Wellbeing, Longevity and Optimizing Healthspan with Mt. Sinai

Speaker 1:
Welcome to TD Cowen Insights, a space that brings leading thinkers together to share insights and ideas shaping the world around us. Join us as we converse with the top minds who are influencing our global sectors.
Oliver Chen:
Welcome to the Retail Visionary Podcast Series, a podcast about visionary ideas and people. My name's Oliver Chen, I'm TD Cowen's new platforms, retail, and luxury analyst, and we're thrilled to co-host this with Dan Brennan. He leads TD Cowen's tools and diagnostics team and coverage. In this episode, we host Zahi Fayad, the co-director of Mount Sinai's healthspan initiative to discuss longevity and the growing consumerization of healthcare.
Zahi Fayad PhD is the Lucy Moses Professor of Medical Imaging and Bioengineering at the Icahn School of Medicine at Mount Sinai. He's also the founding director of the BioMedical Engineering and Imaging Institute. And his work sits at the intersection of advanced imaging, AI, and translational medicine, with a focus on shifting healthcare upstream towards early detection. Zahi, it's a real pleasure to have you here.
Zahi Fayad:
Pleasure to be here. Thank you so much. Great seeing you guys again.
Oliver Chen:
Tell us about your career journey. What brought you to Mount Sinai? And what inspired you to focus on longevity? How'd you arrive at this work?
Zahi Fayad:
Yeah, that's really good, it's actually totally ... My journey have definitely had a path that was very interesting.
So what got me really to Mount Sinai was a person called Valentin Fuster. He used to be the chief of cardiology at Mount Sinai. He's still there, but he is now emeritus. And he is really one of the leading cardiologists in the world. I mean, he's really world-famous.
I came across him where he came to talk to us about some of the new discovery that he has been making. So he went into looking of cadavers, people who died, and trying to figure out what caused their death from cardiovascular disease. So he focused on studying what are what we call today plaque or atherosclerotic plaque or deposits within your artery that leads to heart attack and stroke. But it was not very well understood. How does these plaque form? And are the plaque that are obstructive or the plaque that eventually rupture leads to the problem? So he discovered that you could have an artery that looks fine from a flow point of view, but what kills you is actually these atherosclerotic plaque.
So the reason why I'm telling you this is that this actually triggered in my head this whole aspects related to screening and prevention. And that in a way, initially I was focused and I came to Mount Sinai because he recruited me here 29 years ago and I helped build the cardiovascular imaging program. But my focus from day one has been can I see and predict the disease really early on? And as I evolve into my work and research, this road cross that the whole aspect of health and longevity is what I'm really focused on. But it all came from that initial thinking, how can we see disease before it manifests itself?
Dan Brennan:
Well, that's super interesting, Zahi. This is Dan Brennan, as Oliver introduced me. So maybe just as a follow-up to that, what do you think is most misunderstood today about longevity science?
Zahi Fayad:
Yeah, that's a great question. I mean, I think there's definitely a lot of interest in longevity. We still, this is such a new field. As you said, Dan, a lot of misconception.
But what people think about when they speak about longevity, and maybe because it has to do with the word that we're using, they think about living longer. And that what they think is the goal that we want to have people live beyond the age of 100, 120, so we can break that record. And even some people are talk about longevity, they think that we were trying to have people live forever. There's definitely movement of people who are thinking about that, but that's not our goal right now, at least not in phase one.
What we're trying to do right now is to bring this whole aspect of being healthy, being sharp, being functional through the last decade of your life. There's always a gap, about basically 10 years when you get faced with chronic diseases and then when you eventually die. These last 10 years of your life are actually miserable and terrible, so we want to be able to compress that. And that's what we call that gap, we call healthspan versus lifespan. And we want to compress the gap between the two.
That actually, I think what I'm more excited about, being able ... And if you ask me myself, I want to be vital. I want to continue to age, but remain extremely virile as I get older. That's the goal that we're trying to do. And that really is the misconception, is the aspect of living longer or living forever.
Oliver Chen:
Well, Zahi, building on Dan's question, where are we in this phase? And one of the major themes is becoming proactive rather than reactive. What needs to change for these shifts to happen?
Zahi Fayad:
So Oliver, the good news is that definitely there's attention, and especially the public. The public is being very attentive to this. And everybody talks about wanting to live healthy. And I think right now we have this shift in that we are in the early stages. There are no miracles right now that we have. If somebody comes to you and tells you, "I have this, do X, Y, and Z." I think you should be a little bit skeptical.
Right now, what we are trying to do is, number one, we're trying to bridge the science, the biology to basically the aspect of the clinical translation. There's a big gap between. There's still so many unresolved issues that either because we have not dove too much into it ... Actually today, I didn't read the study, but today there was a study that was published looking at multivitamins. And they were looking at Centrum, the famous supplier, not to promote anything. And this was a two-year study showing that actually multivitamins are actually useful. So I've been skepticals of multivitamins because I've never seen major studies that talks about health with them. We talk about vitamins when we have a deficiency.
So I think we are learning. So we're in the early stage, but what I think, what I'm trying to do, and we are trying to really bring science into it. We have to be able to anchor all our recommendations with studies and with science that helps drive this field.
Dan Brennan:
So maybe just thinking about the drivers here, how much of the move towards proactive health do you think is being driven by consumers versus institutions? And what's accelerating that shift?
Zahi Fayad:
It is very true, Dan, that the consumer in a way is basically pushing this. I mentioned this in the title of the book by Eric Topol. In the past, we used to say, "The doctor will see you now." Now we say, "The patient will see you now." I mean, we know that there is a very much consumer-led change that is happening. That's happening.
In parallel, I also think, Dan, that there are people like myself and researchers in academia and clinician who are also looking and looking at this field in a serious manner. We're discovering new biology that we did not know in the past, that used to be important in terms of health and longevity. So we have these two things coming in.
They're not all coming in at the same speed. There's still many institution, very few institution who are investing into longevity and health, but I think this is a new trend and I'm happy also that the general public is pushing for it. However, we have to be cautious because a lot of these things sometimes led by the consumers or believed by the consumer are not really true. So we have to continue with this research and with this dialogue to educate both sides in terms of where this field will be going and where this field is going to have actionable things to provide to the consumers in a clinical fashion.
Oliver Chen:
Zahi, one of the models that we follow here out of our Glow Ahead Conference, which Dan and I co-hosted, is diagnosis, personalization, then ritual in terms of ritual being the consumer side. But personalization and AI go hand in hand. Tell us a bit about the DigiTwin Project and what's happening there and also your views on how AI will intersect with healthspan.
Zahi Fayad:
Right. So the digital twin, I mean, this word gets used in many, many ways. It doesn't belong to me. It came all about from the 1970 or so, in industry and NASA trying to create a computer version of a system. And we are trying to figure out if we could use the same concept to try to create a computer version of somebody's health, which mean that I can assemble all the data points related to your health. And today, because of the advent of, let's say, screening methodology, blood markers, continuous glucose monitoring, continuous measurement, physiological measurements with wearables, we are now becoming extremely data rich. Rather than being episodic, health in general is consumed in an episodic fashion, but now we're trying to see, can we now create this continuous monitoring of health and finally create, with AI, these AI agent, these EI models where we can now not only give you the recommendation about your health for the week, for the months, but also make predictions in terms of how would you look like in 10 years? How would you look like in 20 years? So you could do better planning.
This is something you guys are very familiar with when you do financial planning. You look at the whole portfolio, you look at the whole person. So we want to bring this same exact analytics methodology, we want to bring them into the aspect of the health. And the digital twin is such a project.
I have a project where we call the Mount Sinai Digital Twin, where we bring people to our facility. We do four-hour testing, in depth testing on them within the clinical physical plant, and then we equip them with sensors and wearables and instrument they could use remotely. And we connect that throughout the year, we have now an observation of what's happening to their health and what is being changed in terms of their environment and how they are reacting to it.
Dan Brennan:
So concierge medicine has become kind of more ubiquitous today, I think, than it's never been. And as a 55-year-old, I'm certainly focused on concierge medicine. But talk to me about concierge science. What does concierge science mean in practice? And how is it meaningfully different than traditional concierge medicine?
Zahi Fayad:
I think the concierge science is something that's structurally different than what we in the past called concierge medicine or functional medicine. I mean, it's really now bringing in the rigor of academic research and everything that we're learning from the biology, everything that we're learning using platform technologies for screening tools that I mentioned like we are deploying in the digital twin. And then using this in a personalized way and saying, "Okay, the question isn't, are you sick?" That's chronic disease management. The question is, what can we use from your profile of your biology? How can we now optimize your health? And how can we either optimize it for a short period of time, or how can we have a long plan that is being followed?
At the same time, again, I want to emphasize that these are not, again, episodic events. We want to be able to have this concierge science to be something where you are fully connected with your healthcare providers, the person who are taking care of you, equipped with data, and able to intervene as early as possible when they see changes to your health and to your biology profile.
That's very different, what we do sick care today. Sick care today is, okay, we only see you when you are really sick and come to us when you have that chest pain or when you suddenly lose your memory. That's not the way we are trying to do. We want this to be personalized, we want to be proactive and we want to be continuously.
Oliver Chen:
Zahi, there can be too much data sometimes and all these modalities coming out. So what do you think really is required or what are your hypotheses? And what are your more exciting examples of what you're saying now to Dan's question in terms of how this is evolving now?
Zahi Fayad:
So that's something I think a lot about. I mean, we are definitely in an era of learning, which means right now I am erring to the side of acquiring maybe a lot, oversampling, if you want to use the terminology that is scientific or ... I'm taking way maybe too much data because I am not sure which are the real data point that are useful at this stage. Eventually, we as a community in this area, we're going to learn that we are going to probably just take, let's say, million data point and we're going to distill that to a few, maybe ideally we're going to be optimizing over maybe 12 data points.
This is not different than what people do in human performance. If you are an athlete, you are going to be measured a lot initially. We're going to get a profile on you and understand you. And then after that, you're going to optimize to get to that, to get extreme 1% so you can win that gold medal. We're going to optimize few things. There's no way you're going to optimize all the points. That's how athletes train in general, and that's something that I'm trying to see how I can learn from all the data sets that I have. And eventually, my goal is if I want to be able to scale that, try to do this at minimum data point that is needed for optimizing your health.
Dan Brennan:
Oliver touched upon AI earlier, Zahi, but obviously it's everywhere today, right? Everything we do, it's only just beginning. But it's democratizing information, but still measurement means expensive. So when you think about how AI can create the most real leverage in longevity today, where do you see that?
Zahi Fayad:
I mean, I don't think we will be able to have this conversation, and I can talk to you about the digital twin, if AI did not exist. This kind of data that we are collecting and we have in our hand is extremely complex. It has different dimensions.
For example, an MRI has a certain scale, a blood marker has a different scale. We were not able in the past easily to integrate that data and to fuse it together. It's still an unsolved problem, but the tools to be able to do this, especially with multimodal foundational models, now I have the capability to take these different data point and accelerate the development to create these AI predictive models.
And Dan, as you said also, that's also one of our best way to be able to scale. In order for us to bring this to scale at a cheaper way, scale or cheaper product, we will have to use AI in order to do this, due to the massive amount of data that is there. And also we don't want to burden the providers with all that data. They're not able to consume that data, so they need help in order to do this.
Oliver Chen:
Another hot, relevant topic, but also quite profound is biology first. What does that mean to be biology first? And what's happening there with the work you're doing? What should people know about this who maybe never even heard this term?
Zahi Fayad:
Yeah. Yeah. I mean, I think when we think about biology first mean that aging is not a single disease. Aging is everything, which mean that you have cardiovascular disease, you have cognitive disease, you have cancer, et cetera. So you really would like to be able to bring the biology first into it because age is non-linear. It varies dramatically between individuals. It cannot be tracked with a handful of just annual labs.
Again, we are changing the whole way of practicing medicine. Medicine right now, number one, is to care. Number two, it is very much siloed or it is looking at one disease at a time. You'll have a heart problem, you go to the cardiologist. You have neurological problem, you go to the neurologist. You have cancer, you go to the oncologist. But aging is a combination of all of them.
So we are going to hopefully start training physicians to be able to consume this whole data from biology, there's all these data points in order for us to tackle aging. And as I said, we are going to have the practice of medicine and the relationship with the patient. It is not going to be only when you're sick. It is not going to be at this episodic annual visit. It is going to be a continuous relationship, which means that you want to bring to the provider all the tools that will help them facilitate that workflow.
That's what I think is biology first. We are not going to be looking at the aspect of the current ... We're going to violate basically all the reimbursement and the financial logic that we have in the business of medicine right now. So you have to bring the biology first and create that business model around it.
Dan Brennan:
Zahi, you talked about earlier with the digital twin concept, the importance of these kind of wearables and kind of what they could do. So maybe looking ahead, what kind of sensors or even entirely new measurement approaches do you think will define the future of health monitoring?
Zahi Fayad:
Yeah. I mean, I'm wearing right now two of them right there and I use them personally. They help me a lot with everything that I do, from sleep to exercise to kind of stimulating and managing my health and competing with myself, trying to get better and better.
So I think this is generation one. I mean, these are sensors that are focused on physiological aspect, very important. So we can know heart rate, temperature, oxygen saturation, autonomic nervous system, the heart rate variability. All these are great.
I think we are going to see the next generation, which will be more at the molecular level. We started to see this with the continuous glucose monitors. Again, showed us that, hey, you could put in a patch, measure your interstitial glucose and manage your diabetes, but also manage your health such as your nutrition, maybe your exercise and other health metabolic markers.
The next generation is very close. I mean, we are starting to see, I mean, if you look at the literature like we do on a weekly basis, many papers, and we are developing our own sensors at Mount Sinai that are generation two, where now we're looking at molecular markers. So all the different analytes that we have within our body can one by one started to be measured using these sensors. So now we have, in a sense, within your reach, 24 hours, you have labs at home, on you, on your body. I mean, you don't have to go in and draw blood from a device and send it to Quest or to LabCorp. You are going to be able to get these measurement right away, 24 hours, something we've never seen before. I mean, I started to look at sweat measures of inflammation. I've never seen throughout the day how your inflammatory immune system modulates within the day. That's incredible, very rich information.
So more and more, we're going to get into that. It's going to help us obviously not only we got to read a number, but we're going to try to tailor intervention according to these new molecular biological measurement that we have. So I am extremely bullish on sensors. I think the technology is going to continue to evolve. The adoption by the consumer is going to continue and the adoption by the healthcare system is going to continue.
That's an area that's extremely exciting, an area also where you can democratize very quickly and deploy at scale compared to, for example, I mean, I'm in the field of imaging. I started in there, but I do everything now. Imaging, very expensive. I mean, we spend millions of dollars on every MRI scanner. We build, it takes us a lot of money to build it, to put it there, and we ask people to go to it. And that's not what we want. We want this more continuous measurement that we could do as much as possible remotely in an accurate fashion. Yeah. Yeah.
Oliver Chen:
Zahi, you've touched upon this earlier, but what technology are you most excited about? What are your forecast or top views over the next three to five years? What are your predictions for what will rise in importance?
Zahi Fayad:
Yeah. I mean, I definitely is super excited about the sensors. I think because I've drawn my analogy and I see what's the impact of sensor to have made on industry. If you look at a Tesla, you look at an Airbus, thousands of sensors on these engines or on the plane, on the car, and that's going ... Obviously, it's helping you drive the car better. It's helping maintaining the car better, helping avoiding accident. All these, we should be adopting them for our health. So I think sensors and remote monitoring is going to really have an incredible impact and useful. Cheaper technologies that we can diagnose, let's say, disease without using an MRI or a CT scanner or I'm saying retinal imaging. There are now portable systems. There are systems that you could wheel around in a cart, you can put them in point of care, you can use them at home. I think these are incredibly important.
And then obviously I'm very excited about how we add AI and AI agent and multiple agent into you being a coach. So now you have in your hand multiple doctors or multiple coaches that are managing your information and linking that to your real clinical outcomes.
Oliver Chen:
The consumer component of this will be very interesting in terms of helping drive trust and adoption and rituals and also bringing stickiness and intersecting with what happens with adaptive and agentic. But final question, I think everybody listening to this might want to come see you for office hours, but what should people do who are interested in healthspan? What should they read and what should they do as individuals or leaders? And then last, last, what's least well appreciated about healthspan?
Zahi Fayad:
So number one, I welcome anybody to reach out to me. I hope you can provide my information. Seriously, I'm so passionate about this and I think we need to have a dialogue, continue with people on this and educate. So number one, reach out anytime. Welcome to visit our lab, maybe be part of the digital twin study that we have.
We also have other protocols that we did not talk about related to new intervention. We are finalists in the XPRIZE Healthspan Challenge. That's an incredible program that we are part of and we'll be enrolled. We just finished phase one of the study, but we will be in the future enrolling people as a certain age. Okay. So we are continuing with the XSPAN Healthspan study, which is an interventional study for aging and longevity. And we will welcome people to participate and I'm happy to send information on that.
Now, the other aspect more general, in terms of what I tell people when I meet at the bar, at the restaurant, or in the hallways, I mean, I encourage everybody to start simple into the journey, but really be very proactive, which means if you really want to get into this, start as early as possible. Number one, start with easy habits. For example, walking and taking at least 7,000 steps a day, that's one thing that you could really easily bring into your life.
Second of all, I mean, step it up a little bit. I mean, I think monitoring your sleep duration and trying to get good sleep hygiene is important because that's going to drive so many other either positive or negative things.
And then after that, once you graduate from the steps and the sleep, begin an exercise regimen, a little bit of resistance training, a little bit of cardiovascular. And then little by little, up the ante and make this part of your daily routine. You could skip a day during the week. Skipping three days in a row has been shown [inaudible 00:27:23] habits to be a bad thing. But again, life is there. But once this becomes part of your routine, you will not even think about ... You don't say to people, "I go to the gym." You go to the gym and this will be part of your life.
And then obviously after this, once you start doing that, you suddenly are going to start watching your nutrition and what you eat. This is all snowball effect. Don't start all at the same time, one at a time. And then have a plan and measure your outcomes with one of the wearables, focus on maybe one, you don't need to go crazy and go very ... I go crazy on it myself because I like that. But again, you can start simple and then you'll see incredible effect. Either you'll feel it physically, you'll feel it mentally, and then obviously you'll feel it when you do see your doctor on your annual checkup. You'll notice that, wow, you've done incredible work without me.
Oliver Chen:
Well, Zahi, that was really informative. And also the golden ticket to meet you was a first, as well as this being so personally and professionally relevant as we figure out the future of healthcare, the future of consumer, and what health spend means. Thank you. Thank you. Dan, it's a pleasure being here with you today.
Zahi Fayad:
Thank you again for making me part of this, and I would love to continue our conversation now or later.
Speaker 1:
Thanks for joining us. Stay tuned for the next episode of TD Cowen Insights.