David Agus’s “The End of Illness” is part vision statement and part instruction manual, a sometimes idiosyncratic mix of scientifically minded polemic, imperative self-help book and erudite guide to hot-button health issues. The author suggests that his vision involves a revolutionary reimagining of the whole field of health and wellness. He delivers a coherent and often convincing guide to some of the most confusing issues currently discussed in popular health writing, and at times an articulate, fascinating and opinionated tour through medical concepts, medical research and medical conundrums.
Agus is an oncologist and an entrepreneur, the co-founder of two companies that provide personalized profiles of medical risk. He is a profound believer in technology, not only that of his own companies — which he advocates to the point of showing us his own medical test results, as delivered by that technology — but health-care technology in general.
However, he is most definitely not a believer in the wide range of supplements and simple answers often proffered in self-help books. Somewhat endearingly, at times the argument made by the complex science that he cites boils down to saying, with Michael Pollan (or your grandmother), something as basic as “Eat fresh food.” He also argues for a strenuously regular (and regularly strenuous) schedule, with set times for exercise and relaxation. But he explains the reasons in terms of physiology, science and a strong conviction that the body can be understood only as a very complex system. In other words, this is a self-help book that avoids magic bullets and quick fixes, arguing instead for a recognition of the body’s intricate systems of homeostasis and self-repair.
The strength of “The End of Illness” is that it brings medical research and a sophisticated understanding of the complexity of human physiology to bear on explaining practical methods for preventing disease and improving health. In fact, Agus provides a formal series of health rules. He wants his readers to take charge of their medical details and understand individualized risk and individualized therapy: “Know as much about yourself as possible through the use of technology, including how you metabolize drugs.” He wants us to understand the potential importance of the body’s inflammatory response, which, he argues, is at the root of much pathology: “Take charge of hidden, sneaky sources of chronic inflammation that can trigger illness and disease by wearing comfortable shoes daily, getting an annual flu vaccine, and asking your doctor why you’re not on a statin and baby aspirin if you’re over the age of forty.” And he wants readers to assist their bodies’ homeostatic and anti-inflammatory systems by avoiding stress and shocks to the system: “Keep a strict, predictable schedule 365 days a year that has you eating, sleeping, and exercising at about the same times day in and day out.”
Though some of the rules are quite straightforward, the book is at its best when it takes on complexity. Agus’s discussion of vitamin D is both sane and detailed, tracing the basics of vitamin D metabolism and then examining the many claims made in recent years about the dangers of vitamin D deficiency and the potential curative (not to say, panacea) effects of supplementation. This vitamin, important in regulating calcium and bone health, is also involved in many other physiologic processes, from cell growth to inflammation. “But despite its role in many of the body’s vital functions,” Agus writes, “we must be careful about making broad statements about vitamin D and its link (‘associations’) to various illnesses and disease. Despite thousands of studies, there’s not a lot of strong research showing consistent benefits from vitamin D supplementation.”
At the same time, by discussing the body’s regulatory mechanisms, he raises questions about the effects of vitamin supplements (for D and for others) and argues strongly against “overly general recommendations for everyone regardless of their vitamin D (or fill in the blank) status.”
It would be valuable to have more of that same appreciation of physiological complexity and diagnostic ambiguity when the discussion turns to proteomics, the analysis and understanding of proteins. Agus argues strongly that looking at the proteins produced in the body may hold more promise diagnostically and therapeutically than analysis at the genetic level, and his discussion of how to weigh family history and genetic risk is clear and helpful. He compares DNA to a list of ingredients, saying: “The quality of the food depends on lots of details of how they get combined and processed — on the cooking. In the human body, this ‘cooking’ is about how the body processes the DNA through its magical mix of creating proteins.”
But from a clinical point of view, protein analysis can also be complicated and fraught with diagnostic ambiguity. Though the field holds much promise, our early attempts at detecting cancer through circulating proteins have not necessarily been straightforward. Agus writes, “If you’re a man, prostate specific antigen (PSA) tests can identify prostate cancer early through a simple blood sample.” I would have enjoyed reading his analysis of the clinical issues involved in PSA testing; this protein-based test has been controversial for years because of the complexities of interpretation, treatment and prognosis. The studies need to be interpreted; the recommendations for who should be tested have changed; the treatment for cancer, when detected, is sometimes worse than the disease. It’s another complicated algorithm involving risk, family history and personal preference.
Although Agus is an oncologist, his book is not focused only on cancer. Still, he makes interesting arguments about the ways that we understand this most feared of diseases. He argues that we may have gone astray in thinking about cancer as we do about infectious diseases — that is, in taking the approach that the body has been invaded and the doctor’s job is to administer drugs that kill the invader. He offers a different approach: “Cancer is a symptom of the breaking down of the conversation that’s going on within and between the cells.” And he laments that decades of cancer research have not moved us far enough along in treating the disease and saving lives — which brings us back to prevention and healthy living.
“The End of Illness” draws much of its power from the author’s voice, whether rueful about the mixed results of cancer research or profoundly optimistic about the future of proteomics and health-care technology. Agus tries to make both health and illness very personal, arguing the importance of knowing yourself — your habits, your family history, your genetic risks, even your proteins.
THE END OF ILLNESS
By David B. Agus with Kristin Loberg
Free Press. 336 pp. $26