Quantum Healthy Longevity: Talk at Longevity Med Summit, Portugal, 5 May 2023
The general trend has been that we’re living longer – but life expectancy is falling and the gap in healthy life expectancy is widening between richest and poorest – in the richest countries in the world.[i]
The average American now has the same chance of living a healthy life as someone from Blackpool which has the lowest healthy life expectancy in England.
In the UK, we spend a fifth of our lives in poor health – and the poorer you are, the greater the proportion of your life spent in poor health. We must close the gap of the almost 20-year difference in healthy life expectancy between the richest and the poorest.
This needs to change – and is the burning platform. We have an entrenched 'sickcare' model and invest disproportionately in the cure without understanding and addressing the cause.
Despite healthcare advances, we have not integrated the biological, psychological and behavioural factors of ageing across the lifecourse that represent 80% of the determinants of our health.
System change is needed to focus on health as an asset to invest in, not as a cost in an increasingly unsustainable healthcare system buckling under the burden of poor health driven by growing health inequalities and ageing populations.
The time is now to address the system change needed mobilising technology and science to accelerate healthy people, planet and economic growth. Working with my colleagues at National Innovation Centre for Ageing (NICA), Dr Nic Palmarini and Professor Lynne Corner, we launched the Quantum Healthy Longevity Innovation Mission in November 2022, supporting the UK government’s ambition to harness frontier technologies including AI, quantum computing and systems biology to tackle big, real-world problems in climate and health.
As set out in the Lancet[ii] and supported by world leaders, including Nir Barzilai, David Furman, Brian Kennedy, Luigi Ferrucci, Linda Fried, Alex Zhavoronkov and others, we need to understand environmental factors encompassed in the exposome in terms of helping humans not only to survive but to thrive in their ‘real world’.
At the heart of the mission is a deep, integrated understanding of people’s needs and aspirations that contribute to maintaining health across the full life course[iii]. This embraces the emerging research in computational approaches to the psychology of ageing that links with biological and biomedical ageing as well as the behavioural aspects for ageing well, including nurturing brain health and investing in brain capital.
We need to understand environmental factors encompassed in the exposome[iv] in terms of helping humans not only to survive but to have the resilience to adapt to stress and to thrive in their ‘real world’.
The ‘exposome’ reflects the complex exposures humans face, which can lead to systemic chronic inflammation affecting lifelong health.[v] The exposome includes the food we ingest, the air we breathe, the objects we touch, the psychological stresses we face, and the activities in which we engage.[vi]
We also know that some people are more resilient than others when confronted with stress in their environment.[vii] Resilience is a concept getting more attention and relates to understanding how humans adapt to adverse conditions and recover from them, and reflects individual qualities such as personal control, a sense of purpose, and optimism. Stress resilience can be improved, but the outcomes and effects depend on the type of intervention and the species treated.[viii]
We know human psychology is complex and changing behaviour tough. We need to make it easy to keep healthy and well. And cheap. We need the right environments to make the best choices. The simple fact is that if it is not easy or cheap or woven into the fabric of our daily lives, hopes and dreams it won’t happen.
Sometimes it is the simple hope that a quick fix will work. A recent article in JAMA[ix] said that more than half of adults take dietary supplements; In 2021, people in the US spent an estimated almost $50 billion on dietary supplements and the dietary supplement industry spent about $900 million on marketing. Most of the 90,000 supplements on the market have no evidence whatsoever that they improve health.
What many companies are selling are quick-fix hopes, not necessarily solutions that work. Hope is reflected in the placebo effect of course too- some say it will add two years to your healthy life expectancy. And yes, it is true there is a lot of hype in longevity research. No single drug or molecule yet can outdo the effects of a bad lifestyle or being in the poverty trap- if you do not eat healthily and you don't sleep or exercise enough or are stressed through financial worry and loss of hope, 10 years or more of your life is at risk.
Psychological ageing is under-explored in research – yet connecting health and mind seems to be the focus of most of the longevity clinics emerging around the world treating real human beings.
My colleagues and I at NICA are exploring this and ways to increase societal brain health and brain capital.[x]
Psychological ageing has been a topic of high interest to Alex Zhavoronkov, Founder of Insilico Medicine and Deep Longevity. They recently published a paper analysing data from almost 12,000 adults that showed psychological factors substantially contribute to biological ageing. The pace of ageing detected with a novel ageing clock was shown to accelerate if a person feels unhappy, lonely, or has trouble sleeping.[xi]
All this points to the need for solutions that work not only on the biology of ageing but the psychology of ageing too, and also overall resilience, the ability of the body to adapt to stress.
We need solutions which give people hope and allows them to follow their purpose, their reason for keeping alive.
We also need solutions that are easy and accessible to everyone. Health needs to embrace the revolutions that have already come to other aspects in our lives, like banking and shopping – we are used to convenience and choice, and ever more so.
The UK is poised to be a ‘test bed for health’ to understand these links between biology, psychology and behaviour and drive next generation products and services.
There are a number of levers we can pull to drive this step-change in thinking and action.
First, we need to harness science and technology more effectively to drive impact at scale. The latest developments are increasingly telling us we need to move upstream in health prevention. There has been a huge wave of biology breakthroughs spanning ‘omics’ research and the ‘hallmarks of ageing’, as well as a better understanding of biological systems on the whole[xii] [xiii].
In parallel of course we have seen an explosion in analytical and modelling technologies. Thanks to AI, we are getting increasingly powerful tools. DeepMind recently won the Breakthrough Prize for its AlphaFold tool that has successfully predicted the structure of nearly all proteins known to science.
The latest AI kid on the block now is of course the large language models / including ChatGPT4 – with many arguing, including the likes of Elon Musk, we are galloping dangerously ahead without the governance to keep the more intelligent machines than humans from destroying us. Musk is now proposing ‘TruthGPT’ incentivised around understanding the universe so there is an inbuilt mechanism for algorithms not to learn how to destroy it.
We have new companies pioneering AI-driven systems using ageing clocks and biomarkers to analyse biological big data at scale. Humanity[xiv], for example, is using ageing clocks and biomarkers to give users insight into their current risk rating and health recommendations around factors such as weight, sleep, physical exercise, lifestyle, and diet.
And this means more than drugs to target the underlying biology of ageing. We need to look at the entire exposome, that describes all the factors that influence our health and ageing trajectory, including behaviour, environment and lifestyle.
We need to activate citizens and consumers too of course. Health data is plentiful, especially since most data we generate in our lives will affect or relate to our health in some way. This is gold stuff for biomarkers in ageing research.
Smartphone apps and wearable devices provide a largely untapped source of data about health behaviours in people’s day-to-day environments. The data are large in scale, collected at low cost, and often recorded in an automatic fashion, providing a powerful complement to traditional surveillance studies and controlled trials.
It is therefore not a surprise that digital biomarkers have gained large interest during recent years as non-invasive markers of health and disease. As they typically allow for continuous monitoring, they may also be used for the development of biomarkers to measure resilience too, because they can measure ‘the ability to adapt’ in response to an external challenge (whether it be food, stress, activity, etc) reflecting the resilience of the biological system.
Digital measurements have the advantage of being measured non-invasively, passively, continuously, and in a real-world context. This is why Alzheimer’s Research UK initiated the Early Detection of Neurodegenerative Disease study (or EDoN) with the Gates Foundation- using digital biomarkers via smartwatch to detect diseases like Alzheimer’s years before the symptoms of dementia are evident.
A prime example of citizen health engagement in the UK is Our Future Health[xv], a partner in our mission, that has been set up recently to recruit 5 million healthy volunteers in a major health study which aims to predict who will get ill in their later years even before they show symptoms to come up with new ways to prevent, detect and treat diseases such as dementia, cancer, diabetes, heart disease and stroke.
The UK government is committed to leveraging ‘pro-innovation’ regulatory reform, to unlock the potential of exponential advances we are seeing in science and technology. This forms part of its ambitions to be a science and tech superpower while still focussed on applying its so-called ‘Levelling Up’ policy agenda to increase healthy life expectancy and reduce health & wellbeing disparities in their government manifesto commitment to drive economic growth ahead.[xvi]
The government have commissioned a Pro-Innovation Regulation of Technologies Review which will focus on identifying opportunities and enablers for digital technologies, life sciences and green industries.
The UK Digital Strategy commits to rolling out world-class digital infrastructure across the UK and promoting data as an enabler, including looking at persona data wallets and intermediaries, improving access for researchers and analysts to citizen-consented data which can then link to the so-called ‘world’s largest longitudinal cradle to grave dataset’ from NHS healthcare records.[xvii] [xviii]
The Life Sciences Vision published last year[xix] in the UK outlines 7 critical healthcare challenges that government, industry, the NHS, academia and medical research charities can work together on at speed to solve – from addressing ageing to tackling dementia.
This was the first time that research in the biology of ageing was deemed a priority, and is one of the 7 ‘challenges’. Exploring the role of ageing biomarkers to move forward clinical trials to prevent and/or delay the diseases of ageing is important here. Biomarkers could accelerate and shorten clinical trial times by acting as surrogate endpoints upstream in the health trajectory, and measure risk and progression of major age-related diseases. However, there Is no agreed standard or list of approved ageing biomarkers for clinical trials; and there is no international consensus or set of validated biomarkers of ageing or ageing clocks.
This gap can be addressed by data-intensive omics, capture of digital biomarkers through ‘effortless AI’ (eg wearables) and application of machine learning, quantum computing and systems biology. A new study in JAMA[xx] shows that it is feasible to determine a person’s degree of resilience based on an individual’s heart rate variability that can be measured using smartwatches.
The UK government is also committed to finance reform, for example, giving pension funds more freedom to invest in innovation, as well as unlocking capital to support scale-ups and venture capital.
Through my work at Business for Health, we are taking a steer from what has guided the climate change agenda and net zero targets with the ambition to bring ‘Health’ into ESG-driven investment, that is, ‘ESHG’.
An ESHG framework focussed on equitable health outcomes will help the business and investor community drive positive change and impact as part of the Quantum Healthy Longevity Innovation Mission[xxi], through long-term strategic projects that reduce the risk factors that can damage health, like unhealthy food, poor work, pollution, and poor housing, and are incentivised and measured by their impact on positive health and wellbeing outcomes. This aligns with aims of the international Reform for Resilience Commission[xxii] that called for the global community at COP27 and Davos in 2023 to strengthen ESG standards by incorporating health metrics to build more resilient societies.
There are three core elements of the mission. First, we are designing a platform to support an open, federated, multidisciplinary approach to share data, methodologies and to contribute to the build and evolution of ideas to enable public and private organisations to share data for public benefit, while ensuring public trust.
Second, the AI platform will evolve taking innovation out of the laboratory and directly into peoples’ homes, with healthy products and services designed and developed for unmet needs that make a real and measurable difference to people's lives and to planetary health too.
Third, we want to create an open distributed Biomarker Data Bank linked to other Trusted Research Environments (TRE)- to translate insights from the exposome into intelligence, application, and commercialisation of science into societal benefit for all. A key output would be an atlas of geroprotective interventions.
This will inform the evolution of ‘Longevity Cities’, a strategic initiative developed by the National Innovation Centre for Ageing, and supported by the World Bank, that is rooted in the principle of 'health is the new wealth'.[xxiii]
The first Longevity City is being trialled in Newcastle where NICA is based, and is acting as the template for cities around the world, including Milan, Tokyo, Barcelona, and Hamilton in Canada.
The aim is to create environments with products and services, or ‘Longevity-as a-Service’, that make it easy for people to follow healthier lifestyles well before old age, enabled by infrastructure, services and policies that also influence the social determinants responsible for 80% of our health.
In summary, our mission will harness developments in longevity science and data innovation to capture deep insights from genetics, biological, behavioural, environmental and financial data; harnessing such ‘life data’.
The prize is huge if we can encourage citizens to share their data for public benefit while still enabling commercial enterprises to prosper. Such ‘data philanthropy’ would accelerate the prevention and cure for dementia, for example, by delving deep into the complexities of the ageing process.
[i] IHME Global Burden of Disease
[ii] Woods T, Palmarini N, Corner L et all. Quantum Healthy Longevity for healthy people, planet, and growth, Lancet, https://doi.org/10.1016/S2666-7568(22)00267-7
[iii] Ferrucci L. Geroscience Brings New Focus on the Life-Course Approach to Health in Humans. Innov Aging. 2020 Dec 16;4(Suppl 1):803. doi: 10.1093/geroni/igaa057.2914. PMCID: PMC7742840
[iv] Wild CP. Complementing the genome with an “exposome”: the outstanding challenge of environmental exposure measurement in molecular epidemiology.Cancer Epidemiol Biomarkers Prev. 2005; 14: 1847-1850
[v] Furman D, Campisi J, Verdin E et al. Chronic inflammation in the etiology of disease across the life span.Nat Med. 2019; 25: 1822-1832
[vi] Paul G. Shiels, Johanna Painer, Barbara Natterson-Horowitz, Richard J. Johnson, Jaime J. Miranda, Peter Stenvinkel; Manipulating the exposome to enable better ageing. Biochem J 30 July 2021; 478 (14): 2889–2898. doi: https://doi.org/10.1042/BCJ20200958
[vii] Dantzer R et al. Resilience and Immunity. Brain, Behavior, and Immunity 74 (2018)2 8-42; https:/ /doi.org/10.1016/j.bbi.2018.08.010
[viii] Liu H1, Zhang, JiY and Yang L, Biological and Psychological Perspectives of Resilience: Is It Possible to Improve Stress Resistance? Frontiers in Human Neuroscience. 2018. doi: 10.3389/fnhum.2018.00326
[ix] https://jamanetwork.com/journals/jama/fullarticle/2793472%20-%20jed220043r2
[x] Eyre H, Faulkenberg M, Das S et al. Brain capital: an emerging investment opportunity. Psychiatric Times. 2022; https://www.psychiatrictimes.com/view/brain-capital-an-emerging-investment-opportunity
[xi] Galkin F, Kochetov K, Koldasbayeva D, Faria M, Fung HH, Chen AX, Zhavoronkov A. Psychological factors substantially contribute to biological aging: evidence from the aging rate in Chinese older adults. Aging (Albany NY). 2022 Sep 27; 14:7206-7222 . https://doi.org/10.18632/aging.204264
[xii] López-Otín C, Blasco MA, Partridge L, Serrano M, Kroemer G. The hallmarks of aging. Cell. 2013 Jun 6;153(6):1194-217. doi: 10.1016/j.cell.2013.05.039. PMID: 23746838; PMCID: PMC3836174
[xiii] Le Couteur DG, Barzilai N. New horizons in life extension, healthspan extension and exceptional longevity. Age Ageing. 2022 Aug 2;51(8):afac156. doi: 10.1093/ageing/afac156. PMID: 35932241; PMCID: PMC9356533.
[xiv] http://www.humanity.health
[xv] Our Future Health, https://ourfuturehealth.org.uk/
[xvi] Science and Technology Framework, March 2023, https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1140217/uk-science-technology-framework.pdf
[xvii] https://www.gov.uk/government/publications/digital-regulation-driving-growth-and-unlocking-innovation/plan-for-digital-regulation-developing-an-outcomes-monitoring-framework
[xviii] https://www.gov.uk/government/publications/data-saves-lives-reshaping-health-and-social-care-with-data/data-saves-lives-reshaping-health-and-social-care-with-data
[xix] Life Sciences Vision, July 2021, https://www.gov.uk/government/publications/life-sciences-vision
[xx] Hirten R et al. A machine learning approach to determine resilience utilizing wearable device data: analysis of an observational cohort https://academic.oup.com/jamiaopen/article/6/2/ooad029/7147662
[xxi] https://www.businessforhealth.org/new-events
[xxii] Reform for Resilience, https://www.r4rx.org/cop27-statement-2022
[xxiii] https://uknica.co.uk/blog/2021/09/04/health-is-the-new-wealth-newcastle-city-of-longevity/