Pam Brar Preventative health designed to extend the healthy human lifespan TEDxSanDiego 2018
What if I told you that just by attending this TEDx talk you might live a longer and healthier life? Stay tuned, I’ll come back to that.
For as long as I can remember I have wanted to change the world. As a kid, I can still remember my nightly ritual of reading under the covers with a flashlight while making lists of things, like how to end world hunger. By the end of eighth grade, when most of my friends were relishing the summer before high school, I went to my parents and announced that I wanted to go to college – not in three years, but this year.
You see, it occurred me that I really did want to change the world and I wanted to get started right away. The plan was clear. I knew instinctively that I couldn’t change the world alone. My dream was to be part of a team of people who shared a big vision. My plan was the following; skip high school, go to college, and then med school.
My parents were both educators, so they were supportive of my plan. “If you can figure out how to do it, honey, we’ll help you.” Cue the obstacle course of standardized testing hurdles. First, the graduate equivalency diploma test. Then the California Achievement Test. Then the SAT. Finally, the ACT. With all of those behind me, I was admitted to the Class of 1991 at Southeastern Louisiana University in my hometown of Hammond, Louisiana.
The only nonnegotiable for my parents, I would have to join a social club before the end of my first year, so as to avoid being a complete weirdo. No problem. I was off to the races. I was just giddy that the universe actually understood my plan. College was a blast. I really was lucky, I ended up with a group of really protective friends who took me in under their wing. The summers I would spend on adventures.
I remember the first summer I went to NASA at Cape Canaveral, Florida as part of the Space Life Sciences Training Program. There, I was part of a team that was assigned the task of designing an operating room in zero gravity. That was pretty crazy stuff for my 16-year-old self.
The next summer I spent at Michael DeBakey’s Summer Surgical Program at the Baylor College of Medicine. There my task was to be part of a team that got to design surgical innovations for issues that would come up repeatedly.
Somehow, by some miracle, I managed to get a seat at the table with these really smart people trying to solve big problems. Those four years of college sped by and then it was off to LSU Med School in New Orleans.
There comes a time, I remember, during the fourth year of med school, after you’ve rotated through all of the different specialties, when you have to decide the path that you’re going to take for residency that will ultimately determine your career direction. Well, I loved every single specialty. This was kind of a problem. General surgery, dermatology, psychiatry, cardiology, you name it.
I remember talking to my mentor and she encouraged me that maybe the best thing was to keep all of my doors open. Internal medicine seemed to be the most logical choice. My next stop would be Scripps Clinic Green Hospital, just down the street from here, for another four years of learning from really talented physician scientists.
Now the year was 1999 and I was lucky to be offered a staff position to stay on at Scripps Clinic and start my practice. Between making diagnoses, sometimes big, mostly small, I got to play the role of marriage counselor, accountability coach, and cheerleader for my tribe of patients. I grew to love them as people. In turn, my practice grew quickly.
I really was committed to helping prevent disease in my patients. Like any new job, there were challenges. One of my biggest challenges was having to be at the mercy of insurance companies when trying to decide what treatment or testing was best for my patients.
That first year of practice, I had my head down seeing patients, and I heard that a team of scientists did something that I couldn’t even believe possible. They sequenced the human genome.
I was blown away by this accomplishment. What would this mean to humanity? Would this change our ability to help people, to personalize their treatment? Would people live forever? I was mesmerized by this. I remember thinking, “God, this could be a really interesting tool in my toolbox.”
Then something happened. Something that changed me and my direction forever. When you go into practice at the same place that you do your residency, inevitably you’ll come to care for a colleague or a former professor. So it was that I came to care for one of my very favorite professors. I’ll call him Dr. P.
He was a kind and gregarious man in his early 60s. A true humanitarian. He would spend every summer in the Philippines caring for underprivileged kids. When we were residents, he always had time for us. Now that I was his colleague, I was determined to return his kindness.
I remember seeing him in the stairwell one morning that December. He called up to me, “Hey, Pam. I’ll be in to see you in a couple of weeks. It’s my New Year’s resolution to get a physical.”
I remember being pleasantly surprised when he actually followed through. I got his lab results on my desk. Nothing terribly scary. His LDL cholesterol was about 20 points higher than goal. His blood sugar was borderline. I can still picture those results on my desk with the pale pink Post-It note in my own writing reminding me that he would be in to see me on January 5th.
Then on New Year’s Eve, on his front doorstep he died of a heart attack. I was devastated. My mind was flooded with questions. What if he had been in to see me the week before? Would I have detected his risk? Would I have somehow with my skills and tools been able to save him?
I had to admit when I looked myself in the eye in the mirror, I remember thinking, “I’m not sure that even with my best intentions I would have been able to see this coming.” Disease was winning. This was a turning point for me. I remember thinking, “I have to be part of a change.”
Don’t get me wrong. With every year there will be incremental improvements in medicine. But, I have never been a fan of increments. It occurred to me that the conventional approach that we were taking was just not working. We were still missing out, we were still losing people.
I knew I wanted to be part of a different way of thinking. I started to wonder, was it the insurance model that was broken? Maybe if we had more time with our patients, we would be able to hone our disease detecting abilities. How could I know more and know it sooner?
I thought to myself, “Maybe I’ll try a different model.” I sort of transformed my practice into a concierge model where you end up seeing fewer patients and spending more time with them.
Now, it was definitely a more gratifying way to practice. I felt like I actually could partner with my patients to come up with a personalized plan for their healthcare. After doing this for about five years, after enough different things had happened, I realized even though it was a better way to practice, my tools were still the same.
Fast forward to 2015. A team of scientists and physicians were going to prototype a precision health lab in La Jolla. Leading the team would be none other than J. Craig Venter, the scientist responsible for sequencing the human genome.
The testing would include whole body MRI, whole genome sequencing, and a host of other technologies. It would be called the Health Nucleus and the focus would be early detection and risk prediction with the goal of extending the healthy human lifespan. This testing would provide details of human health down to a molecular level. The testing would include stool microbiome, metabolomics, whole genome sequencing.
Wait a second. This was the opportunity that I had dreamt of. I joined the team at Human Longevity in 2015, which meant closing the doors of my medical practice.
Now I was like a kid in a candy store. I no longer had to beg insurance companies for ordering the tests that I thought were necessary. I was able to get access to a wide range of information for my clients. It really allowed us to practice a more proactive rather than reactive approach. And you didn’t need a doctor’s order, an individual could decide if they wanted to be empowered with this information.
The testing would include whole genome sequencing, which would allow us to understand genetic predispositions to diseases like heart disease, cancer, and other conditions like Alzheimer’s. Whole body MRI would allow us to detect small brain aneurisms, early stage cancers, sometimes more advanced cancers, sadly, and also even metabolic conditions like fatty liver. Stool microbiome testing would allow us to look at all of the inhabitants of our GI tracts, some of which might be associated with disease.
Let me give you an example of how this type of proactive testing works. There’s a patient that stands out in my mind. She was a 44-year-old woman. I’ll call her Rebecca. She was at the Health Nucleus as part of a corporate group. She was pretty diligent about her health maintenance; she would have annual mammograms, pap smears every other year, she exercised about three days a week, and I would say her diet was pretty clean overall.
As part of our testing protocol, anyone over the age of 35 would receive a coronary calcium score. Rebecca was included in that bunch. I remember sort of being surprised when I saw her results. Not even a little surprised, really surprised.
It turns out that her calcium score was very elevated, placing her at the 95th percentile for risk for her age. This meant that over the next 10 years her risk of a cardiac event was approaching 25%. When I had to sit her down and review these results with her, she was shocked. Heart disease was not even on her radar. She didn’t have any risk factors that she was aware of and she was certainly not having any symptoms.
If she had gone to her regular doctor’s visit, it’s really unlikely that she would have had this test as part of her armamentarium. She didn’t really meet any criteria for it.
A look at her genetics did reveal that she was at higher than average risk for heart disease. A deeper look into her genome showed us that she was actually a pretty poor candidate for statins, which we all know are one of the mainstays of prevention of heart disease.
I consulted a friend who is a cardiologist and referred her over. He felt that she would be an excellent candidate for an injectable drug called Repatha, which is a very potent inhibitor of cholesterol production. That combined with her desire to really get motivated now and change her habits, she reduced her alcohol intake and increased her exercise.
These were the kinds of tools that I dreamt of, sharp and precise tools to help us all, guide our treatment for our patients, and to help our individual patients live longer and healthier lives. For just a second, I remember being transported back to Dr. P’s case. What if I had had this kind of knowledge, would he still be here?
Now, the beauty of this approach is that for each of the patients that chooses to go through this testing we gather a really large volume of data. The challenge of this approach is that we gather a really large volume of data.
Currently, all of this information is reviewed by a team of geneticists, bioinformaticians, radiologists, internists like myself, and a summary of all of that is created. As powerful as that brain trust is, I really believe it will be machine learning that allows us to make more rapid analytical decisions and change the face of human health.
Today, this type of testing is not covered by insurance. It’s an out-of-pocket expense. I believe that as we’re able to show better outcomes and longer lives with higher quality, this will become a more routine way of thinking about health maintenance.
While today we’re able to actually look at every single letter of someone’s genetic code, it still shocks me that we still only understand what about 2% of the human genes actually do.
As science advances and we make more correlations between DNA and health, it’s my belief that with your genome in the database you’ll receive continual updates so that you can understand more about yourself and your health. This takes knowing more and knowing it sooner to a whole new level.