“100K” Marathon: A Decades-Long Health Study Makes Its Business Case

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into his system. He does that over the course of about a year and a half, and his symptoms go away. He’s been disease free for about five years.

Now, you can’t prove it, it’s the “n of 1” notion. But he took an intervention based on a mechanism, and his outcome got better. That’s why we want to do this large study, to see if it’s true in general. Is it really beneficial to take that much calcium? What are the ancillary effects, what’s happening in other systems? What’s the downside?

It’s allowing a person to monitor their own body and make better decisions about lifestyle and how it relates to disease. So there’s Alzheimer’s, there’s the osteoporosis case, diabetes is the other major obvious case. Control of your sugar can stave off moving from a pre-diabetic state into diabetes.

There are major drivers of health for which we think there is at least beginning evidence, and perhaps even established evidence like in diabetes, where you can make certain lifestyle choices to change the disease outcome substantially, and you can measure early-stage kind of things.

X: So as you open up these “n of 1” personal interventions, and you track them, are you worried about encouraging companies that aren’t regulated and that go right up to the line of making medical claims? Do you have an obligation as originators of this data to monitor whether people are using it wisely, or others are taking advantage of them?

NP: We see this study as very much in opposition to the snake oil salesman, or the person trying to just figure out from anecdotes. Let’s say someone is doing an alternative treatment for which there’s not much evidence. Someone might say I tried this probiotic that’s going to radically change what’s happening in my gut. Maybe they get their microbiome done and see that nothing changed. People are making these lifestyle choices about themselves now on very little data. We hope by adding this scientific information, each individual can observe what’s happening inside his or her own body.

I do think we have a responsibility, and I also want to emphasize that we’re not looking to provide medical information here. We plan to work with the medical system. If something pops up that looks like an early marker for cancer, it’s not going to be a suggested lifestyle choice. It’ll get referred right back into the healthcare system.

X: You’re using wellness coaches?

NP: In the pilot study we have a coach that works with the pioneers all individually. As we go to 100,000 it’ll be hard to have a personal coach for everybody. So we’ll be looking more at scalable models: lots of Web videos and information, maybe there’s a coach you call for special questions. Perhaps one coach for every 1,000 people. It’ll come down to cost structure.

X: What’s the relationship between coach and participant?

NP: They have to be trained in understanding what the data mean. The two coaches we have now are spectacular on that front. There’s a lot of information that gets fed back, so we try to pull out the actionable items, and come up with simple messages for people. It’s someone who’s like a nutritionist, who understands the relationship between the data we’re seeing and the actions we can take. We have to come up with methods that let people understand as easily as possible what their own data is.

X: That gets back to the question about your obligation.

NP: Yes, we want to provide good science to individuals so they have a clear understanding exactly what the evidence is behind any of the associations or identifications that are found. We’ll focus our efforts around those areas that we have the best evidence for, or the most pressing need for the individual.

X: So Seattle will be the Mecca for new wellness coaches?

NP: We want Seattle to be the epicenter of the wellness industry, and we believe it’ll ultimately be bigger than the healthcare industry.

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