Tuesday, January 26, 2016

Uncertain Health in an Insecure World – 73

“Life, With Parole”

With risk comes stress, and with stress comes damage.

Resilience is defined as “the ability to become strong, healthy, or successful again after something bad happens.” Once only popular in self-help motivation spheres, it has since deeply penetrated organizational culture parlance. Whether an individual or a corporation thrives over time often depends on personal or collective endurance, in the face of accumulated adversity.

Recently, the term resilience has gained traction in the scientific community, related to an organism’s durability… its very survival… in the face of life’s mounting bad odds of disease.

First, just what are the bad odds?
A large U.S. actuarial survey by Milliman, Inc. (2010) of the risk of critical illnesses – cancer, heart attacks and strokes – confirms the old medical adage that “life has a poor prognosis”. For healthy 25 year-old non-smoking males, the risk is 24% by age 65; the risk doubles to 49% for smokers. By comparison, only 35% of female smokers develop a critical illness. If a male reaches the age of 55 years without a chronic disease, the risk of developing a critical illness in the ensuing decade is 17% for non-smokers, and 36% for smokers. For 55 year-old women, the corresponding rates are 12% and 23%.

Such data are somewhat intuitive. Smoke and you die, especially if you’re a guy!

The risk of critical illnesses is just one slice of the bigger picture of chronic diseases – diabetes, hypertension, auto-immunity, arthritis, lung disease, etc. In a 2013 Pew Research Center report, 45% of U.S. adults reported living with at least one chronic illness. The rate increases to 75% among U.S. adults aged >65 years. Interestingly, advanced age and lower education levels were co-variables of both higher chronic disease and lower internet access. These chronic conditions increase the likelihood of acute emergency room visits and critical illnesses. 

Probabilistic concepts of chronic disease causation have been well studied by epidemiologists.

The bitter 1950’s debate about the link between cigarette smoking and lung cancer was among the first tests of this quantitative science. At places like Massachusetts Institute of Technology, the math behind cause & effect (i.e., risk factors relationship to chronic diseases; above) has been extensively studied since the early days of the big data-analytics era circa 1990 (Long, WJ. The Probability of Disease, 15th Symposium on Computer Applications in Medical Care, 1991). The 2012 Australian Institute of Health and Welfare report on the Risk Factors Contributing to Chronic Disease made the public health case for staying sober, not smoking, exercising and maintaining a normal BMI – in 126 colorful pages!!

A large Canadian insurance firm (Manulife; www.manulife.ca) has an app for that (below).

Just like in criminal justice, the presence of “priors” – age, gender, and smoking status – are the primary determinants of the sentence… of death, or life.

The Resilience Project was established by Steven Friend of Sage Bionetworks and Eric Schadt of the Icahn School of Medicine at Mount Sinai.

The project’s goal is to look all over the world for unique “heroes” – those who have bad genes and lifestyle risks, but who also demonstrate freedom from chronic diseases. This highly novel approach – studying why people who should be dead or dying stay healthy and alive – is the antithesis of decades of epidemiological and biomedical research into why humans get sick.

In the words of Steven Friend (TED Talk, Vancouver, March 2014, above), who began his medical career studying genetic susceptibility to childhood cancers, “We have the power to diagnose, yet not the power to fully treat.” Friend poses the case for not studying those who are sick and their risks – “Maybe we should be studying those who are well.” A few individuals may have prior risks, but also have some “hidden protection factor” in their genomes.

In 2013, Friend and Schadt began to collect cheek swabs (above) from adults >40 years old who were healthy as kids, screening them for genes posing a risk of childhood disease. Citing protective gene mutations against AIDS in people with high HIV viral loads, and against heart diseases in those with high blood lipids, they work globally in an open crowd-sourced way to “decipher these positive outliers.” By decoding the tissue samples of Project participants, to date they have found dozens of candidate “hero genes.

Friend and Schadt are convinced that individuals, not “anointed experts”, are the key to the success of The Resilience Project, and to future related disease prevention strategies. Says Friend, “We don’t know how to read the read the sentences… (or) how to follow the narrative” of the genetic code. As such, “We don’t know how to develop drugs that restore function.

Absent resilience, the best sentence we humans can plead to is death.

The Resilience Project offers evidence-based justice in the face of this death sentence. 

We in the Square believe in resilience… in life with parole, with the possibility of time added for good behavior. 

We believe in heroes...

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