It’s in Your Genes? — 4

Well before we get cancer vaccines, we will see a shakeup in how we do cancer screening. Today, this is largely based on age as the dominant factor, which means if you are in this age group, get that screening. But only 14 percent of cancers in the United States are detected via mass screening, an expensive and inefficient method, which also induces considerable anxiety due to a preponderance of false positives. We’re also seeing a significant rise in cancer among young people, such as colon cancer in people in their twenties, which is well below the age threshold for screening. With the help of AI analysis of multiple layers of data from a person’s health records, we can identify people at increased risk, irrespective of age. There is no need to screen people who have no—or extremely low—risk of cancer. Accurate prediction of high-risk status for major conditions like cancer and Alzheimer’s that we can act on means we can live longer, healthy lives. Just integrating the information from our genes with our gut microbiome has substantially increased our medical forecasting capability across common chronic diseases.

We’re already seeing preclinical evidence of vaccines putting the immune system in a kind of low gear that will likely be very useful for preventing or controlling autoimmune diseases. This approach applies to a wide range across type 1 diabetes, multiple sclerosis, and inflammatory bowel disease. Creating drugs and finding vaccines for prevention of Alzheimer’s disease and other neurodegenerative conditions have been the most vexing challenges, supplying a graveyard of hundreds of failed attempts. Even the ones that have recently garnered FDA approval have modest efficacy, at best. The relentless pursuit of this vital objective, especially with accelerated AI drug discovery, will someday lead to powerful interventions to block neuroinflammation and destruction of brain tissue. CRISPR genome editing, which has been approved for conditions that were previously untreatable but can now be cured, may help. CRISPR stands for clustered regularly interspaced short palindromic repeats, a certain pattern in our genetic code we hadn’t noticed at all until 1987. The CRISPR pioneer and Nobel Laureate Jennifer Doudna posed this intriguing question: “Could we protect people who have a genetic susceptibility to Alzheimer’s from getting it by using CRISPR to alter the genes that might be causing that predisposition, and doing it early, before somebody is already kind of in the throes of dementia?”

Over the decades, I’ve had the opportunity to do patient-oriented research for advances in biotechnology in large randomized trials, novel monoclonal antibodies, biosensors, genome sequencing, and genome editing of stem cells. While I’ve long been a skeptic that we’d ever see antiaging drugs, as opposed to drugs that treat specific diseases that mostly afflict those in later life, I’ve changed my mind. From the billions of dollars of investment in advancing the science of aging and start-up companies with top-flight scientists, I’ve become convinced that we’re in the early stages of realizing that big audacious goal. It’s an important reason I thought writing this book was warranted. Unfortunately, a lot of the hype right now is misplaced, not aligned with evidence in people, and can put the progress and the field at risk. Well before such systemic interventions against aging itself kick in, we’ll be making major advances chipping away at the prevention of age-related diseases. That’s the realistic and attainable counter to aging that is starting to blossom.