Category Archives: Longevity Medicine

Summary: Researchers have designed a new model of life expectancy thats based less on disease diagnosis, and more on other factors including cholesterol levels and lifestyle.

Source: Duke University

A new model to predict the life expectancy of older people relies less on their specific disease diagnoses and more on factors such as the ability to grocery shop, the amount of certain small cholesterol particles circulating in their blood, and whether they never or only occasionally smoked.

The findings from a study led by Duke Health researchers provide a way to predict whether a person over the age of 70 is likely to live two, five or 10 years. The markers may be obtained during a doctor visit, so they could be a useful guide for clinical care.

This study was designed to determine the proximal causes oflongevitythe factors that portend whether someone is likely to live two more years or 10 more years, said Virginia Byers Kraus, M.D., Ph.D., professor in the departments of Medicine, Pathology and Orthopedic Surgery at Duke University School of Medicine and lead author of the study appearing online in the journaleBioMedicine.

Properly applied, these measures could help determine the benefits and burdens of screening tests and treatment for older people, Kraus said.

Kraus and colleagues launched their inquiry at an opportune time, having been directed to a cache of 1,500blood samplesfrom a 1980slongitudinal studythat enrolled older people.

The banked samples had been drawn in 1992 when participants were at least 71 years old and then stored at the NIH. They were scheduled for destruction, but the researchers arrived in time to transfer them to Duke for analysis.

The blood samples had the additional fortuitous feature of being drawn at a time that preceded the widespread use of medications such as statins, which could have skewed the results. Moregood luck: study participants had been followed for several years and had filled out questionnaires about their health histories and habits.

Capitalizing on all the features of the older study, the researchers were able to apply current sophisticated analytical tools. Led by Constantin Aliferis and Sisi Ma at the University of Minnesota, the researchers were able to delve into health factors to identify a core set of 17 predictive variables that have a causal impact on longevity.

The analysis found that a leading factor associated with longevity across each of the studys benchmarkstwo-, five- and 10-years after participants had their blood drawnwas physical function, which was defined as an ability to go grocery shopping or perform housecleaning chores. Surprisingly, having cancer or heart disease was not among the main predictors.

Forolder peopleliving two years beyond the time their blood had been drawn, the leading factor associated with longevity was having an abundance of high-density lipoprotein (HDL) cholesteroland not just any HDL lipids, but high volumes of very small HDL particles.

This was especially surprising, Kraus said. We hypothesize that these very small HDL particles are the size that is best at scavenging and clearing endotoxin, a potent inflammation-causing molecule from gut microbes, from the circulation [VBKMP1] .

The small particle may also be best able to get into the nooks and crannies of cells to remove the bad cholesterol, so having more of them could provide this protective benefit.

At five years beyond the originalblooddraw, just being of a younger age was predictive of longevity, along with cognitive function. And among the longest survivorsthose living 10 yearsthe best predictor was a persons smoking history, with non-smokers faring best.

These measures clarify and enrich our understanding of mechanisms underlying longevity and could point to appropriate tests and potential interventions, Kraus said.

She said the next stage of research is to use additional analytical tools to improve the predictivity and identify potential targets for therapies.

Author: Alexis PorterSource: Duke UniversityContact: Alexis Porter Duke UniversityImage: The image is in the public domain

Original Research: Open access.Causal analysis identifies small HDL particles and physical activity as key determinants of longevity of older adults by Virginia Byers Kraus et al. eBioMedicine

Abstract

Causal analysis identifies small HDL particles and physical activity as key determinants of longevity of older adults

The hard endpoint of death is one of the most significant outcomes in both clinical practice and research settings. Our goal was to discover direct causes of longevity from medically accessible data.

Using a framework that combines local causal discovery algorithms with discovery of maximally predictive and compact feature sets (the Markov boundaries of the response) and equivalence classes, we examined 186 variables and their relationships with survival over 27 years in 1507 participants, aged 71 years, of the longitudinal, community-based D-EPESE study.

As few as 8-15 variables predicted longevity at 2-, 5- and 10-years with predictive performance (area under receiver operator characteristic curve) of 076 (95% CIs 069, 083), 076 (072, 081) and 066 (061, 071), respectively. Numbers of small high-density lipoprotein particles, younger age, and fewer pack years of cigarette smoking were the strongest determinants of longevity at 2-, 5- and 10-years, respectively. Physical function was a prominent predictor of longevity at all time horizons. Age and cognitive function contributed to predictions at 5 and 10 years. Age was not among the local 2-year prediction variables (although significant in univariable analysis), thus establishing that age is not a direct cause of 2-year longevity in the context of measured factors in our data that determine longevity.

The discoveries in this study proceed from causal data science analyses of deep clinical and molecular phenotyping data in a community-based cohort of older adults with known lifespan.

NIH/NIA R01AG054840, R01AG12765, and P30-AG028716, NIH/NIA Contract N01-AG-12102 and NCRR 1UL1TR002494-01.

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How Long Older Adults Will Live Comes Down to 17 Often Surprising Factors - Neuroscience News

A pair of new drugs offer something many Americans desperately want: a way to lose weight.

In clinical trials, Novo Nordisks NOVO.B, -0.43% Wegovy helped adults lose about 15% of their body weight. The drug, which received approval from the U.S. Food and Drug Administration last year, had such a successful launch that its now in short supply. Eli Lillys LLY, -2.02% tirzepatide, meanwhile, is still in clinical trials, but data from a Phase 3 trial showed that people taking the drug lost up to 22% of their body weight.

For the roughly 42% of Americans who are obese, these results are nothing short of a miracle.

Wall Street is thrilled, predicting a global market for the drugs as big as $54 billion by 2030. And physicians feel they finally have a new treatment option for their patients. I was prescribing Wegovy almost as fast as I could, said Elizabeth Fryoux, a physician who practices obesity medicine at the University of Mississippi Medical Center.

And there is more research coming: Lilly and Novo are also running studies to figure out if the same drugs can reduce the risk of death or improve outcomes for conditions like high blood pressure and stroke that often go hand in hand with obesity.

But there are roadblocks to getting these therapies to patients who need them. Late last year, Wegovy ran into supply issues brought on by a combination of high demand and production issues involving the syringes used in the pens that inject the medication. The issues are expected to resolve sometime before the end of the year. The stigma surrounding obesity, meanwhile, may be discouraging insurers and policymakers from covering these drugs.

The drugs developed by Novo and Lilly to treat obesity have both been approved, in different formulations, to treat Type 2 diabetes. Those therapies Novos Ozempic and Lillys Mounjaro, which got FDA approval in May are covered by Medicare, the federal health-insurance program for older adults and people with disabilities. Medicare doesnt cover Wegovy or other FDA-approved weight-management therapies, including Vivus Qsymia.

If we have a drug that is Wegovy that is for weight loss, and its not covered, but we have a drug that is Ozempic, and its for diabetes, the exact same drug is covered, said Holly Lofton, a physician who works in obesity medicine at NYU Langone Health in New York City. Theres not a drug issue. Theres a we dont want to treat this patient issue. That comes from stigma or discrimination or lack of knowledge about obesity as a condition.

A decades-old law prohibits Medicare from covering prescription drugs to treat weight gain or weight loss. That means the roughly 49 million people in the U.S. who get their prescription drug coverage from Medicare would have to spend more than $1,300 a month for a Wegovy prescription, putting access far out of reach for many. Even for people with private health insurance, these drugs may not be covered. Less than 10% of people have commercial health insurance that covers weight-management therapies like Wegovy.

But an aggressive lobbying push in Washington and quiet support in different parts of the Biden administration indicate that the longstanding rule is being reconsidered. The House Appropriations Committee in June described Medicare coverage for obesity drugs as a matter of health equity. The Office of Personnel Management, the federal governments human resources department, this year reiterated that obesity drugs cant be excluded from insurance plans for federal workers. The bottom line is that we follow the science and, in this instance, the science is telling us that we should recommend uptake of anti-obesity drugs more strongly than we did previously, an OPM spokesperson told MarketWatch.

This line of thinking suggests that additional federal coverage may not be far behind, said UBS analyst Colin Bristow.

Ted Kyle runs ConscienHealth, an obesity advocacy organization. That momentum comes from people having a better understanding of what were dealing with, he said. Ten years ago, policymakers would come out and say, Fat people need to eat less and move more.

A vanity drug or an outdated policy?

Until recently, the medical community often blamed obesity on a lack of willpower or a mismatch between calories consumed and calories burned. The American Medical Association now considers obesity a disease, and doctors describe patients as having overweight or obesity, not as being overweight and obese, and refer to weight management, not weight loss.

But that shift in thinking is still relatively new the American Board of Obesity Medicine, which certifies physicians who work in this field, was set up in 2011 and challenges remain. A story published last spring in The New York Times reported that a health insurer had declined to cover Wegovy for a patient on the grounds that its a vanity drug.

That feels so stigmatizing, said Diana Thiara, medical director of the University of California San Franciscos weight management program.

The Medicare ban on covering weight-loss drugs, which was part of the implementation of the Medicare Part D program in 2003, likely results from that same stigma. It also followed the fenfluramine phentermine (fen-phen) crisis of the late 1990s, in which the stimulants fenfluramine and dexfenfluramine, prescribed for short-term use for weight loss, were pulled from the market when it was discovered they could cause heart-valve damage that in some cases resulted in death.

The newest class of weight-management drugs as well as therapies like Qsymia and Currax Pharmaceuticals Contrave, which were approved about a decade ago are not stimulants. Tirzepatide and Wegovy, which is the first new weight-management drug to have been approved since 2014, are what are known as glucagon-like peptide-1 (GLP-1) agonists. When paired with physical activity and calorie reduction, they help slow digestion and increase the release of insulin so that patients end up feeling full faster and for longer.

These actually are now very physiologic, Lofton said. Most of them [are] hormones that were giving people to adjust their gut and brain pathways to send different messages about hunger and fullness and desire to eat.

Medicare does pay for bariatric surgery and behavioral weight-loss therapy. Over the years, legislative fixes to the medication ban have been proposed, including the Treat and Reduce Obesity Act, which has been introduced several times over the past decade, most recently in March of 2021. Lilly and Novo are both lobbying to change the Medicare language, and physicians, including NYUs Lofton, have also been calling on lawmakers to do so.

So far, those efforts have not been successful.

Medicare is behind the times, and its hampered by its own outdated policies, said Dorothea Vafiadis, director of the National Council on Agings Center for Healthy Aging. If you look at the CMS stated commitment, they are designed to close gaps in healthcare access, quality, and outcomes for underserved populations. And this really kind of flies in the face of that commitment.

The National Council on Aging, along with obesity advocacy organizations such as the Obesity Action Coalition, receive funding from the drug companies that market or are developing weight-management therapies. So do Kyle and Lofton, among other physicians and advocates. These financial relationships, though common in U.S. medicine and public policy, also underscore the billions of dollars in sales that may be at stake for Lilly and Novo.

A $54 billion market

Companies are racing not only to develop the most effective weight-management drug but to market the one that can best improve outcomes for obese patients beyond losing weight.

Novo expects to have the first batch of data from its Phase 3 clinical trial which will show whether Wegovy can reduce the risk of heart disease and stroke by mid-2023, according to a spokesperson. (The company also makes Saxenda, an older weight-management drug thats been shown to reduce body weight by about 5%.) Lilly, which is expected to soon file for FDA approval of tirzepatide as a weight-management therapy, also plans to launch a Phase 3 trial later this year to evaluate whether its drug can reduce morbidity and mortality.

If either study shows positive results, it could change the conversation with insurers and employers, because the value of an individual patient taking one of these medications will then be twofold. Not only will patients lose weight, but their comorbidities may improve, possibly averting costly medical care down the line.

Morgan Stanley predicts an obesity-drug market as large as $54 billion by 2030. UBS predicts $25 billion in peak sales for tirzepatide, which would make it one of the bestselling drugs in history, according to the banks analysts. SVB Securities puts peak sales expectations for tirzepatide, taking into account its potential use for both diabetes and obesity, a little lower, at roughly $21 billion. For context, Humira, AbbVies rheumatoid-arthritis drug, is the worlds top-selling drug, generating $20.7 billion in annual sales in 2021.

Historically, [insurance] payers viewed obesity drugs like they did Botox for wrinkles. They viewed it as something that was a cosmetic drug that should not be covered by insurance, said David Risinger, an SVB analyst. There needs to be a rethinking of coverage when there are drugs that offer transformational health benefits for a disease, even if its common.

If thats the case, think of these drugs less like Botox and more like a new knee.

No medication for weight loss to date shows reduction in morbidity and mortality from cardiovascular disease, Thiara said. [Insurers] say, This is an older population. Theyre not going to benefit from a longevity standpoint from treating their obesity. So, therefore, were not going to cover it. But there [are] other things, like quality of life, that matter. And Medicare covers other things like joint replacement or acid-reflux medication. Theyre not necessarily reducing morbidity and mortality either. Theyre just letting somebody whos older enjoy their life.

Lilly and Novo are both on track to spend more on lobbying in 2022 than either company has spent in the last three years. Lilly has lobbied this year in favor of the Treat and Reduce Obesity Act and Medicare coverage of treatments for Alzheimers disease, as well as against legislation that would cap insulin costs, spending $3.9 million in the first half of this year, after paying out $7.5 million in 2021.

Novos lobbying this year has primarily focused on getting Medicare Part D to cover obesity drugs through legislation like the Treat and Reduce Obesity Act, the Build Back Better Act, and the appropriations bill. The Danish drugmaker spent $2.2 million on lobbying in the first half of this year, after spending $3.6 million in all of 2021.

Theres no way that patients are going to be able to afford that

Mississippi has one of the highest rates of obesity in the U.S. Its also one of the poorest states, and its Medicaid program doesnt pay for weight-loss surgery, which means there are few options for the 40% of adults in the state who are obese.

Fryoux, the University of Mississippi Medical Center obesity specialist, began prescribing Wegovy to her patients in mid-2021, right after it was approved. At that time, Novo offered a coupon that allowed people with insurance to pay $25 a month for a prescription for six months. (People who have Medicare Part D coverage arent allowed to use coupons provided by pharmaceutical companies.)

But by the end of last year, Wegovy was in short supply and the coupons ran out, leaving patients on the hook for at least $1,000 a month if they wanted to keep taking the drug.

Theres no way that patients are going to be able to afford that unless youre a millionaire, I guess, or a celebrity, Fryoux said.

So for now, shes prescribing Ozempic the formulation of the same drug thats used for patients with diabetes off-label to her patients with obesity, because Ozempic is covered by Medicare.

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Why arent new drugs that can help you lose weight more widely used? - MarketWatch

Yesterday, we brought you the first installment in our longevitys burning questions series, in which we ask some of the longevity heavyweights and pioneers speaking at the upcoming Longevity Investors Conference their views on some of the significant issues in the antiaging field.

Longevity.Technology: Longevity is on its way to becoming the most significant investment opportunity available; the Longevity Investors Conference targets the global investor community and brings a whole range of institutional investors together with top class and longevity-experienced speakers. Later this month they will together explore relevant insights into the field, expert education and investment opportunities, as well as enjoying excellent networking possibilities in the scenic and exclusive town of Gstaad.

Longevity.Technology readers can get their exclusive invitation to the leading investors-only longevity conferenceHERE.

Previously, we found out the LIC communitys views on the areas of the field of longevity that hold potential for the biggest improvement. Today, explore a couple of topics, the first being what our hivemind considers to be the current biggest trend in longevity and whats set to explode?

One of the foremost thinkers in the field, Dr Barzilai is the Director of The Institute of Aging Research at the Albert Einstein College of Medicine.

He told us that the biggest improvement is in the investment in gerotherapeutic biotech, which is estimated to be $40 billion by some.

It is the major driver in the field, Barzilai told us. It drew some billionaires to invest in moon shot projects, it will help raise money to complete the TAME trial that may cause a regulatory tsunami, and it also harbors some of the more unique biology targeting aging that we are discovering through the drug development rather than the scientificpapers.

Dr Brenner is the developer of the intellectual property behind ChromaDexs Tru Niagen. He told us that the biggest trend in longevity is to use biomarkers, such as GrimAge, toscore interventions.

As no one has shown that lowering a GrimAge score correlates with better functional outcomes, I am unconvinced of the utility of these biomarkers, he says. I like to stay away from things that explode and that is why I am alive and well and doing research.

Internet entrepreneur Michael Greve became a longevity trailblazer when he created the Forever Healthy Foundation.

He told us that: No one knows the future, but we invest in never-done-before approaches,that, if working, have a tremendous potential to be a desirable treatment for everyone over the age of 40.

As Director of the Centre for Healthy Longevity at the National University of Singapore, Dr Brian Kennedy is committed to translating research discoveries into new ways of delaying, detecting, preventing and treating human aging and associated age-related diseases.

In research, the big thing is now rejuvenation-based strategies, which arevery promising but still in the research stage, he told us.

I would also not discount gene therapy approaches in the medium term. This technology has been slowly evolving and is now being used to treat diseases, he said, adding that ultimately, targeting aging genetically may be an excellent strategy to extend healthspan and lifespan.

Dr Fortney is CEO of BioAge, a biotech on a mission to develop a pipeline of therapeutic assets that increase healthspan and lifespan.

Dr Fortney told us that cellular reprogramming has received a lot of attention lately, on multiple levels, including advances in academic research, the entry of multiple companies into the field, and the sheer size of investment by some big players.

Although the ideas are quite new and applications are likely to be far in the future, the promise of reprogramming for reversing age-related decline is enormous, she said, adding that although this area isnt currently a major focus for BioAge, they wish their colleagues in the cellular reprogramming field the best of luck as they start down the path toward developing therapeutics that can extend healthy lifespan.

As for whats set to explode what Im most excited about is the speed of clinical translation and the growing number of aging drugs that are entering clinical trials today, both at BioAge and at other companies in the longevity space, she said. Once we get the first few successful trials, well see an explosion of interest in an already rapidly growing sector.

Co-Founder of SENS Research Foundation, Dr de Grey has just announced his new research foundation.

When it comes to what constitutes a big trend, says de Grey, the answer differs greatly depending on ones perspective.

From the point of view of the Longevity Investors Conference delegates, I think the biggest trend is diversity and synergy, de Grey explains. Damage repair is inherently adivide-and-conquer strategy, in which big results will only be seen when multiple therapiesare given to the same people at the same time.

Dr de Grey believes that the smart money needs to go to those who are creating the framework for that the venture funds and holding companies whose portfolios have the potential to deliver truly transformational combination therapies.

As for whats set to explode, well, let me be a bit radical here and highlight cryonics, says de Grey.

Cryonics has had an even harder time than damage repair in being understood asa valid and promising medical research area, but we now have a very rapid growth in new players in that space, including providers like Tomorrow Biostasis and research outfits likeLorentz Bio, led by highly credentialed people in terms of both biomedical and commercialexpertise.

De Grey feels that the further we progress in developing rejuvenation biotech that really works, the more the world will want to take that bridge to the future.

A former ER doctor, Dr Killen is an antiaging and regenerative medicine physician who specialises in aesthetics and sexual medicine. She told us that as a stem cell physician, she can see great potential in regenerative therapies.

In the coming years, well see more and more allogeneic (the donor and patient are not thesame) stem cell therapies become available and well see products that are engineered tosolve specific problems, she told us. My hope is that these off the shelf cellular products will be widely available at a reasonable price so we can start to see the democratization of regenerative medicine.

Dr Martin Borch Jensen is the CSO of Gordian Biotechnology and the force behind the the successful Impetus Grants.

He told us that the biggest current trend has to be partial reprogramming, with Altos, Retro, NewLimit and other companies focusing on this approach to reversing cellular age.

Lets see how hard that turns out to be! he says.

I think something that will increasingly impact the aging field is high-throughput functionalgenomics coupled with active learning computational analysis Borch Jensen continued.

For example, running a pooled CRISPR screen to knock out genes in a population of cells, isolating cells that fail to turn senescent in response to normal stimuli, then sequencing the gRNAs to identify the target genes and repeating the screen with combinations of these targets. This approach is enabling work in cancer and other fields, and (with the right readouts) will do the same in aging.

Our second burning question concerned our panels longevity journey; we wanted to know what was the inspiration for their longevity point and has the journey been as expected?

Amy B Killen

Dr Killen was an emergency physician for ten years before becoming interested inlongevity medicine.

Ultimately, I was inspired by my patients, she told us, explaining that she saw the effects of aging and age-related diseases every day in the emergency department.

I saw the effects of lack of education and poor lifestyle choices, combined with limited access to resources and support from the medical establishment, she says, adding that she ultimately left the emergency department to make herself healthier and in doing so, discovered an entire field of study that is primed to restore vitality in all of us.

It took a little time for me to think of aging as a disease, but once I wrapped my head around it, I couldnt think of it in any other way!

Kristen Fortney

If we could cure all cancers, we would add just a few years to average lifespan, says Fortney, adding that the same goes for all cardiovascular disease, and the many other illnesses that become exponentially more common as we get older.

But if we could slow aging in humans to the same extent that weve already done over and over again in mice, we could extend longevity by decades, and most of those years would be healthy, she says. Likewise, from the many humans who already live past 100 in good health, we know there must be mechanisms that allow human bodies to enjoy dramatically longer lives.

This idea was one of the major inspirations for Fortney to found BioAge, a journey which, she says, has been exciting, to say the least!

Im constantly impressed by the rapid rate of scientific and now clinical progress in the aging field, Fortney adds, explaining that as more and more companies and scientific organisations join the fight and more resources enter the field, she sees that continuing into the future.

For more information, please visitwww.longevityinvestors.chor email[emailprotected]Or, bag your exclusive invitation to the leading investors-only longevity conferenceHERE.

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We might not know the future... but we can spot its longevity trends - Longevity.Technology

Michael Ringel, PhD, JD, Managing Director & Senior Partner, Boston Consulting Group (BCG), ... [+] presenting at the 9th Aging Research and Drug Discovery meeting organized by the University of Copenhagen and Insilico Medicine. Presentation title "The Emerging Commercial Landscape for Aging Biology-Based Therapeutics"

While I had very high expectations traveling to the 9th Aging Research and Drug Discovery (ARDD) forum, the largest five-day annual gathering of the longevity biotechnology industry organized by the University of Copenhagen, the event did not fail to impress. I can spend endless hours covering the lectures of top-tier academics, pharmaceutical industry leaders, and venture capitalists, but these would be better covered in the conference proceedings. However, one lecture titled The Emerging Commercial Landscape for Aging Biology-Based Therapeutics by Dr. Michael Ringel, captivated even the most experienced industry executives and the established aging researchers.

Dr. Michael Ringel at the 9th ARDD conference

The sheer fact that Boston Consulting Group (BCG), the worlds most venerated consulting firm specializing primarily in strategy and management consulting, became a knowledge partner of the ARDD indicates that the meeting has reached a certain level of credibility and longevity biotechnology is a clear trend. BCG is known for being very impartial, knowledge- and experience-driven, and providing valuable strategic insights to the boards and CEOs of the worlds largest corporations. The firm is used by governments all around the world when they want to get deep industry insights or when they want to formulate a national strategy around a specific trend. From what I know, BCG was used by the Kingdom of Saudi Arabia to help formulate their famous Longevity Strategy, which resulted in the creation of the $1 Billion a year non-profit, Hevolution Foundation.

Dr. Michael Ringel, BCG presenting at the 9th ARDD in Copenhagen

One differentiating feature of BCG is the quality of its slides. They often manage to turn a very complicated story into a set of visually appealing, easy-to-comprehend slides that provide a clear problem definition, recommendation, situation assessment, and alternatives. These slides are rarely shared by the customers as they usually represent a substantial investment and intellectual property.

Therefore, when during his 30-minute talk, Dr. Ringel went through over thirty of these valuable slides, those of us who understand the value made sure to get the recording of the lecture.

Here are some of the top takeaways from Dr. Ringels presentation that Im able to share:

Michael Ringel, PhD, JD, Managing Partner, BCG, presenting at the 9th Aging Research and Drug ... [+] Discovery meeting

I knew Dr. Michael Ringel prior to the ARDD as a well-known strategy and management consultant in the pharmaceutical industry. After almost 25 years at BCG in healthcare practice, he is on a first-name basis with every pharma CEO, board member, investor, and government official, and is a walking encyclopedia who also knows most of the emerging technologies and their applications.

From left to right: Eric Verdin, MD, CEO of the Buck Institute for Research on Aging, Mehmood Khan, ... [+] MD, CEO, Hevolution Foundation, Michael Ringel, PhD, JD, Managing Director, BCG, Alex Zhavoronkov, CEO, Insilico Medicine

Here, I asked Dr. Ringel a few questions to get his perspective on longevity biotechnology and the future of this exciting new field:

Alex Zhavoronkov: Michael, I know that aging biology is not only your professional focus but also your personal interest. What made you interested in this field?

Dr. Michael Ringel: Alex, thanks so much for having me. It truly is a pleasure to sit down with you. One disclosure before we start the discussion. One of the investors in your company, Insilico Medicine, is B Capital Group. My company, BCG, is a partner to B Capital Group, and so I have an indirect and small financial stake in your company that we need to mention.

As to my interest in the field, Ive spent my career working in healthcare, trying to help companies bring better medicines to people. And when I found out there is an area of biology that underpins not just one, but the majority of the chronic diseases that burden us, I realized the impact it might have on human health. Preventing multiple diseases with one intervention is a potential game-changer, if you can make it work. The key word being *if*. But when you dig into the science, you find out in fact theres really good evidence to support the notion. We just have to do the work to translate what weve seen in the lab to humans.

Alex Zhavoronkov: You have been in biopharma for over 25 years and you have seen everything. You saw Geron, Sirtris, ResTORbio, Unity, and many other companies in this area. How do you see the field of aging biology evolving and propagating into the biopharma industry and how did the field change over the past decade?

Dr. Michael Ringel: Understanding a new area of science can sometimes take a long time and then sometimes there are these great leaps forward. In my youth in the 70s we knew about caloric restriction, which is still one of the best-validated interventions. But we didnt know much about how it works. That began to change in the 90s, kicked off in part by Cynthia Kenyons seminal work in worms, as we began to understand the biological pathways involved. We saw the first pharmaceutical intervention proven to work in a mammal, in mice, just over a decade ago with the NIHs Interventions Testing Program. Today there is a small but growing pipeline of drug candidates in clinical testing. I believe we are on the cusp of the first demonstrated effective intervention in humans, which I believe will be one of those great leap-forward moments that galvanize interest in the field.

Alex Zhavoronkov: In your opinion, how long will it take the pharmaceutical industry to buy into the concept of utilizing aging biology as a platform for drug discovery for a range of therapeutic areas?

Dr. Michael Ringel: We are already seeing activity. We know from publicly available information that many companies have external partnerships or internal units, including AbbVie, Novartis, Regeneron, and others. For instance, UCB has partnered with your own company, Insilico Medicine. So it has already started. I believe that over the next decade, we will see a burgeoning pipeline focused on various pathways of longevity biology, and once the first clinical studies demonstrate proof-of-concept, we will really see interest grow.

Alex Zhavoronkov: Of course, you can not talk about Saudi Arabia and Hevolution since these are clients but I was one of the key opinion leaders interviewed for this project in 2019, and BCG was clearly involved. Why is longevity biotechnology so important for any emerging economy and do you think other countries should prioritize longevity in a similar way?

Dr. Michael Ringel:I cant give opinions on specific companies or foundations and would refer you to their leadership for questions about them. But as to the general point of why this matters all over the world, in developed and emerging economies, it is because it has the promise of being such a powerful way to improve human health. Weve seen that just throwing more money at the current healthcare system has not improved lifespan or healthspan, and we even have had retrograde motion in some areas, with lifespans declining. In part, that is due to the growing burden of metabolic disorders like diabetes. What we need is a better way, more focused on prevention an ounce of prevention is worth a pound of cure. And thats where longevity biology is critical. It is, at heart, a preventative approach. And the core pathways are the very same ones that are implicated in the metabolic disorders that are a growing issue all over the world.

Alex Zhavoronkov: What is your advice to the young entrepreneurs in this nascent longevity biotechnology industry?

Dr. Michael Ringel: Theres a lot that you need to do as an entrepreneur you need to figure out funding, build a team, set up operations, choose your preclinical and development plans, develop partnerships, and a million other things Im always incredibly impressed by how much thesel young entrepreneurs can accomplish, juggling all these things at once. But the sine qua non, the thing you cannot do without in biotech, is good science. All the rest of the work is built on the foundation of a good idea, a new way to help people. So my advice is make sure youre investing your time and energy getting as deep into the science as you can.

Alex Zhavoronkov: Finally, how did you like the ARDD conference, what were your major takeaways, and will you come again next year?

Dr. Michael Ringel: To me ARDD is a unique conference in longevity, bringing a heavyweight mix of the most impressive scientists in the field together with the most promising start-ups and a great set of investors. For anyone already in the field, it is the place to be, and for anyone looking to learn more, I cannot think of a better place to get a crash course. Particularly the large pharmaceutical companies would benefit by bolstering their attendance to get deeper into this field.

The 9th Aging Research and Drug Discovery meeting, Grand Hall, University of Copenhagen, September ... [+] 2022

Michael Ringel, PhD, JD, Managing Director and Senior Partner, Boston Consulting Group

Michael Ringel, PhD, JD, is Boston Consulting Group's global leader for innovation analytics and research and product development, and is a core member of the firms Corporate Finance & Strategy practice. Michael is a frequent contributor to industry journals, including Nature Reviews Drug Discovery, and has coauthored numerous BCG reports on innovation, R&D, and corporate strategy. He received a BA in biology from Princeton, a PhD in biology from Imperial College London, and a JD from Harvard Law School.

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Celebrity Strategy Consultant Predicts What Will Be The Most Impactful Area In The Pharmaceutical Industry - Forbes

"If you haven't trained with any focus by the time you're 30, you need to be," says Lyon. Everyone's body is different, but if you can, she recommends a combination of cardiovascular activity (specifically zone 2 training) and resistance training. Zone 2 training really just refers to any cardio workout that gets your heart pumping to the point where you can still hold a conversation, but it might be difficult to do so. "That zone 2 training is critical for mitochondria," notes Lyon. "It's important for glucose utilization for the foods that you're eating, and overall it provides a base."

However, it's not enough: "In your 30s, I really believe everybody should be doing three to four days a week of hypertrophy training," she adds. Hypertrophy training is all about increasing muscle mass, namely through weight training. "As opposed to [using] much heavier weight and lower volume, the volume is important," Lyon adds. (Meaning, more sets and reps with less intensity.) "This is really about growing your muscles," she notes, and strong muscles are crucial for sustaining longevity.

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3 Research-Backed Tips To Make Your Muscles Act Younger - mindbodygreen

This Prioritizing EquitySpotlight session is sponsored by the Robert Wood Johnson Foundation and the American Medical Association Foundation.

Over the past several years, there has been an increased awareness of the exclusionary policies and practices that have restricted and impacted the health innovation ecosystem for communities that have been historically marginalized and minoritized. These historical truths warrant restorative remedies to heal and reconcile past and current harms.

This session will explore restorative justice in the context of the health care innovation space and related policies, practices, politics and strategic opportunities to center healing and humanity in health care design and technology.

Keeys: All right. Good afternoon, everybody. Welcome. Well, welcome to us to the stage. I'm Mia Keeys and I'm so very glad to be joined today by all of you here. We're going to be talking about centering restorative justice within health innovation and I'm really quite honored to be joined by you all who are policymakers, whether you're tech innovators or C-suite level executives. All of you have quite the role with respect to standing up for restorative justice in your own practices and within your own communities.

During this session, as I've mentioned, we're uplifting restorative justice, and what we mean by that in the context of health care innovation and policymaking and practice refers to the collaborative approach that brings together those key constituents who have historically been marginalized or minoritized or just not a part of decision-making processes, bringing all of those persons together to bear on the decisions made around practices, policies that have historically been a part of different organizations and have been perpetuated by offending parties.

Now that definition was adapted from the American Association of Medical Colleges, also by the Restorative Justice Network, the UN Human Rights Commission and finally from the American Medical Association's organizational strategic plan for embedding equity and advancing racial justice and health equity. I'm really especially proud of that. I was a part of that mission when I was with AMA not too long ago, but today, we are really very excited to be joined by Dr. Jamila Michener.

She serves as the associate professor in the department of government at Cornell University, where she's also the co-director of the Cornell Center for Health Equity. She's known as the poverty scholar, right? Yes. I love that about you and your research. Dr. Michener's research focuses on poverty, racial inequality and public policy here in the United States. Her recent book, Fragmented Democracy: Medicaid, Federalism and Unequal Politics, examines how Medicaid in particular affects democratic scholarship and democratic citizenship. Dr. Michener, thank you so much for joining us.

Dr. Michener: Thank you for having me. Hi, everyone.

Keeys: We also have with us on the screenI can't see her heresomeone who I say is probably one of our most compelling voices and eloquent champions of all things related to justice, of really this century, Dr. Ruha Benjamin. Dr. Benjamin is the author of Race After Technology, and I'd be remiss if I didn't show you my dog-eared copy, right? You probably have the same thing on your shelf, right?

Dr. Michener: I love it, yep.

Keeys: Exactly. And she also has a forthcoming book, which I have to make sure to get. It's called Viral Justice: How we Grow the World We Want. She is a professor of African American studies at Princeton University, where she studies the social dimensions of science, medicine, technology, with a focus on the relationship between innovation and inequity, knowledge and power, race and citizenship, and health and justice. She's also a yogi and a recent beekeeper if I'm not mistaken.

Yeah. Thank you so very much, Dr. Benjamin, for joining us today and we really appreciate both of you being here. I'm going to go ahead and jump right into our questions. The first one is for you, Dr. Benjamin. The primary focus of your work is the relationship, as I mentioned before, between innovation and equity, particularly focusing on intersection of race, justice, and technology. Can you speak to the damage that's caused by structural racism in particular and especially the role of exclusionary practices within the field of innovation? Then I'm also wondering how do you feel in terms of hope for restoration?

Dr. Benjamin: Thank you for that question. I'm thrilled to be with you all virtually and so that's a heavy question. I call that a dissertation-worthy question because we could talk about it for hours but I'm going to limit my reflections to a couple of minutes. I think for starters, we have to understand that innovation doesn't necessarily lead to something that is good or desirable. As a starting point for this conversation, we have to disentangle what we think of as technological prowess from social progress, one that doesn't necessarily lead to the other. We can think of many examples. I'll just put a few on the table.

The first person who put up a "Whites Only" sign on their business was being innovative. They were doing something new to get to a certain end. Well, think specifically in terms of historical context. J. Marion Sims, who's sometimes referred to as the father of gynecology, who honed medical techniques by experimenting on enslaved Black women, he was being innovative. Likewise, something like the electric chair, at the time that it was developed, was considered a technological marvel, a more humane way of killing people but we have to ask ourselves, who was that making feel better, that more humane way of killing? Certainly not the person who was on the other end of that innovation.

As a starting point for this conversation, I want to encourage us not to conflate technological prowess with social progress. We should assume that any new invention is going to include social inequities unless and until proven otherwise. That is it is on the onus of those who are creating these new technologies to show us that they are not going to reinforce social inequity and injustice. We can't just go according to the marketing hype because there are all kind of buzzwords that create a shiny veneer of new technologies that hide the actual impact of these.

I'll just name two quick ones in the context of this pandemic and health technologies. Research has shown that the pulse ox that measures oxygen saturation level and many people have used it at home in order to decide when to rush to the hospital. It doesn't work as well on people with darker skin tones. Likewise, there are health care decision algorithms that are currently impacting millions of patients in this country that have shown to have a bias against Black patients even though the algorithms are seemingly color blind. The key here is to understand that glossy exteriors routinely hide dangerous interiors. They don't have to. It's not inevitable but it's predictable.

To this last part of your question, any hope for restoration, yes. But this hope isn't going to come in the form of glossy PR announcements and flashy, eventful initiatives that gather a lot of attention and credit for those who are finally doing something about these issues. Any way forward is not going to be for people but with people who are impacted by harmful systems. It's not going to be top-down but community-driven forms of redress. And also it's not going to make us feel warm and fuzzy if it's really reckoning with the forms of injustice, the complicity.

Here I'm thinking specifically about medical injustice but we can talk about economic injustice. We can talk about housing injustice, so it's not going to feel warm and fuzzy. If it is, then we're probably not doing it right. Finally, I want to say that the harms that are created, that we're talking about, they're created because of business as usual. That means that repair has to happen in everyday practices, in the nitty gritty, in the fine print, in the design of products, and so that's where we should focus our attention rather than on these big flashy forms of restitution that often are just rhetorical rather than substantive.

Keeys: Thank you so very much with that, Dr. Benjamin. I want to just hearken back to some of your words you said. Tech prowess is not equivalent of social progress and innovation is not always for the social good, and then finally you said reckoning is not warm and fuzzy. I'm surmising but I think that that really brings us, segues very well into something I'd like to talk with you about, Dr. Michener. You know, in your research and your writings you describe the application of a racial equity and policy framework. You call it the REAP framework, right? In terms of health policy being innovation, what does that form of innovation offer in terms of advancing restorative justice or that reckoning as Dr. Benjamin mentioned, particularly when it comes to those lasting harms related to unequal health care?

Dr. Michener: Yeah. Thank you for the great question and it's always unfortunate to go after Dr. Benjamin.

Keeys: No, no.

Dr. Michener: Because so much of the kind of core of the framework that I developed that you mentioned is actually reflected in those comments. Two core aspects of that that I'll point out, in particular, that will help me to sort of get to your question around health policy and what health policy has to offer around innovation and restoration, restorative justice. Two core aspects of that framework are as follows. One is that if we want to identify the kind of sources of things like structural racism, these injustices that embed in fundamental ways inequities in our society and in our practices, if we want to be able to identify those so that we can rectify them, we have to attend to the kind of nitty-gritty of process.

Process is more important in many ways than outcome. When it comes to racial disparities, for example, we tend to focus pretty heavily on outcomes. In fact, that's what disparities are. They're an outcome, and of course, there's good reason. Outcomes can flag problems for us but those problems are fundamentally in the process, so part of what I do in the framework is say what parts of the policy process do we need to attend to and where in those various parts of the policy process do opportunities for injustice, for structural racism to be perpetuated, where do those opportunities emerge?

There's a lot there, so I won't say anymore except to say process is crucial and attentiveness to it is crucial. The second partand this is part and parcel of the firstthat's a core aspect of the framework is to say that voice is crucial. In other words, for the folks who have power, who are making decisions, who are making policy at a national level, at a state level, at a local level, sometimes even at the level of specific institutions, businessesfor example, if those folks who have the decision making power and who often have other kinds of power and resources, economic power and so on and so forth, are the primary voices driving policies, those policies will inevitably disadvantage the folks who don't have power.

Whether intentional or not. Good intentions don't actually circumvent that core problem. We have to pay attention to process and a fundamental element that we have to build into process is voice. When it comes to health policy we see this in so many ways. I have a big study that I'm doing right now, a cross-state study, and we're talking to people who have struggled with health problems throughout the pandemic and getting a sense of the kind of nitty-gritty of their experiences and trying to understand what it looks like to create changes in those people's lives on a structural level.

We're working with and advising state and local governments around how they can make policy change to improve the lives of especially people who are at the economic and racial margins. What we're finding is that many of the kinds of innovations that we can get most excited about are experienced really differently in people's everyday lives. We talk to people about things like telehealth, which in many ways can be a great option for folks who have challenges around mobility or disability, for folks who have other kinds of challenges that make it hard for them to get traditional health care but for many other people and even for some of those folks, telehealth as it's actually implemented becomes a potential purveyor of bias and discrimination.

There are lots of examples of that, of things like that. For example, government agencies are constantly adapting new systems. They have these systems for managing their files and managing their clients, and managing their casesand they get pitches from whichever businesses are designing those systems and want to sell them to a government contract, want a government contract that can be very lucrative for them. They get these pitches, and they implement these systems and often have no idea what the consequences are for the people who are relying on the functioning of those systems in order for them to get vital resources for daily lives. Without robust incorporation of the voices and perspectives of those people, without, in fact, them having some power over the processes of innovation, the outcomes will inevitably lead to inequity. That's a lot of the kind of thing that the framework highlights.

Keeys: In your framework it's voice, right? It's voice, it's decentralization and you have to look up her framework, for sure.

Dr. Michener: It's a lot. I was sparing you all of the boring details and trying to draw out the highlights.

Keeys: My takeaway from your framework is that it's not as if legislators or persons in decision power can say we legislate that all people treat their neighbor with kindness and respect. That's not what you're going to see in a law, right? That gets back at the whole idea of good intentions don't necessarily always come through in the process. We're talking here about the process, and the process is not just something that happens in the middle. Restorative justice and bringing in those voices doesn't just happen as a checkpoint. It's continuously across the continuum of the process you referred to.

Dr. Benjamin, I want to bring you back in this conversation here. In your works, you've contributed a lot to a body of work that debates how science and technology shape the social world, in general, and how people can and should and do critically engage techno-science, grappling all the while with the fact that we might bring health and longevity to some, as in those innovative technologies might bring health and longevity to someand to Dr. Michener's pointreally very much leave others by the wayside. Can you speak to those shifts or changes that would likely occur if restorative justice were front and center or even mandatory for leaders and decision-makers within innovation?

Dr. Benjamin: Yeah, I want to talk about this not so much in generalities but I want to offer a very concrete example of this in action that people can study, learn from, adapt to their own context. Very recently two physician researchers at Brigham and Women's Hospital in Boston, they analyzed 10 years of hospital data at Brigham and Women's, specifically among cardiology patients. They found significant disparities in how Black and Latinx patients on the one hand and their white counterparts on the other were being treated when they came to the hospital with heart failure. Black and Latinx patients were sent to general medicine service while white patients were referred to the specialty cardiology service where patients have much better outcomes.

They analyzed this data and then they created what they call the Healing ARCA-R-Cand ARC stands for acknowledge, redress and closure. This team, what they did was they presented this data to the priority neighborhoods around Brigham and Women's, those in which these patients were coming from and they're developing a community oversight initiative specifically around this issue. One of the concrete innovations that their team created was in the electronic medical recordnow you have a flag so that when a provider is looking at a patient's chart, for a Black and Latinx heart failure patient, it flags the provider to refer them to cardiology rather than leaving it to the discretion of the provider or relying on patient's self-advocacy.

The lesson here that Morse and Wispelwey, who are the two physicians leading this research, the lesson here is that not only do they call for society-wide restitution, kind of federal level laws and policies but they are encouraging every single institution and organization to look at the history of racism and inequity in their own locale. What's happening under our own roofs? What forms of disparities are being produced because of business as usual? It doesn't rely on the malice or the hate in someone's heart but it's a combination of a lot of factors that they identified that was leading to these disparities.

What they encourage us to do is to engage in local anti-racist efforts, and in this case, it's a combination of what we might call social innovation that is letting communities lead the process, including them in the research, having their oversight. Remember, community-driven, not top-down, but it also includes a technological component. That is including this flagging function in the electronic medical record that forces providers to reckon with their own bias, not letting them sort of rest on their own assumptions. The last resource I'll just put on the table in addition to Professor Michener's important framework is something everyone can look up called Beyond the Statement, by Color of Change.

Statement there is referring to all of those anti-racist statements that have come out in the last two years in which corporations and organizations and universities lay claim to a certain set of values and commitments. Beyond the Statement is getting us to think about concrete actions, taking those statements and actually directing them into the business as usual. Two things stand out when you look up the Beyond the Statement recommendations. One is incorporating racial equity audits.

That is evaluating the products, the policies, the data that we are producing for discrimination and the other thing, there's a number of recommendations but the other thing I'm just going to highlight for sake of time is that we have to create civil rights-oriented accountability systems that are tied to performance evaluations for employees. That is, what we're talking about here can't be extra icing, only those who self-select into DEI work. It has to be tied to performance evaluations and it has to be civil rights oriented. I would encourage everyone to download and study Beyond the Statement by Color of Change, to really think about how they can implement those recommendations in their own businesses and organizations.

Keeys: I think we had a couple of snaps in the audience with everything you all are saying. We're coming close to time but I just want to give you one last question here, Dr. Michener. With all that you both have identified, what are your overall thoughts in designing practices and policies for monitoring, for building access, for building in accountability at the civil rights level, at the local level with respect to your work?

Dr. Michener: Yeah. You know, again, Dr. Benjamin offered some really, I think, important concrete illustrations and a great resource that she pointed to. I mean, given time to wrap us up, I would emphasize two things and the first, I think, is I always want to say this to people. There are no easy answers and so this is a long game. It's not a game but it's a long process and I can't tell you how many studentsI teach lots of students at Cornelland we will look at policies that were intended to be, whether they were using the language at the time, anti-racist, that were implemented in the 1990s or the early 2000s or the 1960s. We've been trying to do this for so long. Maybe these problems are intractable. Maybe these people, maybe there's something wrong with them and not the systems because we've been trying. We've been doing all of these things.

Certainly, in the wake of George Floyd's murder, there were a whole flurry of policies that were implemented or practices that were implemented, statements that were made across all levels of government, in the business world and beyond, and some of these things are going to come to fruition and perhaps there will be progress clear. Some of them we won't know because no one's measuring or evaluating them, so that's one concrete point. We have to pay attention to the outcomes connected to what it is, the changes that we're making. But some of them are going to fall flat.

They're just not going to work and the temptation is to say, Well, we tried. But the problems are entrenched enough that the focus has to be on long-term solutions and long-term mapping out the processes that work, holding onto the things that show promise, letting go of the things that don't, learning lessons along the way. I want to emphasize that this isn't like, I'm going to think of the cool next DEI thing that's going to fix everything. Just like policy, processes don't unfold like that in government. They don't unfold like that anywhere, so the question is how are we going to deal with mistakes? How are we going to understand what success looks like?

I would emphasize that the voice component is crucial in both of them. Dealing with mistakes, in fact, is a question about restoration and restorative justice. Wow, we didn't mean to do this. We haven't meant to do this but we keep finding ways that we're perpetuating inequities. We can try to ignore it. We can sweep it under the rug. We can deny it. We can point out the things we're doing right so that we can draw attention away from the harms or we can actually focus on restoration and change, and we can get there and can identify and rectify the harms only if we pay attention to the folks who have the most at stake and we ensure that they have power in the processes that are unfolding. The last thing that I would say is that none of this is comfortable. Part of what I always tell people is that power isn't a zero-sum thing. It's not exactly as if the more power I have, the less Mia has but power dynamics do change environments.

If the people who are most affected by things like structural racism, folks at the economic and racial margins, have more power and if we build our practices and our processes to ensure that, it means that the folks who have power now who are comfortable, who are at the top, who are getting to determine what innovation looks like and what the important outcomes are and what success isthose people will have to now share power with others who before didn't have it. Maybe that's some of you, many of you in this room. It's uncomfortable and so recognizing that change that leads us towards restorative justice, social justice, however it is that you frame what the goal is with respect to justice, is uncomfortable and often means sacrifice, and doesn't feel good. I think that's a really important aspect of the commitment.

Keeys: The process of restorative justice. That's it. That's it. Thank you. Dr. Jamila Michener, thank you so very much for your work. Dr. Ruha Benjamin, on a personal level, I studied both of your works for my own dissertation and then also I'll say just by serendipityDr. Ruha Benjamin is a good friend of my late sister and I think if she were here in the flesh, she would be so very proud. So, thank you so much for your attention. Please make sure that you read these ladies' works and apply, apply, apply restorative justice in your own processes through your strategies and thank you so much for your attention.

Disclaimer:The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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Prioritizing Equity Spotlight series: Centering restorative justice in health innovation - American Medical Association