The End of Illness
A new book on proteomics, and how getting a dog can improve your health.
Dan Kitwood/Getty Images
Even as the publishing industry staggers through its geologic shift, one genre remains impervious to change or threat: the self-help book. These advice-packed tomes generally come in two distinct flavors: either a get-tough pep talk about discipline and self-control, the sort of thing one might expect from a high-school gym coach, or a set of bromides Grandma might have offered, advising moderation in all things. The End of Illness, an entry (in the health subcategory) from January, sets out to explain how we all might live to the age of 90. Naturally, it tilts toward the grandmotherly end of the self-help spectrum. “Consider getting a dog,” advise its authors, the oncologist and entrepreneur David Agus and his co-writer Kristin Loberg. But they’ve added to the formula with an enjoyable bonus: an interesting if self-serving foray into the futuristic world of proteomics.
What, you may be wondering, is that? A field so new that the word itself—a mash-up of protein and genome—was invented less than 20 years ago. The discipline (and its name) were initiated by Marc Wilkins, an Australian researcher who in the 1990s thought the world’s love affair with the genome was misplaced. He reasoned that DNA, genes, and chromosomes lack a right-now currency and therefore are of limited value in our quest to understand human disease. After all, how could an inflexible, skeletal helix of genetic information that’s passed on at conception predict whether someone would have a heart attack at 50? Shouldn’t there be a more immediate biological signature to examine, one that reflects a person’s health situation right this second?
Wilkins thought that we would be better off studying not the gene but rather the gene product. The gene, that pampered science-class superstar, doesn’t just preen and stretch across the famous double helix of DNA all day, it actually does something in the human body: It makes proteins. Some genes (we’ve got about 25,000 of them) can multitask as well, spitting out a variety of different proteins. In fact we’ve each got about a million proteins, which, in the words of the NIH, “drive the workings of [our] cells, tissues, and organs.” Many of these are floating through the great, chaotic swamp of the bloodstream, while others stay inside the cell membranes. (Click here for a visual explanation). Taken together, all these compose the proteome.
So how can we use a knowledge of the proteome to our advantage? Here’s the premise: In response to the micro-slings and arrows of daily living, we spit out a wide range of proteins, one to increase this hormone, another to adjust that inflammatory response, a third to induce nausea after your last greasy meal. Something for everything. Since each of these proteins must travel in the bloodstream, a sampling of blood will provide a direct reflection of the day’s oeuvre. The proteome is a diary to end all diaries.
Agus has some fun with the topic, and takes a surprising amount of credit for its development. (He runs his own proteomics company.) Then he lays out a compelling argument for its centrality in the routine medicine of tomorrow. He mentions “theragnostics”—the use of patients' proteomic compositions to predict how they might respond to a costly and potentially toxic treatment. And he dreams of the day—coming soon, maybe—when proteomics, not colonoscopy, will identify early polyp growth and incipient cancer.
But he’s done with all this by the end of Chapter 5, with another nine to go. Just when we’re ready for more Tomorrowland, Agus suddenly goes back in time, to the good old days where Grandma ruled. He’ll spend the rest of the book (another 150+ pages) sitting at the dining room table and dispensing tidy advice about this and that: Choose a multicolored diet; get wireless headphones so you can walk while you talk on the phone; etc. Thankfully, he has moments of crankiness, too, and takes on a few of the sacred cows munching across the self-help terrain: vitamins and "fresh" vegetables like the poor wintertime tomato that are actually out-of-season and light on nutrients. But he also spends a lot of time echoing the echoes of a thousand other echoes as he endorses exercise, fresh fish, and avoidance of junk food. (In the book’s finest moment, he informs us that Americans spend $5.3 billion dollars per year on potato chips.)
In addition to his alternating moments of iconoclasm and of staleness, Agus embarks on a strangely uninformed detour into the weird world of inflammation, proclaiming it “bad” because football players tend to die young. Apparently, that’s because their bodies are often inflamed, not because they are wildly overweight and chock-full of anabolic steroids, uppers, downers, weight-gain shakes, and all the rest. It is ironic that after striving to elucidate the world of proteomics with so much subtlety and nuance, the book would be so casual in its explication of this topic. Inflammation comprises a complex and interlocking web of chemicals pushing and pulling in all directions, none of which is intrinsically good or bad. Like the proteome itself, it defies catch-all descriptors or value judgments.
And Chapter 11, called “The Wonder Drug of Keeping a Regular Schedule,” seems unrelated to any reality experienced by a member of Homo sapiens. Here Agus offers some sound, grandmotherly advice in favor of the regular life. Wake up at the same time, go to sleep at the same time, and live happily ever after. But this is a very simple and unrealistic solution: After all, shit happens. People are restless because children are sick, bills can’t be paid, threatening memos appear at the end of the work day, and pretty strangers smile suggestively. Life is full of excitement good and bad; for most adults, sleep is what children do.
The author covers a lot of ground and can be forgiven for many standard crimes—pushing his own wares, talking down to the reader, and guessing wrong on some remedies. (His breathless endorsement of the statin class of drugs seems especially ill-timed, for example, given the recent FDA warning linking their use with the development of diabetes.) But he goes way too far at the book’s end. Here, in the final pages, Agus enjoins us to follow him in the March to Total Health, and hints, strongly, that failure to do so would not only mean ducking good advice but actually inviting illness, as if disease were by its nature self-inflicted. In his words: “The end of illness resides in all of us. It’s up to each of us to do what we can to put an end to it. For those who have the courage to join the revolution currently taking place in medicine, I welcome you.”
This blame-the-victim mentality lays responsibility for sickness clearly at the feet of the poor sucker who didn’t join the right team, but could have. This is scientifically incorrect and morally appalling. As David Rakoff writes in his book, Half Empty: “A sense of humor … is a fine stance if it works for you, but its inverse seems to constitute a failure of character; ultimately a judgment against those folks who just aren’t funny or stylish enough to disarm their metastases with well-dressed wit. “
Yet Agus’ final, dismal flourish exposes the secret reason for the continued popularity of these sorts of books for writer and reader alike—they perpetuate the faulty premise that we are in control of our future. Yes, if we just keep our nose clean enough and do (or don’t) eat our vegetables, vitamins, health shakes or whatever, then we, too, will live forever, or almost! But this point of view misses the most basic fact about human health: Illness often happens in ways that neither Agus nor the proteome nor the genome nor even Mr. Wizard could ever predict. To embrace this sort of cosmology is as narrow and restrictive as endorsing a system of divine retribution for the sinner who dallies too long with the devil. In matters of human health, neither science nor faith is as good as advertised; but science at least has the responsibility to acknowledge its limits.
Kent Sepkowitz is a physician in New York City who writes about medicine.