Job of the near-future: health advisor

The health advisor is analogous to the financial advisor or mortgage broker that arose last decade when it became possible to trade stocks and get mortgage quotes on the internet. This advisor is familiar with the whole ecosystem of services and service providers in a sector whether finances, home buying and selling, or in this case, personalized health management.

The health advisor designs comprehensive wellness plans that integrate multiple health data streams such as family history, personal health history, genomics, and eventually microbiomic, proteomic and metabolomic profiles. The health advisor would recommend what type of genomic sequencing to sign up for (for example, 23andMe genotyping or Illumina whole human sequencing) and interpret the results and suggest action items. The health advisor would recommend and administer self-tracking programs and gadgets for diet, nutrition, medication and supplementation, exercise, and sleep management. The health advisor would recommend clinical trials or crowdsourced health studies that might be relevant for individuals to join. The health advisor could be compensated with pre-tax HSA (health savings account) dollars or other tax-advantaged funds.

This is a job category of the near future, as health advisor certification programs and wellness coaches are already arising.

Advances in translational antiaging skin research

There are many exciting innovations in translational anti-aging skin research. Personalized genomics is an important emerging field of science being applied to human biology with applications in skin disease risk assessment, wellness profiling, and product response customization.

Simultaneously, there are promising anti-wrinkle remedies being commercialized such as cellular therapies, topical treatments, retinoid and botox substitutes, and advances in skin manufacturing initially developed by the military for battlefield healing are starting to be applied to the aesthetic dermatology market, for example, dermal substitutes, next-generation skin grafting, and spray-on skin.

Excerpted from Translational antiaging skin research.

Complement proteins: possible predictive biomarker of Alzheimer’s disease

Recent research has uncovered more details about how the brain works. As brains develop, the many initially-formed synapses get pruned. How this occurs is important to understand as synapse pruning also occurs in neurodegenerative disease.

In synapse pruning, many mechanisms are operating together in a systems biology fashion, but one key dynamic is that protein molecules (complement proteins C1q and C3) are tagging weak synapses for elimination. For example, complement protein molecules are massively upregulated in Alzheimer’s disease. The Cq1 genes have been shown to come on very early in the case of glaucoma and are proposed to be a global dynamic of synaptic loss in neurodegenerative disease (e.g.; Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, ALS, etc.).

The early and prominent role of complement genes and proteins suggests the possibility of measuring them as a predictive biomarker of neurodegenerative disease.

Steady advance of stem cell therapies

Stem cell research and related therapies (including regenerative medicine and cellular therapies) is an industry with a strong possibility of having a significant near-term impact on worldwide public health. One reason is the industry’s linkage between policy, science, industry, and patient advocacy, as was clear in the attendance and programming at the 7th annual World Stem Cell Summit held in Pasadena CA, October 3-5. Other science-driven fields such as synthetic biology, nanomedicine, and aging might benefit from cultivating such a multi-disciplinary perspective. Stem cell therapies are useful not only in cell-replacement therapies, but also in disease modeling, drug discovery, and drug toxicity screening.

Disease therapeutics and clinical trial focus
Stem cell therapies are currently being applied to over 50 diseases particularly in the areas of heart, lung, neurodegenerative, and eye disease, and cancer and HIV. Dozens of companies are developing therapeutic solutions which are in different stages of clinical use and clinical trials. Some high-profile therapies include Dendreon’s Provenge for prostate cancer, Geron’s first-ever embryonic stem cell trials for spinal cord injury, Fibrocell’s laViv cellular therapy for wrinkles, and well-established commercial skin substitutes (Organogenesis’s Apligraf and Advanced BioHealing’s Dermagraft).

Policy
Stem cell policy issues under consideration include medical tourism, standards for large-scale stem cell manufacturing, and lingering ethical debates over the use of embryonic stem cells.

Science
Contemporary stem cell science advances include a focus on techniques for the direct reprogramming of cells from one lineage to another without having to return to pluripotency as an intermediary step, improved means of generating and measuring induced pluripotent cells, and progress in approaches to neurodegenerative disease, for example establishing causal factors for early-onset Parkinson’s disease, generating neuronal cells and dopaminergic cells, and neural stem cell lumbar implantation clinical trials.

Blood Tests 2.0 advances with dried blood spot testing

Moving into an era of preventive medicine and health self-hacking, blood tests 2.0 is an obvious area for expected innovation, moving whole classes of blood tests from $100+ lab-administered arm draws to fingerstick tests conducted at home. One of the most promising techniques for realizing blood tests 2.0 is dried blood spot (DBS) testing. From a biochemistry perspective, the volume of blood taken in a serum draw is not required for many tests; a few drops would be adequate for many tests. Some exciting recent progress in dried blood spot testing was announced with NanoInk’s protein biomarker detection platform, based on dip pen nanolithography, which was used to identify and quantitate four clinically-relevant cytokines. The technology cannot detect everything, but could possibly be used to identify hundreds of proteins, and pave the way for low-cost home blood marker monitoring.

Home-administered fingerstick tests are already available for several markers, although the cost is not necessarily cheaper and a health care professional may still need to be involved. Blood spots from a fingerstick are placed on filter paper to dry and then sent to a lab for analysis. Tests are available for vitamin D, hormone levels (including estradiol, progesterone, testosterone, and cortisol), cardiometabolic markers (including insulin, high sensitivity C-reactive protein, total, HDL and LDL cholesterol, hemoglobin A1c, and triglycerides) from ZRT Labs. Theoretically, dozens of blood tests could be re-invented as fingerstick tests that are self-administered and interpreted in easy diagnostic readers or mobile-phone attached sensors.

Robotic benefits could accelerate into the service and software industries

An animated discussion about the future of robotics occurred at the September 24, 2011 Boulder Colorado Future Salon. One claim is that the last few decades in robotics might be analogous to the status of the computing industry in the 1950-1970s, growing slowly but surely, and suggesting that the pervasiveness and impact of robotics could start to accelerate. There has been significant progress in agricultural automation and factory automation, and this could spread rapidly to service industries and information technology industries.

On the one hand this is the next logical step in fulfilling the ongoing human dream of using technology to provide more free time. On the other hand, while so far robotics has not had a big negative impact on jobs, a more rapid move to automation in more sectors could result in a more significant displacement of human capital.

Industries of the future
There is a tremendous opportunity to identify the industries of the future and start them. Future industries could be clustered by areas such as sustenance (food, energy, and clean resources), health, productive activity, entertainment, and well-being. One obvious group of future technologies will focus on food, for example, vertical farming and lab-grown meat. Mental well-being and enhancement is virtually untapped, although there is some preliminary activity in applying behavioral change and happiness research, and calming technologies. Some key dynamics that govern human behavior will not be going away in the short-term such as the demand for status-garnering and reputation-building (why gaming has been so successful), so industries providing opportunities for this would be well-pitched.

Newtech: enterprise social networks

Like email, instant messaging, and wikis, the latest newtech spreading into businesses is social networks, essentially serving as a private internal version of Facebook and Twitter. Enterprise social networks are used for a number of purposes, first and foremost, status updates to work teams, but also for real-time messaging with colleagues including document transfer, broadcast announcements, and opinion capture via polls. There are several companies in the enterprise social software sector (Gartner chart). Among the most vibrant are Yammer and Chatter (affiliated with salesforce) each of which has over 100,000 corporate customers in a wide range of industries from finance to entertainment to professional sports; Jive is a third large company in the space. The standard pricing model appears to be freemium-based, free for light-users and $5/seat/month for power users. Enterprise social networks are typically externally-hosted.

Two of the key challenges that come to mind with enterprise social software are: consolidation with other internal communications platforms and data mining. As with enterprise instant messaging, archival and retrieval is important, both at the personal level (for productivity) and organization level (for information systems backup and compliance). There need to be effective ways to consolidate and mine multi-platform internal communications. Formalizing the explosion of casual interaction as it naturally occurs could be abstracted into value-added tools such as a codification of internal knowledge and expertise in the internal wiki for training purposes. It might also be possible to integrate communication flows unobtrusively and automatically into prediction markets or other sentiment analysis algorithms to capture opinion about key upcoming events like product launches and quarterly sales results.

Human augmentation substrate: the microbiome

The human microbiome, comprising 10x human cells, is interesting not only for its significant role in determining health, disease, drug response, and individuality, but also in possibly being a less-invasive human augmentation substrate, for example, bringing nanoscale connectivity and memory processing modules onboard via the microbiome.

New research has identified that only five microbial lineages exist on humans: firmicutes, bacteriodetes, actinobacteria, proteobacteria, and other phyla which is surprising compared to the diversity of microbial phyla on Earth. However, within the lineages, there are many strains and species, for example 1,600-2,000 distal gut species of microbial bacteria in each person, only 7% of which were known previously (paper). Gut bacteria is critical to human functioning, one activity is producing butyrate in colon epithelial cells to maintain energy homeostasis. (paper, article)

The microbiome is a complex adaptive system: resilience and vulnerability
Research extends beyond characterization - an investigation of perturbations to the human microbiome has shown resilience in recovery following a disturbance. However there is vulnerability with persistent perturbation. The human microbiome may not reassume its initial state unless the disturbance is at a frequency that the system has experienced before and for some time. In this case, the system may get stuck in an alternative state or local maximum. (paper).

Time, complexity, entropy, and the multiverse

FQXi, the Foundational Questions Institute, held a multidisciplinary meeting investigating the Nature of Time in Scandinavia August 27 – September 1, 2011 (Figure 1). FQXi promulgates original thinking and research on fundamental questions in physics and cosmology through research grants and essay-writing contests on topics such as “The Nature of Time,” and “Is Reality Digital or Analog?”

Figure 1. Multidisciplinary topics covered at the FQXi Time Conference

Time is familiar in the sense of the three space dimensions and the one time dimension around which human affairs in the physical world are organized. Additionally, each person has a subjective and identifiable relationship to time, even though this may be little more than a convenient construct. In science, time has been developed to the greatest degree in physics and cosmology, and in the philosophy of science. Other fields too are starting to consider time more robustly, including complexity, biology, and computation.

The conference addressed the issue of the arrow of time from many perspectives. While most fundamental laws of nature are time-symmetric, some areas have a time arrow flowing in one direction such as thermodynamics, quantum theory, radiation, and gravity. This can be problematic to explain. A suggested analysis structure involving the trade-offs between complexity and entropy as systems evolve over time served as a useful model for analyzing different aspects of time throughout the meeting.

Inciting Brownian motion at the macro-scale

Entropy is the process of moving from order to disorder, for example one’s desk becoming cluttered after being cleaned. In many cases, lower entropy states are desirable as they connote greater order. Without doing work to decrease entropy, it generally increases at the macro level (the spacetime of objects that humans encounter on a daily basis). Entropy increases and time appears to move only forward.

At the micro scale of atoms, Brownian motion occurs (the constant jiggling of atoms), and creates an important case where the Second Law of Thermodynamics (heat eventually dissipates; systems move from being warm to cold) does not hold. Brownian motion at the micro scale also allows fluctuations in the arrow of time and in entropy, e.g.; time may flow forwards and backwards, and there may be fluctuations towards lower and higher states of entropy. This can be seen not just at the very-very small Planck scale and the atomic scale of statistical mechanics (for example, atoms jiggling in a gas), but also at the level of cells in the body, and in another example, pollen cells suspended just the right way in water.

That Brownian motion can occur at the comparatively larger scale of cells suggests that it may occur, or be induced to occur at even more macro levels too. For example, in complex adaptive systems, an economy has phases of Brownian motion, when rational agents are jiggling constantly to make the invisible hand of supply and demand meet. Perhaps incentive structures including policy may be used to facilitate the persistence of Brownian motion and devolution of entropy in macro-level systems.