Longevity rules

No high heels? Some of Dr David Agus’s ad­vice might sur­prise you.

Friday - - Friday Contents - A Short Guide to a Long Life by David B Agus, MD, is pub­lished by Si­mon & Schus­ter

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.

Dr Agus with his wife, Amy Povich, and chil­dren Miles and Syd­ney

Not afraid of con­tro­versy, Dr Agus says the obese and smok­ers should pay fines

Steve Jobs im­pressed Dr Agus in truly liv­ing un­til the day he died

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