The end of illness?

A California cancer expert and author claims that one day, people will die suddenly rather than after years of decline.

By JUDY SIEGEL-ITZKOVICH
Device that detects skin cancer 370 (photo credit: REUTERS/Mark Baker)
Device that detects skin cancer 370
(photo credit: REUTERS/Mark Baker)
After myriad clinical studies on how to prevent disease, there are clear guidelines on what people generally need to do and eat to have a shot a longevity. Yet, from time to time, recommendations fall to the wayside as new discoveries result in “course corrections” on the path to long life and health. Gobbling multivitamins, for example, is now out and working out in the morning following by a day of office work is out.
Prof. David Agus, a prominent 48-yearold oncologist at Cedars-Sinai Medical Center in Los Angeles and author of the bestselling book The End of Illness, has aimed beyond increasing the numbers of nonagenarians around the world. He dispenses medical advice aimed at helping people to live robustly until their last breath – like Moses the prophet was gathered unto his fathers without first suffering from any debilitating illness. Originally published in 2011 in English by the Free Press Division of Simon and Schuster, the book has just been translated into Hebrew by Matar.
(One hopes that the Hebrew edition will expunge the original endorsement that appears on the English version from Lance Armstrong, the disgraced “seven-time Tour de France winner.”) Agus, who comes from a prominent Jewish family – his grandfather, Rabbi Jacob Agus, was a theologian and the author of books on Jewish history and philosophy – is coming to Jerusalem later this month.
The author was invited to attend the Presidential Conference by President Shimon Peres – who is well known for his own healthy longevity.
Agus graduated from Princeton University and received his medical degree from the University of Pennsylvania School of Medicine. He then did his residency at Baltimore’s Johns Hopkins Hospital and completed his oncology fellowship training at New York’s famed Memorial Sloan-Kettering Cancer Center, where he also headed the tumor biology lab.
His dealings with cancer led to his exploration of genetic influences and his co-founding of two California companies – Navigenics, a personal genetic testing company, and Applied Proteomics, which searches the blood for biomarkers that provide early warning or prevention of disease. Agus us currently a professor of medicine and engineering at the University of Southern California’s Keck School of Medicine.
The 335-pageThe End of Illness, his first book, was on The New York Times bestseller list. At the outset, Agus notes that colleagues were surprised he went to treating and researching cancer because, with exceptions, “there’s little hope for survival in many cases, and the cure is as evasive today as it ever was. I’m infuriated by the statistics, disappointed in the progress that the medical profession has made and exasperated by the backward thinking that science continues to espouse, which no doubt cripples our hunt for the magic bullet.”
He continues: “The war on cancer might be ugly and destructive on many levels. But on a positive note there are many lessons learned in the experience of this war that can then be used to prevent future wars and maximize peace. After all, the goal should be to avoid ever having to go to war rather than to win a war. And in the health realm, this is especially true.”
HIS IDEAL end of life is “to live robustly to a ripe old age of 100 or more. Then, as if your master switch clicked off, your body just goes kaput. You die peacefully in your sleep after your last dance that evening.
You don’t die of any particular illness, and you haven’t gradually been wasting away under the spell of some awful, enfeebling disease that began years or decades earlier.”
The “end of illness,” he writes, “is closer than you might think.”
He wrote his book to propose a new health model that will “dramatically change your view of the human body,” “show you how to apply that model to your own life” and to “reveal eye-opening medical technologies that are currently available or in development that can help you to achieve the quality of life and longevity that you deserve. With the information disclosed in this book, you’ll commence a journey down a completely different path from the one you’re on now, and it will change your life for the better,” Agus enthuses.
He advocates looking at and “honoring the body” as being composed of complex, whole systems. He also states that there is no “right answer” in health decisions but several right answers. “You have to make the right decisions for you – based on your personal code of values and health circumstances and in consultation with your own physician.”
He uses the term “metrics” to measure one’s state of health on a regular basis.
Early in the volume, the author provides a four-page “Personal Health Inventory Questionnaire” in which he asks readers to assess themselves as laymen. How do you feel? How do you rank your energy level? How much do you exercise compared to years ago? Do you walk easily? How is your sense of smell? Do your socks leave indentations on your legs? Have your nails changed color lately? Do your joints hurt? How’s your appetite? Do you get colds a lot? How’s your stress level? Are you happy with your weight? Rate your overall satisfaction with yourself on a scale of one to 10. Yet none of these are sensational or any different from what a general practitioner would conventionally ask a new patient.
While the conclusion of the Human Genome Project in 2003 earned many headlines and was thought to presage the finding of more treatments and even cures for many illness, these were false hopes.
Knowing what genes are defective is not enough, wrote Agus. Identifying the estimated 25,000 different proteins (enzymes and other substances) whose presence or lack thereof bring about disease is more important, he continued.
Agus provides a long discussion of proteomics and genetics – but since he coowns businesses that offer people expensive tests, not many of which already have practical applications for extending life or avoiding disease – some creeping suspicions entered my mind regarding conflict of interest.
He writes clearly as the sub-heading of one of his chapters: “Consider Genetic Testing.” Know as much about yourself as possible through the use of technology, including how you metabolize drugs, Agus writes in his “Health Rule” at the end of numerous chapters. “Technology has allowed us to live long enough to develop age-related disease. it will also allow us to present, treat and manage agerelated disease so we can live robustly for as long as possible.”
ALTHOUGH I have long been an advocate of health promotion and disease prevention – just living right – instead of disease being treated in clinics and hospitals, the advice that Agus gives in his book did not knock my socks off. Here is a partial list: Women should not wear high-heeled shoes on a regular basis, as this chronic trauma of the legs causes “inflammation” that triggers illness. He noted that boxers, football players and others exposed regularly to physical trauma are also likely to develop damaging inflammation.
“Be wary of headlines that tell you what’s good or you. Scrutinize data before accepting it as dogma,” he writes in a chapter in which he criticizes the massive sales of multivitamins, especially vitamins C, D and E. “Ditch shortcuts to nutrition and health, which can shortcut your life.
Unless you are correcting a legitimate deficiency or addressing a condition such as pregnancy, then you likely don’t need to be taking multivitamins,” Agus writes.
It’s very odd for an oncologist who knows that tobacco is the number-one preventible cause of death that he doesn’t mention smoking cessation even once in the book! The author even insists that certain vitamins in multivitamin pills could feed tumors, and so are best avoided. Although megadoses of vitamin C have been regarded as bad advice not long after Chemistry Nobel Prize Laureate Dr. Linus Pauling advocated them, and vitamin E supplements not been proven to prevent disease, Vitamin D continues to be endorsed by a huge pile of research studies.
While Agus does recommend eating a diet rich in the vitamin, he claims that many people are deficient but still perfectly healthy. Israeli 1%-fat milk is already enriched with vitamin D, but 3%-fat milk is not because dairy companies market more-expensive cartons of milk with added vitamin D. Yet a Health Ministry panel has recommended that all types of milk be fortified.
Agus’s doubts about the vitamin do not outweigh, for me at least, numerous lectures by academics and huge numbers of clinical studies that recommend fortification and taking of vitamin drops and tablets to help prevent a gamut of disorders, from osteoporosis to ovarian cancers.
Although Agus advises people to eat substantial amounts of fruits and vegetables, he warns that much of the produce in supermarkets have been cold-storaged and put on display for so long that one can’t regard them as “fresh.” Thus, frozen vegetables that are taken from the fields and quickly frozen are probably “fresher” – will less loss of vitamins – than many sold in supermarkets and even in open-air markets, he insists. In any case, if one can’t always buy frozen produce because of the expense, cooking it in a little water or microwaving them for a few minutes is better if they cannot be eaten uncooked.
While fruit juices are considered by many people to be “liquid good health,” Agus sensibly warns against them, because they lack the original fiber of the fruit and are chock-full of natural sugar, which is no better for you than foods to which white or brown sugar or honey has been added.
As for eating in general, Agus endorses “moderation,” eating on a regular schedule without snacking (but most nutritionists recommend snacking on low-calorie vegetables and even fruits), consuming coldwater fish at least three times a week (these include most salmon, sardines, tuna, rainbow trout, anchovies, herring, halibut, cod and so on).
He also recommends eating a “multicolor diet” of fruits and vegetables, but this too is nothing new, as the Israel Cancer Association has for years recommended this, noting that each color represents different nutrients that the body needs. Agus recommends drinking red wine (one glass a night) five times per week, “unless you’re at high risk or breast cancer.” But not all experts endorse drinking alcohol to prevent heart disease; they may prefer olive oil, which does not pose the risk to drivers.
“Sitting for long periods of time, he writes, even if you exercise rigorously once during the day, has biological effects that are surprisingly worse than we even imagined.
Find opportunities to move your body as much as you can during the course of your usual day. For example, take the stairs instead of the elevator, and get a cordless telephone to walk around your office while speaking rather than sit at your desk. All this should be in addition to engaging in traditional exercise.”
While his advice about not being stationary would certainly win approval from all experts, not all think that exercise once a day and sitting behind a desk the rest of the time is as dangerous as Agus claims.
The oncologist is an enthusiastic advocate of taking a statin pill (to reduce cholesterol, inflammation and cancer, he says), a daily baby aspirin and annual flu examinations.
But taking a statin daily and automatically is not recommended for all, as it may have disturbing side effects, even loss of memory; always consult your personal physician. Over-the-counter, low-dose aspirin, too, may cause bleeding and should not be taken without asking your doctor. However, the Health Ministry and others do recommend annual flu shots for everybody over the age of six months.
It isn’t easy for me to differ with Nobel Prize laureates, famous authors, a former US vice president and a leading computer executive whose endorsements on the back of the book call it “profound,” “brilliant” and use other superlatives. I found it an interesting and thought-provoking volume that could benefit many people who improve their lifestyles. But it will not lead to the “end of disease.” It does not show the way to the cure of cancer.
Prof. Cliff Hudis, a renowned oncologist at Memorial Sloan-Kettering who was interviewed on these pages a few weeks ago and knows Agus personally, summarized the book more soberly: “David Agus discusses some common sense ideas that are regrettably not commonly applied even as there is increasing scientific justification for them. Eat well, exercise, stay slim and get some sleep are good for you, and just plain good!”