Book review: 'The End Of Illness'

Book: The End Of Illness
David B Agus
Simon & Schuster
336 pages
Rs599

The End Of Illness is an irresistible title. It has the oracular ring we’ve grown to expect from lifestyle gurus and the makers of health foods. The author, though, has credentials of a different ilk. Dr David B Agus is an oncologist who pioneered genetic analysis as a predictive tool for cancers and is presently exploring proteomics for early detection and custom-built therapy. Translated, this means he’s a cancer scientist with hope. Just so we’re clear, faith is no part of his agenda. Still, it makes him a prophet of sorts.

To most of us, cancer therapies are hell. The therapeutic plethora tells us that either nothing works, or everything does, but up to a point. That point is often reached with tragic promptitude. The slate is further clouded by the idiom of discourse. The ‘war against cancer’ has all the moral flavour of a righteous obligation. Vigilantes trawl the net for new therapies and return disappointed when they find these out of reach. Patients and their caregivers pitch their last paisa on drugs whose toxic bite is worse than the cancer’s. Onlookers watch helplessly as their loved ones endure anguish after anguish. Doctors realise, with every case they see, that statistics have nothing to do with the individual.

Cancer is a terribly personalised disease, but so, Dr Agus points out, is any disease. The practice of medicine hasn’t yet satisfied the first dictum of Hippocrates: “Do no harm.” Dr Agus argues that new science will finally make this possible by telling us the why of what works on whom, and how.

I picked up The End of Illness with high expectations, and, for the most part, read on encouraged by the author’s muscular intent in debunking medical fads. This he does with great patience and in lucid prose that can be read without impatience.
Statins, among the most rabidly prescribed drugs, are generally perceived as controlling levels of fat in the blood. This book explains the JUPITER Trial — the study showed that statins were protective against stroke and heart attacks even in people with normal or low cholesterol levels — with clarity. So is cholesterol really the clue to latent cardiovascular disease? No, emphasises Dr Agus — it is C-Reactive Protein, the biomarker that tells us a pathological inflammation lurks within.

The catch here, of course, is that almost every chronic disease known to science — and a good many that are yet unknown — work their ravages through inflammation anyway. So, if a drug blocks the process of inflammation, it is bound to be hailed as panacea, until we see it up close, warts and all. Every drug known to us, from opium down to aspirin, Vitamin C, Prozac and Viagra, has had its hour in the sun.

Dr Agus is an oncologist, therefore his take on chemotherapy is of particular significance. The examples he cites profile a losing battle between drug and disease. Increasing dosages are matched by increasing recurrences. What then is the yardstick of cure — tumor shrinkage, improved quality of life, or simply longevity as measured in days?

Dr Agus writes, “It’s quite possible that we already have all the drugs we need to treat the vast majority of diseases ... 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.”
Will this mean an end to illness?