Bring Your Questions for End of Illness Author David Agus

Here’s an obvious but sobering thought: every one of us will someday get sick and die. And here’s a happier thought: with ever-advancing medical technology and research, we can now avoid many kinds of illnesses and add more years to our lifespan.

The oncologist David Agus lives halfway between those two thoughts. He is a professor at USC, the founder of Oncology.com, a co-founder of Navigenics, and now the author of The End of Illness. Most impressively, perhaps, he was recently a guest on The Daily Show

The End of Illness is Agus’s take on how the body works and why it fails. Along the way, he challenges a lot of conventional wisdom about health with academic studies and his own medical experience. Arguments in the book include: that taking vitamins may increase the risk of cancer; that sitting at a desk all day may be as damaging as smoking; and that you can tell something about a patient’s health based on whether she wears high-heel shoes. One review of the book reads: “A ‘rock star’ doctor says throw away the vitamins, load up on baby aspirin, and keep moving.”

Agus has agreed to field questions from Freakonomics readers, so please fire away in the comments section below, and as always we’ll post his answers in due course. To get you started, here’s the book’s table of contents:

Part I: The Science and Art of Defining Your Health

Chapter 1: What Is Health?
Chapter 2: A Pound of Cure
Chapter 3: Go Back to the Future
Chapter 4: Rotten Eggs and Cute Chicks
Chapter 5: Two French Restaurants, One without Butter

Part II: The Elements of Healthy Style

Chapter 6: Proceed with Caution
Chapter 7: The Truth about Synthetic Shortcuts
Chapter 8: The Fallacy of “Fresh”
Chapter 9: Hot and Heavy
Chapter 10: Running to Sit Still
Chapter 11: Timing Is Everything

Part III: The Future You

Chapter 12: High-Tech Health
Chapter 13: The Give-and-Take
Chapter 14: The Art of Doing Nothing
Conclusion: Of Mice and Men and the Search for the Master Switch

This post is no longer accepting comments. The answers to the Q&A can be found here.


lurker

Why load up on baby asprin? Can't this be bad for you?

vimspot

3 questions
- What do you think of the talk on anti-angiogenesis here http://www.ted.com/talks/william_li.html and in particular, of the foods he recommends to combat cancer?
- Do you think vitamins that are food based make any difference, or they are all just problematic? What about b-complex for vegetarians, Vitamin D3 and omega fatty acid supplementation
- Japanese people have low rates of cancer. If you were to guess do you think it's possibly the high level of consumption of seafood, cruciferous vegetables or fermented foods?

Enter your name...

The Japanese people don't have a low incidence of cancer. Their age-adjusted rate is 140% of the world average rate. Compared to the US, they have about a 10% lower death rate from cancer, but a higher DALY (disability-adjusted life years) rate (meaning that they lose more years than the US from being sick or dead from cancer).

The real difference between Japan and the US is a different distribution of cancers: the Japanese have fewer colorectal cancers, and far higher rates of (far more deadly) stomach cancer. Japanese people are also more likely to get cancer (and die from it) at a significantly younger age.

Andreas Moser

You can't avoid death; but when you die, you don't want to have deathbed thoughts like these: http://andreasmoser.wordpress.com/2011/08/15/deathbed-thoughts/ Think!

MrAtoZ

What's your thinking of relative roles of nurture vs. nature in the progression, or lack thereof, of major diseases we see later in life, i.e. heart disease, cancer, dementia, etc. How much is environment and life choices and habits, vs. how much is genetic and may be influenced only through genomic assessments and interventions?

James

"Here’s an obvious but sobering thought: every one of us will someday get sick and die."

Obvious, but far from true. A good percentage of us will die from injuries - car wrecks, fires, drowning, windstorms, falls, and such. And of course suicides...

It's also interesting to think about how many people already don't get sick and die, at least of diseases that were historically commonplace. Ran across a quote from Voltaire the other day: "Upon a general Calculation, threescore Persons in every hundred have the Small-Pox. Of these threescore, twenty die of it in the most favourable Season of Life, and as many more wear the disagreeable Remains of it in their Faces so long as they live. Thus, a fifth Part of Mankind either die, or are disfigur'd by this Distemper. But it does not prove fatal to so much as one, among those who are inoculated..."

Abhi Pandey

1) As a medical student, I think some of the ideas you champion do and will have a place in Medicine. But I also think that these innovations, like all medical innovations perhaps, will be very costly. How long do you think it will take before insurance companies will cover genomic sequencing or other molecular technologies? What about Medicare?

2) What do you think about IBM's Watson wearing a white coat? If you ran your own hospital, what would "Dr. Watson" do there?

3) If one of you relatives declared that he/she wanted to see his/her genetic profile without consulting any medical professional, how would respond?

Dan B.

It's become de rigueur to say that patients need to be more engaged and accountable for their health, but there are huge psychosocial, economic and institutional obstacles to change. Where are the best opportunities for breaking the old "I feel sick; I go to a doctor; they heal me" relationship with healthcare?

Abby

I'm a 4th year medical student, and I watched your interview on the Daily Show when it first aired and really took issue with the way you presented many of these things. It seemed that you simplified your "solutions" to the point that it may actually be dangerous for people to listen to what you suggested. For example, you implied that EVERYONE should be taking aspirin. This, of course, leaves out the fact that aspirin (like other NSAIDs) increases the risk for GI bleeding and other side effects. As another example, you took issue with the fact that people spend money on vitamins and supplements (giving Vitamin E increasing the risk of prostate cancer as an example), saying, "Why are we taking these things?" This, again, leaves out the many vitamins that are actually very important for people to be taking (folate in women to prevent neural tube defects, vitamin D and calcium to prevent osteoporosis, etc.) I'd love it if you would respond to why you don't present a more nuanced view that would help people see that the current medical establishment is not simply ignoring the obvious solutions you are espousing.

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Douglas

Many occupations require one to sit for long periods behind a desk. What can people do to minimize the damaging effects of this occupational hazard?

Henry jarmuszewski

It's natural that we should try to prolong our lives but how do we become reconciled to our mortality?Isn't the search for "the end of illness" just a denial of the inevitable?

Jim Steele

Other than taking aspirin what are the best things a person can do to lower their risk of cancer? As someone with Crohn's Disease I've been advised not to take aspirin, which is why I'm curious. (http://www.mayoclinic.com/health/crohns-disease/DS00104/DSECTION=treatments-and-drugs).

health aspirant

I guess the question is whom do we trust in a profit driven medical market place. AFter learning this week that I may be diabetic and experiencing a bit of memory loss as the result of taking 10 mg's of a statin, I am taking myself off that stuff and going on a heavy duty exercise and diet program- no cheating. My doc likes to be ahead of the curve- the problem is which one- take x, get y. don't take x, get z.

Ben D

What are the top 10 actions I can take to reduce my cancer risk?

Allison

I always tried to get all my vitamins through my diet until I was diagnosed with ulcerative colitis. My doctor suggested a daily multi-vitamin to supplement my diet since my body wasn’t absorbing nutrients as well. Would you say there are certain people with health problems, such as myself, that can benefit from taking vitamins?

Evan

I am a first year medical student and have seen several of your interviews on TV, have read several other descriptions of your work, and generally agree with your point of view of treating the human body as a complex emergent system. You make mention of several studies indicating, for example an increased or decreased risk of cancer when consuming certain products, and likewise for other diseases. Isn't that the same basic argument that studies have been making for a while? Shouldn't you instead be concerned with the overall mortality rate when taking a medication compared to not taking it? Ultimately, shouldn't not dying (i.e. living longer) be more important than just not getting cancer considering you might die of some other cause sooner instead because the same item that reduced your risk of cancer increased your risk of fatality otherwise?

Xavier Sala-i-Martin

I met David in Davos and I was really impressed. I had dinner with him one night and I followed his recommendation; statins and baby aspirin. I also read the end of illness in one weekend! Loved it! But two days ago I read that statins will get a warning label because of danger of diabetes. I am a professor of Economics at Columbia... and I am confused with so much contradictory advise. Unless you say otherwise I will continue with statins and baby aspirin (as you suggested at the Davos dinner)... but it is hard for the non experts to keep up with the news... My strategy for now is "do what Agos says". For some reason and even though I met him twice in a week, there is something in his eyes that make me trust him. Problem is that he also recommends to work with my doctor and I do not trust the degree of preparation of this doctor when he gives me advise that contradicts "the end of illness". Hemce, I am in a state of profound confusion: about to turn 50, completely healthy, taking statins and baby aspirin and ready to do a DNA and proteomics test. Any advise, doctor? P.S. Lookimg good at the Oscars. My wife (the professional triathlete that sat at our table in Davos and I were happy to see you at the Oscars)

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crquack

So you trust a celebrity doctor who is trying to sell his book "because of something in his eyes" but you do not trust * your* doctor who, while presumably familiar with your specific condition, contradicts the former individual's advice?

Have you looked at the actual evidence for ASA use in primary prevention of anything in general population? Surely to an Economics professor this should be more important than a gut feeling.

jack

Do you think there is a sound medical basis for the use of antidepressants and antipsychotics?

This might sound trivial (or maybe controversial in some circles), but I have had some doubts in my mind after reading Marcia Angell's New York Review of Books articles on the "Illusions of Psychiatry."

Thank you..

Ann Anu

Two questions
What is your take on the low carbohydrate diet? Is it good our bad for our body? What about running bare feet or in a minimalist shoes?

Eric M. Jones

Data point: When Anna Nicole Smith died the coroner wrote: COD: Drug Overdose; Contributory Factors, Smoking, Obesity, Depression and Vegetarianism. She might have made it with a belly full of cheeseburgers.

Scott Kovarik

There is growing evidence that the Lipid Hypothesis can and should be rejected. You suggest people read Michael Pollan's "In Defense of Food" which has a chapter devoted to rejecting the Lipid Hypothesis. Yet, you still support the idea of people taking statins, people who are not in the high risk category for heart disease. Your basis for this is the anti-inflammatory benefits of statins. Two questions :

1) Don't you think there are better anti-inflammatory alternatives than statins, alternatives that don't produce a lot of the negative side-effects such as memory loss, muscle pain, higher rates of cancer? It seems one can achieve similar benefits by losing weight and by taking baby-aspirin, consuming red wine, etc?

2) What are your thoughts on the Lipid Hypothesis? There is strong scientific evidence that cholesterol is not a cause of heart disease, only that it is correlated. And the correlation between cholesterol levels and mortality is essentially nil.

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