TEDMED Visionaries: An interview with David Agus

Today is the inaugural installment of our new blog series, TEDMED Visionaries. We’ll feature in-depth Q&A’s, interviews, podcasts, guest posts and more from our speakers and from leading innovators in the converging worlds of tech, health and medicine.

Our first guest is David Agus, M.D., oncologist and author of the bestselling book, “The End of Illness,” who spoke at TEDMED 2011.

Q: In your book, and in your talk at TEDMED, you mentioned doctors recommending potentially harmful interventions – like smoking, margarine and vitamins – without having data to back up their advice. Why does that still happen, in today’s info-rich age? How could doctors share knowledge better?

Agus: Many times we (the medical community) make recommendations prematurely before prospective data is available. The realization that we are a complex system means that any intervention will change the system, and may do so with a negative health consequence. My hope is that with the digitalization of medical records we will be able to learn from our actions in real time and improve medical care iteratively. Although we like to think that we live in an info-rich, high-tech world, there’s still much about the human body that we just don’t know or understand yet. When a doctor makes a recommendation, it’s with the best intentions, but medicine is still very much an art rather than a science. In the future, that will shift as technology supports the exchange of data-driven wisdom among doctors, which will then inform their decisions.

David Agus

Q.As we head into a future that increasingly uses proteomics and the personal diagnostic tools you envision, how will physician training have to change to accommodate these advances, if at all?

Agus: I think a call for a new way of training physicians is necessary. We need to modernize our medical education system to reflect new understandings and technology. At the same time, we have to be aware of the “human” part of medicine and not lose that important art.

Q. Proteomics and other diagnostic tools may give us a great leap forward in treating some of our most pervasive ills. What, in your opinion, will be the toughest to crack in terms of having a cohesive view of the disease mechanism? Depression? Cancer? Obesity, or Alzheimer’s?

Agus: It’s hard to grade disease complexity, but I think all diseases deserve new thinking and application of technology. As I state plainly in my recent book, it’s quite possible that we already have all the drugs we need to treat the vast majority of diseases — even the ones that entail a breakdown of the system such as cancer or Alzheimer’s disease, and aren’t caused by an invader. We just don’t know how to use this library of drugs (method), how much to use (dosage), and when (schedule). New techniques for collecting health data in the future will hopefully inform this idea.

Q. What is a timeline by when we might see proteomics testing become common? In fact, when will genetic testing become standard as a baseline health metric? It seems that it is no longer prohibitively expensive.

Agus: Proteomics tests exist today—we use them routinely (e.g., prostate specific antigen to detect signs of prostate cancer, pregnancy tests, inflammation tests, etc.). Newer proteomic tests that will benefit from the advances in technology will be introduced in the next several years. In terms of access to these technologies, as well as more widespread use of genetic testing across the general public, I presume that will happen as the technologies become cheaper and we strive to change our healthcare system.

Q. CDC employees carry statins and meat tenderizer to reduce inflammation, should a virus like H5N1 strike, and to neutralize toxins. Do you carry any remedy or health talisman with you at all times, other than wearing comfortable shoes?

Agus: Statins can reduce inflammation, and meat tenderizer can be used to degrade protein-based toxins (if something bites you). I don’t carry anything myself, but I do wear comfortable shoes that don’t hurt my feet (to reduce my levels of inflammation!), I do take a statin and aspirin, and I wear a Nike Fuel Accelerometer on my wrist.

Q. Your book strongly advocates taking personal responsibility for our health. Many of us know what’s good for us, though, and still fail to do it. What’s the missing link?

Agus: I think we need to all better understand the long-term consequences of our actions. I wrote the book to make a difference in this regard. It all comes down to incentives — that’s the missing link. I can tell you that you have a 30 percent chance of becoming obese based on the general population, which is probably meaningless to you. But if I could tell you that your risk of becoming obese in your lifetime is 60 to 80 percent based on your genetics, this would likely mean something, wouldn’t it? That might be enough to inspire you to pay more attention to the lifestyle habits that factor into your weight. That might be enough to motivate you in ways you never thought possible to control your waistline. That’s the power certain technologies such as genetic testing can have on individuals. Another way to look at it: If you knew that your personal risk for having a heart attack in your life was 90 percent, you’d probably do everything you could to treat your heart well. Hearing another umbrella statistic such as “heart disease is the leading killer in our country” has little impact, if any. But learning that your genetic profile puts you in a higher-than-average risk group for suffering from a heart attack speaks much louder than general statistics.

–Interviewed by Stacy Lu