Innovation prizes are best at promoting refinements, not revolutions. While health and longevity depend primarily on the exposome, the corporate mentality in the US, including the corporate thought of physicians, leads to Medicalization and a treatment paradigm for promoting health. We in the US live in a Medicalization paradigm that is bad for health – the US has the most expensive and worst performing “healthcare” system in the world. People in healthcare make money when they perform treatments and making money is the key performance metric for most all that is done in the US. The Medicalization mentality leads the X-Prize to offer $101 M for a reductionist therapeutic strategy that reduces aging. This XPrize challenge will refine Medicalization, help some people make money, but offer little in improving healthspan as it ignores the greatest contributor to healthspan – our exposome.
Our exposome, what we’ve been exposed to throughout our lives, determines about 90% of your health status (Rapapport et al, 2010), not genetics. Even so-called “genetic diseases” such as sickle cell anemia are characterized by, as the CDC says, “People with [sickle cell trait] usually do not have any of the symptoms of sickle cell disease and live a normal life.” So why is it that most people with the genetic trait said to cause sickle cell, don’t have the disease? We don’t know the environmental determinants of sickle cell because we don’t study them. Instead, because it’s easy to do so and is in fashion, we study the genetics and create unaffordable genetic treatments for the disease that are so cumbersome that it requires the patient to be in the hospital for months and potentially for a year while spending millions of dollars for one treatment. Not often discussed in the media is that the sickle cell treatment requires chemotherapy to eliminate bone marrow cells. Chemotherapy has side-effects, including an increased risk of different types of cancer. In this case, while the treatment paradigm can lead to diminished healthspan, focusing on the environmental causes of sickle cell can increase healthspan.
Treatment’s a money-maker though, something that will benefit a few – a few millionaires and billionaires, and possibly a few patients. When I say it may benefit a few patients, we have to aks the question, “compared to what?” Will the treatment benefit patients who do nothing other than the treatment? Possibly it is better than doing nothing. Is treatment better than altering one’s exposome? Probably not. Most clinical trials for a treatment use “doing nothing” as the comparator. The trial will not be the treatment versus a beneficial alteration of the patient’s exposome. Such as clinical trial would likely lead to failure for the CRISPR clinical trial. If that happens, money is lost and we can’t have that because the treatment system is about making money.
Although FDA has approved this treatment, will it be commercially viable, and will it really work and be safe? Or will it be like most FDA approved treatments that don’t work, and the many that are later pulled from the market for severe safety issues? We live in a country that is dominated by the treatment paradigm, and largely ignores the most important determinant of our health – our environment. Calling sickle cell anemia a genetic disease, when the environment is key and most people with the sickle cell genetic trait don’t have symptoms, is but one example. The XPrize Healthspan program is a continuation of our moving down the wrong path to optimize health, and even within the treatment paradigm, will likely provide incremental benefit, if any.
Looking at the greatest determinants of healthspan, exposure to environmental toxicants has been shown to associate with molecular hallmarks of aging (Pandics et al, 2023). Advances in geroscience have led to a paradigm shift in our understanding of the pathogenesis of chronic age-related non-communicable diseases (NCDs). It is now recognized that all age-associated diseases share common underlying cellular and molecular mechanisms of aging. These mechanisms include increased oxidative stress, matrix breakdown, cellular mitochondrial and energetic dysfunction, impaired cellular stress resilience, genetic instability and DNA damage, induction of cell senescence, heightened state of inflammation, epigenetic dysregulation, altered proteostasis, disruption of intercellular communication (including endocrine changes), stem cell dysfunction, and dysregulation of energy sensing pathways. Proteins are particularly labile, including to the many nanoparticles in the environment, leading to aging processes throughout the body.
The US healthcare system does little to nothing in preventing and remediating these exposome induced aging processes. In fact, healthcare is a large part of the problem. Being needlessly irradiated by physicians, undergoing unneeded surgery (75% of stents are unneeded and unneeded C-sections are a national epidemic), or taking useless drugs, such as those for cancer, induces a harmful exposome that leads to aging. Yes, the US healthcare system is bad for your health, empties your bank account if you are a user but fills it if you are a provider. As Dr. Allen Roses, M.D., of Duke University, has said, most of our prescription drugs don’t work. This is true for many drug categories, including cancer and antidepressants. We also know that most medical procures don’t work, and the level of harm they cause is rarely known. According to Howick et al (2022), “More than 9 in 10 healthcare interventions studied within recent Cochrane Reviews are not supported by high-quality evidence, and harms are under-reported.”
Medicalization and its treatment paradigm continues to waste much of society’s money. We have medicalization and the treatment paradigm because all of the healthcare money flows to treatment and treatment research, not prevention and not the environment. Our National Institutes of Health, which controls about 85% of all medical and biological research in the US, is controlled by physicians, not scientists. And what do physicians do – they treat. They don’t prevent and they are clueless about the environmental aspects of health. The XPrize Healthspan program continues this tradition. It is led by Peter Diamandis, M.D., a guy with one peer-reviewed journal article as a junior author, an apparent con-artist, cofounder of a failed biotech company and a fake university, and a self-proclaimed authority on almost everything. This is a guy who has never built anything of consequence. As a result of our medicalization, the US will continue to have the most expensive and worst performing “healthcare” system in the world, and the XPrize will only foster more of the same.
Stem Cells, Health, Technology 