issues of blood pressure and cholesterol control have made it a challenge to get to normal. We’d still be dinged as “failures” in the quality-measures department for not achieving the recommended clinical goals, but both patients feel vastly better and are much healthier now.

So there’s bad news and good news. But the real news for these two patients – and for many, many more like them — is that diabetes is a marathon, not a sprint. Although there have been a flurry of life changes right now, diabetes is something they will live with for the rest of their lives. They will always have to be cognizant of what they eat. They will have to keep track of medications, glucose levels, carbohydrate intake, doctors’ appointments, exercise, and weight.  They will have to be on the lookout for the many complications that diabetes can bring. This of course is not news to anyone who has diabetes or treats diabetes, but for these two patients this was news.

Now, we gear up for the long haul, the messy, complicated, occasionally gratifying business of living with a lifelong chronic illness.

Dr. Danielle Ofri’s newest book is “What Doctors Feel: How Emotions Affect the Practice of Medicine.” She is an associate professor of medicine at NYU School of Medicine and editor in chief of the Bellevue Literary Review.

http://well.blogs.nytimes.com/2013/10/17/the-challenge-of-diabetes-for-doctor-and-patient

The gist of my concerns…

Post-change makers festival closing event, here’s a first go at capturing my main beefs with the health system – a little rough around the edges but captures the gist:

 

  Appearance Reality Vision
Mission Brittle health system Bankrupt sickness market Sustainable learning wellness market
Universality Universal healthcare Safety net + PHI Universal
Payment Fee for care Fee for activity Fee for outcomes
Leadership Run by experts Run by amateurs Run by the finest minds
Levers Doctors in hospitals prescribing pharmaceuticals and performing procedures Unmanaged social determinants with doctors spruiking pills and procedures Actively managed social determinants featuring broccoli magnates

That said, and given the issues and concerns we discussed, I suspect some (if not all) of what needs to happen, has to happen alongside or entirely outside the existing system. Hmm.

I just returned from the closing event for this: http://changemakersfestival.org/

I didn’t have a chance to properly speak with Jenny about our discussion, but got the impression that there simply wasn’t the kind of support for think tanks here that existed overseas.

That said, I did have a reasonable chat with Nicholas Gruen – an very interesting economist and thinker – and suspect there may be an alternate angle to pursue… will keep you posted.

The behaviour change arms race…

Behavior change is difficult, but to date it has dominated by industries, such as the processed food industry, who have mastered the art of mass market behaviour change through a withering combination of product research, development and engineering, marketing, advertising and promotion, all founded on an unstoppable and lucrative business model. At this moment in history, industry is the unopposed, global behaviour change super power. Serious capital investment with serious returns but with the unfortunate side-effect of producing a global epidemic of non-communicable disease.

The institutions charged with protecting the public’s health have been caught flat footed. Rather than trying to neutralise industry’s behaviour change efforts, medically-dominated health systems have instead chosen to layer their own lucrative pharmaceutical and surgical business model on top.

Doctors quite legitimately pay lip service to the “diet and exercise” mantra because they know it doesn’t work. And why doesn’t it work? Because anyone can say eat healthier food and exercise, thus making it difficult to justify their years of training and high fees. It’s much better for doctors to note “diet and exercise”, but then pump the drug and surgery options.

So what needs to happen?

A countervailing super power must be established. Not one founded around a powerful business model, but rather a movement of interested citizens, concerned by the grotesque monentization of the population’s health. In effect, a competing super power in the behaviour change arms race.

Key characteristics:

  • protect the children
  • use evidence, but don’t wait for conclusive results
  • empower with data
  • apply political dark arts

Funding sources:

  • social impact bonds
  • crowd sourcing
  • private health insurers
  • government (not a good time for this)

Inspirations

  • Purpose.com
  • GetUp.org.au

 

Institute for Health Metrics and Evaluation

 

This extraordinary resource by the Institute for Health Metrics and Evaluation was handsomely funded by the Gates Foundation and features interactive data visualisations across a range of country-based and global data sets. The data has been carefully curated and is very handy for looking at risk factors and causes.

IHME

http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-arrow-diagram

Jeremy Heimans :: movement entrepreneur

From: Aim higher than president

Movement entrepreneurs are digitally savvy outsiders who create new sources of power by aggregating and mobilizing the voices of many.

Tips:

  • Use institutional power but don’t become institutionalised – small groups of passionate people are lean and nimble and have autonomy are more powerful than those in power.
  • Build a movement, not a cult of personality – less susceptible to cock ups.
  • A movement is not an internet meme – build for the long term.

Resilience In Complex Adaptive Systems

Terrific O’Reilly Velocity 20 minute presentation by a Swedish Anaethestist on complex adaptive systems and a framework for thinking about them.

Resilience In Complex Adaptive Systems: Operating at the Edge of Failure
Richard Cook
Royal Institute of Technology, Stockholm

Capture

http://youtu.be/PGLYEDpNu60

Resilience In Complex Adaptive Systems: Operating At The Edge Of Failure

Systems seem to run at the very edge of failure much of the time. The combination of high workload, limited resources, pressure for additional features and capability, and inherent software, hardware, and network fragility is a noxious kettle of stuff always about to boil over in the form of outages, degraded response, or functional breakdowns. For insiders the surprising thing about our systems is not that they fail so often but that they fail so rarely! This good performance in the face of adverse conditions is called resilience. An important conclusion from resilience studies is that it depends critically on human operators and their ability to anticipate and monitor the system, react to threats, and sacrifice some goals to protect others. This talk will introduce resilience and a model of system dynamics useful in analyzing failed and successful event management and offer an explanation for why our systems run at the edge of failure.

Lunch date with Dickon

From: Paul Nicolarakis [mailto:paul.nicolarakis@outlook.com]
Sent: Thursday, 24 October 2013 8:09 PM
To: ‘Dickon Smart-Gill’
Subject: RE: Singpaore

Beautifully captured Dickon, and thank you for the eBook (it won’t go anywhere).

References for some of my contributions:

–          Online CBT pioneer: Prof. Helen Christensen/Black Dog Institute > blackdoginstitute.org.au // moodgym etc.

–          Research on protein and satiety in locusts, mice and men > Stephen Simpson

–          The Vitality Group (Sth Africa) – 15 min intro video on front page helpful, similarly 1hr webinar http://www.thevitalitygroup.com/

–          A short White Paper on Health Insurance billing analytics

 

Things we didn’t even get to, but expect to at some stage:

–          Antifragile by Nassim Nicholas Taleb (author of Black Swan) >> totally rocked my world, suspect you might enjoy

–          Very strong case for plant based diet by Michael Greger MD

–          4 Hour Body by Timothy Ferris >> where I started my body hacking journey (slow carbs, protein, cruciferous, blow out, but also stuff on sex etc.)

–          Proteus Digital Health – end to end health monitoring, including blood composition via skin patches (warning: interesting but potential ufero)

–          Scanadu – personal medical tricorder

–          Ginger.io – behavioural health analytics platform

–          Omada Health – evidence-driven, online preventive health programs

–          Eatery by Massive Health – recently acquired by Jawbone, but previously doing some interesting things with diet, analytics and amazon’s mechanical turk  (warning: interesting but potential ufero)

–          Kaggle – data modelling competition platform (I’m mates with its founding chairman)

 

Rough vision for what I want to get going over the next 5 years (from diary post):

Over the next five years, I want to develop a health-generating, outcome-remunerated, scalable, for-profit enterprise dedicated to the effective (i.e. live outcome data and analytics, a la rapid learning health system), efficient (i.e. probably not involving doctors) optimization of population health through the application of mobile-mediated behavioural economics, epigenetics, ubiquitous sensors, real time, predictive analytics and the social determinants of health.

 

 

From: Dickon Smart-Gill [mailto:dickon@outlook.com]
Sent: Thursday, 24 October 2013 7:11 PM
To: ‘Paul Nicolarakis’
Subject: RE: Singpaore

 

Notes from our lunch

 

CBT apps are as effective as face to face with professionals. Mood Gym

 

Body by science – Doug McGuff – high intensity, simple exercises.

 

Eatstop eat attached.  A quick and easy read. I bought it, so please don’t forward it on to others just in case my name is encoded into the pdf somehow.

 

Leangains.com – 16-8 protocol. Obviously this guy is genetically gifted, but the fasting technique works for me too.  The key is ‘never any guilt’ if you mess up one day, simply forget it and try the next day.

 

80/20 rule for weight loss 80% being diet, the 20% being exercise.

 

Vitality – south Africa – interesting model to approach insurance companies.

 

Your potential opportunity with the data analysis for medical insurance claims/fraud. Possibility for the same sales approach that they used in the stock trading world.

 

Cauli dabbed with macadamia oil in an 210 degrees fan oven. Crunchy yet still moistish in the centre. Excellent snack food. I suggested adding turmeric (curcumin) for it’s anti inflammatory characteristics. Though not to modify the taste as that is already in order.

 

Standing desks (we both use them and see the benefits).

 

Feel free to add what I missed.

 

Dickon

 

 

 

 

 

From: Paul Nicolarakis [mailto:paul.nicolarakis@outlook.com]
Sent: Wednesday, 23 October, 2013 7:18 PM
To: ‘Dickon Smart-Gill’
Subject: RE: Singpaore

 

Great. How about 1230 for something meaty at:

 

Royal Mail

2 Finlayson Green

Ascott Raffles Place

 

http://www.ladyironchef.com/2012/12/the-royal-mail-prime-ribs-singapore/

 

 

 

 

From: Dickon Smart-Gill [mailto:dickon@outlook.com]
Sent: Wednesday, 23 October 2013 7:02 PM
To: Paul Nicolarakis
Subject: Re: Singpaore

 

Looking good for lunch. Name the time and place. I’m easy.

Sent from my iPhone
On 23 Oct, 2013, at 15:21, “Paul Nicolarakis” <paul.nicolarakis@outlook.com> wrote:

How are you looking for tomorrow? Any chance of lunch or afternoon instead of evening?

 

 

 

From: Paul Nicolarakis [mailto:paul.nicolarakis@outlook.com]
Sent: Friday, 18 October 2013 10:56 AM
To: ‘Dickon Smart-Gill’
Subject: RE: Singpaore

 

done

 

From: Dickon Smart-Gill [mailto:dickon@outlook.com]
Sent: Thursday, 17 October 2013 12:59 PM
To: Paul Nicolarakis
Subject: Re: Singpaore

 

Pencil in the evening of the 24 th.

Sent from my iPhone
On 17 Oct, 2013, at 8:15, “Paul Nicolarakis” <paul.nicolarakis@outlook.com> wrote:

I’m currently leaving on the 25th Dickon, but may stay longer… shall we try for something on the 24th?

 

Cheers, Paul

 

 

 

From: Dickon Smart-Gill [mailto:dickon@outlook.com]
Sent: Thursday, 17 October 2013 12:01 PM
To: ‘Paul Nicolarakis’
Subject: RE: Singpaore

 

Hi Paul,

 

I’m in Bangkok now.

 

However, on the 24th, 25th 26th, I’m in Singapore.

 

Does that overlap with your travel?

 

Dickon

 

From: Paul Nicolarakis [mailto:paul.nicolarakis@outlook.com]
Sent: Thursday, 17 October, 2013 5:31 AM
To: ‘Dickon Smart-Gill’
Subject: Singpaore

 

Checking in again… will be in Singapore next week, let me know if you’re around for a bevvy. Cheers, Paul

 

 

 

From: Dickon Smart-Gill [mailto:dickon@outlook.com]
Sent: Saturday, 14 September 2013 12:47 PM
To: ‘Paul Nicolarakis’
Subject: RE: g’day

 

I’m in Bangkok right now and will still be in Bangkok on Wednesday.

 

Thanks for the invite, if I were in singapore I would definitely have met up with you.

 

Dickon

 

From: Paul Nicolarakis [mailto:blackfriar@gmail.com]
Sent: Saturday, 14 September, 2013 5:05 AM
To: Dickon Smart-Gill
Subject: g’day

 

Hey Dickon,
Am in town through to Wednesday – would be good to catch up if you’re around?
Cheers, Paul