Home' Technology Review : March April 2012 Contents Feature Story
technology review March/ April 2012
When I first meet Smarr and he gives me a tour of his institute,
commonly known as Calit2, I tell him that I find it difficult to
separate promise from hype, noting that his endeavor has all the
pitfalls of any “n = 1” experiment—a test in which only one person
is the subject. “Every disruption begins with an n of 1,” he replies.
Smarr has a standard-issue office on the side of a sleek six-story
building, but much of his floor resembles a hip architectural firm.
Workstations zigzag across a vast space that features exposed vent-
ing pipes and electrical conduits on the naked ceiling. His chief
assistant, who lives near San Francisco, talks to coworkers via
Skype and a dedicated computer monitor. Across the room, chairs
are arranged before a wall of 30-inch displays stacked five high and
14 wide, with a total of 286.7 million pixels that can simultaneously
show dozens of brain scans or the stars in a galaxy.
Though he has no laboratory of his own, he shows off the proj-
ects at Calit2 as though each were one of his children. The labs
investigate everything from machine perception and game cul-
ture to integrated nanosensors and 3-D virtual reality. One, which
Smarr recently tapped to determine his peak oxygen consumption
and maximum heart rate, studies ways to improve individual and
population health. Another researches digitally enabled genomic
medicine—a blend of self-quantification devices with wireless
technology and DNA data.
The place makes my imagination dance. So, too, does Smarr’s
medical sleuthing of his own body. Not only does he want to con-
vince others that they can fundamentally alter the patient-doctor
relationship and transform physicians into partners, but he’s also
going public with his biodata, hoping to crowdsource information
that will lead to new insights about the elusive links between DNA
sequences, biomarkers, and disease. I soon buy into his vision,
embarking on a closer examination of my own disease that, at the
very least, scuttles my resignation to it.
Larry Smarr stumbled into his role as a proselytizer for digitizing
and then crowdsourcing medicine; he stresses that by nature he is
a reserved and private person. He was born and raised in Columbia,
Missouri, where his parents ran a flower shop from the home base-
ment. One of his greatest passions is the quiet, solitary cultivation
of that most finicky and delicate of plants, the orchid. Yet he has
no regrets about going public in writings and talks with extremely
intimate details about his body. “Most people think I’m crazy,” he
says. But as a result of his candor, many people have contacted him,
he says, and he shows me how a Google search on his name now
pulls up articles about his quantified-health quest before everything
else he has published in his distinguished career.
Smarr says he “got outed as a quantified self ” after he spoke at
a technology summit in May 2010. A session titled “BioNanoInfo
Technology: The Big Challenges” featured him on a panel with
Leroy Hood, a cofounder of the Institute for Systems Biology
in Seattle and one of the inventors of the first automated DNA
sequencer. Hood discussed his push for technology that he hopes
will introduce an era of medicine he calls P4: predictive, preven-
tive, personalized, and participatory. Smarr told his own story of
using self-quantification to lose weight. A reporter interviewed
him after the session, seeking more details, and in the wake of
that article, speaking requests started to pour in.
Hood envisions a day when devices using nanotechnology will
measure 2,500 markers in blood to track fluctuations in what he
estimates are about 50 proteins in 50 of the body’s organs. But
that is not yet practical, so Smarr settled on about 100 biomark-
ers to understand how his dietary changes were affecting his body.
Levels of one of the markers, C-reactive protein, or CRP, stood
out as higher than normal.
CRP triggers an immune response by binding to the surface of
ailing cells, and the level of it should be less than one milligram
per liter of blood. Smarr’s level in November 2007 was 6.1. More
alarming still, over the next seven months it steadily climbed to 11.8.
He felt fine, but he decided to seek a doctor’s advice, worried that
something was amiss. The doctor dismissed Smarr’s self-charted
longitudinal CRP data, telling him to return if he had symptoms.
“Doctors are the gatekeepers, and they’re worried about getting
disintermediated,” he says, comparing them to the bank tellers
who initially bad-mouthed ATMs.
Within a few months, a sharp, persistent pain in the left side of
his abdomen sent him to the doctor’s office, and he was diagnosed
with acute diverticulitis, an infection of pockets in the wall of the
colon. A blood test showed that his CRP had climbed to 14.5 dur-
ing the attack. He took antibiotics, the symptoms resolved, and his
CRP dropped to 4.9 —but that was still unusually high. Concerned
that these readings might, as he had read, indicate a plaque buildup
that could lead to a heart attack, he had doctors do ultrasounds of
his carotid artery and found that it was indeed thickening.
To better understand the attack, he had his stool analyzed for,
among other things, lactoferrin, a marker of inflammation. His
lactoferrin, too, rose several times to sky-high levels—200, whereas
the normal count is less than 7.3 . When he overlaid his results on
a graph with his CRP fluctuations, he noticed that the two roller-
coastered in tandem. A colonoscopy in December 2010 revealed
extensive diverticulitis, but Smarr, who had trolled the medical lit-
erature online, remained unconvinced that this was his underlying
disorder. He became particularly intrigued by studies that linked
high lactoferrin levels to inflammatory bowel disease.
At this point, Smarr discovered that UCSD had recently hired
a new head of gastroenterology, William Sandborn, who had pub-
lished a compelling study that charted rises in lactoferrin levels dur-
ing flares of inflammatory bowel disease. The two met and decided
to do yet another colonoscopy. By then, Smarr’s lactoferrin level
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