THE FOUR PRESCRIPTION MEDICINES KUHN Lawan was taking were precisely right for the cancer with which she had been diagnosed. But the drugs weren’t working. Not even a bit. The elderly Thai woman’s lung cancer persisted. And with it, it seemed, the end of her life was growing ever nearer.
Her children were understandably distraught. The doctors had told them that Lawan’s cancer was likely treatable. They seemed to have caught it early, after all. The fear and uncertainty they’d felt when their mother was first diagnosed had been replaced with hope, only to give way, once again, to fear and uncertainty.
Dr. Mark Boguski has spent a long time thinking about people such as Lawan and about how modern medicine has long failed so many people like her, especially later in life.
“In the most common manner of medical thinking, Lawan was getting the right care,” he told me one day. “Her doctors in Thailand were top notch. But that’s the thing about how we do medicine.”
Most doctors, he said, still rely on early-twentieth-century technology to diagnose and treat life-threatening diseases. Take a swab and grow it in a petri dish. Bang the knee and wait for a kick. Breathe in, breathe out. Look to the left and cough.
When it comes to cancer, doctors note where a tumor is growing and cut out a tissue sample. Then they send it to a lab, where it is put into wax, cut into thin slices, stained with red and blue dyes, and looked at under the microscope. That works—sometimes. Sometimes the correct medicine is given.
But sometimes it isn’t. That’s because, the way I see it, looking at a tumor in this way is the equivalent of a mechanic trying to diagnose a car’s faulty engine without plugging into the vehicle’s computer. It’s an educated guess. Most of us accept this sort of approach when it comes to potentially life-and-death decisions. Yet in the United States alone, with one of the better health care systems in the world, about 5 percent of cancer patients, or 86,500 people, are misdiagnosed every year.1
From the time he began studying computational biology in the early 1980s, Boguski has been driven by the idea of making medical care more exacting. He is a luminary in the field of genomics—and one of the first scientists engaged in the Human Genome Project.
“What we call ‘good medicine’ is doing what works for most of the people most of the time,” Boguski told me. “But not everyone is most people.”
And so there was a chance, and not a small one, that Kuhn Lawan was getting the wrong care. And that might have actually been making her worse.
But Boguski believes there is hope in a new way of doing medicine. A better way. A way that uses new technologies, many that are already here but simply not being utilized to their fullest potential, to refocus our medical system on individuals—upending centuries of deeply entrenched medical culture and philosophy. He coined the term precision medicine to describe the promise of next-generation health monitoring, genome sequencing, and analytics for treating patients based on personal data, not diagnostic manuals.
Thanks to the plummeting prices of DNA sequencing, wearable devices, massive computing power, and artificial intelligence, we’re moving into a world in which treatment decisions no longer have to be based on what is best for most people most of the time. These technologies are available to some patients now and will be available to most people on the planet in the next couple of decades. That’s going to save millions of lives—and it’s going to extend average healthy lifespans irrespective of whether we extend maximum lifespans.
But for millions of people like Lawan, these advances cannot come soon enough. When her family sought a second opinion in the form of precision DNA sequencing of her lung tumor biopsy, the totality of the danger she was in became crystal clear. Lawan did have an aggressive cancer but not the kind of cancer for which she was being treated. She didn’t have lung cancer; she had a solid form of leukemia growing in her lung.
In the vast majority of cases in which cancer is found where it was found in Lawan’s body, it is indeed lung cancer. But now that we can detect the genetic signature of specific forms of cancer, using the place where you find the cancer as the only guide for what treatment to use is as ridiculous as categorizing an animal species based on where you’ve located it. It is like saying a whale is a fish because they both live in water.
Once we have a better idea of what kind of cancer we’re dealing with, we can better apply emerging techniques for dealing with it. We can even design a therapy tailored to a patient’s specific tumor—killing it before it has a chance to grow or spread to another place in the body.
That’s the idea behind one of the cancer-fighting innovations we discussed earlier, CAR T-cell therapy, in which doctors remove immune system cells from a patient’s blood and add a gene that allows the cells to bind to proteins on the patient’s tumor. Grown en masse in a lab and then reinfused into the patient’s body, the CAR T-cells go to work, hunting down cancer cells and killing them by using the body’s own defenses.
Another immuno-oncology approach we discussed earlier, checkpoint blockade therapy, quashes the ability of cancerous cells to evade detection by our immune systems. Much of the early work on this technique was completed by Arlene Sharpe, whose lab is located on the floor above mine at Harvard Medical School. In this approach, drugs are used to block the ability of cancer cells to present themselves as regular cells, essentially confiscating their fake passports and thus making it easier for T-cells to discriminate between friend and foe. This is the approach that was used, along with radiation therapy, by former president Jimmy Carter’s doctors to help his immune system fight off the melanoma in his brain and liver. Prior to this innovation, a diagnosis like his was, without exception, fatal.
CAR-T therapy and checkpoint inhibition are less than a decade old. And there are hundreds of other immuno-oncology clinical trials under way. The results thus far are promising, with remission rates of greater than 80 percent in some studies. Doctors who have spent their entire careers fighting cancer say this is the revolution they’ve been waiting for.
DNA-sequencing technology has also offered us an opportunity to understand the evolution of a specific patient’s cancer. We can take single cells from a slice of a tumor, read every letter of the DNA in those cells, and look at the cells’ three-dimensional chromatin architecture. In doing so, we can see the ages of different parts of the tumor. We can see how it has grown, how it has continued to mutate, and how it has lost its identity over time. That’s important, because if you look at only one part of a tumor—an older part, for instance—you could be missing the most aggressive part. Accordingly, you might treat it with a less effective therapy.
Through sequencing, we can even see what kinds of bacteria have managed to make their way into a tumor. Bacteria, it turns out, can protect tumors from anticancer drugs. Using genomics, we can identify which bacteria are present and predict which antibiotics will work against those single-celled tumor protectors.
We can do all of this. Right now. Yet in many hospitals around the world the if-it-is-here-it-must-be-this and if-the-symptoms-are-this-it-must-be-that modes of diagnosis are still practiced. And so, procedurally speaking, the doctors who treated Lawan had done nothing wrong. They had simply done what doctors all over the world do, following an empirical process of diagnosis and intervention that leads to positive outcomes in most people most of the time.
If you accept that this is simply the way we care for people—and that it usually produces the right results—you could call this an understandable medical approach. But if you picture your own mother accidentally receiving a cancer treatment she doesn’t need while the medicine that will save her life sits on a shelf nearby, you’ll probably come to a different conclusion about what is, in fact, “understandable.”
The hardworking, ethical doctors, nurses, and medical professionals who go to war with death every day, while navigating the overarching standard-of-care stipulations of governmental programs and insurance companies, should never be expected to be perfect. But we can prevent a lot of unnecessary deaths by giving medical staff more information, just as Lawan’s doctors were able to get her onto a new treatment regimen once they better understood what they were dealing with.
Indeed, it wasn’t long after Lawan’s DNA-based diagnosis that she was on a new treatment regimen—one that was specific to the actual cancer in her body. Months later she was doing much better. Hope had returned.
There is hope for all of us. We know that humans, both male and female, are capable of living past the age of 115. It has been done, and it can be done again. Even for those who reach only their 100th year, their 80s and 90s could be among their best.
Helping more people reach that potential is a matter of bringing costs down and using emerging treatments, therapies, and technologies in a way that truly puts individuals at the center of their own care. And that’s not just about diagnosing people right when something does go wrong—it’s also about knowing what to do for us, as individuals, even before a diagnosis has been made.
Since the new millennium, we’ve been told that “knowing our genes” will help us understand what diseases we are most susceptible to later in life and give us the information we need to take preventive actions to live longer. That is true, but it is only a small part of the DNA-sequencing revolution that is under way.
There are 3.234 billion base pairs, or letters, in the human genome. In 1990, when the Human Genome Project was launched, it cost about $10 to read just one letter in the genome, an A, G, C, or T. The entire project took ten years, thousands of scientists, and cost a few billion dollars. And that was for one genome.
Today, I can read an entire human genome of 25,000 genes in a few days for less than a hundred dollars on a candy bar–sized DNA sequencer called a MinION that I plug into my laptop. And that’s for a fairly complete readout of a human genome, plus the DNA methyl marks that tell you your biological age.2 Targeted sequencing aimed at answering a specific question—such as “What kind of cancer is this?” or “What infection do I have?”—can now be done in less than twenty-four hours. Within ten years, it will be done in a few minutes, and the most expensive part will be the lancet that pricks your finger.3
But those aren’t the only questions that our DNA can answer. Increasingly, it can also tell you what foods to eat, what microbiomes to cultivate in your gut and on your skin, and what therapies will work best to ensure that you reach your maximum potential lifespan. And it can give you guidance for how to treat your body as the unique machine it is.
It’s common knowledge that we don’t all respond to drugs in the same way. Sometimes these aren’t small differences in small numbers of people. G6PD genetic deficiency, for instance, affects 300 million people of primarily Asian and African descent. It’s the most common genetic disease of humanity. After ingesting recommended doses of medicines for headaches and malaria and certain antibiotics, G6PD carriers can be caught unawares by hemolysis—what amounts to red blood cell mass suicide.4
Some mutations sensitize people to particular foods. If you’re a G6PD carrier, for example, fava beans can kill you. And while gluten is usually a harmless protein that comes in foods rich in the fiber, vitamins, and minerals we need, for those with celiac disease, it’s a poison.
The same is true of medical interventions: our genes can tell us which are better for us and which could do more harm than good. That’s changing the game for many breast cancer patients. Those who score in a certain range on a genetic test called Oncotype DX, it has been discovered, respond every bit as well to hormone treatments as they do to chemotherapy, the latter of which has far more side effects.5 The tragedy of this discovery is that it didn’t come until 2015. The Oncotype DX test has been in use since 2004, but it wasn’t until a team of researchers decided to take another look at possible treatment options and outcomes that it became clear that the medical community had been subjecting tens of thousands of women to treatments that were more harmful and no more effective.
What Lawan’s case and this study demonstrate is that we can’t simply rest on “this is how we do it” as a strategy for treating patients. We need to be constantly challenging the assumptions upon which medical manuals are based.
One of these assumptions is that males and females are essentially the same. We’re all too slowly coming around to the shameful recognition that, for most of medical history, our treatments and therapies have been based on what was best for males,6 thus hindering healthy clinical outcomes for females. Males don’t just differ from females at a few sites in the genome; they have a whole other chromosome.
The bias begins early in the drug development process. Until recently, it was perfectly fine to study male mice only. Scientists generally aren’t rodent sexists, but they are always trying to reduce statistical noise and save precious grant money. Ever since female mice have been regularly included in lifespan experiments, thanks largely to NIH stipulations, large gender differences in the effects of longevity genes and molecules have been seen.7 Treatments that work through insulin or mTOR signaling typically favor females, whereas chemical therapies typically favor males, and no one really knows why.8
If females and males are in the same environment, in general, females will live longer. It’s a common theme throughout the animal kingdom. Scientists have tested whether it is the X chromosome or the ovary that is important. Using a genetic trick, they created mice with one or two Xs, with either ovaries or testes.9 Those with a double dose of the X lived longer, even if they had testes and especially if they didn’t, thus proving once and for all that female is the stronger sex.
Besides the X, there are dozens of other genetic factors at play. One of the most promising uses of genomics is predicting how drugs will be metabolized. That’s why an increasing number of drugs now have pharmacogenetic labels—information about how the medication is known to act differently among people of different genotypes.10 Examples include the blood-thinning drugs Coumadin and Plavix, the chemotherapy drugs Erbitux and Vecitibix, and the depression drug Celexa. In the future, a patient’s epigenetic age will also be determined and used to predict drug responses, a new field called pharmacoepigenetics. It’s a rapidly advancing technology but some pharmacogenetic tests can’t come soon enough.
For more than two hundred years, the drug digoxin from the digitalis family of plants has been used in small doses by doctors to treat failing hearts (and in larger doses by murderers).11 Even under a doctor’s supervision, your chance of death if you are on digoxin increases by 29 percent, according to one study.12
To help reduce fluid buildup owing to her weakening heart, my mother was prescribed digoxin. I had no idea of the risk and I suspect neither did my mother, who was sensitive to the drug. She steadily declined from living a reasonably normal life to being barely able to walk. Fortunately, my father, a biochemist and a pretty smart guy, diagnosed the problem: the amount of the drug prescribed was superlow, but it had been accumulating in my mom’s heart. He told the doctor to test for drug levels, which she reluctantly agreed to do, and the test came back positive for an overdose.
The drug was immediately discontinued, and my mom recovered to her original self in a matter of weeks. Yes, the doctor should have done regular blood tests for drug levels, but if a test for sensitivity to digoxin prior to prescription existed, the doctor could have been on high alert. How close are we to a test? Not close enough. A few studies have identified genetic variants that predict digoxin blood levels and risk of death, but they haven’t been repeated.13 Hopefully, there will be a pharmacogenetic test for this drug soon, as well as for many more. They are badly needed. We cannot keep prescribing medicines as though we all respond to them the same way, because we don’t.
Drug developers have figured this out. They are using genomic information to find new and revive failed drugs that work for people with specific genetic variations. One of these drugs is Bayer’s Vitrakvi, known generically as larotrectinib, which is the first of many drugs to be designed from the beginning to treat cancers with a specific genetic mutation, not where in the body the cancer came from. A similar story is being written about the failed blood pressure drug Gencaro. It worked well on a subset of the population and, if revived by the FDA, would become the first heart drug to require a genetic test.
This is the future. Eventually, every drug will be included in a huge and ever-expanding database of pharmacogenetic effects. It won’t be long before prescribing a drug without first knowing a patient’s genome will seem medieval.
And vitally, with genomic information aiding in our doctors’ decisions, we won’t have to wait to become sick to know what treatments will work best to prevent those diseases from developing in the first place.
As Julie Johnson, the director of the University of Florida’s Personalized Medicine Program, has pointed out, we are about to enter a world in which our genomes will be sequenced, stored, and already red-lighted for treatments that have been demonstrated to have adverse effects on people with similar gene types and combinations as we have.14 Likewise, we’ll be green-lighted for treatments that are known to work for people with similar genes, even if those treatments don’t work for most other people most of the time. This will be particularly important in developing countries, where the local genetics and gut flora are wildly different from the population the drug was tested on.15 These differences are rarely talked about in medical circles, but they can have a marked effect on drug efficacy and patient survival, including the efficacy of what are thought of as well-understood cancer chemotherapies.16
We are also learning to read the entire human proteome—all of the proteins that can be expressed by every type of cell. Researchers in my lab and others have discovered hundreds of new proteins in human blood, and each protein can tell a story about the kind of cell from which it came, a story we can use to understand what diseases are in our bodies long before they are detectable any other way. That will offer a faster, better view of the problems we’re facing, giving doctors the ability to target those problems with far greater precision.
Right now, when people fall ill, especially older people, they often wait to see if things just “work themselves out” before making an appointment to see a doctor. Only when symptoms persist do they make the call. Then they have to wait—nearly a month, according to one 2017 study—before they are able to see a physician. That wait time has been growing in recent years, owing to the combination of a doctor shortage and an increase in baby boomer patients. And in some places, it’s much worse. In the city in which I live, Boston—home to twenty-four of the best hospitals in the world—the wait is fifty-two days.17 That’s atrocious.
Long wait times aren’t just in the United States, which has a largely private medical system; Canada’s socialized system has notoriously long wait times, too. The problem isn’t how we pay for care; the problem is that we’ve set up doctors as the only conduits to diagnosis and often, in the case of primary care physicians, as the only people who can refer a patient to a specialist.
The backlog could clear soon, thanks to technologies that give doctors the ability to conduct video home visits. Within a decade, using a device the size of a package of gum and possibly even disposable, it will be technically feasible to collect the samples your doctor needs at home, plug the device into your computer, and look together at a readout of your metabolites and your genes.
There are more than a hundred companies just in the United States pursuing lightning-fast, superfocused DNA testing that can offer us early and accurate diagnoses of a vast range of ailments and even estimate our rate of biological aging.18 A few are aimed at detecting the genetic signature of cancer and other illnesses years before they can normally be detected. Soon, we will no longer have to wait for tumors to grow so big and so heterogeneously mutated that their spread is no longer controllable. With a simple blood test, doctors will be able to scan for circulating cell-free DNA, or cfDNA, and diagnose cancers that would be impossible to spot without the aid of computer algorithms optimized by machine learning processes trained on thousands of cancer patient samples. These circulating genetic clues will tell you not just if you have cancer but what kind of cancer you have and how to kill it. They will even tell you where in your body an otherwise undetectable tumor is growing, since the genetic (and epigenetic) signatures of tumors in one part of the body can be vastly different from those from other parts.19
All of this means we’re on the way to a fundamental shift in the way we search for, diagnose, and treat disease. Our flawed, symptom-first approach to medicine is about to change. We’re going to get ahead of symptoms. Way ahead. We’re even going to get ahead of “feeling bad.” Many diseases, after all, are genetically detectable long before they are symptomatic. In the very near future, proactive personal DNA scanning is going to be as routine as brushing our teeth. Doctors will find themselves saying the words “I just wish we’d caught this earlier” less and less—and eventually not at all.
But the coming age of genomics is just the start.
The dashboard on a car equipped with intelligent vehicle technologies is a marvelous thing. It can tell you how fast you’re going, of course, and how many miles the vehicle has remaining before it needs a refill—adjusted second by second based on the conditions of the road and the way in which you are driving. It can tell you the temperature outside, inside, and under the hood. It can tell you what cars, bicycles, and pedestrians are around you and warn you if they’re getting a little close for comfort. When something is wrong—a tire with too little air or a transmission that isn’t shifting perfectly—it can let you know that, too. And if you get a bit distracted and begin to veer over the line, it will take control of the wheel and pull you back on course or drive autonomously down the highway, with no more than a bit of resistance from a hand on the steering wheel to tell it there’s a human there, just in case.
Back in the 1980s, there were very few sensors in cars. But by 2017, there were nearly 100 sensors in each new vehicle—a number that had doubled in the prior couple of years.20 Car buyers increasingly expect features such as tire sensors, passenger sensors, climate sensors, nighttime pedestrian warning sensors, steering angle guides, proximity alerts, ambient light sensors, washer fluid sensors, automatic high-beam, rain sensors, blind spot detection sensors, automatic suspension lift, voice recognition, automatic reverse parking, active cruise control, auto emergency braking, and autopilot.
Perhaps there are people out there who’d be happy to drive without any dashboard at all, relying solely on their intuition and experience to tell them how fast they are going, when their car needs fuel or recharging, and what to fix when something goes wrong. The vast majority of us, however, would never drive a car that wasn’t giving us at least some quantitative feedback, and, through our purchasing decisions, we have made it clear to car companies that we want more and more intelligent cars.
Of course we do. We want them to protect us, and we want them to last.
Surprisingly, we’ve never demanded the same for our own bodies. Indeed, we know more about the health of our cars than we know about our own health. That’s farcical. And it’s about to change.
We’ve already taken some pretty big steps into the age of personal biosensors. Our watches monitor our heart rate, measure our sleep cycles, and can even provide suggestions for food intake and activity. Athletes and health conscious individuals are increasingly wearing sensors twenty-four hours a day that monitor the ways in which their vital signs and major chemicals are rising and falling in response to diet, stress, training, and competition.
As just about anyone with diabetes or HIV can attest, blood sugar and blood cell monitoring are exceptionally easy and increasingly painless affairs these days, with noninvasive and minimally invasive monitoring technologies ever more available, affordable, and accurate.
In 2017, the US Food and Drug Administration approved a glucose sensor, first launched in Europe in 2014, that you stick on your skin to provide a constant readout of blood sugar levels on your phone or watch. In thirty countries, a finger prick for diabetics is becoming a distant memory.
Rhonda Patrick, a longevity scientist turned health and fitness expert, has been using a continual blood glucose–sensing device to see what foods give her body a major sugar spike, something many of us believe is to be avoided if we are to give ourselves the greatest chance of a long life. She’s seen that, at least for her, white rice is bad and potatoes aren’t so bad. When I asked her what food had been the most surprising, she didn’t hesitate.
“Grapes!” she exclaimed. “Avoid grapes.”
Researchers at MIT are working on scanners, straight out of Star Trek, that can give readouts of thousands of biomarkers. Meanwhile, researchers at the University of Cincinnati have been working with the US military to develop sensors that can identify diseases, diet changes, injuries, and stress through sweat.21 A few companies are developing handheld breath analyzers that can diagnose cancer, infectious diseases, and inflammatory diseases. Their mission: to save 100,000 lives and $1.5 billion in health care costs.22 Numerous other companies are working on designing clothing with sensors that can track biomarkers, and automotive engineers are exploring putting biosensors in car seats that would send an alert to your dashboard or doctor if there’s something amiss in your heart rate or breathing pattern.
As I write this, I am wearing a regular-sized ring that is monitoring my heart rate, body temperature, and movements. It tells me each morning if I slept well, how much I dreamed, and how alert I will be during the day. Technology like this has been around for some time, I suppose, for people such as Bruce Wayne and James Bond. Now it costs a few hundred dollars and can be ordered by anyone online.23
Recently, my wife and eldest child came home with matching ear piercings, which got me thinking: there’s really no reason that an even smaller piece of body jewelry—particularly one that pierces the skin—couldn’t be used to track thousands of biomarkers. Every member of the family could be measured: grandparents, parents, and children. Even infants and four-legged family members will have monitors on them, because they are the ones who are least able to tell us what they are feeling.
Eventually, I suspect, very few people will want to live without tech like this. We won’t leave home without it, the same way we feel about our smartphones. The next iteration will be innocuous skin patches, eventually giving way to under-skin implants. Future generations of sensors will measure and track not only a person’s glucose but his or her basic vital signs, the level of oxygen in the blood, vitamin balance, and thousands of chemicals and hormones.
Combined with technologies that coalesce data from your day-to-day movements and even the tone of your voice,24 your biometric vitals will be the bellwether for your body. If you are a man who has been spending more time in the bathroom than usual, your AI guardian will check for prostate-specific antigens and prostate DNA in your blood, then book you an appointment for a prostate exam. Changes in how you move your hands while speaking, and even the manner in which your strike the keys on your computer,25 will be used to diagnose neurodegenerative diseases years before symptoms would be noticed by you or your doctor.
One biotechnological advancement at a time, this world is coming, and fast. Real-time monitoring of our bodies, the likes of which we could hardly have imagined a generation ago, will be as inherent to the experience of living as dashboards are to the experience of driving. And for the first time in history, that will permit us to make data-driven day-to-day health decisions.26
The most critical daily decisions that affect how long we live are centered around the foods we eat. If your blood sugar is high at breakfast, you’ll know to avoid sugar in your morning coffee. If your body is low on iron at lunch, you’ll know it and can order a spinach salad to compensate. When you get home from work, if you’ve failed to go outside for your daily dose of vitamin D from the sun, you’ll know that, too, and you’ll be able to mix up a smoothie that will address the deficiency. If you’re on the road and you need X vitamin or Y mineral, you’ll know not only what you need but where to get it. Your personal virtual assistant—the same AI-driven being who answers your internet search queries and reminds you about your next meeting—will point you to the nearest restaurant that has what you need or offer to have it delivered by a drone to wherever you are. It could, quite literally, be dropped into your hands from the sky.
Biometrics and analytics already tell us when and how much to exercise, but increasingly they will also help us monitor the effects of our exercise—or lack thereof. And our levels of stress. And even how the fluids we drink and the air we’re breathing are impacting our body’s chemistry and functionality. Increasingly, our devices will offer recommendations on what to do to mitigate suboptimal blood biomarkers: to take a walk, meditate, drink a green tea, or change the filter on the air conditioner. This will help us make better decisions about our bodies and our lifestyles.
All of this is coming soon. There are companies that are crunching data from hundreds of thousands of blood tests, comparing them to customers’ genomes and providing feedback to them on what to eat and how to truly optimize their particular bodies, and looking to roll out new generations of these technologies every year.
I am fortunate to have been one of the first people to get an early look at what this sort of technology can offer us. I am a scientific adviser to a local company, spun out of MIT, called InsideTracker.27 By signing up for regular tests, I have been able to follow a few dozen blood biomarkers over the past seven years, including vitamins D and B12, hemoglobin, zinc, glucose, testosterone, inflammatory markers, liver function, muscle health markers, cholesterol, and triglycerides. My tests are taken every few months instead of every few seconds—as they will soon be in our future—but the reports, adjusted to my specific age, sex, race, and DNA, have been instrumental in helping me choose what to order when I sit down at a restaurant and what to pick up when I stop at the market on my way home. I can even have daily text messages, based on my most recent results, that remind me what my body needs.
Along the way, I am creating data specific to my body. And over time, that data is helping me identify negative and positive trends that may be subtly different for me than for other people. We know, of course, that our genetic heritage can have a significant impact on the sorts of food our bodies need, tolerate, or reject, but everyone’s genetic heritage is different. What you need, what your partner needs, and what your children need can likely be found in the meals you put on your table, but the particulars may be quite different.
Biotracking will also help us stop acute and traumatic preventable deaths—by the millions. In 2018, a peer-reviewed study published by the team at InsideTracker and me, showed that biotracking and computer-generated food recommendations reduce blood sugar levels as efficiently as the leading diabetes drug, while optimizing other health biomarkers, too.
The signs of an increasingly blocked carotid artery might be hard to notice in our day-to-day lives, or even in periodic visits to the doctor, but they will be almost impossible to miss when our bodies are being measured and monitored all the time. Same, too, for heartbeat irregularities, minor strokes, venous blockages during air medical transport, and many other medical problems that currently are almost always treated in critical care conditions—when it is too late. Before, if you suspected your heart was malfunctioning, and even if you didn’t, it would take a visit to a couple of doctors to get an electrocardiogram. Now millions of people can conduct their own accurate ECG in 30 seconds, wherever they are, just by pressing their finger to the dial on their watch.
TECHNOLOGIES TO EXTEND OUR LIVES. In the near future, families will be monitored by biosensing wearables, small devices at home, and implants that will optimize our health and save lives by suggesting meals and detecting falls, infections, and diseases. When an anomaly is found, an AI-assisted, videoconferenced doctor will send an ambulance, a nurse, or medicines to your door.
Of course, I use the term watch loosely, given that today’s wrist devices don’t just tell you the time and date. They are also calendars, audiobooks, fitness trackers, email and text programs, newsstands, timers, alarms, weather stations, heart rate and body temperature monitors, voice recorders, photo albums, music players, personal assistants, and phones. If these devices can do all of that, there’s no reason we should not expect them to help us avoid traumatic health incidents, too.
In the future, if you are experiencing a heart attack—even if it’s perceptible only as a slight pain in your arm—or a ministroke, which so often goes undiagnosed until it’s identified on a brain scan years later, you’ll be alerted, and so will those around you who need to know. In an emergency, a trusted neighbor, a best friend, or whatever doctor happens to be closest to you can also be alerted. An ambulance will be dispatched to your door. This time, the doctors at the nearest hospital will know exactly why you are coming in before you even arrive.
Do you know an emergency room doctor? Ask her about the value of a single minute of additional treatment time. Or a single blood test’s worth of additional information. Or a recent electrocardiogram. Or a patient who is still conscious, not in pain, and not suffering from a loss of blood to their brain when they arrive—a person who is able to help in the process of making appropriate emergency health care choices. It may not be long before medics routinely ask for a download of your most recent biotracking data to aid them in making what could be life-and-death decisions.
Biotracking is already helping us identify diseases faster than ever before. That is what happened in the summer of 2017 to a woman named Suzanne. After a time of subtle shifts in her menstrual cycle, changes her doctor very reasonably attributed to a shift into menopause, the 52-year-old woman downloaded an app that helped her track her periods. Three months later, the app sent her an email alerting her to the possibility that her data might be “outside the norm” for women of her age. Armed with that data, Suzanne returned to her doctor. She was immediately sent for blood tests and an ultrasound that revealed mixed Müllerian tumors, a malignant form of cancer found predominantly in postmenopausal women over the age of 65. It took a radical hysterectomy to remove the cancer before it could spread further, but Suzanne’s life was spared.28
The app she used was relatively simple compared to those that are on the way. It required proactive data entry and tracked only a few metrics. Yet it saved her life. Imagine, then, what “hands-off” trackers that collect millions of daily data points can offer us. Now imagine coupling that data with what we learn from routine DNA sequencing.
And don’t stop imagining there. Because biotracking won’t just tell you when your heart rate is up, your vitamin levels are low, or your cortisol level is spiking, it will also tell us when our bodies are under attack—and that could save everyone on this planet.
In 1918—long before our modern, superfast, hyperconnected global transportation network took shape—a worldwide influenza pandemic that some historians believe originated in the United States killed more people in absolute numbers than any other disease outbreak in history.29 It was a violent death, with hemorrhage from mucous membranes, especially from the nose, stomach, eyes, ears, skin, and intestines.30 At a time in which the era of human flight was in its infancy and most people had never ridden in a car, the H1N1 virus found its way to some of the furthest reaches of our globe. It killed people on remote islands and in arctic villages. It killed without regard to race or national boundaries. It killed like a new Black Death. Average life expectancy in the United States plummeted from 55 to 40 years. It recovered, but not until more than 100 million people of all ages globally had had their lives cut short.
This could happen again. And given how much more humans and animals are in contact and how much more interconnected our planet is now than it was a century ago, it could happen quite easily.
The gains in life expectancy we’ve witnessed over the past 120 years, and those to come, could be wiped out for a generation unless we address the greatest threat to our lives: other life-forms that seek to prey on us. It doesn’t matter if we live decades upon decades longer if a pandemic quickly snuffs out hundreds of millions of lives—negating and even rolling back the gains in average lifespan we will have achieved. Global warming is a long-term, critical issue to deal with, but one could also argue that, at least within our lifetimes, infections are our greatest threat.
Ensuring the next big outbreak never happens could be the greatest gift of the biotracking revolution. Individually, of course, real-time monitoring of vitals and body chemicals offers incredible benefits for optimizing health and preventing emergencies. Collectively, though, it could help us get ahead of a global pandemic.
CHANGE IN LIFE EXPECTANCY DURING THE 1918 FLU EPIDEMIC.
Source: S. L. Knobler, A. Mack, A. Mahmoud, and S. M. Lemon, eds., The Threat of Pandemic Influenza: Are We Ready? Workshop Summary, Institute of Medicine (Washington, DC: National Academies Press, 2005), https://doi.org/10.17226/11150, PMID: 20669448.
Thanks to wearables, we already have the technology in place to monitor the body temperature, pulse, and other biometric reactions of more than a hundred million people in real time. The only things separating us from doing so are a recognized need and a cultural response.
The need is already here. It has been for quite some time. It took about twenty years for the deadly mosquito-transmitted Zika virus to spread from Central Africa, where it was first documented, to South Asia and about forty-five more years to reach French Polynesia in the Central Pacific in 2013. In the span of those sixty-five years, it affected just a small part of the world. In the next four years, though—four years, that’s all—the virus spread like wildfire across South America, through Central America, into North America, and back across the Atlantic Ocean to Europe.
Zika, at least, is somewhat limited in the way it can be spread—mostly through mosquito bites but also from mother to child and from sexual partner to sexual partner. It cannot, as far as we know, be transmitted by doorknobs, via food, or in the air-recirculating climate control systems on airplanes.
But influenza can, as can other, potentially deadlier viruses.
On March 23, 2014, the World Health Organization reported cases of Ebola virus disease in the forested rural region of southeastern Guinea, and from there it spread rapidly to three neighboring countries, causing widespread panic. Even the richest country in the world, where eleven people were treated for Ebola, was caught without a unified plan.
That October, people in hazmat suits boarded American Airlines flight 45 when it landed in New Jersey to shine infrared heat detectors on people’s foreheads in an attempt to detect a fever. Kaci Hickox, who worked for Doctors Without Borders, later won a lawsuit that led to a “quarantine bill of rights,” after she was placed in Governor Chris Christie’s “private prison.” On that occasion, and a few since then, the deadly virus has been contained, but humanity may not always be so lucky.
“Whether it occurs by a quirk of nature or at the hand of a terrorist, epidemiologists say a fast-moving airborne pathogen could kill more than 30 million people in less than a year,” Bill Gates told a crowd at the Munich Security Conference in 2017, “and they say there is a reasonable probability the world will experience such an outbreak in the next 10–15 years.”31
If that happens, 30 million could be a very conservative estimate.
As our transportation networks continue to expand in reach and speed, as more people travel to more corners of our world faster than our ancestors could possibly have imagined, pathogens of all sorts are traveling faster than ever, too. But with the right data in the right hands, we can move faster, especially if we combine mass “biocloud” data with superfast DNA sequencing to detect pathogens as they spread through cities and along transportation corridors. In doing so, we can get ahead of a killer pathogen with emergency travel restrictions and medical resources. In this fight, every minute will matter. And every minute that passes without action will be measured in human lives.
Not everyone is ready for the biotracking world. That makes sense. To many, clearly, it will feel like a step too far. Maybe several steps too far.
In order to get to a world in which hundreds of millions of humans—all being tracked in real time for hormone levels, chemicals, body temperature, and heart rate—are standing as sentinels to warn us of public health crises as they happen, someone is going to have to have the data. Who will that be? One government? A coalition of governments? Any and every government?
Maybe a computer company. Or maybe a pharmaceutical manufacturer. Or an internet shopping company. Or an insurer. Or a pharmacy. Or a supplement company. Or a hospital network.
Most likely, it will be a combination of these companies, all under one roof. Consolidation has already started and will continue as these companies set their sights on the largest and fastest-growing sector of the global economy, health care, which now exceeds 10 percent of global GNP and is increasing at an annual rate of 4.1 percent.
Whom do you trust to know your every move? To listen to your every heartbeat? To see you when you’re sleeping and know when you’re awake, like a certain benevolent mythical being of wintertime lore? To be able to identify, through the data, when you are feeling sad, driving too fast, having sex, or had too much to drink?
There’s no sense in trying to convince people that there is nothing to worry about. Of course there are things to worry about. Think having your credit card data stolen is bad? That’s nothing. You can always call the bank and get a new credit card, but your medical records are permanent—and far more personal. More than 110 million medical records were breached in the United States between 2010 and 2018.32 Jean-Frédéric Karcher, the head of security at Maintel, a UK communications provider, predicts that attacks will become far more common.
“Medical information can be worth ten times more than credit card numbers on the deep web. Fraudsters can use this data to create fake IDs to buy medical equipment or drugs,” he has warned.33
We already trade a tremendous amount of privacy for technological services. We do it all the time. We do it every time we start a bank account or sign up for a credit card. We do it often when we point our internet browsers to a new web page. We do it when we sign up for school. We do it when we get onto an airplane. And we do it—a lot—when we use our mobile phones. Have these been good trade-offs for everyone? That’s a matter of personal opinion, of course. But when most people imagine not being able to use a credit card, surf the web, sign up for school, travel by air, or use their phones and smart watches, they quickly conclude that the trade is tolerable.
Will people trade a little more privacy to stop a global disease pandemic? Sadly, probably not. The tragedy of the commons is that humans are not very good at taking personal action to solve collective problems. The trick to revolutionary change is finding ways to make self-interest align with the common good. For people to accept widespread biometric tracking in a way that could help us get ahead of fast-moving deadly viruses, they’ll need to be offered something they have a hard time seeing themselves without.
How to get ready for this world is a conversation that needs to be had. And soon.
I’m there already. Before I began having my biomarkers checked on a regular basis, I did worry about what the ever-changing chemical signals in my body could disclose about me to someone with access to my data. All the data are held on health care– or HIPAA-compliant servers, and the data are encrypted. But there’s always the fear that the data will be hacked. There’s always a way.
But after I began, the information I received was worth far more than the concerns I carry. It’s a personal choice, no question. Now, having seen the changes on my dashboard, I cannot imagine living without it. Just as I now wonder how I ever managed to drive without a GPS, I wonder how I ever made decisions about what I should be eating and how much I should be exercising before I received regular updates from my biosensor ring and blood biomarker reports. Indeed, I am eager for the day in which the data about my health are processed in real time. And if that can help protect others, all the better.
While I was doing my PhD, I had a night job. For about eight dollars an hour, I tested body fluids—urine, feces, spinal fluid, blood, and genital swabs horribly twisted in hair—for the presence of deadly bacteria, parasites, and fungi. It was glamorous work.
At my disposal, I had all the trappings of nineteenth-century technology: microscopes, petri dishes, sterile water. A lab technician transported from 1895 to that 1980s microbiology lab would have felt right at home. Today, this is still how many microbiology labs operate.
Making life-and-death calls this way was frustrating. In every other branch of medicine, we’ve made enormous strides technologically with robotics, nanotechnology, scanners, and spectrometers.
These days, though, I’m no longer frustrated. I’m furious.
Antibiotic-resistant strains of bacteria continue to spread, and new studies implicate bacteria as causal agents in cancer, heart disease, and Alzheimer’s disease.34
But I wasn’t working to solve this problem, until recently. A brush with Lyme disease has a way of intensifying a person’s feelings about these sorts of things.
Our daughter Natalie was 11 years old when it happened. In New England, where we live, there is an epidemic of ticks that carry the bacterial spirochete Borrelia burgdorferi, which causes Lyme disease. Recent estimates suggest that approximately 300,000 people in the United States may contract the disease each year. Left untreated, Borrelia hides out in skin cells and lymph nodes, causing facial paralysis, heart problems, nerve pain, memory loss, and arthritis. It hides in a protective biofilm, making it extremely difficult to kill.
Natalie never had a red ring of skin around a tick bite—a sure sign you’ve contracted the parasite. She had been complaining about a headache and sore back, typical signs of flu. But quickly it became clear that this wasn’t flu—it was something much worse.
She was unable to turn her head. She was losing her eyesight. She was terrified. My wife and I were, too—we’d never felt so helpless in our lives. We began searching online for answers. Potential diseases included leukemia and a viral infection of the brain.
Doctors at Boston’s Children’s Hospital began poring over her. The first test lit up Lyme disease proteins, but the insurance company needed confirmation because the first test occasionally gives a false positive. The second test failed, putting the course of treatment into limbo pending more lab results.
I asked for a microliter sample of Natalie’s spinal fluid to test. My lab was across the street, and I could sequence the DNA of the pathogen. The hospital refused.
Given the state of her symptoms at that point, I’ve since learned, she had a 50 percent chance of survival. Her life came down to a coin flip. At a time when every second counted, doctors were waiting on lab results.
It took three days to confirm that it was a Lyme disease infection, and finally the doctors gave Natalie intravenous antibiotics directly into the large vein next to her heart. She received that treatment every day for nearly a month.
She is okay now, but it was clear to everyone involved, especially Natalie, that we desperately need to be applying twenty-first-century technologies to diagnosing infectious diseases. In Cambridge, Massachusetts, and Menlo Park, California, I’ve helped gather a group of very smart folks—infectious disease doctors, microbiologists, geneticists, mathematicians, and software engineers—to develop tests that can rapidly and unambiguously tell physicians what an infection is and how best to kill it, using “high-throughput sequencing.”
The first step in this process is the extraction of nucleic acids from blood samples, saliva, feces, or spinal fluid. Because it adds cost and reduces sensitivity, the patient’s DNA is removed using innovative methods honed by the same scientists who extract ancient DNA from mummies—one of countless cases of one field of science benefiting another. Next, the samples are processed through agnostic DNA-sequencing technologies, meaning that the system is not looking for any one specific infectious agent but rather reading the genomes in the entire sample. That list is then scanned against a database of all known human pathogens at the strain level. The computer spits out a highly detailed report about what invaders are present and how best to kill them. The tests are as accurate as the standard ones, but they provide strain-level information and are pathogen agnostic. In other words, soon doctors won’t have to guess what to look for when ordering a test or what treatment will work best. They will know.
Just a few years ago, this wouldn’t just have been a slow process, it wouldn’t even have been possible. Now it can be done in days. Soon it will be able to be done in hours and eventually minutes.
But there’s another way to deal with such diseases: we could prevent them altogether.
There is no rational debate over the immensely positive impact of vaccines on life expectancy and healthy lifespans over the past century. Childhood mortality around the world has plummeted, in no small part because we’ve wiped out diseases such as smallpox. The number of healthy children in the world has risen because we’ve destroyed polio. The number of healthy adults has, too. Within fifty years, postpolio syndrome, which causes fatigue, muscle weakness, abnormal spinal curvature, and speech defects in adults, will be extinct.
And, of course, the more diseases we can vaccinate for, especially those that claim elderly people’s lives, such as flu and pneumonia, the more life expectancy will rise in the coming years.
When we inoculate the herd, it doesn’t just protect us individually, it protects the weakest among us: the young and the old. Chickenpox once claimed thousands of lives each year around the world—mostly among the very young and the very old—and accounted for hundreds of thousands of hospitalizations and millions of days of missed work. Those days are over.
A shining example of the power of vaccines to extend lifespan came in the years after the introduction of vaccines for Streptococcus pneumoniae, a major source of illness in older persons and the most common cause of death by respiratory infection. After the Prevnar vaccine for infants was launched in 2000, hospitalization and deaths from pneumonia fell across the board, according to a study published in the New England Journal of Medicine.
“The protective effect we saw in older adults, who do not receive the vaccine but benefit from vaccination of infants, is quite remarkable,” the study’s first author, Marie Griffin, explained. “It is one of the most dramatic examples of indirect protection, or herd immunity, we have seen in recent years.”35
In the first three years alone, deaths from pneumonia were halved, averting more than 30,000 cases and 3,000 deaths in the United States alone, according to another study.36
We can snuff out a lot of killers with vaccines like this.
Yet for several decades, the promise of vaccines to improve the lives of billions of people around the world has been slowed, not only by a distrust of vaccines promulgated by debunked science, but by plain old market forces. The golden era of vaccine research was in the mid–twentieth century, a time that saw the quick development of a succession of exceptionally effective inoculations against whooping cough, polio, mumps, measles, rubella, and meningitis.
But by the latter part of the century, the business model that long sustained vaccine research and development was badly broken. The cost of testing new vaccines had risen exponentially, thanks in large part to increasing public concerns about safety and risk-averse regulatory bodies. The “low-hanging fruit” of the inoculation world had already been picked. Now a simple vaccine can take more than a decade to produce and cost more than half a billion dollars, and there is still the chance it won’t be approved for sale. Even some vaccines that have worked well and been critical for the prevention of epidemics, such as GlaxoSmithKline’s Lyme disease vaccine, have been taken off the market because the unfounded backlash against vaccines made continuation of the product “just not worth it.”37
Governments don’t make vaccines; companies do. So when the market forces are not conducive, we don’t get the medicines we so badly need. Funding gaps are sometimes made up by charitable organizations, but not nearly enough. And economic downturns such as the global recession of the late 2000s and early 2010s left foundations—many of which base their giving on market-tied endowment earnings—unable or unwilling to invest as much in these lifesaving interventions.38
The good news is that we are experiencing a minirenaissance in vaccine research and development, which has tripled between 2005 and 2015, now accounting for about a quarter of all biotechnology products being developed.39
The big one is malaria, infecting 219 million people and claiming 435,000 people in 2017.40 Thanks to Bill and Melinda Gates, GlaxoSmithKline, and Program for Appropriate Technology in Health (PATH), a partially effective vaccine against malaria known as Mosquirix was deployed for the first time in 2017, giving hope that the malaria parasite will one day be pushed to extinction.41
We are also learning how to quickly grow vaccines in human cells, mosquito cells, and bacteria, avoiding the time and expense of infecting the millions of fertilized chicken eggs we currently use, a remarkably antiquated process. One Boston-based research consortium was able to get a vaccine for Lassa fever, a disease similar to Ebola, all the way to the animal-testing stage in just four months and for about $1 million, cutting many years and many millions of dollars from the usual process.42 That’s nothing short of astounding.
At this moment, researchers are starting the final sprint toward the end of a very long race to develop vaccines that will inoculate us against diseases that are so ubiquitous that we simply accept them as part of life. Many thought leaders predict, though with some trepidation, that it won’t be long before we’re no longer throwing Hail Mary passes such as the annual influenza vaccine, which in some years protects less than a third of its recipients, which is still far better than nothing. (If you don’t get flu vaccines or vaccinate your kids, please do. We are privileged to live in an age in which we can protect ourselves and our children from potentially deadly diseases.)
The ability to quickly detect, diagnose, treat, and even prevent diseases that aren’t related to aging but that claim many millions of lives each year will allow us to continue to push our average life expectancy higher and higher, closing the gap between the mean and the maximum.
Even then, organs will fail and body parts will wear out. What will we do when all other technologies fail? There’s a revolution happening there, too.
The Great Ocean Road, which runs along the Australian coast west of Melbourne, is among the most beautiful stretches of highway in the world. But whenever I’m on it, I can’t help but remember one of the most frightening days of my life—the day I got a call telling me that my brother, Nick, had been in a motorcycle accident.
He was 23 years old at the time and touring the country by motorbike. He was an expert rider, but he hit an oil patch, flew from his bike, and slid under a metal barrier that crushed his ribs and ruptured his spleen.
Fortunately, he pulled through, but to save his life, the emergency room doctors had to remove his spleen, which is involved in the production of blood cells and is an important part of the immune system. For the rest of his life, he has to be careful not to get a major infection, and he certainly seems to get sicker more often and take longer to get better. People without a spleen are also at higher risk of dying of pneumonia later in life.
It doesn’t take age or disease to do a number on our organs. Sometimes life does that to us in other ways, and we’re lucky if it’s just our spleen that we lose. Hearts, livers, kidneys, and lungs are a lot harder to live without.
The same kind of cellular reprogramming we can use to restore optic nerves and eyesight may one day offer us the ability to restore function in damaged organs. But what can we do for organs that have completely failed or need to be removed because of a tumor?
Right now, there’s only one way to effectively replace damaged and diseased organs. It’s a morbid truth, but it’s a truth nonetheless: when people pray for an organ to become available for a loved one who needs one, part of what they’re praying for is a deadly car accident.
There’s a lot of irony, or some would say logic, in the fact that the Department of Motor Vehicles is the organization that asks people whether they want to be organ donors: each year in the United States alone, more than 35,000 people are killed in motor vehicle accidents, making this mode of death one of the most reliable sources of tissues and organs. If you haven’t signed up to be an organ donor, I hope you consider it. Between 1988 and 2006, the number of people waiting for a new organ grew sixfold. As I write this sentence, there are 114,271 people on the US online registry waiting for organ transplants, and every ten minutes, someone new is added to the transplant waitlist.43
It’s even worse for patients in Japan, where the ability to get an organ transplant remains far below those of Western countries. The reasons are both cultural and legal. In 1968, the Buddhist belief that the body should not be divided after death fueled an emotion-laden firestorm in the media about whether the first Japanese heart donor had truly been “brain dead” when the heart was removed by Dr. Juro Wada. A strict law was immediately enacted that banned the removal of organs from a cadaver until the heart had stopped beating. The law was relaxed thirty years later, but the Japanese remain divided on the issue and good organs remain hard to come by.
My brother also suffers from an eye disease called keratoconus, which caused the corneas covering his lenses to wrinkle like a finger pushed into plastic wrap. To treat this, he had two separate corneal transplant surgeries, one in his twenties, the other in his thirties, that swapped two other people’s corneas for his. Both times, he suffered through six months of corneal stitches that felt like “branches” in his eyes, but his vision was saved. The fact that Nick now literally sees the world through others’ eyes is an amusing topic for dinner conversation that belies the true depth of our family’s gratefulness to his deceased donors.
Now, as we rapidly approach the era of self-driving cars—a technological and social paradigm shift that almost every expert expects will rapidly reduce car crashes—we need to confront an important question: Where will the organs come from?
The geneticist Luhan Yang and her former mentor Professor George Church in my department at Harvard Medical School had just discovered how to gene edit mammalian cells when they began working to edit out genes in pigs. To what end? They envisioned a world in which pig farmers raise animals specifically designed to produce organs for the millions of people who are on transplant waiting lists. Though scientists have had dreams of widespread “xenotransplantation” for many decades, Yang took one of the biggest steps toward that goal when she and her colleagues demonstrated that they could use gene editing to eliminate dozens of retroviral genes from pigs that currently prevent them from donating organs. That’s not the only obstacle to xenotransplantation, but it’s a big one—and one that Yang figured out how to overcome before her 32nd birthday.
That’s not the only way we’ll be getting organs in the future. Ever since researchers discovered in the early 2000s that they could modify inkjet printers to lay down 3D layers of living cells, scientists around the world have been working toward the goal of printing living tissue. Today scientists have implanted printed ovaries into mice and spliced printed arteries into monkeys. Others are working on printing skeletal tissue to fix broken bones. And printed skin is likely to start being used for grafts in the next few years, with livers and kidneys coming soon after that and hearts—which are a bit more complicated—a few years behind.
Soon it won’t matter if the morbid pipeline for human organ transplantation ends. That pipeline never met the demand anyway. In the future, when we need body parts, we might very well print them, perhaps by using our own stem cells, which will be harvested and stored for just such an occasion, or even using reprogrammed cells taken from blood or a mouth swab. And because there won’t be competition for these organs, we won’t have to wait for things to go catastrophically wrong for someone else to get one—we’ll only have to wait for the printer to do its job.
Is all this hard to imagine? That’s understandable. We’ve spent a long time building up our expectations of what medical care should look like—and indeed what human life should look like. For a lot of people, it’s simply easier to say, “I just don’t believe that will happen,” and leave things at that.
But we’re actually quite a bit better at changing our minds about what we expect out of life, and what age actually means, than many of us think we are.
Consider Tom Cruise. As the Top Gun actor entered his late 50s, with bulging muscles and a straight line of dark hair sprouting from a minimally wrinkled forehead, he was still at work. Not just acting, but doing the sort of acting that has long been the purview of much younger actors. He was still doing many of his own dangerous stunts, too: riding motorcycles at high speed through alleys, being strapped to the outside of a plane as it takes off, hanging off the top of the world’s tallest building, skydiving from the upper reaches of the atmosphere.
How easily do the words “Fifty is the new thirty” slide from our lips these days? We forget what we used to expect life past 50 to look like, not hundreds of years in the past but just a few decades ago.
It didn’t look like Tom Cruise jumping out of airplanes. It looked like Wilford Brimley. In the 1980s, Brimley was one of Cruise’s costars in the movie The Firm. Cruise was 39 and Brimley 58, already a gray-haired old man with a walrus mustache.
A few years earlier, Brimley had starred in Cocoon, a movie about a group of senior citizens who stumble upon an alien “fountain of youth” that gives them the energy—although not the looks—of their youth. The image of old folks running around like teenagers was played to great comedic effect.
It was audacious to think of someone that age acting so youthful. At the time the movie was released, though, Brimley was five or six years younger than Cruise is now. According to Ian Crouch of the New Yorker, Cruise has easily blasted through what he calls “the Brimley Barrier.”44
Barriers fall. And they will fall again. In another generation, we’ll be well accustomed to seeing movie stars in their 60s and 70s riding motorcycles at high speeds, jumping from great heights, and delivering kung fu kicks high into the air. Because 60 will be the new 40. Then 70 will be the new 40. And on it will go.
When will this happen? It’s already happening. It is not fanciful to say that if you are reading these words, you are likely to benefit from this revolution; you will look younger, act younger, and be younger—both physically and mentally. You will live longer, and those extra years will be better.
Yes, it is true that any one technology might lead to a dead end. But there is simply no way that all of them will fail. Taken separately, any of these innovations in pharmaceuticals, precision medicine, emergency care, and public health would save lives, providing extra years that would otherwise have been lost. When we take them together, though, we are staring up the road at decades of longer, healthier life.
Each new discovery creates new potential. Each minute saved in the quest for faster and more accurate gene sequencing can help save lives. Even if it doesn’t move the needle much on the maximum number of years we live, this age of innovation will ensure that we stay much healthier much longer.