Google Bets on Health
bloomberg.com
bloomberg.com
I fear that healthcare will suffer the same fate. Between insurance companies, doctors, hospitals, patients, governments, and every middleman inbetween, nobody is going to want a system that makes one of them irrelevant.
Fortunately, at the time, this exploitation of patient data wasn't permitted, so those efforts fizzled out.
I've been out of the game for a few years, so I don't know the current legal and regulatory landscape.
You can eliminate middlemen if you can show cost reductions for a player larger than the middleman. The big players are providers, payors and technology (pharma/device) companies. Plenty of middlemen in between those that can be made irrelevant.
You'd be surprised. Weak decision-makers -- and they are legion -- fear what they don't understand. They'll justify paying a more for a known entity than even entertain a small risk of chaos or disruption.
In a rational world, you'd be right. We don't live there, unfortunately.
It wasn't a bad idea, Wash, but eliminating the middleman is never
as simple as it sounds. ... 'Bout 50% of the human race is middlemen,
and they don't take kindly to being eliminated.
Even if Canada, where the state is effectively the sole insurer and determines treatments and pricing for everyone (arguably more centralized than in the UK), the actors in the healthcare system are still wary of connecting to each other.
I learned about this recently from someone I know who is working in "health informatics" at a hospital. Their systems don't share any data with other hospitals, the ministry (the insurer and regulator), etc. There's an initiative to have hospitals in just a single major urban area connected, and despite it being a few years in only a few hospitals are actually participating.
I suspect this is correct, particularly between the insurance companies and the providers. The coding of what exactly was done directly drives the reimbursement that the providers get. Thus, there's a clear incentive to be opaque and show the insurers only what you need to. Sometimes for good reason (insurers denying coverage solely for cost reasons), sometimes not (billing fraud).
Heck, even the stuff you do get is written intentionally in bad handwriting by doctors(which they do so to protect themselves, and probably at a risk of harming patients).
I know that your statement isn't suggesting this strategy. I only mention it to note the logical conclusion of a patient-centric system.
Currently, getting access to your own medical records is like getting your own financial records and credit reports, only worse.
Even though I am my data, it is my identity, my self, none of the aggregators and purveyors, who profit from my data, see it that way, and only comply reluctantly.
Source: I designed, implemented, supported five healthcare information exchanges.
It makes sense to back all plausible ventures in this area of development, and since there are at least seven classes of cell and tissue damage that cause aging, there will be a fair number of such ventures in the years ahead. Next up is probably glucosepane cross-link clearance or mitochondrial DNA repair, or perhaps transthyretin amyloid clearance if it ever gets liberated from the disinterested patronage of GSK.
Since Google has a clear interest in this area, even if they are going about it by supporting exactly the wrong lines of R&D at the moment, I imagine they will be involved in the growth of these companies and technologies as they continue to prove themselves effective in animal studies.
The target market is every human being over the age of 30, with a course of treatment every few years to a decade. The treatment will be some form of mass-produced infusion, such as a gene therapy. Comparable technologies from a production standpoint, such as biologics for autoimmune conditions, run at $1-10K per treatment even in the wildly dysfunction US medical system. You can run the numbers; from an economic perspective longevity assurance treatments that work will make most historical therapies look like small potatoes.
http://mendelspod.com/podcasts/brian-kennedy-and-aubrey-de-g...
See the "response to Calico and HLI" portion.
With reference to Calico, the relevant part is this:
"I would say that definitely their hearts are in the right place, but they are a regular, perfectly normal company. They want to make profits fairly soon. Calico have set themselves up as a completely unusual company with the goal of doing something very long-term, however long it takes, they want to actually fix aging. They said so - Larry Page was perfectly clear about that. The question is how are they going about it, and that's getting really interesting. The first thing that they've done, which I feel is an absolutely spectacularly good move, is to bifurcate their work into a relatively short-term track and a long-term track. The short term track involves drug discovery for age-related diseases, doing deals with big companies like Abbvie, and so on. That's all very wonderful and all very lucrative in the relatively short term, and has more or less nothing to do with the mission for which Calico was set up - but it is a fabulous way to insulate the stuff that they do that is to do with why Calico was set up from shareholder pressure. It gets a little more complicated though. So then on the long term side, the stuff being led by David Botstein and Cynthia Kenyon, the question is how are they going about their mission. Of course an awful lot of this unknown because they are a secretive company, but from the perspective of whom they are hiring, and what kinds of work those people have done in the past, one can certainly say that they are not just focusing on one approach. They are interested in diversity. My only real concern is that they may be emphasizing a curiosity-driven long term exploratory approach to an unnecessary degree. I'm all for finding out more and more about aging, but I'm also all for using what we've already found out to the best of our ability to try stuff and see what we can do. I should emphasize that this is only my impression from a very limited amount of information available, but my impression is that it is perhaps turning into an excessively curiosity-driven, excessively basic science, inadequately translational outfit. And that's kind of what I feared when Botstein came along in the first place, because he's on record as saying he doesn't have a translational bone in his body."
The basic point is that they appear to be aiming at drug development to slow aging, which is very hard and speculative. The basic goal is to create a new global metabolic state that ages more slowly than the natural one. The calorie restricted state is an obvious one to try emulating, but that is also very hard: understanding sufficient to do this requires a complete map of cellular biology. More than a decade of research into sirtuins, and a billion dollars in investment, went nowhere for example. That was classed as a promising direction at the outset, and much hyped. But what if you did create a new metabolic state? The outcome would be a small increase in life span, a small slowing in aging, and a therapy that would be useless for old people because they are already damaged.
Compare that with the SENS repair approaches, such as removal of senescent cells, which is already producing far more robust results in mice, and at a fraction of the cost. Such therapies can be used over and again, and produce new benefits each time to the degree that they clear out damage. They are also useful and beneficial for old people, as they will reduce their damage load.
So in short, we can do the slow, expensive, useless path, or the fast, cheap, effective path. So far the research community has chosen the former. Why they have done this is a long, long cultural discussion on incentives and regulation and the nature of how research into age-related diseases has typically worked over the last century. What will change this is a continuing set of convincing animal data from SENS programs.
When did win/win become a bad thing? Would you rather these rich people were building bigger mansions instead?
If it was otherwise, it wouldn't be at all hard to raise funds for initiatives like the SENS Research Foundation's program aimed at medical control of aging. As it is, the number of the ultra-wealthy who have supported this cause is well below 1%, and those have been fairly cautious investments in the grand scheme of things, e.g. those by Peter Thiel.
What is happening at the moment is an initial tipping point of sorts across the entire population in the realization that, hey, treating aging as a medical condition is plausible. Researchers have been saying this for a decade, with increasing volume following the pro-longevity faction winning the cultural battles within the scientific community, but it takes time to bootstrap a movement and get to the point at which Prudential puts up posters suggesting that people should think about living to 150. We may not even be at the main 10% support tipping point yet in the broader population.
A recent Pew study suggests that the majority of people continue to believe that the current state of things is the best state of things, and they don't want live longer because people don't live longer. People want to be slightly better than their peers. Live to 90, because that's a little more than what other people have on average. Be more healthy as you decay into death, because that's a little more than other people have. Stasis is the default opinion, which has always struck me as crazed given the tangible, obvious pace of progress in technology that we are living through.
http://www.pewforum.org/2013/08/06/living-to-120-and-beyond-...
In the end this is no different than any other field of human endeavor. It takes unreasonable visionaries to force beneficial progress down everyone else's throats, and once done everyone else agrees that it was self-evident and obvious.
I do not agree: the situation is getting worse: all rates of diseases are growing rapidly. The USA spends the most money on health care and dropped to place 43 on the list of countries with best health. The USA dropped below Cuba!
So it is time to step back and evaluate the situation.
Lets look at cancer. Around 2003 there was a study publisged in the Journal of Oncology stating that 97% of the patients who had radiation or chemo died within 5 years. There is no followup study but since there are no new treatments, the number is most likely the same. I like a quote of Einstein: repeating the same experiment and expecting a different outcome is insane. So I am against more investments in cancer research since it proves for over 50 years that it does not work. So what to do?
I suggest to look at the works of the "alternative" doctors who get results. The medicince that they practise is "functional medicine" and has great results, but there is no double-blind research to their methods. It is time that this changes. Do the research for the various anti-cancer treatments and find out what works best.
There are many other diseases where functional medicine has far better results than allopathic medicine but they are ignored most of the time. The recent online summit by Dr Mark Hyman (the fat summit) had 120,000 viewers so things are changing for the better but there is a long road to go.
"The hate of men will pass, and dictators die, and the power they took from the people will return to the people; and so long as men die, liberty will never perish." - Charlie Chapman "The Dictator"
You can think of your death as a hard-and-fast deadline to achieve all your dreams - this is pretty motivating for some people. Steve jobs had this to say in a 2005 commencement speech[1]: "Remembering that I'll be dead soon is the most important tool I've ever encountered to help me make the big choices in life. Because almost everything — all external expectations, all pride, all fear of embarrassment or failure — these things just fall away in the face of death, leaving only what is truly important".
Other people's death's can be a gift as well: tyrants don't get to rule forever, and out-dated ideas die with their generations. Immortality would be a good thing in a "Culture"-like society: i.e. if we manage to solve all the other human problems (like greed and poverty) first
1. http://news.stanford.edu/news/2005/june15/jobs-061505.html
For it to be useful as a hard-and-fast deadline, you have to know in advance exactly when it will come. Otherwise, its just knowledge that there will be a deadline at some point in the future, which is very different than a hard-and-fast deadline.
I think everyone has a rough idea on their personal upper limit of their productive time (for me it's 70). There is no lower limit, just like a project with a deadline might be cancelled at anytime.
I do not think baseline homo sapiens have the hardware required to cope with immortality or extended lives (all those memories, lack of the human condition). How bad is time compression experienced at age 7000? A week is a long time to a child, I bet the decades will just fly by. I can imagine the ennui. We would have to evolve into something beyond human to cope with this. It's not going to be in my lifetime, so excuse me for being comfortable with my mortality.
Why would you ever choose "dying" over "not dying"? If you live to be a million years old you have a million years to achieve all your dreams, albeit you don't have as much motivation to achieve them in the first 80 years of your life. If you only live 80 years, then you have a lot of motivation to achieve all your dreams in that timespan but (a) your ambitions might not be achievable in 80 years (b) whatever satisfaction you get from achieving your dreams runs out once you die anyway and worst of all (c) you lose 999920 years of life.
It stands to reason that whoever chooses "die at 80" over "die at 1e6" or even "never die" just doesn't value living very much.
First, visit a nursing home. How much is "not dying" worth? Then, visit an elementary school. Given the earth's finite carrying capacity, do you want to have a world with no children?
Not dying is hard to divorce from not aging, at least in any significant sense. This isn't an argument about a few extra years in exchange for extended morbidity. Compressed morbidity is a valuable counterpoint to modern medicine's unrelenting treatment, and luckily it's gaining momentum in the medical community. But the therapies in question have very marginal returns. Significant life extension is almost certainly only achievable by keeping us young for a very long time.
It is also critical that we remember the principal of autonomy. For all of the elderly folks who would like to move on, there are many who prefer not to, frailty and all. The fact that some would like to die is no justification for denying treatment to those who do not. Denying life extension to people who desire it, by the same argument, it is equally ridiculous.
>Then, visit an elementary school. Given the earth's finite carrying capacity, do you want to have a world with no children?
No, I suppose not, but nobody has the right to ask another to die so that they may bring a new child into the world. There are lots of benefits I might realize from taking advantage of another's suffering, but that doesn't mean I should be allowed to. There is no "right to be conceived". There is a right to life.
Throughout our history if there has been a route by which we can lead healthier, happier and more productive lives. We have tended to take it and that is the reason why anti-aging medicine will progress down exactly the same route and why the arguments against controlling aging do not have any validity at all.
You're free to continue practicing the barbaric ritual of death if you want.
I think that's a pretty good description of what's going on in the last decade of a lot of people's lives. There's a huge bias toward high risk invasive procedures that have a high probability of leaving the patient debilitated even when the expected lifespan increase is fairly modest. Our penchant for hope in difficult circumstances leads to a lot of unnecessary suffering. There is plenty in modern medical practice to consider 'barbaric'. Skepticism with regard to the current crop of medical utopists is warranted, because assuredly current barbaric medical practices were developed and implemented, overwhelmingly, with the best of intentions.
The research community has only just started the transition into treating root causes, which is to say the aging process itself, the accumulating forms of cell and tissue damage that are fundamental, not caused by anything other than the normal operation of metabolism. There are initiatives, some of which have reached the stage of clinical translation, but they are only a tiny fraction of the overall expenditure at present.
This will change over the next decade or two as the first results for fundamental damage repair (e.g. senescent cell clearance) become compelling enough and widely known enough to shift the entire field in the right direction.
Anyway, Dr Dale Bredesen is now doing the second study but I have no idea when the results will be made public. Since the first study showed great results after 4 months of treatment, I am optimistic that it will be faily soon.
The treatment of Dr Dale Bredesen is very different from what the average reader may expect. It is not a medicine-based treatment, but a "general health optimization" treatment with 35 variables. In my opinion, the Alzheimer reversal treatment can be used to prevent Alzheimer, and I hope that in a number of years a study will find out if that is right.
I mean, unless our population is growing—then the older people will be competing with the young!
Living a normal 60-80 year life is like a good book.
Living an eternity would be like taking every page from all the books in a library, randomly shuffling them on the floor, then trying to read through it. Full of people and events, certainly, but devoid of any meaning.
What are these Health Care software systems? Are they distributed CRUD systems between different locations and actors? Are they event driven systems that push a leaner, more efficient process through the health care system? Are they big data / AI products for the macro that identify patterns to help policy, planning, budgets or micro to help as early warning for identify suspicious patterns in areas, surgeries or even an individuals monitoring?
I can see software being incredibly helpful, I can also see it being thoroughly expensive and intensive if the NHS has to go through a multi-million-pound multi-year tending process that is almost immediately invalidated by factors such as it'll need customising so heavily it'll take years to actually tailor correctly, all medical records will need migrating making the entire system redundant before it starts, it has to work across all trusts at once, all patients have to consent etc.
I want to see this help. Software can really benefit everyone, but I fear we are heading for a horrific car crash of 'enterprise' Health Care IT sucking money out of wards and doctors away from patients.
Someone convince me otherwise :)
Philanthropy is nice and all, but that's not why I'm interested in tech companies.
The entire world's population is aging and death by accident is becoming more and more rare.
Health care can essentially become an inelastic good, if you can decrease the entry price you will pick up more and more customers.
If you do it right you can get customers for life and then use your product to extend their life.
Not to mention the rich people that fund this can rationalize away the existential problem.
It was designed at the outset (the IPO of Google) to reduce the power of ordinary shareholders.
http://www.fool.com/investing/general/2015/10/29/is-a-vote-a...
or
http://blogs.wsj.com/cfo/2015/08/12/googles-multi-class-stoc...
Is it, really? That sounds very naive to me.
One example: Flatiron (Google Ventures' biggest health tech investment, if I'm not mistaken) is often described as 'Google for cancer data.' In fact, their mission is "organizing the world's real-world oncology data."
Once you nope out of something so suddenly, it becomes difficult to convince the market that you're serious about it this time.
Trying to cure cancer or Alzheimer's disease is in a different universe entirely.
The two examples in the article:
Foundation Medicine: sequences tumor cells to use for directing cancer treatment. There have been some high profile cases from academic research centers where this has saved lives. Roche purchased over 50% of the company last year.
Editas: Everyone in biology has heard of CRISPR. The company was founded by Zhang and Doudna, although it is now primarily a Broad company (meaning Zhang). It is led by Bosley who previously led Avila to being acquired by Celgene.
The notion that these investments are not doing "actual medical research" is ridiculous.
I'm thinking about SpaceX, they started from scratch and IIRC they cut the costs by 10 (not even counting the reusable rocket game)
http://www.gv.com/portfolio/#life
Several diagnostics and products companies in there. Also several aimed more at basic health care services.
At the risk of sounding wildly selfish, I hope "central nervous system disorders" includes tinnitus. It's hell.
A free and great advice: look at Dr Mark Hyman and Dr Dale Bredesen. Study what they do, how they do it and draw your conclusions. I guarantee you, you will be amazed about your own conclusions!