Insuring Previvors

The story of chess and rice illustrates exponential growth, paralleled in technology and genetics. Moore’s Law on computing power doubling every two years has led to advanced AI, machine learning, and virtual reality. Similarly, rapid advancements in genetics, outpacing Moore’s Law, are revolutionizing disease diagnosis and treatment, potentially transforming industries like insurance by redefining pre-existing conditions.

This article was first published in The Mint. You can read the original at this link.

Legend has it that the inventor of chess asked for some rice as his reward for coming up with the game. To be precise, he asked the king to place a single grain of rice on the first square of the chessboard, two on the next, four on the one following that—doubling the preceding number on each subsequent square of the chessboard. Things proceeded uneventfully for the first 32 squares and, even though he had accumulated over 4 billion grains of rice, that number only represents the rice contained in a large field.

However, once in the second half of the chessboard, things got rapidly out of hand. Sixty-three doublings of a single grain of rice is equivalent to 18 quintillion grains of rice—a number so large that if the grains were placed end to end, it would span the distance from the Earth to Alpha Centauri and back. This is the power of exponential doubling and for his cheekiness in trying to exploit it, the inventor lost his head.

In 1965, Gordon Moore articulated a proposition based on exponential growth that has been called the only rule that really matters in tech. His observation that computing power will double every two years has held true for the past 52 years, and in fact, has been proved to apply in the same way to memory capacity, disk space and the number of pixels in a digital camera.

The exponential doubling of computational power recently crossed into the second half of the chessboard. We have, since then, seen remarkable developments in technology that would not have been possible but for this massive surge in computational power. Artificial intelligence is a reality today; machine learning and neural networks offer us new ways to solve problems that never existed before; virtual and augmented reality have insidiously become part of our lives, and we’ve gotten to the point where computational technologies are advancing so rapidly that the tech we live with must seem like magic to someone who lived just a decade ago.

As rapidly as computation technologies have grown, the rate of progress in genetics has been even more dramatic. Over the past 13 years, the cost of DNA sequencing has dropped 1,000 times faster than Moore’s Law—from $100 million per human to just $1,000. As a result, genetics has advanced at a rate that is almost the square of Moore’s Law, bringing us into the second half of the genetics chessboard in much less time than Moore’s Law took for computers. This means that very soon genetics will start to demonstrate the sorts of magical applications that we’ve become used to seeing in computers.

We can already see, for ourselves, the impact that Next Generational Sequencing is having on the diagnosis and treatment of diseases. Companies like Strand Life Sciences in Bengaluru, have demonstrated how these new technologies can provide remarkable insights into the cause for conditions as benign as colour blindness, on the one hand, and as potentially devastating as Duchenne muscular dystrophy, on the other. It has allowed us to develop therapies to cure diseases previously thought to be untreatable and, will eventually change the way in which medicine is practiced by allowing us to specifically target therapies to meet individual genetic requirements.

As we begin to understand our genes better, our approach to the diagnosis and treatment will change. Siddharth Mukherjee speaks of the emergence of a new class of humans he calls previvors—people who survive diseases they haven’t yet got by undergoing treatment to avoid contracting it in the first place. Before we know it, we will all be previvors—capable of modifying our genetic code to safeguard ourselves from the diseases that our genetic makeup exposes us to.

Given how imminent this reality is, we’d do well to prepare ourselves for the impact that exponential growth in genetics will have on society. One small example of this disruption is the way in which these developments will transform the insurance industry.

At present, mediclaim policies specifically exclude ailments that arise out of pre-existing conditions. They do so on the basis that anyone who failed to disclose a medical condition when he or she bought an insurance policy must have done so with the intention to commit fraud.

As our understanding of genetics improves, it is becoming increasingly evident that many diseases are caused by small aberrations or deficiencies in the genetic code of the patient. By definition, all such diseases, even if those abnormalities had not manifested themselves as observable symptoms at the time of taking out the policy, are pre-existing conditions. By current standards, they would all be ineligible for coverage.

If medical insurance has to continue to work in the second half of the genetic chessboard, we will have to fundamentally redesign the way it works.