Author of “The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Healthcare”, Dr. Eric Topol sits down with OneMedRadio to discuss the ideas and inspiration behind the book. Topol was selected as one of the 12 “Rock Stars of Science” by GQ and the Geoffrey Beene Foundation in 2009.He was elected to the American Society for Clinical Investigation, the Association of American Physicians, and the Johns Hopkins Society of Scholars. In 2004, he was elected to the Institute of Medicine of the National Academy of Sciences.He was named Doctor of the Decade by the Institute for Scientific Information for being one of the top 10 most cited medical researchers. In 2011, Topol received the Hutchinson Medal from the University of Rochester in addition to giving the commencement speech for the School of Medicine and Dentistry. In 2012, Modern Healthcare ranked Topol as the most influential physician executive in the United States.
Click below to hear full audio interview and see transcript that follows.
Brett Johnson: Welcome, Brett Johnson, New York City, OneMedRadio. Today, I am with Dr. Eric Topol. He is the author of The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Healthcare. Dr. Topol is a director of the Scripps Translational Science Institute and the co-founder and the vice-chairman of the West Wireless Health Institute. He’s regarded as one of the country’s leaders and has been one of the most cited clinical research in the area of Cardiology. He’s a member of the National Academy of Sciences. He’s been named one of the 12 rock stars of science in GQ. Thanks for joining us today, Eric.
Dr. Eric Topol: Oh, great to be with you Brett.
BJ: So Eric, can you quickly tell us why did you write this book?
ET: That’s an easy one. For me, it was that I’ve never done a book for the public, but I saw the changes that were occurring, what can occur in medicine are profound, and they only would occur in a reasonable timeframe if I could get consumers educated and activated, and that was all about getting a book out that hopefully would be having the right information, be readable, and help stimulate a conversation.
BJ: What do you think are the things that are the most important for people to know?
ET: Well, I mean there’s a couple things that probably are major themes that are not generally appreciated, but the first might be the fact that we had this remarkable asymmetry of information, with the medical community and doctors being the ones that held all the data and information, and now, that’s, rapidly moved to the patient and consumer level, and that will be held on smartphone, or from a genome sequencer, all sorts of ways that that shift is very rapidly going to occur, and that I think is something that represents the biggest shift in history of medicine alone because that’s like back to the printing press days and the whole Gutenberg transformation.
So that changed a lot of what tradition to do. Instead of being the holders of the day, they’re helping to interpret and partner with patients, and that’s a really big shift at how obviously a lot of physicians are not ready to make nor the American Medical Association, and many other parts of the medical community.
So that’s one big thing that this book is emphasizing, and I don’t think a lot of people realize that this has already started, and there was a false sense that that was going to happen in the ‘90s with the internet and access to medical information, but that turned out to be completely wrong because while you can get information through the internet, it’s not your information and this is a whole different look when it’s actually your data whether it’s your blood pressure or you name it to your data, and now it’s processed, through all sorts of algorithms and geographically displayed, and all of a sudden now, you’ve got insights you’ve never had before, and I include none of us had before because we didn’t have a way to get a blood pressure reading every minute, not even, during sleep or to do one’s own sleep studies at home, and all sorts of things like that.
The other big one though is more in the future like where is this take us to, and that’s where that shifted people have talked about for years. It needs to occur from sickness to wellness or what I should say chronic disease to prevention of disease, and I think we have the tools and the power to now make that shift. And I say that because, the science is advancing so quickly, and we can bring together disciplines in biomedical research that never occurred before.
I’m particularly referring to as one example of embedded nanosensors.
You probably saw in the book about where this can go, but when you take a sensor that’s the size smaller than a grain of sand and put it in the bloodstream, and now, you have personally no added power requirement because just the blood moving itself is enough to power a nano chip for years. So now you have a sensor that can see something that’s circulating in the blood on a moment-to-moment basis, which whether that’s a cancer cell, the first cancer cell, or whether that’s a cell sloughing off from an artery that’s ultimately going to lead to a heart attack, or whether that’s an antibody that’s directed against one own tissue like the pancreas islet itself or diabetes or any other immune disease like, for example, a multiple sclerosis attack before it ever happens or asthma, you name it. You’ve got embedded now sensors and signals that we never would conceive as possible.
A lot of people think, oh genomics. Genomics is just a sequence and how you’re going to have susceptibility to diseases defined, but no, I look at it as genomics is having your body under constant surveillance because genomics gives us new markers of that afford prevention, true prevention for the first time. So you not only know who by genomics might need the sensor, the nanosensor embedded, but you’re also using genomic signatures to direct the signal from the nanosensor to the cell phone. It’s basically turning a body, digitizing you and being like a car where it says lights up, you know, your doors open or your transmission is shot, and here, you’ve got the same warning lights on your phone about your body.
BJ: Now, is that going to be economically possible?
ET: Oh, it’s going to be economically not possible to use it because pervading diseases, of course, isn’t worth all that
BJ: Right.
ET: So once you have a stroke, or once you’ve got a significant heart attack, or once you developed a metastatic cancer, the cost of those things are profound. So if you can prevent any of them, any of these chronic diseases, that is going to be like the greatest return on our investment we could imagine.
BJ: Right. So you see hope that the dilemma of unsustainable healthcare cost could be a sense reversed or certainly diminished by the development of this new technologies.
ET: Yes. I mean I think the ones that we’re discussing, of course, are little ways off, but even today, you could remotely monitor people to keep them out of the hospital. That’s going to become really big in the next year or two. You can prevent the need for sleep study in the hospital which cost $3,000 just by doing it in one’s own home, the comfort of your home bed, for instead of $3,000, you can do it for $100.
And then you can use that same equipment for everybody in the neighborhood like in a family.
So the whole idea is that this is innovating out of the mess that we’re in in healthcare crisis, and one of the frequent questions is well, you’ve got this great technology. It’s very hyper innovative, whatever, but in the past, new technology in the biomedical spaces lead to increased cost, which is kind of what you were getting at, and the difference here is that that could not even be conceived, and new technology now at increased cost is dead in the water.
ET: If it doesn’t have a marked-savings-pay-for-itself-type look it’s not going to go anywhere.
BJ: Right. So the kinds of things you’re describing are really changing the way the healthcare system works, in any case, you talked about in your book, it’s ossified, it’s rigid, it’s the least flexible, and it has made little or no change. Can these new ideas overcome the status quo of people not wanting to change because it changes the economics of our entire existence?
ET: Yes. I really think that’s the case. We’re about to witness, especially if we take a blurred temporal window of some X number of years now, this enormous shakeup like that which we’ve never seen. And in this, new tools, just as we saw how mobile device has changed our daily lives in the last decade, this is the next phase. This is the most precious for our health. So I don’t have any question of the power of the tools that we have at our disposal and how they’re going to continue to really zoom ahead, but this is much more transformative than most people would even imagine.
BJ: Is there going to be pushback from the status quo?
ET: Oh, there always is, especially in the medical community. And the problem partly there is there’s so many threats to reimbursement. When you don’t have to go to an optometrist, but you can just get a $2 add-on to your phone and look in it and get refraction of your eyes, and text to get your eyeglasses made, or you can just take a picture of a skin lesion and don’t have to go to the dermatologist and on and on and on, there’s a lot of pushback, a lot of threat of the traditional reimbursement channels which doesn’t go over too well.
BJ: No, but which means the whole idea of consumers in health is necessary for this to work.
ET: That’s actually the big old reason why I did the book is I felt like we need to fire up the consumerism and the activism. I mean this is what it’s all about. It won’t happen soon enough without that force. And that force is a multiplier now from the social network standpoint, and the power of people is so augmented today relatively to just a few years ago. So that’s why I really believe we have, to some person, an ability to catalyze this.
BJ: So has anyone done a book or who else has been in the space of trying to talk about the issues that you’ve been raising?
ET: I haven’t seen anything yet. I think the digital world is turning everything else upside down, but I haven’t seen yet a dedicated thing on this – I think the idea of their disruptive innovation of Clayton was as close as it was to get to it, but it wasn’t specifically all the digital tools that are going to achieve this, including on the consumer side, the social networking, which is a critical part of all this. But that book of his was, I think, published 4 years ago, and I think things have changed a lot since then.
And so I don’t know of anything else yet that’s been dedicated to have a digital revolution will feel this. And it ain’t just feeling the tool, but also the potential of this consumer-driven revolution. I mean there’s kind of this other level of it. It is oh yeah, they got this the ways to capture data that we didn’t have before, but it’s also getting that to be the mainstay of care prevention, you know, daily routine practice of medicine, and that normally takes 17 years, and that we can’t wait for, and hopefully, we won’t.
BJ: What can we do? What advice do you give to citizens today and how they can help make this new reality happen?
ET: I think that’s the key. What I try to do is say, first of all, you need to seize control of your data because it’s going to be a lot – there’s going to be a flood of it coming and you will be directing it. So for example now, there are recent things like a JAMA paper. Should patient have access to the laboratory data? And I’m saying, “Wait a minute now. How can you publish an article with that question in 2012?”
So the idea that each citizen owns their data and so, that’s like step number one. That includes genomic data, laboratory data, scan data. Of course the office notes across the board. Now, built on that framework and that tenet is the idea that there are new data to be had, and so if you have high blood pressure, you may want to get an app for your phone like the High Health to get a lot more readings that, of course, will be graphically displayed on your phone, and then of course, you can share that with your physician, but also, you know, let’s apply that across the board to other things whether it’s glucose or brain waves for sleep, or you know, and on and on and on.
That data you can get now. And so do you know that? Do you want to get this? Are you ready for this? Are you ready to go beyond e-mail and surfing the web on your phone?
BJ: Interesting. So what’s the next step? Now you’ve done this book. Do you plan a follow up or is there any ongoing work to get this message out?
ET: That’s a great question. I mean I need a recovery period since the book took more out of me than I ever imagined, and it was the hardest I’ve ever worked on anything in my whole career so I got to take a break from that, but I – To me, right now, the whole idea is to try to get as many interested parties like yourself to help prod and get the conversation into higher gear. And so whether it’s people like Reed Tuckson at United Health is a big advocate now. They represent the healthcare industry. Or the informatics, the HIMMS Organization, or mHealth, and the CTA wireless organizations, companies that you might not have ever thought of that would be engaged, but maybe, companies like Qualcomm or Apple, or, GE.
So if we start getting this from multiple fronts, and I’m just kind of a cheerleader here, but if we get key leadership across large segments of the healthcare industry, and in particular, more than anything, consumers, then we can start to, get this actualized.
BJ: Well, thanks for joining us today.
ET: Yeah, I really enjoyed the discussion with you.
BJ: Okay, so that is Eric Topol, M.D., who has written the book The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Healthcare. It’s recently out now, and is, I think, one of the best books that’s been written on understanding the rapidly changing healthcare world. This is Brett Johnson in New York City with OneMedRadio. Good day.