Chapter 194
The Path Forward — 6
Until now, our medical approach has been reactive, with secondary prevention at best. A patient has a heart attack; we put them on statins and aspirin to prevent another event. For a diabetic, we treat blood sugar and lower the hemoglobin A1c. While there has been steady improvement in cancer treatments and less reliance on classic chemotherapy, most patients are not getting diagnosed early and the prognosis has extended survival a matter of months for many of the most successful new treatments. We’re in a reactive rut. But now we have the chance to fulfill the ultimate medical dream of primary prevention. It’s within our reach.
Figure 13.4. Legend on the following page.
Figure 13.4. My results from the Infinity Bio assays. Prior page is my antibody response to the chickenpox proteome, revealing the specific regions strongly recognized by my immune system. This page shows my response to SARS-CoV-2, which is focused on the spike protein, the component included in the vaccines. My antibodies do not recognize other regions of the virus. The table (page 327) shows my aggregated virus reactivity scores compared with control for selected viruses of the 529 species covered in the test (~2.4 million viral proteins represented by overlapping peptides). I have no antibodies to cytomegalovirus. Table above shows some of the human proteins that my autoantibodies recognize (from 27,703 genes covered in the test).
Take Mr. R. P.’s case. He could have had a multilayered assessment at an early age for risk of cardiovascular disease (as depicted in fig. 5.8) and received aggressive primary preventive strategies, including statins and lifestyle+ factors, along with active surveillance, so that he would have never required coronary artery bypass surgery or stenting, nor would he have suffered a heart attack. We now have the blueprint, the five dimensions, and extraordinary potential to suppress all the major age-related diseases.
Before my optimism gets too far out front, let me reiterate the two factors that remain the most formidable obstacles. One is our profound health inequity. This has positioned people who are underrepresented or with low socioeconomic status at the highest risk, not only for their lifestyle+ factors such as poor nutrition or air pollution but also for their access to all the innovations discussed in this book. If expanding health span turns out to be only for the rich and privileged, then it can be considered an abject failure. Just as we are now in a unique position for digital biology to deliver exponentially better public health results, we must address equitable access to health span expanders. The prime example today is the GLP-1 family of drugs, which are not affordable for the vast majority of people who need and would benefit from them the most. Public-private partnerships to find a solution that provides these drugs for no or nominal charge could be a template for many of the other digital biology innovations that become available in the future. Our lack of a universal health system in the United States, the singular outlier of rich countries in the world, puts us at an unnecessary disadvantage for promoting health span expansion at the population level. Health care should be considered a civil right. Our inability to address this albatross of unfairness holds us back.