Joon Yun:
We have an amazing opportunity to reinvent the health care system. But let's first point out how amazing the current system is. As a member of the industry, being a physician and an investor, I'm proud that our health care system has been helping extend the quality of life and the quantity of life for a long time.
But the system we have right now is still not good enough. Why is that? Because right now, what we are doing is we're solving for the futures of aging, which means if we're successful, we create more old people that need more health care. This is a feed forward model of health care consumption that is fatally flawed. Eventually, you're going to kill the economy. And in this current system, everybody ages out and dies. So as good as the system is, we need a radically new system as an alternative.
Now, it's possible that this alternative system is hiding in plain sight. What do I mean by this? Let's go through an exercise. I would like to ask you to count the number of times the letter F appears in this following sentence. It's not a trick question. It's not magic. Just go and count it. And after you're done, look back at me. And I know you guys are fast readers. OK. How many people saw all three? Most of you. Anybody see four? Anybody see five?
OK, so the real answer is six. And now that you know the answer, see if you can count the six Fs. Five, flies, of, of, scientific, and of. So the older we get, the harder it is for us to see what's in front of us. That's one of the features of aging. That's depressing, but you can also see it as an upside. This means that the answers to some of the most perplexing problems in science may actually be hiding in plain sight. We've just got to call it out, like calling out those Fs.
And what if the system we have right now is the second-best idea we ever came up with? We may be stuck in one of these adaptive values-- to use an evolutionary term-- where we can't see over the hills, so we can't see that there's a much better system out there. So let's try to build that system bottoms up, starting from first principles.
First principle number one is to target improving homeostatic capacity instead of homeostasis. That's just one word change. But it changes everything. We all know that we should be thinking about system capacity instead of system state. We do that in every other domain but not in health care. Think about homeostatic capacity as your ability to get to homeostasis. Homeostasis is a state of equilibrium. It's a state. Homeostatic capacity is your ability to get to homeostasis.
Similar words include resilience, robustness, dynamic range, antifragility, coping ability, buffering, autoregulatory capacity. The easiest way to visualizes this is the Weeble Wobble, that toy where you push it, is self centers. That is what nature endowed in us. When we're young, it is so successful and so pervasive, that we don't realize we have homeostatic capacity until we start losing it in midlife, which is about where I am.
And all of a sudden, I can't do the things I used to be able to do when I was a child. I can't ride roller coasters because I come out of it, my Weeble's wobbling. I can't do cartwheels, somersaults. My son has no idea what I'm talking about because he still has an intact Weeble. When it's 50 degrees out, my kids are in t-shirts, and I'm in two layers like this. And they say, dad, it's not cold. I say, guys it's cold. And neither one of us are lying. I've lost homeostatic capacity.
The older we get, the less our ability to tolerate thermal variance. I can't tolerate altitude change anymore. When I take my kids up to Lake Tahoe, they're totally fine, whereas I'm huffing and puffing and I get dizzy. All of a sudden, in the last few months, I can't read menus anymore because my pupillary homeostatic capacity has declined. It doesn't open up enough in the dark, and now I can't read menus.
When kids are sick, they're sick for two days, and they're totally normal. They bounce back. Whereas now, when I catch a cold, I'm coughing for a month. I remember being able to stay up all night in college and feel fine the next day. Now, I went to a Lady Gaga concert on Tuesday. I was still tired on Saturday. There is no recovery.
[LAUGHTER]
Because my homeostatic capacity is weak. Same thing with injuries, wounds. We're losing homeostatic capacity. This is the reason why every high-end athlete, by the time they hit 40, all of a sudden, they go from being an all-star to being forced to retire. Because they're losing homeostatic capacity. Now imagine the things that we can't feel. We just described a bunch of things you can feel.
When we're young, and our blood pressure goes high or sugar goes high, our homeostatic capacity returns to homeostasis. But in some of us, as we age, they go high and stay high. And we give them names like diabetes, hypertension. Is it really those conditions, or have we just lost homeostatic capacity? Have we lost one thing? Is it really an inflammation that's causing aging, or have we lost inflammatory capacities?
So think about what the Occam's razor might be as the core future of aging. To give you one example, I used to be able to eat everything when I was young. And we now think that, well, we need a good diet to deter aging. Well, you know what, maybe we've lost metabolic capacity. Just put the word capacity after everything we're doing, and now you're talking about system dynamics.
OK, so now, we have an opportunity to reframe health. Health 1.0 is the one that nature endowed in us. It works until about midlife. It starts failing us. And we try to restore homeostasis externally through this thing called the health care system. Health care 2.0 is that $3 trillion dollar system that's trying to get us back to homeostasis. We do a pretty good job, but it's a system of whack-a-mole, which is why we all age and die. That's a short history of health care.
OK, so health care 3.0, we have an opportunity to revolutionize therapeutics. What if instead of giving blood pressure lowering medicines as a way to treat high blood pressure-- which restores homeostasis, but we haven't restored homeostatic capacity, so your blood pressure keeps rising in the face of the drug-- we're actually causing system atrophy by treating your high blood pressure with that blood pressure lowering medicine.
What if I had you focus on the opposite? What if we tried to capacity build? Right now all of our drugs induce addiction because our body decompensates further. But the best way to treat high blood pressure is what? Is to raise your blood pressure and your body fights it by lowering it. Isn't that interesting?
The best way to treat high blood pressure is to raise it further, induce homeostatic capacity as your therapy, as a secondary response, rather than the primary therapy of the drug. So what if we put exercise in a bottle? What if we gave you blood pressure raising medicines as a way to treat high blood pressure? That would violate the Hippocratic oath. First do no harm. So we haven't thought about this.
Well, as it turns out, there's incredible empiric validation of this, besides exercise, which helps ameliorate every disease of ageing. What about vaccination? Make your body worse, and you induce homeostatic capacity. It is so pervasively effective. What if we could vaccinate against all the dysfunctions that are associated with aging?
OK, first principle number two is to measure system capacity instead of system state. Right now, when we go to our annual checkup, what do we do? We measure our blood pressure, heart rate, glucose, and cholesterol. These are all state variables. Now, can you really learn much from measuring state variables? Our blood pressure right now rises more from sitting to standing than it does year to year. So why are we measuring these state variables instead of system dynamism?
What we're doing in health care is tantamount to a seismic scientist forecasting collapse risk based on whether you're still standing every year. That tells you nothing. What they do is they push it. Every other system does system testing through dynamic testing, not static testing. So the diagnostic revolution for health care 3.0 is to re-invent all of diagnostics with dynamic data, not just static data. Response diagnostics. Challenges, see how the body does.
Right now, we have very little temporal resolution in biology. All of our data points are state variables. And we don't know how it changes. So we need to add the fourth dimension, the bio science. We're right now living in a three-dimensional world. And right now, so much of data is really bio noise until we actually introduce the time. Dimension.
This is Minkowski. You know, in every other field, we have a fourth dimension. We know that time [INAUDIBLE] is important. We haven't done that yet in health care. This is all upside. There's tremendous empiric validation of this concept. If you look at your heart rate throughout your life, it's pretty static. That's a state variable. But your heart rate responds to exercise.
Your maximum heart rate declines with age. It declines with chronological age and maps [INAUDIBLE] aging. It maps to mortality. And yet we don't use it. I mean, not dying is a great way to promote longevity. And yet, we don't actually use these incredible data sets that we have around blood pressure and heart rate. We have our continuous monitoring. And therefore, we are missing a lot of potential in diagnostics.
What happens if you actually restore homeostatic capacity? What happens? Well, as a 25-year-old, your homeostatic capacity is such that your annual mortality rate per year is about 0.1%. Which means if you could live at that rate of homeostatic capacity, you would live 1,000 years, right? And even then, it's a statistic. It's not a limit.
Because the things that kill you at 25-- the leading causes are trauma and infection and suicide. These are externalities. These are the slings and the arrows of life. But all of a sudden, after 40, aging emerges. And your annual mortality rate goes up until eventually by 120 everyone's dead. So right now, lifespan is a limit. Could we actually convert that into a statistic?
Now, there's a way to talk about all this without ever mentioning the word longevity. What if we could actually restore homeostatic capacity and live at high homeostatic capacity, such that we have a mortality rate that's under 1% per year? It's really about being healthy now, and you get longevity as a free call option. Rather than trying to extend life per se. Let's just stay healthier and see what happens.
And this solves one of the regulatory problems of longevity, which is you can't run longevity trials on humans. It takes too long. So what if you could actually just focus on being super healthy? And let's just see what happens on longevity over time.
OK health care 3.0 is also a lifestyle revolution. And the lifestyle revolution is to focus on improving our dynamic range. What that means is the following. When you go outside right now, it's sunny, it's gorgeous, right? Let's say you spent the day out on the beach. What happens at night? You sleep better.
Well, here's the biology you need to know. We are wired to experience sunlight during the day and enjoy darkness at night. And that's what actually drives melatonin function. But what happens if you don't get enough light during the day? We stay indoors all day? Put sunglasses on, sunblock on. And at nighttime, instead of enjoying the darkness, we put all the lights on. We're losing the dynamic range of light that causes circadian dysfunction, melatonin dysfunction, hypothalamic dysfunction. So expand the dynamic range.
Same thing with temperature. We're wired to be able to deal with hundred degree weather and 40 degree weather. But instead of experiencing that dynamic range, we narrow it by putting coats on, HVAC systems, we move to California. Your blood isn't thinning when you move to California, you're just losing dynamic range. You're debuffering. You're losing capacity. So stretch your dynamic range-- your thermal experience as well.
It's not stress, per se, that's killing us. It's chronic stress. We're wired to be able to deal with intermittent stress. But you've got to mix it in. You know, we're supposed to be having an adrenaline rush. But you've got to mix it in with rest. So it's not meditation that saves you. It's not exercise. It's the variation of stress that you need. Right?
[LAUGHTER]
Our muscles have an incredible dynamic range. Stretching and flexing, that's what keeps it around. If you narrow your muscle's dynamic range by being ergonomic and neutral, what happens? You actually liquefy your muscles and turn them into fat. So we reintroduce dynamic range to our muscles as well. This is why yoga and stretching benefits your health.
OK, is it diet that's killing us? Or is it loss of dietary dynamic range? My intuition is that it's not the fact that Doritos are what's killing us. It's the fact that we are eating too much junk food. What if you had a variation of diet? So you don't have to just eat like one narrow diet. You can actually eat a lot of things. Just keep it diverse. Stretch it [INAUDIBLE] in your diet, and maybe you will actually maintain metabolic capacity.
OK, there are some things that we do all the time as human beings-- or we should be doing all the time-- that actually increase our dynamic range as it relates to HRV, blood pressure variance, cardiac tolerance. Laughing is one of them. It's shown to improve HRV. This is probably why laughing actually is good for your health. Here's another thing that improves HRV-- I couldn't find any pictures of the internet on this one--
[LAUGHTER]
--but this is another thing that improves HRV. Use this metaphorically. Expand your dynamic range not only in terms of your biology and your environmental experience but also your culture experience. Think beyond four dimensions. Try new things. That's what's stretching your dynamic range. Walk home a different way. Go listen to interesting talks. Travel.
These are all the reasons why doing these things I think actually will map to eventually better health. This is a new way to think about lifestyle medicine. If you think about all the things that have resonance, they have a natural dynamic range. Every Shakespeare play will take you on an up and down roller coaster per scene. This is why these things endure. Things that have no dynamic range will not endure.
So here's the plan for health care 3.0. I've committed to endowing all the IP we have in this space-- pledging it publicly, so everybody can have access to it non-exclusively. We're engaging leadership. So I presented this topic at the National Academy annual meeting last year. I was one of the closing speakers. And we are now working with them to establish a series of challenges that will hopefully lead scientists to think in a different way.
We're providing a new regulatory strategy again something more proximate that will have ultimate benefit, but something we can do in real time. Because if you can measure things in real time, it's cheaper, it's faster, it's more effective than trying to run these long, expensive trials. And then funding. We're providing all the funding for this through a series of prizes. And then we have tremendous media partners. The main thing we need out of all of you, though, is that we need people, right? Everything is done through people, as you heard from me earlier.
So we invite all of you to engage. Either entrepreneurs or scientists or funders to start cultivating this new system that will hopefully make the existing system obsolete. This whole thing is a race against time. Looks like I'm running out of time here. You know, there's right now 500,000 people per week that are disappearing off the planet forever from aging-related diseases, which makes it the largest humanitarian crisis in history.
Except we don't talk about it because, you know, we've sanitized our world. They're dying in ICUs, nursing homes, and hospices. I saw them die. Dying is grotesque. It's physically grotesque. It's mentally grotesque. Spiritually, psychologically. This is not OK. We can't be sitting around. Every week we delay, it's another 500,000 people that are entering the queue.
And it looks like maybe I have one minute to talk about the system that's beyond us. And this is what I'm personally very interested in. And it's the idea that why do we lose homeostatic capacity in the first place when we hit midlife? There's an old theory that aging is programmed. This August Weismann promulgated this idea that you want to recycle your body parts in the betterment of creation of new ones.
This idea was around biology for 100 years until it was killed by Peter Medawar in 1953. He says senescence can't be a trait that's selected because it occurs after reproductive age. That's a narrative fallacy. That applies to women but not to men. Plus, reproductive senescence emerges during reproductive age. So there's no selection for runaway increase of reproductive age. Anyway, it's the road not taken. Unfortunately, he said this the exact year that Watson and Crick discovered DNA.
So exactly the year we discovered the code for life is the year we stopped looking for the code for death. So that's just all found opportunity. Now, we've had enough molecular data. We've got genetic technologies. Maybe it's time to put those ideas all back together, see if we can hack the aging code. And that way, we don't have to worry about any of the things we talked about. We just basically restore homeostatic capacity the way it used to be, and hopefully, that'll be the end of aging. Thank you very much.
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