Friday, January 25, 2019

Hacking humans, upgrading Homo sapiens: the role of the Huntington’s disease community and the consequences for life

An influential book by best-selling historian Yuval Noah Harari, Homo Deus: A Brief History of Tomorrow, looks broadly at potential medical advances, thus providing hope for the Huntington’s disease community’s quest for a cure, but it also warns of the vast consequences for human life caused by the advance of biotechnology and the accumulation and control of data.

A professor in the History Department at the Hebrew University of Jerusalem and holder of a Ph.D. from the University of Oxford, England, Dr. Harari published the international blockbuster Sapiens: A Brief History of HumankindSapiens was first published in Hebrew in 2011 and was translated into nearly 50 languages, selling over 10 million copies by 2018.

In Sapiens, Dr. Harari uses macro-history (also known as “big history”) and biological evolution to explain the development of human society over the past several hundred thousand years. He focuses in particular on the “cognitive revolution” that began 70,000 years ago. During this period, the modern human species, Homo sapiens, came to dominate Earth.

“Homo sapiens” is Latin for “wise man.” “Deus” means “god.” In Homo Deus, first published in English in 2016, Dr. Harari projects current trends deep into the 21st century and speculates that humanity could double average life expectancy to 150 years. He also considers the profound changes longer lives would bring such as people in positions of authority stretching out their careers and thus cutting off opportunities for younger individuals.

Ultimately, in this century humanity may seek immortality by developing new biomedical tools and implants, fusing our bodies with high-tech machines, and perhaps also creating non-organic beings.

“You may debate whether it is good or bad,” Dr. Harari writes, “but it seems that […] the twenty-first century will […] involve re-engineering Homo sapiens so that it can enjoy everlasting pleasure. In seeking bliss and immortality humans are in fact trying to upgrade themselves into gods. Not because these are divine qualities, but because in order to overcome old age and misery humans will first have to acquire godlike control of their own biological substratum [bedrock].”

A new scientific dogma: we are algorithms

The idea of ending disease and extending life, even if by only a few years, stirred the depths of my being. The fear of death propels our psyches and civilization. In the Huntington’s community, where the disease’s devastating and fatal symptoms cut off down lives early, the fear of death is ever-present and more acute. I recalled my mother’s death from HD in 2006 at 68 and my condition as an HD gene carrier. At 59, each day without symptoms is a blessing.

Homo Deus also reminded me of my 2010 article “God, Huntington’s disease and the meaning of life,” in which I examined the Catholic Church’s little-known and little-understand acceptance of evolutionary theory and the notion that the Resurrection of Christ could be seen as a genetic mutation.

However, in Homo Deus Dr. Harari also warns that current trends in biotechnology and the gathering and control of data could also lead to the creation of a super-human elite taking control of the rest of humanity, threatening privacy, democracy, and human and civil rights.

“If indeed we succeed in hacking and engineering life, this will be not just the greatest revolution in the history of humanity,” Dr. Harari told the audience at the 2018 World Economic Forum Annual Meeting in Davos, Switzerland. “This will be the greatest revolution in biology since the very beginning of life 4 billion years ago.[…]

“Science is replacing evolution by natural selection with evolution by intelligent design. Not the intelligent design of some god above the clouds, but our intelligent design, and the intelligent design of our clouds, the IBM cloud, the Microsoft cloud. These are the new driving forces of evolution.”

Yuval Noah Harari in 2017 (photo from Wikimedia Commons)

In Homo Deus, Dr. Harari explains that “science is converging on an all-encompassing dogma, which says that organisms are algorithms” – a method or list of instructions for making calculations – “and life is data processing.”

“Humans are algorithms that produce […] copies of themselves,” he adds. The influence of computer algorithms designed by organizations such as Google has grown vastly, taking in fantastic sums of personal data for users of the Internet and personal devices. “Non-conscious but highly intelligent algorithms may soon know us better than we know ourselves.”

In their digital lives, over 2 billion Facebook members have encountered that organization’s problematic algorithm, which a company study found to be a better reader of people’s personalities than even their friends, parents, and spouses, Dr. Harari points out.

Crucial data from HD families

Homo Deus doesn’t mention HD. However, it recognizes the importance of Alzheimer’s disease and the need to prevent it and disease in general. Dr. Harari explains that upgrading humanity would include attempts to expand the abilities of the brain – which, of course, is an organ severely debilitated by HD.

The history of the search for HD treatments is key to the biotechnological revolution. HD-affected individuals and their families have both witnessed and participated in that revolution, starting with the hunt for the huntingtin gene in the 1970s, 1980s, and 1990s, and since then with a growing number of research studies and clinical trials involving thousands of individuals.

At the start of this decade, CHDI Foundation, Inc., the nonprofit virtual biotech focused on defeating HD, pioneered the use of systems biology, which includes the deciphering of vast amounts of biological data, in disease treatment (click here to read more).

CHDI has also collaborated with IBM to seek deeper understanding of the huntingtin protein’s role in the disease. In this effort, IBM has provided its immense computational power and the tools of big data analytics.

Enroll-HD, the CHDI-sponsored worldwide database of HD-affected individuals and family members, has more than 17,000 participants. Thousands of HD-affected individuals and gene carriers have also participated in the research involving the search for so-called modifier genes that affect the age of onset. The scientists have analyzed millions of small variations in these people’s genes.

Digital monitoring and algorithms

An increasing number of researchers and companies are in effect trying to hack HD’s genetic causes. The most prominent is the gene-silencing drug developed by Ionis Pharmaceuticals, Inc., in collaboration with CHDI and other researchers. On December 19, pharma giant Roche, now the drug’s license-holder, announced the first 26 planned sites for the crucial global Phase 3 trial to test the drug’s efficacy.

In that trial, participants will receive the drug via lumbar puncture (spinal tap), the first time this delivery method is being used extensively in an attempt to treat a neurological disorder.

For the study, Roche has designed an HD Digital Monitoring Platform, which will continually measure participants’ biometric data using smartphones and watches.

“The software is what’s special, and the analytics engine behind it,” Erik Lundgren, the Roche lifecycle leader of the HD team, said in an interview last March. “A tremendous amount of data comes in. The algorithms and how you make sense of that is what our team has been working hard on developing.”

A graphic illustrating the Roche HD Digital Monitoring Platform (source: Roche)

Privacy versus healthcare systems

As Dr. Harari warns, the purpose and uses of technologies and information-gathering techniques originally developed for something positive such as curing a disease could result in unintended, perhaps negative, consequences.

Companies such as Google “want to go much deeper than wearables,” he explains.

“If we give Google and its competitors free access to our biometric devices, to our DNA scans and to our medical records, we will get an all-knowing medical health service that will not only fight epidemics, but will also shield us from cancer, heart attacks and Alzheimer’s,” he writes.

However, he observes, “imagine a system that, in the words of the famous Police song, watches every breath you take, every more you make and every bond you break; a system that monitors your bank account and your heartbeat, your sugar levels and your sexual escapades. It will definitely know you much better than you know yourself.”

Google and these other algorithm-based systems could make decisions for us, from selecting which movie to watch to choosing a spouse to settling on a candidate in the voting booth.

In a world in where the stress on data takes on a religious fervor, the demand for the free and massive flow of information could trump freedom of expression and, by extension, people’s right to control their own information, Dr. Harari asserts. He cites pressure from “Dataist missionaries” for free access to all information, including copyrighted materials.

The danger is that “we will just have to give up the idea that humans are individuals, and that each human has a free will determining what’s good, what’s beautiful and what is the meaning of life.” 

“The big battle over what we today call ‘privacy’ will be between privacy and health,” Dr. Harari asserted at the World Economic Forum. “Do you give access to what is happening inside your body and brain in exchange for far better health care? And my guess is that health will win, hands down.[…] Maybe in many places [people] won’t have a choice. They won’t get insurance if they are unwilling to give access to what is happening inside their body.”

What kind of world are we creating?

Because of the many critical issues it touches on regarding humanity’s future, Homo Deus is a must-read book.

For the HD community, it provides valuable context for the difficult medical, social, and ethical challenges involved in the disease and the quest for treatments.

As many in science strive, in Dr. Harari’s words, to “defeat death and grant humans eternal youth,” the complexities of HD and the close collaboration between HD scientists and families may serve as a reminder that the biotechnological and medical sectors should consult disease communities and the rest of society.

Yes, despite having back problems, to avoid HD onset I would take a drug via recurring spinal taps. I would also wear a data monitor, as do people with type 1 diabetes, for example.  

However, I’m also concerned about the dystopian scenarios outlined by Dr. Harari for this century.

What kind of world are we creating for our children and grandchildren?

Monday, January 07, 2019

A friend of the Huntington’s community receives award for HD article in influential Brazilian magazine

Brazilian journalist Mônica Manir, holder of a doctorate in bioethics and a long-time friend of the Huntington’s disease community, received the Prêmio Synapsis (Synapsis Prize) for her in-depth December 2017 article on the disorder in the prestigious Brazilian magazine Piauí.

Titled “Dançando no escuro” (“Dancing in the Dark”), the article provides a detailed portrait of HD, focusing on families in Brazil and other countries affected by the condition, which causes involuntary movements, cognitive decline, and psychiatric problems. Piauí is on the level of The New Yorker magazine.

The Prêmio Synapsis is sponsored by the Brazilian Federation of Hospitals and awarded annually for the best journalistic reports on health issues in the categories of print publications, TV, online, and radio.

For her article, Manir did almost five months of reporting, traveling to the interior to visit a town with a large nucleus of affected families and also to the Vatican in May 2017 to witness Pope Francis’ special audience with the global HD community.

Upon receiving the Prêmio Synapsis in Brasília on November 27, Manir recalled the pope’s declaration that HD should be “hidden no more!”

Mônica Manir receiving the Prêmio Synapsis (photo by Federação Brasileira de Hospitais)

Manir received her degree in journalism at the Universidade de São Paulo (USP), one of Brazil’s leading universities, in 1990. She worked as both a reporter and editor for the Sunday news and cultural section of the newspaper O Estado de S. Paulo.

In 2013, she reported for the paper on the sixth World Congress on Huntington’s Disease, held in Rio de Janeiro. She also set up a talk by me on HD and bioethics in São Paulo at the Centro Universitário São Camilo’s graduate program in bioethics, where she received both her Master’s and Ph.D.

She is also doing a post-doctoral study at the USP’s Instituto Oscar Freire on the dilemmas of predictive testing for people at risk for HD.

On December 5, Manir granted the following interview via e-mail.

GV: What led you to study journalism?

MM: I was always a very curious person. I wanted to understand the “why” of everything. I always pestered my parents with questions. I also loved reading. When I was 14, my sister started studying literature at the Universidade Estadual de Campinas [in São Paulo state] and became a member of the Círculo do Livro [a bi-weekly book club]. I couldn’t wait to “inherit” from her all of those books that arrived at our house. I also loved writing and was praised for my school reports. In middle school, I discovered that the history taught in the schools had a political bias. I felt the wool had been pulled over our eyes with all of the language that permeated the school texts and that often hid the facts. I decided that, by becoming a journalist, I could try to get as close as I could to the truth to help people become more critical and aware. I wanted to be where things were happening and consider all the angles. To do that, I needed to do deeper reporting. That’s why I always preferred working for media that allowed me to do in-depth reporting.

GV: What inspired you to write an article for Piauí about Huntington’s?

MM: Although I already knew about the disease because of the article I did for O Estado de S. Paulo in 2013, I was inspired to do the piece for Piauí by the audience with the pope at the Vatican. I thought it was a theme appropriate for returning to the subject, now in a more profound way, because I would come into contact with the affected, the families, and the health professionals from different parts of the world.

GV: What did it mean for you to receive the Prêmio Synapsis for your article “Dancing in the Dark”? Why is the prize called “Synapsis”?

MM: It meant for me a big investment in an in-depth article. Just to report it took almost five months, including my trip to the Vatican and to Ervália, a small town with a large enclave of people with the disease in the state of Minas Gerais, and also the reading of articles and books, and long interviews with the affected, family members, specialists, artists. Then came the writing up of all that enormous amount of information, the organization of the text, and the fact-checking, and then the final version, which took up seven pages in the magazine. According to the sponsors, the name of the prize is intended to recognize the brilliant ideas regarding the improvement of Brazil’s health system. The term “synapsis” has to do with “link,” “connection.”

GV: What did you say as you accepted the prize?

MM: I thanked the sponsors for their initiative in stimulating discussion about the Brazilian health system, which is essential in a country with such social inequality in all areas. I also thanked Piauí magazine for having invested in a theme still little known, and for having sent me to the Vatican and Ervália to cover different angles of the subject. But I especially thanked the HD-affected, their relatives, and the health professionals, all of whom deal with prejudice, the difficulties of being diagnosed, and the hitches that have occurred in the search for treatments, all of this unfortunately also very common in other rare diseases. Lastly, I remembered the theme of the audience with Pope Francis: “Hidden no more!”

GV: After the ceremony at which you received your trophy, many people greeted you and said that they had not heard of HD but would now take an interest in it. What explains this reaction?

MM: I think the fact that a prestigious magazine like Piauí took interest in the subject is already a reason for reading the article. Another point is that this disease can be present in a family or friends without anybody knowing about it. Or, even if people know about it, they might lack detailed information. So, there’s curiosity about learning more about HD. One couple present at the ceremony said that they knew about the disease because a relative had symptoms. They called it “Huntington’s chorea,” as it is still sometimes known in Brazil, and praised the fact that the magazine had addressed the subject.

GV: It’s been a year since the publication of “Dancing in the Darkness.” Beyond your prize, what has been the article’s impact in Brazil?

MM: When it was published, it drew praise from various quarters, from apartment doormen to Brazilian celebrities, besides the subjects themselves.

GV: What was it like to cover the affected families in Rome in May 2017?

MM: It was a very rich experience! I understood much better the anguish of the families, the factors that accentuated or eased that anguish, and the determination to diminish the silence on the matter. Everybody was very kind to me, answering patiently my endless questions!

GV: What led you to study bioethics?

MM: I think bioethics combines perfectly with journalism in the sense that the guiding concept is “it depends.” Central questions of human existence can’t be viewed just from one angle. It’s necessary to turn the prism and observe the effects that has on the light. It’s necessary to understand the context of a matter, people’s wishes, the internal and external pressures, and, from that point, try to register things with sensitivity. Bioethics showed – and continues to show – me the profound dilemmas of life and death that are still far from being answered with a single response. 

GV: What has most impacted you regarding Huntington’s?

MM: Huntington’s is a hereditary disease that leaves families on hold. Questions hang over them: “Do I carry the gene? Does my child? And my mother? And my nephew?” Despite the existence of a predictive test, very few undergo testing to learn their status before the actual onset of symptoms – which is completely understandable, because there is still no cure. At the same time, there are cutting-edge research projects that could block the genetic trigger and, as a result, help to treat and/or cure this and other diseases.

GV: What message would you like to transmit to the Huntington’s community in Brazil? And beyond?

MM: I would like to say that I understand very well all of the suffering encompassing the disease and how, sometimes, people feel like hiding it in the closet. But I think the prize confirms the main point of the papal audience: we must speak about Huntington’s. Shedding light on things hurts. However, it helps to make people aware of alternatives and of the partners to be found on this journey. The disease does not affect my family, but my empathy – and that of so many other individuals – is not a question of blood, but of soul. I’m with you!