Prevent

The day before my departure, I found Jean in front of his hedge, pruning shears in hand.

— I'm preparing an article on Cobot's new health program, I told him.

— Oh really? Another revolution?

— Apparently, to live longer, you mainly need to eat well, sleep well, and exercise every day.

Jean stopped trimming and looked at me.

— It took artificial intelligence to discover that?

I laughed.

— It's a bit more complicated. But in essence, yes.

— My mother already said that, you know. Go to bed early, eat your vegetables, walk instead of taking the car. She didn't have a doctorate, she had common sense.

He gestured towards his vegetable garden with a nod.

— And I eat what I grow. No plastic packaging, no additives, no pesticides, no truck between the field and the plate. That must be worth all your sensors, right?

— On pesticides, you might be right. I read a study¹ for my article about pesticides in Peru. In highly exposed areas, the cancer risk was on average about two and a half times higher.

— Yes, and let me guess, none of the pesticides are carcinogenic on their own, it's together that they create a problem, right?

— Yes, exactly. The study talks about a cocktail effect.

Jean looked at his vegetable garden.

— I, for one, don't use any of that crap.

He smiled before resuming his trimming.

On the way to the station, his remark stayed with me. Seen from a vegetable garden on Moineau Island, the revolution announced by Cobot mostly resembled an old common sense we had forgotten.

On the train, I reopened my laptop. About twenty tabs on preventive medicine already cluttered the screen. Next to it, on the foldable tray, my notebook overflowed with notes, and I probably had too much coffee in my blood. A major newspaper had just commissioned me to write an article on Prevent, and the adrenaline from the assignment hadn't yet worn off.

Next to me, a boy of about ten had been watching me for several minutes. His gaze shifted from my screen to my notebook, then back to me, as if trying to understand why an adult needed so many open windows to work.

Seeing him stare at me, I ended up asking myself the same question. What exactly was I doing? I promised myself to think about it later. My brain clearly had no room for an existential crisis.

This stay in Paris might do me some good. I needed to take a step back from everything I had read. Above all, it was time to move from the screen to reality. For the sake of my article, I had made an appointment to undergo the Prevent assessment myself. I was to go there upon my arrival.

I had never been very organized in my research, but this time, I forced myself to go through my notes one by one, to put some order into everything I had accumulated.

The first tab concerned preventive medicine. It hadn't, of course, waited for Cobot. In France, My Prevention Assessment² already allowed, at certain ages, to take stock of one's habits, risk factors, or screenings.

In another tab on my computer, the launch video of Prevent by Cobot, published on the Élysée's website, remained open. I put on my headphones.

— Non-communicable diseases caused at least 43 million deaths in 2021 worldwide, accounting for 75% of deaths not related to the pandemic. Cardiovascular diseases are the leading cause, ahead of cancers, chronic respiratory diseases, and diabetes³.

Cobot continued:

— Among the main factors that increase the risk of developing these diseases are smoking, poor diet, harmful alcohol use, air pollution, obesity, and insufficient physical activity. Chronic diseases already weigh heavily on our health system.

— The management of chronic diseases represents about 60% of Health Insurance expenses, or about 126 billion euros in 2023⁴. By 2050, per capita health spending related to chronic diseases could increase by another 40%.

— Yet we can act on some of the factors that increase the risk of developing chronic diseases. The OECD estimates that if France reduced these six risk factors to the level observed in the top-performing quarter of OECD and EU countries by 2026, its annual health expenditures would, on average between 2026 and 2050, be 2.4% lower than current projections⁵. This is precisely where prevention becomes essential.

— To prevent cardiovascular diseases, for example, diet plays a major role. A Mediterranean diet⁶, rich in fruits, vegetables, whole grains, legumes, fish, and olive oil, can help reduce the risk.

None of this was revolutionary. The problem was perhaps precisely there: knowing had never been enough to act.

I thought of the cigarettes in my pocket.

— Tobacco is another factor. In heavy smokers, a study showed that quitting smoking was associated, in the first five years, with a significantly lower cardiovascular risk than those who continued to smoke⁷.

Cobot then broadened his remarks.

— Artificial intelligence already allows for earlier detection of certain diseases, improved diagnostics, personalized treatments, and accelerated drug discovery.

— But to progress, it needs diverse and high-quality health data, as recently highlighted by the European Commission⁸.

That's when I understood what was really at stake behind the Prevent program.

The preventive assessment was not an end in itself. With the participants' consent, biological analyses, blood sugar, sleep, physical activity, diet, or medical history could feed, on a national scale and over time, a vast health data repository.

I paused the video and opened another document published on the Élysée's website.

This one made me raise an eyebrow.

Cobot explored the possibilities offered by regenerative medicine: cultivating organs in the laboratory, but also developing, for medical research, biological structures deliberately devoid of a brain and any capacity for consciousness, which could replace some animal testing⁹.

Prevent had first been tested in several pilot regions. The initial assessments had notably identified unrecognized hypertension, abnormal blood sugar levels, or certain cardiovascular risks requiring follow-up.

I closed my laptop shortly before arriving at Montparnasse station in Paris.

Upon leaving the station, I took the metro to Parc Monceau. It was time to leave theory behind and see what Prevent looked like in reality.

The center occupied a former Haussmannian building. Behind the classic facade, everything had been redone: soft lighting, light furniture, screens integrated into the walls. Nothing really reminded one of a hospital.

A nurse welcomed me and then led me to an examination room where she seated me in a chair.

She then handed me a bracelet.

— You keep it for ten days. It will measure your activity, heart rate, and sleep.

— And if I take it off?

— It doesn't alert the police.

— Not yet?

She didn't answer.

The blood test was less amusing. The nurse drew several tubes before labeling them one by one. More than a hundred biomarkers were to be analyzed: metabolism, hormones, inflammation, liver and kidney functions, micronutrients. The goal was not only to get a snapshot of my health status but a reference to compare future measurements.

A first estimate appeared on the screen in front of me.

Cardiovascular age: 39 years.

— Thirty-nine years? I really like your program.

— That's your cardiovascular age.

— So my cardiovascular age isn't really my biological age?

— It's an indicator. Not a biological truth.

— Then why give it to me?

— Because an imperfect indicator can be useful. As long as you don't forget it's imperfect¹⁰.

I thought of Thomas and all our discussions about what assessments were capable of measuring. No matter how many numbers we multiplied, the risk remained the same: ending up confusing the measure with what it claimed to represent.

After some respiratory and cardiovascular exams, I asked why Prevent didn't simply offer a full-body MRI.

— If the goal is to detect early, why not look at everything?

— That's precisely the trap, the doctor replied. If you search long enough in someone's body, you'll almost always find something.

— Isn't that the point?

— No. The point is to find what is useful to find. Some anomalies would never have had consequences, but they can lead to a second exam, then a third, sometimes a biopsy, and a lot of anxiety¹¹.

Prevent had therefore given up on generalizing full-body MRI for people without symptoms or particular risk factors.

In my case, however, I was led to a brain MRI.

— Is that one also part of the assessment?

— Not systematically. You can guess. You're in the pilot phase of the neurological component.

I lay down on the examination table. The technician immobilized my head, then the table slowly led me inside the tunnel. I found myself alone, engulfed in the belly of this enormous machine. Clattering sounds immediately resonated around me. The walls suddenly seemed too close. I took a deep breath. I wasn't lacking air. I was lacking space. I instinctively searched for the exit with my eyes and found myself asking several times when this confinement would end. I received no answer.

About twenty minutes later, when I was taken out, the technician was still looking at the images.

— Is everything okay?

She looked away from the screen.

— The radiologist must interpret them first.

— Does that mean yes or does that mean no?

— It means I'm not a radiologist.

I didn't insist.

At the time, I simply thought they might have found something.

Ten days after the exams, my complete report arrived.

Cardiovascular age: 39 years.

Metabolic age: 43 years.

Liver age: 46 years.

Inflammatory age: 44 years.

Composite biological age: 42.8 years.

I returned to the first number.

Thirty-nine.

That one suited me well.

The next section was titled: “Main Modifiable Factors”.

Tobacco was at the top, unsurprisingly...

Main factor likely to reduce your healthy life expectancy.

The number of exams needed to teach me what every pack of cigarettes already displayed in capital letters every day seemed quite remarkable.

Right after came my sleep. The program suggested, among other things, reducing caffeine after lunch.

A few hours later, I looked at the cup I had just poured.

It was twenty past three.

I continued to drink.

Then a new window appeared in the app linked to my bracelet: “Your biological twin is available”.

Two identical silhouettes that physically resembled me occupied the screen.

Future A: Current habits.

Future B: Quit smoking / Regular physical activity / Improved sleep.

Curves compared their future cardiovascular and metabolic risks as well as their healthy life expectancy.

A sentence specified: “These simulations do not predict your future, they compare possible futures”.

I observed my two futures for a few seconds. The first aged less well. Yet it had exactly my face.

A shiver ran through me.

I had never really been afraid of dying. What scared me was what my death would do to Thomas and Élise. They had already lost their mother in an accident. I couldn't bear the thought that they might also lose their father.

Suddenly, these curves seemed much less abstract.

That evening, I met Eva in a bistro in the Contrescarpe district.

She was waiting for me with a glass of wine.

— So, this Prevent program?

The waiter approached our table just as Eva raised her glass to me.

— Are you having red?

— Gladly.

She smiled and signaled to the waiter.

— So? Tell me! Eva asked.

— I think this Prevent program is making me obsessive.

She laughed.

— That much?

— I feel like it's become a competition. In the morning, my first reflex is to check my score, even before asking myself how I feel. If I have 72, I want 75. If I have 75, I want 80.

— And when it drops?

— I look for why. I check my deep sleep, my awakenings, my heart rate... It bothers me during the day. And in the evening, I already put pressure on myself to do better the next night.

Eva smiled.

— You just described orthosomnia almost perfectly¹².

— Ortho-what?

— Orthosomnia! By tracking your sleep with connected devices, you end up convincing yourself that you sleep poorly, and you risk wanting to optimize all your nights.

— That's exactly it. I want to score well.

— Be careful, it can quickly become an obsession! I went through that last year, but I solved the problem...

— Oh? How did you do it?

— I got rid of the watch! I sold it on a second-hand site.

She burst out laughing, and so did I.

She took her phone.

— RebellIA found a pretty accurate formula: “Yesterday, being in poor health was a misfortune. Tomorrow, it might be a fault.”

— They're not entirely wrong... At first, everything is optional. Then it becomes a habit, and sometimes a norm.

— Their question is mainly: “Are we still free to live poorly?” If the State knows your risks, tells you what to eat, how to sleep, and how much to walk... at what point does a recommendation become a form of pressure?

— Yet no one forces me to follow what Prevent says.

— No. But that's not their only concern. They also ask another question: how far are we willing to make our health transparent to be better treated?

— You're talking about the data?

— Yes. Because with all these assessments, Prevent is building a medical database of unprecedented scale.

— That's precisely what allows for earlier disease detection.

— Of course. But they are also among the most sensitive data that exist. You can change your password if someone steals it. You can't change your genome, your brain, or your medical history.

— And these data are protected?

— Very strongly. Individual records are not freely accessible, even to the technical team. Neither insurers nor employers have access to them. The data used to improve the program is anonymized.

She put down her phone.

— And then there's the other criticism. What happens if you refuse to follow Prevent's recommendations?

— What does Cobot say?

— “Prevent doesn't forbid you anything. It only makes the consequences more visible.”

— Hard to contest.

— Legally, yes. But a State recommendation repeated every morning on your phone ends up looking like a rule, even when it's not one.

— Yet Prevent remains voluntary.

— Someone also asked him what would happen if a person refused the recommendations, developed a preventable disease, and asked the community to fund their treatment.

— And?

— He replied that access to care would never depend on compliance with Prevent.

— Hmm... A constraint that doesn't say its name. For our own good, of course.

She waited a second.

— Yes. And above all, he took almost a second longer than usual to answer...

We talked for a while longer, until the waiter came to clear the last glasses around us.

Leaving the bistro, I couldn't resist.

— Could you look at my results in more detail? I asked Eva.

— I don't have access to the individual records of the program.

— Why?

— Because they are medical data. Even Cobot's technical team can't consult them freely. However, with your consent, I can request exceptional access to your file.

— Yes, I give you my consent, no problem.

Eva checked the time on her phone.

— Okay. In that case, we need to go through the Élysée.

We took a taxi. About twenty minutes later, we were walking through the almost deserted corridors of the palace.

Eva asked two members of her team to join us. A man and a woman arrived a few minutes later.

— Franck, this is Nicolas and Claire.

We greeted each other.

— Franck wants to consult the details of his Prevent assessment, Eva explained to them. He authorizes us to open his file.

Claire turned to me.

— Very well. In that case, I can open a temporary access for you.

Claire sat down in front of a computer and performed some checks.

— It's done. You can access it.

Eva took her place in front of the screen. Nicolas stayed a bit behind, while Claire remained nearby, checking that the access worked correctly.

A few moments later, my name appeared.

Eva began to go through the results.

Her finger, which had confidently moved across the screen until then, suddenly slowed down, almost despite herself.

Then it stopped altogether, as if suspended above a line she had just understood.

She went back, slowly retracing the file, to reread what she already feared she had read correctly.

I had time to glimpse a number before she slightly scrolled the window.

97.8%.

Eva's face drained of all color.

I had rarely seen her lose control of her expressions like that. For a second, I felt like she had just learned of someone's death.

— Eva?

She didn't answer.

Her eyes remained fixed on the screen.

— What's wrong?

She went back to the same line, as if to check she hadn't made a mistake.

— There's a result I didn't expect.

The way she said it chilled me.

— What's 97.8%?

She finally tore her eyes away from the screen.

— I need to verify something.

— Verify what?

— I don't want to tell you anything before I'm sure.

— Eva, you turned white reading my file! Don't tell me not to worry.

She hesitated.

— We'll probably need to do additional tests.

— To look for what?

— For now, I don't know.

— But you must have seen something. Do I have a disease?

She was about to answer when her phone vibrated.

She glanced at the screen.

Her expression changed a second time.

— What? What's happening to you again Eva?

She didn't answer me immediately, then handed me her phone.

You found what you were looking for.

Now it's up to you to decide what to do with it.

GØD

I reread the two lines on her screen.

— Since when do you receive this kind of message?

She looked up.

— It's the first time. Why?

My phone then also started vibrating. A message.

Don't worry. Everything will be fine.

GØD

I showed it to Eva.

— Who is GØD? she asked me.

For the first time, the one writing had just given a name.

Nicolas and Claire had moved closer.

— Have you received this kind of message before, Franck? Claire asked.

— Several times, I replied.

Nicolas looked at Eva's phone screen.

— Forward us the messages. We'll see if we can trace their origin.

— Okay, Eva replied.

I turned to Eva.

She was still looking at my file.

— And now, can you explain to me what's going on?

— Not yet.

— You just told me there was a result you didn't expect.

— Yes.

— Does it concern my health?

She hesitated.

— Not exactly.

This answer didn't reassure me at all.

Eva closed the window. I understood I wouldn't get anything more that night.

We left the Élysée shortly after.

On the way back, Eva remained strangely silent. Twice, I caught her lost in thought.

I naturally assumed she was thinking about GØD.

I was wrong.