So You Wanna Live Forever?
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An Interview with David Gobel
David Gobel is Chief Executive Officer of the Methuselah Fund. He founded the original non-profit in 2000 in an effort “to reverse or preempt the damage of aging and the suffering it inflicts.” David and I sat down, albeit in two different parts of the country, to discuss the cutting-edge technologies that fight aging, the companies that are leading the way, and the quest to engineer the fountain of youth.
Borders: What is "life extension" -- and what does the Methuselah Foundation have to do with it?
Gobel: There are two kinds of life extension, one based on statistics and one based on one's own particular, non-statistical life. In each case, Life Extension means being healthier and living longer than: a) humans maximally have lived historically as a species (i.e. 120 years); and b) living a longer and healthier life than one individually would otherwise be likely to achieve without thoughtful intervention and new life extending technologies. For example, my mom lived to be 81, and had cancer surgery, knee replacements, insulin and a bunch of other interventions that didn't exist when when she was younger. My estimate is that medical advances added 19 happy years to her life...a huge personal dividend. We want to significantly extend the quality and quantity of that dividend so that 90 becomes the new 40.
By promoting extension of the statistical healthy lifespan, Methuselah has been a major influence on the public and scientific community's perception of the acceptability and value of increasing the maximum human lifespan and health-span. Starting in 2003 via the Methuselah Mouse Prize (four winners to date) and the tireless work of Methuselah volunteers - notably, Dr. Aubrey de Grey - the concept of engineering the delay of the human "expiration date" went from a ridiculous sci-fi fantasy to a non-controversial goal that serious scientists can now pursue without destroying their careers. The only controversy today is not if it will happen, but how soon it will happen.
On the second point of personal longevity, Methuselah has initiated a New Organ Prize (NewOrgan.org) that will incent the creation of something blindingly obviously needed. New parts for people. If a car can run perfectly well as if it had just come off the assembly line 110 years after being built because of replacement parts, why should humans be second class citizens to cars? Why should the 30,000 people who need new hearts at any given time be stuck with death as the likely outcome when your old corvair can easily get a rebuilt fuel pump? It is completely ridiculous, and we intend to do all we can to end the horror of the "Dialysis Matrix," for those needing kidneys currently suffer year after year in silence. So, New Parts For People is our current focus, because no one dies statistically - we die one unique and irreplaceable person at a time. Often because we just need a new part.
Borders: Organ replacement sounds like a great start. So what is the state of the science of life extension, both in general and relative to your mission and prizes?
Gobel: Extension of the maximum lifespan is still in its infancy, but as humanity emerges from the trial-and-error era of medicine to an engineering-based medicine (building from genomics, proteomics, metabolomics, 3D tissue printing, telemedicine, designer nutrition and pharmaceuticals based on one’s specific genetic makeup and a host of emerging technologies), the rate of innovation to increase lifespan will drastically accelerate and affect the lives of people already in their 50s. This engineering-driven medicine is being accelerated by Moore's Law and Metcalfe's Law, Big Data, AI and the invasion of the medical field by Silicon Valley.
Prizes create a pressure to deliver results, not just hope, promises, and opinions. Prizes are a purchase order on future results. Do the deed, get the glory and loot. As mentioned before, there have been four winners of the Methuselah Mouse Prize, and as a result, no one doubts that life extension - even in the already aged -- can happen...because it already has happened. We expect to build a very large movement around our NewOrgan Prize so that 100,000 modest donors demonstrate their will by putting skin in the game.
Borders: Philanthropy in this area is great. But what are some solid publicly-traded companies that are active in life-extension research and associated therapies?
Gobel: Frankly, the field is too young to have produced many publicly traded companies. However, I am very bullish on companies such as Medtronics primarily because they are perfectly positioned and have sufficient scale to drive and benefit from the New Parts for People movement. For a much riskier new company I'll mention Organovo (ONVO), which is the company that produces the world's first three-dimensional tissue printer. (In the interests of full disclosure, Methuselah Foundation was the founding outside investor in this company, so it should be pretty obvious how we feel about it. As a note of caution though, the share prices are highly volatile at the moment.) Finally, another company with exciting technology using autologous stem cell regeneration techniques which is in late stage trials is Cytomedix (CMXI). We have not done financial due diligence on the firm, but the technology has great promise and is reasonably near term from an FDA regulatory standpoint.
Most companies focused on life extension technology are still privately held. One very interesting such company is Silverstone, which makes the MatchGrid Cloud-based paired kidney matching system that has already been instrumental in making 61 kidney transplant operations possible that would in its absence likely not have happened. Their business model is for their software to make possible the pooling and sharing of transplantable organs across hospitals - thus increasing both availability and matching quality of organs. (See this, for example.)
Borders: What is the most promising research avenue for the near term?
Gobel: Several directions: First, there is the switch from trying to slow aging by trying out various drugs, which is the essence of the old approach to all human medicine, to the rational design of biotechnologies to precisely repair or work around each of the causes of aging. As outlined by Aubrey de Grey and others in the Strategies for Engineered Negligible Senesence (SENS), we already know with a fair degree of surety exactly which of the many cataloged biochemical and cellular changes that accompany aging are in fact the root causes of degeneration, frailty, and death. We also know enough about how to revert these changes to be developing the necessary biotechnologies for the task. This is a straightforward research and development plan, or at least as straightforward as research can ever be; progress here at the present time is largely a matter of raising more funding and convincing more of the research community to give up the old drug development line, going nowhere fast, and join the better party.
Secondly, the field of stem cell medicine, encompassing tissue engineering, regenerative medicine, and so forth, offers the prospect of replacing worn body parts and cell populations, or even restoring them in situ without surgery. (See Aastrom Biosciences (NASDAQ: ASTM), Neostem (NBS), and Geron (NASDAQ: GERN)).
[Note: the interviewer’s mother-in-law is a living, walking and running proof that regenerative therapies work. Her knees have been “replaced” using regenerative stem cells rather than titanium.]
It is even a promising matter that cell therapies are hampered by the damaged environment of the old body: Because so much of regenerative medicine is most beneficial to the old, that large industry will be increasingly steered in the direction of understanding how to reverse that environmental damage - how to restore the broken signaling and damaged stem cell niches that lead to poor regenerative capacity in the elderly. (See Celgene (NASDAQ: CELG)).
Lastly, the burgeoning field of immunotherapy, which overlaps with stem-cell medicine in its use and manipulation of immune cells and the stem cells that give rise to them, gives us the promise of rebooting age-damaged immune systems. Much of the frailty of age stems from the disarrayed immune system; it starts to run hot all the time, causing inflammation while failing at its tasks, or becomes mal-programmed and attacks its host, giving rise to autoimmune conditions like rheumatoid arthritis. The immune system is responsible for destroying cells that might become cancerous, and clearing out senescent cells that otherwise stick around to emit damaging signals that degrade surrounding tissues -- but it starts to fall down on those jobs, too. Fortunately, researchers have demonstrated that it is possible to revert some forms of immune system disarray by destroying the immune cell population with chemotherapy and then replacing it from the patient's stem cells. In trials, this approach has been used to cure Type-I diabetes and multiple sclerosis (MS), for example. Further methods will become more sophisticated and more relevant to reversing the general age-related decline of the immune system, not just extreme malfunctions like MS.
A wild card in all this is the potential for the "measured me" movement. This is a movement that puts the person in charge of their own health by arming them with facts and knowledge about their own personal biological universe. My personal estimate is that hand held systems that continuously, conveniently and cheaply monitor all sorts of body functions and status will provide early warnings and recommendations to folks that just don't exist now. I'm very serious in saying that we will have an affordable tricorder within seven years, similar in size to today's smartphone.
Borders: What sort of time horizon are we looking at for seeing some of the more robust therapies come online?
Gobel: The first Autologous Stem cell therapies could arrive within one or two years if they gain FDA approval. The "measured me" movement is ongoing and gaining speed and power. Cloud-based transplant market making networks are within two years at the latest. Designer tissues will take about four years. Small molecule interventions for immune rejuvenation and "getting the junk out" will take 10 years - if there is significant funding [and investment] … which is the rub!
Borders: Why the "prize" model versus other models for incentivizing research?
Gobel: Prizes do not replace other models, but can break logjams and accelerate progress by bringing new blood, treasure and ideas into a field that has had little progress for whatever reasons. For our mission, accelerating progress is meaningful. It means that every day saved means avoided pain, suffering, deaths and avoided estate tax payments.
The path most never-been-done-in-history technologies follow is like a very low and slow power curve. Think of how long it took humans to fly as an altitude graph where the X-axis is time and the Y-axis is altitude. For almost 6,000 years of written human history, the altitude might as well be zero - and then the graphs jumps a bit when, in the late 1700s we get balloons and get up a couple thousand feet. Then in 1903 we get the Wright Flyer followed by a ton of prizes, and we go from a couple thousand feet in 1903 to now literally millions of miles (or as they say "off the charts") now that the Voyager spacecraft has left the solar system.
Another similar power curve is that of famine. For almost 6,000 years, people regularly expected to starve to death at some point. Then, in an effort to gain military superiority for an army in the field, Napoleon issued a prize challenge for any inventor who could preserve food and drink for six months. The prize brought about the solution directly. And ironically, this was the world's first bona-fide life extension technology, as almost immediately the life-span in the west began a continuous ascent of adding .25 years to the typical lifespan for the last 162 years. So, we are using prizes to push the "low and slow" curves up off the bottom so that we get there much faster than we would by other means.
Borders: Staggeringly cool, stuff. You give us lots of reasons to be optimistic. Thank you, David.
Gobel: You’re welcome. Thanks for the opportunity.
Max Borders is author of the forthcoming Superwealth (Fall 2012). Contact him here if you’d like to receive a notice when the book is out.
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