“I really believe diseases are verbs,” says Dr. David Agus, one of Steve Jobs’s oncologists and a medical researcher at the University of Southern California. “You’re cancering. So I want to take you from a cancer state to a health state.”
In his new book, The End of Illness, Agus argues that the key to a radical reduction in illness is to prevent the unhealthy lifestyles that allow diseases to thrive. And while the saying “an ounce of prevention is worth a pound of cure” dates back to Benjamin Franklin, the idea is timeless–even if our current approach to medicine doesn’t always reflect it.
“For example,” he explains, “skipping a flu shot and getting the flu has major implications for heart disease and cancer a decade from now.” Everything from improper running shoes to an unnatural dose of vitamins from supplements can tip off a domino effect of complex reactions. The solutions, he argues, are cutting-edge “proteomics” technologies that allow researchers to customize medical treatments, a insurance system that penalizes unhealthy behavior, and eating and workout habits that are more akin to the active, whole-food lifestyles of ancient man.
Viewing Health As A “System”
Modern health care, Agus argues, has wrongly gone after diseases with laser-like precision. To Agus, proper prevention means getting the body to a place that limits the number of possible ways diseases can develop and thrive. “I’m a big believer in flu vaccines,” he writes, citing a 2006 recommendation from the American Heart Association. “If not to prevent the flu, then to at least prevent marked increases of inflammation that can come back to haunt us later in life.”
Agus notes that many people unwittingly coexist peacefully with mild forms of cancer. His focus is less about destroying cancer cells and more about preventing those who die “from cancer.”
The philosophy also extends to nutrition and diet. For instance, we combat weight loss by driving to the gym to walk on a treadmill–and then return to hunch over laptops for hours on end. “Sitting at your desk is akin to smoking a cigarette,” he says. Prolonged sitting, independent of physical exercise, he writes, “has been shown to have significant metabolic consequences,” influencing everything from cholesterol levels to blood sugar.
As a result, Agus purchased a mobile headset that allows him to talk on the phone while walking around the office. More sophisticated technologies like the Jawbone Up, a smartphone-enabled wristband, monitor activity throughout the day and remind idle users to periodically move about.
The End of Illness is, in part, intended to dispel the common myths that Agus believes are pervasive even among well-informed individuals. He attacks vitamin-crammed supplements, health shakes, and a lack of critical-thinking activities with an entertaining mix of history and contemporary research, ultimately advocating for a lifestyle that is more akin to ancient man: locally sourced or flash-frozen whole foods, constant activity, and prolonged reading and writing, especially during the golden years.
To motivate such behavior, insurance companies should vary prices and subsidies in accordance with healthy behavior–while punishing unhealthy behavior, he says. “Why should people who get the flu shot subsidize people who don’t?”
“We treat everyone the same in this country,” says Agus. “The goal is to figure out who should get what.” Since all medical research is based on the probability of a treatment working, patients are treated like lab rats with various medicines and treatments until (fingers crossed) something works. With an advanced understanding of a patient’s genetic makeup, doctors can know “whether you are likely to experience severe side effects with a particular drug, and in other cases whether the drug is likely to be effective for you,” he writes.
Agus is a pioneer in the field of proteomics, understanding the body’s internal state from its proteins. In 2007, he founded Navigenics, a consumer-facing, low-cost genetic testing company. Proteomics, in part, works by examining chemical traces which are picked up as blood travels through the body, since each “drop goes through all of you and reflects everything going on in you at that moment in time,” he says.
The cover of the book (and picture up top) is an entire human proteom, which can potentially give doctors enough information to perfectly tailor drugs to each individual. Agus argues that “we have most of the drugs we need treat human disease; I just want to learn how to learn and who to use them in.”
“With enough data, error goes away,” Agus says, quoting the old statistics adage that more information allows us to whittle away why things do and do not work. The example, he notes, is Lance Armstrong, who whose cancer was, in part, cured with an injection of platinum-based chemical. Unfortunately, like many promising treatments, Armstrong’s treatment couldn’t be replicated reliably in randomized trials. “I want to learn more about those Lance Armstrong experiences.”
As an experiment in data collection, Agus has placed chips inside the pain pills of his patients, which alert him, by cellphone, if they’re ingested. If a patient happens to up his dosage, and explains to the doctor “‘my pain’s getting worse,’ we can intervene in the cancer then vs. when they’re come back to see me again arbitrarily in three months,” he says.
An interesting experiment in continuous self-montoring was conducted by Tim Ferriss in the best-selling The Four-Hour Body. When Ferriss began measuring the insulin effect of certain foods with an implantable glucose monitor, he discovered some surprising effects that went undecteced in arbitrary finger pricks.
At the moment, we collect a fraction of the data we’re capable of, from details at doctor’s office visits to wearable devices that can constantly measure behavior and vitals. A nascent movement is under way encouraging users to become “data donors,” sharing otherwise private information for public analysis (check out patientslikeme.com).
Open data advocate Jeff Jarvis, meanwhile, helped popularize the highly contentious idea in his public blog about his diagnosis and treatment of prostate cancer (including all the embarrassing residual of sexual dysfunction).
After coming out with the information, Jarvis told Fast Company, a friend revealed his own personal experience with cancer and “he gave me incredible advice that I would not have gotten from any doctor’s pamphlet.” Jarvis acknowledges the critics’ concern over employee and insurance discrimination, but, given his own experience, he is emphatic about erring toward more information. “You’re restricting their ability to cure diseases and to save lives. That’s not only logically absurd, it’s potentially offensive and dangerous.”
Jarvis and Agus both believe that data can be anonymized, yet clever statisticians have found ways of reverse-engineering the data and pinpointing its source. Ultimately, there are only so many individuals of a certain age, race, gender, and with certain conditions–the more data collected, the easier it is to identify the combination of characteristics that are unique to an individual. Thus, in the future, we may have to choose between privacy and the benefits of sharing data.
Some commercial constant-monitoring systems are already available for the elderly, such as General Electric’s QuietCare, which monitors movement throughout the house, and alerts medical staff to any irregularities.
“I want to learn from every experience,” says Agus. “I want there to be medicine that’s improving literally on a daily basis.”
[Profile Image: Todd Hido]