 Thank you all for being here. I'm delighted to be here with David Agus who has been a real pioneer In the field of medicine and also we are very lucky that he has had the megaphone recently And so more and more people are listening and paying attention to your message this is One of 21 sessions that the World Economic Forum has started this year of one-on-one conversations A new feature of Davos and this morning I was Privileged to have a conversation with Dr. Ross and this afternoon with Dr. Agus And if we could listen to what you and Mehmet are saying we would be a much healthier society So let me just start by saying that one of the unusual things About your life is that you are both a professor of engineering and a professor of medicine and also not as unusual but still kind of adorable and Pretty devoted dad who has threw out everything maintained this website where we can track What your two children and your dog yogi? at any point and You recently wrote that miles is the coolest kid So I want to start by asking why is miles the coolest kid and how does Sydney his sister feel about that? No They're both great, you know miles has a passion for science Which is great and Sydney is a passion for learning so to see our next generation get excited about things You know last month I did some of those Sal Khan videos from the Khan Academy Where you could tell kids about science and it's just so amazing that within a week or two a hundred thousand kids Can see science and they get it Your book has that same spirit of passion and optimism in fact the title itself the end of illness is pretty stunning and It was a title which was given to you by Steve Jobs whom you cared for for over five years So why did you come up? Together with Steve Jobs with his very bold Declaration about what's going to happen to our lives, you know, I'm a cancer doctor I see two or three people a week and I have to say I've got no more medicines for you Unfortunately, you're gonna pass away from cancer and cancer wins and I can't do that anymore So first of all I want to make a declaration that we have to prevent disease We are much better at preventing things than treating things yet We're not doing it and it's frustrating healthcare in the United States is 16 and a half percent a gross domestic product And it's growing the only way we're gonna make an impact is to stop it So the end of illness is a bold declaration approach healthcare differently as a complex system not in reductionist take one pills Supplement something look at the whole picture. It's much more of an Eastern philosophy in one sense But it's grounded on engineering and science. Well, that's what I love about everything you've been saying that it is so bold and Since the theme of Davos is here is great transformations. It is truly about great transformations So what has been the greatest resistance to your message, you know the Daily Mail Publish an excerpt from the book a couple days ago. We got 7,000 negative emails. I think I got three positive But part of it when everyone says well, that's the Daily Mail But and I don't know much about the UK press a lot of positive Comments when you passed on the Huffington post. I'm ready. I'm there. I love the Huffington post but you know one of the declarations in the book is about vitamins and this notion that there is yet to be Positive study randomized fashion showing vitamins have benefit for heart disease or cancer and in fact most of the studies have a trend Or a statistical negative if a man takes a vitamin E a day his risk of prostate cancer is 17 percent elevated and It lasts for three to four years after stopping vitamin E So think of it from a society basis the most common non-skin cancer of men 17 percent elevated Society is paying that cost if a woman takes a multivitamin or iron her risk of death is higher Death is a hell of a complication. You start to look through these These studies and they're all negative none are positive and I don't get it All of vitamin is is something the body can't synthesize enough of it doesn't mean more is better So what about other drugs? Prescription drugs yeah, and that's the other thing that people jump on me about because we do talk about some drugs and again I think some drugs are good and everyone says you're backed by the pharmaceutical companies I have no backing by any pharmaceutical company, but if you look at it evolution selects out for who has good kids Evolution doesn't select out for who lives till their nineties or a hundred and so we need to optimize or tweak a little And the predominant way we need to tweak is blocking inflammation So look at a drug that's been around for a long time called aspirin If one takes aspirin one's risk of death from colon cancer is down 60 percent One's risk of all cancers is down 18 percent and delay heart attack and stroke by taking an aspirin Look at statins like lipitor. They were developed lower cholesterol But if you take some with a normal cholesterol and put them on a statin, you'll reduce the incidence of cancer by 40 percent Can you think of the impact on society of reducing the cancer by 40 percent? And I first told this at one of the World Economic Forum retreats in Abu Dhabi and some guy gets up there and goes I guess you can't talk like this. I go. What do you mean? He goes well? The pensions are set up for lots of people to die in their 50s 60s and 70s. You're gonna screw up all our pensions Well, in fact that brings us into politics and one of your Campaigns has been to try and get politicians to talk about health as opposed to talking just about health care to talk about what's Critical to our lives rather than just how we finance it. How are you doing with that poorly? Very poorly, you know, there's X bandwidth for health in Washington And in any country and when almost all of it is spouted in health care finance There's none to be pushed elsewhere. The way we're gonna get real health care reform is changing things You know Michael Dell says you're welcome to smoke a Dell computer Except I'm gonna charge different costs and health insurance for the smokers and the non smokers That's powerful. We need culpability and we need to change behavior if we're gonna make an impact in health And what about just some simple lifestyle changes? Like if anybody Wanted to go away from this session with one simple change that could make in their lives What would that be? So there's one profound thing where the data is just dramatic and it's simple It's called regularity and schedule. So if example today you had lunch at I've ever been as laughing as Davos is This is the one exception this week, I promise you But if you have your lunch at noon today and tomorrow at 2 o'clock for two hours Oh, your stress hormones goes up and your body kind of starts to go into conservation mode saying something's wrong I got to save all my energy to flee that lion. So I'm gonna shut down a little bit. You don't function Well, so I don't care if you have two meals a day or five. It's the regularity part That's key if you look at the data there were a group of kids who they put them to bed And they said let's into the parents wake them up in 10 and half hours Then they said put them to bed the same time and wake them up 10 and half hours later Well, the group that went to bed the same time and got up the same time over a 20% improvement in cognition That's good to great right there. The body strives for regularity You know you look at things like the Framingham Heart Study one of the great protective effects was owning a dog Well, initially we say it's because you know the dog relaxes you well The dog puts you on a regular schedule you get up in the morning to walk that dog you come home You don't stay out at night because that dog is to go out. We need to get back to regularity when you eat when you sleep It's simple David. That's gonna be so hard for me. Can you give us a second one? Well, you're gonna not like the second one as much So the second one is focusing on inflammation and you're not gonna like this at all but One of the great sources of inflammation is by just walking and so the problem is is that the shoes you wear matter So when you wear those simple Italian shoes with just the leather instead of cushioned shoes That's a lot more pressure on your joints. Well, you add that up over days weeks months. That equals bad things What about high heels? You get an exception one day a week But no the more you can reduce inflammation It's things like the flu shot if you skip the flu shot this year you would get sick you get better You'd be fine But a decade from now your risk of cancer and heart disease are up because of that week with the inflammation So I want people to think not just short-term, but long-term, too so What you said actually about shoes is that is It's kind of really important to me We'll have started a campaign at the African post in favor of flat shoes Which at least is a step in the right direction, right? And what we've done is we want to make flat shoes chic So we do slide shows on all sorts of chic women who are wearing flat shoes like Carla Bruni partly She was flat shoes because she's married to a midget of a husband Whatever the reason it doesn't matter. Yes, she wears them and makes them chic So and the other simple thing I'd love to know what you think is sleep Yeah, and we're getting we're not talking about Davos and everybody's walking around the sleep deprived But generally in life. What is the impact of that? It is so important sleep? I mean sleep is your recovery time. The key to sleep is regularity If you start to go to bed every night at midnight and get up at 4 a.m Over time your body will regulate its REM sleep. So you're gonna be healthy and feel good Some people will get 50% REM sleep some people 25. It's the component that is restful in the sleep But the key is the regularity part. You can't go to bed one night at 10 the next night at noon get up at 6 a.m You notice how during the week you get up, you know at 6 a.m. Every morning on that Saturday morning You automatically wake up at 6 o'clock your body loves that regularity. It's ready for it And you know when you go and take a nap on a weekend and not during the week. It hurts you it's bad They don't give me that look No, we just we just installed two nap rooms in our offices in New York. Sorry We actually have a saying that says recovery is an efficiency enhancement tool Well, if you nap every day for 15 minutes the greatest thing in the world if you nap randomly it's bad and The data are just beautiful in that guard with cognitive performance and with athletic performance. They both correlate so Do you have an absolute belief in all data because often data is superseded by data later on right isn't that the Nature of science and the progress of science, you know Yes Well, you know, I went to I was at Dennis Hopper's funeral and Edrashe gave me a painting and it's at sciences truth found out and it's a beautiful saying and I asked him where to get it He said it's written above the science laboratory at Hollywood High School But if you think of that we haven't found most truth as you alluded to so when you look at studies Whether they be in the press or a medical journal not all studies are equal You need to have studies that are large enough that had the right control and where it's published matters If you've never heard of where it's published chances are it's not real If it's published in New England Journal in Madison or the Lancet or a great study chances are it's real But one of the great studies ever done nobody even paid attention to 1953 Jeremiah Morris published on the 26,000 workers in the British Transit Authority Half were the bus drivers that drove the bus and half were the ticket tickers that walked and took the ticket Well, they weighed the same yet the heart attack and death rate was in less than half in the ticket takers Our notion of exercise today for example in America and Europe is an hour in that gym And then you sit at your desk all day. Well, that's wrong the hour at the gym is awesome But if you sit the rest of the day you negate it all and that study was beautiful 26,000 people showing this benefit Whereas another study was done here in the United States 29,000 women Looking at calcium and vitamin D supplementation no effect on bone fracture Another study with 20,000 women give a high dose vitamin D. They increased bone fracture by 20% not decreased it Remember we're a complex system. So when you try to correct one node by giving vitamin D Well, you down regulate the receptor and screw up all the signaling the body's homeostatic You evolve we evolved tanning for one purpose to block vitamin D absorption So it tells us right there it's declaring too much vitamin D is probably bad Yet we all do it. But what about too little vitamin D? Isn't that bad too? Well, I don't know There's associations that lower vitamin D is associated with heart disease and cancer But remember lower vitamin D is associated with obesity with smoking with sedentary lifestyle There's no data even though there have been three large studies giving back vitamin D makes a difference yet. We do it When you're low vitamin D, it may just be you have a high vitamin D receptor when you measure one network of a node It's meaningless Yet we all do it all the time. So something is missing here so how much of your way of looking at the human body and Is based on your engineering, you know the fact that as you have said yourself, you know most doctors Look at one particular Aspect of the human biology and you are looking at the whole complex system So, you know, I mean I have the great advantage if I get to work in the laboratory So we helped develop some of the technology to look at genetics for diseases We now look at the proteins in the blood We can look at the metabolites the bacteria GI tract all these technologies are hope But what they show us is there's so many dimensions to us that we can't understand But you look at a climate modeler He or she will go out there look at the shape of the clouds And they're going to be able to tell what's going on from that from a downstream readout Yet we in biology try to look at the the small focus the one gene the average cancer on diagnosis is a hundred and thirty mutations It's impossible to understand or to model. So we have to take that step back We have to think more like an engineer than a biologist if I asked my son How do you stop a train or my daughter the answer will be you pull the break They don't say let me calculate the speed and the temperature of the tract and the air speak They say you pull the break. We have to think of diseases more like that Let's try to change the system not just correct one little thing because every little thing we do changes the rest of our system So the fact that as you have written and most of our expense in health care is in the last two years of life is obviously partly the result of our political system and Partly out of a regular bad habit, right of not doing enough at the beginning If you reverse that how would you allocate spending? It's a great question. I'm a firm believer You know when you look at the group age 15 to age 55 we spend almost nothing in health care So I want to start to bring it backwards, right? I want to identify what disease you're up against. We have that technology I want to push for prevention. You can take a statin. You go to Walmart in the United States get a 90-day supply for $9 It's not tremendously expensive and the implications are dramatic on society I want to have workplaces and I'm sure you do it Well, you encourage employees to get up and walk around we're in your cafeteria You say listen you're welcome to get a burger, but it's gonna cost twice as much as the salad I'm gonna get that burger to subsidize the salad We have to push toward health employers have to care for their employees Just like parents have to care for their children and if the government says listen when you're 65 in the United States No matter what you do no matter any bad habit will cover all your health. There's something wrong there Life insurance says listen you have a bad habit. We're gonna charge you more for life insurance. We have to do the same for health so I'm sure you get a lot of resistance from libertarians and Who consider this very paternalistic and your point of view is if you want to do all those things We are on your own. Well, I mean why should rest of society with their taxes subsidize the people with the bad habits? We have the technology and the therapy to prevent disease We can delay disease to the 80s and 90s and the paradox is if you live to pass the 80s We don't spend a tremendous amount of your health care when someone's in their 90s and they get cancer or have a heart attack We don't put them on a ventilator. We don't put them on an intensive care. You know, we let them die with dignity 1950s was the last year in the United States. You can die from quote old age now you have to die from a disease We have to change that And so the whole conversation you remember a few months ago around death panels, you know the fear that somehow Doctors would make the decision about who lives and who dies Which is so fraught with emotion in this country. How would you deal with that? Well, we were a part of that and it was misplayed out by all the press except the Huffington Post, of course But because it wasn't doctors It was patients making the decision and the idea was empower a patient with information and he or she All the data says will make a decision in general for not crazy over aggressive care So information will yield good decisions and it you as an individual have a right to say I want a ventilator of crazy things or I want to go with dignity It's your decision and you're right But the key is to discuss that before you're about to die of a disease Discuss it when you're healthy and make those decisions when you can really think them through based on your value system with your family members You can't put a blanket and it wasn't the death panels doctors making this is it was patients the death panel concept was to educate patients And how can you be against education? Well, this is part of the way that decisions are politicized and that's really what you are Fighting against when you talk about some more radical thinking and challenging the conventional wisdom Well, your book is going to be number one in the New York Times bestseller list congratulations a week from the Sunday and There you've had a tremendous response to the message the fact that you are Steve Jobs Doctor has really helped put the spotlight on your message, but the message has been something you've been working on for many many years What has been the the most positive? Response you've gotten I mean we talked about the resistance as we talked about the negative comments in the Daily Mail But what about the most positive most grateful response? Oh, we're getting lots of those and it's just so gratifying is people coming and saying I'm changing my life I'm feeling better You know I've been pushing this message for a long time and obviously the book is a way to scale it I see patients, you know every day in the clinic and I say them this message So on a one-off basis we've been doing it now to be able to scale it is powerful and tremendous And so, you know, we're honored to do it We're honored to put the data out there and we're passionate to try to change health care Not just in the United States, but around the world I mean you look at non-communicable diseases in third-world countries in sub-Saharan Africa. They're dominant there They're taking over HIV malaria and we have to go into those countries and start to make a change Food now food is a major problem in all countries, you know this notion of we want what we want and food makes no sense This is the first year since World War two. There's not enough food to go around in the world in the United States now The notion is well, I want asparagus tonight So you go to the supermarket you find asparagus that came in from chili It sat on the shelf for three days. It is zero nutritional value We have to go back to the old days and say what came in fresh today or if we can't do that What flash frozen because they flee it freeze it within a couple hours of picking we have to think differently in terms of food We have to not be afraid of recombinant DNA food. It was made in the 70s and 80s for more calories per acre We got to start to use science to make food better We have to be sustainable with how we look at fish and other things cold water fish is one of the best foods you can have Yet we're not being sustainable on how we bring it in we have to change that we need to have a concert of world effort Really to say listen if we want to be a healthy society We got to work together with certain principles and tenets to really make things happen And then lastly we have to not be afraid of technology Technology and there's no one technology technology itself will allow us to grow in health care I mean get a load of this there are tenfold more bacteria in your body than there are cells in the body These bacteria they metabolize your food they control your hormone levels So in fact if you look at breast cancer or prostate cancer in China It's a tenth of ours after they move to the United States. It almost approaches ours after a decade We always said it's the Burger King McDonald's. No, it's the bacteria It's the microbiome we call an RGI tract and for the first time this year. We're able to quantify it with new technology I guarantee you over the next couple years. We're gonna start to change it and modulate it to prevent disease So it's an exciting time to do what we do. We just can't be afraid of it But you're also saying that it could be the burger right that it could be the food we No question about it, but I mean again not all burgers are equal right a grass-fed beef is certainly fine things in moderation are good Right, you don't want to go on a crazy diet one way or the other you want moderation You want regularity and schedule you want to know where your food is from you want to say, you know Yes, this burger. Well, is this a force-fed cow of corn? Or was it a grass-fed beef? You want to say, you know, is this food fresh is it not fresh the more you know the better You can't put one class of food and say bad So as a parent yes, and what are you doing with miles in Sydney like they're not allowed to have M&M's or I mean, it's moderation and again my message sometimes work But I couldn't get my kids to stop chocolate milk that all of a sudden they watch this British chef Have a TV show who showed them that at a school that was serving chocolate milk The sugar in that milk filled in a tire school bus that image stopped them from drinking a chocolate milk And it was fantastic So we have to figure out better ways to educate the kids You know Al Gore once told me a story that you know when John Kennedy said we're gonna put on man on the moon People thought he was crazy. Well nine years later Neil Armstrong stepped in the moon The average age of missile command was 28, which means those kids when he stepped on the moon were 19 years old So the people who are gonna make the difference in health care and technology aren't me and aren't you it's that next generation Unless we get them excited about science excited about medicine and physics and engineering. We're gonna lose So are you planning to do more to educate children specifically? I mean this Khan Academy thing blew me away the impact you can have on kids and it's so low-tech It's so simple yet kids get it You know we put story on their cancer as a complex system and I got emails from third graders asking questions about it It's wild, but we got to get kids excited about that. I never had that when I was young Of course you do realize because you do write about it that you're going to get very powerful interests against you Very powerful interest in terms of the sugar Lobby and the berger king Lobby And you actually said here you wrote in the Wall Street Journal in January That the federal agency that administers Medicare pays over half of the medical bills in the US But it doesn't retrieve organized or mined the data Imagine how much better the Medicare system could be if all the data were analyzed to improve public health It's wild. I mean you think about it. We are the most backwards field in the world This healthcare Europe US every country. We've never decided on data elements So that's why you know my hospital calls it a broken leg the hospital next door calls it a fractured leg So we haven't even come up with standard elements to call diseases Once we get to we can actually collect data, which we aren't doing but if we get there We still can't use it yet. We want to learn from every experience I want when you go to your doctor you to start to populate databases so that tomorrow your children or even you can benefit from it I want us to get better every day as we go on health care And you know people can scream at me the lobbies can get upset, but I don't care bring it on I mean I look at death every day in patients when you look at that eye you look in someone's eye You see that you don't care who fights back. You have to change things and One of the ways that you are advocating to change things is with genetic screening You know genetics is a metaphor for technology I want technology to come into place because we don't know what we're doing remember in 1997 a 25 year old kid went into the best cancer centers in the United States He had germ cell tumor in the brain the lung and the liver and they told him listen chemotherapy is going to make you sick Spend your last couple months with your family Instead this kid went to Indianapolis and got platinum the same thing in my ring here He got it because some goofball doc said do cancer cells like electricity or not It happened to use platinum electrodes and it killed some cells a year and a half later He won his first of seven tours to France. I don't know why platinum cured Lance Armstrong But we have to collect this data our country Europe is so good at reporting the negative I only have to tell the EU or the FDA when something bad happens. I never have to tell them when something good happens I want to collect these experiences that we're all going through every day Learn from them so we can get better and better So what about the the data that's been collected around? things that are not scientific like the power of prayer to heal people or positive thinking or visualization or Whatever name you want to give it so I believe in all of those I don't know how to quantify those you know the problem is vice said Arianna What is health? What's your answer? Is it how long you live is it how you look is it your weight is your cholesterol? Is it how you sleep? I don't know what health is so we haven't yet developed a marker for health But think of with the technology so proteomics technology is you put a drop of blood in a superconducting magnet You get a 60 gigabyte picture of all the proteins in the blood you get a picture of the state of you Where's what if I can measure you with prayer or without prayer and say how does that affect heart disease? How does that affect cancer? I can actually quantify it because whenever you start to bucketize things We get screwed up in our field prayer is in prayer positive thinking is in positive thinking it affects everybody differently We're not one-size-fits-all and you can't say that each of these are the same But if we have something to measure we can optimize it and do it right But could it be then that some of the most important things in our lives that affect us very profoundly are not quantifiable No question about it, but you have to develop a metric, right? You have to know what to do for you Everybody's different and so your metric can be listen. I want to know how well I sleep So what I did was I you know red wine is good for you I believe that the problem was it affected my sleep So I would get one of the little monitors that you put on your wrist when you sleep And I would write down one glass of wine and I looked how I slept I would do two glasses of wine one and a half and I realized if I got past one in a quarter I didn't sleep well, so I developed a metric for me and optimized my behavior We have to do that with everything if you're gonna do meditation You got to say listen my goal for meditation is I'm relaxed the rest of the day develop a metric for it write it down Start to optimize things well, actually that's Very much along the lines of something I've been thinking about and whatever I go where there are technologies And I'm sure there are some here engineers. You are one of course Is can we develop a kind of GPS for the soul? You know how? we can we track how we are actually Measuring stress during the day not not when it gets so bad that as you said we're moving to and Fighting disease mode, but while you can still prevent it and then and Personalize the response so that we can see where of course We can personalize and now but think of it as a nap, you know, we can call it I soul There's a new technology get a load of this Where you could put your finger and it costs a hundred dollars on Amazon and it measures your heart rate Well, you relax your heart rate is exactly equal when you're a little bit stressed It's off by a hundredth of a millisecond when you're very stressed is off by a millisecond And so you put it in if you relax it's green if you're a little bit stressed It's yellow and you learn how to push yourself from yellow to green. It's like a mood ring. It's bio feedback But it's a metric we know it's very hard to go from red when you're stressed all the way to relax But you're a little bit stressed. It's a lot easier to go back to green exactly Need to figure this out. Okay, so we'll work on that together. I'm ready. I'm gonna try to clone the soul And then we can start to manipulate it You're a little bit ahead of me But the point is that we need to bring everything together, you know both the most basic things like regularity sleep The kind of shoes we wear and the most ethereal mystical Unmeasurable things which nevertheless are important. I mean that's what is so interesting in your message No question and then my you know, I treat with cancer patients and so to me the most important thing is not what drug or what gene It's hope. I mean hope is the most important thing I have ever seen in patients and it's something that while I can't write down what it is You know it when you see it and I'll tell you when hope is lost everything goes down And when you've seen patients who are losing hope or have lost hope have you found anything that can restore it? It's you know, you know what I bring is I bring the kids who work in our laboratory and I bring them into the clinic Everybody all 30 kids who work in our laboratory. I call them kids, but they're not 30 people who work in our laboratory They come and see patients once a month because to a patient their hope personified They're working on the treatment the cure and those people who do from the lab who come in they don't go home that night They go back to the lab. They stay up all night working on their drug or their technology I want the intersection of hope which is technology and new drugs and what's going on in the lab and the clinic to come together Not to be separate worlds, but at the same time as you have said and hope has to be and To go hand-in-hand with realism because you describe the way, you know Steve Jobs fired you a few times when his results Were not as he had visualized them. Yeah, so there is also that no question I was honored to be part of a team that took care of Steve But like any cancer patient there are ups and downs and the key is you know, there's an old term I learned when I trained in medicine Hawkins called equanimitas Even killedness you know me as a physician. I have to be even killed and I have to bring truth to patients You can't sugarcoat it. You have to be realist, but at the same time you can't take away that hope component It's always there. There's that story of Lance Armstrong that every cancer patient in their back of their mind Hopes it's then and he's a beacon of hope for all of us Well, you've been a beacon of hope for us. Thank you so much for doing it all with so much passion and conviction And thank you for your message and congratulations on the book. Thank you so much