Longevity rules
No high heels? Some of Dr David Agus’s advice might surprise you.
America’s most high-profile cancer specialist, a physician whose patients have included technology moguls, rock legends and Hollywood superstars, wants to tell you something – he’s not very good at treating cancer.
Dr David Agus is a neat, compact man, with receding salt-and-pepper hair and a soft voice. We meet in his modest Beverly Hills office. He’s dressed in the uniform that one of his patients, the late Steve Jobs, encouraged him to adopt – smart grey trousers, a black sweater over a white shirt. Behind him, next to an array of flat screens, stands the heavy, old-fashioned microscope he uses to observe his clients’ mutinous cells.
Rather like Jobs, Agus – as well as being a respected research scientist – is something of a master salesman, and he wastes no time in getting to his pitch. He leans back in his chair, steeples his fingers. “It’s a horrible thing to look someone in the eye and say, ‘We have no more drugs’,” he says, explaining that this is something he does “two or three times a week”.
It makes no difference that many of his patients are immensely wealthy – billionaires, even. If you have cancer today, your prospects are not very different from what they would have been when man first set foot on the moon.
“There are little wins here and there and I love those, but we haven’t made that much impact. If you are diagnosed with lung cancer, or colon cancer, or breast cancer, your life expectancy is not that much longer than it was 50 years ago.”
He pauses. “It’s embarrassing and it’s tough – and it’s why the answer has to be prevention.” This, then, in a nutshell, is the Agus doctrine. In his new book, A Short Guide to a Long Life, he prescribes 65 rules we should follow
to achieve better health. All, he says, are grounded in empirical research. They range from getting a flu shot to working on your posture to finding yourself a spouse. The aim is to delay or, better, to avoid ailments ranging from heart and kidney disease to diabetes and dementia. “Imagine a world where we all die of old age – our bodies go kaput, much like an old car with hundreds of thousands of great miles on it,” he says.
The hyperconfident manner in which he presents this vision has drawn flak from parts of the medical community. (Indeed, he’s been called “the most controversial doctor in America”.) But grant him this: the 49-year-old Agus practises what he preaches.
And so, when I’m led to his office, I find him drinking coffee (rule number 1) and wearing a large smile (2). His shoes are comfortable (3). His activity levels are being monitored by an electronic bracelet, worn on his left wrist (4). He looks well scrubbed (5). He is married (to actress Amy Povich) with two teenage children (6). This afternoon, he will play tennis with his 13-year-old son (7) before taking his dog for a walk (8). At least three times a week he’ll eat coldwater fish (9). Before bed, he’ll take a statin (10) and a baby aspirin (11).
In a corner there is a treadmill desk, where he’ll spend a couple of hours going through emails, walking slowly. (Staying sedentary, he believes, is as bad for you as smoking.) Each one of these actions is part of the Agus formula for longevity.
“With current technology and prevention and the way our bodies are engineered, you can expect to live to your ninth or tenth decade without difficulty,” he says. There is, however, one conspicuous piece of his own rule book that he’s failing to comply with – a regular daily routine. Agus believes that a set timetable fosters health.
But he yanks his own body clock around. He’s just returned to California from the World Economic Forum in Davos, Switzerland – an annual meeting of rich, influential people where the other delegates included the Iranian president, Hassan Rouhani, the US secretary of state, John Kerry, and the UK prime minister David Cameron.
And this morning, Agus was up before 3am to appear on one of America’s most popular morning shows, something he does once or twice a week. “You can’t be perfect,” he says of his hours. If he has the
chance to “educate three or four million people by talking about science, that’s what I’m going to do”.
Since 2012, his life has been a whirlwind of media interest. That was when he published his first book,
The End of Illness. Wired magazine called it a “paradigm-shifting” guide on how to live longer; it was a New York Times No 1 bestseller.
Its success led to him being branded a ‘pop doc’. But Agus can claim a level of credibility that most media-friendly physicians lack. He is a research scientist and a professor of medicine and engineering at the University of Southern California. He was part of a team that discovered that vitamin C can fuel cancer, because tumours can feed on it. (He says that diet supplements are worthless and wants us to stop buying them.)
He has helped usher new drugs into being and has co-founded two medical technology companies.
Besides that, he somehow makes time – two-and-a-half days a week, usually – to see patients, many of whom you’ll have heard of: Ted Kennedy, Lance Armstrong, Dennis Hopper and Johnny Ramone, the guitarist from the Ramones.
The rock star Neil Young called Agus “my mechanic”. The former US vice-president Al Gore has praised Agus for defying “a certain peer pressure” that discourages “taking the discoveries of science into popular culture”.
And, of course, there was Steve Jobs. The Apple tycoon appears to have made himself a kind of mentor. After Agus completed his first book, Jobs took it on himself to call the publisher, to insist its title be changed, from What Is Health? to The End of Illness.
Agus remembers how Jobs told him that you can’t give “a book to someone with the word ‘health’ in the title. It implies that they’re in bad health.” Sure enough, it has been one of the books most often given as a present on Amazon. “Steve knew marketing,” says Agus.
He first met Jobs a year after the Apple boss was diagnosed with pancreatic cancer. At first, Jobs refused surgery. Instead, he tried to treat himself with a strict vegan diet, supplemented by acupuncture and herbal remedies. (Jobs’ initial refusal of conventional treatments has been credited to the “dark side” of his famous “reality distortion field” – his conviction that he could almost will things into being.) Agus was involved only after that phase had ended – “when Steve said he was going to give up the fad diet and go with conventional treatment”.
According to his biographer, Walter Isaacson, Jobs was one of the first 20 people in the world to have all the genes of his cancer tumour, as well as of his normal DNA, sequenced – a process that cost more than $100,000 (Dh367,000). Knowledge of the unique genetic and molecular signature of Jobs’ tumours allowed his team of doctors to pick specific drugs “that directly targeted the defective molecular pathways that caused his cancer cells to grow in an abnormal manner”, Isaacson says.
The technique bought Jobs perhaps six or seven extra years. But each set of drugs only worked for so long before a new formulation was needed. Agus tells me how Jobs described this process of trying to outrun his cancer as “leaping from lily pad to lily pad”. Eventually, the waters swallowed him.
According to Agus, Jobs was a “remarkable” patient. “He got the science; he would argue. He wouldn’t just do what I said; he argued back all the time. He fired me many times – but he understood what needed to be done.”
Indeed, Agus seems – still – to be in awe of the father of the iPhone. “He was a hero and, like many people who are heroes, he lived until the day he died. Many people die the day they are diagnosed with the disease – they ask, ‘Why me?’ – but he lived until the day he died and that’s a beautiful thing.”
Agus appears to have taken several cues from the Apple boss. Like Jobs, Agus is not averse to a little sensationalism if it provides a means to pierce public apathy. He tells me that lifts in offices should be coinoperated – to encourage people to take the stairs. “Every time you take the elevator you are hurting your company, because if you get a disease, it will cost your employer money – and it will impact on the company’s productivity, let alone what it will do to you and your family.”
Smokers, couch potatoes, the obese – they should pay financial penalties, Agus adds.
He doesn’t mind the right sort of controversy. “Whenever you create discourse, you create understanding,” he reasons. He cites the example of Michael Bloomberg, the former mayor of New York, and how his campaign to ban large soft drinks and transfats met with furious resistance. “People argued – ‘Nanny state is good; nanny state is bad.’ But no one argued trans-fats are good for you.”
So, Agus has clearly modelled aspects of himself on Jobs (most obviously, his workplace ‘uniform’). But he wants us to ape the Apple boss, too. Essentially, he’s counselling us to take a greater interest in our health – to be the bosses of our bodies. We should measure ourselves, and keep our health records in digital form in the cloud.
And we should engage our doctors in debate. “Powerful people argue back,” he says of his celebrity patients. “The masters of the universe are not successful because they do what people say – they are successful because they can analyse [data] and make decisions for themselves.”
In A Short Guide to a Long Life, Agus has done the analysis bit for us. The book espouses the idea that prolonged good health starts with lots of smallish changes today. Much of the advice – don’t skip breakfast; avoid sunburn – will be familiar.
Agus notes that Hippocrates made many of the same observations – “Walking is man’s best friend”; “Let food be thy medicine and medicine be thy food” – in the year 4BC. Yet the truth is that few of us have so far incorporated them into our lives. About 50 per cent of Americans are living with a chronic ailment and seven out of 10 will die of a disease that might have been prevented.
Some of Agus’s rules are cute: for instance, “Smile – the act itself will trigger the release of painkilling, brain-happy endorphins and serotonin.”
Others seem quirky – he’s adamantly against high heels; they are a source of inflammation, which can raise your lifetime risk of many illnesses, including heart attack, strokes and cancer, he says.
A few of his dictums will give pause for uncomfortable thought. Rule 56 says to avoid airport backscatter X-ray scanners. Until science can prove they are safe, Agus says, “I’ll be requesting the manual pat-down massage when I go through the [security] gateway at airports. You should, too.”
He debunks fads as well; rule 60 is “no juicing”. “Does the body really like consuming 10 carrots all at once? I think not.”
Or how about “Eat real food”? That means avoiding anything in a packet. It doesn’t matter if it announces itself to be good for you somehow by being, say, ‘cholesterol free’ or ‘antioxidant rich’. “If they have to tell you why you should be eating it, you shouldn’t be eating it.”
In the book, Agus’s is a calm and reassuring voice. In person, it’s more urgent. At one point he asks me if I’ve had a flu shot this year.
I haven’t. “You should get it now,” he says, looking me dead in the eye.
“If you get the flu, in a decade from now your chance of cancer or heart disease is elevated... So go and get that flu shot if you want to play with those grandkids. It’s a sore arm.”
That’s putting it in rather stark terms, I say. “I see the advance of the disease, and what can’t be reversed,” he replies.
His bundle of tips comes in a holistic wrapper. He wants to instil a new way of thinking about cancer. It’s not something that visits us from outside, he says. We don’t ‘get’ cancer. Rather, we need to stop our bodies from ‘cancering’. Cancer is a verb, not a noun.
He also believes that the medical community has fallen into the trap of believing that diseases can be blamed “on single culprits”, when a complex web of causes often really exists. “For decades we’ve tried to reduce our understanding of the body and its potential breakdowns to a finite cause, be it a mutation, a germ, a deficiency, or a number such as a white blood cell count, glucose level, or a triglyceride value.”
But often, he believes, “It does no good to try to understand a certain disease; we just need to control it, much like an air-traffic controller manages planes without knowing exactly how to fly one.”
Review his family history and it’s possible to see a hint of something evangelical in Agus’s DNA. His grandfather, Jacob Agus, was a theologian. His father, Zalman, is a professor emeritus of medicine and physiology at the University of Pennsylvania. Agus himself was recognised as a gifted child. “I did very well on some aptitude tests and, at the time, the US was scrambling to respond to Sputnik, and so they had a bunch of programmes to get kids interested in laboratory work; I’ve loved science ever since. For me, it was an absolute passion. Other kids were out at parties and I was literally injecting rats and doing experiments every day.”
He went on to the Ivy League: undergraduate studies at Princeton and medical school at the University of Pennsylvania. He served his residency at Johns Hopkins Hospital in Baltimore.
But it wasn’t until he encountered the masters of Silicon Valley that he really hit his stride. In 1998, he met Andy Grove, the former chief executive of the microchip giant Intel. They grew close, and Grove, who had spoken out about his own fight with prostate cancer in 1996, urged Agus to become a better communicator.
Agus began speaking in hospitals. He gave about three talks a week during the first year. “I forced myself to be a better presenter,” he says. Grove persuaded him to move to California. In 2000, he took a position at Cedars-Sinai Medical Centre in Los Angeles – a favourite destination for sick film stars.
America’s technologists continue to back him. The computer billionaire Michael Dell recently bought 1,000 copies of his new book to give to his executives. In Agus’s eyes, that kind of investment is just common sense.
In America, the guides cost about $18 (Dh66) each. A thousand copies of the book cost Dell $18,000. If just one employee reads the book and changes his lifestyle enough to prevent a heart attack, the company will avoid about $78,000 in future health-related costs, Agus argues. Even so, he’s aware that he hasn’t talked everybody around.
He has been accused of oversimplifying his message, a criticism, in fact, that played out very publicly on one of America’s biggest television channels. In 2012, the broadcaster ABC aired two reports on
Agus. The first was by Bill Weir, a journalist who called it “the assignment that saved my life”.
Weir asked Agus to subject him to a battery of tests, on air. The news reporter was a 44-year-old father and husband who appeared to be fighting fit. He was shocked when Agus told him that he had the early signs of heart disease – calcification in major coronary arteries.
Agus toldWeir that he was running the risk of becoming “the 45-year-old who went jogging and died”.
“At that moment, I vowed to change,” saidWeir. Among other things, Agus put him on a cholesterol-lowering statin drug regime – a move that he suggests all of us should seriously consider.
However, after the report aired, Weir began to hear from other doctors. In a follow-up piece, Weir suggested that Agus had overstated his risk of dying.
Critics said that Agus had been too strident in his advice, that his warnings had been too stark, that the drugs he had placedWeir on had side effects that were not properly explained. Weir suggested that Agus should have provided more context.
When I mention the ABC reports, Agus appears utterly unrepentant. I ask what he thinks when people accuse him of oversimplifying. “To me, it’s a compliment. I made it simple to get people to understand the basics and have a discourse. So to me, it’s not a bad thing.”
At another point in the conversation, he’ll say that many decisions we make in regard to our health occupy grey areas.
“Very few things in health are ‘Yes’ or ‘No’; most of the time it is based on your value system and a decision for you.” He’ll note that he doesn’t say that all of us should take statins – only that we should consider taking them.
But he soon bounces back to his default surety. “If we all went on statins, we would live longer,” he says. “That’s the data. Is there a downside? Yes, you get some small muscle aches – they go away a day after you stop. That’s it.
“By the way, the cost without health insurance in the US is $9 (Dh33) for a 90-day supply. So this is not enriching the pharmaceutical industry.”
Agus is acutely sensitive to accusations that he’s boosting Big Pharma by pushing lucrative medicines. Defending himself, he points out that the same drug companies make billions from vitamins and other supplements, which he wants us to stop buying.
But as we talk, I start to wonder if the criticism he attracts doesn’t really stem from elsewhere. His own celebrity seems to breed a certain suspicion. So, is the billionaires’ doctor wary of the lure of fame? “For myself ? No. I’m doing this out of weakness, not strength,” he says. He’s circling back to that sales pitch.
“I know I’m not good at treating advanced disease and I view [educating people about prevention] as an obligation. I’m an introvert by nature, so I don’t enjoy being on a pulpit; I don’t enjoy interviews, or going to events. But I feel strongly I can change things.”
So if you’re basking in the glory of middle age, this is something to discuss with your doctor. It’s the cheapest fountain of youth around and requires no prescription.