Most chronic diseases don't begin with obvious symptoms or dramatic warning signs. Instead, they develop quietly over many years, as small changes accumulate in the body. A new perspective from researchers at the Buck Institute for Research on Aging notes that modern medicine often waits until disease is well underway and argues that new technologies could help detect risk much earlier, when prevention may be most effective.
The perspective, aptly titled "We Wait for Disease to Shout. What if We Listened When Biology Whispered?" introduces the concept of the "long tail" of biology. Rather than being caused by a single factor, most diseases and aging-related conditions develop from the combined impact of many small influences, including genetics, lifestyle, environmental exposures, sleep patterns, stress, and changes in the gut microbiome. Over time, these subtle shifts can gradually weaken the body's resilience and increase the risk of chronic disease.
"By the time many diseases are diagnosed, the body has often been drifting off course for years," said Nathan Price, PhD, Buck Institute professor , co-director of the Buck's Center for Human Healthspan and senior author of the paper. "We now have the opportunity to detect those early changes by tracking what's normal for each individual and noticing when biology starts to move in the wrong direction."
The researchers highlight how diseases such as type 2 diabetes, heart disease, and neurodegenerative disorders often begin developing long before symptoms appear. For example, in type 2 diabetes, biological changes related to inflammation, metabolism, and insulin function can occur 10 to 15 years before blood sugar levels rise enough to trigger a diagnosis. The authors argue that catching these early warning signals could open the door to interventions that help delay or even prevent disease.
To make this possible, the perspective proposes a new personalized framework that treats each individual as their own biological reference point. By tracking changes over time, rather than comparing someone to population averages, researchers believe it may be possible to identify subtle shifts that signal increased risk.
Advances in health technology are making this approach increasingly realistic. Wearable devices can now continuously track heart rate, sleep, activity, and other physiological signals, while modern laboratory techniques allow scientists to measure thousands of biological markers from simple samples such as blood, saliva, urine, or even breath. Combined with artificial intelligence tools that can analyze complex patterns, these technologies could help translate large amounts of data into meaningful, personalized insights.
"Medicine has traditionally focused on treating disease after symptoms appear," said Noa Rappaport PhD, lead author of the paper and an associate research professor at the Buck Institute. "Our goal is to shift toward protecting health by identifying risk earlier and understanding how each person's biology changes over time."
The authors also emphasize that major challenges remain. "Advanced biological testing can still be expensive, and healthcare systems are largely designed to treat illness rather than monitor long-term health," said Lee Hood, MD, PhD, distinguished professor and co-director of the Buck's Center for Healthspan. "Ensuring broad access to preventive technologies will be critical to preventing new health disparities. In addition, regulatory systems will need to adapt to evaluate new approaches that rely on personalized data and AI-driven analysis."
Despite these challenges, the researchers say the tools needed to transform prevention are rapidly emerging. By combining wearable sensors, advanced biological measurements, and artificial intelligence, they envision a future in which healthcare focuses not just on treating disease, but on preserving health throughout life.
Citation: We Wait for Disease to Shout. What if We Listened When Biology Whispered?
DOI: 10.1016/j.cels.2025.101509
Additional Buck Institute coauthor: Annalise Schweickart also contributed to the work.
COI: Nathan Price is chief scientific officer at Thorne and has a profit interest in the company. He also serves as an advisor to the Institute for Healthier Living, Abu Dhabi, and various companies where he has equity, including Vitaliti, Rue Four, ProPetDx, and Sera Prognostics.
Acknowledgements: This work was funded by an award from the Proactive Health Office of the Advanced Research Projects Agency for Health (ARPA-H) to the Personalized Analytics for Transforming Health (PATH) Project, the NIH NIA T32 AG000266 grant for Training in Basic Research on Aging and Age-Related Disease, and National Institutes of Health (NIH) grant no. U19AG023122 528
About the Buck Institute for Research on Aging
At the Buck, we aim to end the threat of age-related diseases for this and future generations. We bring together the most capable and passionate scientists from a broad range of disciplines to study mechanisms of aging and to identify therapeutics that slow down aging. Our goal is to increase human health span, or the healthy years of life. Located just north of San Francisco, we are globally recognized as the pioneer and leader in efforts to target aging, the number one risk factor for serious diseases including Alzheimer's, Parkinson's, cancer, macular degeneration, heart disease, and diabetes. The Buck wants to help people live better longer. Our success will ultimately change healthcare. Learn more at: https://buckinstitute.org
