The Lucky Years: How to Thrive in the Brave New World of Health (35 page)

When you think about it, perceptual intuition is a way of looking at yourself and asking, “How can I live better tomorrow based on what I’m doing today? What habits do I need to change based on what I know? What new technologies or habits should I bring into my life?”

Although we’re not always aware of it, we ask ourselves these questions every single day, many times over. Whenever we’re faced with a decision, from deciding what to eat to which medication to try to treat a condition, our first questions are always “What are the options? What are the facts and what data are available to me? What should my solution or outcome be?” All of this activity that our brain performs, below our conscious radar, is a perfect example of our perceptions at work helping us to solve problems and make good decisions. I encourage you to tap your intuition as much as possible and bring more consciousness to those important decisions in life that relate with your health. Identify the phony from the real in health advice and know that your choices must reflect
you
—your biology, your context, and your values. And then let science—and the art you and your doctor bring to it—do the rest.

In the world of medicine, a new concept is being used, stolen from physics and photography, that will increasingly help us in the Lucky Years. Because many times we can’t understand everything, scientists are
coarse graining
biology to make models to predict outcomes. Coarse graining comes originally from photography: as you twist the focus on the lens, you go more and more out of focus until all you can see when you point the camera at a friend is the outline of a human.

If you turn the lens the other way and get into better focus, more and more details come to you—what your friend is wearing, the expression on her face, and her hairstyle. But you didn’t need any of that to know it was a human being. Sometimes we in medicine look at way too many details and try to put them into a model, when if we’d take a step back and examine a coarse-grained element instead, it would work much better. This is not unlike the art historian who can look at a painting
from far away and tell if it’s real or not without having to conduct any fancy scientific research on the canvas or examine it up close with a magnifying glass.

A coarse-grained image of me. The details of my face and body are obscured, but you can still tell the photograph is of a human.

The physics and climate-modeling worlds have learned so much by taking this approach. The meteorologist doesn’t go thousands of feet up in the sky every day and measure wind speed, temperature, and moisture to help predict the weather. Instead, he looks at the shape of the clouds as a coarse-grained element of everything going on, and uses this to help model the forecast. Medicine has to go the same way. If I want to know if you are stressed, I can measure your adrenal and neurohormones and study your brain activity with a functional MRI (magnetic resonance imaging) or PET (positron-emission tomography) scan, or I can simply measure your heart rate variability (HRV)—the time intervals between heartbeats, which aren’t always the same.

Broadly speaking, coarse graining means being able to look at a complex system or structure and make a rough sketch of it without all the nitty-gritty details. This coarse-grained element can then be used as a surrogate for all of the nitty-gritty details that either can’t be measured efficiently or can’t be measured at all. Many of the technologies that will dominate in the Lucky Years will help us coarse grain biology around a specific outcome. For example, we will measure your skin’s electrical conductivity (termed either galvanic skin response, GSR, or electrodermal response) between two points on your arm as a way of measuring that your body is excited or tiring. It sounds pretty wild, but
the skin momentarily becomes a better conductor of electricity when external or internal stimuli occur. I could use this technology to understand which songs on the radio “charge you up” while you are driving, and the car could play these particular tunes if it senses you are about to fall asleep at the wheel.

On a similar note, consider my friend who called me a few weeks ago with an exciting story to tell. He had been wearing a device that gives him a readout through the day of his heart rate. He had a baseline heart rate in the high 50s, but noted that his heart rate went up to the mid-60s on one particular day. And then he came down with a virus. This observation—seeing the trend in his heart rate change and culminate in getting sick—thrilled him. Having this kind of knowledge in advance is increasingly going to happen in the Lucky Years, allowing us to better prepare for or perhaps totally evade those times when we’re destined to be under the weather.

Here are a few more examples: the size of your red blood cells will be used as a coarse-grained measure to check for iron deficiency instead of measuring blood iron and its partners. Cells deficient in iron are much smaller than their counterparts with iron. The “how do you feel” question will be employed with advanced cancer after starting a new treatment to determine if a therapy is working rather than just measuring all of the tumors in the body. While such a broad, general question may sound “unscientific,” it can lead to real solutions and useful information to effect better outcomes. New technologies will be used to further coarse-grain biology and give us shortcuts to help answer some of the key questions that dominate in medicine. Can we coarse grain aging? Aging is a gradual deterioration of organ systems in the body. If we could measure it, doctors could start clinical trials to slow the process, starting at a young age. But it’s likely the subjects would outlive the researchers, using our current standard of survival as the endpoint of clinical trials. That is not a tenable solution. We have to develop coarse-grained measures of aging and use these as surrogates, or representatives, for survival. For example, maybe a combination of how you look, how you feel, and other coarse-grained elements can be
combined with measurements of organ function to yield one number. This number could be studied in clinical trials as a proxy for “biological age.” The comparison of biological age to chronological age would be the endpoint for the intervention. Going forward, you and I will be able to decelerate our aging pace using real-time metrics, such as this.

In 2014, I had the pleasure of spending the weekend in Berlin with Muhammad Yunus, a true hero of epic proportions today from my perspective.
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I don’t know if I’ve ever met a humbler or more altruistic individual, a man now in his seventies whose passion for helping mankind is surely in his DNA. Yunus has created more than fifty self-sustaining companies to lift his country out of poverty, and he can claim zero ownership in those enterprises. Famous in his native country of Bangladesh and world renowned as a civic leader and successful social entrepreneur and economist, Yunus was awarded the Nobel Peace Prize in 2006 for founding the Grameen Bank and pioneering the practice of microfinance—providing banking to entrepreneurs and small businesses that would not otherwise have access to such services. Some have called him the godfather of microcredit. What started as a passion to help “just one person each day” has grown into a global phenomenon of two hundred fifty microcredit programs in nearly one hundred countries. His story exemplifies not only the power of blending art and science, but also catering to people’s basic needs, intuitions, and motivations in pursuit of innovation—and a healthier tomorrow.

Yunus initially got into the business during the famine of 1974, when dying Bangladeshi people began to beg for help from wealthier citizens in the city of Dhaka. Watching this tragedy as an economics professor at Chittagong University, Yunus grew frustrated. His lofty economic theories were not doing anything to help his fellow Bangladeshi families who were barely surviving. He then began to take his discontent to the streets, speaking with the poor and thinking about how he could help them. At first, he lent twenty-seven dollars to a group of forty-two
people in a nearby village who were being victimized by shady, unethical lenders. This inspired the idea of lending small amounts of money to impoverished individuals who could then work toward giving back somehow through a trade or craft, essentially starting businesses that would support their livelihood and contribute to society at large. Yunus couldn’t get local banks to participate in the lending, however. So he vowed to do it himself, and Grameen Bank was born in 1976.

Yunus taught me a lot about how to think about and approach health that weekend in Berlin. Even though he’s a man of the banking world, he’s also a man of the public health world, always innovating ways to bring the two together to effect change in his society. Bangladesh is among the most densely populated countries in the world with more than 160 million people living in an area the size of Iowa. Although it has made significant strides in human and social development since declaring its independence in 1971, Bangladesh has faced numerous political, economic, social, and environmental challenges, including political instability, corruption, and immense poverty. Enter Yunus and his ideas based on a simple concept: “Lend poor people money on terms that are suitable to them, teach them a few sound financial principles, and they will help themselves.”

One of Yunus’s most prized legacies is how he transformed the lending industry in Bangladesh in response to local loan sharking. Proving that the poor can be reliable borrowers (despite conventional banking dogma), his bank has disbursed billions of dollars to millions of borrowers who have no collateral, and it has a 98 percent payback rate even though there’s no legal instrument or written contract involved. Most of his borrowers have risen out of acute poverty and almost all are women. In fact, 98 percent of his loan recipients are women who meet once a week and, through incentives, help to ensure their individual loan repayments. Why focus on lending women money? Traditionally, in the third world, men are the recipients of loans from banks. But this is where Yunus was brilliant: not only were women more responsible about repaying the loans and families benefited more when the women controlled the money, but he also knew that the women in Bangladesh
controlled health decisions in their families. So by focusing on them, he could revolutionize health in his country. And he did.

In 1984, Grameen finalized its “16 Decisions,” essentially a set of commandments that every borrower must accept. The bank set a high bar for itself, with the goal of making each of its branches free of poverty as defined by benchmarks such as having adequate food and access to clean water and latrines. Among the Decisions stipulated in his loans:

Decision Four: “We shall grow vegetables all the year round. We shall eat plenty of them and sell the surplus.”

Decision Nine: “We shall build and use pit latrines.”

When I asked Yunus about the latrine commitment, he explained how sanitation in Bangladesh was horrible at the time his bank started thriving. The widespread squalor led to outbreaks of cholera. People were relieving themselves outside in the open air, allowing the disease to spread. This motivated him to put a condition on the loans that you had to dig a toilet hole in order to get the money. “A pit latrine is a simple, practical way of drastically reducing the incidence of diseases spread by contact with human waste,” he told me. His bankers would actually go into the countryside where their customers were and check for the latrines before dispensing the money.

The incidence of cholera started to plummet. In fact, the wealthy women who didn’t need loans were getting jealous that the poor had pit latrines close to their tents. In Islam, the women don’t regularly go out in daylight, so they’d have to wait (uncomfortably so) until night fell, then walk to the outskirts of the village to go to the bathroom outside. Soon everyone was building his or her own pit latrines.

Yunus continued to take his ideas further. His bank staff taught its members how to prepare a saline solution at home to fight dehydration due to cholera. They developed a rhyming poem so everyone would remember the basic home ingredients to put into water to make the electrolyte solution. Yunus also founded a social company to build and distribute toilets. To further fight malnutrition, in 2007 Yunus partnered
with Dannon, the French multinational milk product company, to develop an inexpensive, fortified yogurt chock full of all required nutrients. Grameen Danone sought to sell cheaply and it took no profit. It has been very successful.

For another example of Yunus’s genius, he once noted that when he would visit villages at night, the children couldn’t read. They were suffering from night blindness, a common result of severe vitamin A deficiency. So he sprinted into action again, this time organizing a business to distribute vitamin A–rich vegetable seeds—for a penny a pack. He first looked into starting a vitamin company, but people didn’t want to take pills. If he didn’t charge, the people would perceive no value. So he solved the problem with the penny-a-pack seeds that would supply the vitamin A naturally (hence Decision Four). The business flourished until soon he was the largest seed supplier in Bangladesh and, not surprisingly, children could see again at night.