Upgrading or Moderating: Two Evolving Views of Healthcare

As I reflect on what I learnt in 2016, I see two somewhat conflicting world-views of health: upgrading and moderating.

One promotes upgrading the human body much like software. In this case, our biological processes can be considered as algorithms that can be improved upon. The other view calls for moderating our dependence on medicine by influencing elements surrounding health, such as food and environment.

Let’s consider both views.

Upgrading the human body

I first heard this phrase from Yuval Noah Harari whose work has deeply influenced me this past year. 

Even though the underlying goal of medicine has been about sickness, the industry is increasingly moving towards upgrading the human body. For example, Testosterone therapy doesn’t cure any debilitating illness but still comes under the purview of medicine. 

An upgrade we’ve taken for granted is how we manage chronic conditions, such as hypertension and diabetes.

At a more complex level, longevity companies (such as Calico and Human Longevity, Inc.) aim to upgrade us by fixing genes that result in disease. 

Our expectations from medicine are evolving from  fixing sickness to  managing conditions to  upgrading the human body.

Much like how we regard smartphones as a necessity today, people will begin to expect upgraded bodies as a new norm. Productivity-enhancing drugs (lookup nootropics popular among Silicon Valley geeks), implantable chips, mind-calming substances (cited as a titanic tool in Tim Ferris’ new book Tools of Titans), genetic modifications and even nanobots that traverse our bloodstream could be part of the new deal.

Through such upgrades, we are expected to become better versions of ourselves - perhaps like Bradley Cooper in the movie Limitless.

Moderating Medicine

Upgrading seems to have exciting benefits. I could continue gorging on pizza, even as I wait for the industry to upgrade me. Win-win, as they say.

Are we missing something? 

The last 50 years of pharmaceutical evolution has shown that quick-fix upgrades invariably have downsides too. I know because of a tiny hypertension drug that I consumed for 20 years. It changed my physiology in a way that I can’t clearly describe. 

I became acutely aware of my dependence on the beta-blocker when I started tapering-off from 5mg/day to 2.5mg/day under the guidance of a well-regarded cardiologist about a year ago. During first several weeks of tapering, I experienced withdrawal symptoms - irritability, flutter in the chest, sleeplessness and mood swings even while my readings showed normal.

Last November (one year later), my cardiologist tapered it further from 2.5mg to 1.25mg. I experienced similar withdrawals but for a shorter duration. After a meticulous physical exam, he had sniggered, “Even while standing, your BP is 120/80!” 

Latest blood pressure guidelines suggest that I may never have had hypertension to begin with (140/90 is the new norm). It’s disorienting to know that I upgraded to fix a bug that never really existed. [Read 4 Disturbing Trends in Healthcare for more details].

But tapering-off is hard work. It requires you to exercise, eat right and in time, meditate, sleep well and skip fun things like binge-drinking into the night.  

Wouldn’t you much rather upgrade?

Upgrade or moderate?

Even if driverless cars could examine our health soon, it’s not all that clear if our advances will upgrade our bodies cleanly without introducing new bugs that require new fixes. 

The modern grocery store gave us convenience but deeply altered what we eat. We now have easy access to a fiber-less, fatty-sugary-salty diet that was unthinkable just a few generations ago.

New lifestyles have led to new diseases prompting us to look for better upgrades. We are stuck in a loop - perhaps to the point of no return. Yuval Noah Harari supposes that our ongoing upgrades will evolve homo sapiens into an altogether newer species that could only be part-human. Ahem.

I guess we must find the balance between these worlds of upgrading and moderating. In it are hidden opportunities to think about healthcare differently. 

How much do we upgrade and buy into new problems? How much do we moderate and work towards better health? 

As a wise-one once said, it’s all in our hands.