The Lucky Years: How to Thrive in the Brave New World of Health (13 page)

The majority of deaths occur among children living in Africa. Although antimalarial measures have dramatically decreased the risk of getting malaria worldwide, a child still dies every minute from the illness in Africa. Before my family and I arrived, we had been taking antimalarial medications for a couple of days and would continue to do so for a week upon return to the United States. But these drugs don’t come free of side effects, and I can’t imagine taking them forever if I were living in an African village where malaria is rampant.

My guide explained to me how he’d gotten used to the constant threat of the disease and that he took the right precautions every day to prevent being bitten by the mosquitoes. He wore shirts with long sleeves and pants, slept in a mosquito-free setting, and used insect repellent. Even the antimalarial drugs themselves aren’t 100 percent effective and must be combined with these basic protective measures. For my guide, strategies that don’t involve ingesting drugs were enough, and so far, so good. He also had faith that if he contracted malaria, he’d be able to recover with proper treatment.

This dialogue reminded me of similar conversations I’ve had with people who tell me they “don’t want to take a statin forever,” or some such. While they appreciate the preventive power of such a measure, at
the same time, they don’t want to commit their bodies to relying on a daily drug for the rest of their lives for prevention’s sake. Obviously, if they need a drug to help manage or treat a condition, that’s one thing. But to take a drug simply to lower a certain risk factor in a sea of many unrelated risk factors, that’s another thing entirely. Part of me respects this perspective now, and it’s one of the messages I may have gotten wrong in my previous book.

When I returned home from Africa, this new perspective shined a light on a lot of other aspects to practicing medicine and helping people navigate their health choices. I started walking around thinking
Everyone is right!
and it was liberating. For example, all diets and supplement recommendations are correct
in the right context
. And that’s the difference between being right and wrong. Context eliminates the need to reduce everything down to good or bad, healthy or unhealthy, virtue or vice. As I said earlier, there is no “right” answer in health decisions—though a lot of people think they are right and try to foist their righteousness on others. Rather, there are several right answers, and probably a few really bad ones for most people. To repeat: you have to do what’s right
for you
, based on your personal code of values, health circumstances, and tolerance for risk, in consultation with your own physician. Of course, this kind of informed choice demands that you be as knowledgeable about your health status and treatment options as possible, which is what you’ll achieve in the Lucky Years.

Today, when you go to the doctor for a wellness checkup, you make an appointment far in advance and then visit the doctor’s office to get your data collected, including blood pressure, weight, and other routine lab tests. The only preparation you make beforehand is probably mental: organizing any questions you might have for your doctor and trying not to feel nervous about the visit. Several days after your appointment, someone in your doctor’s office calls you back with the results of any tests
or lab work that was performed. Sometimes no one even bothers to call you if everything comes back as “normal.”

A future doctor’s visit, on the other hand, will be all about putting the data collected into context so you can know what’s best for you. You won’t go there to collect data. Instead, you will go in
with
your data. Some examples that I foresee: A week prior to your appointment, you will mail a biochip to your doctor’s office that contains a drop of blood from a finger prick that can be analyzed. Your smartphone and other portable devices, some of which will be wearable like watches or bracelets, will be equipped with all sorts of technologies to measure various features about your health. They can listen to your heart and send an EKG to your doctor, as well as transmit the sounds of your heart to a sound cloud to compare and analyze against people who share the same age and lifestyle. They can perform a retinal scan and detect an impressive array of potential problems, from high blood pressure and diabetes to cancer. The data will also have context. What did your blood pressure do when you were upset after a telephone call? How high did your pulse rate go with exercise? How much did you move in the past twenty-four hours? What was your heart rate variability, which is a marker for stress?

If you’re pregnant, those routine prenatal exams will also be transformed through technology, allowing you to monitor the health of your baby all on your own and send data to your obstetrician for review and/or discussion. You won’t even need to undergo an invasive amniocentesis or chorionic villus sampling to examine the chromosomes of the fetus and make sure everything is copacetic. Instead, a small sample of blood will reveal everything a mother-to-be would want to know about her developing baby—and even more about herself. A new type of prenatal test widely available and intended to find genetic flaws in a fetus through the mother’s blood can also reveal previously undiagnosed cancer in the mother. This was an unexpected finding by scientists who were looking for a less invasive way to test a fetus—another example of pure serendipity.

With all these innovations, your doctor won’t have to spend much time collecting your information during your appointment. He or she will sit there with you and devise a game plan based on the data you provided before stepping foot in the office. The doctor can actually review the details and think about it before you arrive. Should you need any additional testing performed in light of your data, you can get it done right there—you won’t have to drive somewhere else or make another appointment two weeks later. In the future, medical centers will be one-stop shopping. Now that’s real-time medicine.

The whole notion of even going to the doctor when you are sick may change. If you think about it, it actually doesn’t make much sense. When you don’t feel well, you have to drive to an office and sit in a waiting room with others who may not like your contagious runny nose. In fact, there are now several start-up companies with doctors on call to come to your house on a moment’s notice, so you can get medical assistance at home. In the future, your wellness checkups will be opportunities for you to interact with your doctor when you are well so you can exchange information and come up with a plan. And when you’re sick, you’ll also be able to call your doctor, with whom you’ll already have a strong relationship, and seek advice for dealing with your current problem. Although technology does allow us to keep a certain distance today, the value of interaction between you and your doctor cannot be overstated.

Those old-fashioned house calls I mentioned are part of the rapidly growing field of telemedicine, which promises to bring doctors and nurses to you rather than you having to travel to their offices or enter an ER for care. In some cases, it entails live video consultations with board-certified doctors, available twenty-four hours a day, who can offer advice, prescribe medicine, and suggest follow-up care. Telemedicine will probably never entirely replace the standard doctor’s office visit, but it will definitely have a role in the Lucky Years. With telemedicine, people in rural or remote areas, or those with disabilities or serious, chronic illness, can connect with specialists on a moment’s notice. If going to the doctor’s office is very difficult, follow-up visits can be made
by video, eliminating the stress of travel. A nurse can communicate with patients regularly to answer questions or to ensure compliance with prescriptions and recommendations. And now, with the technology available, data can be collected and shared with the doctor during the telemedicine encounter. Some small towns have installed kiosks where patients can enter and have their vitals signs checked while talking with a doctor at a distant major university. All of this will help to achieve the best outcome if used correctly.

I realize that there’s already some debate about whether doctors will want to deal with copious amounts of data provided by the patient, but that data ultimately helps reduce errors. Not all data is equal, but with enough data, error goes away. Measuring your blood pressure at noon in the doctor’s office is one piece of data, but imagine coming in with three months’ worth of data. Measuring it at night, early in the morning, after a disturbing phone call, and when you are relaxed with a glass of wine. It’s a statistical fact that more data means less room for error. You may have missed the time of day when your blood pressure spikes if you only measured it once in the doctor’s office. The slope, or the trend, in your data is more illuminating than a single data point. And the amount of data doesn’t have to be overwhelmingly large; the basics will suffice.

Even though your doctor today won’t be expecting you to arrive with a record of your patterns and data since your last visit, it helps to get into the habit of creating the documentation. Start to gather information now. Remember, the trends in data over time yield the most insightful information. The more you can collect and store, the more you will know about what to do in the future. I would even suggest that in the near future you should start to store your plasma (the part of a blood sample with all of the proteins); blood banks can freeze plasma that’s stable for up to twenty years. This will allow you, in the future, to go back and compare your current condition with your data from the past, with methods that haven’t yet been developed today.

An example: Let’s say you develop a relentless cough in 2025 and your doctor orders a chest X-ray. On the X-ray is a 0.5-cm nodule. It
could be scar tissue from a previous infection or it could be cancer. Presently, the only way to determine the diagnosis is to stick a needle in it for a sampling or remove it entirely and examine it under the microscope. This is pretty major surgery, but tens of thousands are done every year in the name of “just in case.” In the future, we will have a blood test that can distinguish between cancer cells and normal cells, but it probably will require a baseline. What that means is that you’ll have a baseline profile of your blood that tells you everything is fine. So once something like a mass is detected, you can consult your baseline to see if anything has changed and treat accordingly. If a certain increasing value that indicates cancer crops up, it probably means you need to take out the nodule. If the blood test has been stable for a decade, then there’s no reason to worry. This will happen time and time again for each potential disorder. The tests of the future depend on context—what is going on in you today compared with what has happened in the past. By having a tube of blood stored annually, you will be able to go back to the past. Right now doing so is not routine, but I imagine this will be standard in your future annual checkup.

The other key element to this new type of visit to the doctor is that all of your data can go into a centralized database, which will create a profile of you compared to others with similar features. That database can give you advice about what to do based on your information and what you might expect to happen, much in the way you’d plug a computer into a car to diagnose the mechanical issues. Now, that’s an oversimplified analogy, for a human body is much more complex than a car, but it nonetheless makes a good point: like diagnosing major problems with a car (not the exterior scratches and worn seats), the body’s chief systems and fundamental physiology can be similarly evaluated (but not the arteries and underlying genetic vulnerabilities). General readouts can have value, and lead the way for further analyses.

To bring in some simple examples, imagine being able to learn,
based on your unique biology within the context of a gigantic database, what to eat (or not eat) to avoid migraines, balance your blood sugar, and lose extra weight without classic dieting; when to stop consuming caffeine during the day lest you sleep poorly; what time of day is ideal for you to be outside or to break a sweat; whether or not you can benefit from any particular medications without side effects; why you wake up routinely at 3:10 a.m. and how to stop that cycle; which songs synchronize with your heart rate; when to go for a walk or otherwise engage in a stress-reducing activity because it’s the time of day when your stress levels peak; and how much you should be worried about your levels of inflammation. You’ll be able to leverage associations made by virtue of aggregate data sets.

So if you’re a thirty-six-year-old female who played soccer in your youth but smoked until you were thirty, you’ll be able to compare your health profile with others who’ve engaged in similar behaviors. And not only will your DNA be part of your data, but also the dynamic conversations that are taking place in your body that can be detected through a variety of measurements, from basic hormones that fluctuate through the day to the proteins found in your blood that follow a pattern and may, for instance, indicate a heightened risk for
X
or the need to treat
Y
.

Proteomics, the study of the body’s proteins, is a rapidly expanding new field at the center of some of the research I’m conducting. We’re exploring how proteins compose the body’s language, and ultimately shape the language of health. Proteomics allows us to eavesdrop on that cellular conversation, which can inform better ways to prevent and treat disorders and diseases. Unlike your relatively static DNA, your proteins are incredibly dynamic. They change minute by minute in your body depending on what’s going on internally. I can’t tell from sequencing your DNA if you’ve just had a cocktail, what kind of foods you like to eat, when you last flexed some serious muscle, how well you slept last night, or if you are under a lot of stress. But your proteins, on the other hand, can tell. They can speak on your body’s behalf, divulging information that’s hard to find elsewhere. Through proteomics, I can start to look at and measure the “state” of your body. And it’s that
thirty-thousand-foot view that allows me to take in the whole picture, at a moment in time. DNA, while powerful and revelatory in its own right, cannot do this.