Half A Heart

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Half a Heart…

technology, global health and human rights

California’s Bay Area is as close to Eden as it is possible to imagine.

It is more beautiful even than Cape Town – which itself is so stunning it brings tears to the eyes every time you visit. Even with these recent unseasonable Noah-like storms and floods, the Bay Area is still the most heavenly place on Earth. And to everyone’s surprise, the sun has started to shine again.

It is also the beating heart of the world’s economy. Here are based pretty much all the most important technology and artificial intelligence goliaths, the innovators and investors that serve them.

 Here is also home to a rapidly growing biotechnology industry. Gilead and Genentech are but two leading examples (and Genentech, interestingly, bought by Roche, is reverse-engineering the older company’s processes and thinking). Blossoming boutique not-for-profit biotech also lives here like Medicines360 (which develops health technology by women for women).

In the Maddaddam trilogy of novels, Margaret Atwood predicts a commercial spurt of biotechnology as the world heads for environmental wipe-out. She envisions mega-corporations, like HelthWyzer, maker of vitamin pills that also make people sick, that then makes the medicines to treat those ailments, driving patients into debt as they get sicker. She describes the Godzilla of them all, RejoovenEsence, from which Atwood’s anti-hero develops the infectious disease that kills virtually everyone on earth, while he also creates his gentle race of citrus-scented super-humans. These humans have prominent and bright blue reproductive organs, which may explain why cable TV executives have had such a hard time bringing Maddaddam into binge worthy TV, unlike the Handmaid’s Tale.

Speculative fiction allows us to anticipate, and on occasion, avoid the worst consequences of our behavior. A sort of down-beat literary best-directions app. Why not approach things from a different angle. Can we not choose to envision a more positive outcome for the creativity going on around the San Francisco Bay? For example,

-       Digital medical records are being mobilized not only to register information, but to track and predict threats – potentially enabling us to avoid zika and ebola outbreaks, the zombie apocalypse of the Walking Dead or the rapid, terminal infection in Atwood’s BlyssPluss.

-       New hardware and software are being developed to diagnose diseases and conditions. The huge reference laboratories we worked so hard to have built in every African capital city university hospital will be replaced by cute iPod-like boxes that will detect everything, including your mood, by just winking at you. More on an unfortunate cul-de-sac on this journey in a moment.

-       Artificial intelligence and computer generation are designing deviously clever new molecules to fit exactly onto viruses, bacteria or defective blood cells, switching them off without causing unwelcome side-effects.

-       And of course, personalized medicine, or as I prefer - peculiarized medicine. If it is not affordable and easily-accessed, I confess I can’t get too excited. But if, in helping the richest amongst us treat the most eccentric diseases, peculiarized medicine also expands knowledge and funding for things that really matter, so be it. An example could be the incorporation of a gene that switches on the growth of bone spurs in young male adults, eliminates them a few years later, and magically persuades them never to run for office.

I think we can envision a promising future. And maybe it is starting to bud already. It is fascinating to see how the new biotechnology companies have learned from (and, indeed incorporated elements and people of) the HIV and human rights movements, as they have sought to address the underlying dilemma of modern-day medicine – how to provide life-saving treatments to everybody, regardless of, gender, sexuality, culture or geography.  Global access is now incorporated into the business model of every drug developer. I have been part of the advocacy for this since the mid 1990s. To my mind, Gilead is the pioneer of technology transfer and manufacturing to Indian generics pharmaceutical drug companies who, by definition, have lower manufacturing costs. There is still much to learn, and nobody would say that this approach has been perfected. However, the commercial model, despite Wall Street, has been transformed utterly.  For transparency, I should declare, and happily so, that Gilead has supported Hunuvat’s work.   

Global health advocates like me, who find ourselves living in the Bay Area, have had a harder time wooing the broader tech industry. It is as if only half our heart is beating. Which might be fine if your ambition is limited to making phones smart enough only to listen to back catalogue of the Pet Shop Boys (get the reference? Heart? Oh well…)

 Yet, in fact, the Bay Area technology giants and the Silicon Valley venture capitalists that feed them, have invested incredible sums in health, and also brought forward their fearsome reputation for disruption.

 In an insightful, and slightly frightening article, The Medical Futurist describes Google’s “Masterplan For Healthcare”. Since 2009, Google’s parent, Alphabet, has invested in over 60 health business opportunities, from 23andMe, Deepmind (which seeks to engage artificial intelligence to speed scientific discovery), to Doctor on Demand (which seeks to enable patients to connect with their physicians from no matter how far apart they are. Of course, the HIV community is already doing a version of this to secure PrEP prescriptions around the world, and that is another story for another day).

Google partners with established health companies, including Johnson & Johnson, with which it created Verb Surgical. Its mission is to “democratize surgery”. Thankfully this does not involve training people to use knives to remove their own tumors, but rather is creating a technology- based end-to-end surgical services platform, enabling physicians to oversee pre-operation planning, making rapid, informed decisions during surgery, and managing post op care.  I am not sure I fully understand what that means.

 But perhaps the most Atwood-esque creation, is Calico, created by Google’s Larry Page in 2013, which aims ultimately to extend human life spans. On face value, this is a hard disruption to swallow. Our cultural “zeitgeist” – from literature, art, comic books and films, rehearses the evil awaiting patiently around the corner for those pursuing immortality. One might even ask, why on earth would you want to live longer than you have to? But more seriously, what does this kind of endeavor say about our priorities, given that children in many parts of the world, including the USA, do not live to see their fifth birthday. Is there some subliminal genetic or intellectual Silicon Valley superiority that needs extending over others and ultimately perpetuating?

 An extraordinarily significant shift in the depth of dialogue between AI and bio technologists, and public health and human rights advocates is needed. As the techs reach into and change our concepts of health, we must collectively bring the promise of artificial intelligence, elastic cloud computing and data drilling to the entire world. We need to hold hands as we take our tentative first steps into this new garden of Eden, tempted by the exotic fruits of opportunity and risk.

 The desperate need for this dialogue could not be better told through the sorry story of Theranos, a Bay area diagnostics company founded in 2003 by a 19-year-old Stanford drop out. The company claimed to have developed point-of-care diagnostic technology that, from a pin-prick of blood, could run over 200 tests. To learn more, listen to the ABC Podcast series “The Drop Out”. It is an enthralling and deeply disturbing narrative. In essence, a multi-billion company was built on a delusion that this leap-frog in technology existed - or was about to exist. When I first moved to the Bay Area in 2010 to lead Pangaea Global AIDS, I could not quite understand why friends and advisers adamantly recommended avoiding Theranos as a potential supporter and collaborator. There was just nothing there.

Theranos represented the logical conclusion of the nasty phrase “you fake it, until you make it”. The greatest strength of western medicine is the pre-eminence of peer-reviewed literature, the definitive open source of clinical science. That Theranos remained in business for over a decade, that technology, engineering experts and their venture capitalists could go so far, waste so much money, is a testament both to the hubris of the human soul, and the need to join the dots between these increasingly complicated siloes of knowledge.

 At its peak in 2013, Theranos was valued at 10 billion US dollars. It is just worth noting that this year, The Global Fund Against AIDS TB and Malaria is requesting 14 billion USD dollars for the next three years, to save 16 million lives and avert 234 million new infections. Just saying. In case someone you know is looking for a smart investment opportunity…