Biohack the Future: Healthcare in the 21st Century

Winter is Coming

Primum non nocere - Latin for "First, do no harm

The phrase "elephant in the room" does not do the coming healthcare storm justice, with most of the developed world facing an unsustainable crisis over the next 30 years.

It's particularly bad in the US, where the combination of rising costs & underfunded pensions threaten to bankrupt the nation:

And it's nothing but grey skies ahead...

The Silver Tsunami

For every single kidney dialysis patient they have, they need 3800 healthy lives to cover it. - Jim Chanos, quoting Blue Cross of California

Covid has laid bare the fragility of health systems globally, particularly as it relates to senior citizens.

Incompetent bureaucrats effectively staged a genocide against old people, with more than 40% of covid related deaths in the U.S. happening in long term care facilities, and you can go ahead and double that number(!) for Canada (note: those articles are somewhat dated).

And guess what? 

The problem is only going to get worse, as seniors are both the largest AND fastest growing demographic globally

That's not how pyramids work….

Left unchecked, the health demands of the geriatric cohort will subsume the entire economy, bankrupting your children's children.

Stan Druckenmiller even did a TED Talk, urging seniors to Please Dear God Think of The Children!:

And when hedge fund managers start protesting, you KNOW the problem is real.

An Ounce of Prevention

Necessity is the mother of invention - English Proverb

Preventative medicine is the obvious solution, and aligning incentives is the principal economic & political challenge of the next two decades…

But I don't see how it gets done through existing channels.

Everywhere you look, the healthcare cartel is enormously powerful: in the US, big pharma, health insurance, hospitals and health professionals collectively represent $630mm in annual lobbying dollars.

(For context, the securities and investment lobby looks positively beggardly by comparison, donating a paltry 97mm)

The medical community effectively draws its own law and - doctor or no doctor - when people can legislate themselves money, they will.

Change is going to take an outsider.

Be Nice to Nerds

This is the computer Bill Gates and Paul Allen used to launch Microsoft, way back in 1974. At the time, it was still sold as a kit for hobbyists

If you want to get an idea of where the world is headed, look to the rebel rockstars of intellect, those high-iq, high-intensity misfits and drop-outs.

And right now, those very special souls are focused on biohacking.

The ODIN DIY Genetic Engineering Home Lab Kit

The genetic manipulation community today is not that far ahead of where Gates & Allen were in '74 - it's still dominated by freaks, weirdos, and mad scientists.

Like this guy:

Do-it-yourself surgery, WCGW?

Josiah Zayner, the CEO of ODIN and the first person to perform a self-fecal transplant, in the hotel room(?!) pictured above.

(NSFL warning: this is even worse than it sounds

The purpose? To reengineer his microbiome and permanently cure his irritable bowel syndrome. 

And apparently, it worked!

Who needs a lifetime of dirty-bomb-style pharmaceuticals when you can take a laser-guided approach, identify what has been bothering you, and fix it once and for all?

Less-insane-but-no-less-curious folks have used more moderate methods, applying creativity via off-the-shelf medical devices, like non-diabetics using glucose monitors - such as the Abbott Freestyle Libre pictured below - to learn how their body reacts to different food types, and coming away with very interesting personal learnings (i.e. salad causes a greater insulin spike than vanilla ice cream in some people).

Imagination is more important than knowledge, for knowledge is limited, whereas imagination embraces the entire world, stimulating progress, giving birth to evolution - Albert Einstein

All the best people I know have been shifting over to med/biotech (shout out to my good friends and amazing founding team at SeamlessMD, and WSO's very own @Techbanking!)  and the coronavirus pandemic has only accelerated that trend.

Follow The Leader

Every Song on Korn's 'Follow the Leader,' Ranked From Worst to Best - The Pit

One conversation centered on the ever accelerating progress of technology and changes in the mode of human life, which gives the appearance of approaching some essential singularity in the history of the race beyond which human affairs, as we know them, could not continue - Stanislaw Ulam, on speaking with uber genius John Von Neumann

And where the talent goes, the money flows! 

The smartest VC's have all been moving away from pure software plays, including big names like:

And if you think VC's are dumb herd animals, check out the last standing OG tech titans of yesteryear, Bill Gates & Larry Ellison.

Both have been devoting an increasing amount of their time to bio initiatives, with Gates leaving MSFT's board to focus on global health and Ellison transforming the island of Lanai into his very own personal wellness laboratory (side note: has anyone here been to his recently renovated Lanai hotel? It looks absolutely wondrous). 

And this is just the beginning!

Life Springs Eternal

Home | fountainofyouthmythBut there is nothing in biology yet found that indicates the inevitability of death. This suggests to me that it is not at all inevitable and that it is only a matter of time before biologists discover what it is that is causing us the trouble - Richard Feynman (Awesome video on immortality btw, VPRO makes amazing stuff)

Down the Street 

and over the Wall,

an Oasis lies 

ours to call (see what I did there?) 

Great engineers look for grand problems, and there is nothing grander than "solving" death.

I'm not a life sciences guy, but people in the know tell me that ageing for a human is no different than ageing for a car - you can refresh, repair, and replace old/defective parts…

Or better yet, UPGRADE!

The young man in the picture above lost his hand in a workplace accident, and feared he would never play drums again..

That is until he connected with musician and inventor Gil Weinberg at Georgia Tech, who worked with him to develop a new bionic hand, capable of using two drumsticks at once - each with alternating frequencies - and enabling the creation of music no unenhanced human can produce.

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I think the biggest innovations of the twenty-first century will be the intersection of biology and technology. A new era is beginning - Steve Jobs

As Moore's law continues unabated, once-impossible problems become trivial.

Humanity has begun transcending its biological roots, merging with its technology, and taking a direct role in designing its evolution.

Imagine a world where people age in reverse - growing stronger & healthier as time marches on - and human life expectancy is measured in thousands or millions of years.

What choices would you make when the consequences will be with you for millenia?

What kind of life would you lead when you could be reasonably confident that tomorrow will always be better than today?

The Final Word

When there is this much money and power up for grabs, you know "they" won't leave it up to hackers and home brew hobbyists.

The coming revolution has already captured government attention, and for good reason: smallpox is estimated to have killed 500 million people before it was eradicated, and in 2017, a biotech firm you've never heard of synthesized a horsepox virus for $100,000.

Moore's Law of Mad Science: Every eighteen months, the minimum IQ necessary to destroy the world drops by 1 point - Eliezer Yudkowsky

All signs point to a huge push for socialized medicine in the United States, with a massive increase in medical tourism for the rich.

(Spoiler Alert: my country has socialized medicine, and it's better in some ways i.e. my father had a heart attack, and the total bill for triple bypass surgery and a month long stay in the hospital was $70 - and worse in others i.e. it can be a many months wait to see a specialist for non-urgent care, and our tech is last gen at best)

Do we have any IP attorney's with a background in computational biology on the forum? 

I would love to get your take on how the business of healthcare unfolds over the next 20-30 years.

What an exciting time to be alive!

Best,

CC

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Comments (52)

Apr 9, 2021 - 6:07am

The Youtube Videos aren't displaying properly so here are the links:

watch?v=GgTwa3CPrIE
watch?v=KscnT6FxMIQ
watch?v=GgTwa3CPrIE

Apr 12, 2021 - 10:31am

Are those links? They aren't playing for me... if I copy/past from the equal sign "KscnT6FxMIQ" and search, the top hit in Google is "Becoming immortal | VPRO documentary" which I assume is what was supposed to be linked. Also, the first and third links you posted appear to be the same, "Beyond bionics: how the future of prosthetics is redefining humanity"

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Apr 9, 2021 - 8:31am

appreciate the tag, I always love your long form posts, I just am uneducated on healthcare from an industry perspective, and part of this is my own stubbornness. I have a hard time thinking innovation is gonna save the world when over 70% of the US is overweight or obese. sure, I believe that innovation will continue and will produce some really cool stuff, I'm optimistic on the mental health front in particular, but I see more hypocrisy than upside in making a type 2 diabetes therapy that costs millions or billions to make when the best type 2 cure ever is already there - put down the fork and go for a brisk walk.

/rant

Apr 9, 2021 - 8:46am

So Bill Gates believes that in the not too distant future, we'll solve the obesity epidemic by reprogramming the microbiome, which apparently controls appetite.

Ray Kurzweil thinks pharmaceuticals are the answer; they will allow us to turn off the fat storage mechanism in the human body.

Apr 9, 2021 - 11:28am

maybe I'm too skeptical and jaded, I fail to see how technology can fix lack of discipline and ownership of one's health. if you take an obese person who's lazy and something controls their appetite but they're still drinking HFCS stuffed sodas and processed sugary garbage, sure they may lose a couple of pounds, but if they're still insulin resistant they're fucked. and even if this pill makes them insulin sensitive, how long will it last? what about other side effects that we don't have a clue about? 

I don't doubt the microbiome plays a part, but I worry about unknowable side effects. there are potentially huge downsides with tinkering on the human body at a population level, there's very little downside to eating the right stuff and breaking a sweat regularly. but then again, that's not profitable so no one is throwing money at the most reliable way to improve one's health - with lifestyle choices.

  • VP in IB - Ind
Apr 9, 2021 - 2:13pm

Metformin already exists and they still progress to type 2 diabetes. You can't fix lack of discipline and fucked dopamine systems. Think of all of the people who get gastric sleeves and then eat themselves to death. Even most of the non-obese people I know are thin because of adderall or coke all weekend long, not because they actually work on their health
 

And things are only going to get worse since people are addicted to the internet and instant gratification like 1-click shipping, etc. 

  • VP in IB - Ind
Apr 9, 2021 - 11:07am

Yup. Americans are obese and immobile, in addition to being self indulgent as all fuck - alcohol, smoking, drugs, looking for band aids or lazy ways out instead of addressing the root problem.

Eg, I do low carb IF but wtf some of these people are inhaling deep fried cream cheese drizzled in ranch and 1 lb of bacon in one sitting because they can still technically lose weight while not having to work out. Seriously wtf is wrong with people and I feel that this kind of shit is strictly a US/UK mentality

The US healthcare system is broken, yes, but look at the people that it serves. It is rarely fit and mindful people who are complaining about healthcare costs, I'll tell you that

Apr 13, 2021 - 2:42pm

Agree. 

But... we're supposed to exercise and eat properly, but many don't, to their own detriment. Pound cure, ounce prevention, etc. So, you could follow that line of thinking into future / biohacking world where we basically just upgrade and/or swap out shitty parts of our physiology as issues arise. No reason to stop being a smoker if you can just get new lungs. New ears if you get tinnitus. New _____ once you've abused and exceeded the biological limit of some artery/limb/synapse.

Apr 15, 2021 - 8:27am

thebrofessor

appreciate the tag, I always love your long form posts, I just am uneducated on healthcare from an industry perspective, and part of this is my own stubbornness. I have a hard time thinking innovation is gonna save the world when over 70% of the US is overweight or obese. sure, I believe that innovation will continue and will produce some really cool stuff, I'm optimistic on the mental health front in particular, but I see more hypocrisy than upside in making a type 2 diabetes therapy that costs millions or billions to make when the best type 2 cure ever is already there - put down the fork and go for a brisk walk.

/rant

Ok so let me ask you this.

I was at one time a competitive athlete, and extraordinarily disciplined - 2 or some times 3 a day workouts, weighing my food, regular blood testing, etc.

But no matter how hard I worked, there were guys I competed against that would absolutely destroy me, despite terrible diets, undisciplined training regimens, party lifestyles, etc.

From an athletic perspective, they were simply superior to me genetically - higher natural testosterone levels, more fast twitch muscle fibers, whatever - and no amount of hard work would ever compensate for that.

Would you agree that for many people (not all) weight control might be more complicated than "putting down the fork and going for a brisk walk?" What's wrong with a chemical/biological intervention if it saves lives? Weight gain is the most common side effect of prescription medication, and given that 66% of all adults in the US use prescription meds, would you agree that for some of them (again, not all) body fat percentage is beyond their control?

Apr 19, 2021 - 10:43am

like all things, there are exceptions, and I'd bet you are a rare exception. what I'm saying is a platitude that is arguably true for most, not for all. I'm 100% for medical interventions, I just think they should be a last resort after you've tried lifestyle interventions. people go for a pill before they go for the gym. you did not do this, are still experiencing issues, and likely your biology needs something medical to tip the scales (literally and figuratively).

so yes, I would agree, for many people it's complicated, but for most people I'd argue it's simple.

Apr 9, 2021 - 10:07am

Well done as always, love these posts. WSO needs more of this type of content vs the millionth post from a freshman asking if they can make 8 figures at a hedge fund.

I'm not too educated on the health care space overall, but I do think that the aging populations of developed nations and improving quality of care in emerging markets through investment as those populations grow are major secular themes for the foreseeable future. As a result, half of my PA is health care tech that I can understand (won't invest in pharma or bio given my lack of knowledge).

Health care has always struck me as having and odd relationship with capitalist economics and incentives. The most profitable solutions are to keep your customers alive, but just barely. The PV of cash flows is truncated when you actually provide a cure. At the same time though, nothing provides stronger incentives to develop new technology, drugs, and innovations like capitalist payoffs. So there needs to be a balance, and a better balance than what we have currently achieved in the U.S. with egregious pricing. I've also always thought that patent lives were too long, likely a result of the massive lobbying effort that you cited, and part of the reason why health care costs are what they are. If patent lives were shorter it would drive more competition and force companies to be more innovative while lowering barriers to entry. I'm not saying eliminate patents, but the current patent lives essentially legalize product and/or category monopolies. As a result, you get abusive pricing with competition eliminated for as long as 20 years. I get it, sometimes the research effort to develop a drug in the first place can take a decade. I don't know what the right number is or if there is a better alternative, this is outside of my core competencies, so maybe someone with more direct health care exposure/experience can comment on whether patent lives contribute to our issues. Just thinking out loud.

Apr 9, 2021 - 10:44am

Or how to get into a tiger cub / activism fund

Instagram: @dickthesellsider | Clubhouse: @dicktoad | Substack: dicktoad.substack.com

Apr 9, 2021 - 3:10pm

Wow, was not expecting a read like this on WSO today. Great post, thanks for the time and effort. I'd comment about it but I actually need to think on this stuff for a bit rather than just run my mouth :)

Dayman?
  • 1
Apr 9, 2021 - 6:42pm

Surprised you didn't touch on gene editing at all. Not just somatic gene editing to cure things like Sickle Cell but germline editing to eventually completely eradicate genetic diseases or even alter predispositions towards disease (e.g., reduce risk of hypertension).

Just read the new Walter Isaacson book on Jennifer Doudna and genomics (and there's a whole host of interesting ethical considerations here too), but seems like this could be a new era of health solutions.

Apr 10, 2021 - 7:09am

I don't have the requisite scientific background to speak intelligently about gene editing, and it would have been a LOT of work to get up to speed.

Apr 10, 2021 - 11:08am

In the short and medium terms, gene editing will probably be amazingly helpful to a small number of people who have diseases caused by single loci in their genomes. Polygenic conditions are more common but will be much more difficult to treat with gene editing- for now, anyway.

A likely alternative is GWAS + genome sequencing + IVF. First, genome studies find statistical correlations between gene variants and physical traits. This allows for the calculation of "polygenic risk scores" for individuals based on their particular genomes. Next, people do IVF and create a few embryos. Then they sequence each of the embryo genomes, find the "best" one, and implant it. Then the mother carries the pregnancy to term.

Right now, the number of embryos that can be produced by IVF is constrained by the number of eggs the woman can produce. But this really gets crazy when you add eggs produced by pluripotent stem cells. Then you could do huge numbers of embryos and pick the extreme outliers. This would fundamentally transform humanity.

We're not that far away from this world. Much of the technology exists now, although some of it has only been used on animals. It just needs to be refined and the cost needs to be reduced.

  • Analyst 3+ in Risk Mnmgt
Apr 10, 2021 - 1:34am

What good is technology in a system in like the US where most people won't be able to afford it and insurance won't cover the technologicaly advanced treatments that are coming? Greed and bad policy has de-stabalized the medical system and we can't realy on it being improved by technological advances.

Apr 10, 2021 - 10:35am

The best way to improve society's health would be to ban all foods that didn't exist in the year 1900. This would be a far cheaper and more powerful intervention than anything the healthcare industry could produce.

Apr 10, 2021 - 11:38am

I wish. A more realistic possibility is that there will be some kind of pharma semi-solution. There's a class of drugs called GLP-1 receptor agonists that look promising. But Doritos and Big Macs are the real problem.

Apr 11, 2021 - 3:15am

No healthcare expertise here unfortunately but love the long term mentality and well thought out explanations. Very interested in infrastructure/energy myself for many of the same thematic reasons, as I feel like they'll become much more important/valuable in coming decades.

Apr 11, 2021 - 4:24am

I have a bit of a problem with this ideas - it's an old obession with extremely wealthy people to live forever, and freezing a dead body to be potentially revived in the future is not a new idea (once the "science" catches up). There is that very arrogant writer who talks about that in homodeus. I personally think this obsession with living forever in your current body is quite unhealthy - as a Christian you get ready for the after life, live a good life on earth and get ready to leave it.

Replacing parts of the body as they age like an old car, sure. There is clearly some good research going into all of this, with the most useful helping people that have lost limbs be able to function again. At the moment there is a lot of faff, as always, from startups and companies trying to raise money by claiming the impossible. I am just not that excited about it.

Tell you one thing that excites me, and in which I've poured money into: nuclear energy and maybe fake protein, I did that.

Not very insightful what I wrote, but it's Sunday and I have a thumping headache.  

Apr 11, 2021 - 5:25am

I mean, it's not just super wealthy people.

Sean Carroll is on record saying that in the not too distant future, technology will allow humans to live for millions of years.

And yes, Yuval Noah Harari of Homodeus is beyond arrogant.

Apr 12, 2021 - 10:51am

Have we ended evolution now that the majority of people survive and can breed? Is taking the direction of humanity into our hands the right thing, the end of evolution, or is this the end of humanity? 

As a side note and tangentially related, birth rates in developed nations are falling like a rock (as is marriage), what do falling birth rates and evolution have in common: the demise of the human race. Sperm counts and testosterone have been falling every year (1-2%) for the last 100 years... and if we continue on this trajectory, sperm counts will fall to zero in about 50 years (they say at that time men won't have enough testosterone to get an erection): https://www.gq.com/story/sperm-count-zero

  • VP in IB-M&A
Apr 12, 2021 - 12:48pm

Spot on. This is the most likely outcome of the next 100+ years and the possible death knell of the human animal, in my opinion. Humanity has been up its own ass about how smart and important it is for millennia, yet we seem to be actively fucking with evolution and positioning ourselves for catastrophic failure as a species.

Honestly, maybe that is evolution at work. Perhaps the removal of humanity or reduction to prehistoric population levels is all part of evolutionary equilibria on a grander (global) scale. We thrive, proliferate, attempt to concur nature and design our own evolutionary path forward, fail catastrophically, and reboot back near the bottom rung. With techno-futurists going on about living forever and synching the human brain with AI, it's actually kind of hilarious to think that a lack of birthrate (driven by our ambition/stupidity/tinkering with evolution) could kill our species off within a couple generations.

Apr 20, 2021 - 10:49am
Have compassion as well as ambition and you’ll go far in life
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