Wednesday, September 25, 2013

Google Calico: The Quest To Improve The World's Health

It was pure joy to see this post from Larry Page (co-founder and CEO of Google) last week about Google Calico:
"I’m excited to announce Calico, a new company that will focus on health and well-being, in particular the challenge of aging and associated diseases.

These issues affect us all — from the decreased mobility and mental agility that comes with age, to life-threatening diseases that exact a terrible physical and emotional toll on individuals and families."
Can you imagine the impact such a big, innovative, engine like Google would have on the world's health?

Having worked in the health field for most of my adult life I can say that some of the biggest obstacles to better health are income disparities and gender inequality. People with the least resources tend to have less education (and vice versa), worse job prospects, worse diets, less social support, less access to basic healthcare let alone sophisticated medical technologies, and worse physical and mental health overall.

Focusing on the education of women has already been shown to improve health on a broad scale:
"Social and economic development [of] women and girls is the most inexpensive and effective tool in the fight against hunger and malnutrition, says a new study on gender and food security."

Women’s education alone resulted in a 43% reduction in hunger from 1970 to 1995, while women living longer led to an additional 12 percent decline in hunger levels, according to the report.

Gender equality is “the single most important determinant of food security”, wrote Olivier De Schutter, the U.N. special rapporteur on the right to food and author of the report, Gender Equality and Food Security: Women’s Empowerment as a Tool against Hunger, released this week."
- Women And Girls Are Key To Ensuring Food Security - Report, July 2013
And in this country, income disparities are at their worst in a century:
"The wealth gap between the top 1% and the bottom 99% in the U.S. is as wide as it's been in nearly 100 years, a new study finds.

"The top 1% incomes captured just over two-thirds of the overall economic growth of real incomes per family over the period 1993-2012," economist Emmanuel Saez of UC Berkeley writes.

Saez attributes the trend not just to technology and job outsourcing, but to the reduced power of progressive tax policies and unions, along with "changing social norms regarding pay inequality."
- Income Gap Between Rich And Poor Is Biggest In A Century, Los Angeles Times, 11 Sept 2013
These are some of the issues I imagined Google might tackle - education, access to clean water, clean air, better nutrition and sanitation. As I read more about Google Calico, my enthusiasm waned.
"In an interview with TIME Magazine, Google CEO Larry Page implied that dramatically extending human life is one of Calico’s main goals; not making people immortal per se, but, according to a source familiar with the project, increasing the lifespan of people born 20 years ago by as much as 100 years."
This sounds more like "life extension" than public health. Life extension is controversial and is distinct from healthcare. It is not so much about health for "us all" as Page put it, but about health for those who have access to the therapies and can afford them. I belonged to a life extension group for a while, years ago, and was put off by the self-centeredness. It was more about tweaking an individual's personal and already privileged life experience than it was about reducing the world's burden from life-threatening diseases.

A Pew Research poll this year that found while 38% of Americans would want life extension treatments ("medical treatments that slow the aging process and allow the average person to live decades longer, to at least 120 years"), 56% would reject them. A majority said life extension treatments are bad for society.


Anti-aging therapies are an extremely lucrative business in the US ("$50 billion of revenue each year"), partly because they are not regulated by the FDA and do not have to meet any bars for efficacy and safety. Many anti-aging therapies, like human growth hormone, are downright risky.

However, Dr. Astro Teller, who along with Google co-founder Sergey Brin, runs Google X, their research lab from which has sprung Google Glass and driverless cars, said recently in an interview with Charlie Rose: "It is our intention to make the world a better place, not to make money." I don't know how a business can exist without making money. I have a feeling that Dr. Teller's claim was more obfuscation or wishful thinking than fact. Indeed, the field of health biotechnology is poised to become a huge growth market over the next several years.

If Google's intention with Calico is to make the world a better place, not to make money, then they might avoid the trap many for-profit health companies fall into ... exploiting the sick for gain. It is not unusual for companies to invoke the image of disease and disability to gather support for a drug or therapy that was developed and marketed primarily to make money. Some commercials for cancer treatment centers are cringe-worthy. The Cancer Treatment Centers of America were recently outed in a Reuters Special Report for skewing their figures and heartlessly turning away seriously ill patients whose deaths would soil the data from which emerge their rosy claims. Kerri Morris, a writer and cancer patient, said of these findings, "Cancer Treatment Centers of America sells hope to desperate people and profits from their desperation."

Drug companies have a history of exploiting the sick. Novartis, as we just saw, had in their employ a man who took an unpaid job at a University which researched and published a study about a type of drug Novartis sold. Lancet said the data "were intentionally altered" by this person to make it appear that the drug was more effective than it was. This is not an isolated case. Several related studies are under investigation for similar reasons. Commercials for drugs are often misleading; they exploit disease and human suffering to make money.

Google has placed at Calico's helm Art Levinson, who waded into the medical industry's unscrupulous muck with Genentech's anticancer drug Avastin when he was their CEO. (He's still Genentech's Chairman, Apple's Chairman, and on the boards of several high profile drug companies). The FDA disapproved Avastin for breast cancer saying it was ineffective and unsafe.

The Economist article also said:
"Cancer arouses intense emotion. Patients and their doctors desperately try treatments that have little chance of working. At the Avastin hearing, one patient sobbed and others booed the panelists. Regulators and politicians have a tough job. They must protect patients' safety, encourage innovation and—soon—have a serious conversation about how much society should pay for a small extension of life. The fight over Avastin has been bitter. Much more is to come."
The Calico project seems poised to take a reductionist approach (with its emphasis on biotechnology and its leadership tightly associated with Big Pharma), which is a marketable approach. It does not look poised to take a preventive approach, which is often not very lucrative. I can't imagine Genentech's Chairman getting involved in promoting, say, a whole food plant-based diet, which evidence suggests is integral in establishing and maintaining long-term health. Well, I can, if it meant they could sell a drug for it. Can a drug ever be as comprehensive as lifestyle change? Replace lifestyle change?

Levinson hasn't outlined any specific projects yet. I shall reserve a bit of excitement.

1 comment:

Bix said...

It just occurred to me... Astro Teller said in that Charlie Rose interview that the reason Google is so secret about their X/moonshot projects, e.g. Calico, is because it would hinder their engineers, it would hold them to some public "standards."

When it comes to drugs and genes and therapies that affect human health, that treat disease, don't we *want* oversight? Isn't that why we have an FDA? To require these interventions to undergo efficacy and safety testing? And if they don't meet a "standard" they can be kept from the public? Genentech's/Levinson's cancer drug Avastin didn't make FDA's bar and was disapproved.

Also, by categorizing them as anti-aging or "life extension" therapies, which don't by-and-large fall under the FDA, is that another way to avoid oversight?

If their plan is to data mine personal medical information, who makes sure there are no breeches of privacy? The HIPAA Act makes sure no one sees an individual's medical data, "The provider must have a signed disclosure from the affected before giving out any information on provided health care to anyone, including parents." (Has the NSA breeched HIPAA?)

I think it would be a good idea for Google to be more transparent. It would avoid people thinking that Google's new venture is a way to somehow circumvent regulation.