Brandon Colby, MD, is a world leader in the field of predictive medicine, a medical specialty that combines comprehensive genetic testing with personalized prevention based upon your genes. Dr. is the author Outsmart Your Genes, a book and accompanying website that provide a guide to the field of predictive medicine. Dr. Colby also serves as the Medical Director of Existence Health, a predictive medicine private practice based in Los Angeles, and he is the founder and CEO of Existence Genetics, a company that provides highly advanced predictive medicine services to the health care industry.
Annuity Digest: Your recently published a book titled Outsmart Your Genes provides a guide to the emerging medical specialty called preventive medicine. You also developed a private practice and technology company focused on this field. Can you briefly tell us how you became so involved in predictive medicine?
Dr. Brandon Colby: My interest in predictive medicine arose initially not because I’m a doctor but instead because I’m a patient myself. I was born with a very rare genetic disease that causes my skin to be extremely temperature sensitive (whenever the temperature of my skin increases to slightly above normal, such as with running when playing almost any sport, my skin blisters and these blisters then have to be laced). Because of this, one of my earliest memories is asking my parents why I was different from other children, with their response being “you’re different because of your genes.” Thereafter, genetics was always very personal to me and I knew from an early age that I’d pursue this field as my life’s work.
Annuity Digest: Is predictive medicine at its inception?
Dr. Brandon Colby: Yes, predictive medicine is at its inception. We stand at the forefront of an entirely new and very powerful field of medicine that now allows us to predict and prevent disease before it ever manifests. This new field finally allows healthcare to be proactive instead of just reactive – we can now focus on the personalized prevention of disease as opposed to primarily waiting for disease to occur and then attempting to treat.
Annuity Digest: How long will it take for predictive medicine to become mainstream?
Dr. Brandon Colby: I believe that in five years predictive medicine will be utilized by most fields in the healthcare industry and that within ten years it will become a standard of care. A new technology called full genome sequencing will soon be commercialized (less than $500 per person) and it is projected that by 2015 almost all newborns will have their genomes fully sequenced (and that by 2020 one billion genomes will be sequenced!) Genetics will soon be fully integrated into all of healthcare, including the practice of medicine and all complementary fields as well, such as nutrition and weight loss.
PricewaterhouseCoopers released a report recently that stated Personalized Medicine will be a $452 billion dollar market by 2015. It’s also projected that almost all newborns will have their whole genomes sequenced by 2019 and that by 2010 one billion genomes will have been sequenced. This means that there is going to be an avalanche of genetic data but the true bottleneck is in the analysis and reporting of this information to healthcare providers so that they can efficiently integrate this information into their practice.
This is an area that my company, Existence Genetics, specializes in – comprehensive clinical genetic analysis and inventing new technologies that allow for genetic information to be reported and delivered in a very straightforward, easy-to-understand, and actionable way to physicians. For example, one primary concept that I focus on is that genetic testing must always be about prevention as opposed to just risk assessment because the real value of genetic information comes from being empowered by it to protect your health and preserve your longevity. My goal is to facilitate the rapid adoption of genetic information by all healthcare providers, regardless of their knowledge or experience in the field of genetics, so that healthcare providers everywhere, including your own, will soon be able to offer predictive medicine services to all of their patients.
Annuity Digest: As you have indicated, the current health system is largely defensive—reacting to disease once it has occurred—and the dominant method of financing in the system (insurance) is not only premised on this defensive approach but also breaks down once there is a reasonably accurate picture of the probability of disease occurring for a particular person. Do you think insurance will be a viable method of healthcare financing in a world where Full Genome Sequencing is widely available?
Dr. Brandon Colby: Insurers will eventually have to cover these tests because they will become standard of care. However, as with any new test, insurers will most likely hold off as long as possible because, unfortunately, most just don’t see profit in prevention (since most people switch insurance companies after five to ten years, insurers would rather let another insurance company pay to treat a disease you may get in 20 years then pay for prevention today since in 20 years you most likely won’t be insured by them anymore and therefore they don’t really care about those costs). Because of this defect in the insurance system, most of these tests will continue to be out of pocket expenses for the next few years. Luckily, however, most (but not all) genetic tests are much more affordable than other types of medical tests because a comprehensive assessment of your genes, which gives you useful information about dozens of diseases, is usually around $500.
Annuity Digest: How do customers and patients pay for predictive medicine at the moment—cash, insurance or a combination?
Dr. Brandon Colby: Almost all predictive medicine services are cash-based. Even tests that have been around for 10 years, such as the breast cancer test, are still routinely denied to be reimbursed by many insurance companies and HMOs. As discussed above, insurers still don’t see profit in prevention and therefore are quite resistant to reimbursing for these types of tests.
Annuity Digest: If cash, do you envision predictive medicine becoming integrated into the current mainstream financing system?
Dr. Brandon Colby: Eventually, yes.
Annuity Digest: Do you have any thoughts on the recent health reform legislation—particularly in light of predictive medicine?
Dr. Brandon Colby: It’s great that it tries to refocus the insurance companies towards preventive services, which would include predictive medicine, but it’s still unknown exactly how this will be accomplished or what the true result will be.
Annuity Digest: Longevity risk and retiree health financing are huge concerns in most developed countries—including the United States. As a society, how do we pay for predictive medicine and the subsequent longevity-related costs?
Dr. Brandon Colby: I strongly believe that in the long run, prevention will always be less expensive than treatment. It’s important to realize that increasing the wellness and longevity of individuals also increases their productivity and value to society (healthy people are able to work more and contribute much more to the advancement of society). So while predictive medicine will enable us to live longer, it will also enable those additional years to be filled with health and vitality, thereby making them much more productive, too. This long-term increased productivity and decreased costs of diagnosing and treating chronic disease (which are responsible for the majority of our healthcare costs) will greatly offset the costs of predictive medicine services. Overall, I envision this being a very significant benefit for all of society.
Annuity Digest: Do you think that extreme longevity scenarios such as those envisioned by Singularity adherents are realistic?
Dr. Brandon Colby: Yes, I do. I think it is realistic to envision extreme longevity scenarios. We’re already learning a tremendous amount about longevity on the genetic level, especially that longevity seems to be exquisitely tied to the heart. Because of this, changes in genes that protect the heart (such as those that cause people to naturally have lower levels of bad cholesterol) can significantly increase a person’s chances of living to over 100 while those that put the heart at jeopardy (such as those that increase bad cholesterol levels) are usually associated with an earlier death. Once we perfect gene therapy and genetic engineering technologies, we’ll be able to replicate those protective changes and fix the harmful ones, thereby allowing many more people to live to 100 and beyond, even if they aren’t born with longevity in their genes. Until that time, we’ll be able to prescribe medications, such as statins (Lipitor, Crestor, etc.) that mimic (to a degree) some of these same effects.
Predictive medicine and genetic technology will be but one component that allows for extreme longevity, working in-parallel with advances in other sciences, such as nanotechnology.
Annuity Digest: What are your views on annuities?
Dr. Brandon Colby: As long as a person knows they won’t need the money until maturity then annuities are an excellent investment. To put it another way, for those people who won’t need the money until far in the future, such as for retirement.
Annuity Digest: Do you have any recommended resources for financing longevity risk and related health costs?
Dr. Brandon Colby: We have to move to a model where prevention is rewarded/profitable for insurers.
Annuity Digest: Is predictive medicine just for the young who have time to think about prevention and acting on the information, or can older people benefit as well?
Dr. Brandon Colby: People of all ages can benefit from predictive medicine, from newborns to older adults. For example, a high risk of a genetic abnormality of the heart that is known to cause sudden infant death syndrome (SIDS) may be detected in a newborn and sudden death averted through the simple, low-cost interventions such as prescribing a beta block. For older adults, such as those in their 60’s and 70’s, pharmacogenomics, which is the application of genetics to pharmacology, is able to provide useful information about many medications as to whether they are likely to be most effective in treating an illness, as well as whether the person is likely to experience side effects to specific medications, and even what the most optimal starting dose is of a medication. This is what I refer to as genetically tailored prescribing.
Annuity Digest: How can retirees think about using predictive medicine?
Dr. Brandon Colby: Predictive medicine services can help retirees make sure that the medications they are taking are going to be effective and are least likely to cause them side effects before they even start taking the medication. And for some, we can now even provide dosing information so that the most appropriate starting dose can be prescribed from day one. Retirees can also learn about their risk for certain preventable diseases, such as arthritis, dementia, cancer, and even obesity, and personalized prevention can help them avoid disease and live a healthier, longer life.
Annuity Digest: Does Medicare cover any of the costs associated with predictive medicine?
Dr. Brandon Colby: As of now, no. But hopefully they will soon because studies have shown that genetic tests given prior to prescribing of a medication can not only save lives, but also billions of dollars each year. For example, a senior member of the FDA’s economic staff stated that if it became standard practice to conduct genetic testing before prescribing Coumadin, also known as warfarin (one of the most commonly prescribed medications in the world), the decrease in the number of adverse reactions would result in a net healthcare savings of as much as $1 billion per year in the US alone.
Annuity Digest: Do you have any retiree and/or Medicare patients in your private practice?
Dr. Brandon Colby: Yes, I do have some retiree patients in my practice but all of the services I provide are paid for out-of-pocket.
Annuity Digest: Will predictive medicine add to health care inflation or will it contribute to productivity and decrease costs?
Dr. Brandon Colby: I’m a very strong advocate that it will contribute to increased productivity and decreased costs over the long run. Medicine today is unsustainable and predictive medicine is the cure – it allows for us to focus on that which is sustainable – prevention.
The following is an excerpt from the book which I think is pertinent to this discussion:
Healthcare costs for the entire world are spiraling out of control. In the United States alone, annual healthcare spending is now more than $2.5 trillion and increasing by approximately 7 percent every year. This represents nearly 20 percent of the U.S. gross domestic product (GDP), but healthcare spending in Canada and Europe represents only 10 percent. More than 75 percent of the cost of healthcare is attributable to chronic diseases, with heart disease in the United States accounting for around $450 billion; smoking, $193 billion; diabetes, $174 billion; arthritis, $128 billion; obesity, $117 billion; and cancer, $90 billion. The vast majority of this money goes to disease management once the disease has already manifested.
A revolution is needed because our current healthcare model is unsustainable. Just as we need a paradigm shift from an unsustainable reliance on fossil fuels to renewable forms of energy, so, too, does the next generation of healthcare require a shift from our dependence on reactionary medicine to a more sustainable proactive approach. Predictive medicine provides the answer because it is based not on propagating the traditional one-size-fits-all reactionary model but on personalized prevention. For our healthcare system to survive, we can no longer rely solely on our ability to reactively treat and must now focus on our power to predict and prevent. Not only does our own personal health depend on it but so does the very survival of the entire global healthcare system.
We stand on the precipice of a new species-level event that will radically change healthcare forever. The genetic revolution is now all about one single individual—you.
Annuity Digest: Thank you Dr. Colby.
