by Azeem Panjwani, Founder and CEO, Arksense (azeem@arksense.co)
I was 11 years old when I was diagnosed with type 1 diabetes - an autoimmune condition where pancreas does not produce insulin
The fix is straightforward in theory: you have to inject insulin for the rest of your life. In practice, it means you are never not thinking about it
And, as a 11 year old kid, I didn’t want to think about it and I wanted to be normal. So I did what kids do when something makes them feel different - I pretended it wasn't there. I skipped taking injections. I ate what I wanted. I did what I wanted to. I didn't check my blood sugar for months at a time
This worked fine for the first decade of my diagnosis
But in 2023, a blood test came back with a few things wrong at once - early onset of kidney disease and grade 1 fatty liver (confirmed via ultrasound). And a few days later, I suddenly lost 90% of hearing in my left ear
I was 22. And all of this was scary for me
The explanation on the internet was simple that this is what happens when you mismanage type 1 diabetes for a decade. The body keeps the score. I had spent nearly eleven years pretending the disease wasn't there
At that point I had a choice. I could keep pretending and be in the denial mode, or figure out how to actually manage this
I found a really good US trained endocrinologist. She put me on an aggressive protocol. And for the first time, I started wearing a continuous glucose monitor (CGM) - a sensor on my arm that tells your glucose levels in real time, all day, 24/7
That device changed everything. But here is what I didn't fully understand at the time: the CGM alone wasn't what fixed things. Two things happened together. First, I could finally see what was happening inside my body. Second - and this is the part nobody talks about - I could run experiments on my own. I ate something and watched what happened. I changed my sleep routine and watched what happened. I adjusted insulin timing and watched what happened. Every intervention had a visible consequence - change in glucose levels. And every consequence taught me something. Over thousands of small iterations, I built a model of my own body to manage the disease well
In three months, I reversed the kidney and liver biomarkers that my blood reports told me were progressing and got my hearing back. The tool made me legible to myself. And once I could see what was happening, I could act on it and run the iteration loop
This entire journey made me highly agentic about managing my disease. It also gave me something I didn't expect - a purpose. Taking charge of my own health, being pathologically curious about what was happening inside my body, running constant experiments to figure out what works and what doesn’t - I realized this is something I cannot not do. Not just for myself. For everyone who is flying blind the way I was
The north star that I am moving towards in healthcare is improving the ratio:
Number of healthy years spent/ Amount of $ spent
People are living almost 10 years towards the end of their life being sick i.e. the average healthspan and lifespan gap is 9.6 years
See the below chart - hospital services have become extremely expensive over the years. And this should not be the case when we know how healthcare can improve the quality of life and economy
And with everything that I do in healthcare, I want to improve the ratio and help people get more and more healthy years with the least amount of money being spent
Healthcare in America is a sick care system, not a health care system
A century ago, the leading causes of death were infectious diseases - influenza, tuberculosis etc. The system got built for them - acute illness arrives, you treat it, the patient recovers or dies. Clean feedback loop. And the model made sense
Then, over years, the disease burden shifted. Today, eight of the ten leading causes of death are chronic conditions. The system never updated much. We still operate on the legacy model - waiting for the crisis, then treating it expensively
Clayton Christensen put it precisely: nearly all Americans are cared for by business models that profit from sickness, not wellness
That is not a resource problem. It is a design problem, I believe
Chronic conditions go undetected until they become emergencies. The system pays $87,000 per year to manage end-stage kidney disease when the same patient at Stage 2 costs $14,000. It is not that we cannot afford to prevent the disease. It is that the system was never designed to try.
I was reading The Infinity Machine by Sebastian Mallaby where the author talks about how in 1970s first clinical appointment with a patient used to be scheduled for a minimum of one hour. By 2019, that hour had been squeezed down to twelve mins in the US and nine mins in Britain and one of the big reasons has been clinicians spending inordinate amounts of time in clunky IT systems
But, this environment is changing right now
A new generation of companies is tackling this - AI scribes, patient navigation tools, automated prior auth, medical billing etc - and capital is flowing in at a scale the sector has never seen. Within 5 years we will be in a situation where there is abundance of healthcare - care available 24/7, doctors with more time to provide hyper-personalized interventions. Care delivery will move from reactive to real time to proactive
This means the supply of healthcare will be massive. People would want to connect with their doctors more often, take charge of their health and get great outcomes
But here is where the bottleneck emerges and many are missing - when intelligence becomes infinite, to provide hyper-personalized and automated care, there will be a massive need for the ground truth of what is happening inside your body in real time
And a correlation of this data with the context of your medications, your diet and in general your life that recommends doctors what works for you and that tells you what to do. One without the other does nothing
I learned this firsthand by wearing the CGM and doing experimentations and adjusting my medications with the help of a doctor. The sensor gave me the data, but the data was not what really fixed me. It was getting the ability to run experiments and do iterations based on what I ate, how I slept, when I took my insulin and how my mental state was. Every variable was visible to me and every change was measured. That loop between the data and the decision is what helped me reverse complications
That is what n-of-1 care actually means. Not a plan written once and reviewed every three months. A continuous loop between what is happening in your body and every decision you make that day with physician in the loop
Cardio-Kidney-Metabolic (CKM) patients have neither half of this - and there are 90 million such patients
We have miraculous drugs that work for them, but majority of these patients are not on those drugs. This is because of issues in care navigation, monitoring and lack of awareness. Everyone gets generalized advice. Multiple doctors (endocrinologists, PCPs, cardiologists, nephrologists) see them once in a quarter, optimizing for their own organs and not seeing the whole person. Patients get prescribed cocktail of medications, but no one really follows up with them. Many times when they do not feel well because of high potassium or any other issues, they are asked to go to an emergency room immediately and stop taking medications. Because of this fear, doctors also hesitate to prescribe and titrate medications that work for these patients
This means high expenditure on care and faster progression to the end stage disease