Science

Steve Jobs’ Doctor Wants to Help Us All Live Longer

By Amy Wallace

Originally appeared in Wired, January, 2013

It’s 6:30 on a Monday morning and already David Agus is doing an admirable job of sticking to the rules. Dressed in the no-nonsense uniform that one of his patients, the late Steve Jobs, encouraged him to adopt and wear daily—gray slacks and a black sweater over a white dress shirt—the pioneering biomedical researcher and oncologist meets me outside his hotel on West 56th Street in Manhattan with a large Starbucks coffee1 in his hand and a big smile2 on his face. Already he’s gone for a brief morning run3, and his activity levels are being monitored by the black Nike Fuelband4 on his left wrist. The previous evening he dined on king salmon5 at Café Boulud, finishing it off with a fine Cabernet6, and, as he always does, he took a statin7 and a baby aspirin8 before falling asleep. Though he hasn’t eaten breakfast,9 he looks freshly scrubbed10 and is wearing comfortable shoes11. In his new book, A Short Guide to a Long Life, he prescribes 65 rules we should follow to achieve better health; in the past 18 hours he’s accomplished a solid 10.

Agus is clearly an overachiever. This morning we are heading to CBS News, where one or two times a week he banters about health topics with CBS This Morning’s Charlie Rose and the other anchors. This has been going on since May and was an outgrowth of the 2012 publication of his best seller The End of Illness, a paradigm-shifting book about how to live healthfully and well. In addition to these TV appearances, he contributes op-eds to The New York Times, appears in Nike’s new Movement Matters public-awareness campaign, and is a regular participant at events like the World Economic Forum in Davos, PopTech in Maine, and the Aspen Ideas Festival.

But Agus, 49, is no average pop-doc. He’s also an accomplished and well-regarded research scientist. A professor of medicine and engineering at USC, he has helped develop new drugs and landmark diagnostic tools, cofounded two health care technology companies, and made breakthroughs in both how to treat cancer and how we think about it. On top of all this, he’s a clinician, devoting two and a half days a week to seeing patients—more than a few of them famous. Sumner Redstone, for example, has publicly thanked Agus for his “miracle recovery” from prostate cancer. “He thinks outside the box,” says Redstone, 90. “Everything he told me to do contributed to my battle against cancer. Today I feel better than I did when I was 20.” Neil Young, who mentions Agus in his recent memoir, calls him simply “my mechanic.” As for Jobs, the iCEO was such a close friend that he helped Agus’ first book find its audience by renaming it. (Agus’ original title for The End of Illness was What Is Health?—but Jobs vetoed it, saying reading it was like “chewing cardboard.”)

The combination of serious scientist and accessible communicator has earned Agus plenty of high-profile admirers. “He’s disruptive” is how his friend will.i.am describes Agus. “A prophet,” says Marc Benioff, chair and CEO of Salesforce.com and another buddy. “What he does is really important,” vice president Al Gore says, praising Agus’ willingness to defy “a certain peer pressure” that discourages “taking the discoveries of science into popular culture.”

For his part, Agus isn’t really trying to defy anyone. To him it’s all part of a single plan. That’s because Agus isn’t just trying to build a career, make a pile of money, or get famous; he’s trying to beat cancer. And he knows that even as he searches for breakthrough treatments and refines state-of-the-art clinical care, these accomplishments alone will not achieve this goal. Agus believes we can conquer this devastating disease only if individuals take ownership of their health. They can’t do that if they don’t know how. So he has taken it upon himself to educate them, one rule at a time.

Not everyone is a fan of Agus’ approach. He has at times been accused of making things a little too straightforward, a little too simple. Should more of us really be taking statins? And we shouldn’t take vitamins? To those critics, A Short Guide is guaranteed to rankle. Because despite its various disclaimers—“The rules in this book are not meant to be blanket recommendations”—the little volume contains Agus’ starkest, most clear-cut prescriptions yet. Such reassuring confidence is expected from health proselytizers, who tend to limit themselves to advice based on scientific consensus. Cutting-edge scientists, on the other hand, are almost allergic to sweeping certainties. By definition, they work in areas that are messy, ambiguous, and subject to frequent and sometimes wholesale revision. They traffic not in answers but in questions. By combining the roles of serious biomedical researcher and dedicated wellness guru, Agus sometimes seems to have boldly decided that still-unsettled science is settled enough to be translated for the masses. He’s confident in his interpretation of the data, whose message he feels is too urgent to wait for the plodding agreement of the conservative medical establishment. The result is that in a field rife with caveats, Agus speaks with a ringing clarity. Which is great, as long as he’s right.

You might say that Agus is genetically predisposed to his career trajectory. His father, Zalman Agus, is a professor emeritus of medicine and physiology at the University of Pennsylvania. His grandfather, Jacob Agus, was a rabbi and theologian who wrote books with titles like The Evolution of Jewish Thought. When he died, in 1986, The New York Times noted that he’d “promoted dialogue between Christians and Jews.” Now grandson David has combined these passions, promoting a dialog about health and medicine with the fervor of a devout scholar.

It wasn’t always this way. To hear him tell it, he was an introverted if precocious science nerd almost from birth—puttering in the lab as a child, competing in national science contests, publishing three papers in peer-reviewed journals before he went to college. He attended the best schools: undergrad at Princeton, med school at Penn, and a residency at Johns Hopkins. He remembers being told, when it came time to pick a specialty, that oncology was “career suicide.” At the time, he recalls, the field “was an insipid branch of medicine bereft of hope and innovation.” But fresh out of Hopkins in 1994, he accepted an oncology fellowship at Memorial Sloan-Kettering Cancer Center in New York City.

While working in the lab of David Golde, then Sloan-Kettering’s physician in chief, Agus was part of a team that discovered that while vitamin C might help prevent cancer, it can become an archenemy when you have cancer. It turned out that tumors feed on it. He also worked to develop a new lymphoma drug under Golde and is among those who did the initial work that led to the pharmaceutical called Perjeta (pertuzumab), which binds to a protein on the surface of about a quarter of breast cancers, effectively turning one of their “on switches” to off.

But as formative as this research was for Agus, the relationships he forged were really what shaped his methods. Andy Grove, former CEO of Intel, had gone public about his fight with prostate cancer in 1996. The men became close after meeting at a “who’s who in cancer research” retreat in 1998. So when Grove offered some constructive criticism, Agus was hard-pressed not to listen. “I love what you’re doing in the lab, but you’re not any good at telling people about it,” Grove said to the young researcher. Agus was defensive at first. “What does that have to do with anything? It’s good science,” he countered. Nonetheless, he began scheduling talks at hospitals around the New York area, 150 over the following year. “I forced myself to be a better presenter,” he says.

It was Grove who encouraged Agus to move to California, where Agus took a position at Cedars-Sinai Medical Center in Los Angeles in 2000. Already, word was spreading about this young doctor who was developing new therapies. But Agus had yet to flesh out his systemic approach to cancer, which would be spurred by two key moments. The first occurred in 2004, when Clifton Leaf, a cancer survivor, wrote a cover story in Fortune called “Why We’re Losing the War on Cancer.” Leaf made a compelling case that the medical community was approaching cancer the wrong way—spending more energy trying to understand it and not enough trying to control it. The article gnawed at Agus. Why was he so powerless to treat advanced cancer?

The second moment occurred five years later, at the Aspen Ideas Festival. There Agus met the famed physicist Murray Gell-Mann, who had won the Nobel Prize in 1969 for his work on the theory of elemental particles. Talking to Gell-Mann crystallized the ideas that Leaf’s article had set in motion. “My ‘Aha!’ moment came when he talked about the complex systems he confronted in physics and how he would go about trying to build models,” Agus wrote in The End of Illness. Physicists were able to build theoretical models of things they still didn’t completely understand and make discoveries using those models. Why hadn’t doctors approached medicine like this? he wondered.

That same year, Agus stood before thousands of colleagues at a meeting of the American Association for Cancer Research in Denver and did not mince words: “We’ve made a mistake.” For 50 years, he said, too many resources had been aimed at analyzing how cancer works. “We don’t necessarily need to understand cancer to control it,” he remembers saying. There were hisses in the audience. It wouldn’t be the last time.

He was already at work on The End of Illness, which he’d begun in 2008. “I wrote the book out of weakness, not out of strength,” he says. “I knew I couldn’t treat advanced disease. So we had to do everything we could to get people to understand that there were ways to prevent it, ways of thinking about it differently, and to spur the field to change.” In the book, he would propose a shift in our approach to managing disease and prolonging quality of life. Most crucially, he offered a new way to think about cancer. It’s not something the body has, he asserted, so much as something the body does. Cancer is not a noun, in other words, but a verb—as in, we need to stop our bodies from “cancering.”

Agus says one of his main goals in becoming an author has been to empower individuals, to give them the best data available and tell them how to use it. “There’s a portion of the population who still want to be told what to do. You can’t ignore them,” he says. But still, he adds, his central aim—counterintuitively—has been to inspire his readers to speak up, ask questions, and challenge accepted norms. Even if that means they challenge him. Rule 27 is “Partner with your doc,” which is fitting, as Agus seems bent on partnering with us all.

No one doubts Agus’ devotion to data. But some say he can take it too far—to the detriment of patients’ pocketbooks and their emotional well-being. Nowhere has that criticism played out more publicly than on ABC News, which did two reports on Agus in 2012—the first in January, just as The End of Illness went on sale, the other in October, right after it came out in paperback. Bill Weir, the correspondent who did both reports, billed the first one as “the assignment that saved my life.” But in the second he admitted, “Now I’m not so sure.”

Weir, a seemingly fit 44-year-old husband and father, volunteered to let Agus use him as a test subject to show how cutting-edge technology can extend life. The newsman underwent a battery of tests, including a full-body CT scan, and then sat down to get the results on camera. He was stunned to hear Agus say that he had lesions with calcification in major coronary arteries. He could be at risk for a heart attack. Agus told Weir that he might become “the 45-year-old who went jogging and died.” Weir needed to develop a regular schedule,12 Agus said, improve his diet, stop taking vitamins, and move around more throughout the day. “At that moment I vowed to change,” Weir reported.

But even as Agus’ book became a best seller, some in the medical community were questioning one of its central premises: That more information is the key to making good decisions, even when the tests used to glean that information may do damage (full-body CT scans, for example, involve radiation exposure). “I started hearing from people the morning after that first report aired,” Weir told me. What they said was that Agus was, as Weir put it in his second report, “a good example of bad medicine.” In his second piece, Weir reported that five doctors had asserted that Agus had overstated Weir’s risk of dying.

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Rules to live (longer) by

1. RULE 18 Start a sen­sible caffeine habit. “Consuming caffeine in moderation from natural sources like the coffee bean and tea leaf has long been shown to confer positive benefits on our health.”
2. RULE 29 Smile. “The act itself will trigger the release of pain-killing, brain-happy endorphins and serotonin.”
3. RULE 17 Jack your heart rate up 50 per­cent above your resting baseline for at least 15 minutes every day.
4. RULE 2 Measure yourself. “You might want to consider adding a tracking app or device of some kind to your life.”
5. RULE 37 Eat more than three servings of cold-water fish a week.
6. RULE 10 Have a glass of wine with dinner.
7. RULE 21 Inquire about statins if you’re over-the-hill.
8. RULE 22 Take a baby aspirin. Low-dose aspirin can not only prevent strokes and heart attacks, it reduces the risk of dying from cancer.
9. RULE 41 Never skip breakfast.
10. RULE 11 Practice good hygiene—in bed and out.
11. RULE 59 Avoid stilettos and other sneaky sources of inflammation. Wear comfortable shoes.
12. RULE 49 Pick up a pooch. Dogs keep you on a regular schedule.

(Since this story contains footnotes, you’ll enjoy it more on Wired.com… Here’s the link!)