Why Medicine is About to Change Forever.

As recently as the early 1800s, any human born could only expect to live to around the age of 35.

In the 200 years since, that has increased by almost 40 years to around 74 as a global average. It’s tempting to think that this is because all the scientific and medical marvels of those two centuries have added significantly to the potential human lifespan.

But that’s not what happened.

What happened is that a combination of sanitation, medical science, health & safety practises and a number of other factors have conspired to significantly reduce the incidence of premature death.

The data show quite clearly that the actual potential span of a human life has remained almost unchanged since time immemorial.

As a growing number of universities, companies and private laboratories are now proving though, our potential for health and longevity may be much, much greater than we ever imagined possible. At the same time, we are beginning to see that the potential costs and other accessibility barriers to high-quality medical care may be much, much lower than they currently stand - and the level of uncertainty inherent to modern medicine may become a thing of the past.

As I’m about to describe, technologies are now coming of age which will drastically improve outcomes in medical care, accessibility of medical care – and which have the potential to allow us to live much longer lives.

I chose to write this piece, not just because the topic is interesting, but because we have recently added some exposure to these technologies across our investment portfolios.

Fascinating times ahead…

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Welcome to the Age of Genomics.

Genomics is a relatively new – and rapidly maturing - field of science. Its focus is the study of the entire human genome and its various interactions. This is where we find genetic markers for a variety of predispositions – and where we are increasingly learning how to use this data to revolutionize medicine.

The Human Genome Project was completed in April, 2003. This marked the first time the entire human genome had been mapped and the full dataset made available for study. It was a landmark scientific achievement which took the better part of 13 years to complete – and cost approximately $3 billion.

Fast forward to today and you can now do more or less the same thing with your own genome, via any number of private companies, for a cost of less than $200.

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What does it do?

With your genome mapped, you’ll immediately have a detailed understanding of how you’re built at the genetic level, including a slew of potential genetic issues (so you can manage them), predispositions for dozens of kinds of cancer, which kinds of diet and exercise are likely to be most suitable for you – and which medications may be most effective in treating you under a variety of scenarios. That’s a very powerful list of benefits.

With highly accurate preventative plans in place and individual medication interactions clearly understood, we expect healthcare outcomes to drastically improve. Some of those benefits are available more or less immediately – and for minimal cost.

As investors (and human beings), we really like anything which has the potential to improve affordability, accessibility, and efficacy in healthcare. Very few themes have the potential to move the needle as far at a global level. Governments seem to like it too, which is why they are now investing heavily in bringing genomic science to a clinic near you.

Given the combination of the policy push, vast private sector investment, and consumer demand once the benefits are more widely known, we expect this technology to be adopted at lightning speed over the coming years.

The final, stunning, possibility here is the ability to edit our ourselves at the genetic level using technologies like CRISPR. If you want to mess around with editing your genes at home, you can already do that with a mail-order kit (totally not recommended). For the less adventurous, it won't be too long before you can benefit from this in a more professionals setting. Just imagine if we could remove predispositions to obesity, a variety of cancers, or congenital cardiovascular diseases out of the gene pool. This is a hair's breadth from becoming reality.

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Where death goes to die?

The underlying cause of most chronic disease can be attributed to one factor: getting older.

To age and eventually die seems a natural and inevitable part of the cycle of life; something people actually work their entire lives towards preparing for. But could we change that? Could we slow ageing to a crawl, or even treat it like a disease? Could we reverse some, or most of the effects of the ageing you have already experienced? Could we, at the genetic level, edit ageing out?

There is a significant and growing body of science behind answering these questions in the affirmative. Many of those answers, as you might have guessed, lie in the realm of genomic science. Every day, scientists around the world are edging closer to a breakthrough which could drastically extend both our lifespan and, more importantly, our healthspan.

To say that this would be of great benefit to the world as a whole is a wild understatement. The economic benefit would be near-incalculable. Imagine people continuing to live healthily and work, well into their 90s. This would substantially mitigate the currently unfunded future healthcare and retirement costs of entire generations. Future financial crises associated with this would either not come, or would come much later than currently anticipated.

I understand that this is one of the more controversial implications of genomic science – and there will be myriad ethical snares around how this particular capability is deployed. For example, will it simply create a situation in which the rich become almost immortal and the poor continue dying between the ages of 65 and 80? Initially, that may well be the case. Over a longer time scale though, I would expect the cost of such treatments to fall dramatically; much as mapping an individual genome has done over the past 18 years. With AI-assisted data analysis, the pace at which new technologies become more affordable is only going to accelerate. Given the vast and far-reaching economic benefits on offer, they may even heavily-subsidized by governments in many places.

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New drugs – and better use of old ones.

There are now nearly 300 medications with pharmacogenomic information. If you’ve never heard that term, it’s because it hasn’t been used much until quite recently. I’d guess that you’re about to start hearing it more often though.

What it means is that the genomic interactions of a drug are understood in detail - and can be used to prescribe drugs with great accuracy, to specific patients, for the treatment of specific conditions. In other words, that a drug might be very suitable for treating a particular condition with one group of patients, but a different drug might be more suitable for another group.

Genomic information can also be used to develop entirely new drugs. In fact, there are a number of companies developing methodologies (and entire platforms) to enable the rapid develop and deployment of such therapies. RNA-targeted therapies in particular are already showing great promise. I'm sure I don't need to elaborate on the fairly stunning developments in messenger RNA (mRNA) technology over the past couple of years...

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Looking forward…

If I seem excited about the possibilities of genomics, it’s most definitely because I am. Both of my parents have had cancer (thankfully, both have bounced back) – and I know many people around the world with chronic illnesses. The developments of which I speak will help prevent others from suffering in the ways that I've seen happen to people I care about. A lot of 'manageable' conditions will become genuinely treatable - and may even become editable out of their genetic make up.

I also know a lot of other people who are keen explorers of the best methods of exercise and dieting to enable them to live the lives they desire. Many of them can now stop guessing – and start moving with what they know will work best.

Where this technology will lead is unknown, but it seems to represent one of the most significant developments in medicine since the antibiotic.

Personally, I’m very excited to see where this will lead.

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