Book Review: The Age of Scientific Wellness
Lee Hood’s company Arivale showed us how to do preventive, personalized health care. His book explores the science — and the missed opportunity.
When scientists at Seattle’s acclaimed Institute for Systems Biology started a new wellness company in 2015, they knew they would find interesting, actionable health advice for their customers. But despite its scientific success, their new startup Arivale filed for bankruptcy in 2019. What happened?
The company was run by the same researchers who had just completed the largest study of its kind at the time, a deep dive into the genomes, microbiomes, blood markers and lifestyles of 100 people at multiple time points over several years. Their study goal was to prove the value of a systems approach to health, which they described as “P4 Medicine” — predictive, preventative, personalized, and participatory. And now Arivale would open the same high-resolution P4 approach to anyone willing to pay the $2,000 annual price for access to their state-of-the-art medical testing. Customers could benefit from direct access to the cutting edge, and the scientists would get a stream of willing subjects to pay for the research.
It seemed like a slam dunk. Already millions of people were paying for genomics services from 23andMe, and this was way more comprehensive.
In their new book The Age of Scientific Wellness, Arivale co-founder Lee Hood and his fellow Institute for Systems Biology scientist Nathan Price describe in readable and fascinating detail the science behind the project and the many discoveries they made along the way. As a close Arivale follower from the beginning, I enjoyed reading the behind-the-scenes scientific insights — many of which I learned here for the first time — a fascinating glimpse into what could be the future of health care for everyone even as a cautionary tale of why that dream ultimately couldn’t quite match reality in this case.
No data like the present
Arivale treated its community like family, hosting happy hours and many private events, including cooking lessons that focused on in-depth discussions of the science of personalized health. I often met Hood, Price, and other scientists at these events, including once when Hood, who in his 80s boasts about doing 100 push-ups daily to stay in shape, chided his younger co-author Price for not doing the same. “It’s not fair,” quipped Price. “He has a 40-year head start!”
Long before Arivale, Lee Hood was an acclaimed genomics pioneer, the inventor of an automated DNA sequencer and other instruments that paved the way for the Human Genome Project, and he had played a key role in founding numerous biotech companies, including Amgen, Applied Biosystems, Rosetta Inpharmatics, and many others. Along the way, he became convinced that the human body is a holistic system, not a reductionist series of parts to be poked separately when things go wrong.
Counting the data from Arivale, he and his fellow scientists eventually collected detailed physiological measures for more than 5,000 individuals and, importantly, the data was longitudinal — they took measurements regularly over time. When any of the 5,000 people later became ill, the scientists were able to “rewind the tape” to pinpoint exactly which biomarkers had changed — in some cases a year or more before any symptoms appeared. With each new such case uncovered, they were able to apply what they learned to others in the program — in some cases forestalling completely the potential bad outcomes.
For instance, “Lynn” was an apparently healthy, active woman of normal weight who ate an excellent diet full of vegetables, fruits, and lean meats. But her stubbornly high cholesterol levels would have signaled to a regular physician the need for a simple prescription for a statin or some other cholesterol-lowering drug. But the Arivale team, with its systems approach, noticed something else: thyroid markers that indicated an early-stage autoimmune condition. By adjusting her diet and adding some over-the-counter supplements, her thyroid function improved — and her cholesterol returned to normal.
The book gives many such examples, including one that even today should frustrate everyone in the Arivale data set: When their scientists uncovered an intriguing new biomarker that appeared to predict pancreatic cancer in one participant, federal regulations prevented the company from disclosing the information without laborious clinical trials, FDA approval, and physician guidance. Nevertheless, such discoveries demonstrate both the cutting-edge nature of their research and the potential.
The fickle wellness customer
Many books have been written about why the American health care system has failed to bring all the latest breathtaking science and technology to those of us who need it most. The Age of Scientific Wellness offers a peek into how scientists have been trying to solve this bottleneck for themselves and their loved ones — and how the rest of us can follow in their footsteps.
One example: applying a systems approach to Alzheimer’s disease, which tragically affected Lee Hood’s own wife. His lengthy speculations about the cause and potential treatments is worth a book all by itself — and I’d recommend reading this one to anyone with family or loved ones with the condition. Dale Bredesen’s controversial “ReCODE protocol” approach, for example, which calls for a personalized therapy for individuals with multiple treatments, is worth investigating, says Hood. Like most treatments based on wellness, the specifics will vary depending on the person, and usually involve active and regular testing for cognitive decline. Much of the focus is on a low-carb ketogenic-like diet, augmented with targeted supplements and probiotics, plus brain-stimulating games and stress-lowering exercises.
For many of us — especially as we age — wellness is not normal.
If you Google for details, you’ll find counter-claims saying the protocol is ineffective and overhyped, but Hood disagrees. Much of the pushback, he says, comes from Bredesen’s carelessness in an early study, long since corrected. This is not a theoretical exercise for Hood: Both he and his wife share a bad copy of the APOE-4 early-onset Alzheimer’s risk gene, passed along to their son, now aged 57, who inherited two copies that put him at high risk. This is one doctor who literally takes his own medicine.
Other examples, from genomics: Did you know that 5 percent of all people suffer from one of 76 disease-causing genetic variants identified by the American Society of Human Genetics as “actionable for prevention”? If you have one of those variants — like those known to affect many cancers, your optimal dosage for various drugs, athletic ability, and more — taking steps to avoid negative outcomes should be a no-brainer.
Similarly, for many of us — especially as we age — wellness is not normal. Fully 78 percent of Americans over 55 live with at least one chronic disease (like diabetes or high blood pressure). Among 65-year-olds, that number rises to 86 percent, half of whom have two or more. New commercial tests for biological age — and watching the speed at which it changes relative to your chronological age — is another way each of us can find early signs that we are going off track and take countermeasures. (Co-author Nathan Price is now chief scientific officer at Thorne HealthTech, which sells one of those tests for $95 based on the research highlighted in the book.)
It seems so obvious. What could be more important than a healthy body? The question is not so much who would pay a premium to access the latest science and be as healthy as possible — it’s who wouldn’t pay for that privilege? And that’s where the story takes a tragic turn: Too many people, as it turns out.
Including me. As an active and healthy person who has spent years testing the latest scientific ideas and high-tech gizmos for maintaining health, $2,000 just didn’t seem worth it. I signed on after they slashed the price (they eventually dropped it to a money-losing $99/month) but in my case I didn’t learn anything I didn’t already know.
The compelling anecdotes in The Age of Scientific Wellness are interesting precisely because they are exceptional — often remarkable — examples that wouldn’t have been caught otherwise. For most of us, most of the time, health isn’t rocket science — or any other kind of science. You already know what to do: eat more fruits and vegetables, maintain a healthy weight, get some exercise, sleep. And for God’s sake, don’t smoke. But far too many people don’t do these things — even when their doctors tell them they should.
Yes, there are intriguing counter-examples — and the book is chock-full of them — but most of the Arivale customers I knew personally were already aware of the biggest changes they needed to make. The hefty entry price, sometimes paid on behalf of a concerned spouse, was often just an incentive to get serious about obesity and fitness issues and lay off on the double chocolate brownies. Beyond that, much of the premise behind Arivale depends on continued, regular testing that may catch something eventually — or may reveal something retrospectively — a value that is hard to pin down.
Most of us (or our employers) already pay too much for health insurance. We don’t understand why our regular health care providers can’t offer the services Arivale promised. Shouldn’t the testing, monitoring, and advice be included in my annual physical?
Maybe soon, it will. Many of the P4 Medicine discoveries are already being incorporated into powerful new AI models that will greatly extend the diagnostic firepower of existing doctors and their assistants. The important research pioneered by the Arivale scientists is a peek at the future for all of us. The Age of Scientific Wellness is coming.
Originally published at https://proto.life.
