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. By Ariel Leve.
ARIEL LEVE FILE
HABITS: Health-conscious, germophobic
APPETITES: Caffeine addict
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,
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
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
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
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
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.