November 5, 2015
By Vikas Saini, MD
Last month, Craig Venter’s venture, Human Longevity, through a news release, launched Health Nucleus, “a platform that uses whole genome sequence analysis, advanced clinical imaging and innovative machine learning—combined with a comprehensive curation of personal health history—to deliver the most complete picture of individual health.”
On its heels, there was lots of buzz, like here and here. Stat News reported today, noting that some doctors question whether Health Nucleus was really on to something. Would the tests tell patients anything meaningful at all? In interviews with physicians, among them Drs. Rita Redberg and Eric Topol, doubts remained. Stat reported the venture “could lead consumers to believe that more testing means improved health. That notion, they say, could drive customers to get procedures they don’t need, which might even be harmful.”
Here’s what I think: We are in the very earliest innings of a new era, and Venter’s venture is at the cutting edge of it. It’s very impressive.
There will undoubtedly be some very interesting discoveries about the association between genetics, metabolism, the microbiome, and perhaps particular disease conditions. Hopefully, it will open up paths for novel, game-changing treatments. But all of that is going to take a lot of time, and during that time, the signal to noise ratio is going to be really low.
Meanwhile, a big problem with the venture, as others have speculated, is that it plays to the incorrect cultural assumption that more information is always better when that is not really true.
Any correlations found by machine learning techniques between the various huge datasets will be remain very ambiguous for quite a while. They’ll need confirmation, then they’ll need prospective validation, since back-testing is not the same as predicting – ask any quant fund on Wall Street. The meaning and implications of a lot of the findings and correlations won’t be known until outcomes—many, many years later— have occurred.
Whole body imaging is going to discover a lot of incidentalomas and cause needless anxiety and some harms—in short, a lot of mayhem, if they are pursued invasively. Similarly, there will be a lot of correlations that seem important but turn out to be spurious.
Initiatives like this, and for that matter the President’s Precision Medicine proposal, tend to overpromise and overhype in order to convince people to part with their money and fund it. Congress, including Massachusetts Senator Elizabeth Warren, seems like a particularly easy mark for that these days.
It’s disturbing that Health Nucleus was able to sidestep FDA restrictions on the clinical use of experimental tests by operating as a clinical research project under (IRB) protocols. The fact that their early stage business revenue model seems to rely on an IRB shows how badly blurred the lines between basic research, product development, efficacy trials, and marketing have become. To me, that’s part of a more general corruption of the process of knowledge production these days.
I strongly doubt that the $25,000 or $50,000 they spend is going to make them live longer. Of course there will be one or two isolated success stories that will get hyped to justify the venture, but for the vast majority of customers, it is unlikely to yield any meaningful increase in healthspan. The selfish benefit to customers individually will be mostly illusory, and that’s a lot to spend for information that’s interesting but not necessarily impactful.
Earlier this year, Mark Cuban had trouble understanding this point—which may be difficult if you’re a billionaire willing to pay any amount for your health. It would take someone getting their left main artery perforated for the point to sink in. But there are so few billionaires that that is unlikely to happen anytime soon.
The fact that HN had an insurance company commit money says more about the way genomics has been successfully marketed as the next big thing than it does about the value to patients. If I were on the Board of that company, I’d fire the person who cut that deal.
If anything, this kind of spectacle is a strong argument against medical fads for the rich or for private insurance companies playing around with the premium dollar. It certainly demonstrates that some people have more money than they know what to do with or that they need. It’s also a backhanded argument for raising taxes, building more parks and bike paths and paying teachers more. I’d wager that there is a lot more leverage for everyone’s health in doing that than there is in mass genomics testing. In 20 or 30 years, we’ll know exactly how to factor all this information into decision-making. Right now, it’s an ambitious R&D program, funded by the anxieties of the wealthy.