Like many people who are careful about their weight, Larry Smarr once spent two weeks measuring everything he put in his mouth. He charted each serving of food in grams or teaspoons, and broke it down into these categories: protein, carbohydrates, fat, sodium, sugar, and fiber.
Larry used the data to fine-tune his diet. With input nailed down, he turned to output. He started charting the calories he burns, in workouts on an elliptical trainer and in the steps he takes each day. If the number on his pedometer falls short of his prescribed daily 7,000, he will find an excuse to go for a walk. Picture a tall, slender man with the supple, slightly deflated look of someone who has lost a lot of weight, plodding purposefully in soft shoes along the sunny sidewalks of La Jolla, California.
Of course, where outputs are concerned, calories are only part of the story, and it is here that Larry begins to differ from your typical health nut. Because human beings also produce waste products, foremost among them … well, poop. Larry collects his and has it analyzed. He is deep into the biochemistry of his feces, keeping detailed charts of their microbial contents. Larry has even been known to haul carefully boxed samples out of his kitchen refrigerator to show incautious visitors. He is eloquent on the subject. He could sell the stuff.
VIDEO: Larry Smarr shows off his imaging equipment—and the inside of his colon.
“Have you ever figured how information-rich your stool is?,” Larry asks me with a wide smile, his gray-green eyes intent behind rimless glasses. “There are about 100 billion bacteria per gram. Each bacterium has DNA whose length is typically one to 10 megabases—call it 1 million bytes of information. This means human stool has a data capacity of 100,000 terabytes of information stored per gram. That’s many orders of magnitude more information density than, say, in a chip in your smartphone or your personal computer. So your stool is far more interesting than a computer.”
Larry’s fascination is less with feces themselves than with the data they yield. He is not a doctor or a biochemist, he’s a computer scientist—one of the early architects of the Internet, in fact. Today he directs a world-class research center on two University of California campuses, San Diego and Irvine, called the California Institute for Telecommunications and Information Technology, or “Calit2” (the 2 represents the repeated I and T initials). The future is arriving faster at Calit2 than it is in most places. Larry says his eyes are focused “10 years ahead,” which in computer terms is more like a century or two, given how rapidly the machines are transforming modern life. Intent on that technological horizon, Larry envisions a coming revolution in medicine, and he is bringing his intellect and his institute to bear on it.
At 63, he is engaged in a computer-aided study of the human body—specifically, his body. It’s the start of a process that he believes will help lead, within 10 years, to the development of “a distributed planetary computer of enormous power,” one that is composed of a billion processors and will enable scientists to create, among many other things, a working computational model of your body. Your particular body, mind you, not just some generalized atlas of the human frame, but a working model of your unique corpus, grounded in your own genome, and—using data collected by nanosensors and transmitted by smartphone—refreshed continually with measurements from your body’s insides. This information stream will be collated with similar readings from millions of other similarly monitored bodies all over the planet. Mining this enormous database, software will produce detailed guidance about diet, supplements, exercise, medication, or treatment—guidance based not on the current practice of lumping symptoms together into broad categories of disorders, but on a precise reading of your own body’s peculiarities and its status in real time.
“And at that point,” says Larry, in a typically bold pronouncement that would startle generations of white-coated researchers, “you now have, for the first time in history, a scientific basis for medicine.”
When Socrates exhorted his followers, “Know thyself,” he could not have imagined an acolyte so avid, or so literal, as Larry. You’ve heard of people who check their pulse every few minutes? Amateurs. When Larry works out, an armband records skin temperature, heat flux, galvanic skin response, and acceleration in three dimensions. When he sleeps, a headband monitors the patterns of his sleep every 30 seconds. He has his blood drawn as many as eight times a year, and regularly tracks 100 separate markers. He is on a first-name basis with his ultrasound and MRI technicians, who provide him with 3-D images of his body, head to toe. Regular colonoscopies record the texture and color of his innards. And then there are the stool samples—last year Larry sent specimens to a lab for analysis nine times.
Larry is a mild, gentle soul, someone generally more interested in talking about you than about himself. He does not go out of his way to get your attention, and nothing about him is remotely annoying or evangelical. But if you show an interest in his project and start asking questions—look out. Beneath the calm and the deference, Larry is an intellectual pitchman of the first order. His quest to know burns with the pure intellectual passion of a precocious 10-year-old. He visibly shudders with pleasure at a good, hard question; his shoulders subtly rise and square, and his forehead leans into the task. Because Larry is on a mission. He’s out to change the world and, along the way, defeat at least one incurable disease: his own. (More on this in a moment.)
Larry is in the vanguard of what some call the “quantified life,” which envisions replacing the guesswork and supposition presently guiding individual health decisions with specific guidance tailored to the particular details of each person’s body. Because of his accomplishments and stature in his field, Larry cannot easily be dismissed as a kook. He believes in immersing himself in his work. Years ago, at the University of Illinois, when he was taking part in an experiment to unravel complex environmental systems with supercomputers, Larry installed a coral-reef aquarium in his home, complete with shrimp and 16 other phyla of small marine critters. It was maddeningly fragile. The coral kept peeling off the rocks and dying. He eventually discovered that just five drops of molybdenum, a metallic element, in a 250-gallon tank once a week solved the problem. That such a tiny factor played so decisive a role helped him better grasp the complexity of the situation. And as he fought to sustain the delicate ecosystem in his tank, he developed a personal feel for the larger problem his team was trying to solve.
Today, he is preoccupied with his own ecosystem. The way a computer scientist tends to see it, a genome is a given individual’s basic program. Mapping one used to cost billions. Today it can be done for thousands, and soon the price will drop below $1,000. Once people know their genetic codes, and begin thoroughly monitoring their bodily systems, they will theoretically approach the point where computers can “know” a lot more about them than any doctor ever could. In such a world, people will spot disease long before they feel sick—as Larry did. They will regard the doctor as more consultant than oracle.
Not everyone sees this potential revolution as a good one. Do people really want or need to know this much about themselves? Is such a preoccupation with health even healthy? What if swimming in oceans of bio-data causes more harm than good?
“Frankly, I’d rather go river rafting,” says Dr. H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, and the author of Overdiagnosed: Making People Sick in the Pursuit of Health. “Data is not information. Information is not knowledge. And knowledge is certainly not wisdom.” Welch believes that individuals who monitor themselves as closely as Larry does are pretty much guaranteed to find something “wrong.” Contradictory as it sounds, he says abnormality is normal.
“It brings to mind the fad a few years ago with getting full-body CT scans,” Welch says. “Something like 80 percent of those who did it found something abnormal about themselves. The essence of life is variability. Constant monitoring is a recipe for all of us to be judged ‘sick.’ Judging ourselves sick, we seek intervention.” And intervention, usually with drugs or surgery, he warns, is never risk-free. Humbler medical practitioners, aware of the sordid history of some medical practices (see: bloodletting, lobotomy, trepanning), weigh the consequences of intervention carefully. Doing no harm often demands doing nothing. The human body is, after all, remarkably sturdy and self-healing. As Welch sees it, “Arming ourselves with more data is guaranteed to unleash a lot of intervention” on people who are basically healthy.
Not to mention creating an epidemic of anxiety. In other words, the “quantified life” might itself belong to the catalog of affliction, filed under Looking too closely, hazards of.
In that sense, the story of Larry Smarr might be less a pioneering saga than a cautionary tale.
Larry’s journey started with that most American of preoccupations, losing weight. Larry doesn’t update the photo each time he renews his California driver’s license, preferring to keep, as a reminder, the one taken soon after his arrival at UCSD 12 years ago, with his wife, Janet. It shows a 51-year-old Larry, one with more and longer hair, a wide, round face, and an ample second chin. Call him Jolly Larry. He had just arrived from Illinois, a place he now refers to as “the epicenter of the obesity epidemic,” and he had a girth to match his oversize professional reputation. (Deep-fried, sugarcoated pastries were a particular favorite of his back then.) Arriving in La Jolla, Jolly Larry found himself surrounded by jogging, hiking, biking, surfing, organic-vegetable-eating superhumans. It was enough to shame him into action. If he was going to fit in on this sunny new campus, he would have to shape up.
So Jolly Larry started working out, reading diet books, and stepping on the scale every day. At first, his charts were disappointing. Like countless strivers before him, he dropped some weight, but not much, and it kept wanting to come back. Three or four popular books on weight loss left him mostly confused, but they did convey a central truth: losing weight was only 20 percent about exercise. The other 80 percent was about what he put in his mouth. What triggered his breakthrough was the advice of Barry Sears, the biochemist who created the Zone Diet, which pressed Larry’s buttons precisely. Sears proposed that to diet more effectively, one needed to know more. Larry decided to study up on his body chemistry.