Day Three: Genes, Movement, and “Never Alone”
In the April and May issues of Nonahood News, we provided you with summaries of Days One and Two of the Lake Nona Impact Forum held Feb. 26-28. Each year, the Impact Forum brings together, right here in our humble neighborhood, the nation’s leaders in the fields of health and wellness. The forum is a highly exclusive, invitation-only assembly of the best and brightest brains – and celebrity advocates – engaged in bettering our nation’s wellbeing. Nonahood News secured a front-row seat at the forum, where we took copious notes to unlock for you the wisdom dispensed during the conference’s fast-moving discussions. For this account of the forum’s Day Three, we present to you the major ideas we heard in the order the discussions took place.
On Day Three, our venue shifted yet again as we settled into the cozy auditorium of UCF College of Medicine to hear welcoming remarks by Dean Deborah German, who described how, from 2006, a state-of-the-art Medical City had emerged from the cow pastures of Lake Nona, still so beloved by local residents. Dean German introduced the CEO of the next addition to the Medical City, Wendy Brandon, who will manage the Lake Nona Medical Center, the teaching hospital connected to the College of Medicine, slated to open later this year.
At the morning’s first panel, Jonathan Perlin, chief medical officer of HCA Healthcare, sat down with former Senate Majority Leader William Frist to review the evolving healthcare environment in the United States. This was the morning of Feb. 28, and the coronavirus had just begun to loom large in the news.
“Over the last 48 hours, the world has changed,” stated the sober Frist, but little did he or any of us know just how much change the next few weeks would bring. “Viruses don’t have visas; pandemics don’t need passports,” continued Frist, while underscoring the critical importance for presidential leadership during crises such as a global pandemic. In Frist’s view, coronavirus could well influence the election this November as voters seek a president who both appreciates science and can bring the country together. Fearing an imminent wave of burnout among U.S. doctors, Frist, a medical doctor himself, warned that we need to “change the culture of health” in this country.
“Everyone knows a cancer survivor, but no one knows an Alzheimer’s survivor,” declared president of the Buck Institute for Research on Aging, Dale Bredesen, opening a discussion on the still hypothetical “first survivors” of that disease. Estimates are that 45 million Americans will eventually die of Alzheimer’s, the origin of which, according to Bredesen, is at least partly bacterial. Bredesen likens Alzheimer’s to a “roof with 36 holes.” Monotherapeutic treatments that rely on a single drug to plug just one of those holes are apt to prove ineffective. Instead, successful treatments will require an integrative, holistic approach, and the drugs used to attack the disease will necessarily be highly complex. But ultimately, argues Bredesen in his bestselling book, The End of Alzheimer’s, the disease, like leprosy and polio, “will become a scourge of the past.”
Two panels ensued on the nascent field of gene therapy. In the first of these, Fortune editor-in-chief Clifton Leaf reappeared to probe the work of University of Pennsylvania professor Carl June, who has successfully employed genetically-engineered cells that are reintroduced into patients’ bloodstreams to cure certain types of cancer. Professor June’s bearing and discourse conveyed an extraordinary level of medical knowledge and experience, the profile of a doctor who brooks no nonsense.
In the past century, treatments of cancers have evolved from surgery to radiation and then, from the 1950s, to chemotherapy. Conscious of the limitations of the one-size-fits-all chemotherapy treatments, June and his colleagues at Penn decades ago began to research genetic therapies. Success in this approach came only in 2010 when a middle-aged male patient of June’s who had exhausted all other available treatments was infused with chimeric antigen receptor cells, or Car T cells. (June explains that, in ancient Greece, a chimera was a mythical fire-breathing creature made up of two or more otherwise incompatible beasts, such as a lion or goat for a head and body to which was appended a snake for a tail.) Car T cells are composed of T Cells – the cells that fight infections in our bodies – that are drawn from the patient and then genetically modified in combination with the patient’s B Cells for reinjection back into the patient. In this first case, June expected some improvement in his patient. But he was amazed to observe the Car T cells multiply exponentially to rampage and kill the cancer cells en masse. Pounds of tumor in the patient’s body suddenly and unexpectedly disappeared. Following similar successes in other patients, the FDA approved Car T cell therapies in 2017.
But the cancer war is not over, warns June, who also worries that more Car T cell trials are now taking place in China than in the United States. In the absence of investment in genetic therapies, June believes that we could lose our edge in the field to our large Asian rival.
Continuing the discussion on genetic therapies with June were University of Florida professor Barry Byrne and FDA Deputy Commissioner Amy Abernethy in a panel on the field’s “next promising frontier,” moderated by Amicus CEO John Crowley. The conversation soon centered on the FDA’s difficulties in keeping up with the science of genetic therapies. The FDA, which sees scaling up the manufacture of individualized treatments as a major bottleneck, is learning about genetic therapies along with the scientists working in the field and requires considerable time to conduct long-term studies on the effects of the therapies.
John Crowley relayed stories of patients at the University of Florida suffering from Pompe disease, a rare inherited disorder in children that causes progressive muscle damage. At that institution, clinical trials of genetic therapies using selected viruses to treat the disease have shown to be both effective and safe. In the coming years, as the study of individual genomes progresses, diagnoses of rare diseases should become more targeted and specific, and soon there could be hundreds of types of genetic therapies, ideally much less costly than those available today.
What already invented devices to improve our overall health and wellbeing might soon become commonplace in our daily lives? Television personality Nicole Sawyer of Bloomberg News led a fascinating panel to address this question and discovered some surprising innovations that might have otherwise been overlooked. The CEO of View, Inc., Rao Mulpuri, described the astonishing features of the windows his company manufactures. We mortals generally think of windows in homes as useful devices that do nothing more than bring in light and let us look outside. Who would have thought that windows could be smart? View’s windows, which are connectable to Wi-Fi, are genuinely intelligent. The tinted double panes automatically adjust the light they filter from outdoors to create the optimum environment for human eyes. Studies have shown that smart windows such as View’s reduce eyestrain, produce better sleep, and improve cognitive function.
What View has done for the common window, the Lighting Sciences Group has brought to the common light bulb. At the WHIT House (for Wellness + Home + Innovation + Technology) on Tavistock Lakes Boulevard, the Group has installed several highly innovative smart lighting products. As examples, the Group co-founder, Fred Maxik, cited the capacity of certain lights to sterilize countertops and even indoor air (a useful feature during a pandemic), while others increase blood flow. Still others synchronize with the daily cycles of circadian rhythms, providing proper lighting for the precise time of day. Continuing the discussion, Paul Jacobs of XCOM Labs described a not-too-distant future where people will be able to inhabit two worlds simultaneously, our physical world and a virtual cyber world. “The technology is not quite there yet,” said Jacobs, but it is developing rapidly. The virtual worlds we occupy will be of cinematic quality with avatars who are doubles of your physical self, so genuine that you might not be able to distinguish the virtual from the real. And of course, as we have learned in the abuse of facts on social media, serious dangers lay ahead if some powerful institution manages to manipulate the content and (apparent) reality of these virtual worlds. Technological fixes may be developed to minimize this risk, but the risk is real. With the advent of 5G technology, which will power these innovations and for which Lake Nona will serve as a testbed, these innovations – together with their challenges – will soon arrive at our neighborhood doorsteps.
Mid-morning had arrived. The salubrious effects of my early morning coffee had dissipated, worn away by the crushing waves of technical information my brain struggled to absorb. But one more panel stood between me and a break. This session was entitled “Pediatric Moneyball: Why Children’s Health Impacts America’s Economic Future.” To launch the session, moderator Lawrence Moss of the Nemours Children’s Health System painted a pessimistic picture of America’s healthcare. As a nation, we spend over $3.6 trillion on healthcare in this country, but the outcomes we receive are pathetic: Of the world’s 34 developed countries, the United States is among the bottom five in infant mortality and life expectancy. Why can’t the richest country in the world provide better healthcare for its citizens?
The president of Vassar College, Elizabeth Bradley, believes that an aspiration to ensure better health has never been coded into our national culture. Americans value security, of course, but security in the form of protection from foreign enemies and local criminals, not from threats to our health (though the current pandemic may change these views). AMA president Patrice Harris underlined the influence of “adverse childhood experiences” on the overall health of our nation’s youth. The market president of AmeriHealth Caritas, Karen Dale, delved further into the healthcare challenges experienced by the less fortunate residents of cities such as Washington, D.C. Her insurance company works to remedy these challenges by offering to its members – mainly Medicare, Medicaid, and CHIP (Children’s Health Insurance Program) patients – managed care, pharmacy benefit management, and behavioral health services. The health of a newborn actually begins before the mother becomes pregnant, insists Dale. Any pre-existing health issues impact the pregnancy and health of the child. In addition to good nutrition, children need a safe, stable, and healthy environment to grow up in.
“Even if you have a roof over your head, it may not be safe or healthy,” says Dale, so AmeriHealth partners with housing providers to offer decent living arrangements for their members. “Engaging people in their personal healthcare is never easy, especially where health education is low,” Dale stresses, but although Americans are often wary of action by the federal government, private/public cooperation to improve pediatric health, for example in data sharing, is starting to take hold at the local level.
For our morning “movement break,” the Urban Yogis returned to the stage to lead the audience in a few tricky exercises aimed at increasing our blood flow and restoring our desperately depleted cognitive function. At that moment, I did not guess that we were also training for a tennis-ball-catching competition an hour or so hence.
Next on the agenda was a serious talk about suicide. Two celebrity actresses, Mariel Hemingway and Gabriella Wright, took the stage with Deepak Chopra and moderator Poonacha Machaiah, CEO of the Never Alone Foundation, to discuss the subject. Loneliness is one of the major social issues of our times as, every 12 minutes, a suicide takes the life of another American. Hemingway has been haunted by the seven suicides in her family, including those of her famed grandfather Ernest and her supermodel sister Margaux. In her 20s, Hemingway came to realize that her “life was a gift” and that she was the “orchestrator of her life.” This epiphany had led her to devote much of her adult life to the cause of safeguarding both physical and mental health.
I suppose I should have heard of cinema icon Gabriella Wright who, like Mariel Hemingway, had lost a sister, French singer Paulette Wright, to suicide just 16 months earlier. Wright is that rarest of phenomena, a perfectly bicultural film star equally at ease in French and English. Listening to her, even as she talks on a simple stage at a conference about health, is an intoxicating experience. In speech that ascends close to poetry, Wright shares her passion for combatting the mental anguish amongst the young that leads to tragic loss of lives. Following her sister’s death, Wright reflected, “Not only could I not save the world, I couldn’t even save a member of my own family.” In her grief, Gabriella decided to act. With the support of Deepak Chopra and Poonacha Machaiah, she founded the Never Alone Foundation to promote “mental hygiene,” particularly among the young.
For Never Alone co-founder Deepak Chopra, what is missing in our national culture is the concept of “cultivating joy,” which he views as a common-sense solution for improving mental health and hygiene. The seeds of happiness, says Chopra, are positioned at a set point in the brain, and that set point is determined during the first five years of one’s life. “The fastest way to be happy,” Chopra advises, “is to make someone else happy.”
The final three panels of the forum pivoted to discussions about movement, from personal exercise to sports at the championship level. In the first of these on “Why Movement Matters,” sports medicine activist Vonda Wright declared, “We are not destined to go from vibrancy and vitality to decrepit and aging. We were designed to move.”
This theme of the importance of exercise as we age was picked up in the next panel featuring the oldest Olympic medalist in cycling, Dotsie Bausch, who won her award at the age of 39 at the 2012 games in London. Three years before competing in those Olympics, Bausch abandoned meat and switched to a purely plant-based diet. She had thought that eating only plants might reduce her strength and endurance but found instead that not only both improved, but that the inflammation throughout her body that had long afflicted her was reduced to zero. “I thought that I would lose my identity on a vegan diet,” mused Bausch, but she discovered instead a strong connection between a healthy diet and good mental health. And who could imagine a better testimony for a plant-based diet than her remarkable performance at the London Olympics?
We ended the morning and the entire forum with the appearance of a gifted champion in sports, the legendary tennis star Chris Evert, whom USTA chief executive Stacey Allaster welcomed to the stage. Evert frankly admitted that she was never the strongest or the fastest in tennis, but she outdid her competitors in one crucial capacity: mental toughness. “Every point matters,” says Evert, “and if your back is against the wall, you have to figure out how to win. Mental can win over physical.” In her career, Evert carefully studied her rivals and applied an exceptional level of discipline in her training and preparation. “You have to take risks,” advises Evert as she discovered that coming up to the net for a winning shot was essential in battling her archrival Martina Navratilova. Throughout her career, Evert managed to combine femininity with championship sports and now builds on her celebrity through her annual Pro-Celebrity Tennis Classic events that have raised tens of millions of dollars to combat drug abuse.
Our energetic Impact Forum host, Gloria Caulfield, rose to the dais one last time to orchestrate a surprising topoff to our proceedings. From the Urban Yogis, we had already learned that “movement matters.” So Caulfield, together with Chris Evert and Stacey Allaster, took out tennis racquets and hit a pile of bright yellow balls around the auditorium. Two of those balls came my way, and I caught both. My superstitious self regarded this minor achievement as a positive omen for participating in future iterations of the Lake Nona Impact Forum – so that I might open up the annual proceedings even just a crack for local residents. (But at a future Impact Forum, could I ask to have my virtual avatar at my side, catching virtual tennis balls, taking virtual notes, and writing a virtual Nonahood News column indistinguishable from the genuine article?)
Over the past three days, I had been drenched in a flood of facts about the state of America’s healthcare and wellness. Despite the palpable brokenness of our healthcare infrastructure, I learned that there is an army of brilliant women and men in this country who continue tirelessly to achieve astounding accomplishments in health and medicine for the benefit of us all. Striding home, I felt a deep sense of pride that these leaders in health and wellness had chosen our modest neighborhood, Lake Nona Medical City, to gather for this annual event of such national importance.
Photos Courtesy of the 2020 Lake Nona Impact Forum