Integrated Healthcare: Thinking Tanks & Shooting Blanks
How do you put shingles on a house with no roof?
How do you fill up on that super premium 93 octane gasoline with no tank?
Pretty tough to do, isn’t it? Yet the world of healthcare has many espousing a similar mantra:
“An overly pulverized bit of collagen that miraculously work into crevices around your aging eyeballs.”
“This newly discovered Nootropic that magically penetrates the top few millimeters of your cerebral cortex.”
Sounds a bit ridiculous, yet it has become the default strategy for many healthcare providers, supplement companies and emerging technologies.
How do I know this? I was one these folks for much too long.
Top Down
We have evolved to think in a pretty linear fashion. It’s simple, and for the most part our brain loves simplicity. Imagine being an early Homo sapien living in a jungle somewhere,
“Me eat food. Me feel good and have energy.”
“Me have sex. Me feel good and make little me. Wow.”
“Me see lion. Me run away. Bye Bye.”
Pretty simple isn’t it? That sort of primal existence didn’t take much thought or nuance. Our ancestors didn’t have or need the brain power to wander the apple isle of the grocery store debating Honey Crisp or Royal Gala the way I do.
But slowly over time things change. Our brains went from a primitive 500 grams to the close to 1500 grams we have today. While many theories abound as to the impetus of this great expansion, I will focus on what I feel is the greatest result of this mass expansion, behavioral flexibility.
Flexible Behavior
Supersizing the brain has bestowed on us a level of behavioral flexibility unmatched in the animal kingdom. Think about it, you have the remarkable ability to convey a particular emotion with one half of your face. There is no other species that can do this.
You plan events long into the future and acquire the information, resources, and anything else necessary to make those plans happen. Our brains are now wired for flexibility and with flexibility comes complexity. 86 billion neurons worth of complexity, waiting and needing your love on a daily basis.
Greedy Brain
The adult brain weighs close to three pounds yet consumes more than 20% of the energy requirements needed on a daily basis. It takes in about 11 million bits of information per second yet consciously processes about 50 bits per second. Where does the rest go? What gets tied up in subconscious or subcortical processing? We just don’t know, yet this becomes critical to understanding the full capacity of the brain, and by default, ourselves.
Reductionism
At the outset it makes perfect sense that when studying a complex system, you break that system down into smaller, more manageable components.
Entire scientific careers are built off of PhD’s studying one particular gene, or specific molecule and this is fantastic and absolutely necessary. We need this level of specificity to understand these individual components. The problem occurs when we take these individual components and move them back into the complex worlds of health and disease.
You can take cancer cells, put them into a petri dish, sprinkle them with blueberry powder and watch as the cancer cells die. Does this mean that blueberry powder cures cancer? Absolutely not. Very few things in medicine or biology work in this sort of reductionist way.
Systems Biology
The opposite of reductionism. Systems Biology takes the individual components and studies the interactions between components rather than just the components themselves. This makes a lot of sense when dealing with the level of variation and complexity inherent to biology.
You tell 20 different people to eat a banana and you can get 20 different insulin responses. Some folks will feel great after, some lethargic, and in a few rare cases even allergic. This is the level of variation we see when eating a banana; imagine the variation when dealing with something as complex as human behavior.
This leads to the major the drawback with a systems biology approach; it’s hard and messy! You need computational models and high-level analysis of vast amounts of data to be able to determine patterns that may emerge from the fragmented pieces of data.
Anxiety as an Example
Reductionist approach: The genes you inherit can definitely play a role in anxiety disorders. Twin studies indicate between 32–67% of inherited influence across certain anxiety disorders. Here are a few examples of genes linked to anxiety:
RBFOX1 (generalized anxiety disorder)
TMEM132D (panic disorder)
SLC6A4 (protein coding for anxiety disorder)
Yet none of these genes, or the many others tied to anxiety are enough on their own to be able to explain a person’s behavior, let alone a diagnosis. The environment as well as gene-environment interactions plays a critical role.
Rates of anxiety have risen sharply during Covid-19. This can ONLY be attributed to the changes in our environment and how our environment interacts with our genes.
Systems biology approach: A more holistic approach involving many of the “omics” we now see in medicine, (genomics, epigenomics, proteomics, transciptomics, metabalomics) as well as neuroimaging, movement, food logs, sleep hygiene etc. That data then gets packaged up and run through Artificial Intelligence and machine learning algorithms that actually get “smarter” as it receives more and more data. Internationally recognized groups like www.netramark.com are emerging as leaders in this complex space.
Systems Biology is also not enough on its own. You need methods in place to filter the vast amounts of data and then classifiers to make sense of it. Then, if swimming upstream wasn’t tough enough already, you need to be able to boil it down even further and make sense of the information back to the patient/user.
Nobody cares that you collected 10 million voxels of data on a brain scan, they want to know what to do about it.
Integrating Biology into Healthcare
A bottom-up approach is key. We must incorporate a diversity of disciplines that complement and challenge one another to unravel the vast complexities of biology and behavior.
Building a house requires skilled disciplines in concrete, forming, electrical, plumbing, drywall, flooring, roofing, design etc. Building a model that addresses the complexities of behavior requires the same approach: a think tank brimming with behaviorists, ecologists, biologists, geneticists, physicians, mathematicians, programmers etc. This is the type of flexible, co-operative effort needed to change healthcare at scale.
Long gone are the days of forced hunting for food, not becoming food, and procreating for the slim shot (no pun intended) of passing your genetic information to a subsequent generation. Our world has been forever changed within the evolutionary blink of an eye.
For the first time in history, we have the profound ability to communicate across billions of people simultaneously and witness the resulting behaviors in real time. We can celebrate, mourn, and revolt with others from across the globe. We are connected in a way that seemed unimaginable decades ago, and staying connected is a must.
