Two Medical Reports
The science of me
Scientists say they can map out your medical destiny: what diseases you’ll get and how you’ll die. But would knowing the future improve your life? Two of our writers bared all for the truth
TIM RAYMENT FILE
HABITS: Solitary, impulsive
APPETITES: Food, work, sex
EXERCISE: None
ATTITUDE: Optimistic
We think science can tell us almost anything: we live in an age when experts can say how a mummy died 4,000 years ago, or name the Yorkshire Ripper hoaxer in hours by taking DNA from an envelope licked in 1979. We have MRI scans, genetic and hormonal testing, and tiny cameras that can explore inside us. What can science reveal to us? And how much would you really want to know?
Tucked away in an up-market shopping mall in Scottsdale, Arizona, is a research institute where you can walk in off the street and get yourself tested to the extreme. This is the Kronos Optimal Health Centre, which asks its clients for seven tubes of blood before a two-day programme of physical testing. Then, in Britain, there are experts in psychological testing who will describe your personality with frightening accuracy; people who can divine what you eat and where you live, from a strand of hair; a professor of eye surgery who was able to study my tears and see what I’d had for lunch the previous day. How much do these people know?
This is the exercise, then. Take one Adam, one Eve. Each outwardly healthy, each old enough to harbour hidden killers. Ariel Leve is 38; I turned 46 this month. She is a vegetarian New Yorker who is anxious about her health; I’m a careless Englishman who knows every dietary pronouncement and follows none. We invited scientists on two continents to tell us whatever they can, with life-changing results.
In Britain, we have a simple model of health care: we wait for disease to show, then we treat it. What doctors do not find, they do not have to deal with until there are symptoms. Take eye examinations. The eye is the only place in the body where nerves and blood vessels are on display, which means it has a story to tell about health. In Britain, eye tests are done mainly on the high street and the motive is to sell spectacles, not detect disease. In middle age, I still have good vision; “super-vision”, in fact. Thus I have never had a proper eye examination. That’s Britain, and it’s why our elderly have higher rates of eye disease than in other developed nations.
Private health screening tends to give broad advice on diet and lifestyle. Yet scientific advances in the last decade have introduced real precision, allowing the purchase of knowledge that was once the property of fate. Women can find out how many eggs are left in their ovaries in the comfort of their bathroom, while men can test their sperm count without stepping out of the house. The new era raises the exciting prospect of individual care – of preventive treatment tailored to your actual make-up, with health resources used efficiently for the first time.
“There is little doubt that in 50 years’ time a genetic profile will be part of your health check,” says Kay Davies, an Oxford professor of anatomy. “It may not tell you how long you will live, because of the large environmental component, but it will say how to minimise any risks for heart disease, Alzheimer’s and so on.”
In half a century? We want this now. And guess what – you can have a version of it immediately.
Unlike Ariel, who approached this exercise with respect for the tests and dread of the results, I was cheerfully sceptical. So what if I turned out to have the genetic markers for cancer or heart disease? We’re such complex beings that genes are just part of the story. Intimate flirting with science holds no fear. Friends asked if we were going to receive counselling with the findings.
I don’t need counselling, I thought: I would rely instead on a study of 678 nuns in the Journal of Personality and Social Psychology, who were asked in the 1980s to write self-portraits. The women who were positive about themselves tended to live significantly longer. I am an optimist, and how is science going to factor in that?
At Kronos, medicine is based on risk assessment: it tries to do now what our Oxford professor sees as the future. At the frontier of commercial science, the tests are familiar but more sophisticated. When you run on a treadmill for a health insurer in Britain, electrodes monitor how the heart performs under stress. At Kronos, you also wear a face mask to measure how efficiently you process oxygen. In Britain, the body mass index is indicative of the content of fat in your body; in Arizona a full body scan shows where this fat is. The work yields more statistics than a person needs: the report on my screening runs to 257 pages.
I now know my left arm is 20.7% fat, and so is my right. I can see not only the levels of “good” cholesterol and bad in my blood, but the precise make-up of these fats, and the fact that my level of coenzyme Q10, “a terrific antioxidant” that is made in the body and can be found in a variety of foods, is barely acceptable at 0.591. My bones are so dense they are almost off the scale, but feeble habits mean my upper-body muscular strength is poor. My biological age is 53, seven years older than my chronological age. I know from a brain scan that I have mild diffuse cortical atrophy. This means my brain has shrunk. It is common with age and moderate drinking. So what?
I made no effort to improve the results. The day before testing, this was my diet: breakfast, none; lunch, a chip butty (white bap, butter, chips); supper, a big meal at the wrong time of day. Life is a lottery, and it turns out that I am blessed with what Kronos called awesome blood chemistry, which is better than expected for my age, while Ariel, for all her dietary excellence and gym membership, is a heart attack waiting to happen. The results were not all good news; we’ll get to the alarming findings later. For now, science has delivered the same as a medical, but in blazing colour. How would we use the extra detail? And do we have the mental strength to take action?
Dr Almuth McDowell, of the Psychometrics Centre at City University in London, conducts psychological assessments with questions that are repeated in different ways to trap anybody who tries to manipulate the results. She assesses prudence (how careful and sensible you are), fortitude (your degree of comfort with hard work), temperance (the ability to control aggression), justice (fairness in decision-making), faith (including how likely you are to conform), charity (honesty and openness) and hope (a sense of purpose and your attitude to change). Another test assesses traits such as whether you get your energy from working alone or in a team, and how far you feel the need to consult others before making a difficult choice. With no understanding of these tests, I guessed every one of my scores correctly. This tells us two things. One is, I know myself. The other is, the tests are accurate. From this area of science, there is nowhere to hide.
For the record, I have a high score for justice, suggesting I am balanced and impartial, and a low one for faith, showing reluctance to conform to rules. I am found to be careless with mundane tasks, which is true. Ariel’s scores revealed a suspicion of others’ motives, and an even lower score than mine for faith, indicating that she ignores advice. (She does.) Her strengths include a commitment to hard work, and she also has the top score for nervousness and sensitivity to others, reflecting how she gets flustered under stress and absorbs other people’s emotions.
Later came an 86-page genetic report, entitled Cellf: The Science of You, offering informational riches in return for a ludicrously simple act. To get a genetic analysis, all you do is rub inside a cheek and send off the swab to America, with some forms to report on your diet and exercise. Back comes an assessment of whether genes and lifestyle put you at risk. I have three genes that threaten the bones; this is interesting, as I also have a parent with osteoporosis and bone-marrow cancer. Critics will say that you could get to the same place with family history alone, which is true. But I have two parents, and it takes a genetic profile to corner the British male. No longer can I pretend, with a gambler’s optimism, that I have my mother’s genes for building bone tissue: it seems I have my father’s, which means that this simple test offers me a chance to take action that my dad, in an earlier age for science, was denied. With these genes, I “need to pay urgent attention” by increasing my intake of calcium, omega-3 fatty acids and vitamin D.
Turn the page. Next comes my cancer moment. I have genes that imply an impaired ability to deal with free radicals, which attack DNA – triggering cancer – and are linked to heart disease. What’s more, I have variations in the genes that direct how we deal with toxins, presenting an added risk for the same threats to life. These are “lifestyle” genetic tests, from the new science of nutrigenetics; they are not the life-saving genetic tests that are given by the NHS if you have a family history of breast cancer, for example. Even so, the tone of the report, from a company called Sciona, is beautifully judged.
I am starting to take this seriously.
The advice to those testing positive will be the same as that given to all: eat sensibly and take more exercise. If that’s the case, why buy a test? Well, from the client end of this, there is a reason. Even sceptics sometimes listen to people in white coats. If the genetic report prompts changes in lifestyle, it will be priceless.
One day we will embrace the preventive approach that comes from scientific testing – it will be cheaply available over the counter and we will find it ridiculous to wait for symptoms. I can feel a change as a result of this project: the wealth of information from Kronos included facts such as my low level of selenium, a mineral that can help cut the risk of prostate cancer by 60%. By instinct, I bought selenium supplements a few years ago, but never opened the packet. Now I’m taking them.
The future can be seen in Germany, where a researcher has developed a device that uses the window of the eye to look at the state of the arteries as they respond to your heartbeat. Imagine a machine in every GP’s surgery to look into your eye and predict those two great killers, heart disease and stroke, from the flexibility of your blood vessels. It is not far away.
Nobody could have such a comprehensive going-over without finding cause for alarm, and in Arizona there was bad news for both of us. William Fulton, the medical director at Kronos, was tasked with explaining the mass of information revealed by the screenings there. At first it was a matter of this level being a bit high, that one low. Then we arrived at the microscopic quantities of blood in Ariel’s urine. Among the possible causes was cancer. Ariel was so shocked that she barely noticed the next bad news, which was that each of us showed signs of heart disease. The treadmill test had revealed isolated premature heartbeats. After all my cheerfulness, here was a reckoning. This was real.
The next day a cardiologist who had examined our heart charts said the premature beats were not a cause for concern. This was consistent with the results of a heart scan, using technology so new that its value is controversial. If you put yourself through this process, be prepared for the emotional arc. I went from a state of nonchalance, or denial, to a sudden confrontation with mortality. Then a heart specialist brought liberation, and denial could be renewed. I was free to be British again.
The tests raised an interesting possibility. Fertility tests revealed that Ariel has a healthy supply of eggs. Could science say if we might be compatible? I contact Almuth McDowell, the London psychologist. Would Ariel and I be suited to working together on an intimate project? Well, she says, there are marked differences. Ariel is more likely to be anxious, but my glass is always half-full. “If you remain sensitive to each other,” she says, “this contrast can actually become a strength,” adding in a written report that “Ariel is likely to be more careful and sensible in operations, which may complement Tim’s tendency to go on to the next task before due diligence has been exercised on the present one… Neither of you is terribly interested in working with mundane detail.” I’ll take that as a yes, then.
What did this whole venture show? That as yet, science has little to say that on some level we do not know, and it cannot tell us when we are going to die. But it does offer precision and a greater motive to change. Science gives us detail, too. There was a glimpse of the future in a session with Susan Ayersman, a Kronos nutritionist. She had studied my metabolism and other Kronos statistics, and knew exactly how much protein I need to maintain my 157.18-lb of lean muscle, and how many calories leave my weight the same. The nutritionist also rose to a challenge. I tested her by telling the truth, which is that although I love to eat, I also love to work, and the maximum time I am prepared to give to food preparation is one minute. She thought about this overnight, and came up with an excellent diet that matched my habits. One day, medicine will respond to us with this precision. For now, skilled human beings can tell us as much.
Strands of our hair were fed into a mass spectrometer at Queen Mary, University of London, to measure the “stable isotope signatures” of carbon and nitrogen. This revealed that I am a meat-eater and Ariel a vegetarian. It also identified her as American; US cattle eat maize and ours eat grass, leading to different carbon signatures. Yet the single most impressive moment of the project was when Professor Dan Reinstein, an eye surgeon at the London Vision Clinic, took one look at the fluid covering my eyes and diagnosed a diet higher in saturated fat than fish oil – one day after the chip butty.
For me, this has been a life-changing exercise. Like many optimists, I also have the capacity, in my private life, to deny inconvenient facts. But in the end, there was no hiding from all the measures of risk for disease. I have been given plenty of them, and I reformed my diet and exercise levels the day after the genetic report arrived. I don’t want to be dramatic about this, but I think I might have saved my life.
ARIEL LEVE FILE
HABITS: Health-conscious, germophobic
APPETITES: Caffeine addict
EXERCISE: Reluctantly
ATTITUDE: Pessimistic
Can you handle the truth? I can’t. I have always expected the worst but have never prepared for it. It is in my nature to worry about illness, but would it be in my nature to cope with it? As Woody Allen said, “I’m not afraid to die, I just don’t want to be there when it happens.”
My first instinct was to deny: I didn’t want to know the bad news. Despite being filled with dread, I couldn’t say no to the medical testing for one reason — what self-respecting hypochondriac would turn down the chance to prove: I really am as sick as I think I am?
The only thing that could highlight my Jewish neurotic anxiety more would be to go through this epic journey with a perpetually cheerful, nonchalant British male — Tim Rayment. We would be united on this quest, partners in x-rays and Dexa scans, and there would be someone to pick me up off the floor when I received the ominous results.
Tim’s positive attitude was perplexing. Could he really be that blithe about what dangers lurked inside his body? Most men I spoke to expressed an eagerness to know their expiration date. The collective sentiment seemed to be a carefree shrug. Women seemed less inclined to want to have this information, unless they had children.
There are those for whom illness is merely a challenge to overcome. I am not one of those people. I created a mental abacus and began to calculate degrees of tolerance. On the upper deck were autoimmune diseases: multiple sclerosis, lupus, etc, diseases that frighten me the most because they are incurable, and I could not imagine having the strength to persevere mentally or physically should I find out I was afflicted by one. With lupus, for instance, some of the symptoms are poor circulation in the hands and feet, joint pain, and a butterfly rash on the face. A blood test is given to discover if they are related and add up to the disease.
I know this because I have two out of the three symptoms. Six months ago, independent of this article, I was tested. Back then, I did not have lupus. But six months have passed. Just because I was healthy then doesn’t mean I am now.
On the lower deck of the abacus: terminal illnesses which, if caught early, could be overcome. Cancer, tumours and the like; these had chances for survival and so I would give it a shot. On the bottom deck, too, were viral infections such as hepatitis and everything else from diabetes to glaucoma.
As I sat on the Tube, wedged between the man in a grey suit doing sudoku and the woman with a tattoo of a leprechaun on her wrist, this divvying up of diseases in categories of despair was my private way of preparing. It was, perversely, reassuring.
At the London Vision Clinic, Professor Dan Reinstein detailed the extraordinary amount of information that can be gleaned from the eye. He could check the optic nerve for transmission of signal. Was the brain working properly? Cranial nerves and brainstem function could be examined through eye movements. There were arteries that could signal vascular disease, and inflammation of cells could gauge the immune status of the body. The eye can even reveal dietary aberrations.
Of course, mine are damaged. All my life I have been seriously short-sighted. Without glasses, I am unable to cross the street. But to my great relief, there were no optical defects. My poor vision is, as Dr Reinstein told me, akin to having bad-quality film in the camera. It could be the retina, or the way the brain interprets the retina. In my case it was neither. It was “not normal and we don’t know why”.
There are some questions that will remain unanswered. So I wondered: will the rest of this journey confirm my worst fears? By the end I’d have been scanned, poked, drained, injected, investigated, measured, sampled and analysed. I’d be bombarded with magnetic resonances, electrical impulses and have found out I had things called sex hormone binding globulin levels, ageing biomarkers, and hormones labelled TSH. I’d learn my resting energy expenditure was 1,329 calories a day, which indicates a normal metabolism, but my phenotype interpretation, which is how my DNA reacts to drugs, labelled me an intermediate metaboliser. But was I dying?
At the Kronos Centre in Arizona we were handed our patient itineraries — a travelogue of vitals, scans and assessments. I was apprehensive: it would be rare for an exam as all-inclusive as this not to find something wrong. The cardiopulmonary metabolic test seemed to go well. During the treadmill test I was able to exercise for 11 minutes, 1 second. (Before my test I asked how long Tim had lasted. His time?11 minutes.) A spirometry test was performed to show lung function, an H-scan for biological age, a Dexa scan that measured bone mineral density and body fat percentage on the lumbar spine and hip areas.
When I saw the resulting image, I was in shock. My overall body-fat percentage was 20% but the scan made it look more like 80%. I had the scan of a Nordic speed skater on steroids. No one tells you, when you’re lying down on a metal tray in a tube, that everything flattens out and spreads. If I’d known that, I would have worn a corset. Suddenly I didn’t feel well. I knew the image would be presented standing upright. While these tests and scans were being carried out, vials of our blood and urine were being tested for hormones, trace metals, cholesterol, etc. Soon, it would all be revealed.
But not all tests could be done on site. The waiting room at the imaging centre was eerily quiet. A pimpled teenager in his soccer strip was rubbing his knee, a woman in a cherry-coloured jump suit flipped through a magazine and chewed gum, and an elderly couple whispered questions to each other. Soon we would all be stripped of our rings and clothing, lying still and silent while having mammograms, heart scans, MRIs, or, in my case, all three. It was a room full of vulnerable people who would prefer to be somewhere else.
A brain MRI is loud and claustrophobic but I found it relaxing. I lay back and listened to a ferocious clicking sound that confirmed my brain was being probed from the inside out. This new machine was only in its second week of use; the Ferrari of MRIs. The images would be clearer; the resolution higher.
Unable to wait, I jumped up and charmed my way into the technician’s room for a preview. He allowed me to look at an image of my brain on the computer screen. As he explained what some of it meant, I stared, thinking about how every word, every thought, every moral choice and the ability to decide, came from that image.
Dr Antonio Damasio, professor of neuroscience and neurology at the University of Southern California, explained:?“Science is progressing very fast in certain domains, but not so fast in others. So there is a mismatch between what we can diagnose and what we can provide for treatment.” For instance, an early diagnosis of a disease such as Alzheimer’s, where the treatment has not caught up to the science, would be incredibly damaging psychologically.
A few days passed. Tim and I were called to see Dr William Fulton at Kronos to go over the results. The doctor sat calmly behind his desk, wearing his white lab coat. Our enormous individual binders waited, like the Torah of Wellbeing, to be interpreted. It was our moment of truth. For me, the two areas that mattered most were the areas that yielded abnormal results. There were traces of blood in the urine. This was unusual. Dr Fulton was only doing his job when he answered my next question with frank sincerity. “Tell me,” I stammered. “What’s the worst-case scenario?”
Nobody likes to hear the word “cancer”. Even Tim looked worried. In an effort to make me feel better, Dr Fulton emphasised that my potential for heart disease was far more likely to be a problem than cancer, because my cholesterol levels were very high. This surprised me, since I am a vegetarian who exercises regularly, and for a second I couldn’t figure out which was more disturbing: cancer, or a life without cheese and milk.
Dr Fulton explained that it was probably genetic, but I had a hard time focusing on what he was saying because once you hear the word “cancer”, it’s a long way back to cholesterol. It didn’t help that Tim, who eats something called a chip butty, was fine. But then he was presented with a potential heart problem. With both of us now dying, one worry had to take precedence.
I called my GP in New York. In my “I-might-have-cancer” stupor, I left a message, and as I waited for him to call back, phoned my father to share the bad news. But owing to a long history of hearing about my fatal diseases, I had to put Tim on the phone to vouch for the gravity of Dr Fulton’s tone. Tim, who had never spoken to my father before in his life, was now conversing with him in a dire manner about bladder cancer, heart disease, and blood in my urine. When the phone was passed back, my father told me a story. He was once informed he might have tuberculosis only to find out later that it was a fingerprint on the x-ray. There are mistakes, he said: medicine is an art. This sentiment was echoed by my doctor, who dismissed that this was anything serious. As soon as I spoke to him, I felt better. The familiar voice of authority protected me from obsessive thoughts. Though they didn’t cease entirely, they eased up just enough for me to function.
A week later, I was retested and the results were normal. My doctor, a New York City internist, Dr Robert Samuelson, explained: “The issue is not whether science can tell us things that we don’t know, but whether this knowledge can actually prevent disease or prolong the quality of life. For example, while a CAT scan might disclose a tiny nodule or shadow somewhere in the body, the overwhelming majority of these nodules are benign. But once found, they cannot be ignored; they have to be followed up and possibly biopsied and removed. It takes a lot of unnecessary worrying and invasive procedures to learn that your spot was benign! Additionally, it’s never been proven that removing tiny early cancers in the lung, for example, actually saves lives. The cancers that kill are probably not these tiny cancers that we can detect early.”
Moreover, a lot of tests, he said, are interpreted out of context of the whole being. An isolated lab value may appear abnormal, but when it’s evaluated along with everything else we know about someone’s health and lifestyle, the value is no longer abnormal. His perspective was in contrast to the Kronos philosophy, in that tests are worthwhile if they are highly specific for diagnosing a disorder, and if there is a safe, effective way for treating the disorder. But in some cases, such as mine, they merely provoke a lot of needless anxiety.
According to a 1998 report published in the Journal of the American Medical Association, over 100,000 Americans die every year from adverse drug reactions — a higher figure than those who die in car accidents. Genelex, a Seattle-based company, offers DNA tests, one of which can determine how the liver metabolises and processes prescribed medications. When given to a physician, this profile can prevent future catastrophes by lowering the incidence of an adverse reaction.
Each person falls into one of the four categories for each of the pathways tested. There are ultra-extensive, extensive, intermediate and poor metabolisers. I am intermediate. I metabolise medicine slowly and will need a lower dosage, as they build up in my system. Had it turned out I was an ultra-extensive metaboliser, I would be in terrible pain after surgery because the painkillers would have little or no effect.
One area of testing where I had no anxiety was the psychometrics. Maybe because there is nothing about my mental health and ability to function that could astonish me. At the Psychometrics Centre we were given a set of tests to determine our ability to function in the workplace. What stood out were my strengths: creative, insightful, careful and sensible when carrying out tasks, effective and confident when it comes to hard work. It also determined my weaknesses: no discipline, suspicious of the intentions of others, may ignore the advice of those who know better. Of course, I’m not sure I agree with the experts on that.
Nearing the end of this journey, I was forced to overcome my trepidation at tackling a psychological, rather than physiological, reality. At 38, was I ready to take responsibility for having procrastinated procreation? The Fertell female fertility test measures the ovarian reserve. It is an easy test with immediate results and has proven to be over 95% accurate. As it turns out, my ovarian reserve was normal. Great. I was fertile with no one to share my fertility with.
So in the end, what did it all add up to? I am healthy. And when I thought I might not be, my reaction surprised me. Because, after the initial shock, my immediate impulse was to want to know more. I did not fall into a sinkhole of inertia; denial was no longer an option. Science has told me something unscientific. That panic is about helplessness, and with information comes a sense of control. I’m grateful there is nothing wrong, but aware that this respite is fragile and temporary. Despite all this I remain, where health is concerned, as vigilant as ever. Only now, when I have dry eyes or bleeding gums and assume that it’s indicative of something fatal, instead of avoiding it, I’ll want to know.
From the U.K. Sunday Times Magazine, April 30, 2006
Scientists say they can map out your medical destiny: what diseases you’ll get and how you’ll die. But would knowing the future improve your life? Two of our writers bared all for the truth
TIM RAYMENT FILE
HABITS: Solitary, impulsive
APPETITES: Food, work, sex
EXERCISE: None
ATTITUDE: Optimistic
We think science can tell us almost anything: we live in an age when experts can say how a mummy died 4,000 years ago, or name the Yorkshire Ripper hoaxer in hours by taking DNA from an envelope licked in 1979. We have MRI scans, genetic and hormonal testing, and tiny cameras that can explore inside us. What can science reveal to us? And how much would you really want to know?
Tucked away in an up-market shopping mall in Scottsdale, Arizona, is a research institute where you can walk in off the street and get yourself tested to the extreme. This is the Kronos Optimal Health Centre, which asks its clients for seven tubes of blood before a two-day programme of physical testing. Then, in Britain, there are experts in psychological testing who will describe your personality with frightening accuracy; people who can divine what you eat and where you live, from a strand of hair; a professor of eye surgery who was able to study my tears and see what I’d had for lunch the previous day. How much do these people know?
This is the exercise, then. Take one Adam, one Eve. Each outwardly healthy, each old enough to harbour hidden killers. Ariel Leve is 38; I turned 46 this month. She is a vegetarian New Yorker who is anxious about her health; I’m a careless Englishman who knows every dietary pronouncement and follows none. We invited scientists on two continents to tell us whatever they can, with life-changing results.
In Britain, we have a simple model of health care: we wait for disease to show, then we treat it. What doctors do not find, they do not have to deal with until there are symptoms. Take eye examinations. The eye is the only place in the body where nerves and blood vessels are on display, which means it has a story to tell about health. In Britain, eye tests are done mainly on the high street and the motive is to sell spectacles, not detect disease. In middle age, I still have good vision; “super-vision”, in fact. Thus I have never had a proper eye examination. That’s Britain, and it’s why our elderly have higher rates of eye disease than in other developed nations.
Private health screening tends to give broad advice on diet and lifestyle. Yet scientific advances in the last decade have introduced real precision, allowing the purchase of knowledge that was once the property of fate. Women can find out how many eggs are left in their ovaries in the comfort of their bathroom, while men can test their sperm count without stepping out of the house. The new era raises the exciting prospect of individual care – of preventive treatment tailored to your actual make-up, with health resources used efficiently for the first time.
“There is little doubt that in 50 years’ time a genetic profile will be part of your health check,” says Kay Davies, an Oxford professor of anatomy. “It may not tell you how long you will live, because of the large environmental component, but it will say how to minimise any risks for heart disease, Alzheimer’s and so on.”
In half a century? We want this now. And guess what – you can have a version of it immediately.
Unlike Ariel, who approached this exercise with respect for the tests and dread of the results, I was cheerfully sceptical. So what if I turned out to have the genetic markers for cancer or heart disease? We’re such complex beings that genes are just part of the story. Intimate flirting with science holds no fear. Friends asked if we were going to receive counselling with the findings.
I don’t need counselling, I thought: I would rely instead on a study of 678 nuns in the Journal of Personality and Social Psychology, who were asked in the 1980s to write self-portraits. The women who were positive about themselves tended to live significantly longer. I am an optimist, and how is science going to factor in that?
At Kronos, medicine is based on risk assessment: it tries to do now what our Oxford professor sees as the future. At the frontier of commercial science, the tests are familiar but more sophisticated. When you run on a treadmill for a health insurer in Britain, electrodes monitor how the heart performs under stress. At Kronos, you also wear a face mask to measure how efficiently you process oxygen. In Britain, the body mass index is indicative of the content of fat in your body; in Arizona a full body scan shows where this fat is. The work yields more statistics than a person needs: the report on my screening runs to 257 pages.
I now know my left arm is 20.7% fat, and so is my right. I can see not only the levels of “good” cholesterol and bad in my blood, but the precise make-up of these fats, and the fact that my level of coenzyme Q10, “a terrific antioxidant” that is made in the body and can be found in a variety of foods, is barely acceptable at 0.591. My bones are so dense they are almost off the scale, but feeble habits mean my upper-body muscular strength is poor. My biological age is 53, seven years older than my chronological age. I know from a brain scan that I have mild diffuse cortical atrophy. This means my brain has shrunk. It is common with age and moderate drinking. So what?
I made no effort to improve the results. The day before testing, this was my diet: breakfast, none; lunch, a chip butty (white bap, butter, chips); supper, a big meal at the wrong time of day. Life is a lottery, and it turns out that I am blessed with what Kronos called awesome blood chemistry, which is better than expected for my age, while Ariel, for all her dietary excellence and gym membership, is a heart attack waiting to happen. The results were not all good news; we’ll get to the alarming findings later. For now, science has delivered the same as a medical, but in blazing colour. How would we use the extra detail? And do we have the mental strength to take action?
Dr Almuth McDowell, of the Psychometrics Centre at City University in London, conducts psychological assessments with questions that are repeated in different ways to trap anybody who tries to manipulate the results. She assesses prudence (how careful and sensible you are), fortitude (your degree of comfort with hard work), temperance (the ability to control aggression), justice (fairness in decision-making), faith (including how likely you are to conform), charity (honesty and openness) and hope (a sense of purpose and your attitude to change). Another test assesses traits such as whether you get your energy from working alone or in a team, and how far you feel the need to consult others before making a difficult choice. With no understanding of these tests, I guessed every one of my scores correctly. This tells us two things. One is, I know myself. The other is, the tests are accurate. From this area of science, there is nowhere to hide.
For the record, I have a high score for justice, suggesting I am balanced and impartial, and a low one for faith, showing reluctance to conform to rules. I am found to be careless with mundane tasks, which is true. Ariel’s scores revealed a suspicion of others’ motives, and an even lower score than mine for faith, indicating that she ignores advice. (She does.) Her strengths include a commitment to hard work, and she also has the top score for nervousness and sensitivity to others, reflecting how she gets flustered under stress and absorbs other people’s emotions.
Later came an 86-page genetic report, entitled Cellf: The Science of You, offering informational riches in return for a ludicrously simple act. To get a genetic analysis, all you do is rub inside a cheek and send off the swab to America, with some forms to report on your diet and exercise. Back comes an assessment of whether genes and lifestyle put you at risk. I have three genes that threaten the bones; this is interesting, as I also have a parent with osteoporosis and bone-marrow cancer. Critics will say that you could get to the same place with family history alone, which is true. But I have two parents, and it takes a genetic profile to corner the British male. No longer can I pretend, with a gambler’s optimism, that I have my mother’s genes for building bone tissue: it seems I have my father’s, which means that this simple test offers me a chance to take action that my dad, in an earlier age for science, was denied. With these genes, I “need to pay urgent attention” by increasing my intake of calcium, omega-3 fatty acids and vitamin D.
Turn the page. Next comes my cancer moment. I have genes that imply an impaired ability to deal with free radicals, which attack DNA – triggering cancer – and are linked to heart disease. What’s more, I have variations in the genes that direct how we deal with toxins, presenting an added risk for the same threats to life. These are “lifestyle” genetic tests, from the new science of nutrigenetics; they are not the life-saving genetic tests that are given by the NHS if you have a family history of breast cancer, for example. Even so, the tone of the report, from a company called Sciona, is beautifully judged.
I am starting to take this seriously.
The advice to those testing positive will be the same as that given to all: eat sensibly and take more exercise. If that’s the case, why buy a test? Well, from the client end of this, there is a reason. Even sceptics sometimes listen to people in white coats. If the genetic report prompts changes in lifestyle, it will be priceless.
One day we will embrace the preventive approach that comes from scientific testing – it will be cheaply available over the counter and we will find it ridiculous to wait for symptoms. I can feel a change as a result of this project: the wealth of information from Kronos included facts such as my low level of selenium, a mineral that can help cut the risk of prostate cancer by 60%. By instinct, I bought selenium supplements a few years ago, but never opened the packet. Now I’m taking them.
The future can be seen in Germany, where a researcher has developed a device that uses the window of the eye to look at the state of the arteries as they respond to your heartbeat. Imagine a machine in every GP’s surgery to look into your eye and predict those two great killers, heart disease and stroke, from the flexibility of your blood vessels. It is not far away.
Nobody could have such a comprehensive going-over without finding cause for alarm, and in Arizona there was bad news for both of us. William Fulton, the medical director at Kronos, was tasked with explaining the mass of information revealed by the screenings there. At first it was a matter of this level being a bit high, that one low. Then we arrived at the microscopic quantities of blood in Ariel’s urine. Among the possible causes was cancer. Ariel was so shocked that she barely noticed the next bad news, which was that each of us showed signs of heart disease. The treadmill test had revealed isolated premature heartbeats. After all my cheerfulness, here was a reckoning. This was real.
The next day a cardiologist who had examined our heart charts said the premature beats were not a cause for concern. This was consistent with the results of a heart scan, using technology so new that its value is controversial. If you put yourself through this process, be prepared for the emotional arc. I went from a state of nonchalance, or denial, to a sudden confrontation with mortality. Then a heart specialist brought liberation, and denial could be renewed. I was free to be British again.
The tests raised an interesting possibility. Fertility tests revealed that Ariel has a healthy supply of eggs. Could science say if we might be compatible? I contact Almuth McDowell, the London psychologist. Would Ariel and I be suited to working together on an intimate project? Well, she says, there are marked differences. Ariel is more likely to be anxious, but my glass is always half-full. “If you remain sensitive to each other,” she says, “this contrast can actually become a strength,” adding in a written report that “Ariel is likely to be more careful and sensible in operations, which may complement Tim’s tendency to go on to the next task before due diligence has been exercised on the present one… Neither of you is terribly interested in working with mundane detail.” I’ll take that as a yes, then.
What did this whole venture show? That as yet, science has little to say that on some level we do not know, and it cannot tell us when we are going to die. But it does offer precision and a greater motive to change. Science gives us detail, too. There was a glimpse of the future in a session with Susan Ayersman, a Kronos nutritionist. She had studied my metabolism and other Kronos statistics, and knew exactly how much protein I need to maintain my 157.18-lb of lean muscle, and how many calories leave my weight the same. The nutritionist also rose to a challenge. I tested her by telling the truth, which is that although I love to eat, I also love to work, and the maximum time I am prepared to give to food preparation is one minute. She thought about this overnight, and came up with an excellent diet that matched my habits. One day, medicine will respond to us with this precision. For now, skilled human beings can tell us as much.
Strands of our hair were fed into a mass spectrometer at Queen Mary, University of London, to measure the “stable isotope signatures” of carbon and nitrogen. This revealed that I am a meat-eater and Ariel a vegetarian. It also identified her as American; US cattle eat maize and ours eat grass, leading to different carbon signatures. Yet the single most impressive moment of the project was when Professor Dan Reinstein, an eye surgeon at the London Vision Clinic, took one look at the fluid covering my eyes and diagnosed a diet higher in saturated fat than fish oil – one day after the chip butty.
For me, this has been a life-changing exercise. Like many optimists, I also have the capacity, in my private life, to deny inconvenient facts. But in the end, there was no hiding from all the measures of risk for disease. I have been given plenty of them, and I reformed my diet and exercise levels the day after the genetic report arrived. I don’t want to be dramatic about this, but I think I might have saved my life.
ARIEL LEVE FILE
HABITS: Health-conscious, germophobic
APPETITES: Caffeine addict
EXERCISE: Reluctantly
ATTITUDE: Pessimistic
Can you handle the truth? I can’t. I have always expected the worst but have never prepared for it. It is in my nature to worry about illness, but would it be in my nature to cope with it? As Woody Allen said, “I’m not afraid to die, I just don’t want to be there when it happens.”
My first instinct was to deny: I didn’t want to know the bad news. Despite being filled with dread, I couldn’t say no to the medical testing for one reason — what self-respecting hypochondriac would turn down the chance to prove: I really am as sick as I think I am?
The only thing that could highlight my Jewish neurotic anxiety more would be to go through this epic journey with a perpetually cheerful, nonchalant British male — Tim Rayment. We would be united on this quest, partners in x-rays and Dexa scans, and there would be someone to pick me up off the floor when I received the ominous results.
Tim’s positive attitude was perplexing. Could he really be that blithe about what dangers lurked inside his body? Most men I spoke to expressed an eagerness to know their expiration date. The collective sentiment seemed to be a carefree shrug. Women seemed less inclined to want to have this information, unless they had children.
There are those for whom illness is merely a challenge to overcome. I am not one of those people. I created a mental abacus and began to calculate degrees of tolerance. On the upper deck were autoimmune diseases: multiple sclerosis, lupus, etc, diseases that frighten me the most because they are incurable, and I could not imagine having the strength to persevere mentally or physically should I find out I was afflicted by one. With lupus, for instance, some of the symptoms are poor circulation in the hands and feet, joint pain, and a butterfly rash on the face. A blood test is given to discover if they are related and add up to the disease.
I know this because I have two out of the three symptoms. Six months ago, independent of this article, I was tested. Back then, I did not have lupus. But six months have passed. Just because I was healthy then doesn’t mean I am now.
On the lower deck of the abacus: terminal illnesses which, if caught early, could be overcome. Cancer, tumours and the like; these had chances for survival and so I would give it a shot. On the bottom deck, too, were viral infections such as hepatitis and everything else from diabetes to glaucoma.
As I sat on the Tube, wedged between the man in a grey suit doing sudoku and the woman with a tattoo of a leprechaun on her wrist, this divvying up of diseases in categories of despair was my private way of preparing. It was, perversely, reassuring.
At the London Vision Clinic, Professor Dan Reinstein detailed the extraordinary amount of information that can be gleaned from the eye. He could check the optic nerve for transmission of signal. Was the brain working properly? Cranial nerves and brainstem function could be examined through eye movements. There were arteries that could signal vascular disease, and inflammation of cells could gauge the immune status of the body. The eye can even reveal dietary aberrations.
Of course, mine are damaged. All my life I have been seriously short-sighted. Without glasses, I am unable to cross the street. But to my great relief, there were no optical defects. My poor vision is, as Dr Reinstein told me, akin to having bad-quality film in the camera. It could be the retina, or the way the brain interprets the retina. In my case it was neither. It was “not normal and we don’t know why”.
There are some questions that will remain unanswered. So I wondered: will the rest of this journey confirm my worst fears? By the end I’d have been scanned, poked, drained, injected, investigated, measured, sampled and analysed. I’d be bombarded with magnetic resonances, electrical impulses and have found out I had things called sex hormone binding globulin levels, ageing biomarkers, and hormones labelled TSH. I’d learn my resting energy expenditure was 1,329 calories a day, which indicates a normal metabolism, but my phenotype interpretation, which is how my DNA reacts to drugs, labelled me an intermediate metaboliser. But was I dying?
At the Kronos Centre in Arizona we were handed our patient itineraries — a travelogue of vitals, scans and assessments. I was apprehensive: it would be rare for an exam as all-inclusive as this not to find something wrong. The cardiopulmonary metabolic test seemed to go well. During the treadmill test I was able to exercise for 11 minutes, 1 second. (Before my test I asked how long Tim had lasted. His time?11 minutes.) A spirometry test was performed to show lung function, an H-scan for biological age, a Dexa scan that measured bone mineral density and body fat percentage on the lumbar spine and hip areas.
When I saw the resulting image, I was in shock. My overall body-fat percentage was 20% but the scan made it look more like 80%. I had the scan of a Nordic speed skater on steroids. No one tells you, when you’re lying down on a metal tray in a tube, that everything flattens out and spreads. If I’d known that, I would have worn a corset. Suddenly I didn’t feel well. I knew the image would be presented standing upright. While these tests and scans were being carried out, vials of our blood and urine were being tested for hormones, trace metals, cholesterol, etc. Soon, it would all be revealed.
But not all tests could be done on site. The waiting room at the imaging centre was eerily quiet. A pimpled teenager in his soccer strip was rubbing his knee, a woman in a cherry-coloured jump suit flipped through a magazine and chewed gum, and an elderly couple whispered questions to each other. Soon we would all be stripped of our rings and clothing, lying still and silent while having mammograms, heart scans, MRIs, or, in my case, all three. It was a room full of vulnerable people who would prefer to be somewhere else.
A brain MRI is loud and claustrophobic but I found it relaxing. I lay back and listened to a ferocious clicking sound that confirmed my brain was being probed from the inside out. This new machine was only in its second week of use; the Ferrari of MRIs. The images would be clearer; the resolution higher.
Unable to wait, I jumped up and charmed my way into the technician’s room for a preview. He allowed me to look at an image of my brain on the computer screen. As he explained what some of it meant, I stared, thinking about how every word, every thought, every moral choice and the ability to decide, came from that image.
Dr Antonio Damasio, professor of neuroscience and neurology at the University of Southern California, explained:?“Science is progressing very fast in certain domains, but not so fast in others. So there is a mismatch between what we can diagnose and what we can provide for treatment.” For instance, an early diagnosis of a disease such as Alzheimer’s, where the treatment has not caught up to the science, would be incredibly damaging psychologically.
A few days passed. Tim and I were called to see Dr William Fulton at Kronos to go over the results. The doctor sat calmly behind his desk, wearing his white lab coat. Our enormous individual binders waited, like the Torah of Wellbeing, to be interpreted. It was our moment of truth. For me, the two areas that mattered most were the areas that yielded abnormal results. There were traces of blood in the urine. This was unusual. Dr Fulton was only doing his job when he answered my next question with frank sincerity. “Tell me,” I stammered. “What’s the worst-case scenario?”
Nobody likes to hear the word “cancer”. Even Tim looked worried. In an effort to make me feel better, Dr Fulton emphasised that my potential for heart disease was far more likely to be a problem than cancer, because my cholesterol levels were very high. This surprised me, since I am a vegetarian who exercises regularly, and for a second I couldn’t figure out which was more disturbing: cancer, or a life without cheese and milk.
Dr Fulton explained that it was probably genetic, but I had a hard time focusing on what he was saying because once you hear the word “cancer”, it’s a long way back to cholesterol. It didn’t help that Tim, who eats something called a chip butty, was fine. But then he was presented with a potential heart problem. With both of us now dying, one worry had to take precedence.
I called my GP in New York. In my “I-might-have-cancer” stupor, I left a message, and as I waited for him to call back, phoned my father to share the bad news. But owing to a long history of hearing about my fatal diseases, I had to put Tim on the phone to vouch for the gravity of Dr Fulton’s tone. Tim, who had never spoken to my father before in his life, was now conversing with him in a dire manner about bladder cancer, heart disease, and blood in my urine. When the phone was passed back, my father told me a story. He was once informed he might have tuberculosis only to find out later that it was a fingerprint on the x-ray. There are mistakes, he said: medicine is an art. This sentiment was echoed by my doctor, who dismissed that this was anything serious. As soon as I spoke to him, I felt better. The familiar voice of authority protected me from obsessive thoughts. Though they didn’t cease entirely, they eased up just enough for me to function.
A week later, I was retested and the results were normal. My doctor, a New York City internist, Dr Robert Samuelson, explained: “The issue is not whether science can tell us things that we don’t know, but whether this knowledge can actually prevent disease or prolong the quality of life. For example, while a CAT scan might disclose a tiny nodule or shadow somewhere in the body, the overwhelming majority of these nodules are benign. But once found, they cannot be ignored; they have to be followed up and possibly biopsied and removed. It takes a lot of unnecessary worrying and invasive procedures to learn that your spot was benign! Additionally, it’s never been proven that removing tiny early cancers in the lung, for example, actually saves lives. The cancers that kill are probably not these tiny cancers that we can detect early.”
Moreover, a lot of tests, he said, are interpreted out of context of the whole being. An isolated lab value may appear abnormal, but when it’s evaluated along with everything else we know about someone’s health and lifestyle, the value is no longer abnormal. His perspective was in contrast to the Kronos philosophy, in that tests are worthwhile if they are highly specific for diagnosing a disorder, and if there is a safe, effective way for treating the disorder. But in some cases, such as mine, they merely provoke a lot of needless anxiety.
According to a 1998 report published in the Journal of the American Medical Association, over 100,000 Americans die every year from adverse drug reactions — a higher figure than those who die in car accidents. Genelex, a Seattle-based company, offers DNA tests, one of which can determine how the liver metabolises and processes prescribed medications. When given to a physician, this profile can prevent future catastrophes by lowering the incidence of an adverse reaction.
Each person falls into one of the four categories for each of the pathways tested. There are ultra-extensive, extensive, intermediate and poor metabolisers. I am intermediate. I metabolise medicine slowly and will need a lower dosage, as they build up in my system. Had it turned out I was an ultra-extensive metaboliser, I would be in terrible pain after surgery because the painkillers would have little or no effect.
One area of testing where I had no anxiety was the psychometrics. Maybe because there is nothing about my mental health and ability to function that could astonish me. At the Psychometrics Centre we were given a set of tests to determine our ability to function in the workplace. What stood out were my strengths: creative, insightful, careful and sensible when carrying out tasks, effective and confident when it comes to hard work. It also determined my weaknesses: no discipline, suspicious of the intentions of others, may ignore the advice of those who know better. Of course, I’m not sure I agree with the experts on that.
Nearing the end of this journey, I was forced to overcome my trepidation at tackling a psychological, rather than physiological, reality. At 38, was I ready to take responsibility for having procrastinated procreation? The Fertell female fertility test measures the ovarian reserve. It is an easy test with immediate results and has proven to be over 95% accurate. As it turns out, my ovarian reserve was normal. Great. I was fertile with no one to share my fertility with.
So in the end, what did it all add up to? I am healthy. And when I thought I might not be, my reaction surprised me. Because, after the initial shock, my immediate impulse was to want to know more. I did not fall into a sinkhole of inertia; denial was no longer an option. Science has told me something unscientific. That panic is about helplessness, and with information comes a sense of control. I’m grateful there is nothing wrong, but aware that this respite is fragile and temporary. Despite all this I remain, where health is concerned, as vigilant as ever. Only now, when I have dry eyes or bleeding gums and assume that it’s indicative of something fatal, instead of avoiding it, I’ll want to know.
From the U.K. Sunday Times Magazine, April 30, 2006
posted by Dr. Joe at 3:51 AM
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