Leaders as Humble as They are Successful

Refreshingly candid conversations with some of today's most humble leaders. Adam Kaufman dives into topics often left unexplored. His guests’ challenges, fears, and motivations show what it takes to become a humble leader.

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Dr David Agus: Driven by Hope and Inspiration

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Dr David Agus: Driven by Hope and Inspiration

Dr. David Agus is one of the most sought after physicians in the world. Apple co-founder Steve Jobs had Dr. Agus lead his medical team for years; More recently, Larry Ellison, the billionaire chairman of Oracle, asked Dr. Agus to create the most innovative medical research center in the U.S. And Howard Stern even calls our Up2 guest, his doctor! Most importantly, Dr. Agus deploys his passion for health to treat all of his patients with an informed-intensity and willingness to do all that is possible in pursuit of the "End of Illness."

Bio

Dr. David B. Agus is a professor of medicine and engineering at the University of Southern California Keck School of Medicine and Viterbi School of Engineering and the founding CEO of USC’s Lawrence J. Ellison Institute for Transformative Medicine. He is one of the world’s leading physicians and the cofounder of several pioneering personalized medicine companies. Over the past twenty-five years he’s received acclaim for his innovations in medicine and contributions to new technologies that will change how all of us maintain optimal health. He’s also built a reputation for having a unique way of looking at the relationship of the human body to health and disease. He explains, “Sometimes you have to go to war to understand peace. My work on the front lines of the cancer war has taught me a lot about all things health related, much of which is surprising and goes against conventional wisdom.” As a contributor to CBS News, he comments on important health topics regularly on television.

Dr. Agus specializes in treating patients with advanced cancer. His clinical responsibilities include the development of clinical trials for new drugs and treatments for cancer, supported by the National Cancer Institute and other private foundations (he has no financial ties to pharmaceutical companies). He serves in leadership roles at the World Economic Forum, among other prestigious organizations, and is a recipient of the Ellis Island Medal of Honor. After earning his BA from Princeton University and medical degree from the University of Pennsylvania School of Medicine, he completed his medical residency training at Johns Hopkins Hospital, a research fellowship at the National Institutes of Health, and an oncology fellowship at the Memorial Sloan-Kettering Cancer Center.

Dr. Agus’ first book, The End of Illness, was published in 2012 and is a New York Times #1 and international best seller, and subject of a PBS special. His second book, New York Times best-selling A Short Guide to a Long Life, was published January 2014, and his newest book The Lucky Years: How to thrive in the brave new world of health, also a New York Times bestseller was published in 2016. He is presently working on his fourth book, tentatively called Deep into Nature: What We Can Learn from the Tree of Life.

He lives in California with his wife, two children, and two dogs named Sadie and Georgie.

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Dr David Agus' Books

https://www.amazon.com/David-Agus/e/B005QU10AS%3Fref=dbs_a_mng_rwt_scns_share

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Dave Douglas: Welcome to another episode of Up2. Eight years ago, Up2 started as a live event series showcasing leaders who are as humble as they are successful. The humility piece is extremely important as we identify leaders who can inspire others. We try to focus our interviews on the non-business aspects of their lives. And in doing so, have found there is a real thirst to explore their hearts and minds in atypical ways. Our host as always is Adam Kaufman, and our guest today is Dr. David Agus. Thanks for joining us. We'll be right back.

Adam Kaufman: Hello. My name is Adam Kaufman, and I'm thankful you're joining us today on the Up2 Podcast. I want to tell you about a group that I'm grateful for, and that is TownHall, Cleveland's most popular restaurant and one that I can say is the only place my wife tells me she can eat every meal, breakfast, lunch, and dinner. TownHall was the first all non-GMO restaurant in the US a few years ago, and they're now expanding into Columbus, Ohio soon. I'm also very selective about who we choose to partner with for this podcast. And it was with open arms that I embraced the idea of partnering with Bobby George and TownHall. To learn more about what they're up to, you can visit townhallohiocity.com.

Dave Douglas: Welcome back to the Up2 Podcast. Today's guest is Dr. David Agus. And here's your host, Adam Kaufman.

Adam Kaufman: Dr. David Agus, he is one of the world's leading physicians and the co-founder of several pioneering personalized medicine companies. He's a professor of medicine and engineering at the University of Southern California and the founding CEO of USC's Larry Ellison Institute for Transformative Medicine. During the past 25 years, he's received acclaim for his innovations in medicine and contributions to new technology that will change how all of us maintain optimum health. He's also built a reputation for having a unique way of looking at the relationship of the human body to health and disease. Here's a quote of his I like, which illustrates our guest's willingness to take risks and also his confidence, "Sometimes you have to go to war to understand peace. My work on the front lines of the cancer war has taught me a lot about all things health-related much of which is surprising and goes against conventional wisdom sometimes." He's also a contributor to CBS News and quite frequently appears on This Morning, especially now as the nation's top story continues to be the pandemic. Dr. Agus specializes in treating patients with advanced cancer, and I've witnessed this firsthand countless times. His responsibilities include the development of clinical trials for drugs and treatments for cancer. Trust me, our guest today is always on the front end of new thinking and new treatment. He's repeatedly asked to serve on FDA panels and National Cancer Institute advisory boards. He serves in leadership roles at the World Economic Forum among other prestigious organizations. He's a recipient even of the Ellis Island Medal of Honor. He's a preferred doctor to prime ministers, CEOs, rock stars, even Howard Stern. Our guest was on Howard Stern recently. He earned his BA from Princeton and medical degree from University of Pennsylvania. He's written three New York Times bestselling books. He lives in Beverly Hills with his wife and his two children. David Agus, welcome to Up2.

Dr David Agus: Thank you, Adam. It's a privilege to be here with you.

Adam Kaufman: What have you been up to?

Dr David Agus: I am involved trying to fight this horrible deadly enemy, COVID-19 and at the same time, caring for all of my patients with disease. It doesn't stop, right? The diseases don't go on hold as the virus comes. And so while we may be staying at home as a country, I am here in the lab and I am here seeing patients because we have to. Unfortunately, there's still a lot of suffering going on in our country and we can't stay at home when that happens. I love how in the introduction though you call me confident, I think it's the opposite. But by seeing what I see and being on the front lines of the things I do, I realize that we need to get so much better at what we do. I'm not confident in all of what way do, I really realize that we have a long way to go before we end pain and suffering in this country from disease.

Adam Kaufman: Well, that's your authenticity and humility coming out right at the beginning here. Our shows theme is actually leaders who are as humble as they are successful. So maybe I didn't choose the right word, but I wanted to think of a word that shows that you have the confidence to challenge conventional thinking at least. Maybe on a certain topic, you don't have confidence. I've just always loved how you're willing to take the counter position when you know it to be right one.

Dr David Agus: Listen, when you see pain and suffering like I see and you certainly have seen it, you have no choice but to push, you got nothing to lose. These patients have so much to lose. And so it's my job to be the aggressor, it's my job to be the perturber and the distracter because it's not about my career, it's about helping people. And unfortunately, I think in our space, careerism is a major issue because people are focused about I need to get a paper. Remember, when you do a scientific paper, only the first author and the last author get credit, nobody in the middle does. So it means that only two groups can work together for credit. You can't have 3, you can't have 4, you can't have 10. And so the goal is to fight disease. If I asked you who put the Mars Rover on Mars, you say JPL, the Jet Propulsion Lab. You don't say an individual's name. If I say who discovered this molecule? You say an individual's name. So I think we have to change science and make it much less about me and more about team.

Adam Kaufman: Well, let's make this fist few topics a little bit about you if we could, if that's okay. I know you'd rather not. You're out West, you're coming at us from Los Angeles thanks for remote conversation today. We have spent a lot of time together in Southern California. And I remember one year you said to me, I don't even think you'd remember this, but you said, "Adam you're so Californian," you were making a compliment I think. I said, "What do you mean?" He said, "You need to move out to California." And I said, "What does that mean?" And you said that Andy Grove I believe told you one time when you were at Sloan Kettering considered one of the top cancer hospitals in the world, "You need to come West young David," he might've said. And you said to me, "Back East, the mid West, you hit singles., you hit doubles. Out here in California, we swing for the fences." Do you remember that?

Dr David Agus: There's no question. Andy didn't put it in those kinder terms. I met Andy, I'm sitting in my lab in Sloan Kettering, which my lab was literally the size of a cubicle. And there's a knock at the door and I look up and my jaw dropped. And I look, and there's the guy who that man was Time man of the year, he was that year-

Adam Kaufman: The chairman of Intel for our listeners, the chairman of Intel.

Dr David Agus: Yeah, Intel. Holocaust survivor, one of the most inspirational. Cliff Leaf, the editor-in-chief of Fortune and I wrote his obituary, and we said he was mean, he was nasty, he was beautiful, he was kind because he was all of those. He had a driven focus that was amazing. But he knocks on my door and he goes, "David Agus?" this is my interpretation of a Hungarian accent, which by the way is not very good. And he goes, "David Agus?" I go, "Yes." He goes, "I just need to tell you you're a good scientist but you're a horrible public speaker." I go, "It's about doing the science, and I had been working on a drug." Then he goes, "Part of your obligation is to teach." I go, "Okay." And literally I would get faxes in this office every day of somewhere to show up to give a lecture. He forced me, he didn't ask me, he just did it to go someplace and get better at public speaking.

Dr David Agus: But then at some time he said to me, "David, you stay on the East Coast, you will hit singles. Singles are good for your career, but they're not good for society. You go to the West Coast, you swing for the fences. You strike out, you start again because you have to swing for the fences." And literally he helped negotiate my contract in institutions. Can you envision a head of medicine in a hospital having Andy Grove who's this [inaudible 00:08:03], brilliant negotiator call up to negotiate for a pipsqueak doctor who was me a contract. Doctors don't have agents, we have nobody to negotiate. We take whatever they offer us-

Adam Kaufman: I love that story.

Dr David Agus: And we're lucky to have a job. And these hospitals are like, "What hell just happened?"

Adam Kaufman: Who is this guy?

Dr David Agus: But he looked after me. I remember once going for a walk with Larry Ellison and Steve Jobs. And we were having dinner in Andy's. First of all, it's the only time in their life they ever showed up early because Andy was so remarkable. And Larry Ellison goes to Andy, he goes, "Steve and I were talking, and you're the only person we would ever work for because you're such an amazing leader. You wrote the book Only the Paranoid Survive. And we would have learned so much about management from you." And Andy looked at both and goes, "Neither one of you are good enough to work for me." And you can see their faces just drop because they were almost sad that he said this and he was serious.

Adam Kaufman: And Larry Ellison, the chairman of Oracle, you remain close with today. And in fact, he's the named benefactor of the center that you lead, right?

Dr David Agus: Larry is one of my closest friends and an inspiration to me. One day several years ago, we're having breakfast. And he said, "David, what's your dream." I go, "My dream is to have a place where scientists of different disciplines, engineers, mathematicians, physics, cancer doctors can actually be together and have different ideas and argue together to help cancer." Because by definition, my people, cancer doctors failed. So I need different ways of thinking and to have them in one place to do that. And he said, "How much will it cost?" I go, "I don't know, $200 million to build a building with all the things we need." He said, "Done." And I go, "What?" He goes, "Let's do it." And we did it, we actually literally just moved in about a week and a half ago. If you see it, but it's crazy amazing.

Dr David Agus: Every wall is glass so kids could go on tours and see and want to be a nurse, a doctor, a scientist when they go in. We have the apartment building next door so scientists around the globe can stay here for months at a time and be able to use their brains to help us. You call a mathematician and say, "Would you like to come for three months and live in Santa Monica and help use your brains to think about cancer?" Nobody says, no. I mean, they're all stepping up, and it's really remarkable in that regard.

Adam Kaufman: That's awesome. Now, right behind you, is that some high tech coffee maker or some aluminum machine or what do you got right there?

Dr David Agus: It's a microscope. When I trained at Sloan Kettering, one of the key things to me is, one of my mentors, David Goldie, an amazing guy used to say, "Every patient, you got to look under the microscope at their blood, at their cells, the white cells, the red cells." And it gives you a framework of everything going on in the body. And medicine is about pattern recognition. It's not about knowing facts and memorizing things. And so if you start to see thousands of patients and you recognize that when the cells look like this, this happens, or this happens, you're going to get better at what you do. And so every single patient, I look at the cancer and their blood under the microscope. And I've developed an art because my field is an art form right now. It's not really a science, even though people think it is. The dirty secret is it's still an art.

Adam Kaufman: I want to ask you about your art, you are quite the artist. We over the years have talked about various new things that you were pursuing. And I feel like you're always on the front end of some new technology long before it becomes adopted. I first met you in the context of Navigenics before personalized medicine was so common-

Dr David Agus: But we were young.

Adam Kaufman: I had hair and yours was a little less gray, but you still have a enviable head of hair. So whether it was personal genomics or then you taught me about the importance of studying blood with your applied proteomics company. I'd never heard of that before. And just in general, personalized medicine, you were talking about it long before others were. Where do you think this innovative mindset of yours comes from? Can you tell me a little bit about your parents or what type of family you were born into, or where do you think this tolerance for risk comes from?

Dr David Agus: It's interesting, I think about it all the time. My dad was a kidney doctor at University of Pennsylvania, my mother a nursery school teacher. And they were the least risk tolerant people that existed, conservative, by the book, nothing of the kind. And early on, I realized I didn't like that, I wanted to take risks.

Adam Kaufman: How old do you think you were when you were thinking like that, like high school age?

Dr David Agus: I was the geek in high school where other kids were going to camp, I was working in labs. I would go away to labs and I was lucky to be part of a program that the government at the time we were a decade or more after Sputnik. And so they started a program where they took young kids and they said, "Let's put them in the lab and let's study how they evolve." And they had these psychiatrists follow us and they still do, I still get questionnaires from them. So I was exposed to lab in early age. And just the notion of seeing the textbooks being written by the experiments done, I was like, "Oh my gosh." And it was a moment to me where I want to do this, I want to be part of writing the textbooks.

Dr David Agus: And at the same time, I realized, I don't want to just be in the lab, I want to apply it. So the notion of being able to translate science, being involved in both was to me the most exciting thing in the world and even was able to pursue that and push that. And so I was lucky that I went to an Institute in Switzerland called the Basel Institute. And while I was there, the people we were with actually won the Nobel Prize this year for discovering antibodies. So these are these proteins that can target disease. And that was what the entire biotech industry was founded on. And so the biotech investment banks at the time all called me up and said, "Can you explain the science to us?" And I was able to stop delivering pizzas at Princeton, which is what I was doing to pay for college and consult and explain to them the science of these companies. And it changed my life. This was Princeton, New Jersey. New Jersey delivering pizzas in the winter is not a fun thing to do.

Adam Kaufman: Doesn't get any better than that.

Dr David Agus: Build's character, but it wasn't a fun thing to do. and I was being exposed at the time to every new startup, all these new ideas. And it just clicked a light bulb. My life has been through mentors and friends and almost all of them are in the tech industry. And these were the people, I mean the Larry Ellisons the Andy Groves who just said I don't want to create what the world needs, I want to create something and then show the world they need it. I want to start from scratch.

Adam Kaufman: You pursue so many different things at the same time like the tech advisory work that you just described a little bit, the biotech work, seeing patients, research yourself, public speaking, writing books. What are you doing when you feel most alive if there's one favorite of all those activities?

Dr David Agus: To me, it's thinking I get up early in the morning. I do the CBS morning show.

Adam Kaufman: What time do you get up?

Dr David Agus: So I'm up at 3:00 AM because I have to do the morning show at 4:00, I mean, this is live in New York. But it gives me this window kind of 5:00 to 7:00 before the kids get up, before my wife gets up, me and the dog who's remarkable. She loves me like nothing, she doesn't judge me at all. And just to sit there and read and write. My grandfather who was amazing, he was a philosopher and a rabbi once told me that you got to really take advantage of when your brain is sharpest. And I know when I wake up my brain is so much better in the morning than it is in the afternoon. If I schedule my day-

Adam Kaufman: That's definitely true for me. Are people different though, are some people more evening people?

Dr David Agus: No question about it. You need to know yourself, which goes back thousands of years, but we forget about it today, but knowing yourself. And so in that morning, I can read and think and write much, much better than any of the time of the day. And I have the solitude to do that. I realized that my brain works best when it's with colors and nature. So I sit, I face the chair so I could see green, the tree and that just makes my brain work and I can sit there and write and think and be creative. And the rest of my day, like unfortunately many of us it's getting things done, it's not being creative-

Adam Kaufman: Your to-do list.

Dr David Agus: Having the privilege of having an hour or two to be creative every morning is the coolest thing in the world.

Adam Kaufman: And then I'm the opposite. At the end of the day, I can't do much productive work after dinner time or 8, 9, 10 o'clock I need to shut it down. So I'm definitely a morning person as well.

Dr David Agus: I'm in bed by 8:30 or 9:00. You have a more exciting life than I do, believe me.

Adam Kaufman: If you weren't a physician, and you're not just a physician, but I'll identify you as a physician, what do you think you would be outside of medicine? Because you have dabbled in a lot of other things.

Dr David Agus: I think about it a lot is that I would never give up seeing patients. Those interactions, the ability to help people is what drives me. It's what enables me to do the schedule that I do, it's what makes me who I am. It's being able to have a foot in both worlds. I couldn't just be a writer, I couldn't just be a technologist. It's being able to do both, is to see the problems, smell the problems, live the problems, and then be able to solve the problems. To me, it's the coolest thing in the world and it makes me who I am. I'm almost by definition, I'm a lazy person. And what drives me is seeing-

Adam Kaufman: We know that's not true.

Dr David Agus: Well, but it is. If I didn't have this neurosis, "Oh my gosh, he's shuffling, she's suffering, I have to help them," I wouldn't be driven like I am. it's not a natural drive, It's a drive because I see suffering and I want to do something about it.

Adam Kaufman: Last week I interviewed the youngest general in the United States Air Force. And every minute of her day is scheduled. I think other than her, you're the busiest human being I know, and she has 80,000 people reporting her. I don't think you're a lazy person is my point here.

Dr David Agus: No. By definition, my dream, we all have dreams. My dream is to just sit outside and take a nap. So in that regard, I think I'm lazy.

Adam Kaufman: Do you ever let yourself do that thought? I hope you do. You're always talking to us about wellness and downtime.

Dr David Agus: Certainly there are times you can in this COVID-19 pandemic where my job is to step up, my job is to push governments. My job is to find a way so we can deal with this issue, which is causing so much pain, suffering, and death across the globe. We have no choice but to double down on everything we're doing.

Adam Kaufman: And I want to talk about the pandemic in a minute, but I first have one question about your original area of expertise, cancer. Do you think, Dr. Agus, in the last couple of years I've been starting to realize, and you might think this is an obvious answer, but to me it isn't. Do you think it's more likely that a PhD medical researcher or a computer scientist is going to discover the cure for cancer eventually? And I know cancers are different, but now I'm thinking it might be more like a software engineer than someone in a traditional medical lab.

Dr David Agus: Funny, Steve Jobs said to me when he was suffering, he goes, "David, why can't we just debug my cancer like I debug a program?" It's a very interesting and intriguing question you have. And I don't think it's going to be either. I really think it's going to be a combination. You need someone who lives and smells of the disease, you need someone who understands the biology. You need somebody who thinks and knows how to do code. You need somebody who understands complex emergent systems like a physicist does. You need an engineer who can develop the technologies in a way that can then be applied. And it's the hybrid of those, we're going to get the answer. In our world, we've separated the different verticals.

Dr David Agus: When you went to high school or college, you have physics, you have math, you have biology. In the real world, they're intermingled. And yet we refuse to do that. Scientists, if you go to most institutions, you have the scientists and you have the clinical buildings. What is that about? Why aren't they together? Why don't patients walk by a lab every time they go to the doctor so they can see hope in front of their eyes. If you're suffering from a disease and you see a researcher researching the disease that you're suffering from, that's hope personified. Why in the world would they be in separate buildings?

Adam Kaufman: So are these multidisciplinary teams that you're describing as a potential team to cure cancer, are they in existence anywhere?

Dr David Agus: Yeah. Listen, my life changed about a decade ago where a man that Walter Isaacson who was head of the Aspen Institute at the time put me on stage with a physicist, Murray Gell-Mann. So Murray discovering the quark is string theory. He won the Nobel prize in 1969 when I was four years old. And Murray is asking me questions about cancer for an hour, and this intrigued me. First of all, smartest man in the world. He had these questions written down here and he would ask a question. And then in capital letters underneath, it says, remember to smile. So he was set up like this and smiled after every question. So I loved the fact that the smartest man in the world needed to be reminded to smile.

Adam Kaufman: I have smiles drawn on my notes here to remind myself to smile as I talk to you, happens to the best of us.

Dr David Agus: I just look at your face and I smile.

Adam Kaufman: Oh, okay. Thank you David.

Dr David Agus: The way he asked me questions and the insight he gave just in that hour together literally changed my life. I then to one of the big National Cancer Institute meetings, and I got up there and I said, "Cancer is a complex emergent system. You don't have to understand it to control it." And people actually hissed in the room. They were pissed off because to them it was all about understanding. And so it really is a new notion. The physicists don't understand all of the laws of nature neither control it. And they course green things to be able to give them greater insight. They look at the outliers, and from those outliers, they learned the rules of nature. We ignore the outliers and we look at the mean, what is the average response rate? Instead of saying, who's the person who had amazing response and who didn't respond at all? And learn from them.

Dr David Agus: So all of a sudden it gave me a new way of thinking and opened my eyes. And for the last 10 years of his life, Murray worked with us and worked with us on cancer and really gave me a new era. And I was able to bring him to the National Cancer Institute. And they started programs across the country really to encourage people from the physical sciences to think about things like cancer. And it's still one of the most successful programs the National Cancer Institute has had.

Adam Kaufman: I know he was a major influence on you. Do you ever think about who you're influencing in your work or who's watching you? I know you're a humble person, but do you think about that ever or legacy?

Dr David Agus: Part of it is my job is to give back. Part of the reason for this institute is I wanted to be able to have students really see the joy of what I do. In today's world, every kid wants to go work in Silicon Valley. They're going to work for a tech company. Very few say I want to grow up and solve the problems of biology, of cancer, of multiple sclerosis, of Alzheimer's. I know very now that I'm at that stage in my career where I'm not going to make the impact that I could if I were younger. So I need those young kids to get excited and be passionate. So my job, part of it is to educate. Part of is to get them excited about what we do to tell the stories, the history, they can realize ... I have a painting in my office that says science is truth found out, because I really believe that. And most of those truths, we don't know yet.

Dr David Agus: The textbooks over the next decade will be proven half wrong. And when you explain that to a kid, their eyes light up. They have the opportunity of solving problems and to change the world. And I want them to understand that.

Adam Kaufman: I love your positive energy, and you just mentioned textbooks changing. I brought with me today one of my favorite books, The End of Illness, your first book. And I remember in this book, David, you were talking about how we shouldn't dedicate too much of our personal game plans towards what we read in the textbooks because medical technology changes so rapidly. And you wrote that like eight years ago, and I still remember it. So we shouldn't plan like our next 25 years health plan with current understanding. So do you continue to feel that way or are things changing even faster?

Dr David Agus: If you look at the data, in about a decade, about 60% of scientific papers were proven incorrect. That's astonishing-

Adam Kaufman: In a decade, more than half.

Dr David Agus: More than half.

Adam Kaufman: And more [crosstalk 00:23:51] people writing those things.

Dr David Agus: No question about it. And so our field like it or not does not change very quickly. Most of the new incident has to be iterated, it's proven a little bit correct, and then proven more correct. And it iterates and it goes back and forth. Or when somebody shows this it's in one context, problem is the body has nine different contexts in which these things happen. And people make the over assumption that it fits all contexts. And so we're learning that now. That gray area is really hard for people to comprehend. You alluded to the fact that I founded some companies, one was Navigenics where you spit in until we sequence your DNA, and we say the probabilistic basis of achieving certain diseases. Here's the probability you'll get Alzheimer's, the probability of an average person is X, you may be 2X.

Dr David Agus: And so it's very hard to understand probable, they're not deterministic, they're not definitely going to happen. They're probabilistic. You need to understand this, and we have to figure out a way to make people to do that. The problem with health is if I say, "Adam, I want you to do something today, it's going to help you in 20 years," you roll your eyes at me. And people don't get that because there's this lag time and a delay. We don't have an immediate feedback loop.

Adam Kaufman: You had me spit in the tube, the Navigenics tube. And then two years later, you called me in the hospital. I don't want to get emotional because I had a blood clot. And you said, "Adam, didn't this DVT propensity show up on your test." And I didn't change behavior because of that, I was invincible, I was 40 at the time. But you were right, we Americans, maybe it's a human nature type thing, we don't follow the longterm plan very well I don't think whether it's weight loss or exercise.

Dr David Agus: Or wearing a mask, and no offense to our country,

Adam Kaufman: As simple as that.

Dr David Agus: If everyone wore a mask in three weeks, there'd be no virus. To get normative behavior change, you need leadership. And in our field, food and health, which is 31% of the US economy, there is no leadership. And that's a problem. If I asked people who were the health leaders? They don't know. The first health leader any kid has ever seen in the last two decades is the idea of Tony Fauci stepping up, which is great. But we really need leaders in our space that we look up to, that we emulate, that can really dictate what normative behavior you should and could be. And we don't have that.

Dave Douglas: You're listening to the Up2 Podcast, we'll be right back.

Adam Kaufman: One of the aspects of podcasting I enjoy the most is the ability to delve into long form discussions without any interruption, other than a periodic commentary about one of our partners. I'm grateful that Calfee, Ohio based law firm has agreed to partner with us. They have offices throughout Ohio and also in Washington DC, in New York, and Indianapolis too. They are a full service firm, every type of legal need. One example I'll share right now because so many of our listeners are entrepreneurs is not too long ago a friend of mine sold his company to a public corporation. And with that came some restrictions and ramifications on his future employment. And to navigate through that properly, he asked my advice. And without hesitation, I recommended Calfee because I knew they'd have the right type of specialist to help him with his particular needs. And my friend continues to rave about that experience. And I'm very grateful that Calfee has agreed to partner with Up2. So whether it's selling your own business or the more routine needs of creating your first will or anything in between, this firm can really do it all in terms of legal needs. Once again, the firm is Calfee. You can find them at calfee.com or on the Up2 foundation website.

Adam Kaufman: During the first season of the Up2 Podcast, I had several companies and entrepreneurs approach me about potential partnerships, but I'm really selective before choosing to do something like that. One choice we did make happily is to partner with Vivid Front, a full service, digital marketing and website design agency based in Cleveland that works with both local and national brands. They've built their entire client base on referrals, and they've won a lot of awards, including the 2019 Inc Magazine top 5,000 fastest growing companies, North Coast top places to work and several others. They're known for their talent, they're known for their creativity, they're known for their culture. A firm I liked before we agreed to partner together for this show. Check out vividfront.com or you can email me and I'll introduce you to their dynamic leader, Andrew Spott.

Dave Douglas: Welcome back, you're listening to the Up2 Podcast with Adam Kaufman. Today's guest, Dr. David Agus.

Adam Kaufman: Let me talk about the pandemic if we could just for a moment. Is it true now we're finding more that this may be isn't a respiratory problem and it's more of a cell problem?

Dr David Agus: Unfortunately, there are a lot of these internet rumors on things. Well, doctors got it all wrong, they're understanding it wrong, there's this and this. And if you don't use a ventilator, ventilators are killing people, so use this. There aren't secret conspiracies out there, the science is clear. This is coronavirus, this is like the common cold. Josh Lederberg probably one of the great scientists of our time in the 1990s said the only thing that will threaten man's and women's dominance on this earth is the virus. It is our wits, our brain versus their genome. Over a million years of evolution, we changed 1%. In one day, this pesky virus can change 1%. And so the problem is that this virus is different than almost every other virus we have faced for two reasons. One is that 40 plus percent of people are asymptomatic and they could spread it without knowing it.

Dr David Agus: So they think they're well and yet they can kill grandma by hugging grandma. And then it's the fact that most viruses, the day you become symptomatic is when you're contagious. This virus you're contagious several days before you're symptomatic. So all of a sudden, again, people who mean well can cause harm. And then the virus discriminates. For some reason, people who are African-American, who are Hispanic, who are obese with diabetes, who have blood pressure issues end up at the hospitals and others don't. And so the notion of treating people differently isn't something we're used to as a country. And that's difficult. We're the only country that I know of with a bill of rights, we have a right to do what we want. But if your behavior affects the health of others or endangers others, then we have to take a step back. And it's very hard to get those ideas out there.

Adam Kaufman: Can you talk a little bit about the promise of manufactured antibodies? Is that a productive path to have us go down?

Dr David Agus: Yes. There was a remarkable scientist that was able to show that if I give Adam Kaufman a virus, and if I look in his bone marrow, there's some B cells that are making antibodies that bind to, in this case, the spike protein, which is exactly where the virus binds to our cells to get inside. So if I could take those B cells that are making an antibody, this protein, and I could scale them, then I can make monopolar antibodies that will turn off the virus. So they've been made, there about a half a dozen of these in the clinical development now with companies that are ongoing. And they're going to work, so they will be able to turn off the virus. And then you couple that with a vaccine, which again is working now.

Dr David Agus: The coolest thing in the world to me and kind of the greatest realization of what academic universities should be is that the leading vaccine candidate in the world is not from the coolest biotech company, is not from the techiest university. It's from a university that survived the plague that was born in 1046, Oxford University. So Oxford University, the least tech place there is has the leading vaccine candidate, and I think that's a beautiful, bringing us back down to our roots of academics. And it's fantastic, it's working and it will be here in the fall and it will help all of us get back to not normal, but a new normal.

Adam Kaufman: So would that come in a American branded company or just to the government directly or how would that Oxford discovery get to us?

Dr David Agus: It's so beautiful to me in a humanist way that the two probably best candidates for vaccine, one from Oxford was licensed to AstraZeneca and it can only be sold for no profit. They said, "Listen, you license this for your brand, but you can't make a dime from it." And Johnson & Johnson said who has the other vaccine, "Listen, we're not going to make a dollar on this. We don't want to make money off a pandemic of people suffering." Every other vaccine candidate is about making dollars, these two are about them helping the world. And I love that.

Adam Kaufman: Yeah, and I love your optimism. One other theme that you talk about in all three of your books is the power of being optimistic, just moving beyond the pandemic topic, but just whatever our health problems might be that we face in our lives. Can you talk a little bit more about why optimism really matters more than people might think?

Dr David Agus: In the middle of this new building we have, it's 100,000 square feet, labs, clinic, everything. We have a sculpture that says, four letters in a square, HO and PE. Because to me, that's what my building is about, that's what medical research is about. That's what think tanks are about is providing hope. Hope and optimism are what drive you. If you look at cancer and you look at really any disease, there's a beautiful study that saw people with a belief system, it doesn't matter what it is. It could be God, it could be in a statue. People with a belief system do 30% better across the board than people without. I think that's beautiful in many regards. You have to be hopeful and optimistic and it changes the brain. I mean, try it. If you smile right now, your whole body changes. Our bodies were designed to be hopeful and optimistic.

Adam Kaufman: You mentioned God and hope and statue, and I'm reminded you used to spend time at Johns Hopkins, one of my favorite health institutions. And there's the famous welcoming Jesus statue with the open arms right under the main dome there. You can't help but have hope when you see that I imagine when you're coming through those walls sick or caring for a loved one.

Dr David Agus: Listen, Hopkins changed my life. And in fact, the library in our building here, we named after the founder of Hopkins, a man named sir William Osler. Osler was at University of Pennsylvania and he was passed over to be head of it, and he went to Hopkins. And that building where you see that beautiful sculpture is a building that Osler designed. He did something that no other doctor did is he actually talked to the patients. Doctors in those days used to talk to the nurse and get what to do and tell the nurse what to do. But he walked room to room in that building. And if you remember, that building is round. And so the reason we call it going on rounds is because Osler would go bed to bed, to bed in a circle.

Adam Kaufman: I didn't know that.

Dr David Agus: That's where the derivative and the word came from is going on rounds-

Adam Kaufman: Does every doctor know that or is that just something you have pulled out? Because I have never heard that, that's amazing because rounds is talked about everywhere not just at Hopkins obviously.

Dr David Agus: It's very important for me and our building, we have a history of medicine museum. In fact, we have Osler's stethoscope. And the reason we do is that I want people to realize that I'm building on hundreds of years of learning. And this isn't a story you want to pass, we're going to reinvent the future. This is learning from the past. Yes, still did at Hopkins, the patient is on stage at the beginning of grand rounds. And they have a conversation about when they were first diagnosed for every single lecture, is rooting it in the reason we're doing the research, the reason we're a doctor is to help the patient, period. And I think that's something that we need to have a reminder of every day. Osler was able to do that, and I think it's powerful, which is why he is one of my role models and heroes.

Dr David Agus: He wrote a book, it was so beautiful about looking at disease beginning, middle, and end that Rockefeller's priest read it on a train. And that was the beginning of medical philanthropy because he went to Rockefeller, he goes, "Oh my gosh, you have to see this book." And literally it started the idea of medical research and medical philanthropy because he was able to write and get his ideas out there to the public.

Adam Kaufman: You've talked about Gell-Mann and we've talked about Ostler. I know someone else who had a big influence on you was Steve Jobs the famous Apple co-founder. I was so impressed that for years you and I spent a fair amount of time together and you never once told me, and I only read it after his death that you were supposedly the lead physician helping the team to keep him alive for many years. We now know that to be true, it's been written in many places, but just so impressive. This is, I guess, that multidisciplinary approach that you were talking about that we need more of at cancer in general in America. But can you talk a little bit about how he influenced you or maybe what takeaways you still live with today that you first learned being around someone like that?

Dr David Agus: I was one of many doctors who took care of Steve, and it was privilege to me, with every patient I have. I pinch myself every day that these people put their lives in my hand. And I'm like, "Oh my gosh." I mean, it's a crazy responsibility. But Steve was remarkable. He had an ability of projecting the future. Walter had called it in the book the reality distortion field, where he literally would say, "Hey, this is the iPad, it's going to happen." And it did. He made everyone believe that, and it happened. He tried that in health and it didn't always work. So he hung up on me hundreds of times and fired me. I mean, given that I wasn't paid I was doing this because I cared, it was fine. And an hour later he would call back and we'd have more of a discussion. But everyone always says to me, "How can you take care of these remarkable people?" And part of it is that I stand up. My belief is to stand up to them about what I think is right.

Adam Kaufman: That was the confidence that I was referring to in the beginning, you have a confidence to stand up.

Dr David Agus: Not sure it's a confidence is that I have no choice and that I'm doing it for the right reasons, which is to help them. To me, confidence is a funny word. I have my true North is to help them, nothing else. It's not to do their decisions, but it's really to give them. Medicine is about value system based decision, that for me is to give them the data to make the right decision. And so I will fight to make them understand what the data are and how to deal with that. Many people don't stand up, they're very intimidating characters. This is the first time in their life they've been out of control. And so they don't act in a way that's the most political. My job is to forget that and just realize that this is the disease talking many time not them. But Steve was amazing. The moments with him, I treasure and they were a privilege.

Adam Kaufman: Didn't he convince you on a lighter note to think about dressing somewhat the same way every day so you didn't have to think about it like wear black and white every day and save some time?

Dr David Agus: First of all, it's an easy convincing. You get up at 3:00 AM, not have to think about what to wear, it's the coolest thing in the world.

Adam Kaufman: But most of us do that. We waste time picking this blue sport coat to go with the white top today so that you think I look cool, it's silly.

Dr David Agus: Steve, when I wrote my first book, he goes, "David, you're going to get a lot of media." And he bought a bunch of sweaters and he goes, "Listen, try them on." And he goes, "I want you to wear this." First of all, black and white speaks to the seriousness of what you're talking about, the gravitas of it and then people will focus on what you say and not what you wear. And he goes, "Trust me, they will actually remember you and what you're talking about a lot more if you wear the same thing." And it's true. I'm wearing this outfit when I go out. If I wear a gray sweater, people don't recognize me or whatever. If I wear this, people actually come up and start talking about health. It's pretty amazing to be able to turn on and turn it off.

Dr David Agus: When I wrote that book, I called it what is health, my first book because to me it was the key question, I didn't know what health was. Was it a blood test, how you look, how you felt?" And the publisher called me up and goes, "Steve jobs called and changed the title of your book." I go, "What?" And I call him up, he goes, "David, you can't put the word health in the title, it's a bad word. People's eyes glaze over, it's like chewing cardboard. And he came up with the title of The End of Illness, bold and declaratory. But that was him, he just did it.

Adam Kaufman: I love having the hard copy of the book still, and it's probably in my office. You gave it to me many years ago. A couple more questions just more general in nature, because I have often learned from you about misconceptions like Americans spending way too much money at GNC on supplements. You were the first one to tell me at least 10 years ago that unless there's some proven deficiency one has, we really shouldn't be taking too many supplements. Is that still your view?

Dr David Agus: Well, it's not my view, it's the data. I'm very cognizant of the fact when I write these books, it's not my view on things, it's not my philosophy, I'm just a conduit for the data. And so there is no data, there's yet to be a positive study in the history of man or woman kind showing that a vitamin or supplement has a benefit. We spend more on vitamins and supplements in the United States than we do in all of medical research. And in fact-

Adam Kaufman: Wait, say that again. You said that so quickly, we spend on supplements.

Dr David Agus: We spend more vitamins and supplements in the United States of America than we do a medical research. By the way, we spend more on potato chips than we do on cancer research.

Adam Kaufman: Well, that part I understand, potato chips. Go ahead.

Dr David Agus: We all want to crutch. Listen, I went to McDonald's yesterday, so therefore I'm going to have a multivitamin to counteract it. And they're remarkably branded substances. But all of vita is something the body does precise enough of. It doesn't mean more is better. And so vitamins are life, vitamins are good for you, they're crazily well-branded. For example, mice synthesize vitamin C. So it's not a vitamin to them, it's called ascorbic acid. To us, we can't synthesize it. So we have to have a small amount. One orange has a couple of milligrams, one pill has 500 milligrams. Whoever said that more is better?

Dr David Agus: There's no data to that regard. In fact, there's much data that it may actually cause significant harm. And so I have to be out there just pushing it in. And people do it in a religious notion. Through this COVID-19 pandemic, I've had three death threats, and I've never had that in my life. People normally like me. And so it's a very scary thing where you want to take a view and you have to take a view. It may either be vaccines, and these become religious elements for them. It's not about science and data or fact, it's about religion. And it's very hard to argue that.

Adam Kaufman: Another question that a friend wanted me to ask, I was speaking with him yesterday. He's only 40, and he believes in fasting. Fasting is so popular, so trendy, different forms of fasting right now. I already see you smiling. He's doing a 90-hour fast. He believes that cancer can be starved if you limit the sucrose and the glucose going into your body. And I said, "I'm going to ask the expert." That sounds so crazy to me.

Dr David Agus: Your friend, if he's fascinating for 90 hours, if I check his blood glucose the minute before he starts fasting, it'll be 100. The minute he stops fasting, it'll be 100, It ain't going to change. So there's plenty of sugar there to feed his cancer. So the problem is that fasting means different things to different people. So the notion of intermittent testing, which is long periods without food every day, that's fine. The key is just meals the same time every day.

Adam Kaufman: Yeah, routine. You've always told that to me, the body loves routine.

Dr David Agus: It's not me saying that, it's the data saying that Adam.

Adam Kaufman: If talk to you and I'll talk to the data, but you're my curator of the data.

Dr David Agus: When you skip a meal and long periods of fasting, stress hormones go up in the body and you can actually cause significant problems. You got to decide, am I a two-meal a day person, a three? But nothing in between, no snacks. You're going to lose weight, you're going to feel better, you're going to act better. And it's remarkable for health. When your body doesn't know when you're going to eat, the stress hormones, insulin, cortisol are always up, and those cause significant problems. And you'll look at that. Baseball players when they change the time zone, so they change their schedule, performance goes down, batting averages go down. The key is just that regularity and schedule has an enormous impact and it's very simple. Everybody wants that fad. If fads work, we'd all be doing them.

Adam Kaufman: And I'm not patronizing you by saying this, you look the same as you did when I first met you. What does your fitness regime look like, do you walk or do go to yoga, meditate? What do you do?

Dr David Agus: For fun, I play tennis, which I love. So I get to play that on the weekend with friends and my son. And I'm very cognizant to do things that make me uncomfortable. I do yoga. No offense, I don't like it, I'm not good at it. But I want to do things that put me in a discomfort zone because I think the data really showed that that's a benefit. I try to move as much as I can during the day, I try to do something every day where I get my heart rate 50% higher for where it starts for 15 minutes. So I'm not crazy fitness-

Adam Kaufman: You must eat pretty healthy though.

Dr David Agus: I eat my three meals a day, I try to do them with family. I try to do them in moderation. I have my glass of wine at night-

Adam Kaufman: Don't eat on planes. When you're flying a lot, you don't eat on planes?

Dr David Agus: I try to keep on that schedule. So if I'm on a plane when it's lunchtime, I'll eat lunch. But I try to stay to that regular schedule. I try to have every week meal more protein and fat based with some carbohydrates, try to eat real food, try to get away from processed things. I have my routines and foods I like. I make choosing the meals for the week a family thing. We all talk about it, we all choose it.

Adam Kaufman: It's a way of life.

Dr David Agus: My daughter now is in charge, is awesome, she's the best.

Adam Kaufman: I'm sure your wife likes to help too so she can involve somebody else in those big decisions. Before we wrap up today, I wanted to get any closing thoughts you had on kind of like a broad based post pandemic. What are you most excited about in terms of medicine/wellness/technology? Can you give us a peek behind the curtain so to speak big picture?

Dr David Agus: My dream is that the good of this pandemic is two things. One is we think and act like a community because what you do matters to others. And then we also have an awareness of health. And I think it's a convergence because the day the pandemic ends we're not going to go back to a new normal, but we're going to go back to a normal where they're going to be technologies that are going to be very powerful that we've never had before. One of the things that pandemic will yield is the ability of point of care testing. So right now you, Adam, you go to your doctor, he or she check your blood, they check your blood pressure. They collect a lot of data and they call you a few days later with the results. Very soon, you will have something at home where you could check your blood results, maybe even telemedicine with your doc and do them when you need to do them not just when you have an appointment and develop a feedback loop that is very powerful.

Dr David Agus: You will have devices that will be able to measure your insulin, your glucose through the skin. So I tell you, well, don't eat this, it's going to make your insulin go really high, you roll your eyes at me. You see it on yourself happening, you're going to change your behavior overnight. And I think that's powerful. I learned a lesson. I went to one of the Silicon Valley companies and they said help us with a diet of our employees. And I made the salad subsidized by the burgers. And I thought that was so clever, employees got pissed off. Two weeks later, we changed it. Next to each food, we put the good and the bad. And then literally overnight, behavior changed.

Dr David Agus: You give people the right information, they do the right thing. You tell them what to do, their shoulders to go up and they say no. And so part of the job is to give information to individuals and to personalize that. And we're at a revolution in technology and especially of point of care where we will be able to do that. I'm one of those geeks that has a pad under my mattress, and I measure my sleep every night. The power of that is I know I have more than two glasses of wine, I don't sleep well. And so I changed my behavior, I have a feedback loop there. And I really think we're going to do that on a larger scale, and it's going to democratize medicine because whether you're rich or poor, these technologies will be efficient and will be value-based. So they're going to be part of the insurance companies and the payers will be bringing them to the patients because we're going to get better outcomes.

Adam Kaufman: Well, between the energy on this conversation and your research, the center you're running, your patients, which I'm sure you'll be seeing tomorrow. I think you have too much free time, it's probably time you write another book.

Dr David Agus: Oh, I'm on it. This is the coolest book ever. It's just so fun and exciting. One of the things I realized very quickly is we've been on this earth for a million years evolving, but so is every other creature. So I've been talking to the world experts, talk to Jane Goodall on the big apes. I talked to [Walczak 00:48:17] on ants, on elephants, and giraffes. I say, "Here are the hallmarks of Alzheimer's, heart disease, cancer, and longevity, what can I learn from your system?" And learning from other creatures on this earth has been eye-opening to me. We can learn so much for our health from the adaptations and the things other creatures do. It's been the coolest thing in the world. What can we learn about your dog sleeps all day? Well, that gives us insight into our sleep.

Dr David Agus: Elephants don't get cancer, that gives us crazy insight into preventing cancer. Giraffes have a blood pressure of 250 over 200, what can we learn about blood pressure for us from them? It's been really eye-opening for me and a privilege to work with these scientists who never had really thought that their science could help humans. It's been really exciting and fun. And so we're finishing that book now.

Adam Kaufman: That's amazing. Do you have a timeframe when it might be out or a title even just so we can look for it down the road?

Dr David Agus: It's be out next year. Right now, the title, which the publisher hates, but I love so that normally tells you that it's not going to be the title, it's called Deep Into Nature because Albert Einstein once famously said at the end of his life, if you look deep into nature, you will find the clues to everything. And so to me, it's a powerful, beautiful title. So we'll see.

Adam Kaufman: Well, it's been powerful and beautiful speaking with you. One hour of your time goes so quick to me. So thank you.

Dr David Agus: Thank you, Adam. We love you and we hopefully will see you in person at some point in the near future.

Adam Kaufman: That'd be awesome. Thanks for all you're doing. Bye-bye.

Dr David Agus: Thank you. Bye-bye.

Adam Kaufman: Takeaways from today's discussion with Dr. Agus. So grateful, first of all, that he gave us some of his valuable time with me. I think about how Dr. Agus is not confident in spite of all his success proving Aristotle's famous line that the more, the more you realize you really don't know. Number two, he mentioned so many people who were important to him along the way. They inspired Dr. Agus, pushed him, opened doors for him. And that reminds all of us that everyone benefits from having mentors. Number three, we all should be aware of our best thinking time and the environment in which we perform most effectively. Me, for instance, I'm definitely most productive early in the morning. Number four, people dealing with health matters respond 30% better when they have a belief system or faith in place. And relatedly, how hope enhances our recovery, sharing the idea of how powerful it would be for patients to walk by a lab while being treated. I think that's a tremendous idea. Was there anything else Dave that stuck with you?

Dave Douglas: There was one other thing that I thought was pretty interesting, and I definitely took from this episode. And that was that his work is an art form. We hear about practicing medicine. And this statement about his work being an art form, he's reminding us that medicine is not an exact science and they're still figuring some things out.

Adam Kaufman: Yeah, you're totally right. I think everyone believes medicine is by definition of science. But he once again reminds us, there's a lot of gray area, it makes it an art. Please email me, text me, post on our social media channels. Let us know how you think we're doing. Give us ideas on possible speakers and tell us a little bit about your favorite moments in the podcast.

Adam Kaufman: Up2 is a production of Evergreen Podcasts, a special thanks to our producer and audio engineer, Dave Douglas. I'm your host, Adam Kaufman, and thank you so much for listening to the Up2 Podcast.

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