The Health Issue 2019

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EDITOR'S NOTE 03

LONGER LIFE 04

A BRAIN-MACHINE INTERFACE 08

8 HOURS OF REST FOR A CLEAN BILL OF HEALTH 11

Contents A MENTAL HEALTH PANDEMIC 14

A CONVERSATION ABOUT DESIGNER DNA 18

THE ECONOMICS (AND POLITICS) OF HEALTH COVERAGE 26

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Editor’s Note Hello & Welcome to White Collar!

When asked about how they select and priorities issues at the Bill & Melinda Gates foundation Melinda said, “So a lot of the work that we do in the developing world is around health. If you don’t start with great health, you can’t go on to get great education and then live your full potential.”

Good health is the best launching pad to our absurd little ambitions. There’s plenty of disruption in this space, so much so that it’s changing the world way we view the human condition.

Questions like “Is aging a disease? and if so can aging be cured?” have triggered an incredible surge of funding into research and now, development.

Despite the hope and promise of where medicine is going, we have to be aware of the state of healthcare as is: Infant mortality is still a huge challenge in Africa and the middle-east, and even in the developed world, places like the United stated, getting a shot of insulin is absurdly expensive despite it being relatively cheap to manufacture.

Aside from the profiteering and politics of this Industry, the life expectancy of people around the world is going up. Governments are getting more and more involved in a regulatory role. There’s no changing the fact that the rich will always get the benefit of new tech first; but as more policies are implemented hopefully the rest of us can get the same access.

We love hearing back from you across our social media! Let us

Contributors:

Michael Kiruthi, Esq Daniel Kathare Ian Macharia Kyama Kivuva

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know what your thought are.

Kyama Kivuva

ManuKyama

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LONGER LIFE

Can we, and Should we, live forever?

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elsewhere, varies from one faith to the other.

We are often split between accepting the finality of death and attempting to beat it. Ren’s statement, though said in jest, points to a genuine venture, and a lot of start-ups have come up in this space.

Is radical life extension possible? And if it were, what would it look like?

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his is Ren Zhengfei, the founder of Huawei.

He recently broke the silence, denying allegations about Huawei’s Spy-cam stories and subsequently dropped a few interesting facts about himself; like how he’s an apple fan (which seems pretty obvious since Huawei’s user interface feels like a ‘distant cousin’ of apple’s). Another interesting fact about Ren is that he wants to live forever. He is currently about 74 years old, and during the press conference he was asked when he would retire. To which he responded with a vague joke about immortality.

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“The timing of my retirement will depend on when Google can invent a new medicine that will allow people to live forever. I’m waiting for that medicine,” he joked.

The timing of my retirement will depend on when Google can invent a new medicine that will allow people to live forever. I’m waiting for that medicine ” Ren Zhengfei, founder of Huawei.

This was one of the best diversions a CEO could give when asked about retirement however, Google’s parent company Alphabet, and other Silicon Valley companies have bet big on research and technology that can one day “make death optional”.

The fragility of life is something we all think about.

Some confine it to the privacy of their thoughts and others openly lament about it, or interrogate it, through their works in writing, paintings and sculptures.

We have always been curious about the different ways we could beat death, be it through our reputation’s ability to outlive us or through a more spiritual approach where death is seen merely as a transition to more life, whether continued on earth or

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Ray Kurzweil, the Head of Engineering at Google put it this way, “I’ll never be able to come on stage and say ‘I’ve done it, I’ve lived forever’, but I talk about 3 bridges to radical life extension. Bridge one is what you can do right now to stay healthy the old fashion way so that we can get to bridge two.

A key idea of mine is that information technology progresses exponentially and health & medicine is now in Information technology and that was enabled by the genome project. And it’s not just the collecting this object code of life that’s progressing exponentially but our ability to understand it, to model it, to simulate it, but most importantly to re-program it.”

On June 26th, 2000, U.S President Bill Clinton, surrounded by scientists and world leaders, presented the ‘Human book of life’, which contained man’s entire mapped genome, and said, “When we get all this worked out and we’re all living to 150 –

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(laughter)—young people will still fall in love, old people will still fight about things that should have been resolved 50 years ago -–(laughter) –- we will all, on occasion, do stupid things, and we will all see the unbelievable capacity of humanity to be noble.”

But this wasn’t an overnight process, certain steps had to be taken:

They started to ask questions like, ‘What are the chances of getting a condition due to aging as compared to other risk factors?’ or ‘by how much does aging amplify your chances of getting these conditions’ these questions helped them find a great starting point for research and also helped them gain a bit of perspective. They knew that the data they would get from studies like these would point at a tangible next step.

Step 1: Understanding what causes death

Their findings were shocking.

If you’re going to understand how to extend life, then you have to know what causes the very thing that you’re trying to avoid.

“Aging is a major risk factor for death from any one of those diseases that we’re afraid of… From cancer, from cardio-vascular disease, from Alzheimer, from Diabetes. Now you might stop me and say ‘just one minute, for cardio vascular disease isn’t it cholesterol?’ Well, cholesterol is a 3 fold risk, but aging is a 5,000 fold risk!” Emphasized Nir Barzillai, an ‘Aging’ researcher while talking to the team from, Explained a docu-series on Netflix.

Breakthroughs in modern medicine are pushing the limits of what treatment means. Medicine has always been used as a therapy to treat, remedy or manage certain conditions, however with an influx of information medicine is beginning to transcend therapy and move into enhancement.

Research shows that in America the leading cause of death among the elderly is chronic conditions. These are usual suspects Cancer, Cardio vascular diseases, Alzheimer and Diabetes. Governments, organizations, pharmaceutical and tech companies have thrown billions at the attempt to discover cures for these chronic conditions and up to date the race is still on.

When talking about the third bridge to life extension, Ray said “...At bridge 3 we will have medical nanorobots, which are computerized and the size of blood cells. They will basically finish the job of the immune system. Currently we, already have intelligent devices the size of blood cells, they ARE blood cells, our T cells. But they evolved thousands of years ago when it was not in the interest of the human species to live very long so they don’t recognize diseases like cancer, which happen to get people much later in life.”

A common trend was starting to emerge, and scientists started to wonder if they were asking the right questions when it came to tackling chronic conditions. A few of the industry professionals decided to take a step back and begin to investigate the common thread that seems to join all these chronic conditions… Aging!

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Cholesterol is a 3 fold risk, but aging is a 5,000 fold risk!

It’s difficult to argue with numbers like that. All the arrows from the research studies seemed to be pointing directly at aging, and so it made sense that they should investigate the process of aging. And just like before, it started from the question they asked. Questions like ‘Why do different animals have different rates of aging?’, ‘Can aging be slowed down?’ or ‘Can aging be cured?’ the latter is a question that they didn’t really know to ask because institutions like the FDA hadn’t exactly classified aging as a condition that can be cured. But one thing they have conceded is that aging amplifies the risk of chronic diseases.

Step 2: Treating the underlying cause “…And so, what we think about in the aging field is how can we find the core problem that is causing all these downstream pathologies and fix that and eliminate the chance of them occurring in the first place,” said Laura Deming, an ‘Aging-Biotech’

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investor, when interviewed on Explained a docu-series on Netflix.

Research into aging revealed the connection between senescent cells and age related diseases. As we age, increasing amounts of our cells enter into a state known as senescence. Normally, these cells destroy themselves by a self-destruct process known as apoptosis and are disposed of by the immune system. Unfortunately, as we age, the immune system declines, and increasing numbers of senescent cells escape apoptosis and accumulate in the body. One way to lengthen life is through flushing these cells. It has already been done in mice and has improved their quality of life, health and longevity by dramatically reducing their chances of developing chronic illnesses.

There are already a few well-funded start-ups in this field trying to figure out how to flush senescent cells in people. We’re eagerly waiting for news on this front however some industry professionals seem to think that these startups may have already been beat by a drug that’s on market today! A drug called Metformin.

So, how does Metformin work? At the beginning of this article we looked at how the genome project allows scientists to understand the basic code of life.

They used this knowledge to knock out a targeted gene called ‘Daf-2’ on the c. elegans worm. This worm normally has a lifespan of about 14 days however when they observed the worm whose genes they edited on day 13, it seemed younger and more active than the others in the lab. The worm went on to live about 28 days. Through mutating this gene scientists successfully doubled the life-span of the worm.

In 2000 a different group of scientists did the same procedure on the fruit-fly and their study noted that ‘the fruit fly’s life-span almost doubled’.

In 2005 a similar study was carried out in mice by yet another group of scientists and their study noted that ‘GH mutant mice live 50 per cent longer and exhibit

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significant difference in several aspects of energy metabolism’ and that ‘the IGF-1 mutants are resistant to age related diseases’.

Metformin works on the human version of the same gene and regulates insulin production. In 2014 a UK study showed that 78,000 patients taking metformin lived a bit longer than non-diabetics. It also found that people with diabetes who take metformin have 30 per cent less cardio vascular disease, and 30 per cent less cancers.

Ray Kurzweil responded to this UK study by doing a study of his own with MIT scientists and they found that metformin killed cancer stem cells which are the causing agents for cancer. This may mean that we might have found a way to prevent cancer. This could help us significantly extend our life-spans and is great news for those who can afford these drugs.

However until recently people were lucky to make it past the age of 5 and in some parts of the world today people this is still the case. Infant mortality is still an issue that a lot of countries are still grappling with and according to data from the World Bank, African countries are still among the leading in infant mortality with Nigeria having about 65 deaths and the D.R.C having 70 deaths (per 1000 births). At a time when we seem to be at the edge of monumental discoveries that could push the human life-span even further shouldn’t we set aside a few more resources to make sure that EVERYONE at least makes it to old age?

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Is this the next step in evolution?

A B R AI N - M A C H I NE I N T E R FA CE

Neuralink is a start-up that’s taken on the challenge of connecting the brain directly to computers; which in and of itself sounds like something out of a Science fiction movie. It was started in 2016 by Elon Musk but wasn’t publicly reported until 2017, after which they seemingly fell off the face of the earth… until now.

So why suddenly do a live-streamed conference now?

“The main reason for us doing this video is recruiting.” Said Elon as he kicked off the event, “We want to have the best talent in the world to come and

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work at Neuralink.”

Already off the bat, there’s a lot of questions about the implications behind such kind of technology; questions like: • Is it safe to implant?

• How much will it cost?

• Is it secure enough to not be hacked?

Do we really need it?

Before starting any company/start-up/think-tank, people usually identify a need that they would like to

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meet. We can’t speak to what exactly Elon was up to at the time but the use cases for this kind of tech are numerous especially in medicine. They Involve:

neurons.”

Looking at it that way we can see the logic behind how they could go about creating something that takes advantage of the way our brains function in order to give and receive high quantities of information from computers, directly. Their goal is to, “record from and actively stimulate as many neurons as possible across diverse brain areas.”

To understand and treat brain and spinal disorders: “It’s important for us to address brain-related diseases, if you survive cancer and Heart disease odds are, you will have a brain-related disorder… for example Alzheimer or Dementia.” Elon explained, “If you know someone who has broken their neck or The team at Neuralink has tried their best to scale broken their spine… we could solve that with a chip.” down on-chip and thread size maximizing safety by Though he tempered expectations by clearly expressing that despite his extravagant promises that it’ll be a slow an arduous process. “There’s an incredible amount that we can do to solve brain disorders and all of this will occur, quite slowly… Getting FDA approval for implantable devices of any kind is quite difficult and this will be a slow process where we will gradually increase the issues that we solve.” making the process almost fully automated. They equate their process to LASIK surgery, which has Preserve and enhance your own brain: an excellent track record for speed, safety, and Elon has been critical about Artificial Intelligence (AI) precision. for a long time. He doesn’t trust it one bit and the “The operation, on a per chip basis, involves a 2 mm only future he’s willing to settle for is one where we’re incision which will be dilated to 8mm for insertion at par with AI. “We can do a full brain and machine and then closed right up. It’s so small that it doesn’t interface which means we are going to… and this is even need a stitch… and the interface to the chip going to sound pretty weird but… achieve a sort of is completely wireless as well, so you won’t need to Symbiosis with artificial intelligence.” have wires sticking out of your head.”

He continued to state that “Even in a benign AI scenario, we are going to be left behind, but I think with a high bandwidth Brain-Machine Interface we can go along for the ride.”

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We can do a full brain and machine interface which means we are going to… and this is going to sound pretty weird but… achieve a sort of Symbiosis with artificial intelligence.

So how does it work?

Elon posits the idea that everything about the human experience takes place in the brain, “Everything that you perceive, feel, hear, think is all just action potentials… it’s all just neural spikes… it feels so real *taps mic* but these are all impulses from

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They’ve intentionally designed the threads to be about the size of a neuron in order to reduce trauma to the brain when inserted and they can have up to 10,000 electrodes that are to be inserted into the human brain, all of which are read & write meaning they can both receive and give information.

The neuralink team is highly specialized in all the different fields that come together to make this possible and have figured out analog to digital conversion of the neural spikes that occur in the brain, and also the digital to analog stimulation that can simulate haptic touch, sound or even visual feedback.

We still have very little information about what the removal process would be like if we have a faulty implant or in the case, someone just doesn’t want it anymore. We don’t know what the downside of implanting this tech could be but if the N1 chip is used as a therapy the rewards could out-weigh the risks.

If the N1 chip is used as an enhancement It’s easy to imagine a scenarios from Netflix’s Black Mirror, episodes like ‘Playtest’ or ‘Striking Vipers’ where the implant could be used to create an incredibly realistic Virtual Reality (VR) gaming experience or an episode like ‘The Entire History of you’ where you could have perfect recall of your memories on demand. (All of the mentioned episodes are spoiler-free btw)

a radical shift in the way we learn and perceive the world. “A wide variety of information content is readily available in the brain,” stared Philip Sabes, senior scientist at Neuralink, “there are signals that encode speech and language, your mood, pain, when you’re thirsty…hungry and esoteric things like mathematical reasoning.” During the presentation, Philip also spoke about how they could tap into specific neurons located in the Hippocampus that has cells used for location and views and has cells that represent places that you know very well. If you tapped into these cells you could map out an entire area from someone who knows it well and share that information which could be incredibly useful for people who travel often.

The Neuralink team have their sights set on having their first human implant before the end of 2020. “A monkey has been able to control a computer with its brain.” Said Elon during the Q&A part of the event.

They mentioned that Neuralink will be synched with your phone.

“The overarching idea is to make the future a better place and hopefully not pave the road to hell with good intentions…” said Elon.

One thing is for sure though, this implant could cause

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EIGHT N HOURS OF REST FOR A CLEAN

ew York is called the City that never sleeps, a phrase that’s reminiscent of the lifestyle that comes with living and working in the

City.

In most cities, there aren’t enough hours in a day, it’s quite the challenge to strike a balance between work, play, family and ‘Me time’. We look at our overbooked daily-planners and eventually come to the conclusion that the only place we can borrow an hour or two to do the things we prioritise or love is from sleep.

I mean who needs to lay motionless for a whole 8 hours, when borrowing an hour here could help you finish that very important proposal or get you in the perfect position to get a jump on the markets. You’ve heard the phrase ‘You can sleep when you’re dead’, Matt walker, Professor of Neuroscience and Psychology at UC Berkley thinks that this mortal advice.

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“Your body is smart, and it needs a certain amount and it’s not the more, the better.” said Andy Bellatti, a registered nutritionist. We’re finely

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tuned and function optimally when we have the right balance of components and it covers everything from nutrition to exercise and even sleep.

We all know that sleep is vital, but just how important is it?

Side effects of little or No sleep

Brain We’ve all pulled an all-nighter in a frantic last-minute attempt to memorise the entire syllabus before an exam.

People swear by this move and love the feeling of doing something in the face of intense pressure.

Matt Walker and his team decided to test if the all-nighter lives up to all the hype by taking a team, splitting it in 2.

One stayed up all night (the sleep derived) and the other slept (the sleep group). There were no coffee or stimulants offered to the sleep deprived either.

When morning came they subjected each team to exercises where they would learn a whole list of new things and their knowledge of these new subjects was then examined; all of this while they monitor the brain activity inside an MRI machine.

They found that there was about a 40% deficit between the sleep group and the sleep deprived when it came to the performance. The brain needs sleep before learning or creating new memories, but what is it about sleep that is so good for learning and memory?

Well, Sleep deprivation in a way shuts down your memory inbox and it’s a lot harder to retain new memories. When studying the sleep group by placing

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electrodes strategically all around the head, they noticed these powerful brainwaves that happen during the deepest stages of sleep that build up to amazing bursts of electrical activity called sleep spindles. These deep sleep brainwaves act like a ‘memory transfer’ process for memories, moving memories from the inbox (the hippocampus) to a more permanent region of the brain.

Sleep’s impact on the brain trickles down to things like temperament, mental health and so much more.

We can clearly see this in the statistics taken during Daylight Savings, an event that affects about 1.6 Billion people across about 70 countries, in Spring when we lose about an hour of sleep, there’s a 24% percent increase in heat attacks the very next day. It doesn’t stop there though there’s an almost similar in driving accidents and suicides as well. In autumn when we gain an hour of sleep there’s about a 21% decline in heart attacks and the other mentioned phenomenon.

Aging & reproductive health Men who get by with about 4-5 hours of sleep begin to present as though they were about 10 years their senior. This can be noted in their levels of testosterone as well as the shrunk size of their testicles. There are similar impairments in female reproductive health caused by a lack of sleep.

Immune System Lack of sleep is a serious blow to our immune system, specifically to our natural killer cells which are like the FBI of our immune system. Our natural killer cells actively combat disease causing pathogens

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and even cancerous tumour cells. The best case is to have an optimum number of natural killer cells.

When the level of natural killer cells was measured in people who slept for about 4 hrs a day it was found to be about 70% lower than in people who got about 7 or more hours of sleep. Lower levels of natural killer cells can be a trigger for Cancer of the bowel, cancer of the prostate and breast cancer.

This data was so staggering that the World Health Organisation has classified any form of night time shift work as a carcinogen because of the disruption of your sleep wave rhythm.

DNA Code The implications of little or no sleep erodes the very fabric of biological life itself, our DNA genetic code. In this study they took a group of healthy adults, limited them to 6 hours of sleep a night for a week and measured the change in their gene activity profile relative to when the same individuals got a full 8 hours of sleep. What they found is a significant 711 genes were distorted in their activity. They also found that of the 711 affected genes, half were increased in their activity and the other half were down regulated.

The genes that were down regulated with respect to lack of sleep are related to your immune system. And the genes that were up-regulated are associated with the promotion of tumours, chronic inflammation and stress which can cause cardio vascular disease.

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How to get better sleep: Regularity: Sleep at the same time every day and wake up at the same time every day. Budget for about 7 or 8 hours of sleep and keep this as consistent as you possible can regardless of whether it’s a weekday or weekend. Your body will automatically adjust to the rhythm and this will improve the quality of sleep.

Keep it Cool: You have noticed that it’s easier to sleep when it’s too cold rather than when it’s too hot. Your body needs to drop its temperature by about 2 degrees in order to initiate and stay asleep.

Calming activities before bed: Try to do activities that calm you down, like reading a book or solving a puzzle as a sort of transition from an active to a more passive mood.

Avoid sugary drinks, Alcohol or caffeine: Sugar, alcohol and caffeine in certain amounts are stimulants that can disrupt sleep and raise your body temperature.

Reduce/Remove electronics from the bedroom: The fewer distractions you have in your bedroom the better. Anything that can compete for your attention against sleep should be treated as the health risk that it is.

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A Mental Health Pandemic: Why cases of depression are on the rise & what we can do to help What is depression?

Depression has been described as “losing interest in important parts of life”.

Mind, A UK campaign group describes it this way:

Here’s how to identify depression; some symptoms may include: • Eating or sleeping too much or too little.

• Pulling away from people and usual activities.

“It starts as sadness, then I feel myself

• Having low or no energy.

shutting down, becoming less capable of

• Feeling numb or like nothing matters.

coping. Eventually, I just feel numb and empty.”

• Feeling unusually confused, forgetful, on edge, angry, upset, worried or scared.

• Thinking of harming yourself or others.

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There’s been a lot of buzz about depression across every from of media available and as a result it’s filtered through into our conversations. Some older people dismiss the rise in buzz about depression as a form of ‘millennial over-sensitivity’ and then pivot to advice like “pray and meditate”, but the data points to an incredible surge in depression across all age groups since 2013.

Blue Cross and Blue Shield looked at medical health insurance claims from 41 million insurance holders. “Diagnoses of major depression have risen dramatically by 33 percent since 2013,” the report reads.

According to the report: 2.6 percent of youths aged 12 to17 were diagnosed with major depression in 2016, a 63 percent increase from 1.6 percent in 2013.

Among young adults aged 18 to 34, 4.4 percent had major depression in 2016, compared to 3 percent in 2013. That’s a 47 percent increase.

The highest percentage of major depression diagnoses were among people aged 35 to 49. The survey found 5.8 percent of 35-to 49-year-olds had major depression in 2016, compared to 4.6 percent three years before.

Clinical depression has surged to epidemic proportions in recent decades, from little-mentioned misery at the margins of society to a phenomenon that is rarely far from the news. It is widespread in classrooms and boardrooms, refugee camps and inner cities, farms and suburbs.

At any one time it is estimated that more than 300 million people have depression – about 4% of the world’s population when the figures were published by the World Health Organization (WHO) in 2015.

There’s been significant increase in diagnoses across all age groups which is a cause for alarm. According to the Centre for Disease Control, Depression “may be caused by a combination of genetic, biological, environmental, and psychological factors.”

Here are some risk factors and triggers for depression: • Experiencing traumatic or stressful events, such as physical or sexual abuse, the death of a loved one, or financial problems.

• Going through a major life change‚ even if it was planned.

• Having a medical problem, such as cancer, stroke, or chronic pain.

• Taking certain medications.

• Use of alcohol or drugs.

• Irregular sleep and eating habits.

• Consecutive events that continuously destabilize you.

• A genetic predisposition.

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Why are cases of depression on the rise?

Social Media: Millennials were the first generation to grow up with the constant flow of information from the internet and social media [and] they are being bombarded with details about the personal and professionals lives of others,” said Jessica Singh, a mental health therapist and founder of Transcendence Counseling Center.

“Millennials can’t help but compare their situations and achievements to everyone else’s, which can leave them feeling insecure and unaccomplished,” Singh siad. As a result, “Millennials are feeling the pressure to always look and act like they have it all together.

This can easily result in lowered self-esteem, anxiety, or depression,” she said.

Conspiracy of external events: Sometimes things just don’t work out; and it has a domino effect that affects other parts of your life and the end result is a spiral. Cases like these are more common that we care to admit. If a round of layoffs

experience most people come to see me because something has gone wrong in their life and not necessarily because they have a psychological condition”

Why do depression stats differ from one country to another?

While rates for depression and other common mental health conditions vary considerably, the US is the “most depressed” country in the world, followed closely by Colombia, Ukraine, the Netherlands and France. At the other end of the scale are Japan, Nigeria and China.

The stark contrasts between countries have led some to dub depression as a “first world problem” or a “luxury”. The logic is that if you are staring down the barrel of a gun or you don’t know where the next meal is coming from, you have no time for such introspection.

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Recent research points to myriad reasons, many overlapping: in particular less developed countries often lack the infrastructure to collect data on depression, and are less likely to recognise it as an illness. Also, people in these countries are more likely to feel a social stigma against talking about how they feel, and are reluctant to ask for professional help.

happens, even if it isn’t personal people tend to take it personally and this can lead to occasional drinking and withdrawal social engagements and in turn can damage existing relationships.

What can we do to fight depression?

If you’re unemployed and depressed it isn’t obvious that the problem is in your head. It’s just a problem

“If you’re unemployed and depressed it isn’t obvious that the problem is in your head. It’s just a problem.” said Jordan Peterson, a clinical Psychologist. “We don’t tend to classify psychological problems that way, but we should. There’s no psychological category for ‘Client in serious trouble’ but in my

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The WHO estimates that less than half of people with depression are receiving treatment. Many more will be getting inadequate help, often focused on medication, with too little investment in talking therapies, and therapies are a cornerstone to recovery.

A good place to start is limiting drug and alcohol use

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and eventually stopping it completely. During this period it’s important to eat a balanced diet, regularly exercise and drink 8 glasses of water a day. Physical fitness puts you in an excellent position to begin successful recovery.

together should accompany therapy. Talking to a qualified professional is an excellent idea. “Therapy has really worked for me,” said Charlamagne tha god, a popular radio host, “prayer works … and so does therapy.”

Getting the right amount of rest is essential as well.

It’s important to also schedule 7 or 8 hours of sleep.

And reme mber to keep it as regular as you possible can. It may be hard at the beginning, but you could look at our article on sleep for more pointers about how to get a good night’s sleep and all the advantages that rest can have on you.

The most common talking therapy is cognitive behavioural therapy, which breaks down overwhelming problems into situations, thoughts, emotions, physical feelings and actions to try to break a cycle of negative thoughts.

Physical fitness and Rest

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Anne P R O F E S S O R

A CONVERSATION ABOUT DESIGNER DNA WITH

Muigai

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he first draft of the Human ‘book of life’ was written in 2001.

It contains 3 billion pairs of A’s, C’s, T’s & G’s which represent the human genomic code that each of us carries in almost every cell.Once we discovered genetics around 1953, it took us around 48 years, the space of a single life-time, to learn how to read it and figure out how to re-code it for reasons that suit us. One area that’s currently receiving a lot of attention is therapy, where genetics is being used to prevent and cure diseases. Another area is enhancement, where already healthy people could use it to improve their existing traits (some say this could be the next step in plastic surgery).

There’s endless possibilities about what we could use genetics for and as people’s imaginations runs wild, there has been a sustained uproar all around the world about the ethics of genetic manipulation and an ever growing concern that we are opening a ‘Pandoras box’ whose consequences we don’t fully understand.

We caught up with Professor Anne Muigai, a Genetics expert and academic recently appointed to the World Health Organization, to try and shed more light about Designer DNA, the current state of gene editing tech and what could be possible in the future:

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Who is Anne Muigai?

I am a second born of three girls. We grew up in Nairobi and on a farm in Kitale.

We went to school in Nairobi and during the holidays our father would take us to the farm.

My father was, and still is in a way, my role model.

He was a maize breeder and was very passionate about his work. He made science so easy because he explained things in an easy and factual manner. It is not surprising that my younger sister Beatrice ended up as a commercial wheat and maize producer and I ended up in a science field.

Were there any traits that pointed to a career in science & education earlier on in your life?

I never dreamt that I would be doing what I am doing now. If all had gone according to plan, I would have ended up as a dentist. But I got selected for Bachelors of Education at Kenyatta University (KU), after missing the entry points required to be admitted into the University of Nairobi Dental School. I remember telling my dad categorically that I did not want to become a teacher – actually there were a lot of tears involved too! He made me a promise, that if I finished the degree he would send me off to the United States of America to study dentistry there. So I reluctantly went to KU with a strategy of getting the degree done in the shortest time possible.

During my second week of university I walked into Prof GDE Njagi’s class- and he blew my mind with talk of genes and DNA. When he talked of mobile genes that move around cells my dream was completely shattered (Actually I never raised the issue of dentistry with my father or anyone again!)

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Njagi became my second mentor since it was an area that was new to me and I needed information on where the genetics path led to. Njagi advised me to commence on my Masters soon after completing my undergraduate degree. So I did a Masters in Plant Genetics and after that I guess I was a geneticist?

How does one end up as a molecular population geneticist?

What was your journey to this position like?

A series of coincidences led me to being a molecular population geneticist.

I tried to get a scholarship in the plant genetics area and it was not so easy. Time was passing and I was worried that it was taking too long. I mentioned this to Prof Mabel Imbuga (who became my mentor) and she encouraged me to consider doing a PhD in animal genetics. After all, she said, at the cellular level, plant and animal cells are very similar.

I was not very convinced that that was the case.

I guess she saw me stalling because one day she put me in her car and drove me from Juja (where the JKUAT main campus is located) to the International Livestock Research Institute Campus on Naivasha road, a distance of approximately 45 km.

She introduced me to some scientists who told me about the research they were doing in so many aspects of animal health and genetics. It sounded so interesting! So the next time they put out a call for applications for PhD students, mine was among them and I was delighted when I was admitted.

The project I was admitted into involved the characterization of the indigenous livestock of Africa using molecular markers. My component was the sheep of Africa and I have spent the last 16 years working on this, i.e characterizing indigenous livestock – especially sheep and goats,

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using genetic (molecular) markers so that they can be conserved. My efforts towards this were recently recognised by the African Union who presented me with an award.

How do we get more people interested in genetics in Africa?

I think the world of genetics has applications in very many facets of life, including medicine, agriculture, pharmacy, climate change...the applications are limitless.

The subject can get technical and to interest many young people in this area we need to simplify it, break down the issues and use the approach my dad did...to tell interesting stories about genetics and tie them up with current issues that are happening around us. This is what I do with my students. I always try to link what we are studying to their day to day life.

What’s your job description at the WHO? Recently I was appointed to be a member of the first expert panel of the WHO expert Advisory Committee to develop global standards for governance and oversight of the Human Genome editing. So it is not a full time position.

The purpose of the panel is to provide expert advice or make recommendations on how WHO can govern emerging technologies that are being used to edit the human genome. The CRISPR technology is one such technology. It is a controversial technique when it is applied to humans.

What’s CRISPR? CRISPR (pronounced crisper) technology is a new technology that is being used to edit the genome of organisms. It involves the addition, deletion or altering segments of the DNA sequence.

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This method is causing a buzz in the scientific world because the technique is relatively easy to use and it is a versatile and precise method to manipulate any organism’s genome. The technology was developed by scientists who made the observation that bacterial genomes have similar inbuilt mechanisms that allow them to edit their genome as a response to attacks from viruses and other types of pathogens.

Why is there so much hype and buzz about CRISPR? We know that many diseases have a genetic origin and CRISPR offers the possibility of treating conditions at the genome level rather than at the symptomatic or organ level. Currently the buzz is about how this technology can be used to prevent diseases like cancer from occurring and even more importantly, from treating the diseases at the genomic level. The method has successfully targeted the core of cancer cells in mice and thus mice with prostrate and liver cancer were treated.

Super bugs killed and destroyed themselves after they were edited using the CRISPR technology.

One achievement that is being celebrated is the creation of mosquitos that were highly immune to the plasmodium parasite, the parasite that causes malaria, using this technology. This has enormous potential in the eradication of malaria.

When people hear about something like this all kinds of ideas begin to seem like real possibilities. What are some of the moonshots for genome editing?

Perhaps that there will be a supermarket where one can shop for organs to be used in organ transplantation? There is ongoing research in this area. These organs would be produced from pigs that have undergone

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gene editing to make their genes very similar to human genes, so as to limit the possibility of organ rejection. Of course the end is still a long way off, but there is excitement because of the possibility of production of a limitless supply of pig organs that can be used for human transplants.

Of course this possibility opens up another ethical Pandora’s Box. The question of whether these organs would be easily accepted recipients given their diverse religious and cultural backgrounds or whether people who have undergone such transplants would undergo discrimination from the rest of the society. These are a few applications in the human world.

In the plant and crop world, crops such as maize, soya bean, rice and wheat have had their DNA edited using CRISPR. The gene edits involve the production of crops with new traits such as drought and disease resistance as well as higher yields.

These traits are especially important to African farmers, who are grappling with diseases affecting their crops and climate change. We envisage that in approximately 5-10 years these crops will be in the market.

How many years before we have a handle of it?

It is difficult tell. Technology is moving very fast, better CRISPR technologies could be developed or another new technique could come and overtake CRISPR. While the CRIPR technology is easy and versatile to use the technique when applied to human beings it may not be as precise.

You see when one is dealing with gene manipulation in plants or animals and in the process accidentally deleted a gene or three, it may not be so serious. However such deletions in humans may cause death, serious disabilities or even induce diseases such as cancer. Allan Bradley of the Wellcome Sanger Institute in the UK believes that there is a chance that some of

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these manipulated cells could turn cancerous. The risks associated with the technique have not been determined and it is too early to tell.

CRISPR is mostly famous because of one use case, ‘Designer babies’.

What else could people use this new tech for?

There’s plenty of use cases and the most urgent one is treatment on an individual’s somatic cells.

Somatic genome editing involves the transfer or manipulation of genes found in somatic cells (i.e cells that are not involved in reproduction) e.g. white blood cells can be manipulated to remove the genes causing leukemia and inserted back into a patient. Such effects cannot be transferred to the next generation.

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Germline technologies could contribute to the birth of designer babies, babies born after their parents have pre-selected their children’s traits.

In this case children would be treated as objects, where they would only be acceptable to their future parents if they contained certain traits, looked a certain way, were disease free and had a high level of intelligence.

In livestock we pre-select parents in order to get new and improved breeds that would produce more meat or milk for instance. But do we want to extend that to children? Children born after pre-selection of the best parental combinations and pre-selection of the “best” embryos post gene

CRISPR offers the possibility of treating conditions at the genome level rather than at the symptomatic or organ level.

On the other hand we have cases where a gene edited baby is a final product.

This type of manipulations are known as germline genome editing. Doing these type of experiments on babies is completely unethical. I am completely opposed to any research that alters the genome of human eggs, sperm or embryos because such changes can be passed onto future generations and thus alter the course of the future of mankind.

There is also there’s the issue of the risk associated with the technique itself and wither the individuals have given informed consent. The individuals on which such experiments are being carried out cannot choose whether they want this type of treatment or not. That brings in another angle, in that we are doing live experiments on babies who cannot speak for themselves. Questions on whether the technique in itself is ethical and whether human rights are infringed when the technique is being done ought to be taken into consideration because these children cannot give their consent for their genetic material to be modified.

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manipulation, would have to live with the fact that they were allowed to proceed to term because they passed some prescribed standard set by someone who could or could not have been their parents and their siblings were eliminated because they did not reach the high standards. This is another form of eugenics which is not remembered fondly in our history as mankind.

Can Gene editing produce an army of Super soldiers?

Can we really have a soldier who can stay awake for days, communicate without advanced communication devises, who can eat and digest grass, who can be tortured and will not break down because they cannot feel the pain?

To answer this question lets go to nature and ask if there are organisms that have these traits, because if they are then we can assume that with this technology (and some rouge scientists) we would

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be able to transfer the relevant genes into man.

And we find that Dolphins do not sleep- because if they did they would drown, Alaskan sled- dogs don’t tire and are able to run for days without rest or food, goats eat grass and digest it pretty well, in fact they grow fat from it! And bats navigate their flight paths using echolocation.

However, and that is a big however, there are serious moral, ethical and legal considerations that need to be taken before any government considers going down this road.

Fortunately many governments have introduced laws or are in the process of producing laws that have put a moratorium on germline gene editing.

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It is my hope that many African countries quickly react to this and begin to enact laws that would prohibit or ban germline edition that include genetic enhancements.

Is there anything on you that you’d want to change at a genetic level?

Every human has something that they would want to change about themselves. Me too! Perhaps I would be happier if I weighed less (laughs)....But wanting to change something and actually doing it using genetics are two different things. I would never consider using genomics to achieve that!

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T H E

E C O N O M I C S

( A N D

P O L I T I C S )

O F

HEALTH COVERAGE Cutting edge advances in the medical world are all the rage today. As technology develops, medicine has taken a number of impressive steps towards solving some of the most challenging health problems that face the modern world. Robotic surgeries, artificial organs, gene therapy, wearable smart health gear, virtual consultation, and nano-medicine are just a few that catch the attention.

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Some, such as radical life extension through leveraging of biotech, nanobots and artificial intelligence, are already pushing the ethical boundaries of modern medicine to the limit before its full potential has become a reality. All these developments are highly important in their own unique ways, but they have one thing in common: they are costly!

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Diseases and medical conditions still account for an average of three-quarters of annual deaths around the world. And while you may think that infectious diseases are probably to blame for these, you would be quite wrong, because most of them are noncommunicable conditions that can be managed by quality healthcare.

However, a little economic perspective is important when interpreting this information. Majority of people in the lower income groups are in developing countries. According to the World Health Organization, more than half of the deaths in these countries result from Group I conditions. These include infectious diseases, prenatal and postnatal complications, and nutritional deficiency.

It goes downhill from here: each piece of wearable device costs between $100–$500, artificial organs average $100,000–$300,000 for just the first year, gene therapy ranges between $500,000–$1,000,000, while the costs of radical life extension procedures are yet to be fully determined. Even the best health care systems by cost still exceed the $2,000 mark, making those systems impracticable in developing countries.

Perhaps one of the best economic solutions available to low-income countries is universal health care (UHC). Unlike other health care system (such as private/government insurance or out-of-pocket payment) UHC gives people unprecedented access to quality health care services while simultaneously protecting them from the financial costs that modern health services are notorious for.

While other systems are highly segmented and discriminatively priced in terms of the type of service, UHC avails all medical services to everyone, including preventive care, treatment, rehabilitation, and palliative care. While this may sound expensive, studies have proven that investing in the health of a nation has high economic rewards for the country in the long run.

Additionally, majority of deaths from noncommunicable diseases are also from middle and low-income countries. This only points to one thing: the cost of access to quality health care.

You may be curious about how much cutting edge medicine costs. A single robotic surgery will set you back $3,568 per procedure according to the journal of the American Medicine Association. This is just about the gross national income in low-income countries, which stands at about $3,895 in 2019.

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When people are healthy, they have more financial freedom and time to invest in their social and professional development. This translates into a stronger and happier nation as well as a larger working class, which translates into higher quality in terms of work input. It reduces the levels of social discontent, giving the government more time to develop the nation.

This has been witnessed in Asian countries such as Singapore and South Korea, which are now economic powerhouses, not just in their respective regions, but globally.

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