3 Questions – 3 Answers: Bioviva

A new format starts here on the blog: The 2b AHEAD expert network in dialogue. Health experts regularly raise relevant questions on the future of health. Other experts from our network comment on this – and in turn ask new questions that will go to new experts. In this way, an inspiring dialogue grows and we will continue to expand it. Would you like to become a part of it? Just send me a short mail or comment here.

In the focus today: Liz Parish and Avi Roy from Bioviva

The expert questions today go to Liz Parrish, founder and CEO of Bioviva, and Avi Roy, CTO of Bioviva. Bioviva is one of the pioneers of telomerase – or to describe the result: Bioviva is working to prolong human life by intervening in the genetic code. Significantly prolonging it. Bioviva’s research focuses on the ageing processes of individual cells. Parrish, Roy & Team are among the most important drivers of the longevity movement.

Success-based medicine

Peter Ohnemus, DacadooPeter Ohnemus, Founder and CEO of dacadoo: With digital health, the proof of positive outcomes of drugs can be fully documented. When do we want to start designing a 100% outcome-based healthcare system?

 

Liz Parrish, BiovivaLiz Parrish, Founder and CEO of Bioviva: We do not have any evidence to support the claim the ‘digital health’ can absolutely prove positive (or negative) outcomes for drug trials. Most molecular and physiological biomarkers are hard to measure digitally without having an advanced molecular pathology lab. But regardless, your question regarding the outcome-based healthcare system is a valid one. Currently, in the UK the National Institute for Health and Care Excellence (NICE) balances the choices of medicines available to patients based on a multifactorial assessment of cost-effectiveness, opportunity costs associated with decisions, and the impact of treatment option on quality-adjusted life years (QALY). QALY’s and disability-adjusted life years (DALY) are the main outcome-based method to test the efficacy of a treatment in a healthcare system. Although flawed this is currently considered the gold standard by health economists and politicians. In conclusion, all countries that can afford to have a functioning health care system try to assess the efficacy of treatments based on outcomes, but the biomedical science community need to provide them with better biomarkers than QALY and DALY’s.

Who do we trust?

Arkadiusz Miernik, Universität FreiburgProfessor Arkadiusz Miernik, Freiburg University:  Should we trust the big pharmaceutical companies or rather biohackers in the future?

 

 

Liz Parrish 2, BiovivaLiz Parrish: We think that it is foolish to blindly trust any organisation or system. At BioViva we really like the Russian proverb, which was used by President Ronald Reagan on many occasions, “Trust but verify.” To elaborate, we are building a standardized bioinformatics testing platform which will test the efficacy of anti-ageing treatments regardless of them being produced by big pharmaceutical companies, or small biotech startups, or indeed biohackers.

Consequences for the immune system

Florina Speth, 2b AHEADFlorina Speth, Senior Researcher, 2b AHEAD ThinkTank: How does our immune system react when we continuously and permanently prevent diseases?

 

Avi Roy, BiovivaAvi Roy, CTO, Bioviva: Dr Speth, I am not quite sure that I understand your question, but I’ll try to answer it. In biogerontological research, and at bioviva we are trying to rejuvenate the human body and its organs and tissues at a cellular level. Our research and therapeutics target the hallmarks of cellular ageing which includes genomic instability, telomere attrition, epigenetic alteration, loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, and altered intercellular communication.  these processes happen in every cell type in the human body. when we think about treating a disease we are not necessarily thinking about cardiovascular disease or dementia instead we are targeting these fundamental cellular processes that go awry overtime. Therefore immune system cells will be beneficially affected by these anti-ageing treatments and would produce favourable outcomes. We imagine a future where we can rejuvenate long live cells, kill cells that are senescent or cancerous, and create new functional cells from stem cells.

Demographic change and healthcare: Good News

Demographic change and healthcare: The core business of health insurance in the future will no longer just be healing the sick. Health insurers will support healthy people – from the prevention of diseases to increasing well-being and life expectancy. This is the result of a current trend study by 2b AHEAD ThinkTank. Demographic change has a direct impact here.

Trend study health insurance

The healthcare sector will undergo unprecedented change by 2030. With digitalization, the possibilities of medical research, diagnostics, therapy, rehabilitation and prevention are growing at exponential speed. These effects are nowhere more evident than among the fastest-growing groups in our society:

  • The old who don’t feel old even when they retire,
  • the still older, who in many cases can still lead an active and active life, and
  • the very old, still rare today, soon an everyday occurrence.
The good news

The majority of today’s forecasts and future studies address demographic change as a problem and a threat. Of course, it will present us with social and economic challenges of an unprecedented scale. But for both individuals and our communities, demographic change represents the greatest conceivable progress: the considerable extension of one’s own life in activity and self-determination. Demographic change may be expensive news, but above all it is good news.

People born in this decade realistically reach an age of over 100 years. It is the interaction of four influential drivers that brings the dream of longer life within reach. The first condition is the freely available gene analysis. The second development concerns the breeding of individual copies of internal organs, which may be optimised compared to the previous version. The third prerequisite is a comprehensive understanding of the aging processes of humans. The fourth element is the synchronization of the human psyche with the virtual world. A breakthrough in research in all four fields is likely in the coming years.

For the sake of completeness: There is a well-founded opposite position to this, especially taken up here in the blog. It is represented among others by the medical ethicist Ezekiel J. Emanuel. He fears extension as a phase of helplessness and diminishing dignity.

The increase of well-being

A decisive change in dealing with human health is the disappearance of the binary assumption that a patient is either healthy or ill. This categorical distinction has always been a fiction anyway. Nobody’s just sick or just healthy. Instead – assuming the corresponding amount of data and its continuous collection – the individual well-being can be measured and located on a scale. This is changing the goal of medical action. While yesterday the focus was on repair and damage prevention, tomorrow it will be on gradually improving one’s own well-being. What can I do to feel a little better tomorrow – and who will support me? The enlightened healthcare customers of the future are very consciously and with the support of digital assistance systems selecting the most competent physician for their situation, the appropriate insurance and the trustworthy data manager from their individual healthcare network. At the same time, they will no longer accept that the interaction of several service providers is associated with increased effort for them.

In the near future, evidence-based, personalised recommendations for targeted prevention will replace the always identical bonus booklets of health insurance companies and lump-sum and overall undirected health-promoting measures.

Test Case Robotics in Nursing

This can be clearly seen in the emergence of robotics in care. Robotics became a widely accepted matter of course in the course of the 1920s. This has long been the case in the field of dementia care. The fact that a robot has the patience to listen to the same question, the same story, the same excitement over and over again as it did the first time makes this development even easier.

However, the development will not be limited to animated stuffed animals. This is shown in the example of medication. Where nursing staff still have to work by hand today, the procedure is time-consuming and prone to errors. The next step is automated dispensing of medication to the patient at home: individual implementation of the medication plan by a pill robot. In the next step, robots learn to analyse the state of health of humans. By blood sample, air analysis, nutrition tracking, later by observing the skin temperature, the movement patterns and by voice analysis. The dosage of the active ingredient is calculated in real time.

In the next expansion stage, the medication robot is able to print the individually appropriate active ingredients onto a carrier directly before ingestion. Is this a relief for the nursing service? With great certainty. Does this development, and thus indirectly the demographic change, have the potential to improve the well-being of the individual patient? With a very high probability. These are the simple questions. But whose knowledge is the robot`s work based on? As soon as he has access to networked medical knowledge, his professional competence will always be higher than that of the individual doctor. For the time being, the family doctor is still needed to issue prescriptions, which also makes up for a reason to exist professionally. His profession will change permanently, a thesis that Markus Bönig of Vitabook has just confirmed here. The medicines or active ingredients do not have to be purchased in the pharmacy around the corner anyway. This opens up completely new business areas for new players.

Smart Home

An additional driver of this development is the currently exponentially growing networking of buildings, starting with Ambient Assistant Living. The smart home of the person in need of care is the first and most competent care robot. This means that completely new players are suddenly active in the health industry: Network operators, property managers, building contractors, manufacturers of electronics and sensor technology. This, too, is an indirect consequence of demographic change.

Health insurers as the health promoters of the future must start much earlier in the process, which means that they will occupy a much more active and positive position in the perception of health customers. The one-size-fits-it-all-principle has had its day. In future, health promoters will not react only when health customers are ill, but will continuously monitor their current state of health and act before the onset of a foreseeable illness. This too: That’s good news.

 

Healthcare in old age: Why this man limits his medical care himself

We live longer and longer. So far so familiar. In any case, from a Western perspective, this is basically synonymous with: This is an enormous step forward in civilization. We are getting older – and we will be able to enjoy the gain in lifetime healthy and fit. Healthcare in old age ensures that we extend the phase of active life. It promises to limit and limit the time of helpless, suffering existence.

The counter thesis represents Ezekiel J. Emanuel, oncologist and medical ethicist at the University of Pennsylvania. He’s pointing: We’ll postpone the date of our death. The time, however, when we can no longer live fit and active, is moving forward. And drastically. His consequence: He plans to limit his life. 75 is a good age to be remembered positively by family and friends. To be precise, Emanuel is not planning suicide or euthanasia. But after his 75th birthday he will only accept palliative medicine, not curative medicine. No tests for prevention, no nutritional optimization, no exercises for mental fitness. Healthcare in old age exclusively for the well-being, not for the prolongation of life.

Ezekiel Emanuel Healthcare im AlterHe published his position and the underlying statistics in a detailed article in The Atlantic: Why I hope to die at 75. The editor Mareike Kürschner took up a conversation again and now, four years after the statement, asked again (Paywall). Meanwhile Emanuel is 61 years old – the self-chosen end is in sight. We’re in position.

The path to self-determination

Two thoughts stand out: Emanuel describes quite touchingly how the fact of the self-chosen end completely changes his perspective on the years before. How he feels activated to take care of the big questions of life. To attract important people from his environment, to learn, experience, experience… Obviously, the limitation of life expectancy leads to exactly the degree of self-determination and self-efficacy that healthcare providers often promise in vain in old age.

The second idea lies on a higher level: We afford to spend a considerable portion of the health care costs for the last 14 days of life alone. Against this background, the conscious renunciation of the attempt of healthcare in old age to find out a few more months of life is almost revolutionary. As understandable as this attempt may be in individual cases – from an overarching perspective it sometimes seems somewhat desperate.

I put this up for discussion: the better we understand how to prolong human life, the greater our responsibility grows to determine the point in time at which the bow closes with dignity. tbc.