Chapter 8
It’s in Your Genes? — 5
Let me emphasize up front that certain points of progress I mention in the chapters ahead may seem far off, as much as fifteen years away. However, keep in mind that I’m referring to the time when these changes will likely be incorporated into medical practice. That doesn’t mean you wouldn’t have the opportunity to take advantage of some of these now, which I’ll identify, such as upending your cancer screening plan, using AI to help make a diagnosis or as a second opinion, or manipulating your gut microbiome. Furthermore, your knowledge about many of the potential health span expanders now will raise awareness when they can be available to you or your family, even when they are in research protocols, well before their general acceptance.
OBSTACLES
Health inequities across society are a profound problem in the United States, no less globally. If health span expanders are only accessible to the wealthy, then all they will do is make those inequalities worse. The lack of universal health care in the United States, unique among high-income countries, is holding us back. Genome editing for sickle cell anemia or GLP-1 drugs for obesity come at a high cost, making them less available to the people who can benefit the most. Efforts to improve health span for everyone must prioritize reducing and ultimately eradicating these gaps. We’re beginning to see dedicated efforts to deliver these technologies to the underrepresented, such as mental health apps, AI diagnosis of retina disease in diabetics, or accelerated AI adoption for smartphone ultrasound imaging in low- and middle-income countries. Addressing narrow cultural biases that are embedded in AI models requires far more attention.
Ireference results from the UK Biobank study of 502,000 participants many times in this book. With the participants’ genome sequence, electronic health records, medical scans, and extended follow-up now approaching twenty years, the study has yielded seminal new insights for promoting health span. However, it is not a diverse population, with 94 percent of the participants of white ethnicity. We must have such resources that are multiancestry, and the All of Us initiative in the United States, the largest investment for a medical research program in our history, is pulling that together. I’m pleased to be a significant contributor to that effort.