Search This Blog

Tuesday, March 6, 2012

Book Review: The End of illness by David Agus, MD

The recently published book, “The End of Illness” by David Agus, MD has received considerable positive attention. Its author is a professor of medicine and engineering at the University of Southern California medical school and the school of engineering. He heads USC’s Westside Cancer Center and the Center for Applied Molecular Medicine, and cofounded two companies that are attempting to personalize medicine: Navigenics, which seeks to identify an individual’s predisposition to various diseases from genetic testing, and Applied Proteomics, which intents to get even more health information from quantification of an individual’s proteins. He chairs the Global Agenda Council on Genetics for the World Economic Forum, and has received several awards including the 2009 GQ Magazine Rock Star of Science award.

I must say at the outset that the book is somewhat of a disappointment. It’s virtually impossible for a book to live up to such an audacious title and I hope it was the publishers who titled it rather than the author. In reality, the book offers little hope for an end to illness. Rather, it mainly offers a peek into a future in which, through genetic and protein testing, a patient can be well informed about his/her predisposition to various diseases and responsiveness to drug therapies. But the value of such knowledge seems to be overstated. Agus postulates that, knowing one’s tendency towards obesity will motivate someone to eat better and exercise more. However, all of us should be trying to do so. It is best to do all we can to maintain and improve our health, rather than merely targeting our greatest weaknesses. Also, many people know what their vulnerabilities are, from overeating to smoking to inactivity to drug abuse, but such knowledge most often fails to correct such adverse behavior. Thus, the book’s praise of what the author’s companies do comes across as both self-aggrandizement and advertising of services or investment opportunities.

Despite the weaknesses in the book, it offers some good basic health advice, most of which has been widely reported in other books and articles on health. Some of the book’s major points {with the book's recommendations in bold and my comments in brackets}:

We may never understand illnesses such as cancer. In fact, we may never cure cancer, which is why prevention is key. {This obvious point contradicts the book title’s hype. While preventive measures can reduce the risk of cancer, and possibly delay its onset to more advanced ages, there is no indication of anything on the horizon that can prevent cancer. In fact, as we continue to improve treatment of heart disease and infectious disease, a greater percentage of people are likely to live long enough to die of cancer.}

Everyone should ask for the following tests at their checkup. {The first three are typically done. The C-reactive protein is usually done for those with risk factors for heart disease. The PSA test is often done but is controversial because of its poor ability to determine who really needs further, more invasive, procedures. The test for thyroid stimulating hormone is not typically done except if there are symptoms suggesting a need for it. The hemoglobin A1C is not typically done but is a better test of long-term blood sugar than the standard blood glucose test as an indicator of diabetes risk.}:
·         Fasting lipid profile
·         Comprehensive metabolic panel – status of kidneys, liver, electrolyte and acid/base balance, blood sugar, blood proteins
·         Complete blood cell count -  red, white, platelets
·         High-sensitivity C-reactive protein
·         PSA for men
·         Thyroid stimulating hormone
·         Hemoglobin A1C – Measures long-term blood sugar

Daily aspirin reduces the risk of cancers of the gastrointestinal tract, prostate, lung, colon/rectum, esophagus {Anyone contemplating taking a daily aspirin should first check with his/her doctor as the drug increases the likelihood of potentially serious or even fatal internal bleeding}.

Genetic tests can show risk of cancer (breast, colon, lung, prostate, stomach, melanoma), autoimmune disease, vascular problems (aneurism, deep-vein thrombosis), macular degeneration, glaucoma, Alzheimer’s, multiple sclerosis, restless leg syndrome, atrial fibrillation, heart attack, Crohn’s disease, celiac disease, type II diabetes, obesity, osteoarthritis, and dose-response to drugs. {Of course, Agus’s company would be the obvious candidate to do such testing}.

Even though Vitamin D has looked good in some observational studies, it was associated with a rise in falls and fractures in older women. High blood levels of Vitamin D may also be associated with an increased risk of more aggressive forms of prostate cancer. {While it still appears that Vitamin D supplementation is advisable, particularly in less sunny parts of the world, large daily dosages (in excess of 1,000 IU) should likely be avoided}.

Antioxidants can worsen cancer because the body uses free radicals to fight bacteria and cancer. Free radical oxidation is a normal part of energy production, immune reactions, and cell signaling. {This is one of the most important points in the book. Most books and articles today suggest that the more anti-oxidants the better. However, supportive evidence applies mainly to eating foods high in antioxidants rather than taking antioxidant supplements. Also, Agus points out that Vitamin C can be health-promoting if you don’t have cancer, but it can actually enhance the growth of cancerous tumors once they invade your body.}

In a large trial, beta carotene increased the risk of mortality, and showed an increased risk of lung cancer in a Finnish study, while vitamin E increased the risk of hemorrhagic stroke but decreased the risk of ischemic stroke. Heavy vitamin use was associated with an increase in the more deadly form of prostate cancer. {Agus is generally against vitamin supplementation, especially in megadoses, and he makes a fairly strong case.}

Keep a strict, predictable schedule of eating, sleeping, and exercise, even on weekends. {I think this is one of the weakest parts of the book. Agus is adamant about the importance of keeping on a regular schedule, but he presents the barest of evidence to support his case. Humans are by nature flexible and adaptable. I don’t see any harm at exercising at different times of day if that is what you can fit into your schedule. It’s certainly better than skipping exercise sessions.}

Reduce inflammation by wearing comfortable shoes daily, getting an annual flu vaccine, and asking your doctor about taking a statin and daily baby aspirin. {Caution: A recent study showed that statins increase the likelihood of memory problems and diabetes. Aspirin can increase the risk of bleeding. So either of these drugs should only be used when needed and for people who can well tolerate them. A more natural way to prevent inflammation is to eat a diet high in vegetables and fruit and low in saturated fats and cholesterol.}

Because the causes of death among men are ranked as follows, exercise is extremely important for health (the numbers in parenthesis represent percent contribution to death risk). {It may seem surprising that obesity is low on the list, but that is likely because it represents the risk of obesity independent of all the other risk factors. But we know that obesity actually increases the likelihood of all the other risk factors except smoking. So it is still important to avoid obesity.

  1. Low cardio-respiratory fitness (15)
  2. Hypertension (14)
  3. Smoking (8)
  4. High cholesterol ( 4)
  5. Diabetes (4)
  6. Obesity (2)
Sitting for long periods has strong negative health effects even if we also exercise daily. {Recent studies have supported this point.}

Share your medical information whenever possible. {I feel that, in his enthusiasm about potentially having an enormous database with which to analyze disease risk, Agus totally fails to recognize the privacy concerns of patients. How can one be sure that one’s personal medical information will not be used to deny medical or life insurance coverage, inflate rates, or discriminate in hiring based on perceived disease risk?}

Don’t disturb the body’s homeostasis via excess drugs, supplements, inconsistent schedules, sleep deprivation, or excessive eating, drinking, or exercising. {Yes, it is possible to exercise too much. The main threat of too much exercise is overtraining syndrome, characterized by fatigue, irritability, sleep disturbance, and a decline in physical performance. It can take weeks or months to recover from severe overtraining syndrome, so it is best to be sensitive to symptoms.}