An Investigation Into Treatment, Prevention and Health
DAVID AGUS, M.D., ZEROES IN ON INFLAMMATION, MEDICATION AND VITAMINS.
In Western culture, particularly the United States, different people define states of health in different ways. To some, health is a function of access to health insurance, an approach that is based largely in disease management. To others, health is about prevention as achieved by exercise and nutrition.
Within this latter group, there are many subsets: nutrition to some is balanced eating, while to others it’s about achieving some perfect combination of vitamins, extracts and other supplements. Exercise is usually the province of an entirely separate group of experts who rarely overlap — endurance athletes, strength trainers and yoga practitioners, to name a few.
In his book, The End of Illness (Free Press, 2012), author David B. Agus, M.D., takes a critical look at both treatment and preventive models to formulate an unconventional treatise on health. He says he chose the book title because something about the title “How to Be Healthiest” would send the wrong message. In his words, “To me, health sounds like something I’m supposed to eat but tastes really bad … [T]here is no ‘right’ answer in health decisions; rather, there are several right answers. You have to make the right decisions for you — based on your personal code of values and health circumstances, and in consultation with your own physician.”
So is it really possible to end illness? The book never promises something quite so absolute, but it does proffer several ideas that challenge many of our health orthodoxies:
- Think of your body as a system. While conventional health care often means taking a pill to address a specific health problem, it should be noted those pills usually have a systemic effect — meaning, there are many unintended consequences all over the body. The same goes for vitamins and supplements: A certain vitamin may have a positive health benefit, but taking it in isolation from the food from which it is derived may have a net-negative result. “A single drug can have an amalgam of effects,” writes Agus, “whether for good or bad.”However, it is key to note that Agus, a classically trained, board-certified physician, does not shy away from the use of drugs to address many health issues, even if there are wide-ranging, systemic effects. He provides an example where women with a certain type of breast cancer have a higher survival rate when they take bisphosphonates, a bone-building drug more often used for osteoporosis. The point is simply to know how a drug, vitamin or other therapy will affect all of you, whenever possible.
- Be your own doctor. Many people, particularly if they are younger, have moved away from a paternalistic view of their physician. Instead of “The doctor knows best,” Agus urges readers to take an active role in their formal health care. Ask questions about how your doctor stays current on the latest medical research and technologies. Also be willing to question a recommendation, such as a prescription or surgical procedure. There are no “right” decisions for everyone; the patient needs to develop his or her own set of health values. Show up for checkups with a list of things — how you feel and where, what do you take (pharmaceuticals and supplements, if any) — and without worry about judgment (say, in recreational drug use, alcohol consumption or sexual activities). If you have a doctor who judges you, you have the wrong doctor.
- Study your family genetics. From as simple a matter as quizzing older relatives about who died of what, you can get information on family predispositions to various diseases. (Note: Genetic counselors can lead you in this process before you seek out a genetic test.) This knowledge can guide you as to what to look for in annual checkups, with self-examinations and in your lifestyle choices (e.g., smoking cessation for families prone to throat cancers and respiratory diseases).
- Beware of vitamins by synthetic (nonfood) means. Agus notes that about half of all adults take some type of multivitamin pill. He thinks “taking vitamins generically for health makes no sense … [W]e can get all the vitamins we need from the foods we eat, assuming that you make an effort to eat nutrient-dense foods from natural sources. More vitamins doesn’t mean better.” To this last point, he notes how cancer cells thrive with large amounts of vitamin C. He goes on to challenge a modern orthodoxy, that antioxidants in pill form somehow fits into a healthier, natural order. “I believe that this harkens back to the original premise of the book: the body is a complex system,” writes Agus. “Changing one variable will have many effects in the system that we have yet to develop technology to fully comprehend. Increased ingestion of antioxidants may push the system in the ‘wrong’ direction.”
- Reduce inflammation. Under the best circumstances, inflammation is a protective response to harmful elements (e.g., a fever is your body inflamed, temporarily, to fight off bacteria or a virus). But inflammation that is chronic becomes a disease unto itself. The author cites everything from uncomfortable shoes (singling out women who wear high heels) to retired football players who were obese and sustained injuries as examples where a stress factor ultimately led to an ailment and even premature death. Agus does surprise us with prescribing interventions to most people regarding inflammation: In addition to wearing comfortable shoes, he suggests getting an annual flu vaccination, exploring the implications of being on a statin drug (they appear to have benefits beyond lowering cholesterol) and taking a baby aspirin every day if you’re over 40 years old.
- Be active all day. Disturbing to anyone who exercises regularly for an hour a day, Agus argues for more frequent, shorter periods of physical activity multiple times per day. Vigorous movement is itself an anti-inflammatory, as the production of endorphins from exercise counteracts the stress hormone cortisol. This mechanism cannot be stored up, apparently — and unfortunately. The individual benefits most from movement and exertion several times a day. While that may seem impractical for most, it provides further incentive to take the stairs, go for a walk at lunch and balance the evening with the morning, should you be one to exercise more frequently at one time and not the other. Bodyweight squats in your office cubicle, perhaps?
- Do nothing. Agus reaches into reference books on medicine from the beginning of the 20th century. Physicians at the time routinely administered placebos that they knew would have no direct effect on a disease. But they also believed that placebos had a beneficial effect. He quotes the instructor: “Patients do get better, some of them anyway, from even the worst diseases … [Placebos] did no harm, so far as he could see; if nothing else, they gave the patient something to do while the illness, whatever, was working its way through its appointed course.” He theorizes that in place of popping pills, the patient can focus on the body’s “inherent self-healing mechanism by regulating it naturally.” (Note: Next time you consider elective surgery, consider that according to a 2010 study by the University of California at San Diego, 244,388 deaths due to medication errors in American hospitals occurred between 1979 and 2006, an average of more than 9,000 per year. That doesn’t include infections from such things as the MRSA (methicillin-resistant Staphylococcus aureus) superbug or C. diff (Clostridium difficile).
Why The End of Illness stimulates an important conversation
A small nugget in the book caught this writer’s attention, that having to do with human growth hormone (HGH) supplementation by middle-aged men. It’s become the fountain of youth for many to simply slap on a patch or take a pill to get the noticeable benefits of increased testosterone levels: easier weight loss, easier muscle gain from strength training, improved libido, general increase in energy overall. But within Agus’s view that the body is a system, there may well be other, unintended and possibly adverse side effects.
Agus cites a 2011 study of Ecuadorians whose genetic makeup prevents normal processing of HGH. While this means they suffer from dwarfism, they only rarely get cancer or diabetes. Agus postulates this means reduced human growth hormone — contrary to trends in Hollywood, sports and elsewhere — is beneficial to health. We currently see an epidemic of HGH (testosterone) distribution, promoted by television commercials aimed at men over 40, via our conventional medical system. The experience that women had with estrogen therapy was disastrous and should be a cautionary tale. Agus suggests there is something to worry about.
In summary, the book does not provide a neat, simple approach that one might find in other books in the health section (e.g., “Eschew chemicals — eat only organic produce!”). Instead, it honors certain modern inventions while valuing principles of health that have been around for hundreds and sometimes thousands of years.
That seems to make a great deal of sense. Our bodies and our health are too complex for simple fixes.