The Key to Ultimate Health: Bioresilience

This essay proposes increasing and sustaining bioresilience as a method to achieve low mortality rates, much longer healthy lifespans and, eventually, ultimate health.

Let’s envision a model for healthy, functional longevity based on evaluating and improving the body’s bioresilience.

Bioresilience is the body’s capacity to respond to stress. One way to visualize bioresilience is to imagine a WeebleTM, the toy that self-centers when pushed. Evolution selects for increasing bioresilience, and it and so effective during youth that we notice it more by its decline after midlife when recovery from biologic stress—be it a late night, hangover, jet lag, cough, injury, wound, or a rollercoaster ride—diminishes. Our tolerance of environmental variation, such as changes in temperature or altitude, weakens. Our pupils respond inadequately to changes in light, so menus are harder to read at dinner.

Now consider objective changes that we can’t feel. When we are young, our bioresilience returns elevated blood pressure, glucose, and inflammation to baseline. As we age, those levels may no longer self-tune sufficiently, leading to hypertension, diabetes, and inflammation, respectively. If loss of bioresilience is a common framework that helps explain the diverse features of aging, could enhancing the body’s bioresilience mitigate the aging process and promote healthy, functional longevity
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Is The J.P. Morgan Healthcare Conference Still Relevant?

Photo by Scott London

The 36th annual J.P. Morgan Healthcare Conference, happening in San Francisco, has become the Burning Man of biotechnology.

It’s no longer the under-the-radar West Coast pilgrimage of eclectic pioneers gathering to have brief encounters with interesting people, share insights about drugs, and behold a blossoming movement. Like Burning Man, the Conference in 2018 is mainstream. At least Jamie Dimon, the keynote speaker, won’t be wearing a pink tutu.

With success comes congestion—those who have been to both agree that Burning Man is the lesser fire hazard. In the gridlocked corridors, old-timers small-talk about the way things used to be. Nostalgia reigns, and so does the status game among attendees as to what year they lost their Conference virginity (mine was the same year I went to my first Burning Man).
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Retail’s 2017 Trend of the Year: Hypebeast Arbitrage

Hypebeast arbitrage was retail’s 2017 Trend of the Year.

Even in a retail year marred by increasing store closures and bankruptcies, one phenomenon is bucking that trend. The oldest strategy in the hype business — giving buyers an opportunity to speculate and profit in the secondary market — has resurfaced in a big way in the Technology Age. Think Beanie Babies meets cryptocurrency ICOs.

Let’s call the phenomenon what it is: hypebeast arbitrage is the simultaneous buying and selling of extremely popular merchandise to exploit differing prices in the market. The hyped merchandise generally are birthed through a scheduled “drop,” a strategic, highly-choreographed manna release from high above Madison Avenue at volumes and prices far lower than would be justified by demand. Instant sellout and hype are inevitable, though it’s not quite clear which of these two was engineered first. Look behind the curtain and you might find a math wiz optimizing the relationships between retail price, secondary price, release volume, number of retail outlets, and distribution of stock keeping units.
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Remembering Sam Houston

photo by Harris County Sherrif’s Office

Houston, the city most affected by Hurricane Harvey, is named in honor of former Texas governor Sam Houston. He was the lone governor within a future Confederate state to oppose secession from the Union in 1861, which led to his removal from office. To avoid bloodshed of fellow countrymen, he also refused an offer of a Union army to put down the Confederate rebellion. Instead, he retired to the country, where he died before the end of the Civil War.

Concussion Discussion

My cognitive function has been significantly altered since suffering a series of major hockey-related concussions during my 20s. We didn’t know much about concussions back then. However, even today’s “conservative approach” and “concussion protocol” may too turn out to be another round of false security that we will further regret in the future.

While it may protect against direct impact, helmets do little to protect against the various secondary physical forces (example: shearing forces of differential tissue deceleration) that can cause permanent neuroanatomic damage to the brain, including those found in TBI, diffuse axonal injury and CTE. Spuriously, the vast majority of people who eventually will end up with CTE can look normal by every imaging and blood tests for decades after the injury; thus, normal tests in the early years can be misleadingly reassuring.

On a separate note, in the last 3 MRIs shown to me by friends whose kids suffered sports-related concussions that were bad enough to miss school time, I noticed an anatomic shape variation in a part of the brain that regulates mood, memory, vision, sleep and headache. As a radiologist, I have never seen it described in the medical literature and my neurologist colleague at Stanford hadn’t heard of it either. Since these cases did not have baseline scans, I don’t know if the concussion caused this variation. I also don’t know if the kids had this particular variation before the trauma — it can be congenital — and this predisposed them to manifest more severe symptoms after impact. It’s too small a sample size for me to be concerned at this point, but I’m going to look for this finding in MRIs of other kids that develop concussions, and if the pattern persists, I may fund a formal study at Stanford.

I am concerned how little we know about the biology of concussions in 2017.

The Bad News about Fake News

We can try to combat the fake news culture by:

  1. Regulating media, forcing them to stop
  2. Asking media to stop

Obviously, these are not viable solutions. Regulating media would be censorship. If existing news outlets policed themselves, other fake news sites would arise like to fill the gap and lure the unwitting.

Another option is for us to take responsibility for seeking truth rather than taking the bait of headlines that fit our pre-existing worldviews. Yet the latter tendency is precisely what evolution selected and is difficult to override. Media outlets dedicated to fact-checking and balanced editorials are themselves subject to bias. Moreover, people generally don’t seek those features in the first place or they process the information through biased mental models. Primary sources, even when available, are rarely offered or sought.

There is no tidy solution and that’s troubling.

National Academy of Medicine Grand Challenges Longevity Initiative

Aging & Longevity Grand Challenge

As the inaugural challenge in its Grand Challenges in Health and
Medicine initiative, the National Academy of Medicine will seek to
transform the future of human aging and longevity by catalyzing
innovation and progress.

Human beings are living longer than ever before, thanks to dramatic
advances in medicine, public health, and economic and social progress. Exciting innovations in science and technology have potential to improve quality of life as we age — and even extend the lifespan. As the world’s aging population approaches a tipping point, accompanied by unsustainable health care costs and social burden, it has never been more urgent to support the next breakthroughs in healthy aging.
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GDP Benefit of Health Innovations: The Health Dividend

A World Bank report estimated that the 2014 GDP toll, directly and indirectly, attributable to the recent Ebola outbreak in Africa will be between $2.2 billion and $7.4 billion.

World Bank report estimated that the 2014 GDP toll, directly and indirectly, attributable to the recent Ebola outbreak in Africa will be between $2.2 billion and $7.4 billion. The viral outbreak has infected 14,000 people.

If so, what is the implied economic benefit—in terms of averted GDP loss—of health innovations that rid the world of the bubonic plague, which once killed an estimated one-third of the global population in 5 years, and smallpox, which killed an estimated 300 million people last century? What is the implied economic benefit of health innovations that now allow those infected with the human immunodeficiency virus (HIV)—which has killed 32 million people globally—to be able to live as long as uninfected individuals?

Earlier in 2014, a media furor arose over another virus, hepatitis C. As companies usher in the first curative drugs for this deadly viral pandemic that has already infected 130 million people globally, politicians are tripping over themselves in  on drug pricing.

While a debate rages about the cost of these drugs, it is also important to contemplate and calculate the implied GDP benefit—the health dividend, if you will—accrued by economies made healthier by these innovations. The public is generally unaware that they are collecting this health dividend because the human mind tends to overlook averted losses despite its significant economic value.