Promising Outcome for the Creative Destruction of Medicine


                Eric Topol, MD

An interview with Eric Topol, MD


       In his recent book, The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care, Eric Topol, MD, urges people to do no less than dismantle and reassemble their thinking about health care.
       Creative destruction conjures up in my mind a vision of The Who’s Pete Townshend smashing his guitar to smithereens. A dubious prescription from a renowned physician?
       Topol borrows the term from a mid-century economist, for whom it meant: transformation that accompanies radical innovation. Here it means looking clear-eyed with great optimism at what lies ahead. It views health care transformation under way, grounded in precision medical care and disease-prevention strategies that leverage all available resources—and fuses them into a paradigm shift.
       Topol, a cardiologist at the Scripps Clinic, serves as director of the Scripps Translational Science Institute and chief academic officer for Scripps Health, all in La Jolla, Calif. He is a professor of translational genomics at The Scripps Research Institute, and The Gary and Mary West chair of Innovative Medicine. Topol co-founded and serves on the board of the West Wireless Health Institute, a nonprofit applied medical research organization that takes aim at cutting costs associated with delivering health care. He serves as editor-in-chief of Medscape and theheart.org. He is among the most oft-cited researchers in medicine, and has been elected to the Institute of Medicine of the National Academy of Sciences.
       Health care technology has become so sophisticated that we can now “digitize” people, focusing in infinitesimal detail on their health status. Topol strives to rally consumers of health care services to become change agents, who, en masse, embrace a new model of health care delivery that engages their affinity for technology on many popular platforms they use today.
       In Topol’s view, the era of one-size-fits-all diagnostics and treatment is history. I asked him to fill us in. If you’d like to hear it in his own words, listen to the podcast here. 

CLP: You view “old” medicine as “dumbed-down,” and “new” medicine as being comprised of a synergy of wireless sensors, genomics, imaging, information systems, mobile connectivity and bandwidth, Internet, social networking, and computing power and data universe. How do the pieces fit together?

Eric Topol, MD: Well, that’s a big contrast. The way we practice medicine today is really at a population level, and we don’t have all the vital information about each individual. And the exciting thing is that we’re going to have that. We have a lot of that already today, and it’s just going to get enriched in an exponential fashion going forward. So, this is the most exciting time in the history of medicine. It’s also the biggest shake-up in medicine.

CLP: What will virtual office visits to the physician of the future look like?

Topol: Well, it turns out that they’re immensely popular when they’ve been used. There are studies now to show that the vast majority of patients much prefer a virtual visit. It doesn’t mean that physical visits, traditional visits, are going to be ruled out. They still will be used, but for limited purposes that can’t be matched by—or exceeded by—the virtual visit. The way it will look is that through video, secure connects, the data would be transferred either in real time, because of sensors that the person has on, or through screen shots, on the phone, or tablet. The doctor has all this stuff on a wall and can touch screens and look at all the data from that individual information and provide guidance and experience as to where to go from there. So, this will be very efficient because they can be data-rich, not requiring the usual prolonged wait to get into the office. And also, in fact, having complete contact, eye contact, rather than what is typically today keyboard tapping and lack of contact. So this can be a really great interaction if it’s framed properly.

CLP: Do you expect Watson (the IBM computer with remarkable artificial intelligence, famed for smoking its human competitors on the TV show Jeopardy) to play a significant role in the provision of health care? If so, what will it be?

Topol: I do think that the supercomputer, whether it’s Watson and other alternatives, are going to be a vital step forward in health care because we, as physicians in the medical community, cannot possibly store and keep up with the immense data that is continually being updated and upgraded. And so, when we see a complex individual, trying to assess just their differential diagnosis, to have the ability to read through tens of millions of pages of medical content in a few seconds, it’s something we’ll never be able to do. Whereby a supercomputer can be a great force to help give the entire medical [community] more literature up to the moment for the benefit of that patient’s diagnostic accuracy.

CLP: What is the necessary, appropriate democratization of DNA? You say getting more granular, drilling down into DNA sequencing, will move the field forward. Can you update us on this?

Topol: Right, so the problem we have today is that there’s a lot of movement against each person being able to access directly their DNA data. And we’re at a time when sequencing now, full, whole-genome sequencing—is possible and becoming eminently more affordable. So, organizations such as the American Medical Association and others have lobbied the government not to have physicians be bypassed—not to have direct access to consumers. I believe that’s a mistake, because it’s the individual’s DNA. And the more individuals cue into their own genomic data information, the better we will be. That has to come with educational tools, and with physician involvement, as appropriate. But it would not be appropriate, to me, to have this be required of a physician in order for each person to have access to their [DNA]. They have rights to their own genomic data.

CLP: Will cancer sequencing—digitizing the cancer—become a practical clinical diagnostics tool on a large scale any time soon?

Topol: I think we’re moving in that direction. It will take a while to get there. I think, routinely, in the future, people with a new diagnosis of cancer will have the tumor sequenced. They’ll have their own germ-line native DNA sequence that will determine what are the pathways responsible for the tumor, both at that moment, and potentially, if there’s a relapse in the future. That will really help design biologically matched, precise therapy. So, I think this is a really exciting time in cancer therapeutics based on matching up the biology of the cancer with the appropriate treatments. We don’t have all the treatments for all the different pathways that can cause cancer, but hopefully, a lot of those holes will get filled in over time.

Judy O’Rourke is editor of CLP. For more information, e-mail jorourke@nullallied360.com.