Fitness wearables for disease prevention should be the new norm says Dr Michael Snyder, a leading figure in genomics and personalised medicine. Ark Invest FYI interviewed him about his preventative medicine, AI, and comprehensive multi-omics analysis for predicting and preventing diseases.
Dr Synder explained the challenges and future directions of personalized medicine. His insights on remote monitoring, longitudinal health tracking, and the critical role of data in transforming healthcare from reactive to proactive are worth listening to. Moreover, he pointed out that the medical and healthcare professions funded disease, but were backward in funding primary healthcare to prevent disease.
Fitness Wearables For Disease Prevention Work
Dr. Snyder is the cofounder of Personalis, SensOmics, Qbio @qbioinc, January AI, Filtricine, Mirvie, Protos, Protometrix (now part of Thermo-Fisher). Affomix (now part of Illumina). He serves on the board of a number of companies. Dr Snyder is the author of the book: “Genomics and Personalized Medicine: What Everyone Needs to Know”. (Amazon)
Today genomics, part of a larger movement toward personalized medicine, is poised to revolutionize health care.
Lifestyle Diseases are Increasing
Obesity is Rising
Lifestyle diseases, heart disease all rising.
Cancer Rates
Cancer rates are higher in western countries. Early detection improves survivability.
Cancer Types
The top 5 cancers are breast, lung, prostate, colorectum and pancreatic cancer. Early detection decreases mortality.
Heart Disease
Global deaths from heart and circulatory diseases averages 56,000 people each day or one death every 1.5 seconds. They are the world’s biggest killers. Globally, heart and circulatory diseases killed an estimated 9.8 million men and 9.2 million women in 2019. Heart disease accounts for over 1 in 4 (27 per cent) of all global deaths. [2]. While the total number of deaths is increasing, the age standardised numbers have been decreasing. Heart disease in women is rising.
- In high-income countries: Heart disease death rates have generally declined over the past decades due to better prevention, early detection, and treatment.
- Low- and middle-income countries: Heart disease deaths are now rising, often outpacing declines in other causes of death. This is likely due to several factors, including:
- Increased risk factors like smoking, unhealthy diet, and physical inactivity.
- Limited access to healthcare services for prevention, diagnosis, and treatment.
Genetic Testing
Genetics provide 26% of our health and longevity. We used to study one gene at a time and it was cumbersome. Now, technology allows study of all the genes at once. This systems approach bringing genetics to medicine has led to more understanding and powerful diagnosis. Cross-referencing an individual’s genetic sequence – their genome – against known elements of “Big Data” brings new insights. Elements of genomics are already being incorporated on a widespread basis, including prenatal disease screening and targeted cancer treatments. Dr Synder says the cost of this is coming down towards $100 per full test of the genomic makeup.
While genetics only provides 16% of ones lifespan, it does provide a blueprint for physical appearance, disease propensity and behaviour. Health is not genes per se, but the regulation of them. Gene regulation, or turning the genes off or on is now the new medicine.
A few genes predict mutations for some diseases like breast cancer genes, but these are the rareities.
AI is incredibly important in understanding the whole system.For example in ALS (Amyotrophic lateral sclerosis) which is nerve / spinal disease. Traditional genomics suggested 7 genes were the cause, but it turns out that with AI researchers found over 695 genes controlled the expression of ALS.
What’s the 84% of Life Expectancy? – Lifestyle
The 84% of life expectancy is incredibly complex. Which life style behaviour will impact life expectancy. Some factors are known, but there are many unknown including epigenetics which is external factors changing gene expression. Synder was confidence research is slowly knocking off the unknown causes. Microbiome is a part of the equation.
He expressed confidence that it was possible to modify lifestyle to get to living to 120 years, although he said 200 years was possible. Some factors are known. E.g. 9% of Americans are diabetic, and 33% are pre-diabetic. Those numbers are rising. Lifestyle changes and behaviours can be influenced by technology and feedback practices, including continuous glucose monitors and real time feedback.
How to Live to 200 Years, or 120
Dr Synder says there is no physical reason not to be able to live to 200 years. To do so, one would want to live a pain-free and productive life, die quickly at the end, and not linger for decades. The research will get to a stage to identify a healthy baseline, and the type of life to live. Found 4 key factors today include:
- Genetics – but only 18% contribution to longevity.
- Exercise, and especially weight lifting. Weights reduce muscle mass loss (sarcopenia). Muscle mass decreases approximately 3–8% per decade after the age of 30 and this rate of decline is even higher after the age of 60. I.e. over 0.2kg to 0.6 kg per year (2 to 8kg per decade)
- Glucose continuous monitoring. Monitors are available for less than $100, and provide constant monitoring to enable
- Smartwatch to enable continuous monitoring and feedback
More Measurements
Current medical tests are less than 15 but even then, some are not important. Research has demonstrated there are hundreds of measure. DNA, molecules, RNA, body and gut (microbiome). Synder started a project 11 years ago with 109 people and took over 1,000 measures of each of them.
The measures caught diseases before they had any symptoms. Within the first 3 years, the study caught 49 people with presymptomatic diseases including one with lymphoma, 2 people with precancer, and 2 people with severe heart issues.
Deep data analysis is required to understand over 800 measures, including whole-body MRI, The MRI study caught pre-ovarian and pancreatic cancers in the study cohort. If cancer is caught early, medicine can treat the cancer. Catching these diseases after symptoms appear is disastrous and likely to fail.
Monitor
A key part of the measuring is to use wearables to monitor and adjust lifestyle. Over 50% of the global population own a smartphone. A smart watch / monitor can provide most of the monitoring. Wearables are incredible health monitors, and wearing them 24 hours measures heart rate variability – which is a key measure for many diseases. Blood oxygen is not very accurate but is good enough to see changes. Delta maps are more important than absolute values.
Some of the other measurements that smartwatches can do include dry skin, which is indication of diabetics. Blood pressure. Haemoglobin levels. Using a continuous blood glucose monitor to measure the interstitial glucose provides a baseline, and then AI can predict ongoing glucose levels..
Eg. Covid and viral infections – can pick up Covid 80% and 3 days before systems. Moreover, stress is picked up, or even mental health stress. Inclusion of this external sensitive data has cybersecurity and privacy risks.
Dr Snyder was asked when this becomes normal. He said to start out with smartwatch, and the challenge is to get the medical fraternity onside. He suggested that there needs to be some financial incentives. Doctors may only spend 6 to 15 minutes in a consultation whereas the monitor is continuous and with AI can assess hundreds of measures.
Dashboards – Just Like a Car
While the research area is working out all the measures, a dashboard can summarise the whole complex data. All cars have a dashboard. Oil light, brake lights, doors open. A racecar may have up to 400 sensors, but they use a dashboard to summarise, but can drill down to the information needed.
Health monitoring is similar, and currently, medical information is poorly organised. Information is often in silos, and not easily accessible. Snyder envisages a dashboard, e.g a Cardiovascular light goes off and the physician or specialist can dig down to see which sensor has been triggered and follow up that.
Pathology reports and imaging are still poorly recorded and reused.
Human Tumour Atlas
They discussed the human tumour atlas. HTAN is a National Cancer Institute (NCI)-funded Cancer MoonshotSM initiative to construct 3-dimensional atlases of the dynamic cellular, morphological, and molecular features of human cancers as they evolve from precancerous lesions to advanced disease. Humans are loaded with cancer cells. Most don’t cause cancer. Our immune system keeps them in check, and that is why more cancer comes to older ones as the immune system becomes less effective at age. Environment also keeps the cancer from growing.
More Reading
- Genomics and Personalized Medicine: What Everyone Needs to Know® Michael Synder https://www.amazon.com.au/Genomics-Personalized-Medicine-Everyone-Needs/dp/0190234768
- Global Heart & Circulatory Diseases Factsheet https://www.bhf.org.uk/-/media/files/for-professionals/research/heart-statistics/bhf-cvd-statistics-global-factsheet.pdf
