October 15, 2015 (Vol. 35, No. 18)
Wellness Startup Intends to Democratize Personalized Medicine
As the benefits of the genomics revolution trickle down to patients, Arivale aims to open the floodgates by providing people with meaningful information they can use to manage their health long before the appearance of illness.
Arivale’s mission goes beyond general advice on diet and exercise. Instead, it analyzes each client’s genome, clinical chemistries, lifestyle, and microbiome to produce specific advice tailored to individuals.
“We can identify genetic variants among individuals that identify which foods will add weight—carbohydrates vs. fats, for example—and how much exercise is needed to effectively lose weight for specific individuals,” co-founder Lee Hood, M.D., Ph.D., says.
Arivale co-founder and CEO Clayton Lewis, a triathlete, has experienced this difference in his own life. For example, his attempt to follow general consumer dietary advice left him discouraged. “I tried the Paleolithic diet,” he recalls, “and I moved slower.”
According to the Paleolithic diet’s advocates, humans are still ill-adapted to agricultural-age fare. People, then, should “Go Paleo,” which means eating meat, nuts, and berries—foods that presumably nourished our Paleolithic forbears. But the diet actually increased Lewis’ inflammation markers, concluded an Arivale analysis.
“As turns out, my body processes carbohydrates very efficiently,” Lewis insists. “In fact, my body needs them to operate efficiently.” Based upon information from Arivale, Lewis made changes that lowered his inflammation and improved his sports performance.
Challenging the Status Quo
“The U.S. healthcare system is upside down,” contends Lewis. “Some $4 trillion is being spent annually on diagnostics and therapeutics after a person becomes sick, but 90% of an individual’s wellness is determined by genetics and lifestyle.”
“Disease,” Dr. Hood adds, “appears much earlier than it typically is detected.” In support of this assertion, Dr. Hood points to the results of a proof-of-concept pilot study that was launched in 2014 by the Institute for Systems Biology, a nonprofit biomedical research organization that Dr. Hood cofounded in 2000. (He currently serves as the organization’s president.)
In the pilot study, 107 healthy people underwent whole-genome sequencing; proteome, metabolome, and gut microbiome analyses: as well as ongoing monitoring of their vital signs and physical activity. Of these participants, notes Dr. Hood, “91% had nutritional issues, 68% had inflammatory responses, 56% had cardiovascular issues, and 53% had diabetic abnormalities, yet seemed healthy.”
In addition, 43 of the 107 participants were prediabetic, and 2 were diabetic (but undiagnosed). “We converted seven of the prediabetics to completely normal clinical chemistries” by modifying their diets and lifestyles, informs Dr. Hood. The others, he says, are moving in the right direction, thus demonstrating the value of integrating different datasets to gain new, actionable insights.
“One of the striking conclusions from that pilot is that we can use genome-wide association data to calculate the genetic risks for individuals in 60 to 70 disease phenotypes,” Dr. Hood points out. He emphasizes that correlations were spot-on for type 2 diabetes, Crohn’s disease, cardiovascular disease, and many other conditions.
The Consumer Value Proposition
By concentrating on improving wellness, Arivale aims to reduce the need for diagnostics and therapeutics. “We are passionate about providing access to high-quality healthcare that prevents diseases from developing,” Lewis says. “We’re launching a scientific wellness industry.” The difference between Arivale and general wellness programs is that Arivale provides actionable information based upon a person’s own DNA, chemistry, gut microbiome, and activity levels.
“We take a 360-degree view,” Lewis declares. “We look at the whole genome sequence, and three times a year we perform clinical tests of blood and saliva and analyze the gut microbiome.” All of this information, Lewis explains, is combined with Fitbit data to determine the quality and quantity of sleep and activity levels.
“Complex data is the most important element in developing actionable recommendations,” maintains Lewis. “Customers, however, also want a relationship.” Therefore, Arivale assigns each client a coach who engages with them monthly to relate their goals to their most recent datasets and help them stay on track.
Arivale is targeting a group that Lewis calls Health Hopefuls.” It consists of people over 40 who may have experienced an adverse event. Depite the setback, they remain passionate about accumulating new experiences and enjoying life. “If they are to gain these new experiences,” proposes Lewis, “the Health Hopefuls will need better wellness.”
Taking a Systems Approach
The Arivale approach is based on Dr. Hood’s systems biology work, which is meant to realize a form of medicine that is predictive, preventive, personalized, and participatory. Dr. Hood calls it P4 medicine.
Reflecting the P4 ideal, the 107-person pilot project embodies a suitably wellness-oriented value proposition: establish a new baseline for health, develop a clear and actionable game plan, and avoid disease.
“That longitudinal study of healthy people created a dense data cloud to identify actionable possibilities to improve wellness or avoid disease,” notes Dr. Hood. The study collected data on individuals’ clinical chemistry, proteins, metabolites, and microbiome on a quarterly basis. Quarterly intervals enabled the company to see transitions from good health to illness and back again, creating a metric for wellness.
“Soon,” Dr. Hood predicts, “we also will have metrics that enable us to distinguish between physical and psychological wellness.”
Arivale launched in Seattle in July and will expand to the San Francisco area later this year. Launches in other, as-yet-unspecified, cities are being planned for 2016.
“This is a concierge medicine experience,” states Lewis. He adds that the initial price for the pioneer group of clients is $2,000—less than half the cost of the assays alone. The full price is yet to be determined. It is not covered by insurance.
“The essence of the program,” insists Dr. Hood, “is to enable people to optimize their human capital, feel better, more productive, and engaged with life.”
Arivale is funded by Maveron, Arch Venture Partners, and Polaris Partners. The company recently closed a Series B financing round, raising $36 million, on top of its initial $3 million Series A funding.
“We’re in the wellness business, not the healthcare business,” Lewis emphasizes. “The importance of wellness as part of the healthcare system is utterly obvious to us, and we feel it must be obvious to clinical practitioners.
“We believe Arivale will revolutionize healthcare by making it take wellness seriously for the first time. Wellness is key to preventive medicine and to reversing major diseases at a very, very early state. That, in turn, will transform healthcare.