[Dr. Snyder]: I think the healthcare system is broken. I think when you're healthy, they
just don't measure you very often and when they do, they measure very, very little. So
you know, go into a doctor's office now and it looks like the doctor's office 40 years
ago, they'll bring out the stethoscope, a few things, and measure, you know, 15 things,
say, "Oh, you're great, go home." Yeah, if you think about where the world is
today, we can measure so, so much more. And so the genome is one thing, we talked about
that with the diabetes. But you can make all kinds of molecular measurements. You can measure,
as you say, all your RNA, all your proteins, all your metabolites, all your lipids in your
blood, and you can do your metabolites and your lipids and your urine and proteins, and
your microbiome, all these things you can measure.
And we don't know for sure what's important and what's not. But we do know we get a much
more complete picture when we do that. It's like, looking, you know, at...say you're doing
a jigsaw puzzle is what I would say we're doing now. Where if you put out five pieces,
that's how medicine is today, you try and guess what that puzzle is like, or what is
the picture in the puzzle. You really don't stand a very good chance from 5 pieces if
it's a 1,000-piece puzzle. When you put all 1,000 pieces there, you have a pretty good
idea what that picture is. And that's how we view health, we want to get the 1,000-piece
picture on everybody. And we want to do it over time so we can see if that picture is
changing. So basically, that's what we're doing, we're
profiling people very, very deeply, and then we do it over time so we can see the shifts.
And one thing we've learned is that everybody's profile is different. I know that sounds obvious,
but people don't realize how different they are. And in fact...and it doesn't matter which
measurement we use, whether we're following your proteins, or your metabolites, or your
lipids, your pattern will be very, very different than mine. And it'll be fairly stable over
time, believe it or not, there will be some things that'll change but for the most part,
it's the same. And not only that, what happens is if you
get sick, say you get a viral infection or something else, your profile will shift. But
believe it or not, you will still look more like you than me when I'm sick. So what that
means is that it's very hard to tell the difference when somebody is ill if you're comparing them
to everybody else. But it's really easy when you compare them to themselves. So that's
why we think these profiles are really important while people are healthy so you can detect
that shift really, really easily. And it turns out that that's been very, very important.
So in our study, we have 109 people, and just from the first little over 3 years of profiling,
49, almost half, learned something important about their health. And it was all kinds of
different areas. Some was in the area of cancer, some was in the area of cardiovascular, other
the metabolic space. And just as some examples, we caught some with early lymphoma. Two people
with pre-cancers, they weren't cancers yet, but they have a good chance of turning into
cancer. We caught it early, they're called MGUS and smoldering myeloma. And then there
were two people with serious heart issues, they had no idea. One was a really young guy,
from his genome sequence, we figured it out. And another one is from wearables, and so
on and so forth. Caught people with diabetes who didn't even know they had diabetes. And
then we saw people become diabetic. And it was no one technology. That's the power
of this, this global profiling let us see the whole picture. And so sometimes it would
be, for example, the genome sequence that discovered this, sometimes it might be the
protein markers, and sometimes it was imaging, and it was no one, again, technology that
did it. Sometimes it's the combination. See, well, the image looked a little off. Look,
these protein markers are off. Let's do some follow-up there, and sure enough, you'd see
the person had an underlying condition always before symptomatic. So it's very, very powerful.
Half of these people learned, again, some pretty darn important things. You don't want
to learn about you have a heart condition by getting a heart attack, that's not the
way to learn. So we think this big data profiling is very, very important.
[Dr. Patrick]: Do you think that the trends from, you know, the way the healthcare system
is now to this more precision medicine system that you're talking about where it's, like,
you're gathering all this data from people and you're making very, you know...you're
making decisions based on their personal data and a lot of it. Do you think that's something...like,
how do you think we're going to be able to transition to that point because we will get
there, right? [Dr. Snyder]: Right. So there needs to be
a change at so many different levels. One is don't mistake, what we're doing is a research
project. But what we've learned is that what kinds of measurements are powerful that, you
know, medicine can use. So once again, we've spun off a company. I'm a believer, academics
are great at proof of principle and discovering things, but they're terrible at scaling. So
we've formed a company, in this case, Q Bio that does a medical version, what I was saying.
And it's not cheap, it costs $3,500, which some people can afford, but most people probably
can't right now. But I hope, as time goes on, we'll get it cheaper.
We would still argue getting a thorough exam where they do deep molecular measurements
and a whole-body MRI is still very powerful because the same thing, we caught a lot of
diseases early. Some with early pancreatic cancer, for example, prostate, heart conditions,
just from the first bunch of people we've been profiling. So we know this is powerful.
Now, why won't medicine do it? Well, first of all, the system is broken, once again,
nobody pays to keep you healthy. Medicine in the U.S., people typically get paid when
they're ill. So if you know, you walk into a hospital that's when the doctor gets paid.
Nobody...if you're healthy, nobody is going to pay you if you walk into a hospital to
keep you healthy. So we need to re-incentivize a system to make
it different. And there are ways of doing that I think. So for example, probably pay
employers to keep you healthy because then your productivity will be better. So I could
see where if we could have, you know, big places, like, Google or Facebook, or what
have you have their employees covered by these sorts of things, they would have healthier
workers, and that would save them time. I think also economically if we can show...and
certain areas, this has been done, like, for cardiovascular disease. You can probably make
an argument that it is important to get people measured so they stay healthy because if they
have a heart attack and go on long-term disability, that's really expensive.
So I think you have to find these niches. And the other thing you have to do, you have
to show...like, insurers don't want to pay unless you've proven to them it works. And
this is true for all new technologies even when it's pretty obvious, this is an important
thing to do nobody will pay to implement it until you show it works, and it saves them
money. Otherwise, there's no reason for doing it. So I think we need to change the mindset
of the insurers, we need to have physicians embrace this stuff, that's another thing.
When genome sequencing first came out, we told people we're running around sequencing
healthy people's genomes, a lot of physicians freaked out, told me what we're doing was
wrong. They still tell me what we're doing is wrong, that we shouldn't be profiling so
deeply, because you're going to learn all these things you're going to break the healthcare
system, you're going to turn everybody in a hypochondriac. And I think that's just very
demeaning to people because I think people...it's just very paternalistic. People are very good
at deciding for themselves what they want or don't want in terms of information. And
getting this information to catch disease early is a no-brainer to me, and people are
going to handle it. Now, actually, they're warming up to the idea of genome sequencing
is okay. But I guarantee 10 years ago most physicians thought this is a really bad idea.