Interviews

Eric Topol, M.D. / Q&A for BN.com

In The Creative Destruction of Medicine, you argue that radical innovation and a true democratization of health care are within reach, but only if we consumers demand it. Why now?
Current medical practice is paternalistic, "Doctor Knows Best" because patients do not really have access to their own data. That is radically transformed in an era of wearable biosensors that connect to your smartphone, and rapid, affordable whole genome sequencing. The opportunity to know so much about the medical essence of oneself is going to be unprecedented...and we are well on our way now. No one has more vested interest in one's health than the individual. And finally each individual will have access to virtually everything that makes him or her tick!

What must consumers do now to make these changes happen?
Start by getting educated about the new options. About genomics and how each drug one takes interacts with your DNA—to avoid serious side effects or to make sure that the drug will actually work...and at the right dose. About which sensors can be used to track heart rhythm, sleep brain waves, glucose and virtually every physiologic metric. Moreover, start getting access to all of your office visit notes, lab tests, scans (including copies of the image and dose of radiation you were exposed to), and know that if you or a loved one develops cancer that only by request for some tissue to be frozen will proper DNA sequencing be possible. Most importantly engage with your social network to create and sustain a real consumer health revolution.

Why is the current medical community so resistant to change?
The medical profession is ultra-conservative. It took 20 years in the early 1800s for doctors to accept the use of a stethoscope, and not much has changed 200 years later. This will all happen eventually—it is inevitable—but we can't afford for individuals not to get optimal care and prevention NOW. And much of the innovations have the potential to markedly lower the costs of care, by making it much more precise, individualized, and ultimately preventive.

What other obstacles are there?
The regulatory agencies such as the FDA, which are especially risk-averse. The life science industry which has to reboot to develop therapies that are not for mass medicine, but now for highly select patients. That requires new models of clinical trials and new expectations for overwhelming effectiveness—now that we can digitize each human being. And a key caveat is that the doctor is involved as a partner, and does not treat the DNA, the scan, or the laboratory test—but treats the patient.

Would you expect such a transformation to dramatically lower insurance costs?
In the past, new technology has not lowered costs. But in the early going of this digital medical era (in its nascent phase) we are seeing exciting signs of frugal innovation, such as a portable high resolution pocket ultrasound device which should be part of the physical examination and could cut billions of dollars of unnecessary ultrasound scans each year. And wireless tracking of heart rhythm to avoid emergency room visits and hospitalizations.

How would patient privacy be assured in a world where every heartbeat is being recorded?
Once anything is digitized, there is a concern about hacking, leaking and a breach of privacy. The only approach that makes sense is that this has to be overwhelmingly positive and effective, while at the same time the risks of any leak of data be minimized to the nth degree.

What makes you so optimistic about this coming revolution?
This is unquestionably the most exciting time in medicine—as a physician and researcher for almost three decades—there has never been this potential for a radical change and upgrade of how we can render health care. And at the same time these incredible innovations are blossoming, the power of the people has soared to heights that were previously unimaginable. In parallel, and concurrently, a digital revolution that finally strikes medicine (it has hit virtually every other aspect of our lives) and a social revolution that has made things happen like the Arab Spring and Occupy Wall Street—we are well positioned for a creative destruction and rebooting of medicine going forward.