Book Review: The End of Illness

[FEATURED ARTICLE]

Cryonics, May-June 2012

The End of Illnessby David B. Agus, MD.  Free Press, 2011.

Reviewed by Steve Bridge

So, here’s one of those choice games that young people play – We have a new medication.  75% of those who take it will become ageless and immortal; 25% die immediately.  The only way to know which is which is to take it.  What do you do?

Too unrealistic?  OK, here is another medication.  It fights cancer and heart disease and increases lifespan of perhaps 25% of individuals.  It has no major observable effect on 50% of those who take it; but 25% of those who take it have shortened lifespans.  What do you do?  Don’t know?  You’re probably already taking it.  It might be Vitamin D, or beta carotene, or aspirin, or a statin drug, or a combination of many other substances for which the research has shown confusing results.

If you are reading this, you are probably taking a number of supplements and medications.  We are each our own life extension experiment, with an experimental subject number of ONE.   Some of us may turn out to win, some of us will surely lose; but in either case, we probably won’t know why.

We start as individuals with unique genetic patterns, grown in the womb of a mother with a unique genetic pattern which produces a specific combination of proteins and hormones which helps us grow differently from anyone else.   Our mother has a unique set of experiences during our 9-months residence within her – exposure to chemicals, ingestion of food and drink, alcohol and tobacco use, medication, health problems, stress, etc.  Those experiences filter down to our own growing bodies during that 9 months and affect us for the rest of our lives.   When we are born, we continue our unique experiences – diet, surroundings, family life, pollution, weather, physical activity, exposure to viruses, bacteria, fungi, and so on without end.

And now we as adults, with no way to control our own starting points, purposely take unique combinations of medications, vitamins and other supplements (whose specific content we may not know and cannot control)), food combinations in a dizzying variety of diets (equally uncontrollable in their nutritional details), various forms of exercise and leisure activities, and equally diverse forms of sex, friendship, and other interpersonal connections.

Yet, in spite of that uniqueness, we still hope that some popular magic bullet of a pill or juice or food or perhaps some combination of them will help us feel better and live longer.  We hope this with such a combination of great fervor and little evidence that we are easy marks for salesmen.

That is one of the central messages of The End of Illness by David B. Agus.  In general, this message makes sense and goes along with many doubts I have had in the past, and I am positive that many of you recognize those doubts, too.  So you might pick up a book with an optimistic (some might say “hubristic”) title like “The End of Illness” hoping to find a path to the answers.  That title promises a lot more than the author delivers, although there is value in the book for many readers.

Agus has some useful thoughts about the future of medicine and about what you might do to improve your health today.  However, if you are even moderately well read in general health magazines and books, you won’t find too much new here.

Agus encourages the reader to know himself by asking relatives about the family’s health history and by getting genetic testing to set up a baseline of knowledge.  (Perhaps it’s not a coincidence that the author owns Navigenics, a company which does genetic testing and counseling.  But he doesn’t dwell on that and I don’t see a hard sell for it.)  He thinks that the real progress in future medical diagnosis and treatment will come from the study of proteomics – the identification and understanding of the proteins in the body.  For Agus, genetics is like the blueprint for the house, but the blueprints cannot tell when the house was made with defective materials or when it is invaded by mice or mold.  The proteins tell what is going on now.  He believes that this is how physicians in the future will eventually be able to view each person as an individual and to prescribe individual treatments, diets, and lifestyles.  (It is perhaps not a coincidence that the author also owns a company called Applied Proteomics).

Proteomics might cause a change in the way medicine is viewed in the future, from a current focus on the treatment of discrete diseases and conditions to an emphasis on maintaining the condition of “Health”, whether we understand the actual causes of illness or not.  Hence, “the End of Illness.”  “Nice”, I think.  I’ve been saying exactly that in cryonics talks for 20 years, although I’ve been using other words like “nanotechnology” and “genetic manipulation” to explain how this will work.  “Proteomics” will be another nice catchword to add.

At this point I was expecting Agus to really dig into this subject and offer several meaty chapters on how the study of proteomics might progress into the medical miracles of the future.  And maybe the author wanted that, too.  But the history of sales for detailed books on what medicine might be like in the future is a meager one.  Five or ten thousand copies isn’t what the good doctor or his publisher are going for.  So the rest of the book is fairly standard advice for what you can do to be healthier today.

First, we spy a bit of inconsistency.  In spite of his insistence that there isn’t a magic pill for everyone, the author writes, “The end of illness is achievable because of two fundamental beliefs.  For one, most diseases are delayable or preventable, and two, a sense of optimism that the “magic pills” to treat many of the diseases of today will be available in the next two decades.”    I’ll summarize some his main points on how to delay the problems.

Exercise.  Don’t have a job where you sit on your butt all day.

Eat fresh foods, not prepared foods.  “Fresh” does not mean food sitting around in the grocery for a week.

Eat fresh whole fruit and vegetables.  Juicing is a bad idea because tearing up the plants cells robs the juice of much of the nutritive value.  But drink one glass of red wine 5 night a week. (Isn’t wine a form of “juice?”)

A healthy gut, with the right kinds of bacteria might be as important as anything else.

Don’t take vitamin supplements.  You can get all the vitamins you need from fresh food.  (More on this in a minute.)

Maintain a regular schedule of when you eat, sleep, and exercise.  The body’s rhythms are important.

Wear good shoes and do things to control inflammation.  If you are over 40, take statin drugs.  He is very insistent on this.

Get flu shots.

If you aren’t sure what to do, doing nothing is often better than doing something radical.  (Which would seem to go against the insistence on statins).

Each of these is filled out in some detail in the book.

The most controversial part of this book for some readers, including many of you, I suspect, will be Agus’s insistence that you avoid nutritional supplements unless you have a specific deficiency that can be shown to improve with supplementation.  Using the media hype over Vitamin D as an example, he spends a whole chapter examining the claims for and against Vitamin D.  He points out that many of the headlines of miracle cures associated with Vitamin D are actually from results in laboratories or in mice, not in human trials.  Other research from observations of high Vitamin D levels being protective can be explained in other ways.  He states that the actual human trials for Vitamin D show very mixed results.  Part of the reason for this is that Vitamin D comes into the human body from sunshine and from a variety of food sources.  It is almost impossible to precisely control how much Vitamin D a person actually receives or produces internally.  He also says that the human body, as it does with many substances and conditions, attempts to maintain homeostasis in Vitamin D levels.  Adding Vitamin D to the human system may simply cause the body to deactivate cell receptors for that vitamin in an attempt to maintain balance.  And he points out that some studies show that higher blood levels of some forms of Vitamin D are associated with higher risks of cancer.

In shorter fashion, Agus discusses what he sees as the downsides of supplementation with Vitamin C, and especially beta carotene.  He mentions research that suggests Vitamin C might both tend to prevent cancer but then accelerate the cancer growth once a tumor occurs.  He even believes there is strong evidence that too many antioxidants will prevent the body’s own free radicals from attacking cancer cells.  “I am not aware of any clinical trial demonstrating a general health benefit to taking supplemental vitamins and have in fact come across some disturbing negative effects found in some studies.”

I do not claim any expertise or even great knowledge of the research in vitamins or other supplements, yet I take many myself.  I cannot argue either for or against Agus’s opinions.  I don’t know whether or not my idiosyncratic combination of diet, exercise, supplements, and genetics is making me healthier or less healthy.  I look pretty good and am very healthy for my age – but what factors are responsible for that?  Aside from some well proven generalities (I don’t smoke or use illegal drugs; I don’t live what used to be called “a dissolute lifestyle.”), there is no way I can know.  I certainly am NOT going to advise you to either take or to avoid taking supplements or anything else.  If you want to argue with Agus’s conclusions, argue with him, not with me.

So what makes this a “best-seller?”  I kept waiting for the big revelation – the new information, the moment that would make me really pay attention or maybe get angry.  It never happened.  But The End of Illness has been a hot item — #1 on the New York Times non-fiction list and still #359 on Amazon after three months.  There is a long waiting list for it at my library.  But the book itself is mostly a pretty ordinary discussion of ways to live a healthy life, not much different from many others that have been published.  The particular combination of details is unique, perhaps, but there is nothing earth-shattering, really nothing even controversial except for his rejection of vitamin pills.  And that is hardly revolutionary; there many writers in the anti-supplement camp.

The title is catchy, of course, even if it doesn’t deliver on its promise.  But this is pretty much a triumph of public relations.  Lots of great quotes (from his friends, business partners, and people who have been praised in his book) on the cover.  Well-planned appearances on influential TV shows like The View and The Daily Show.   The book is easy to understand, written for a mass audience, and promises to make you feel better.  If you haven’t read a book about healthy living for many years, it might even work for you.  But for the true “end of illness,” we have a long way to go.