An international leader in new technologies and approaches for personalized healthcare, Agus explains his latest text, A Short Guide to a Long Life.
Dr. David B. Agus
Tavis: The Affordable Care Act is opening the door for more Americans to receive the healthcare they need. Well and good, but many physicians insist that the best medicine is preventative medicine.
In other words, don’t get sick in the first place. Dr. David Agus is one of the country’s leading cancer researchers and experts heading USC’s cancer center and the Center for Applied Molecular Medicine here in L.A.
He’s also a best-selling author. His latest tome is called “A Short Guide to a Long Life.” It offers a roadmap for practical ways to stay healthy. Dr. Agus, good, sir, to have you on this program.
Dr. David B. Agus: Tavis, it’s my privilege.
Tavis: Thanks for the time. Dr. Oz was on this show not too long ago, and I read somewhere where he called you the most controversial doctor in America. What did he mean by that, and was that a compliment?
Agus: Well listen, I love Mehmet. I was on his show, and that’s how he billed me. I said afterwards, “How can you do that? I’m actually, I think, the most conservative doctor, because everything we said is data-driven and we demand the data.” He said, “If I said that, nobody would watch.” (Laughter)
Tavis: Yeah. But what was his definition of “controversial?”
Agus: Some of the things we say in our book are against the popular thought. So we say don’t take vitamins or supplements. There has yet to be a study showing a benefit to vitamin or supplement, and some of them cause significant harm.
No benefit, possible harm – don’t do it. So a lot of people who take the vitamins, obviously he talks about that on the show, so that’s where the discord came from.
Tavis: This, as I mentioned, is your second book. Your first book was – and I think this story’s true, you’ll tell me. But Steve Jobs, the late Steve Jobs, had a hand in actually not naming but renaming your first book. Is this a true story?
Agus: Yes. So when I submitted it to the publisher I called it “What is Health,” because to me that was the key question. I don’t know what health is. Is it a blood test, is it how you look, is it how long you live, is it how you feel? I don’t know what it is.
How can you optimize on something when you don’t have a parameter upon which to optimize? A week later I got a call back from the publisher that said Agus, Steve Jobs changed the title of your book.
I’m like, “He did what?” I called up Steve, I go, “What’s going on?” He goes, “You can’t put the word ‘health’ in the title. It’s a bad word in our country. People’s eyes glaze over. It’s like chewing cardboard. You need a bold, declaratory title.”
So “The End of Illness” turned out to be the title. So I said, “Why would you call the publisher and not me? We speak almost every day.” He said, “It’s their job to market the book, not yours.” I said, “All right.”
Tavis: (Laughs) Hard to argue with Steve Jobs.
Agus: Especially on marketing, believe me.
Tavis: On marketing, hard to argue with him. I assume you were happy with that change.
Agus: Listen, it was a privilege to know him. I learned so much from him, and yes, anything he told me, especially on that kind of thing, I did right away.
Tavis: I’m not going to – I don’t want to put you in a position of having to violate doctor-client privilege, but what do you take away from these relationships that you’ve been able to have with a long list of very high profile Americans as their physician?
Agus: Listen, it’s a privilege. From each one you learn something. Steve lived until the day he died, and it’s such a beautiful thing to watch. Some people are diagnosed with a disease and die mentally the day their diagnosed.
He lived until the day he died, and that sense of optimism, of really getting something out of every day, is something that will stay with me forever.
Tavis: I’ve had a few friends, sadly, one that comes to mind particularly that everybody knows, I talk about her all the time; she was my executive producer at my radio program, a beautiful sister named Sheryl Flowers, who died 42, way too young, of breast cancer.
I got to know her doctors pretty well, because I was spending a lot of time visiting her, of course, when she was getting her treatments, and I’ll remember as long as I live the difficult time that her physician had when she actually passed away.
I remember looking at him, thinking how does he do this consistently? Because I know that Sheryl wasn’t the only patient that he’d ever lost. So how do you – you’ve got a tough job, man.
Agus: Listen, if I can make someone live longer or better, even if they pass away from the disease, if I can make it a better process, I’ve done a good thing. So but two to three times a week I have to look someone in the eye and say, “I’ve got no more drugs to treat your cancer,” and I don’t want to do that anymore.
So the reason I wrote a book on preventive medicine is exactly that. The best way to treat cancer is to prevent it, and much of cancer we can prevent or delay, yet we’re not doing it in this country.
So we really need leadership to do it. When the greatest healthcare leader over the last decade is the mayor of New York City, you know there’s something wrong with healthcare leadership in this country.
Tavis: How is it that you balance your own life when the most difficult thing you do every week, two or three times a week, is to tell people, “I ain’t got nothing else for you?”
Agus: Half of what I do is research, and so the ability to try to develop new drugs – the new drug for breast cancer came from our lab. So that really gives us the hope on the other side, is technology and drugs.
So you have to marry the taking care of patients and seeing the downside with the upside, which there really is hope there that we can make a big difference. Then for me, it’s my downtime spending with my family.
That’s why we’re here, is to really make that next generation of our children better people than we are.
Tavis: So to the text, “A Short Guide to a Long Life.” Is it really that simple, that it can be a short guide to a long life?
Agus: Listen, 65 rules, do’s and don’t do’s. All of those are data-driven. These are the rules that we need to act on.
Tavis: How do we, then, to the text, go about preventing these cancers that you referenced earlier?
Agus: Well there’s a pill a day that costs $3 a year that if you take it reduces not the incidence but the death rate of cancer by 37 percent, heart disease by 22 percent and stroke by 17 percent.
It was first described by Hippocrates 2,400 years ago when he said, “You take the bark of the willow tree and chew it, pain and fever go away.” It’s called a baby aspirin. So just that will have a marked effect on cancer.
Then behavior matters. It’s what you eat, it’s when you eat. All of those things have an impact on disease. Then it’s the screening part. We go through lists of them, but each one adds a couple of percentage. The key is put all the odds in your favor.
Tavis: If all these add percentages, like, how high does the number end up being?
Agus: Well right now we think about half of disease comes from parents, you inherit in your genetics, and half is your behavior. We could dramatically modulate behavior, and we can actually change the influence of genetics with some of these medicines.
So you can reduce your risk of many of the diseases by close to 50 to 75 percent by taking some of these actions.
Tavis: That’s a pretty high number, by the way.
Tavis: Yeah. How did you settle on these 65? I know they’re all data-driven, but I suspect there could have been fewer than 65; there could have been more than 65. Why these 65?
Agus: These are the ones I think that are actionable. There’s more than one study showing they work and that these are the ones we need to really move on today.
There are many other things that are getting there and over time will reach that level, but these are the ones that hit critical mass on data and that we need to start to move.
Tavis: Do these 65 pieces of advice apply to fellow citizens across the board, or are there distinctions to be made by gender, by race, by ethnicity, et cetera?
Agus: These are more across the board, and so within them there are going to be subsections. People of certain race or ethnicity may be at higher risk of something (unintelligible) pay attention.
I don’t mean for everybody to do all 65. I just want them to know them, and then based on their value system, their race, their risk of disease, their family history; they talk to the doctor and make the right decisions for them.
But I want the conversations to happen. All too often your doctor makes a decision for you without you being involved. I want you in charge of your healthcare.
Tavis: So I’m working on this book about Dr. King right now and the last year of his life, and King famously said in that Mountaintop speech that longevity has its place; I’d like to live a long life.
But prior to that speech, King, in another interview, had made the point that when asked about his life that he didn’t want to necessarily live a long life, that wasn’t his priority, but that he wanted to live a good life.
That what he wanted to leave behind, more than anything else, was a committed life. Not a long life necessarily, but a good life, even though longevity has its place.
The reason why I raise that is because your book is called “A Short Guide to a Long Life.” I wonder whether or not we over-value, we put too much on living a long life, number one, and number two, are our systems ready for the baby boomers and beyond to live lives that are too long. Does that make sense?
Agus: No question about it. It’s a key question, right? If you’re 80 years old and you’re not enjoying things and everything hurts when you move, then that’s not a good long life.
What I want people to do is go back to the last year in the United States you could do this was 1953 – that was die with a death certificate saying “Cause of death: Old age.” Ever since then we need a cause – Alzheimer’s, heart disease, cancer.
I want to go back to dying of old age. So the way we do that is we prevent disease. The paradox is if we prevent these diseases, healthcare costs will go dramatically down.
Because if you live past the mid-80s, we don’t put you on a ventilator, we don’t put you in an intensive care unit. We don’t do these crazy things that don’t make you live longer or better and cost society tremendous amounts.
But the key is getting people to start to take action today that’ll help them tomorrow. Nineteen percent of kids in high school today smoke tobacco. So it’s an amazing thing that they are portending for themselves a bad outcome, and they don’t get it yet.
How do you get a 20-year-old to change something 30 years from now? Do this today; it’ll help you in 30 years. They just give you a stare like you’re crazy.
Tavis: Let me go out on a limb here.
Tavis: I started this conversation, Dr. Agus, by referencing Obamacare and making the point that more people finally can get the care that they need. Yet it occurs to me as I sit here and talk to you and listen to you that the real way to solve our healthcare problem in America is for us not to get sick in the first place, because the system is just not designed – well, let me be frank about it.
The system is designed to make money, and the system makes money off of our getting sick. So if we don’t get sick, then the system has a problem, but at least we’re living longer lives.
Somebody ain’t making as much money, but I can live with that, as long as I’m living a good, long life myself. But I wonder, having said all that, how realistic it is that we can actually get a handle on the things that don’t just make us sick, but indeed the things that make the healthcare industry money. You’d be out of a job, wouldn’t you?
Agus: Listen, I would love to put myself out of a job, but you’re right – we incentivize to do procedures. Surgeons get paid for doing surgery. Doctors get paid for treating disease.
We don’t get paid for preventing. We have to change the incentives. I once talked before one of our legislative bodies and said, “Listen, I would make it so you only have to pay a drug company if the drug works.” Why would you pay if it didn’t work? That’s going to push for innovation.
At the same time, we need to change our system to incentivize doctors and patients for health. Listen, you can do any behavior you want. You can smoke, you can be large, you can drink soda, anything you want, and then society pays for the healthcare ramifications of your behavior.
We need to take personal responsibility there. The Affordable Care Act does allow that. We’re allowed to charge smokers a higher insurance premium than nonsmokers.
So really for the first time on a federal level, that’s possible. The problem is the last 15 years in Washington there’s X bandwidth for health, and it’s all been about finance.
We need to change that and move it to actually talking about health, not healthcare finance. I’m a believer in access to care, which ACA brings us, and that’s awesome.
But at the same time we need to bring that discourse for health out to the open and start to have the tough conversations about what to do to make the system different.
Tavis: Before I lose you, earlier in this conversation, at the very beginning, in fact, you gave a huge shout-out to Michael Bloomberg. You want to unpack that for me?
Agus: Well listen, Michael Bloomberg, the mayor of New York City, says you can’t have transfats, you can’t’ have large sodas, and everyone argues back and forth, saying nanny state is good, nanny state is bad.
Nobody argued that transfats were good for you. So that argument of the nanny state actually brought understanding. With discourse comes understanding. So whether you were tall or short or rich or poor and you went shopping in New York City, your behavior was different after that discourse.
So he was brilliant, and I say this tongue-in-cheek is that Bush did exactly the same thing with stem cells. It was brilliant. He told people no federal funding for stem cells, and then the discourse happens.
Everybody in New York, L.A., across the country, knows what a stem cell is. Obviously we’re being somewhat facetious here because he didn’t mean that, but with discourse comes understanding. We have to start to talk about these things and get people to understand what healthcare means, what health means, and what are the ramifications of the things we do.
Tavis: Speaking of ramifications, exit question here – what would the ramification ultimately be on our healthcare system if we could get fellow citizens to employ the advice in this text?
Financially or beyond, how would that impact, since again these are the costs that seem to be bankrupting everything? Corporations are trying to figure it out, the government’s trying to figure it out, individuals.
The major reason for individual bankruptcy in this country, as you know, is healthcare costs. How would us following this short guide to a long life impact our entire system?
Agus: Well the beauty is that for the individual, for society, and for government, it’s going to work. So companies now are buying this for their employees, because it says I care about you and they lessen their costs.
One heart attack costs a company $78,000. One case of colon cancer, $122,000 to the bottom line of a company. So not to put it in dollars and cents only, but when they save a case, that hits their bottom line in addition to the productivity of the workers and everybody being happy.
So these rules are achievable by all, they’re aspirational by all, and all of us can do those with relatively low money, have a major impact on our health. That aspirin is $3 a year.
It’s not just what you eat, it’s when you eat. So if you have your meals the same time every day instead of whenever you want, dramatically lower diabetes. So these are things that we can all do and should all do.
So the rules range from something as simple as get naked every week because I want you to look at your body and know the changes, to taking your own measurements like your blood pressure, to actually changing some of your behaviors. But I believe in them and I hope it can make a difference in healthcare.
Tavis: He is the man when it comes to these subjects, and I’m honored to have had him on this program. His name is Dr. David B. Agus. His new text is called “A Short Guide to a Long Life.” Pick it up, won’t you, and live a long life. Dr. Agus, good to have you on.
Agus: Thank you, Tavis. I appreciate it.
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