The End of Illness

David B. Agus

• Publisher: Free Press
• Year: 2012
• Print ISBN: 9781451610192
• eBook ISBN: 9781451610208
• Topic: Medicine
• Subtopic: Alternative & Complementary Medicine

Can we live robustly until our last breath? Do we have to suffer from debilitating conditions and sickness? Is it possible to add more vibrant years to our lives? In the #1 New York Times bestselling The End of Illness, Dr. David Agus tackles these fundamental questions and dismantles misperceptions about what "health" really means. Presenting an eye-opening picture of the human body and all the ways it works—and fails—Dr. Agus shows us how a new perspective on our individual health will allow us to achieve a long, vigorous life. Offering insights and access to powerful new technologies that promise to transform medicine, Dr. Agus emphasizes his belief that there is no "right" answer, no master guide that is "one size fits all." Each one of us must get to know our bodies in uniquely personal ways, and he shows us exactly how to do that. A bold call for all of us to become our own personal health advocates, The End of Illness is a moving departure from orthodox thinking.

PART I

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The Science and Art of Defining Your Health

If I had to sum up this entire book in a single phrase, it would be this: get to know yourself. I don’t mean that in a cosmic or purely psychological way. I’m a big believer in what’s called personalized medicine, which refers to customizing your health care to your specific needs based on your physiology, genetics, value system, and unique conditions. We are finally entering an exciting time in medicine where we have the technology to custom-tailor treatment and preventive protocols just as we’d custom-tailor a suit or designer gown to one’s individual body. But it all begins with you. You have to know yourself in a manner that you’ve probably never done before.

Right now, most of us live by sweeping, general guidelines that are one-size-fits-all. If you want to lose weight, for example, you pick a diet that’s marketed to everyone and which likely recommends that you eat more fibrous vegetables and cut back on processed sugar. If you want to reduce your risk for cancer, you’ll be told to avoid tobacco smoke, to exercise regularly, and to take early detection seriously. But imagine being able to have a more explicit oracle into your future health, as well as a more exacting set of rules to follow today. Think about what it would be like, for instance, to know precisely how to tweak your diet to effortlessly lose twenty pounds for good, or to have a detailed list of things to avoid and things to embrace that make you feel fantastic and be in tip-top shape, or to know what the perfect amount of medicine X is for you to combat affliction Y successfully with no side effects. That’s the promise that personalized medicine has to offer.

But, once again, you won’t be able to enjoy the benefits of personalized medicine until you get up close and personal with yourself. Nothing about health is one-size-fits-all, so until you know how to perform your own “fitting,” you won’t be able to live the long and happy life that’s awaiting you.

The checklist below used to be buried deep in the book somewhere—long after I’d done a lot of explaining and storytelling—but I’ve since plucked it out and placed it here. I want to give you a first step in the right direction before I spend a couple hundred pages fleshing out all of my recommendations in detail. This questionnaire was originally designed to help you prepare for a checkup with your doctor, giving you clues to discuss during your visit. However, while piecing this book together, I realized that the same questionnaire should be filled out before even reading the book, which will help you to know yourself better before embarking on this adventure. I also know that you want to be told what to do as soon as possible, and even though you’ll find lots of “health rules” to consider throughout this book, many of which will be called out at the ends of chapters, at least the following questions will equip you with concepts to think about as you read further and incorporate my advice into your life. This questionnaire is also downloadable online at www.TheEndofIllness.com/questionnaire, where you’ll find a version that you can respond to directly on the page to print for your records and/or take to your doctor.

Personal Health Inventory Questionnaire

• Overall feeling: How do you feel? It’s arguably the most important question to ask of yourself. You might feel great today, but how about yesterday? When do you have your low moments? Is there a pattern? Is it hard for you to get out of bed in the morning?

• Energy levels: How would you rank your energy level on a scale of 1 to 10? How has it changed in the last year?

• Schedule: How regular is your schedule of when you eat, exercise, and sleep? Is every day the same or different?

• Breathing: Anything abnormal to report? Do you hear or feel rattles when you breathe? Does it hurt to breathe deeply? Do you cough when you take a deep breath? Answer these questions when you are at rest and after exercise.

• Exercise tolerance: How much can you comfortably tolerate? How does this amount of physical activity compare with how you felt and how hard you moved your body last year? Does anything hurt or feel funny when you move or exercise?

• Walking: Are you walking the same way you always have? Do you lean to one side and never did before? Do you hunch over more? Is it hard to walk fully upright?

• Sensations: Anything unusual or out of the ordinary to report in any part of your body? For example, how is your sense of smell? Is it as strong as ever? Weak?

• Skin: When you scan your skin for any strange marks, growths, or bumps while naked in front of the mirror, do you find anything? Has anything changed since the last time you examined your skin? Do your socks leave indentation marks on your ankles/legs? (If so, this could indicate that your heart isn’t working properly and fluid is getting stagnant in areas, increasing your risk for a blood clot.)

• Hair: Has your hair changed at all in terms of thickness, texture, growth/loss, and so on? Have you lost hair around your ankles? This could be a sign of a circulatory problem, especially noticeable in men. Conversely, do you have hair growing in odd places, such as your arms and face? This could signal hormonal changes, especially in women.

• Nails: These dead tissues can actually tell you a lot. Have they changed in appearance or color lately? Discolored nails can signal certain conditions, from a simple infection to diabetes. If your nails have a yellowish hue to them, it’s time for a diabetes check. Nails can also indicate iron levels. Look for a whitish crescent C at the base of your nails, which indicates good iron levels.

• Fingers: Do your joints ache after using them? If you’re a woman, is your ring finger longer than your index finger? If so, you may be twice as likely to suffer from osteoarthritis. That’s according to a 2008 study in the journal Arthritis & Rheumatism, which discovered this odd connection and hypothesized that longer ring fingers are linked to higher levels of testosterone exposure in the womb. Higher prenatal levels of testosterone lower the concentration of estrogen, which is critical to bone development. If you’re a man whose index finger is longer than your ring finger, your risk of prostate cancer drops by a third.

• Joints: Do they hurt? More in the morning when you get up, or after a long day? What makes the aching joints better?

• Appetite: Is it the same as it used to be? Stronger? Weaker? Do you have serious cravings? If so, for what?

• Breasts: If you’re a woman, do you see or feel any lumps, bumps, or dimples when you perform a breast exam?

• Digestion: Any feelings of discomfort to report? Do you have to use any over-the-counter medications for your digestion/stomach on a regular basis (e.g., Tums, Pepto-Bismol, Tagamet, Zantac, Prevacid, laxatives, and the like)? If you have symptoms, are they better or worse after eating a meal? Do you experience an intolerance, sensitivity, or allergy to certain foods?

• Headaches: Do you experience headaches regularly? Migraines? Do you know the triggers for such headaches? Do you find yourself taking over-the-counter painkillers consistently (e.g., Advil, Aleve, Tylenol, Excedrin, aspirin, and the like)?

• Allergies: Do you have any? Have your allergies changed over the years? How so?

• Sleep: Do you sleep well? Do you resort to sleep aids on occasion? Do you wake up feeling rested most of the time? How consistent are your bedtimes and wake times? Does your bed partner say that you snore? (Sleep apnea, which is often characterized by snoring, is incredibly common today and is a known risk factor for a heart attack. Luckily, sleep apnea can be treated pretty successfully.)

• Pain: Is there any area where you feel discomfort or pain?

• Passing colds and flus: Do you get sick a lot? How many fevers have you had this past year? When you get sick, does it seem to take you longer than your friends or family members to get better? Did you get a flu shot this year?

• Mood: How stable is your mood? Do you have feelings of depression?

• Hormonal cycle: If you’re a woman, is your cycle regular? Are you in perimenopause or menopause?

• Previous diagnoses: What have you previously been diagnosed with? Is there anything that you deal with chronically?

• Stress level: On a scale of 1 to 10, how bad is it? Is it chronic or just once in a while? Does the stress affect your lifestyle? If your stress is work-related, do you love or hate your job? (Turns out that if you love your job despite the stress, you’re much better off than if you hate your job and it causes you stress!)

• Weight: Are you happy with it? Have you tried to change it? What happened when you did? Do you have a paunch that you cannot get rid of?

• Medications (prescription and nonprescription): What do you take, for what conditions, and for how long have you been taking them? This includes all vitamins, supplements, additives, and occasional medications (such as a few Tylenol or Advil for a headache).

• Health-care prevention: Are you up-to-date with things like routine exams/wellness checkups, vaccines, screenings (e.g., Pap smear, colonoscopy, etc.), and blood tests? Do you know what foods you’re supposed to be eating given your underlying disease risk factors?

• Overall satisfaction: If you had to rank how you felt about yourself in general, on a scale of 1 to 10, what would your number be? What kind of report card would you give yourself? What do you want to change in your life?

Unlike other self-tests you find in books and magazines, this one doesn’t have a scorecard at the end. Your answers are your own. Once you’ve incorporated some of my forthcoming suggestions, come back to this questionnaire to check in with yourself whenever you want. See how you change from month to month and year to year. Continue to ask yourself, am I as healthy as I want to be?

Part I is all about defining your health, and I’ll begin by taking you on a tour of how we’ve lost our compass with respect to understanding the human body. I’ll reveal a new perspective that gives us a more accurate compass, and then I’ll help you to use that compass in your journey to optimize your health with the technology we have today. At the end of Part I, I’ll share one of the most powerful medical technologies currently in development that will soon allow each of us to personalize our medicine in a truly sophisticated manner. Knowing about this technology now will give you hope for the future, as well as add context to the information in the rest of the book.

1

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What Is Health?

A New Definition That Changes Everything

Everyone has a vague idea of what it means to live a healthy life. Eating a balanced diet: good. Smoking: bad. Breaking a sweat regularly: good. Binge drinking: bad. Getting a restful night’s sleep: bonus. Being happy: double bonus. Some of us may choose to disregard these basic tenets on occasion, but for the most part, we know the difference between the habits that help us stay youthful and strong, and those that can detract from our well-being.

We try our best to stay out of harm’s way, but what happens when we get sick or develop a chronic medical condition or, heaven forbid, are diagnosed with a serious illness? After experiencing the frustration of Why me? many of us begin to ask ourselves other, more probing inquiries about where we might have gone wrong. Was it something in the water? A lifelong love of hamburgers and fries? An overdemanding boss and, as a result, an overwhelming stress level? Too much alcohol? Too little exercise? Secondhand smoke? Exposure to industrial chemicals? A habit of living dangerously, whatever that might mean? Bad luck?

Or perhaps, some of us think, this outcome was fated because it was just in my DNA all along.

If I could collect a nickel for every time someone in the world thought that genetics was wholly to blame for this illness or that defect, I’d be the wealthiest man on earth. It’s human nature to point fingers at someone or something else for our flaws and shortcomings, and to avoid any personal culpability. Because DNA tends to be a relatively abstract construct, much like black holes or quarks, which we cannot touch, see, or feel, it might as well be a “something else” to which we can assign guilt. After all, DNA is “given” to us by our parents and we have no choice. In this regard, DNA is practically accidental; just as accidents happen, so does DNA, without our having much say in the matter.

What most people don’t think about, though, is that DNA says more about our risk than our fate. It governs probabilities, not necessarily destinies. As my friend and colleague Danny Hillis (whom we’ll meet later when I cover emerging technologies) likes to describe it, DNA is simply a list of parts or ingredients rather than a complete manual that explains how those parts work together to generate results. To hold your DNA responsible for your health is missing the forest for the trees. It’s not the pièce de résistance. I say this knowing full well that DNA does hold certain keys to your health; if it didn’t, then I wouldn’t have cofounded a company that performs genetic testing so you can take preventive measures based on your genomic risk profile. But right from the get-go I want to entice you to start thinking from a broader perspective that goes far beyond your genes. I want you to view your body—from the outer stretches of your skin to the inner sanctum of your cellular makeup—as a whole system. It’s a uniquely organized and highly functioning system that leaves so much to the imagination because we’re only just beginning to solve its riddles.

So therefore, as we probe the mystery of the human body more deeply, we discover that this system, and its complex riddles, don’t necessarily hinge on DNA alone.

The Inescapable Statistics

To understand how we’ve arrived at a place where we focus so much on DNA, and why it’s critical to respect the body as an elaborate system beyond genetics, it helps to explore the evolution of our thinking processes against the backdrop of the challenges we’ve faced—and continue to face—in our quest for health and longevity.

Most of our transformative breakthroughs in medicine have occurred only recently, in the last sixty or so years. Following the discovery of penicillin in 1928, which changed the whole landscape of fighting infections based on the knowledge that they were caused by bacteria, we got good at extending our lives by several years and, in many cases, decades. This was made possible through a constellation of contributing circumstances, including a decline in cigarette smoking, changes in our diets for the better, improvements in diagnostics and medical care, and of course advancements in targeted therapies and drugs such as cholesterol-lowering statins.

Heart disease has been the leading cause of death in the United States since 1921, and stroke has been the third-leading cause since 1938; together, these vascular diseases account for approximately 40 percent of all deaths. Since 1950, however, age-adjusted death rates from cardiovascular disease have declined 60 to 70 percent, representing one of the most important public health achievements of the twentieth century.

Put another way:

But here’s the sobering truth sitting on the sidelines of these triumphs like a lumbering white elephant: the death rate from cancer from 1950 to 2007 (the most current data available from the Centers for Disease Control and Prevention) didn’t change much. We are making enormous progress against other chronic diseases, but little against cancer. Indeed, there are little wins here and there with unique types of cancer. Take, for instance, chronic myelogenous leukemia, a rare type of leukemia that had previously been a death sentence except for a small number of patients who benefited from bone-marrow transplantation. With the FDA approval of Gleevec (brand name for imatinib mesylate) in May 2001—the same month it made the cover of Time magazine as the “magic bullet” to cure cancer—we now have a way to successfully treat most patients and achieve remarkable recovery rates. The drug targets the particular chromosomal rearrangement that is present in this disease (part of chromosome 9 is fused to part of chromosome 22). In clinical trials, the response rate to Gleevec was over 90 percent. People went from their deathbeds to functional life after taking this small molecule with few side effects. But with the more common deadly cancers, including those that ravage...

Table of contents

• Cover
• Dedication
• Foreword to the Revised Edition
• Introduction: Notes from the Edge
• Part I: The Science and Art of Defining Your Health
• Part II: The Elements of Healthy Style
• Part III: The Future You
• Conclusion: Of Mice and Men and the Search for the Master Switch
• Epilogue: Q&A
• Acknowledgments
• Recommended Reading
• About the Author
• Index
• Copyright