Developing the Art of Group Buy Medical Tourism: 100 People Traveling to Pay $10-20,000 for a Rejuvenation Therapy

We stand at a very interesting juncture in the ongoing development of medicine, travel, and communication. The world is becoming a small place, in which geographically dispersed interest groups can find one another, talk, and organize. The cost of either a round trip by air to a different continent or a cruise that covers a dozen countries is considerably less than the cost of many of the new classes of stem cell therapy or gene therapy. These treatments have been or soon will be available via medical tourism. They are not available or are only just starting to become available in countries such as the US due to the incredible cost and time required to comply with US regulatory requirements in comparison to those elsewhere. Stem cell treatments were the important class of new treatment available via medical tourism over the past decade and in the decade to come will be joined by elective gene therapies, such as myostatin knockout for muscle growth. You'll recall that the analogous follistatin gene therapy was undertaken in an overseas clinic as a proof of concept by the CEO of startup BioViva not so long ago. In a year or two anyone with the money and the insider connections will be able to do the same, and five years from now a competitive international marketplace will offer this gene therapy at a comparatively low cost.

The next decade of therapies available via medical tourism will also include the first narrowly focused rejuvenation therapies. Those already technically possible include the senescent cell clearance approach of Oisin Biotechnologies and the transthyretin amyloid clearance trialed by Pentraxin and GlaxoSmithKline. I expect to see these joined by glucosepane cross-link clearance and perhaps allotopic expression of all mitochondrial genes in the years ahead. Senescent cell clearance is certainly very close, close enough, I think, to that we should be planning how we can help to place these therapies into clinics as soon as possible.

I put down a few thoughts on this topic earlier in the month, focused on how rejuvenation therapies might follow the trail blazed by the stem cell research and development community fifteen years ago, producing widespread and cost-effective availability of treatments - and data on patient outcomes - long before regulators in the US were willing to approve these therapies. Today I'll talk about a different approach to gaining access to therapies for early adopters, one that looks a lot like the organization of group buys or vacations. If you look at what BioViva organized for one person's gene therapy, it is fairly easy to imagine organizing it for a dozen people willing to put up $20,000 and fly to the very same clinic to undertake the very same treatment on the same day. Or get on a cruise and head out to international waters with a staffed clinic on board. The economics will scale as the number of people involved grows: if we can organize a conference in which hundred of people fly to a distant city, or if the "anti-aging" marketplace can organize their large conferences, can we not also organize a hundred people paying $10,000 for a myostatin gene therapy or for the Oisin Biotechnologies senescent cell clearance technology? At that scale, the potential revenue per event becomes large enough to make this worth trying for a startup company - it is comparable to the size of early fundraising rounds.

Of course you or I can't just call up a hundred people and get them on board for a five figure payment and a trip on a given date, for all that I'm very certain that a hundred people in our extended community are up for early access to gene therapy or senescent cell clearance. Gathering this crowd, both for the first time and for later organized medical tourism group buys, would require a small organization devoted to the purpose: web site, a phone line, outreach, marketing, staff to do the work implied by all of the above, and so forth. Fortunately there is no shortage of small organizations in our neck of the woods, and one might reasonably expect advocates to create another if none of the existing groups wanted to take this on. This sounds like a good fit for Lifespan.io or Longecity, for example, if they chose to head in that direction. The entrepreneurs at either BioViva or Oisin Biotechnologies should certainly consider playing their parts in such a plan if provided solid evidence that the market is there and people are willing to pay.

How do you prove a market? Well, the traditional method is that you register an organization, put up a website and phone line, and collect expressions of interest of one form or another: people willing to sign up, people willing to put down a refundable deposit, that sort of thing. If you have a few hundred people willing to do this, well: there you go. Companies have been launched with less proof. This is not to say that I think this will all be straightforward and smooth sailing. Ask anyone who organizes conferences for a living about the challenges inherent in putting a few hundred people in one distant building at one given time. Or ask a cruise line operator about the analogous portions of their business. That said, group buys, medical tourism, and group vacations such as cruises are all established practices. There are people who know how to run these things, and none of the potential problems are surprises in and of themselves. This seems to me a logical evolution of the present medical tourism industry. It doesn't exist today because the sort of treatments that people travel to undertake are highly individual. But given the advent of enhancement and rejuvenation therapies that everyone can benefit from, a whole different dynamic emerges.

So for the community at large, as we ask ourselves how we can best help the rapid development and clinical availability of rejuvenation therapies, I think that the approach I sketched here is worth thinking on. It is something that many of us could help bring about: few specialized skills are required for the mundane tasks of advocacy or assembling an organization to put together group buys. Many of us could help in meaningful ways, and a great many people are motivated to bring about the end result, including those who are presently working on the biotechnology side of the house.

Comments

This is an incredibly interesting blog you wrote today, Reason.

At what age does it makes sense to start considering these rejuv treatments.

Also, I would be interested in supporting an oranization that would start up a community as you suggested. I have not worked for nearly 3 years (though been looking) and live in the Santa Cruz mountains, so not far from SENS.

Again, great thoughts Reason on getting some of these treatments to be more available to the general public and at a too to high price, IMO.

Posted by: Robert Church at March 31st, 2016 6:42 PM

This is a very good idea, Reason.

Posted by: Santi at March 31st, 2016 9:18 PM

Again, an excellent post and idea. Thank you, Reason.

I just throw in a few thoughts. In my eyes, there are two approaches in which this could work, top-down or bottom-up. The top-down approach would require the supplier of respective interventions to make a group-based offer. Overall, this would be a lot less complicated than the bottom-up approach. We would know the price, we would know the intervention and we would just need to find enough participants. The latter should be easy, if the intervention is promising.

The bottom-up approach would require to start a group and organize it. Sooner or later this will require fees for administrative issues. Certain jobs would need to be assigned to people. The most important job would be to find someone who can contact or already has connections to respective companies. Then the price and intervention would have to be discussed and as soon as both are defined, group members would have to decide if they participate.

No matter which approach is realized, I would support both.

Posted by: Claus E. at April 1st, 2016 3:10 AM

Great post. You are seeding the marketplace with a concept that makes a great deal of sense. Also, thank you for all you do every day in this cause. Your efforts are having an impact. You are pushing and advocating in a way that will save lives for unknown many as the paradigm shifts at last. I refer to your site daily and I share posts regularly. It is greatly appreciated.

Posted by: Jersey Jones at April 1st, 2016 10:27 AM

Well I'm not sure that the SENS Foundation endorse this approach.

Posted by: Jim at April 1st, 2016 11:14 AM

Given that the stifling regulatory environment isn't going away, this seems inevitable. Legalities seem trickier than the Blueseed project which itself is suffering from funding difficulties. And grey area projects tend to be rife with opportunists and swindlers, e.g. the Chilean Galt's Gulch drama.

Even though the market might exist, this is enough of a public relations timebomb for biotech firms to preclude Massdrop-style economies of scale. These firms probably would not want to be associated with "preying on hopes" or "taking advantage of Alzheimer's patients" with footage of a third world clinic. And you can imagine the sorts of people who thought Elysium was a great movie are salivating at a chance to caricature a bunch of wealthy people getting cutting edge life extension treatments on a cruise ship.

A biotech firm acting through an established clinic in a country with little to no regulatory burden - and hopefully insulated from US pressure - sounds like our best shot.

Posted by: JordanV at April 1st, 2016 3:04 PM

The fact that there aren't more clinics setup in other countries through existing biotechs doesn't make me hopeful that it'll change anytime soon. I hope I'm wrong, and some of the bigger players start doing it, but we'll see.

Posted by: Ham at April 1st, 2016 3:17 PM

I don't know if it is actually 10 years wait for most of these treatments... for most of the people who would be interested. Most people would not travel and pay for a treatment until it has at least been 'proved' in a stage 1 trial. And given that the length of trials has been coming down recently is a stage 2 and then 3 trial 10 years?

I think the market of gung ho people willing to take a completely untrialled product is rather small.

Posted by: Jim at April 1st, 2016 6:56 PM

Coordinating demand for an emerging supply will be required sooner or later in this space. I like the idea and happy to contribute.

Posted by: Wayne at April 1st, 2016 9:20 PM

Really good article on medium.com from Alexander Masters about patients paying to be part of trials and his attempts to get funding for a oncolytic virus trial in Neuroendocrine cancer:

https://medium.com/mosaic-science/a-plutocratic-proposal-deba1f979bff

“My idea was this: there are over 100,000 people in the world worth more than £20 million. According to medical statistics, between three and five people in every 100,000 get neuroendocrine cancer every year. So, three to five supremely wealthy people will have neuroendocrine cancer.

For £1 million, I was going to sell one or two of these plutocrats a place on Professor Essand’s bug trial.”

Obviously cancer kills you in fairly short order, so is a powerful motivator for these plutocrats, but aging often involves pain, which is also a motivator. Could you set up a similar 'dating agency' for aging interventions?

Posted by: Jim at April 2nd, 2016 1:50 PM

@Jim: My sense is that in this space of possible combinations involving trials, people paying, startup companies, small insider groups trying new therapies for their own set of motivations, positive and negative publicity, there are viable arrangements somewhere.

A logical starting point from where we are today would be to try a small group with BioViva or Oisin, assuming they'd be up for it, as a test of the waters, and go from there. There are probably numerous other logical starting points for different groups. It is no doubt well worth reading up on past discussions on this topic.

Posted by: Reason at April 2nd, 2016 2:16 PM

This kind of medical tourism will become common in the coming decade. I also think that "bio-hackers" will develop or copy these therapies in home labs as well. Since they cannot market them due to FDA regulations, many of them will simply publish their "recipes" on the internet and inspire many others to replicate their work. Bio-hacking will become cheaper and more powerful as the instruments and tools needed become cheaper and more powerful (mostly based on micro-fluidics technology). There will be some push-back on the part of the FDA and other regulatory agencies although I don't know how much of it there will be. As long as the bio-hackers do not market and attempt to profit from their work (without FDA approval), I don't see how the regulatory agencies can stop this as it becomes a first-amendment constitutional issue. That is, I could develop an anti-aging therapy that repairs my mitochondrial DNA in a home lab. Since I cannot market it as a therapy, I can certainly publish a book on how to do it and sell that. The FDA would be in gross violation of my first amendment rights if they tried to prevent me from publishing my book.

Posted by: Abelard Lindsey at April 2nd, 2016 3:33 PM

I agree with @Abelard Lindsey in that bio-hackers will be able to replicate and copy many therapies that are developed by larger biotechs and also will slowly but surely begin producing their own therapies. Indeed this is something that I would like to devote my time and energies to.

However I disagree that they wouldn't be able to profit handsomely from this, and along similar lines to the main thrust of this excellent post (I do agree they might profit from books too, and perhaps "Dallas Buyers Clubs"). Once you've copied or otherwise developed a therapy you could just set up a shell in some other country, producing and selling it from that other jurisdiction in which the proprietor does not have patent rights. The FDA only regulates sale of therapies into the USA.

People might travel to that jurisdiction to access it. Or,
They might order it online and you ship it to them like online pharmacies today.
The proprietor might try to sue the customers in countries in which they have patents, but this is unlikely given the difficulty in policing this. Made more difficult if paid for in some digital currency.

This is like the Pirate Bay model for digital media now.

Posted by: Mark Bruce at April 6th, 2016 6:14 AM

Mark,

You might be right. At least I hope you are right. However, I read of a case of an American citizen in Florida who was marketing an unapproved (FDA) therapy involving a supplement (I forget which) where you traveled to Peru to undergo it. The guy received cease and desist letters from the FDA. So, he relocated to Peru and actually naturalized himself there (he had a Peruvian wife, I guess). He was eventually arrested and extradited to the U.S. over this.

Posted by: Abelard Lindsey at April 8th, 2016 10:56 AM

Interesting article. I'd imagine the average person wouldn't experience the same thing, since they likely wouldn't be doing the advertising or anything like that. The medical tourism thing in general is something that intrigues me, but I hope I won't have to eventually turn to. We'll see I suppose.

Posted by: Ham at April 8th, 2016 3:20 PM

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