Do we need to move beyond a germ based approach to medicine, based on fighting an external invasion of the human body? Is a more preventative, complex systems approach needed for diseases like cancer, heart disease and diabetes, which arise from dysfunctions within our bodies?
That’s one of the questions raised by Dr David Agus in his book, ‘The End of Illness.’
Dr David Agus is a Professor of Medicine who heads the University of South California’s Westside Cancer Center and the Center for Applied Molecular Medicine.
He describes cancer, for instance, as ‘a symptom of the breaking down of the conversation that’s going on within and between the cells. Somehow the cells are deciding to divide when they shouldn’t, not telling each other to die, or telling each other to make blood vessels when they shouldn’t, or telling each other lies.’
This leads him to conclude, ‘Honor the body and its relationship to disease as a complex emerging system that you may never fully comprehend. Diseases such as cancer, heat disease , diabetes, autoimmune disorders and neurodegerative diseases reflect breakdowns in that system. Cancer, for instance, isn’t something the body ‘has’ or ‘gets’; it’s something that the body does.’
If this assessment is correct, what can we do to tackle such diseases? Dr Agus recommends that we make use of emerging new technologies, bringing together computing, engineering and medico-scientific expertise – as with proteomics, the study of proteins, which he describes as, ‘the exploration of how proteins create the language of our bodies – and the language of health.’
He predicts, ‘Medicine will shift from being heavily trafficked on the treatment side to the prevention side, rooted in science based predictions. What will make this possible is the universal embrace of complex systems medicine, which blends biology, computing, engineering and a layer of rationale from the physics world to try to understand the behaviour of a “whole” (as in the whole human body) in terms of the interactions among its parts – its genes, its proteins, and any other molecules that play a defining role.’
Interestingly, he argues, ‘DNA says more about our risk than our fate. It governs probabilities, not necessarily destinies.’ He sees proteins as the more dynamic component in our bodies.
These assessments lead him to suggest that a) we focus on personal metrics, asking our doctor to do a number of different tests (to assess the state of our own individual bodies, whose interactions may not be exactly the same as someone else’s, for instance due to the genetics of ethnicity) – a precursor to future treatment ‘individually created for you.’ and b) that we aim to work with our bodies, which naturally seek to achieve internal balance (as with the way our bodies maintain an even temperature most of the time).
That’s why he argues against taking supplements, which may disturb the body’s natural working and lead to health risks, compared with natural sources. For instance he considers Vitamin D supplements unlikely to help and possibly (based on cancer research) likely to harm. He advises getting Vitamin D naturally eg through sunlight, which the body has evolved to make good use of.
Indeed he argues against our doing anything which disturbs the body’s natural balance. As he says, ‘Homeostasis is the body’s paradise….When we place too many forces on it unnecessarily, such as through drugs, supplements, inconsistent schedules, sleep deprivation, and excessive exercising, eating, or drinking, we break that homeostasis. The good news is we can let our bodies come back to homeostatis naturally just by honouring its preferred rhythms and being mindful of the body’s inputs.’ That’s why he sometimes suggests the value of simply doing nothing.
Having said this, Dr Agus sees some drugs, such as statins, as having generally beneficial system effects and ‘similar to statins, with their diverse, system wide effects on the body, bisphosponates (taken for osteoporosis) have many potential uses other than preserving and building bone, and have anticancer effects. It’s recently been shown that people who take bisphosphonates are gaining an extra five years of life.’
Dr Agus incidentally doesn’t see free radicals, in themselves, as quite the villains they have been portrayed as. ‘Oxidation is a necessary evil in the body’s attempts to conduct reactions and to support its overall homeostasis. Free radicals are necessary for living organisms…they are used by our immune system to kill bacteria, and they also act as part of the cell signalling process for many “normal” functions of the cell. ‘ However, he does recognise, ‘When the oxidisation is in overdrive, which results in a surfeit of free radicals, problems can emerge.’
If the early part of ‘The End of Illness’ suggests sometimes radical new approaches, the later part is more conventional, often, for instance, covering points we have already flagged up on Age Watch, including the value of mental and physical activity in building a Cognitive Reserve to protect against dementia; the nutritional value of frozen vegetables; and the value of exercise and dangers of spending too much time sitting down. For example he explains that research into the health benefits of exercise stretches all the way back to comparisons of the health of sedentary bus drivers and more active bus conductors in the 1950’s – with the bus conductors routinely living longer.
Dr Agus also explains that virtually all chronic conditions have been linked to chronic inflammation. That’s why he recommends a range of ways to reduce inflammation, from wearing comfortable shoes and avoiding violent sports to getting regular flu jabs.
‘The End of Illness’ has its critics. Some say that Dr Agus presents too optimistic a view of the benefits of aspirin and statins, not pointing out their side effects. This is true up to a point, although the NHS advises that the risks from statins affect very few people and are outweighed by the benefits.
Others argue that the book has been marketed as presenting a revolutionary new perspective but that much of it contains material which is already well known – a point we have already observed, having covered much of this in previous Age Watch articles.
There is also the question of commercial self interest. Dr Agus has himself invested time in setting up companies in some of the fields and technologies he recommends.
Overall, however, this is a book worth reading. It suggests ways medicine could well develop in the years ahead, based on a new way of looking at the type of chronic illnesses common in the developed world and the application of new technologies. It reinforces the importance of each us being proactive in looking after our health – and contains a range of potentially useful advice (some relatively new, some long established).
The End of Illness Dr David B Agus Simon & Schuster IBN – 13 978 - 1849839150