Creative medicine: David Agus battles cancer by looking at the big picture

It was a $200 million conversation.
August 2, 2016

It was a $200 million conversation. 

Over breakfast one day, Oracle CEO and technology entrepreneur Larry Ellison asked his friend, cancer specialist Dr. David B. Agus, to share his vision for tackling cancer. The latter described a center involved in cancer research, prevention and treatment, one that would embrace a wide range of disciplines, from engineering and physics to art and food. 

The result? Ellison in May announced a $200 million gift to establish the Lawrence J. Ellison Institute for Transformative Medicine of USC, with Agus at the helm. 

Agus brings impressive credentials to the new role: The 51-year-old heads the USC Norris Westside Cancer Center, and the Center for Applied Molecular Medicine, co-founded two personalized medicine companies and regularly appears on “CBS This Morning.” The author of three best-sellers, including his most recent book, “The Lucky Years,” released in January, Agus spoke with the Journal about getting the institute up and running — it’s expected to open on the Westside in two years at a yet-to-be-determined site — as well as how technology is revolutionizing health, and what he learned from his grandfather, the rabbi.

Dr. David B. Agus is the founding director of the recently announced Lawrence J. Ellison Institute for Transformative Medicine of USC. 

Jewish Journal: You’re a professor of medicine and engineering. That’s an unusual combination.  

David Agus: My life changed when Walter Isaacson, head of the Aspen Institute, invited me to do a session there with [Nobel Prize winner] Murray Gell-Mann. Murray’s probably the greatest living physicist. He discovered the quark, string theory. … Murray viewed the world differently. He thought like a physicist. And it taught me that we’ve been thinking the same way for generations — thinking like biologists.  

Around the same time, [former Vice President] Al Gore [connected] me with Danny Hillis. Danny was at Disney Imagineering. Danny built the first supercomputer. … [He’s] one of the great engineering thinkers. Suddenly, I was talking about cancer to an engineer and to a physicist and it really started to show me that we have to think differently. … So if I want to treat cancer, I don’t just want to target the cell, I want to target the whole system. 

JJ: You disagree with what you call the reductionist view prevalent in cancer research today. 

DA: [Researchers] keep looking at the cancer cell and forgetting everything else. This [bias stems] from germ theory, which says that as soon as you know what you’re up against, you know how to fix it: You look in the microscope and see what bacteria it is, and you know how to treat it. And that’s correct. The problem is, human diseases — Alzheimer’s, cancer, heart disease — are from within, not from without. So looking at one cell [only gives] you a tiny piece of the puzzle.

JJ: Is it fair to say that you believe the emphasis on cancer should shift from treatment to prevention?

DA: It just makes a lot more sense. I was with the vice president [Joe Biden]. … He asked me outright if I think we’ll be able to cure cancer in my lifetime. And I said no. We’ll be able to hopefully control it and manage it and reduce the suffering dramatically, but we’re not going to be able to cure cancer. Yet most cancers — not all, but many — can be prevented.

JJ: You’ve written about the role of data in promoting health and preventing disease.

DA: The National Library of Israel asked me to speak [at the launch of] their new building … to talk about Maimonides with a contemporary view. … Maimonides would look at everything he did and record what happened. It got into some graphic details, like what foods he ate and how they affected his sexual performance. He listened. Data is just that. It’s the accumulation of not just one person, but lots of people pulled together where we can start to look at outcomes and … learn things … we wouldn’t be able to [recognize without pooling] large numbers of individuals.

Studies came out recently, for example, [showing that women with] ovarian cancer who took a beta-blocker — an inexpensive, generic drug for blood pressure — lived 4 1/2 years longer [than those who didn’t]. That was identified by big data. And now, there are prospective [clinical] trials to [validate this result]. … We need a new culture of sharing our own data. Obviously, in a privacy protected, anonymized way. But if we do that, we can transform medicine.

JJ: Data are macro. Proteomics, something else you endorse, is micro. Can you explain what proteomics means and how it relates to cancer prevention and treatment?

DA: “Omics” means “the study of.” So proteomics is the study of proteins. … In 1976, if [a woman thought she was] pregnant, we took a tube of blood … and injected a rabbit. Five days later, if the rabbit’s ovaries were enlarged, we knew the woman was pregnant. That was the state-of-the-art in 1976. In 1977, along comes this company, Warner Chilcott [makers of the first home pregnancy test kit available in the U.S.], and for $9 they had the first proteomic, or protein, test. Rabbits of the world rejoiced and we radically changed maternal health and neonatal health by looking at one protein. Now, through technology, we have the ability to look at all the proteins in the body. We can actually listen to the body talking [at the cellular level].

JJ: Your second book, “A Short Guide to a Long Life,” makes disease prevention seem so simple and doable.

DA: Those 65 rules … are based on the data. If one practices them, one can dramatically reduce one’s risk for disease and dramatically increase the chance of a longer life with better quality years. The difficulty is, how do you get individuals in their 20s to do something that changes them when they’re 40 or 50 or 60? How do you get people to think in decade horizons? Not just about today, but about tomorrow. That’s been the challenge in health. 

JJ: What would you tell someone in their 50s or 60s, who perhaps hasn’t practiced such great health habits, who might feel discouraged and think, “Well, I’ve already blown it?”

DA: At any age, if you begin to practice these habits, you’re going to do better. If … you start walking just a few hours a week — not getting your heart rate up, just moving — you live longer. The data are very clear. These are not dramatic changes. The data show that if you live with someone, you live longer. And if you own a pet, you live longer. If you eat your meals at regular times and nothing in between, you reduce the risk of certain diseases. … Evolution selects for having good children, not for living into your 90s. The reason we need to tweak [our behavior] is because our bodies weren’t evolved to last to the 90s and we want to do that. And we can do that — with quality years — if we do the right things.

JJ: Tell me about the Lawrence J. Ellison Institute for Transformative Medicine. 

DA: We will have a building where we address the full scope of health from wellness to cancer, both on the patient care side and the research side. … The greatest thinkers across the globe … will come and live there and be engrossed. … 

The only way of bringing in the different sciences to help in a cross-disciplinary way … is to [enable them to] live and smell the disease. Patients will have the choice of letting people watch their treatments or having them in privacy. Radiologists will go over scans with groups of scientists from different disciplines. Same thing with the pathologists. There will be artists making art. Chefs making food. And so it really is vertical in a different way.

My job is not just to treat cancer but to change how we treat cancer. The more resources I have — the more philanthropic dollars or federal grants — the more I can do and the quicker I can move. Several times a week, I look a patient in the eye and say, “I’ve got no more drugs to treat your cancer.” I don’t want to do that anymore.  

JJ: What brought you to medicine, and to cancer medicine specifically?

DA: I was in a lab at an early age [due to a test that identified children with an aptitude in science]. … My first scientific presentation in a meeting was at 14. I was a geek. I had remarkable mentors. My father was a doctor.

I still remember the day when I was training at [Johns] Hopkins and I went to the head of medicine — my boss at the time — and said, “I’m going to go to Sloan Kettering and focus on cancer.” He looked at me and said, “Are you crazy? It’s barbaric. It’s giving poisons to people. … Go into something like cardiology or pulmonary, where you can actually help people.” That made my resolve stronger. I wanted to go into the field that was in its beginnings … something where I could work in the lab and translate that right away to patients … [and not wait] two decades later to see it benefit patients. Literally, it could be a month later. 

JJ: Does Judaism play a role in your life, or in your practice of medicine?

DA: It certainly plays a role in my life. We’re members of a remarkable synagogue here in L.A., IKAR. Rabbi Sharon Brous is a guiding light for myself and my family. 

[Judaism] plays roles in how I approach problems, my morals and ethics. My mentor is Shimon Peres. He wrote the introduction for the Hebrew version of my first book [“The End of Illness”]. He wrote that when the mirror came along, the world changed. People looked at themselves differently and all human interaction changed. The technology described in the book is the new mirror. It’s such a beautiful way of looking at it.

In my field, it’s not just what you do, it’s how you do it. We’re privileged to have the background of Judaism, which changes what I do and changes how I approach — whether an individual patient or a problem.

JJ: In what way does it change your approach?

DA: One thing that Judaism does is make us think of … the whole. Especially in today’s world, where literally there’s a discovery happening every week, we have to think of the impact. We have to think of what it means on a larger basis.

JJ: Any other thoughts you’d like to share with Jewish Journal readers?

DA: We as Jews, because we are a relatively inbred population, have certain diseases we have to be aware of. Atherosclerotic (heart) disease and certain kinds of cancers are dominant in our ethnic group. You need to listen to your body and to look at your history. 

One of my jobs is … to educate. Early on, I didn’t view it as that. [The late engineer and author] Andy Grove … pushed me to schedule literally hundreds of talks in several years to get better at public speaking and presenting. He said, “It’s your obligation to educate. What good does it do if you have the knowledge and nobody else gets it from you?”

JJ: Clearly, you took that to heart.

DA: It’s a very powerful way of thinking about things. I also got that from my grandfather. My grandfather [Rabbi Jacob B. Agus] was one of the great scholars, and yet he felt an obligation to have a pulpit — to communicate. Because to educate just the intellectuals with his books … [wasn’t enough]. He had an obligation to speak to a congregation. That made an impact on me. 

[Last year], I went back to Baltimore when his synagogue invited me to give a talk. And so I got to stand at his lectern. I still remember as a kid, running up there after Shabbat services or Rosh Hashanah, running up there to hug him. … Getting to speak from there was pretty remarkable.

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