>>Male Presenter: We’re delighted to have
Dr. David Agus joining us today. He’s a professor of medicine and engineering at USC, and heads
up the Westside Cancer Center and the Center for Applied Molecular Medicine there at USC.
He clearly excels in business as much as he does in academics. He’s the cofounder of two
personalized medicine companies. One is Navigenics and the other is Applied Proteomics.
His recently published book, The End of Illness, calls for a shift in the fundamental ways
in which we think about the actions of health and illness, including a view of the body
as a complex system rather than a series of simple causal chains. He balances this philosophical
approach with a very practical one, laying out recommended annual health checkpoints,
lab results that you should have done regularly, and why you should not sit down all day at
your job. His book is really, for me, was all about prevention and how to keep yourself
healthy, which is an area that both Google and Googlers need to own as we grow older.
If all of that somehow left you in doubt about his brilliance, Dr. Agus also has achieved
a degree of celebrity stardom. He was on the Daily Show a few weeks ago with Jon Stewart.
I guess what we’re really all wondering is what Jon Stewart says to his guests as he
leans over the desk as the camera pans out. With that, I welcome Dr. David Agus. [applause]>>David Agus: Thank you. It’s funny, Jon Stewart–
Before the show, I went up to him and I said, “I’m scared to death. I’m a cancer doc. I
do all this media, but being live with a comic scares me a little.” And he said, “Listen,
I’ll give you a hint. Most people at the end of the show stand up and leave, but there’s
30 seconds when the credits roll. You lean forward and talk to me. People will think
we’re friends, and it will work.” [laughter] Then I lean forward at the end and he goes,
“The deal was for me to have told you this, is now you have to be my doctor.” [laughter]
It’s a pleasure to be here. Thank you. The End of Illness is a declaratory, aggressive
title. I submitted it to the publisher about 8, 9 months ago. It was called, at the time,
What Is Health?, as an homage to Schrödinger’s What Is Life? book from the 1940s. I had a
call from the publisher saying, “Agus, Steve Jobs just called and changed the title of
your book.” I’m like, “He did?” And they’re like, “He changed it to The End of Illness.”
I called Steve, and I said, “Steve, I love the title, but why didn’t you tell me or discuss
it with me?” He goes, “Agus, it’s not your job. It’s theirs.” I was like, “Okay.”
I thought about it, and it is obviously and aggressive title. But it’s something I believe
in. I truly believe we can delay illness to the ninth or tenth decade. If you look in
the United States, 1956 was the last year you can die of old age on a death certificate.
Since then, we’ve had to have a cause, whether it be diabetes or lung cancer or prostate
cancer. You name it, there had to be a cause. But I want to go back to the era of dying
of old age. The paradox is in that if we delay illness to the ninth or tenth decade, healthcare
costs will come down dramatically. If you get ill in your 80s and 90s or 100s, actually,
you don’t go to an intensive care unit. You don’t go on a ventilator. We treat you with
dignity instead of trying to prolong things. Remember, over 60% of healthcare costs in
the United States right now are the last two years of life. We spend almost nothing from
age 15 to age 55. Obviously, part of the premise that I want to push to you is we’ve got to
shift that because we have to prevent illness. We are the number 1 spender in the world on
healthcare, and we’re ranked 32nd. Washington has ex bandwidth for health, and most of it,
if not all of it, is spent on healthcare finance. None of it’s spent on health.
What I’m going to present you today is a new way of looking at health and really focusing
on what I think we need to do as changes. The book came out 3, 4 weeks ago. What’s amazing
is I’ve already had about 6, now, video conferences with member of the Chinese government. They’re
going to enact parts of the book as law this summer. Whereas the US government, it will
take a decade of debate before they even bring it up to talk about it publicly.
The first question when I talk about this book is everyone says, “You’re a cancer doctor.
Why do you have the right to publish this book and talk about it?” To me, it comes from
the old adage that in order to understand peace, you have to go to war. Fighting cancer
for the last 25 years has brought, in my mind, a whole new way of approaching health.
The team that I work with are two other individuals who bring very unique ways of looking at health.
I’ve got Murray Gell-Mann. Murray is probably the greatest living physicist. Discovered
the quark, string theory. He won the Nobel Prize in 1969. Now, he’s working on modeling
health with our team. And a guy named Danny Hillis, who built the first supercomputer
and discovered RAID storage in the old days, and is again one of the great engineers who
is now working on modeling health now. What you’ll see is the result of us thinking
about health or approaching it as a biologist, a physicist, and an engineer. I’ll show you
a new model, looking at health as a complex emergent system as disease in the body, how
one can apply it, so it will be prescriptive, and then how technology is going to be, in
my mind, what allows us and brings us the hope to actually bring us change.
The first question is: what is health? Is it your cholesterol? Is it your weight? Is
it how you feel? Is it how you sleep? Is it how you look? How do you define health? Any
engineer will tell you it’s impossible to optimize a system unless you develop parameters
on which to optimize. So what is it? Is it how long you live? Is it what you look like?
On what parameter are we going to optimize health? We don’t have a blood test for health.
If I asked you today, “Are you healthy?”, how do you respond? That’s one of the fundamental
problems is I don’t know how to define health when I look at it. We can talk about all the
corporate wellness programs in the world, but corporate wellness programs will optimize
on lowering health insurance costs. Corporate illness programs are about delaying illness
till retirement. But I want to figure out a way to optimize health. We’ll talk about
ways I think we could start to do that, going forward.
Mark Twain, in his imminent wisdom, said, “The only way to keep your health is to eat
what you don’t want, drink what you don’t like, and do what you’d rather not.” [laughter]
When I asked Steve, “Why didn’t you like the title What Is Health?” He said, “If you put
the word health in the title, people think of chewing cardboard.” That’s part of the
problem, is that health is something that we know we’re not going to like if you say
what you have to do. Things that are unhealthy are more appealing. What I’ll try to show
you today is that that’s not really the case. By definition, things in health don’t have
to be unappealing. Again, we go to what is that metric for health.
Well, in the United States, we spent over a billion dollars last year in people over
the age of 50 getting growth hormone. Why? If I give you growth hormone at age 50, 60,
or 70, you’re going to look better in a couple of months. You’re going to be all buff. Your
friends are going to come and be all, “Hey, what happened to you? Did you get a haircut?
You look great.” You’re going to feel better. You’re going to live, on average, 12 or 13
years less. But you’re going to look better. And yet, our country, we do this all the time.
People go in, especially in my city, Los Angeles, and they get shots of growth hormone to look
better. They take, whether it be steroids, they get Botox, they get all kinds of things
to look better. But again, I want people to think about tomorrow as well as today.
There’s an amazing group of people in Ecuador that was identified in a paper in Science
this last year, where they actually looked. They have a mutation of the growth hormone
receptor. These people don’t get cancer and don’t get diabetes at all in their populations.
They have other problems, but what we also know is that species that grow larger or members
of a species that grow larger have more health problems. And yet, we as a society push to
making people larger. One of the chapters of the book is about football players. Football
players are, in general, very large, have a lot of inflammation, as we’ll talk about.
CNN did a story on this for the Super Bowl. I can’t tell you how many hate emails I got,
and letters. “You’re taking away American culture.” “You’re screwing us.” I’m not against
football, but I’m against the concept of inflammation. I’m against the concept of the bigger, the
better, as we’ll talk about. We need to start to identify what are the metrics each of us
individually are going to look at, because obviously, we want to live until our 90s.
The key is avoid disease. I look at 2 to 3 people a week, and I say, “I’ve got no more
drugs to treat your cancer. I’ve run out. And unfortunately, the cancer’s going to win.”
I don’t want to do that anymore. The way to stop that is to avoid disease. Most diseases
can be delayed or avoided. I don’t know if you guys saw the paper last
week, but now we’ll make Alzheimer’s a disease of the past over the next 5 to 7 years. It’s
astonishing, but Alzheimer’s will go away. If you look at it, a month ago, 15% of us
in the room will be affected by Alzheimer’s. As of the data last week, it’s staggering.
There are two big advances. The first is they took a couple of cells that made this abnormal
protein called tau, which is what messes up the brain in Alzheimer’s. They put them in
the brain of a mouse. Then they sacrificed the mouse a couple weeks later. And what do
you know: those tangles are all over the brain. So Alzheimer’s isn’t a disease of the brain,
it’s a disease of a couple cells that then spreads its proteins throughout the brain.
If you block that, you no longer will have Alzheimer’s. We have a mouse model now that’s
accurate. We can develop it. Instead of testing in humans– The problems in testing in patients
is you’ve got to do it for ten years. You’re not going to know until– ahh!– ten years
later whether it worked or not. So now we’ve got a model.
And then, get a load of this, they took a drug for lymphoma that had been FDA approved
already, it’s on the market, and they gave it to these mice. Well, if a mouse– You drop
a napkin in a cage, they chew it up and make a little nest. It’s called nesting. You give
a mouse Alzheimer’s, they just sit in a corner and act like this and do nothing. You give
them this drug for lymphoma with the Alzheimer’s, two days later, they’re making a nest again.
You look in the brain of the animal, 60% of these tangles are gone. Again, this is a drug
that’s already FDA approved and on the market. So we’re going to have a marked impact on
Alzheimer’s and every disease we’ll talk about today. The key is delaying them or preventing
them so you, I, our loved ones, can benefit from those advances.
And again, we talked about that it’s actually going to lower costs if we do this right.
In the 1930s, J.B.S. Haldane, who was the great thinker of the time, said this amazing
quote, because it really is true today. He was right. He predicted it 90 years ago. He
said, “Bacteria and this germ theory is going to screw up everything because we’re going
to forget about the system.” We’re going to treat other diseases like cancer, heart
disease, and Alzheimer’s like infectious disease, and we’re going to be wrong. He was right.
Remember, infectious disease, you make the diagnosis, you know the treatment. It’s easy.
That bacteria, that antibiotic, they work. It doesn’t care if you’re short, round, tall,
fat, green, yellow, blue. It will work because bacteria come from without. The problem is,
human disease comes from within. Human disease, you make a diagnosis, most of the time you
don’t know the treatment because it’s the interaction of that disease in your body that’s
unique in each of us. Very different from infectious disease. Yet, over the last 90
years, we’ve been treating almost all disease like infectious disease. You have X, let me
give you Y. Most of the time, unfortunately, that doesn’t work.
This is one of the sad figures that’s in the book that I get a lot of comments about, which
is heart disease, stroke, down dramatically in death rate over the last 50 years. Cancer,
not really a change. Well, what caused this major decline? Two things. Smoking: we’re
smoking less. And then statins: statins are class of drug that were developed to lower
LDL, the bad cholesterol, and then they were given to patients. They had a dramatic effect
on heart disease and stroke. Turns out that their mechanism, how they work, was different
than lowering cholesterol, as I will talk about. It’s because they’re one of the great
anti-inflammatory drugs we have. The root of diseases like heart disease and cancer
inflammation. In fact, statins will reduce the incidence of cancer beautifully if one
takes them for several years. So, dramatic effect here, yet influenza, right:
we can give vaccines, we have antibiotics, fantastic. Cancer, not really a big impact.
So cancer, we’ve treated a reductionist way. The amazing thing about cancer that people
don’t get is– Again, I was one of the heads of the Cancer Genome Project, so I’m as guilty
as anybody else. But if you look at breast cancer under a microscope, a pathologist will
look and say, “Hey, it’s breast cancer.” They don’t care what the genetics are. The body
doesn’t care what the genetics are. Breast cancer looks like breast cancer. Colon cancer
looks like colon cancer. Evolution is selecting out for phenotype, what it looks like, not
the underlying genetics. There are 150 ways to get to be breast cancer, yet they all look
alike. Yet our treatments, we keep trying to hit those molecular abnormalities. We forget
the other part. A clinical trial was done about 10 years ago
that people thought was crazy, that now is the standard of care in the treatment of a
disease, breast cancer. What we did was it took women after optimal treatment. Half got
placebo, and half got a drug that builds bone, a drug for osteoporosis. Recurrence was reduced
by 40% Why? Breast cancer metastasizes to bone. If you change the soil, the seed doesn’t
grow. We just made the body inhospitable to breast cancer. And what do you know, it didn’t
come back in those women. A powerful statement, a powerful way to treat disease. Because to
me, diseases like cancer, Alzheimer’s, heart disease, they are verbs, not nouns. You’re
cancering. You’re heart diseasing. I want to change you from that disease state to a
health state. It’s a different way of approaching disease if you think about it.
The way I look at it is at a complex emergent system, where you’ve got inputs. Your input
is your DNA. Your input’s what you eat. It’s your environment. It’s your work environment.
It’s your friends. Those are all your inputs. Your output is how you feel. That middle state
function has been historically hidden. We haven’t been able to look at it. Historically,
we give change in input and we see how it affects the output, with all those inputs.
But we’ve never been able to look in the middle. Well, on the cover of the book, let me just
borrow this for one sec, we can all of a sudden see the state function. This is a picture
of the human proteome. It’s a drop of blood going through a supercomputer, I mean a superconducting
magnet, where we get a 50 to 60 gigabyte image of all the proteins in the blood. That’s that
state function. For the first time, we can see. We’ll talk about that a little more in
a minute. But all of a sudden, you’ve got various state functions that are equivalent
classes of history. They are patients with heart disease, patients with cancer. We can
start to modulate them. For the first time now with technology, we can actually see them.
Well, the bad news is it is almost impossible to understand complex emergent systems. The
good news is, you can control the systems you can’t understand. If I asked my 11 year
old boy, “How do you stop a train?”, he just says, “You pull the brake.” He doesn’t first
say, “What’s the weight of the train? What’s the track made of? What’s the temperature?
What’s the air speed?” He just says, “Listen. I’ve got to figure out a way to control it.”
My field has spent the last 50 years trying to understand diseases like cancer rather
than just working on ways to optimize and control them.
The average cancer on diagnosis has how many mutations? 130. If I can pick one that I could
target with a drug, do you really think it’s going to make a major difference? Remember,
my field, cancer, we try to shrink the disease by 50%. That’s called a win, and that’s what
we get FDA approval on. Well, 50% isn’t even an order of magnitude when you’re talking
hundreds of billions of cells. There’s something missing here in what we’re doing. There’s
something missing in how we’re approaching these.
1997, I was a trainee at Sloan-Kettering. A kid, 25 year old kid, had germ cell tumor
of the brain, the lung, and the liver. He went to the best hospitals in the country.
They told him, “Listen, chemotherapy is just going to make you sick. Why don’t you go home
to Texas and spend your last couple months with your family?” Instead, this kid went
to Indianapolis. He went there because some goofball doc, and I say the word goofball
affectionately, he took two platinum electrodes and put it in a gel and said, “Do cancerous
cells like electricity or not?” Well, it turns out, they didn’t really care about the electricity.
But some of the platinum in those rods killed some of the cells. So they gave it– This
is the same thing in my wedding band. They give it intravenously to this kid in Indianapolis.
A year and a half later, he won his first of 7 Tours de France.
Why did platinum cure Lance Armstrong? I have no freaking idea. Yet you can find 50 explanations
in the scientific literature. “Well, it affects the DNA adducts and here and here.” Again,
we don’t really know how these drugs work. Most chemotherapy, I’ll challenge you, I don’t
think chemotherapy has any data that it actually touches the cancer cell. It works, believe
me, but it probably changes your system so the cancer doesn’t want to grow anymore. We
don’t have data that it actually targets and hits the dividing cancer cells. Cancer cells
are very similar to normal cells. So again, when you think of this complex emergent system,
we have to look at different ways of measuring the system, looking at perturbations, when
we look at disease. Remember, I’m the same field that put out
ads like this. I’m the same field that put out ads like this. And this. And this. You
can’t forget the dentists. I’m the same field, that 25, 30 years ago said, “Take margarine,
not butter.” We killed millions of people by telling them to do that. Over and over
again, we make these declaratory statements without any real data. We make these observational
findings. There’s an association of X with Y, and therefore, we should avoid X.
One of the things I’ll talk to you about in a minute is vitamins. Again, which gets people
really upset, because many people– Vitamins have been a crutch which they’re leaning on
for the last several decades. And I’m taking away that crutch. They get really upset. I
spoke at the Commonwealth Club last night, and I had protestors. I’ve never had a protestor
before. It’s true, I’m different than most people in that the protestors were 85 years
old. It’s a very different kind of protestor who protests with what I have to say. But
you’ll look at things like vitamin D, as we’ll talk about. Right now, if you’re over the
age of 50, 60% of people are taking vitamin D supplementation. The government in Canada
had to outlaw vitamin D testing because it was 11% of their healthcare budget two years
ago. Why are people testing for vitamin D? Because there are associations. People with
lower vitamin D have a slightly higher cancer rate and a slightly heart disease rate. Also,
if you smoke, you have lower vitamin D. If you’re obese, you have lower vitamin D. Nobody’s
saying if you give vitamin D, you’re going to stop smoking, but there’s that association,
too. We’ll talk about some of the data, because it really has been leading us astray in many
of the things we do. One of the great examples is exercise. Our
exercise notion in our country is: you do an hour of exercise at the gym or the DVD
you put in your machine and watch and do some yoga for an hour, and then you sit at your
desk the rest of the day. Well, if you start to look at the data, real studies, and we’ll
talk about some of them, as old as 60 years old. The data shows that an hour of exercise
a day is awesome. You sit the rest of the day, you negate it all, and it causes harm.
In fact, that harm, if one does a quantitation on incidence of heart disease, it’s worse
than smoking, if you look at it. So they key is moving.
The original study done is the coolest study. It was published in 1953 in the British medical
journal Lancet. Nobody paid attention to it. It wasn’t referenced for literally 40 or 50
years. They did something with privacy rules, now nobody can do. This guy, Jeremiah Morris,
went and looked at the 26,000 workers in the British Transit Authority. He just looked
at all their data. He didn’t care who they were. He just looked at their data. What he
said is that there were two classes of employees. There were the bus drivers that sat 90% of
the day and drove the buses. Then there were the ticket takers that walked around and took
the tickets on those double decker buses. Well, the heart disease deaths were 60% less
in the ticket takers compared to the bus drivers even though they weighed the same, they ate
the same, they lived in the same neighborhoods. They had everything the same. The difference
was one group sat and one group walked. Powerful argument.
He went further in that paper. This is one of the coolest graphs in science. It looks
at death rate as associated with profession. What it showed is the worst professions were
hairdressers who stood in one place, or the typists who sat in one place. The best professions,
believe it or not, were the coal miners and the gardeners, because they moved and they
walked. Today, Nike is launching a product that’s
called Fuel, which is a band which you wear. It looks at how much you move during the day.
It communicates via Bluetooth. It creates these communities, because unfortunately or
fortunately, depending how you look at it, we all need competition to do the right thing.
It’s going to create competition among friends, among corporations, employees, to start to
move more during the day and quantitate it. Moving equates to better health. I wore one
of those accelerometers and I realized I was sitting most of the day. I got one of those
phones that made me look like an air traffic controller. Now, when I’m in my office, I’m
walking, talking on the phone. I’ve reduced by half the amount of time I sit. Someone
comes to meet you during the day, say, “Let’s go for a walk.” That’s a sign of respect,
rather than just sitting in a conference room and talking. I know what a difference in corporate
culture, but over time, will make an enormous difference on health.
Obviously, I talk a lot on negative stuff, and what we’re doing wrong. But obviously,
we’re doing things right. If you look in the United States between 1900 and 2008, there’s
a dramatic increase in how long we live. True, much of that increase comes from reducing
infant mortality, because these data can be somewhat misleading. If infants live past
the age of 5, the chances are they’re going to live till they’re 60. That obviously skews
the results to the right. Especially worldwide, now, we’re starting to eliminate much of infant
mortality. But at the same time, we are living longer. So we are doing some things right.
The problem, the fundamental problem, is that evolution selects out for who has good kids.
It doesn’t select out for who lives until their 90s. We forget that sometimes. In order
to go to your 90s, you’ve got to optimize a little, and tweak, because evolution didn’t
take care of us. There are things that can help you during childbearing years that may
hurt you later on. For example, if you skip your flu shot this
year, which I’m sure none of you did. If you skip your flu shot, and you got the flu, you
will all survive. I guarantee you. You’d have five, six, seven days of feeling poor, etcetera,
and then you’d go back to work and you’d be fine. A decade from now, your risk of heart
disease and cancer are 10 and 12% elevated, because those five to seven days of marked
inflammation will have its manifestation a decade from now. Our culture is all about
what will affect us today, not tomorrow. We have to think more long term, as I’ll show
you. US mortality, and this is–. Unfortunately
the data is several years lagging, always. If you look at it, a quarter of deaths are
heart disease. Men higher than women, so 40% of us will die of heart disease, about 20%
of them women, will die of heart disease. Cancer, stroke, infections. Most of these
things are delayable or preventable by current technologies. Yet most of the things we’ll
talk about we ain’t really doing. I’m not sure why.
One of the technologies in full disclosure. I’m a cofounder of Navigenics, one of the
DNA companies out there. You guys are an investor. Google was an original investor in Navigenics.
I did it because the government had been spending close to a billion dollars a year looking
at gene associations with disease. And yet, nobody was using the data or benefiting from
it. So 1974, Monsanto’s annual report, they set 150 million dollars to sequence one gene.
Two weeks ago on Nightline, Bill Weir, the Nightline anchor, came to my office. This
was live on Nightline. We sequenced his genes. We showed he was higher risk of heart disease.
Based on that, we did a heart scan, live on TV. He’s a 42 year old, fit guy. Kids under
the age of six. Traveling all over the world. He’s now in– Just did a report yesterday
on the Foxconn workers for Apple and all the issues. He’s traveling all over. We showed,
live on TV, that in his heart artery, the big artery, the LED going to his heart, there’s
a big lesion there. He would have had a heart attack in the next one, two, or five years,
but we identified this live on TV using the preventive strategies. It saved his life.
The next day, the American Heart Association, in their beautiful wisdom, says, “Agus screwed
up. He wasn’t eligible for screening.” I’m like, “Are you guys serious? Either your criteria
are wrong, because he was positive. Something is missing in this picture here.” So then
they said, “Well, you’re right. Maybe the criteria can be changed a little. But technology’s
bad, and screening, and there are problems with that.” I got, “Then you guys should be
saying, ‘Why aren’t we putting more research in technology to do better screening?’ Just
blanket saying, ‘He shouldn’t have been screened because too many people will be screened’,
that’s the wrong thing. So it really scares me in that regard.
Many of you have already done this, but this is me. These are my DNA results. Did it overnight
tell me exactly what was going on. No. But it was somewhat of a religious moment for
me, because all of a sudden, I looked and I knew more about me. I realized I have a
42% chance of having a heart attack. I had a normal cholesterol. Based on that, I went
on a statin. We’ll talk about that data in a minute. I’m on an aspirin. I’m lean body
mass. I exercise. I actually changed behaviors. I eat better. When I saw myself on a piece
of paper. We always view ourselves different than we really are. It changed me.
But it’s not only your genes. This is a chart where the black is the genes, the white is
environment. Almost every disease, there’s an environmental part that we can control,
and there’s a genetic part that we can blame our parents for. Although we like to blame
our parents for everything, none of these diseases are deterministic. They don’t just
happen. We can prevent them. Whether it be by behavior, changing environment, or actually
drugs, all of them can help. When we talk about drugs, and we’ll talk more
about statins, but I get vilified saying I’m a shill for the pharmaceutical company. “Agus
is out there pushing drugs. He works for them. He doesn’t want to push the natural things
because then he’ll be out of business in treating disease.” The drugs I push– You know how
much a statin costs? Without health insurance, you can go to Wal-Mart and get a 90 day supply
for $9. These are generics. These are available. These will radically change healthcare when
we start to look at the data. Aspirin. An aspirin a day, $3 a year to take
baby aspirin, 81 mg a year. If you start to look at the data, after five years of aspirin,
death due to GI cancer down 54%. One case of colon cancer to a company like Google costs
$247,000. Again, if you can reduce that by half by saying, “Take an aspirin”, I don’t
get why people aren’t doing it more. After 20 years, death. Death is a bad side
effect. Death due to prostate cancer down 10%. Lung cancer, 30%. Colo-rectal cancer,
40, esophageal cancer, 60%. You start to look at this data. You start to say– Listen, I’m
not saying anybody should take a pill. But I’m saying that conversation with a physician
needs to happen. You need to say, because there are reasons why you shouldn’t be on
it. But you need to have to conversation and say, “Listen, I understand there’s data. This
may benefit me. What are the downsides? Talk about me as an individual, given my family
history, given my genetics, given my risk factors. I want to know why I’m not on something
like this.” If you’re a company and you say to your employees, “Listen, you can do whatever
you want. But if you have that discussion with your doctor, I’m going to give you a
discount on your health insurance, because it’s going to benefit us.”
Michael Dell was a hero to me in that he said, “Listen, I have 105,000 employees at Dell.
They’re welcome to smoke. But if they smoke, they’re going to have a different health insurance
cost than the non-smokers. Because why should smokers be subsidized by the non-smokers?”
That data are profound. We need to push and change. Obviously, it’s aggressive. People
would get upset. But we’re the number one spender in healthcare in the world, and our
results are dismal. 16 1/2% of GDP and growing every year. Unless we start to enact things
and change and prevent, it ain’t going to get smaller.
You start to look at drugs like statins. Again, these are prescription drugs now, although
about 6 months ago, they were filed to go over-the-counter. They’re generic. Again,
they are inexpensive, costing about $36 for an entire year of treatment. You start to
look at the data. The Jupiter study, which was really a pivotal study because it took
people who had normal cholesterol. A normal cholesterol. Not a high cholesterol, a normal
cholesterol. They put them on a pill a day. What it did was it delayed heart attack and
stroke by over a decade. Many cancers reduced their incidence by double digit percentages.
Yes, a percent of people or less will have some side effects. It’s 100% reversible. If
you have it, you stop. But again, if we can have this dramatic effect on disease, why
aren’t we using it more? The cost is so low. Again, I’m not getting why we’re not doing
it. And yet, we do the other side, which is we take pills. Ends up costing more than these
pills I just talked about. 39,000 women tracked over 19 years. You can
criticize all the study all you want, but they looked at women who took vitamins. Vitamin
B6, folic acid, and copper, and iron versus women who didn’t. Actually, the women who
took the vitamins were healthier baseline. They were skinnier. They had less diabetes.
They looked at them and said, “What’s the difference in the outcome? Well, a 15% higher
death rate in the women who took the supplements.” 15% higher death rate in the women who took
the supplements. I look at that and I say, “Whew. By the year 2004, 65% of women in this
country were taking supplements.” I said, “There’s got to be some data behind it, or
why would all these women be doing it? Why would it be a multi, multibillion dollar industry
if there weren’t some benefit there to it?” Then I look on the internet, and this is just
in the last couple months. These are all the headlines about vitamin D. According to this,
it can cure every disease known to mankind. I mean, that’s great. Then I look and said,
“There’s got to be data here. There’s got to be data why this happens.” In the United
States, now, over 75% of us are quote low in vitamin D. There’s data that there’s an
epidemic of low vitamin D over the last decade. As we spend more time indoors, wear sunscreen,
vitamin D levels are coming down. Yet, hip fracture rates are also down over that same
period. So it starts to make you wonder why is that really the case? What is normal? Who
defines what a normal value is? When I was born, I didn’t come with an ingredient manual
that says, “Your normal value of vitamin D should be X.” Because remember, vitamin D
is a network, not an individual node. There’s vitamin D, there’s the receptor, and then
there are six signaling molecules. All we’re measuring is one part of a network. So if
you’ve low vitamin D, it probably means you’ve got a high binding receptor. Or you’ve got
an elevated number of receptors. Or one of the signaling molecules is a little bit higher
than somebody else. Yet, we look at this and we all start saying, “Hey, we’re low in vitamin
D. We’ve got to correct that.” But part of it comes from the notion that if you go to
your doctor and he or she draws arbitrary lab values, because unfortunately most of
them are somewhat arbitrary, and they say, “Come back in a year”, you say, “Listen. I
shouldn’t have gone. There was no value from going to my doctor. That wellness visit. He
didn’t tell me to do anything. Or she didn’t say anything different.” They say, “Vitamin
D’s low. Take vitamin D.” You perceive value. That physician perceives they gave you value.
That perception is key. About 2 and 1/2 years ago, the World Health
Organization came out with a blanket statement saying, “Cell phones may cause brain cancer.”
There was a panic around the world. If you start to look at what is the root data they
went on, what they did was they looked at 26,000 people with brain cancers. They asked
the brain cancer patient and the spouse, “How much did you use the cell phone?” When they
answered, it was almost 2 and 1/2 times more in the brain cancer patient than the spouse.
So spouses are a good control. Pretty similar genetics, same environment, eat the same,
live the same. And 2 and 1/2 [inaudible] more cell phone usage. Well, clearly, there may
be an association. A clever group went and said, “Let’s audit the cell phone records,
because we can do that.” They went back and they were exactly the same, because human
perception is we blame something. “I have brain cancer, I must have done something wrong.
Well, the cell phone, that’s why. I talk on the cell phone.” So they perceive they did
it differently. You went to breast cancer patients, 2000 breast
cancer patients, and you say, “What was your diet before and after you were diagnosed with
breast cancer?” Uniformly, the women said, “My diet was horrible. I have breast cancer.
I saw the light. Now I’m healthy.” When they went back and audited what they ate, it was
exactly the same. So again, human nature is we’ve got to blame something. There’s something–
When something bad happens, something’s wrong. “Something happens to my child, it must be
that vaccine they got, because there’s got to be a reason for it.” Or “If I have this
problem, it’s got to be because of something I did or something in the environment”, etcetera.
We all want to blame something. But let’s go back and look at the data of
vitamin D. They took women 70 years and older, over 2000 of them, and they gave them a very
high dose of vitamin D. That raised their serum vitamin D level for a year. 26% higher
fracture rate. Not lower. Higher fracture rate. So all of a sudden, women are taking
vitamin D to increase their bone density and prevent fractures. And yet, this is a very
well respected journal with a couple thousand patients. So an increase in bone fracture
rate. Hmm. Remember, the body’s homeostatic. You take a bolus of something, you down-regulate
receptors and you screw up the signaling. What’s the only reason we tan? To block vitamin
D absorption. Right there, evolution has a very difficult way, it requires a lot of energy,
that we’ve evolved so we don’t have too much vitamin D. Yet we take these big boluses of
pills all the time. Then, well, “maybe the dose was too high.”
So they did a study in women where they took women– oh!– who, in the nurses’ health studies.
Again, over 20,000 women were looked at. They gave them vitamin D and calcium. The regular
vitamin D and calcium that most people take. The Os-Cal D or whatever brand it is. In that
study, there was no effect on bone fracture by taking calcium and vitamin D. There were
side effects that caused kidney stones, it affected gastric upset, all of those things.
Yet no benefit. Most women, most women over the age of 60, take calcium and vitamin D.
The first question to ask your doctor if they say, “You should be on calcium and vitamin
D” is “Why?” Osteoporosis, we know, is a genetic disorder. Taking calcium and vitamin D doesn’t
make it better. Yet we do it. Again, something a little screwy there, in my mind.
And then this study. This was a $240 million study, almost a quarter billion dollars stamped
by the US government. Vitamin E. We know vitamin E’s a great antioxidant. Everybody’s taking
it to prevent prostate cancer. Let’s see how much it prevents prostate cancer. So they
gave men 400 units. This is the same amount in a multivitamin. They gave them that. After
three years, they halted the study. A quarter billion dollar study. Why? Because there was
a 17% higher incidence of prostate cancer in the men who took vitamin E. That lasted
for three, four years after stopping the vitamin. A 17% increase in the most common non skin
cancer in men. First of all, the impact on the individual is staggering. The impact on
society, on companies, on our health insurance, is staggering because we’re taking this. Again,
what am I missing here? We’re talking a $20 to 30 billion impact on healthcare by this
excess in men diagnosed with prostate cancer. Then you look. The government said, “Listen.
Maybe there are some studies that we’re missing here.” So they looked at 63 studies with more
than 500 people in a randomized fashion with multivitamins and heart disease and cancer.
None of them showed a benefit. Zero showed a benefit. I’ve just showed you a number of
studies with clear negatives. And yet, none has yet shown a benefit. In 2004, they looked
and they said, “People who smoked, or former smokers, we’ve got to give them high dose
antioxidants to prevent lung cancer, because they’re dying like in droves of lung cancer.”
28% higher lung cancer when they took these supplements. 17% higher death rate when they
took these supplements. Again, pills, I’m not sure they actually have benefits. Clearly,
they’re causing harm. The other side of the equation is looking
at how technology’s going to fit in. Because clearly, there probably are some people that
benefit from taking pills. If you’re pregnant, you need to take prenatal vitamins. There’s
certain eye conditions were vitamins have been shown to help. Maybe some people with
their diet need it. But we need technology to start to say who needs what, because blanket
statements like I’m making probably aren’t the best thing going forward.
In 1976, if you thought you were pregnant, or your spouse thought she was pregnant, you
took a tube of blood, you went to a hospital because it couldn’t be done anywhere but a
hospital. Every hospital in the country had a rabbit floor. We took that blood, and we
injected it into a poor rabbit. Five days later, we sacrificed the rabbit and we looked
at the rabbits ovaries. If they were enlarged, you were pregnant. That was the state of the
art in 1976. Well, 1977, the first proteomic test was approved by the FDA. It was a $10
urine-based test for pregnancy. Rabbits over the world rejoiced. [laughter] All of a sudden,
we had a binary outcome. Yes/no whether you’re pregnant or not. It radically changed reproductive
health, women’s health, child mortality because we can actually give prenatal vitamins, we
can take care of women because we knew they were pregnant. Changed everything.
We need more technologies like this. We now have the capacity with newer technology, to
actually bring them in. This is the proteomics. This is the cover on the book. This is that
20,000 foot view of the state of the system, where, instead of–. In our country, we do
a colonoscopy at age 50, because that’s where the risk rewards come together, and that’s
what’s cost effective. I love that word. It’s cost effective to do. Well, what do you say
to the 4000 people in the United States last year who died of colon cancer under the age
of 40? “You weren’t cost effective?” What do you say to the fact that only 17% of people
who should have colonoscopies do, at age 50? What if we had a blood test to say who had
a colonic polyp? First of all, we would do it in the right people. We’d have almost 100%
compliance. And the other is, we have a quality metric. Did that doc get the polyp our or
not? Because right now, there is no quality metric. That’s what technology can do, is
start to personalize things. We’re not far away from that.
There’s a newer technology coming out that’s pretty wild. Turns out, you and I have 10
fold more bacteria in us than we do cells in our body. If someone is in China, you look
at the incidence of prostate cancer and breast cancer, it’s 1/10 what ours is. After they
move to the United States, after a decade, it starts to approach ours. “Well, then it’s
the Burger King and the McDonald’s.” Turns out, that’s not the case. It’s the bacteria
in the water. It’s our microbiome. They get populated with our bacteria. Well, those bacteria,
they control how you metabolize your food. They control your hormone levels. For the
first time ever this year, we’ve learned to quantitate them and actually look at what
type are populating what individual. I guarantee you, over the next several years, we’re going
to start to modulate them to reduce risk for disease, which will be powerful.
I’m a believer in prevention. I look at the data. There are little things one can do that
can radically affect health. In the Framingham heart study, one of the most protective effects
wasn’t what you ate, it wasn’t your weight. It was actually owning a dog. We look at the
data. “A dog? Well, it relaxes you.” Well, it’s not that it relaxes you. It puts you
on a regular schedule. If you start to look at the data on regularity, it is profound
for health. If you have your lunch today at noon, and then tomorrow at 2:00, for two hours,
stress hormones go up. When stress hormones go up, the body goes in a protective mode.
It says, “Hey, listen. There might be a lion coming. I’ve got to really save energy. I’ve
got to shut down.” So you get about a 25-30% decrease in cognition. You get about a 36%
decrease in exercise performance. You actually gain weight because you lower metabolism dramatically
to try to save energy. So if you eat on a regular schedule, sleep on a regular schedule,
dramatic effect on health. It’s the person who randomly goes by places like this and
grabs and apple that hurt themselves. If you have an apple every day at 3:00, greatest
thing in the world. Regularity is key. Almost as important as what you eat. Very powerful,
costs nothing, and can have a dramatic effect on health.
So I’m happy to stop here, answer questions. I know we’ve went through a lot and went all
over the place. But all the data is in the book. We’re proud of it. It’s aggressive.
I’d love to get comments back from you. Email me. Tell me what you think. But again, questions,
we’re happy to talk. I appreciate it. [applause]>>Agus: Yes.>>male #1: : Thanks for coming to talk.>>Agus: Thank you.>>male #1: I guess I’m curious about what
you would say about the way people interact with their doctors. At the start of your talk,
you mentioned that in China, they’re going to implement some of the stuff as law. In
the United States, it’s going to be much more decentralized and debated. I can go to a doctor
who graduated medical school 20 years ago or 40 years ago or 5 years ago, and they’re
probably have very different reactions. But you advised us to not even take an aspirin
a day without going to that.>>Agus: I want that discussion to happen,
you’re right. One of the things we put early in the book. You can download it. It’s a four
page questionnaire I want you to fill out before you go to your doctor. There’s this
old adage, and obviously you here know well which is “Enough data, error goes away.” When
you go to your doctor, they check your blood pressure at 1:00. Well, who ever checks it
in the morning when you get up? At night when you go to bed? When you’re pissed off after
a phone call? I want a lot of data. I want you to look at your own metrics. You go on
with all your data. But if your doctor’s not going to listen, go to a different doctor.
It’s a free market system. The only way we’re going to change it is from the ground up.
I wrote this book so each of us can be in charge and go in with that data. Go in and
say, “Listen. The studies show this. I fit that study. What do you think?” and start
to have a real discussion. You can go in with everything written down in this questionnaire
before you go in, so that five minutes, if you’re lucky, ten minutes with your doctor,
you can actually use it correctly. But you’re right. We have to change the doctors.
We are incentivized, and I’m as guilty as anybody else, for treatment. We’re not incentivized
for prevention. We need to change that in our country. The average time on a health
plan is 4 1/2 years. Your health plan doesn’t care about preventing your heart disease.
It’s not going to happen for 10 years, and you’ll be on somebody else’s plan. We have
to change that way of thinking, and we’re going to do it from the ground up.>>male #1: Thank you.>>male #2: [clears throat] One of the [clears
throat] fascinating and compelling points I think you made was that we should look at
the proteome and look for ways to modify your biochemistry to conform to that template.>>Agus: Yes.>>male #2: I assume that’s a good starting
point. But do think that there’s going to be a need to look at it as a dynamic system
where the template will adapt over age or time or environmental conditions? How do we
figure out the right template for a person?>>Agus: With enough data. The thing is, I’d
love there–. One day, when you go to your doctor, he pricks your finger. It goes into
some technology that profiles it. You’re populating the data set as well as getting something
back from it. Just akin to my search on Google is better today than it was yesterday, I want
medicine to improve on a daily basis. And we’re not. We don’t have common data elements.
It’s shocking. You call it a broken leg, I call it a fractured leg. Nobody’s standardized
data elements and nomenclature in my field yet. It is absolutely from the 1920s. We need
to change that. The technology is here. We’ve got to use it right. Building the standards
to allow it to actually grow. Yeah.>>male #3: I recently saw a documentary about
Stanislaw Burzynski. It seemed like a really interesting documentary. I looked online to
get more information, and it seemed like the government and the entire medical community
thought this guy was a quack.>>Agus: So you really think there’s a conspiracy?
This is a guy in Texas who now has moved to Mexico who has a drug that he developed called
antineoplaston. He charges cash, $60,000, to give it to you. He argues, there’s a conspiracy–
What he does is he went to all the cancer meetings, stands up in the audience. He goes
to some random meetings and he stands up and starts talking about it. Everyone’s like,
“Sit down, be quiet”, because it’s interrupting whoever’s talking about something else. He
films it and shows these videos. “The community is against me.” They’re against him because
he’s interrupting somebody else speaking. There have been four randomized studies done
with this, causing increased death, shorter life span, than not. He’s out there saying,
“There’s a conspiracy. The government and doctors want to hide it because we’re going
to take away their business if I cure all disease.”>>male #3: : I feel like–>>Agus: What am I missing here?>>male #3: : –he doesn’t seem trustworthy,
which is why I didn’t totally–>>Agus: : There were four randomized trials.
It didn’t work. Made people live shorter.>>male #3: I was just more curious about–
I’m more interested in experimentation because bodies are different. What might work for
you might not work for me and vice versa. I’m wondering if you feel like there’s something
within the system that just doesn’t allow as much experimentation as there could be.>>Agus: That’s a great point. By definition,
with advanced cancer, you want to be on a clinical trial because standard therapy doesn’t
work. You want to experiment and do new things. We are very much risk averse in our world.
The capital markets have been closed to biotechnology for the last 15 years. There are very few
of any biotech companies. Pharmaceutical companies are bonds. They want to return 5% a year.
They’re not taking risk and doing their clinical trials. One of the arguments in the book is
I think we have enough drugs out there. We’ve just got to learn how to use them, and we’re
not. So I agree with you. We need to take more
experiments. Cancer patients especially are willing to take any risk in the world because
they’ve got no choice. And yet, most of the time we don’t do that. It’s public that I
was one of Steve Jobs’ doctors. He puts in his book how we sequenced his genome. We didn’t
sequenced his genome. We sequenced a couple of genes. We looked at it, and everything
we did was part of clinical trials. He went on drugs, and so did everybody else there.
I’m a believer in trials. I’m a believer in doing randomized clinical trials, or clinical
trials that are single armed to see if these drugs work. And many of them do. I chair one
of the brain cancer foundations. About seven or eight years ago, I got a call from a doctor
in Galveston, Texas, who said, “I give this drug called Avastin, a Genentech drug, to
a patient with glioblastoma, and it worked.” I go, “There’s no way. It’s too big to even
get across the blood-brain barrier.” This story’s in the book. She said, “Well, here
are the scans. They look real.” So we did a trial on people who failed chemo. They have
weeks to live. And at six months, nobody progressed. This drug that didn’t even cross the blood-brain
barrier worked because it bound a protein and lowered the pressure of the cancer. When
you lower the pressure, the cancer stops growing. A year later, it’s FDA approved and standard
treatment for brain cancer. So we need to keep our eyes open and learn from every experience.
Be they with somebody who’s a little questionable or not. But right now, all we do is we have
to report the negatives to the FDA, the side effects to the FDA. I have a good response,
a cure, I never have to report it. Nobody knows about it. It’s hidden. We need to change
that. We need to get data out there. We need to talk about our experiences and learn from
them, because we’re not now. Yeah.>>male #4: I really like a lot of the examples
you’re giving about the different kinds– sorry– kinds of inflammation that can occur
from sitting or obviously, not eating at the same time every day. What I’m really curious
about: is there some kind of centralized source where you know the risk factors of various
types of inflammation? Because I think this is missing out there.>>Agus: You’re 100% right. We have a poor
man’s metric now, which is called high sensitivity c-reactive protein. But we need to get better
metrics for measuring different kinds of inflammation, optimizing whether it be the shoes you wear.
Your feet hurt at the end of the day, that’s inflammation. I want to optimize. I want to
have a marker to say there’s less inflammation or more. This is where we need to put the
research focus, where technology needs to go. And it’s not right now. But you’re right.>>male #4: For example, relative to other
factors, not eating at the same time every day–. It’s great that it yields an insight.
I guess there’s other types of inflammation that we’re unaware of, but that inflammation
in particular, how does that–>>Agus: That’s not inflammation as much as
stress hormones. Eating at the same time. But yeah, we can’t quantitate that for an
individual. We can only quantitate that for the collective group. What you’re getting
at is that we want to start to do it for your individual, and say, “For you, it’s better
to do X, Y, or Z.” That’s what I hope technology will be able to yield. Right now, the only
mature technology we have is genetics. The others are immature. But genetics, I mean,
it’s akin to standing outside two Chinese restaurants and looking at the ingredient
list. They’re exactly the same. You taste the food, one could be awesome, one could
be horrible. Genetics is your ingredient list. What’s going on in that moment in time, that’s–
There may be the metabolomics or the microbiomics or the proteomics. That’s the next generation.>>male #5: You mentioned about not taking
the flu shot. That actually surprised me. What you’re saying is, if you get flu, that
has negative consequences later, 10 years down the road. Which is opposed to what you
hear. “You’re not getting sick enough.” Generally, we basically have very good, compared to you
live in other countries where you get sick more often. Generally, your body has more
immune built up. Essentially, it doesn’t have auto– you have less autoimmune diseases because
your body’s not fighting any diseases.>>Agus: I guess I’m missing the point.>>male #6: [inaudible] You’re better off having
been exposed to–>>Agus: Well, you are being exposed. A vaccines
exposes you, but it’s less inflammation.>>male #5: But the inflammation part, does
it– Essentially, you’re saying it lasts longer. Can you elaborate more on if you became sick
now. What are the downsides to that?>>Agus: I think of it very simply. If I give
you a vaccine, you’re going to make a– your arm hurts. You’re making an inflammatory response.
You’re making antibodies against whatever pathogen is in there. Again, if you’re lucky
and it was that flu strain, you’re not going to get sick that year. If it’s a different
flu strain, your flu is going to be less because you have cross-reactive antibodies. But you
get the flu, it’s a staggering inflammatory storm. You feel it. You can barely move for
days. That inflammatory storm, your body shuts down things like DNA repair and others to
shunt its energy to fight off that viral infection. And bad things can happen down the road. Yes.
I think it’s a good thing to be exposed to–. As a child we’re exposed to multiple different
pathogens. We develop new responses over time. But vaccines are good. Vaccines expose you
to these in an environment where you don’t get as much of this profound inflammation.>>male #5: But isn’t it like, you’ll need
a vaccine at the age when you are basically fit? Not such a good thing. I can understand
why very early, you are–>>Agus: No. Again, the immune response, the
small immune response you make to a vaccine compared to seven days of having an influenza,
it’s a dramatic effect. At least, the data show that.>>male #5: You mentioned the rabbit study.
Didn’t the rabbit die when you actually inject with human blood?>>Agus: : No. It was plasma. It wasn’t blood
cells. Just the plasma. Yes. The rabbit died when you cut off his [laughter] or her head.
Yes.>>male #7: I saw you on the Daily Show, so
my question might be in the book. But a lot of your presentation was very much a blanket
against vitamins. Vitamins or external supplements, in that nature. In any age group or areas,
do you have exceptions for that, or is that your general philosophy?>>Agus: Sure. I mean, pregnant women I think
should be on vitamins. We know that it helps for prenatal health. Again, I’m not blanket
against vitamins. It’s more as an example. I want you to question everything you put
in your body. Say, “Why am I doing this? Is there data that I should be taking this pill?”
I pray that one vitamin works. I’m not against them. I just pray they work.
Everybody in the world juices now. Once you put a vegetable or fruit into a blender, it’s
all degraded. Within hundredths of a millisecond. James Lind, captain of the British Royal Navy,
amazing guy. He won the Battle of Trafalgar, he beat the French, because he had limes on
his ship. His troops didn’t get scurvy, and the French did. Like any good entrepreneur,
at the end, he said, “I happened to sell the extra limes.” He sold the lime juice. It didn’t
work. Didn’t cure scurvy. Why? As soon as you squeeze that lime, everything’s degraded.
I just want you to ask the question. Everything you do. “Why am I doing it for me?”>>male #7: You talked very positively about
statins. Is that at a certain age group, or–>>Agus: If you look at the data, people with
average risk factors, they start around 40 showing a benefit. People with high risk factors,
if they start at 20, there’s more of a benefit. It really depends on– If everyone in your
family had heart attacks in their 40s, you want to start earlier. If you’ve got no history
of heart disease or cancer in your family, maybe you don’t want to do it at all. So I
really want that discussion to happen with your doctor, based on you. But I think the
discussions should happen now, for all of us, in our 20s or 30s or 40s. Keep having