How old are you?
A simple enough question, you may think, but not for Dr Tom Stubbs, co-founder and chief executive of epigenetic testing company Chronomics.
Epigenetics is (to quote the Chronomics website) the study of heritable phenotype changes that do not involve alteration in the DNA sequence. It’s essentially how environmental factors – from what we eat to the air we breathe – affect our gene activity and expression. You can’t change your DNA, but you can change your epigenetics.
Epigenetic testing is one of the most accurate methods for determining biological age – that is, how much your body is ageing, which may or may not match your literal chronological age.
This isn’t a hard concept to grasp – we all know that if you chain-smoke, drink heavily, eat junk food and never exercise, you will age faster than someone with a healthier lifestyle. But how much faster?
Answering that question is just one service offered by Chronomics. With a saliva test that you can do from home and send off, the company can analyse your epigenetic data and determine how old your body thinks it is.
Having been persuaded to try this out for myself, my biological age thankfully matches how long I’ve lived. But for £179 plus £19.99 a month, Chronomics is offering far more than that.
Stubbs, who has a PhD in epigenetics from Cambridge University and has worked at the frontier of this new field of research, wants to give people the tools to take charge of their own health, fusing epigenetic data with lifestyle analysis to work out what we all need to do as individuals to lead not just longer lives, but healthier ones.
Chronomics users, whether they pay for the product themselves or get it as part of their health insurance or workplace wellness programme, sign up for an account via the app. Once the saliva sample has been analysed, the results are available to view online. As well as the raw data, other features, including biological age, help users make sense of what it all means.
Stubbs is particularly excited when it comes to the smoke exposure feature. As someone who has never smoked, I am relieved but unsurprised to find that my exposure is just three per cent. But for those who do smoke cigarettes or have in the past, the insights can be much more valuable.
Stubbs points out that, despite the barrage of information about the harms, smokers often convince themselves that the science doesn’t apply to them, citing stories of chain-smoking relatives who lived to their nineties.
The epigenetic test strips away that excuse, as people can see directly the impact that cigarettes are having on their DNA. Stubbs says that he’s seen this work as a reality check to convince people to cut down or quit, suggesting that the personal aspect makes it much harder to ignore than generic health warnings or grotesque images on packaging.
The flip-side is that the test also shows the value of quitting.
Average smoke exposure for current smokers ranges from 63 to 78 per cent, whereas for former smokers it’s zero to 56 per cent. If the test is repeated over time (which Stubbs hopes will be the norm), people can see first-hand how their efforts to stop are having a direct, positive impact on their health.
The next big project for Chronomics is to develop a similar tool for alcohol consumption (from which I would likely fare far less well).
And that’s just the start.
You can see the eventual endgame: a holistic picture of how everything – diet, exercise, screen-time, sleep, sex, stress – is affecting our bodies in real-time, and what we need to change to stay healthy. Combined with the genome mapping already on offer elsewhere to test for genetic predispositions to certain diseases, this kind of data-driven personalisation is the future of healthcare.
Alongside the saliva analysis, Chronomics asks users to fill in a detailed lifestyle questionnaire.
I’ll admit to being somewhat taken aback by the personal nature of some of the questions, which range from the expected (diet, exercise, medical history) to sections on income, mental health, past trauma, and even sexual activity. What advertisers would do to get their hands on that kind of information.
This reluctance is probably why Chronomics makes such a big deal of its data policy. Front and centre of its website is a promise that “you own your data, and we will never sell, redistribute, or do anything without your knowledge and consent”.
So what does it do with it?
As part of the service, users are invited to share their data with its team of healthcare professionals – which currently includes two medical doctors and an epigeneticist. The idea is that they will help you make sense of your epigenetic results combined with the lifestyle data, and be able to offer personalised recommendations for becoming healthier – all managed via the app.
It’s clear that Stubbs’ vision goes far beyond warning people that they have a predisposition to developing heart disease or advising them to stop smoking and exercise more.
Tellingly, he talks not about “healthcare” but “health management”. That means not waiting until something is wrong before going to a doctor, but understanding the health of your body, taking proactive steps to maintain and improve it throughout your life.
Whether we like it or not, big data is coming to healthcare. From fitness trackers to genome mapping to data drives led by patient groups with specific conditions, the race is on to harness this technology revolution to understand how our bodies work and develop truly personalised medicine.
With this progress comes controversy. Whether it’s the NHS working with Google’s DeepMind, or concerns about corporate wellness schemes exercising draconian control over their employees, the risks are as clear as the advantages.
I might benefit hugely from a bespoke treatment plan developed using the data of other people like me, but I don’t want my boss, businesses, or the government to have access to intimate details about me.
As such, I’m wary about sharing that information with anyone. People who have access to Chronomics via their employer or insurer may be even more concerned about who, exactly, gets to see their results.
Stubbs acknowledges the risks, which is one reason why he is at pains to reiterate that it is the individual who remains in control, regardless of how the service is paid for. But he passionately believes that, with better understanding of what’s going on in epigenetics and in medicine more broadly, these fears can be alleviated.
“The more people share data, the faster we can move away from generalist solutions to health problems and more towards personalisation,” he tells me. “And also the quicker we can get to better proactive health management solutions for individuals rather than worrying about, when people get sick, what are the generalist ways we can fix it.”
And this is a revolution that, he feels, we should all want to be part of.
“The biggest killers on the planet today are not ebola or diseases that come from infectious agents. They are non-infectious things that we don’t even see – we’re just doing them, living them – that lead to things like cancer, heart-disease, type 2 diabetes.
“Being able to shine a light on these things and have public health initiatives to combat them early enough is going to be the biggest leap forward.”
What about the kind of dystopian future that we’ve seen depicted in fiction, from George Orwell to the TV series Black Mirror, where governments and companies track our every move, with chilling consequences?
“The biggest way we can go wrong is if companies and other people in the area of precision medicine aren’t educating people with the movement of what’s happening,” Stubbs argues. “I think if people understand what’s happening, I don’t have a worry about a dystopian future.”
I’m still not sure I’m 100 per cent convinced. But if it all comes down to this question: if specific lifestyle changes would make you or a loved one live healthier for longer, would you want to know?
And if so, what would you be prepared to trade for that information?