Biotech Breakthroughs and the Quest for Human Longevity

Chapter 3: Game Changers: The Future of Biotech and Healthcare

"Today I will do what others won't, so tomorrow I can accomplish what others can't." – Jerry Rice

Becoming the captain of my school football team was a hard-earned achievement. So, when I sustained the second Achilles Heel injury, it seemed like a cruel twist of fate. Yet, working through this breakdown in my life led me to some remarkable insights about the current job market and the cutting-edge technologies poised for exponential growth. One such domain is, of course, biotech, especially in the realm of healthcare. In fact, Jerry Rice's words from the beginning of this chapter perfectly capture the spirit of perseverance and innovation that drives advancements in this emerging domain.

Ask any doctor or policymaker, and they will tell you that the key to a robust public healthcare system is wide-scale accessibility. During my interview with Dr. Geetha Manjunath, CEO of NIRAMAI, I was struck by her passion for making healthcare accessible to those who need it the most: the genetically, financially, and socioeconomically vulnerable groups. Geetha's determination to expand the scope and reach of diagnostic screening is aptly reflected in her forceful questions: "I lost one of my cousins' sisters to breast cancer. How can so many women just die?"

The second line hit me hard as well. Having had two surgeries less than twelve months apart, I am all too familiar with the complicated rituals of medical treatment—the vicious cycle of consultations, screenings, surgery, pain management, and physical therapy—and how they can leave someone with a uniquely pessimistic view of healthcare as a whole. For many, undergoing prolonged medical treatment can be a particularly thorny experience in a country like the US, which has one of the highest costs of healthcare in the world.

This imbalance became all too apparent when the pandemic hit. Covid-19 was not just a medical disaster but an existential crisis for humanity. Mass vaccinations and country-wide quarantines became the norm, as did "Zoom school" and remote work. Drug development was fast-tracked, and telehealth, which had been sidelined for decades, suddenly found itself in the spotlight. Post-COVID, another domain drew increased attention: human longevity. Unsurprisingly, the pandemic led to an urgent focus on the extension of healthspan rather than just the lifespan. In other words, people don't just want to live longer but also healthier. Quality of life has emerged as an important need in the modern world. No wonder then that the human longevity market is estimated to be valued at $1.8 trillion, dwarfing other industries like space tech, which stands at $680 billion.

Before we venture further into the territory of human longevity, it would be useful to understand how our perspectives on healthcare have changed in recent times. I promise this will be a worthwhile tangent. First, I'd like to discuss a couple of cool concepts that I learned about while preparing for my interviews with health tech pioneers on Exponential Edge.

HEALTH: 1.0 > 2.0 > 3.0

The concept of Health 3.0 represents an exciting evolution in healthcare based on the interplay of technology, social networks, and personal health management. In contrast, we would use the term Health 1.0 for systems where patients primarily rely on traditional means for information, such as talking to family members or reading materials about their conditions. In the Health 1.0 framework, the process of observing and detecting symptoms in a patient was very linear and sequential, often resulting in limited or outdated knowledge.

With the advent of Health 2.0, the landscape of medical science as a whole began to change, as patients started utilizing the internet to download articles and engage with content. If you remember our discussions in Chapter 1, this model of medical engagement became popular towards the late 90s, coinciding with the dot com bubble and its ensuing burst. In Health 2.0 scenarios, patients could discuss their online findings with healthcare providers, but the interaction mainly remained one-way, with patients consuming information rather than actively participating in their health-related discussions.

Now, the Health 3.0 model takes this a step further by integrating the principles of the semantic web and VR tools to create personalized data access and optimize user experiences. In this new paradigm, patients not only access information but also engage with it interactively. As I learned from several guests on my podcast, including Jay Srinivasan and Geetha, platforms and networks allow individuals to add their health experiences and retrieve tailored information that directly addresses their unique needs.

MEDICINE: 1.0 > 2.0 > 3.0

Dr. Peter Attia, the renowned physician with an enviable patient list (including Elon Musk and Chris Hemsworth), has a similar philosophy when it comes to medicine. For instance, Medicine 1.0 takes us back to a time when scientific understanding was pretty basic. We didn't have the scientific method to guide medical practices, which means doctors relied on methods that were largely guesswork. Picture this: instead of treating illnesses effectively, they were bloodletting and using leeches, sometimes causing more harm than good. The knowledge about how the body works and the causes of diseases was largely undeveloped, so treatments were often ineffective, and patient outcomes were poor.

Then we roll into Medicine 2.0, which really kicks off around the late 19th century. This period marked a significant shift thanks to advancements like germ theory, which established that pathogens, or germs, cause infections. With the development of the scientific method and randomized clinical trials, healthcare began to professionalize. However, while there was a greater focus on diagnosing and treating diseases like diabetes, Alzheimer's, and cancer, this model still emphasized treatment after the fact rather than emphasizing prevention. You could say that the saying "Prevention is better than cure" was not as popular then.

Finally, we reach the modern era of Medicine 3.0, championed by figures like Dr. Peter Attia. This approach shifts the focus significantly towards preventive care instead of just treating diagnosed conditions. This medical philosophy hinges on understanding the underlying causes of diseases and taking proactive measures to avoid them in the first place. Medicine 3.0 stresses the need of living a healthier life for longevity—going beyond just avoiding illness and actually enhancing overall well-being, that is, your healthspan. The goal is to turn patients into active participants in their health, rather than just passive recipients of treatment.

In short, the Health 2.0 paradigm made medical information more accessible through the internet, and Medicine 2.0 laid the groundwork for addressing immediate medical needs. The next step in terms of Health 3.0 involved personalizing user experience of the healthcare system, while the Medicine 3.0 framework seeks to prevent the emergence of disease itself, helping us lead longer and healthier lives by taking a proactive approach.

This chapter explores two key vectors of the Health 3.0 and Medicine 3.0 paradigms: simplified early detection and mass accessibility. The conversations I had with the founder of NIRAMAI and the CEO of Truvian Health exemplify these concepts.

Geetha Manjunath – NIRAMAI

When I chatted with Geetha Manjunath, the CEO of Niramai, it was clear that her ideas really fit well with what we call Health 3.0 and Medicine 3.0. She's all about empowering patients, using pragmatic and widely used tech, and focusing on prevention.

Geetha's work on using technology to improve breast cancer detection is a great example of the Health 3.0 vibe, which is all about making healthcare personal and easy to access. She said, "I want to do something in this space…Why are so many women dying of breast cancer?" This shows just how dedicated she is to tackling a huge health issue and the need for us to be proactive instead of just reacting when problems arise. By creating a non-invasive way to detect cancer early using thermal imaging (these scanners are widely available and used at airports) and AI, Geetha is not just making screenings more accessible but also helping women take charge of their own health.

Speaking with Geetha Manjunath on my podcast was emotional and inspiring. She shared her motivation for creating Niramai after experiencing personal losses in her family due to late-stage breast cancer. Geetha shared that after losing two cousins to the disease, she felt compelled to address the alarming mortality rates associated with breast cancer, particularly in India, where the statistics are stark: "Every other lady detected with breast cancer is dying within two years." While speaking about this painful topic, Geetha stressed that "the most common reason why we lose loved ones to such diseases is late detection," highlighting the critical need for early intervention.

This proactive mindset is at the core of Medicine 3.0, which seeks to prevent diseases before they escalate rather than simply treating them after diagnosis. Geetha's educational background is just as impressive as her staunch ideals about patient care. She earned her master's degree in computer science and a PhD in AI from the Indian Institute of Science in Bangalore. Her extensive experience includes working at C-DAC (Centre for Development of Advanced Computing), where she was involved in developing India's first supercomputer. Then she moved on to Hewlett Packard, where she worked with international researchers and focused her efforts on AI. Over the years, Geetha's passion for applying AI to solve real-world problems, particularly in healthcare, became the cornerstone of her career.

Challenges in Breast Cancer Diagnosis

Breast cancer remains a leading cause of cancer-related deaths among women worldwide. Geetha explained that current diagnostic methods like mammography often fall short. First, she noted that current screening methods are often prohibitively expensive in countries like India: "It's almost like $250,000 for a really good mammogram machine." Additionally, Geetha identified another deficiency in the current Health 2.0 paradigm of breast cancer detection, particularly for younger women. She explains, "Mammography does not work well on dense breasts...it makes it [the cancer / cancerous tissue] much harder to find."

These limitations often lead to late-stage detection when the treatment options are limited and less effective. Geetha's drive to address these challenges led her to explore alternative methods that could provide early and accurate detection for all women, regardless of their breast tissue density or geographic location.

Geetha also highlighted how important it is to educate people about breast cancer screening, which fits right in with the participatory spirit of the Health 3.0 framework. She mentioned, "We need to create awareness... you need not wait for a lump to appear to actually go to a hospital."

NIRAMAI And Health 3.0

In 2016, Geetha founded NIRAMAI, which stands for "Non-Invasive Risk Assessment with Machine Intelligence," along with Nidhi Mathur. The company uses thermal imaging combined with AI to detect breast cancer earlier. This technology is non-invasive, affordable (uses existing widely deployed Thermal Scanners), and applicable to women of all ages. "What AI does here is to bring in the accuracy of interpretation," Geetha explained during our conversation. The AI algorithms analyze thermal images and identify abnormal patterns that indicate the presence of cancer. This innovative approach has the potential to improve the accuracy and availability of breast cancer screening.

Niramai's core technology, known as Thermalytix, utilizes thermal imaging combined with artificial intelligence to detect breast abnormalities in a non-invasive and radiation-free manner. The process begins with the patient cooling down in a room for 10–15 minutes, after which a thermal device captures five thermal images from a distance of three feet.

Geetha explained, "The procedure takes less than five minutes," making it both quick and convenient. These images are then analyzed by Niramai's AI-powered software, which generates a report that is sent to a senior radiologist for certification.

What sets Thermalytix apart from traditional mammography is its ability to work effectively across all age groups, particularly for women under 45, who often have denser breast tissue that mammograms struggle to assess.

Geetha pointed out that "mammography is not affordable for many women," whereas Thermalytix is designed to be both low-cost ("less than $2," in her words) and portable, significantly increasing accessibility. She emphasized that the technology can detect very small tumors, stating, "Thermalytix has been shown to detect very small tumors, as small as 4 mm."

Once the thermal images are captured, Niramai employs a suite of AI algorithms to analyze the data. These algorithms perform several functions, including quality checks to ensure the images were taken correctly, segmentation to identify the breast area, and feature extraction to analyze blood vessel structures and thermal asymmetries.

Geetha mentioned that the AI system can produce various scores based on vascular activity and thermal patterns, which helps in determining whether further investigation is needed. The system also incorporates unique algorithms to detect blood vessel structures, which can help identify deep-seated tumors that might be missed with traditional thermography.

Thermalytix also embodies the multidisciplinary and multimodal nature of Health 3.0 by utilizing AI to enhance diagnostic accuracy. Geetha explained that the technology employs machine analysis to generate a quantitative thermal analysis report, which improves the reliability of results compared to manual interpretations.

This integration of AI not only streamlines the diagnostic process but also provides actionable insights for healthcare providers, enabling them to make informed decisions quickly. Geetha stated, "The AI comes in and says has this been done properly," showcasing how technology enhances the overall patient experience and engagement.

Furthermore, Thermalytix promotes a user-centered approach, allowing for privacy and comfort during the screening process. Geetha mentioned that the testing environment is designed to be private, stating, "It's like a changing room... the technician is outside." This focus on patient comfort aligns with Health 3.0's goal of creating a supportive healthcare environment where individuals feel safe and respected.

Future Prospects

NIRAMAI's technology has already shown promise in clinical trials and has been well-received in the medical community. Geetha's vision extends beyond India, as she aims to make this technology available in other regions where breast cancer screening is limited. "AI can actually help in identifying people who have an abnormality who need to be brought to a hospital," she said. Thermalytix is now FDA approved in the US.

Geetha also spoke about how she envisions collaborating with healthcare providers, government bodies, and non-profit organizations to implement screening programs in underserved areas. By integrating NIRAMAI's technology into existing healthcare systems, Geetha hopes to create a global impact, making early breast cancer detection accessible to all women, regardless of their socio-economic status or geographical location.

Nuggets of Wisdom from Geetha Manjunath

1. "Developing innovative methods is not easy. Perseverance is key."
2. Ensure that solutions are effective and validated rigorously.
3. Embrace challenges as opportunities for growth. Everything is an opportunity.
4. No age is too late to start a career.

Jay Srinivasan – Truvian Health

A crucial element of the Medicine 3.0 framework is technology-assisted patient empowerment, meaning we are given all the resources to understand our malfunctioning bodies—and not just rely on the doctors' often-incomprehensible jargon. In my conversation with Jay Srinivasan, the CEO of Truvian Health, it became clear that his ideas align closely with the concepts of Health 3.0 and Medicine 3.0, which emphasize patient empowerment, preventive care, and the integration of technology into healthcare.

Jay's vision for Truvian Health embodies the principles of Health 3.0, particularly in how he aims to make healthcare more accessible and actionable for consumers. He states, "If you could make routine blood testing convenient, affordable, and actionable, that's what we're all about." This focus on convenience and affordability is central to Health 3.0, which seeks to democratize access to healthcare and enable individuals to take charge of their health.

Jay's Career Journey

Jay's passion for healthcare innovation was immediately apparent. The story of Jay's career journey was dynamic and exciting, as he jumped from engineering to business, and finally to healthcare. "Right from when I was a kid, I always wanted to be a doctor," he shared.

Jay's journey in education highlights his dedication to blending engineering with healthcare. After earning his Bachelor's degree in Electrical Engineering from NIT Karnataka, in India, Jay pursued a Master's degree in Biomedical Engineering at Drexel University. Adding to this impressive list, Jay also completed the MBA program at Northwestern University.

Currently, Jay serves as the CEO of Truvian Health, a company dedicated to making routine blood testing convenient, affordable, and actionable. Truvian developed a tabletop diagnostic instrument that combines multiple testing technologies in a single system. In Jay's words, "We brought all these technologies together into a single system that's no bigger than a desktop computer."

This compact device can perform a wide range of tests, including lipid panels, metabolic panels, and blood counts, providing quick and reliable results.

What sets Truvian apart is that it is the first company to demonstrate that a multi-modal platform can achieve clinical performance comparable to central labs using just a single sample. So far, their integrated platform has been evaluated on over 50,000 samples from 5,000 donors, boasting a reliability rate of over 98%. This level of performance is crucial for ensuring that patients receive timely and actionable results, which can help in preventing diseases before they escalate.

From Centralized to Accessible Healthcare: Theranos Aftermath

In the U.S., around 50% of adults skip routine blood tests due to the complexities involved, including long turnaround times that can lead to delayed medical interventions or missed diagnoses. Truvian's automated benchtop platform promises to simplify this process, enabling accurate and comprehensive blood tests without the usual hassles.

Jay emphasized the importance of early and frequent testing to prevent chronic conditions. By decentralizing blood testing, Truvian Health seeks to make it easier for people to monitor their health regularly without the need for frequent visits to centralized labs.

Of course, in the wake of the Theranos scandal, Jay understands the importance of maintaining transparency and regulatory compliance. Truvian Health is taking significant steps to distinguish itself from the infamous Theranos, which collapsed under scrutiny for its misleading claims about blood testing technology.

One of the key ways Truvian is doing this is by being transparent and upfront about its processes and regulatory requirements. Unlike Theranos, which made bold assertions about its technology without proper validation, Truvian is committed to following the necessary protocols to ensure safety and efficacy. Jay emphasized this commitment during our conversation. He explained that they are actively raising funds to refine their technology and navigate the regulatory landscape, stating, "We are raising the money to proceed with a year-long process to refine our technology and submit it to the FDA for approval." As I was writing this chapter, Truvian announced that they had raised another $74 Million to commercialize their benchtop diagnostic device that can reside in every neighborhood pharmacy.

Moreover, Truvian is not just aiming for FDA approval but also a CE Mark in the European Economic Area. Clearly, they are committed to upholding international standards and broadening their potential market reach. Jay mentioned that they are submitting applications for both 510(k) clearance and a "clinical laboratory improvement amendments" waiver, which would allow their devices to be used in retail settings or doctor's offices. This regulatory diligence is a stark contrast to Theranos, which often sidestepped such critical oversight.

Future Vision

Jay's vision for Truvian Health includes global expansion to make its diagnostic technology available to a broader population. Jay's vision also includes the integration of the Internet of Things (IoT) for remote monitoring and predictive maintenance. Additionally, AI will play a crucial role in enhancing diagnostic accuracy and providing actionable insights. "Artificial intelligence and everything around it is something that's going to take precedence," Jay concluded.

Nuggets of Wisdom from Jay Srinivasan

1. Health is the most important thing in our lives and making efforts to focus on health is paramount.
2. Everyone deserves access to affordable healthcare. It's our right as humans.
3. Disruption is necessary in the healthcare industry to initiate important change.
4. Partnerships are more important than intelligence. Aligning with other minds and other businesses makes the biggest difference.
5. Educating consumers about healthcare leads to a more comprehensive coverage of healthcare needs for all who require healthcare services.

Conclusion

Reflecting on these conversations, I was reminded of Jerry Rice's famous words—which is why I have included them at the beginning of this chapter. Each of these innovators took significant risks to pursue their visions, to do what others were not interested in doing, and in the process, they transformed healthcare and biotech. Both Geetha and Jay's philosophies align closely with the principles of Health 3.0 and Medicine 3.0, which emphasize patient empowerment, accessibility, and the integration of advanced technology into healthcare.

Biotech and human longevity are undeniably poised to grow further over the coming decades. These pioneering efforts pave the way for a future where healthcare is more effective, inclusive, and accessible. Having been hospitalized twice for significant surgeries, I think of myself as a stakeholder in the widespread adoption of Health 3.0 and Medicine 3.0 principles with the purpose of extending our healthspans. Hopefully, the insights from these leaders will guide us in capitalizing on the opportunities that lie ahead.

One-Minute Takeaway

1. Human Longevity Focus: The post-COVID era has shifted the focus to extending the healthspan, with the human longevity market estimated at $1.8 trillion.
2. Preventive and Personalized Care: Healthcare 3.0 emphasizes preventive and personalized care, aiming to address chronic diseases long before symptoms appear.
3. Early Detection: Early, simplified detection technologies for cancer, cardiovascular, and neurodegenerative diseases are crucial for effective intervention and treatment.
4. Accessible Diagnostics: Decentralized approaches to blood testing make routine diagnostics more accessible and convenient for patients. This is especially needed to catch metabolic diseases earlier.