Even before the Human Genome Project marked its completion way back in 2000, Craig Venter used to carry a holographic information-bearing silicon chip around in his wallet—the kind that you sometimes saw on credit cards—with the photo of a regular-looking guy. This card, Venter would proudly tell people, contained every bit of the man’s genetic code. It could tell you that if he smoked, or that his chances of developing cancer before age 60 were almost 4 out of 10. It revealed whether he might have a genetic tendency toward some mental or emotional illnesses, and explained that he was among the 30 percent of the population that benefited from taking aspirin to fight heart disease (which was good news, because he was carrying the APOE gene—DNA that made him more likely to suffer from strokes and heart disease). Armed with this information, the man could decide what sort of diet might be best for him, explore the time of day he was most productive, maybe even improve his chances of finding a compatible mate.
Where did this font of biological data come from? How could anybody, even Craig Venter, have information like this in his back pocket in 1999? Well, he couldn’t. It was just a mock-up Venter used during lectures, a fake illustration. But back then, he assured people, once genomes were cheap enough to be sequenced, once all the nitty-gritty details of selfness were properly nailed down, the day would come when people would have that card in their hands and could take control of their lives—because the vast genomic database at their disposal would allow each and every person to know all there was to know about their medical future.
It took 15 years, but in October 2015, Venter finally envisioned a service at Human Longevity, Inc., that could begin to deliver the very insights that faux chip had only pretended to provide. At last, the technology was catching up with the concept. Venter even had a name for it. He called it the Health Nucleus. For an eye-watering $25,000, it guaranteed that whoever cared to come to HLI’s San Diego offices could be as biologically scrutinized as any human on the planet.
In the corporate world, companies often examined the health of potential CEOs or other corner-office executives. But Health Nucleus made those checkups look like the diagnostic equivalent of a grade school nurse asking little boys to turn their heads and cough. Several of the tests were so advanced that under FDA rules, HLI had to characterize the service as part of a study. This essentially made the patient a complicit lab rat in a large experiment designed to accumulate the highest quality genotypic and phenotypic information HLI could gather, while generating some income along the way. Whoever signed on to Health Nucleus would not only have their genomes inspected, but also their bodies, brains, gaits, and bone density—even their metabolites and microbiomes—all the better to delay the inevitable date of their particular demise.
To anyone not checking beneath the surface, Health Nucleus might look like a money grab; an innovative way to rob as many members of the One Percent of their excess cash as possible. But the service was absolutely legitimate. It also promised that as new information emerged, participating customers would be updated on an ongoing basis.
Besides, Venter had to make some money. By July 2016, HLI had raised north of $300 million. But the investment had come from traditional investors who (because they didn’t include Larry Page and the generous people on the Alphabet board) required, if not profit, then at least revenue, some return on investment. This meant Venter had to generate income and get actual research done at the same time, and that sometimes made life a royal pain. After all, who wouldn’t prefer to do pure research and wrestle with the sublime mysteries of human biology without having investors breathing down one’s neck? But how had Mick Jagger once put it? “You can’t always get what you want.”
Not that it was in Venter’s nature to bide his time anyway. He relished concrete, preferably spectacular, results, just as he had with Celera during his battles over the Human Genome Project, his creation of the first synthetic life-form, and the Face Project. That was why it was so important to not simply tweak the medical arts, but to revolutionize them. Thus came HLI’s Health Nucleus, a doorway to reinvention.
FOR ANYONE WHO WANTS to take advantage of HLI’s Health Nucleus service, there are certain protocols. They aren’t the Final Protocols, like the ones practiced at Alcor—the opposite, really—all about avoiding the requirements of Alcor’s Chill Chamber. Before arriving, each client is politely asked to fill out all manner of online questionnaires about their health, and to submit every bit of medical information possible to the assigned Health Nucleus physician: recent blood tests, brain scans or MRIs, histories of surgery or illness—as much phenotypic information as possible.
On the surface this seems reasonable enough, but occasionally the questionnaires could cause dark thoughts to arise in a patient’s mind. Take the section on magnetic resonance imaging (MRI). “The MRI…produces detailed pictures of organs, soft tissues, bones, and virtually all other internal body structures…[and helps] researchers quantify volumes of different parts of the brain…to understand your risk of certain neurological conditions that are associated with aging.”
When reading passages like this, the reasonable part of a client’s brain thinks, Well, sure, this makes sense. Why wouldn’t I want to know if I have a brain aneurysm waiting to happen, or that I’m losing neurons at an alarming rate, or my bones are brittle, or cancers that have not yet begun to reveal themselves are lurking within? Knowing these clearly gives me advanced warning, an upper hand.
But then, some of the more unreasonable parts of the brain kick in, like the amygdala, the little fear center lodged in the middle of the brain behind the eyes: But do I really have to know everything about the density of my bones? Or the total content of my body fat, or the discovery that soon my marbles will start trickling south?
When people balked at partaking in the Health Nucleus like this, it confounded Venter. Why wouldn’t they want to know that they had medical problems before they got out of hand, rather than die an early death like his father had? Venter told me about a woman who had read an article about him and the Health Nucleus in Forbes. She tweeted him to say he was evil because he wanted to use the tools to change God’s will. “So cheating death means you’re trying to cheat God?” Venter responded. “He wants you to die of prostate cancer so you better just get on with it?”
For those who partake in the Health Nucleus experience, the scrutiny begins even as the client rolls up to the facility to be greeted by Virgil, the security guard at HLI’s San Diego offices. He’s there with a big smile as patients are escorted into the futuristic confines of a suite. The service is entirely first class. No refrigerator-white walls, no gurneys or saline bags hanging from rolling poles, no beeping and gurgling machines as one waits interminably for the medical amenities. Here, the atmosphere is more spa-like, with bright and engaging staff who provide visitors with spiffy, loose clothing, healthy snacks, both breakfast and lunch to order, even selected reading—simply pick any book on the shelves in your suite, and peruse it while comfortably awaiting the next battery of tests. Take it home afterward, if you like.
Nevertheless, the day of testing itself lasts eight full hours. Shortly upon arrival, the phlebotomist siphons off 20 or so vials of blood. These are needed to entirely sequence the subject’s genome, all three billion base pairs. Companies like Ancestry.com and 23andMe might say they are analyzing your DNA, but the truth is they only look at snippets of it: the parts science already largely understands, like how much Neanderthal DNA you can claim, or what part of the world various members of your family hailed from, and, more recently, in 23andMe’s case, insights into whether you have the genes associated with heart disease or Parkinson’s or Alzheimer’s. These make up a few drops in the oceans of information contained in any human genome.
The Health Nucleus, on the other hand, sequences all the patients’ DNA. They may not understand much of what it means right now, but only by gathering the information in the first place can the great AI algorithms hope to unpeel their secrets. It’s part of the big biomedical feedback loop.
In addition to the genome, the service gathers two other “omes” as well: the metabolome and microbiome. Sampling the metabolome allows scientists to analyze the trillions upon trillions of small molecules roaming within and among the cells of the body that drive millions of yet unknown pathways within. One of the joys of sequencing the microbiome is that it requires a stool sample to get a look at what is going on in your gut.
If science still remains in the dark about the genome, the metabolome and microbiome are even more confounding, like strange hieroglyphs from an ancient culture: undeniably real, but mystifying beyond any sensible ciphering. The metabolome takes science into the wild world of proteins and the marvelous ways they fold, pucker, and build out the hardware that drives every one of the 100 trillion cells within your body. The microbiome is an altogether different system that includes the ranks of invisible symbiotic organisms, mostly bacteria, that live within each member of the human race—usually in the stomach and intestines, but in several other sectors too, including the skin, hair, and eyes.
Amazingly, the microbiome consists of 10 times the genetic information the human genome itself does, and is as much a part of what keeps us alive as our own DNA. It affects diet, health, disease—even emotion. But the details of how all these high-speed transactions take place remain almost entirely mysterious, because only recently did we really learn they existed or had meaning at all. The only sure thing any scientist can say right now is that, together, all of these “omes” somehow communicate with and profoundly affect each person’s life.
In addition to these tests, Health Nucleus patients spend an hour and a half having every centimeter of their brains and bodies scanned. HLI promises the highest resolution MRI scans in the world. Resolutions fine enough to pick out sticky beta-amyloids in the brain or signs of neuronal shrinkage, or cancer tumors the size of a pea. Later, electrocardiograms—movies of a subject’s heart as it goes about its quotidian labors (42 million beats a year)—are administered.
Next comes the DEXA bone density scan, which reveals not only how much muscle a subject has in comparison with body fat, but where the muscle and fat themselves reside—a key indicator of health, or lack of it. Gait tests also assess how subjects move. Telltale signs of a shaky gait can reveal the earliest signs of dementia.
Finally, cognitive tests end the day, monitoring how quickly the brain reacts, as well as how it handles logic, spatial problems, and decision making.
It is difficult to imagine the Health Nucleus running a more thorough examination of your “self,” and by 2016 it was working. Two years in, 500 brains and bodies had been run through HLI’s hardware, thoroughly analyzed and tabulated. Venter had found that fully 30 percent of the clients had discovered some serious problem that they had otherwise been unaware of. Venter was careful to point out that these were not people who had been heading to the hospital because their doctors had found something wrong with them, or because some symptom had made it clear they needed to be treated. These were people who had assumed they were perfectly healthy!
Revelations like that could be sobering. Research suggests that Health Nucleus has been able to detect diseases related to aging that were serious enough to warrant treatment within the next month in 8 percent of its 209 participants. In 2 percent of these participants, early stage cancers were detected.16
Venter told the story of one woman, just 27, who had her brain scanned by Health Nucleus. Deep inside, the doctors found an aneurism: a damaged vessel that looks like a bubble in a tire. Thanks to the discovery, she arranged immediately for a neurosurgeon to remove it. It is possible she could have lived a long life with the aneurism in there waiting to explode, said Venter. But chances are that one day, the vessel would have blown out. “Her first, and last, symptom would have been bleeding to death through her nose.”
Then there was the story of an older couple all prepared to go on an overseas vacation the day after their Health Nucleus visit. They were in good health, they thought, and figured the battery of tests would be a little something they could revisit after they returned. Except the machines found a cancer tumor beneath the breastbone of the husband that had been missed in previous exams. Not long after the surgery, the man contacted Venter to say the exam ruined their vacation, but saved his life. So, thanks.
VENTER LOVED TO TELL STORIES like these. Not that he wanted anyone to be ill, but because the illnesses were discovered early. That was the point. They provided the most dramatic possible examples of the direction he felt medicine should take the human race. You thought you were okay, but you really weren’t. Your body found you out. But that’s a good thing, because now we have predicted the weather of your medical future. Now the trouble can be repaired. Maybe not every time, but far more than if you had remained clueless.
Venter admitted that for now, HLI was mostly using Health Nucleus’s scanners, MRIs, sound waves, and needles to make these discoveries. Maybe that was still a bit reactive in the old-fashioned way, but was that so bad? Already, Health Nucleus was uncovering cancers early enough to cure them. Once the omes—the genome, metabolome, and microbiome—got cranking and the artificial intelligence algorithms began making sense of all that data, then science could get down to creating a new kind of Precision Medicine. At least the current version of the Health Nucleus was a start.
Health Nucleus’s high costs were still a problem, though. After all, who but the wealthy could use such a service? But Venter was working on that, and like the cost of sequencing the genome itself, he was certain the prices would plummet. Brad Perkins, HLI’s chief medical officer, predicted that in 10 years everyone would have his genome sequenced. It would be as normal as checking your ears, and the cost would be zero. But first, gather the data and crunch the numbers. That was the ticket.
Well, one of them, anyhow.