
Google Bets on Health - adventured
http://www.bloomberg.com/news/articles/2016-02-12/google-ventures-seeks-to-make-name-as-farsighted-health-investor
======
jbob2000
I had a conversation with a coworker who used to build software for the
criminal justice system. To make a long story short, it turned out to be
impossible to make a good software system for the criminal justice system.
Between the courts, police departments, and government, nobody was willing to
give up any data, fearing they would lose their own value in the system.

I fear that healthcare will suffer the same fate. Between insurance companies,
doctors, hospitals, patients, governments, and every middleman inbetween,
nobody is going to want a system that makes one of them irrelevant.

~~~
seehafer
> Between insurance companies, doctors, hospitals, patients, governments, and
> every middleman inbetween

You can eliminate middlemen if you can show cost reductions for a player
larger than the middleman. The big players are providers, payors and
technology (pharma/device) companies. Plenty of middlemen in between those
that can be made irrelevant.

~~~
psaintla
You would think that's the case but from experience it's not. I can name two
hospitals in NYC that were supposed to see savings from EHR implementations
but ended up having multiple competing EHRs that don't speak to each other
because of conflicts of interest. You forget there in many cases there are
many payors, tech vendors and providers within a single institution.

~~~
wefarrell
That's been my experience as well. EHR providers have no incentive to exchange
data with each other and will do everything in their power not to. There are
regional efforts towards interoperability but there needs to be more political
will to mandate cooperation.

~~~
epmatsw
Eh, Epic and Cerner interface fine, and offer HL7 interfaces, and Epic in
particular bends over backwards to do what their customers want for
implementations. My impression was that hospitals are (understandably)
reluctant to allow their direct competitors direct access to information
they've collected.

~~~
psaintla
I wouldn't go that far with Epic. They always have some unadvertised module
they try to push on hospitals the minute they want to interface with a third
party.

------
reasonattlm
The first rejuvenation biotechnology companies developing therapies to target
the aging process itself - rather than producing compensatory/palliative
treatments for specific manifestations of late stage aging - are already past
their seed stage. Unity Biotechnology and Oisin Biotechnology are both working
on different methods of senescent cell clearance, for example. Removal of
senescent cells has been demonstrated to extend life in mice, improve
cardiovascular health, etc.

It makes sense to back all plausible ventures in this area of development, and
since there are at least seven classes of cell and tissue damage that cause
aging, there will be a fair number of such ventures in the years ahead. Next
up is probably glucosepane cross-link clearance or mitochondrial DNA repair,
or perhaps transthyretin amyloid clearance if it ever gets liberated from the
disinterested patronage of GSK.

Since Google has a clear interest in this area, even if they are going about
it by supporting exactly the wrong lines of R&D at the moment, I imagine they
will be involved in the growth of these companies and technologies as they
continue to prove themselves effective in animal studies.

The target market is every human being over the age of 30, with a course of
treatment every few years to a decade. The treatment will be some form of
mass-produced infusion, such as a gene therapy. Comparable technologies from a
production standpoint, such as biologics for autoimmune conditions, run at
$1-10K per treatment even in the wildly dysfunction US medical system. You can
run the numbers; from an economic perspective longevity assurance treatments
that work will make most historical therapies look like small potatoes.

~~~
sounds
Can you explain your analysis, "going about it by supporting exactly the wrong
lines"?

~~~
reasonattlm
There is an audio interview with Aubrey de Grey (SENS Research Foundation) and
Brian Kennedy (Buck Institute for Aging Research) in which that is discussed
in some detail.

[http://mendelspod.com/podcasts/brian-kennedy-and-aubrey-
de-g...](http://mendelspod.com/podcasts/brian-kennedy-and-aubrey-de-grey-
their-converging-approaches-aging-research/)

See the "response to Calico and HLI" portion.

With reference to Calico, the relevant part is this:

"I would say that definitely their hearts are in the right place, but they are
a regular, perfectly normal company. They want to make profits fairly soon.
Calico have set themselves up as a completely unusual company with the goal of
doing something very long-term, however long it takes, they want to actually
fix aging. They said so - Larry Page was perfectly clear about that. The
question is how are they going about it, and that's getting really
interesting. The first thing that they've done, which I feel is an absolutely
spectacularly good move, is to bifurcate their work into a relatively short-
term track and a long-term track. The short term track involves drug discovery
for age-related diseases, doing deals with big companies like Abbvie, and so
on. That's all very wonderful and all very lucrative in the relatively short
term, and has more or less nothing to do with the mission for which Calico was
set up - but it is a fabulous way to insulate the stuff that they do that is
to do with why Calico was set up from shareholder pressure. It gets a little
more complicated though. So then on the long term side, the stuff being led by
David Botstein and Cynthia Kenyon, the question is how are they going about
their mission. Of course an awful lot of this unknown because they are a
secretive company, but from the perspective of whom they are hiring, and what
kinds of work those people have done in the past, one can certainly say that
they are not just focusing on one approach. They are interested in diversity.
My only real concern is that they may be emphasizing a curiosity-driven long
term exploratory approach to an unnecessary degree. I'm all for finding out
more and more about aging, but I'm also all for using what we've already found
out to the best of our ability to try stuff and see what we can do. I should
emphasize that this is only my impression from a very limited amount of
information available, but my impression is that it is perhaps turning into an
excessively curiosity-driven, excessively basic science, inadequately
translational outfit. And that's kind of what I feared when Botstein came
along in the first place, because he's on record as saying he doesn't have a
translational bone in his body."

The basic point is that they appear to be aiming at drug development to slow
aging, which is very hard and speculative. The basic goal is to create a new
global metabolic state that ages more slowly than the natural one. The calorie
restricted state is an obvious one to try emulating, but that is also very
hard: understanding sufficient to do this requires a complete map of cellular
biology. More than a decade of research into sirtuins, and a billion dollars
in investment, went nowhere for example. That was classed as a promising
direction at the outset, and much hyped. But what if you did create a new
metabolic state? The outcome would be a small increase in life span, a small
slowing in aging, and a therapy that would be useless for old people because
they are already damaged.

Compare that with the SENS repair approaches, such as removal of senescent
cells, which is already producing far more robust results in mice, and at a
fraction of the cost. Such therapies can be used over and again, and produce
new benefits each time to the degree that they clear out damage. They are also
useful and beneficial for old people, as they will reduce their damage load.

So in short, we can do the slow, expensive, useless path, or the fast, cheap,
effective path. So far the research community has chosen the former. Why they
have done this is a long, long cultural discussion on incentives and
regulation and the nature of how research into age-related diseases has
typically worked over the last century. What will change this is a continuing
set of convincing animal data from SENS programs.

~~~
sounds
The investors are aging. It seems like there's a pretty definite time horizon
for the employees: are the investors "getting old"?

------
matt_wulfeck
I can't help but feel the motivating factor here is not helping people live
longer (invest in food storage, transportation, and production and help
millions of people survive). Instead this seems to me more like wealthy folks
beginning to fear the realization that someday they will grow old and die like
the rest of us.

~~~
haberman
Imagine being in a situation where doing anything that benefits both yourself
and others is used as evidence of your selfishness because it will benefit
you.

When did win/win become a bad thing? Would you rather these rich people were
building bigger mansions instead?

~~~
asdfologist
Yeah but your way of thinking isn't good for getting karma on HN. Pretty much
any HN thread on a big company doing something good is dominated by cynics who
cannot fathom the possibility of people out there wanting to make money and
benefit the world at the same time.

------
matt_wulfeck
Death is a gift. We are not built to live forever and we should never wish it
so. I encourage us all to focus on increasing the quality of all of our lives
and not the quantity of our days.

"The hate of men will pass, and dictators die, and the power they took from
the people will return to the people; and so long as men die, liberty will
never perish." \- Charlie Chapman "The Dictator"

~~~
natrius
Your dichotomy is a false one. Do you really think anyone's trying to keep
frail old people alive just to count off more days? It seems clear that the
goal is to eliminate diseases and decline, which would increase everyone's
quality of life.

You're free to continue practicing the barbaric ritual of death if you want.

~~~
shawn-furyan
> Do you really think anyone's trying to keep frail old people alive just to
> count off more days?

I think that's a pretty good description of what's going on in the last decade
of a lot of people's lives. There's a huge bias toward high risk invasive
procedures that have a high probability of leaving the patient debilitated
even when the expected lifespan increase is fairly modest. Our penchant for
hope in difficult circumstances leads to a lot of unnecessary suffering. There
is plenty in modern medical practice to consider 'barbaric'. Skepticism with
regard to the current crop of medical utopists is warranted, because assuredly
current barbaric medical practices were developed and implemented,
overwhelmingly, with the best of intentions.

~~~
reasonattlm
There is a good technical reason for the present state of medicine for age-
related disease, which is that it overwhelmingly addresses proximate causes
rather than root causes. Near all treatments attempt to mess with the complex
disease state in a late stage of its progression, or in some way compensate
for loss of function by adjusting other processes into a higher state of
activity. It is expensive, error-prone, and the gains are tiny. The underlying
root causes continue to run forward unaddressed.

The research community has only just started the transition into treating root
causes, which is to say the aging process itself, the accumulating forms of
cell and tissue damage that are fundamental, not caused by anything other than
the normal operation of metabolism. There are initiatives, some of which have
reached the stage of clinical translation, but they are only a tiny fraction
of the overall expenditure at present.

This will change over the next decade or two as the first results for
fundamental damage repair (e.g. senescent cell clearance) become compelling
enough and widely known enough to shift the entire field in the right
direction.

~~~
mhkool
Dr Dale Bredesen has published an article about a small study where he
reversed(cured) Alzheimer in 9 out of 10 patients. The purists will say that a
group of 10 is too small to draw any conslusion and mathematically speaking
they are right. But the mistake that these people make is that they do not
understand that Dr Dale Bredesen is on the right track and what is necessary
to repeat the study with a larger group. There is a lot of lack of interest in
promising treatments.

Anyway, Dr Dale Bredesen is now doing the second study but I have no idea when
the results will be made public. Since the first study showed great results
after 4 months of treatment, I am optimistic that it will be faily soon.

The treatment of Dr Dale Bredesen is very different from what the average
reader may expect. It is not a medicine-based treatment, but a "general health
optimization" treatment with 35 variables. In my opinion, the Alzheimer
reversal treatment can be used to _prevent_ Alzheimer, and I hope that in a
number of years a study will find out if that is right.

------
ed_blackburn
Forgive my ignorance but with the UK government being very bullish with
enforcing its (in some places google influenced) ideology upon the NHS. My
interest in such matters has suddenly piqued.

What are these Health Care software systems? Are they distributed CRUD systems
between different locations and actors? Are they event driven systems that
push a leaner, more efficient process through the health care system? Are they
big data / AI products for the macro that identify patterns to help policy,
planning, budgets or micro to help as early warning for identify suspicious
patterns in areas, surgeries or even an individuals monitoring?

I can see software being incredibly helpful, I can also see it being
thoroughly expensive and intensive if the NHS has to go through a multi-
million-pound multi-year tending process that is almost immediately
invalidated by factors such as it'll need customising so heavily it'll take
years to actually tailor correctly, all medical records will need migrating
making the entire system redundant before it starts, it has to work across all
trusts at once, all patients have to consent etc.

I want to see this help. Software can really benefit everyone, but I fear we
are heading for a horrific car crash of 'enterprise' Health Care IT sucking
money out of wards and doctors away from patients.

Someone convince me otherwise :)

------
grondilu
IMHO that's sad, really. If they focus on things like that, it either means
that they feel they don't have much more to bring in their original activity
(A.I., networks and computer science), or that they have lost interest in
these subjects and want to focus more on "saving lives". Kind of like Bill
Gates and his philanthropic activity post-Microsoft.

Philanthropy is nice and all, but that's not why I'm interested in tech
companies.

~~~
placeybordeaux
Or they see a better ROI.

The entire world's population is aging and death by accident is becoming more
and more rare.

Health care can essentially become an inelastic good, if you can decrease the
entry price you will pick up more and more customers.

If you do it right you can get customers for life and then use your product to
extend their life.

Not to mention the rich people that fund this can rationalize away the
existential problem.

~~~
grondilu
But big pharma companies have existed before Google. I was not interested in
them and I don't want Google/Alphabet turn into one of them. If they focus on
healthcare, they're doing something completely different which is of no
interest to me. As a shareholder of Alphabet, I feel this is some kind of a
treason.

~~~
maxerickson
You are aware of the share structure of Alphabet?

It was designed at the outset (the IPO of Google) to reduce the power of
ordinary shareholders.

[http://www.fool.com/investing/general/2015/10/29/is-a-
vote-a...](http://www.fool.com/investing/general/2015/10/29/is-a-vote-at-
alphabet-inc-worth-15.aspx)

or

[http://blogs.wsj.com/cfo/2015/08/12/googles-multi-class-
stoc...](http://blogs.wsj.com/cfo/2015/08/12/googles-multi-class-stock-
structure-made-alphabet-move-unique/)

~~~
grondilu
I haven't looked at the details as I had not much illusions about it anyway. I
was a shareholder before the split and I did not bother selling after it.
Maybe I should, and as I said that's sad.

~~~
maxerickson
I edited my comment at about the same time you posted this, the closely held
voting class control was also an aspect of the previous structure.

~~~
grondilu
Yeah I was vaguely aware that I had not much voting rights. That's what I
meant by saying that I had not much illusions about it. Google is such a cool
company that I thought I should own some shares anyway. But if it turns into a
healthcare company, I'll get rid of them.

------
melted
Google did bet on healthcare once before. I don't know if you remember, but
they noped out of that after about 2 years, and Microsoft noped out shortly
thereafter IIRC.

Once you nope out of something so suddenly, it becomes difficult to convince
the market that you're serious about it this time.

~~~
nostromo
Google Health was a fairly simple CRUD app.

Trying to cure cancer or Alzheimer's disease is in a different universe
entirely.

~~~
melted
Trying to cure cancer or Alzheimer's requires actual medical research, which
is a money sink at the scale Google is ill prepared to tolerate. So it'll be
some kind of data management one way or another.

~~~
cowsandmilk
Google Ventures is just a VC fund. And they are funding businesses that are
largely agreed to be legit enterprises.

The two examples in the article:

Foundation Medicine: sequences tumor cells to use for directing cancer
treatment. There have been some high profile cases from academic research
centers where this has saved lives. Roche purchased over 50% of the company
last year.

Editas: Everyone in biology has heard of CRISPR. The company was founded by
Zhang and Doudna, although it is now primarily a Broad company (meaning
Zhang). It is led by Bosley who previously led Avila to being acquired by
Celgene.

The notion that these investments are not doing "actual medical research" is
ridiculous.

~~~
melted
Since when "Google Ventures makes a minority investment" means "Google makes a
bet"?

------
sirkneeland
_When describing his vision for GV and the health-care areas he wants to
invest in, Maris lists genomics, cancer, central nervous system disorders and
aging_

At the risk of sounding wildly selfish, I hope "central nervous system
disorders" includes tinnitus. It's hell.

~~~
abawany
I suffer from this too and tried the very gimmicky but free/easy trick
described at
[https://np.reddit.com/r/WTF/comments/3l3uri/these_guys_light...](https://np.reddit.com/r/WTF/comments/3l3uri/these_guys_lighting_a_mortar_shell_in_their_garage/cv3474n)
. It gives me relief for a few minutes. When one has spent as long as one can
remember with this noise, even perfect silence for a few minutes is rather
heavenly.

~~~
danieltillett
I don’t have tinnitus, but I love to learn of hacks like this.

------
mhkool
The article has too many words like "bets" and "investments". There is no
strategy, other than do something not regulated by the FDA. This is definitely
too weak.

A free and great advice: look at Dr Mark Hyman and Dr Dale Bredesen. Study
what they do, how they do it and draw your conclusions. I guarantee you, you
will be amazed about your own conclusions!

------
mtgx
I'm looking forward to seeing Google put its DeepMind AI and quantum computer
to work on health problems and various cures in the next 5-15 years.

