February 9th, 2016

#FZGPS: thriving in a ‘brave new world’ of health – big data and living to 100

Dr. David Agus, oncologist and biomedical research physician, joined Fareed Zakaria to discuss medical breakthroughs resulting from the implementation of electronic medical records and his new book, The Lucky Years (2016), about how ‘big data’ is improving medical outcomes for patients.

Dr. Agus explains that while physicians initially resisted digitizing their records, it turns out that the practice has ignited a knowledge revolution that is radically changing recommendations and improving medical outcomes.  And that other examples of ‘big data’ evaluation of epidemiological experiences among populations is yielding vast knowledge for even non-medical interventions that may improve healthy aging.  Dr. Agus discusses the concept behind the cancer therapy that may have curbed the progression of former President Jimmy Carter’s metastatic cancer, how some women on beta blockers may be living longer with ovarian cancer, and how sleeping in a more quiet room may delay neuro-cognitive decline.

The full transcript of the interview may be found after the jump.  MANDATORY CREDIT for reference and usage: “CNN’s Fareed Zakaria GPS”



FAREED ZAKARIA, HOST: Big data has changed much of what we do: how we work, how we shop, how we travel, and so much more. But we are on the brink of a big data revolution in medicine that will change the way we live.

That’s what my next guest says. David Agus is a professor at USC’s medical school, a New York Times best-selling author, and one of the world’s best-known doctors.

His new book is “The Lucky Years: How to Thrive in a Brave New World of Health.”  Welcome.


ZAKARIA: So people have been saying for a while now, oh, there’s a revolution taking place in medicine, the human genome and all this stuff. And, you know, I just look at it as a — as a consumer of health care, it hasn’t changed very much.

Why is this going to be different now?

AGUS: Well, we’re at that inflection point. Literally, things are changing.

So President Obama, in his first term, said every doctor, to their kicking and screaming and lament, has to do an electronic health record. So all of a sudden, we have data going from illegible handwriting into databases. And we’re learning from this big data.

At the same time, technology, whether they be genome or proteome or other -omes, and other technologies, have come together to really create a tipping point.

So what has happened in the last several years is transformative, from making cancer more of a chronic disease to learning from big data to manage all diseases, including, you know, cognitive decline in the brain. It is wild.

We’re really at a special time.

ZAKARIA: So give me an example of how all this — having all this data is going to, in some way, produce a better treatment or cure.

AGUS: So there is a great case that just happened of women with ovarian cancer, a deadly disease when it spreads. They started to look at large numbers of them. And if you happen to be on a blood pressure medicine called a beta blocker, you live about a year-and-a-half longer.

So no one would have ever picked this up by biology. But now, we are starting to do the real studies to make sure it’s real. But certainly the data look very encouraging that going on a very inexpensive, non-toxic medicine can add an extra year of life.

At the same time, we’ve done studies, for example, in Europe. And this is a wild one. If you drew circles around an airport, the closer you live in, the higher the rate of neuro-cognitive decline, meaning that the brain needs quiet time every night. And we got that from a big data study.

And so, you know, I have 150-pound dog that snores. So I put those orange ear plugs in my ear every night because I can’t kick her out of the bedroom, and I get my quiet time and hopefully snow — slow my cognitive decline.

ZAKARIA: So when you — when you look at something like cancer, the…

AGUS: Yes.

ZAKARIA: — the head of MD Anderson, one of the largest, best cancer hospitals in the world, says there is a revolution taking place, and he believes that cancer will become manageable.  Is — why is that?

AGUS: Well, there are two major phenomena happening. One is, they call the Jimmy Carter Effect, right. A 90-plus-year-old individual has melanoma metastatic to the brain, which several years ago was a death sentence.

He went on a treatment that blocks the don’t-eat-me signal all cancers have on the surface. You know, they block the immune system from attacking it by having this don’t-eat-me signal…

ZAKARIA: So wait, explain that. So the cancer cell has a — has a…

AGUS: Has a little…

ZAKARIA: — has a signal that says don’t eat me…

AGUS: Exactly.

ZAKARIA: — to the body — to the body’s antibodies that might otherwise eat it…

AGUS: Right. And so these cells, called T-cells, would come in and eat them up, but they’re blocked. And so this drug blocks that don’t-eat-me signal, and what do you know, he’s disease-free now months later.

And this is time and time again — kidney cancer, melanoma, some types of lung cancer, that works.

The other phenomenon that’s happening now is what we call precision or personalized medicine, which are basically the same thing, which means that — covered by insurance, I can have a patient’s cancer sequenced. And then I can identify targets which are on switches. And there are dozens of drugs now that block each of these on switches.

So in the old days, we categorized cancer by body part — breast cancer, lung cancer. Well, that came from the 1800s in Europe.

Well now, we’re categorizing it by what are the on switches — what are the pathways that are actually signaling the cell, hey, you should go and grow, and we can block them with oral pills.

And I’ve seen it. I can now walk into a patient’s room, and I couldn’t do this two years ago, and with honesty say there is hope to treat your cancer and make it a chronic disease.

ZAKARIA: You claim that we’re even going to be able to start reversing aging.  What does that mean, even?

AGUS: It’s the wildest experiment. I mean have a — hold onto your chair.

So in the 1950s, this woman named Wanda Lunsford did what was her only experiment in science, and she was actually pushed out.

She took an old rat and a young rat and she tied their skin together.

And the blood supplies joined after a day, and then three weeks later, she looked and the brain of the old rat had new neurons growing. The muscles were stronger. The heart beat better. She claimed she reversed aging.

Well, they called her Dracula and Frankenstein and actually pushed her out of science.

Well, earlier this year, three separate labs, one at Harvard, one at University of California, San Francisco, one at Stanford, repeated the experiment, and it worked.

And what they showed is that when you and I turn 25, our stem cells go to sleep. And there are proteins that wake up those stem cells and allow them to refunction and make tissue again.

And so the future — there are clinical trials now in elderly who have a fracture to accelerate healing by giving these proteins.

We’re doing the same thing in people with severe cognitive dementia. I mean, we’re doing it in cancer. Cancer in kids is up to 90 percent curable. Those same cancers, when you turn 25, they’re incurable.

So if I can convince the body it’s young, maybe we can have a bigger impact on cancer.

And so there’s hope. And what’s amazing is the way to reverse aging and to actually make us live better is within us already. It’s just asleep.

So we’re not going to live to 130, but when we live until our eighth, ninth, or tenth decade, hopefully we could do it with real quality years with technologies like this.

ZAKARIA: And all this comes — or much of it comes out of this ability now to analyze massive quantities of data, both, you know, at the biological level and also health records.

AGUS: And the cheap technologies. You put all of those together, it’s powerful.

But it is an issue, right? I mean, we saw Blue Cross’s database got broken into and hundreds of millions of records accessed. So that’s an area that we have to pay attention to and is scary.

But at the same time, we all have to say, listen, my medical records, even if they’re — when I de-anonymize and take my identifiers on them, I want to give them to the public good because I want to be part of the solution, not the problem.

So you have both of those things happening parallelly.

ZAKARIA: Pleasure to have you on. Terrific book.

AGUS: Thank you, Fareed. I truly appreciate it.