[RWS #703] Living Longer: The Future of Medicine & Real Estate

Picture of stethoscope for Real Wealth Show Podcast Episode #703

We have a real smarty on today’s show.

Daniel Kraft is a Stanford and Harvard trained physician-scientist, inventor, entrepreneur, and innovator. With over 25 years of experience in clinical practice, biomedical research and healthcare innovation, Kraft has served as Faculty Chair for Medicine at Singularity University since its inception. He also founded and has chaired the University’s Exponential Medicine program which explores convergent, rapidly developing technologies and their potential in biomedicine and healthcare.

What does this have to do with real estate investing?

Well, as we learn more about how artificial intelligence is being used for healthcare and other technological advancements, we are also learning how it will impact our lives, and it’s affect on real estate.

If people are living longer, they won’t be moving out of their houses as quickly. There may not be as much need for hospitals or assisted living facilities. There’s also a much greater chance that people will outlive the money they’ve tucked away for retirement.

Kraft has multiple patents for medical devices, immunology and stem cell-related technologies through faculty positions at Stanford University School of Medicine and the pediatric bone marrow transplant service at the University of California, San Francisco.


Podcast Transcript: Prolonging Life with Technology

Kathy Fettke: Daniel, welcome to the Real Wealth Show.

Daniel Kraft: Great to be here, thanks.

Kathy: It is really an honor to have you here. I follow you guys closely at Singularity and I think you’re obviously on the cutting edge of what’s happening out there. Again, thank you so much for sharing some of it with us today. As I mentioned, we have a lot of listeners from the Silicon Valley, a lot of people who are investing in real estate but a lot of people who are just probably wondering what the world’s going to be like in the next five, 10, 15, or even 20 years. I don’t know if we can look that far out. Let’s just start with aging. How do you see medical advancements affecting how much longer and healthier we can live?

Daniel: We’re not getting older all the time, but the future is coming faster than some might think particularly here in “Silicon Valley.” A lot of people are interested in “longevity” and some are interested in living forever. I think forever’s a very long time. I’m more interested– I’m a physician, the chair of medicine at Singularity University that started to think more about health span rather than just life span.

If you look back 100 years, I think you know the life expectancy back in, 100 years ago, 1910 or so before antibiotics and vaccines was 50s or so. Now, dramatically, we’re up there in the high 70s, I think in the U.S. even though that’s gone down a notch, I think, probably thanks to the opioid epidemic. There is an opportunity to leverage sometimes very basic technologies again, like vaccinations, clean water, good food to optimize our health and our health span. In the longevity space, I think we are going to see more and more people living– Kids today, I’ve got three and five-year-olds, their odds of living to 100 or longer are quite good, which means we need to rethink education, social constructs, do people retire at age 65, how do we think about health insurance, life insurance and even real estate. Are people going to be aging in place?

I think no one wants to be living to 110 in a nursing home, not able to think, walk, talk or communicate. We want to think about enabling tools as folks have some physical and even mental decline to use technologies to improve their quality of life and provide resources to not create a burden on society at the same time. A lot’s happening in this space. We can talk about everything from longevity drugs to 3D printing organs, but bottom line, it still comes down to fundamentals. If you want to live a long, healthy life, eat well, don’t smoke, get 30 minutes of exercise three times a week, have good social connections, sense of purpose. Sometimes, it isn’t about magical new technologies but doing the basics.

Kathy: Very good point. I love that. All right. Right now, what is the average life span in the U.S. I imagine it ranges?

Daniel: I think for women, it’s early 80s and men, it’s late 70s. I think it’s [unintelligible], certain ethnic groups– Sometimes, our genetic code is trumped by our zip code. There’s a lot of that focus on social determinants of health, understanding– Do you have access to healthy foods? Are you near a market or are you only surrounded by fast food restaurants. But sometimes there’s a very dramatic five or 10-year difference in life expectancy, one or two zip codes apart.

Again, it might matter who and where you are and where you live. Definitely, it’s creeping up. Definitely, there are questions of you might live into your 80s or 90s but the risk of getting dementia is higher. There’s some estimates that once you’re over 90, more than 60% has some form of dementia. That’s a critical issue. We’re learning to, hopefully, identify who’s likely to get Alzheimer’s maybe 10 or 20 years early and then potentially be proactive and find ways to stop or reverse it from occurring, just like we take statins for folks who might have high risk of a heart disease because their cholesterol is high.

We’ll, hopefully, just try to identify folks earlier in their lives when they’re younger and healthier, be much more proactive which will give them that runway to live well into their 90s in a highly health span-effect function.

Living Well With Proactive Healthcare

Kathy: People really should be meeting with their doctor and looking at any Alzheimer’s prevention young, are you saying in the 50s, 60s?

Daniel: Well, some folks do get brain issues earlier in life. One of the challenges with things like Alzheimer’s is it does have new ways to predict it from your genetics, from like a 23andMe-type profile, all the way to needing a video game to track your eyes or some other forms of blood and eye tests. The challenge is what you do about that? We know that being socially engaged, learning languages can do somewhat preventative, but there still isn’t an obvious prevention or cure.

More importantly, certainly good to see your doctor on a regular basis to be proactive, to identify things you could be doing earlier in your life. A lot of them are behavioral based, managing stress, quitting smoking, being careful about your diet. All those are elements that are going to give you a longer, healthier life without waiting for some magical pill or therapy or a gene therapy to save you once you have the problem.

There’s a lot of technology that’s emerging. Some of them are super simple, the world of quantified cells. We’re only 10 years since the Fitbit launched in 2009. Now, we have an explosion of little wearable devices or sensors in your home with batteries that can give you insights. 10,000 steps is probably not the answer. Turns out maybe only 4,500 in the low [unintelligible] to improve outcomes.

How do we start to measure our behavior, some of our activity to our sleep, to our social interaction, to our heart rate and resting heart rate that we can use as tools to have insights ourselves as individuals, share that eventually with our clinical teams to really move from reactive sick care or folks that have usually often wait for disease to show up like a heart attack or stroke or cancer into an era that’s much more continuous with data and where it can be much more proactive, meaning you, as an individual, as a consumer, as a patient, will hopefully, own your health information and your genetic information.

Use that in collaboration with your doctor and health team to live a longer, healthier life and to be proactive about if you have a risk of fall, how future proofing your house with things in your bathroom or if you have a risk of a certain disease, maybe getting screened earlier rather than later. Tons of potential but often that comes down to the individual being proactive and not waiting for problems to occur.

Impact on Real Estate

Kathy: There’s been some theories that baby boomers and aging generations will be moving out of their homes and there’ll be a surplus of homes because there won’t be enough millennials able to buy those homes. The more I hear about breakthroughs in healthcare, I just don’t know if that’s true. It seems like us, seniors, might be living in place longer. What are your thoughts on that?

Daniel: Well, I live in the Silicon Valley area where the housing prices, I know, are pretty extreme. People can’t afford to move out in some cases, you know if they’ve bought 20, 30 years ago unless they move to Arizona or somewhere with lower housing prices.

I’m not an economist, but I think, as we look at the changes of demographics, how and where people live, some of them are changing, some people are doing shared housing to be able to afford to live in expensive areas. We’ve seen some folks who, as they get older, move into not “a retirement community” but collaborative, shared communities where they might have common areas that have central areas to do art and cooking and they maintain this social connection which are super important.

Feeling alone or isolated is more dangerous than tobacco and smoking in terms of how that comes up. There’s, I think, new constructs to how and where we live and also with the emergence of technologies like self-driving cars. The other day, I think I saw three self-driving cars from Waymo, the Google spinout. That can enable folks to get around or live in more remote areas and still be able to come to San Francisco.

That will change real estate and housing prices as well because it used to be location, location, location. When you can jump in your Uber drone that will take you to San Francisco and you might live in Santa Cruz without two hours of driving, that will change how and where people live as well.

Kathy: I want to be able to fly that drone. How much faster can we get to Santa Cruz if we could just fly there.


How soon till we have flying cars?

Daniel: Well, I was just in London and saw a live demo of a flying little electric powered not even a drone, but piloted little hover-cycle which would enable you to really zip around I think it has 20 minutes of battery. Some folks think that might be the future of transportation where you will hop on that. You’ll either drive it yourself, but arguably, just like with driving, the robots are coming and self-driving cars and self-driving drones are emerging faster than we might expect. One of the Singularity University, early startups was Batternet in 2010, which meant the idea of using drones to deliver things like drugs and vaccines to remote locations. Now they’re rolling out in Europe, in developing countries. There’s a company called Zipline, which is a multibillion dollar start-up out of San Francisco that is servicing over 1000 clinics in Rwanda. How we can deliver products, devices, drugs, medical elements, but also transport. I think we’ll see drone transportation, certainly here in the next 10 years. I think in Dubai, there’s already plans to roll that out in the next couple of years.

Kathy: Oh, my gosh, we’re just going to see so many changes. With that, there’s a lot of fear about the stock market today in the economy and we’re at now the longest expansion, people want to know where to put their money. It seems like and I’ve always said that you don’t have to answer this because this is the question you may not know the answer for. I’ve always said, “Hey, you can’t make any more land.” Maybe that’s not true. Maybe we can fly to Mars and create societies there or we can maybe build out the oceans or build up more.

Still, at the end of the day, so far, we can’t build more Earth and dirt to be able to create more housing or more retail. Do you think personally that investing in real estate could end up being a very good investment over the next 10 or 20 years as we’re seeing people stay in their homes and we’re seeing future generations growing and people living longer?

Daniel: I would say yes. Certainly, everyone wants a place to live but the form of how that’s happening is, has the potential to shift. You can look at comfortable markets like Japan, where they’re very small homes, where you could add in new technologies like augmented and virtual reality that you might get a small apartment that feel like you have an ocean view or at the top of Twin Peaks. Social virtual reality, as well, can bring people together and even the nature of the work. We talked about where houses might be the future of work is often remote work.

Again, that might change real estate and pricing because people can live almost wherever they want to be. Usually it’s at a Starbucks with a Wi-Fi connection, but can change how and where people spend their lives as well as how they interact. Does everybody need to buy a lawn mower or have an RV? Now we’re in the sharing economy. I think I’m imagining 10, 20 years from now, the retirees may just have a self-driving RV and drive around the country and they wake up in Yosemite and the next day are in Wyoming, and it’ll still drive them where they want to be. That might be interesting retirement concepts to blend these things together, as well.

Long answer. I think obviously, real estate is proven to be a pretty good investment long-term in many markets. But with shifting demographics, aging populations, do you want to invest in hospitals anymore? We’re entering an era of more virtual care. I think will be less hospital beds. The folks who are in those beds will be sicker but we’re seeing the advent of virtualized care where you can do obviously, telehealth consults, have sensors in diagnostics, even labs on the chip in your home, which will change the nature of how and where we get medical care.

When I think about investing in hospital towers, I’d probably think more about the outpatient clinics and virtualized care where we’re seeing the mini clinics and CVSs and Walgreens try and bring primary care to your local pharmacy or services, which will deliver your new drugs by drone. Amazon health prime will probably be here soon, too. Those are all things that are going to impact how and where we live in this exponential age.

Kathy: Fascinating. It seems like nations are competing today to be the first and the best in AI. How would you say the U.S. compares to say China or other nations who are developing AI?

Daniel: I think we’re at a danger of losing our advantage. Some of it is policy-based. There was recently a story on Bloomberg about academic medical centers losing or having to send their Chinese postdocs and researchers home. Many companies used to stay here and provide a lot of the impetus, a lot of the great startups and technologies have come from, folks from overseas coming to the U.S. Now they’re being blocked by some of the White House policies from getting here. I think we have a danger of losing our edge.

I think AI, I like to think of it as IA intelligence augmentation, is going to start blending into our lives as it already has in so many ways, particularly in healthcare where part of the future will be having AI health coach and time-shares that’s going to learn you and give you nudges to keep you healthy or pick up disease early. The check engine light on your wrist. The Apple Watches today can already pick up heart abnormalities and changes in behavior.

I know China and other folks in the world are moving very quickly in the AI space, it’s going to be the new battleground, I think. The better algorithms you have, the better you can predict both financial markets as well as medical issues and therapies. That’s a big space where there’s lots of potential and competition.

Kathy: Absolutely. Goodness. All right. Well, that was very interesting. I don’t know how that will change over the next five years in terms of America getting on the battle…

Daniel: One thing that’s already changing, it’s already impacting the investment world that Singularity University– I run a program called exponential medicine, but there’s also one called exponential finance. How do you invest? AI agents are changing the game of financial advisers. I use something like Wealthfront to do investments with AI assistance. Again, as I mentioned, more of your healthcare will be driven by AI and machine learning with big data and the ability to now take all this massive amounts of clinical exponential data, turn that into actionable information whether it’s about investments, or your health or your community. It has a ton of potential.

It also has its downsides as well around privacy and who controls AI engines. I always like to say that almost every technology has a plus and a minus. You can 3D print a medical device, you can 3D print a gun, you can use an AI to help discover a drug or to co-opt an economic market. We need to be careful with these tools and think, what are some of the potentials downstream when, for example, in 10 years, they’ll be $100 genome and we can all be sequenced.

What’s going to happen to your life insurance or health insurance when you may be a genetic eight or genetic three? What happens when your employer has information about your healthcare risks, your likelihood to live to 90 or to 60? Lots of both policy and ethics issues that we need to be mindful of as technology accelerates.

Kathy: That’s interesting that you say that because there’s still a lot of people that won’t join 23andMe and they don’t want their medical records online. They’re probably already online would be my guess, somehow.

Daniel: Well, there’s a potential– I like to encourage folks actually to think of themselves not just as blood donors or organ donors but as data donors. Let’s look at a recent example. With only 12 years in to the smartphone world, the iPhone and Google Maps on mobile devices only became ubiquitous basically 10 years ago. Now, most of us couldn’t imagine driving without Google Maps or Waze, that’s crowdsourcing, your speed and location, that’s private data but that builds the map around us.

What if we had a Google Maps or Waze for your health and your health journey or your investment path that was based on encouraging folks to share and using technologies like blockchain to let you opt in and opt out and keep things hopefully secure and private, but there is a power of sharing that will hopefully benefit all of us. All ships will rise. I think we can think about building their ways of anything from your financial plan to your health path, if we all can weave through the eye of that storm and put safeguards in place, but not be overly protective of data because I think data wants to be free and that creates a lot of opportunity and economic benefit as well.

Kathy: Fascinating. What about jobs? There’s a lot of concern that robots are going to take jobs but some people say, “No, it’ll just create more jobs.” What are your thoughts on that?

Daniel: I think there’s been a concern that even with the beginning of the Industrial Age when the loom workers, the folks that used to weave get replaced by machines. I think it creates new opportunities, hopefully, for folks to work at the top of their game. Robots are coming. Let’s take a very common issue. Everyone knows the disruption that Uber and Lyft brought to the taxi world, and now arguably, we’ll have self-driving cars and trucks which are already very close to being on the roads in a normal fashion. What happens to the future of drivers as an example?

In medicine, I don’t think we’re going to replace the radiologist or the dermatologist, the pathologist, with an AI element. There’s already a shortage of most of those specialties, but we’ll start to augment them. It won’t be the AI replacing the doctor, but the doctor who uses AI will replace those who don’t. That will be similar, if you’re a broker or building a business. We need to be collaborative with these tools moving forward. I think– Some jobs, yes, will be replaced but hopefully that gives people the opportunity to work at the top of their license, at least in healthcare, but also to be doing newer paths to creativity and creating value.

Kathy: Excellent. Actually, would you just mind explaining what Singularity University is and how people can be involved in it somehow?

Daniel: Sure. It’s now a 10-year-old institution based in the heart of Silicon Valley at NASA Ames in Mountain View. I’ve been on the founding faculty, I chair medicine. There’s also elements and tracks for AI, robotics, 3D printing, nanotech, genomics, finance. The idea, in a nutshell, is to help educate, enable and empower today’s leaders and future leaders to understand the power and potential of rapidly accelerating some exponential technologies for more longer smartphones to 3D printing, to virtual reality, to nanotech, to blockchain, where are they now, how you might use those to disrupt whole industries.

Kodak went bust thanks to Instagram and digital photography. Kodak went away, as well. Lots of examples of companies being disrupted and being supplanted by new technology. It may be to address a local business issue, but more broadly, Singularity University likes to focus on addressing grand challenges from poverty and education to global health and how to use everything from wearable sensors to machine learning, to virtual reality, to chatbots and drones, to solve solutions and new global ways that impact millions of folks.

We’ve a variety of programs from five-day effective programs to– I run a program called exponential medicine all focused on the future of healthcare. The website is su.org for Singularity University. There are lots of opportunities for folks that think about the future, real estate, investing.

If you are an investor in any form, you need to be thinking about where the pot is going to be, what are the potentials to really impact and solve– and it’s the solutions and the companies that emerge that are solving grand challenges. Many of them are using these fast-paced technologies, where I think the opportunity is to be a winner from the investor side, but also from the innovator and entrepreneurship lens. Check out sg.org for lots of elements and if you’re interested in health care, check out exponentialmedicine.com.

Kathy: Fascinating. This is great stuff, I really appreciate you being here on the Real Wealth Show. I think the bottom line is people need to really stay on top of what’s happening and understand that today’s world, it’s not going to be the same in five or 10 years. Generally, I should say, good investors see those trends coming.

Daniel: I’ll leave you with one thought in terms of trends. Health as wealth. Take care of your health. You’re worth $10 billion. If you’re not healthy, it’s a bit of a so what and we know that the leading cause of bankruptcy of the United States is based on medical issues. Getting too many medical bills or emergencies on the healthcare side. I think it’s really a combined element, the economy, you’re 18, 19% of our GDP is based on a sick care healthcare system. We need new mindsets and solutions in that realm.

Anybody out there listening can be a catalyst for the future of health and medicine by simply trying– if you have high blood pressure, getting connected blood pressure cuffs, and that they that your doctor will they want to see it or not. Start to use some of these tools for yourself, your friends, your family, your employees and start think of it exponentially about what the potentials are in healthcare or investment. There’s a quote from Bill Gates that we tend to overestimate what will happen in a year and underestimate what will happen in a decade. The next decade is going to be quite incredible in terms of what we see in terms of the acceleration across many industries and fields.

Kathy: Fascinating, all right. Thank you, Daniel, so much for being here on the Real Wealth Show and sharing your insights.

Daniel: Thanks for having me.

Kathy: Thank you for joining me here on the Real Wealth Show. You can listen to this and any past episodes at realwealthshow.com.

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