Creative destruction

Eric Topol advocates a digital revolution in medicine.

When Eric Topol, M.D., (M ’79) wrote his address for the University of Rochester School of Medicine and Dentistry’s Class of 2011 commencement ceremonies, he intended to title his speech “The Creative Destruction of Medicine.”

But Mark B. Taubman, M.D., dean of the School of Medicine and Dentistry, told Topol his title would “scare everyone” and urged him to change the title. Topol’s wife and his daughter agreed with the dean, so he changed the title of his address to “Medicine Rebooted.”

But Topol did not relinquish the title or the concept. Earlier this year, he published a book titled, The Creative Destruction of Medicine, and he is shaking up people, if not scaring them, and trying to get them to join the digital revolution he believes will make health care better.

“I’m trying to get my colleagues and the public to realize there is a new exciting opportunity to change medicine by embracing new technology and tools-such as genome sequencing and wireless wearable sensors-that can bring a new height of precision to medicine,” Topol said in an interview. “I’ve been seeing things that can change the practice of medicine dramatically. I can see where this is all headed. It is happening in the digital world, but just hasn’t invaded the medical cocoon.”

Like a preacher on a mission, Topol is taking his message to the public, reiterating his points in interviews and lectures. A number of his talks are available on YouTube. And he is not being mild-mannered.

“This will be a consumer health revolution. People will drive it,” Topol said. “This is the printing press and the Gutenberg Bible that started opening up reading and knowledge to the people. Doctors have had all the information until now. That is changing. With the smartphone, sensors and other tools, we can build a social medical health network and create a level playing field of information … This is not just a mini-disruption; it’s a mega-disruption. It is the biggest shake-up in medicine ever.”

Topol has the credentials to support his predictions of significant change.

Known as one of the nation’s top medical researchers, he is the director of the Scripps Translational Science Institute in California, which focuses on individualized medicine. He also is the chief academic officer of Scripps Health, a senior consultant cardiologist practitioner at Scripps Clinic, professor of genomics at The Scripps Research Institute and co-founder and vice chairman of West Wireless Health Institute, which develops wireless health technology as a means to lowering health care costs.

Author of more than 1,000 original peer-reviewed publications, Topol has edited more than 30 books, including major textbooks on interventional cardiology and cardiovascular medicine. He has been elected to the Institute of Medicine of the National Academy of Sciences. And he was voted the number-one most influential physician executive of 2012 in a national poll run by Modern Physician and Modern Healthcare.

Topol is not only challenging his colleagues in medicine, he is participating in the revolution.

“I haven’t used a stethoscope in more than two years to listen to the heart,” he said. “I use a portable high-resolution ultrasound. I’m showing the patient what I see in real time. 
If they went for an echo, they never would see it. They would be sent to a lab. The person who administers the ultrasound can’t tell the patient anything. They have to call their doctor to get a report. I’m talking to the patient as I examine the heart. I can show a valve that is not moving properly. That is powerful and intimate. Tools used properly can heighten the relationship between doctor and patient. Ultimately, George Engel would celebrate this change.”

Topol has tried a glucose monitor that links to an app on a smartphone.

“It was an education for me discovering what I ate that sent my glucose way up. It has changed my lifestyle,” he said. “Sensors are not only for the gym, for counting our steps or tracking our heart rate when we exercise. When sensors get into the medical space, everyone will realize the opportunities.”

Topol is leading a study of whether a new technology called the Zio Patch, a wireless monitor that is applied to the chest like an adhesive bandage, does a better job detecting arrhythmias than the Holter monitor. The Zio can monitor the heart for up to 14 days. After the prescribed time, the patient removes the patch and mails it for analysis.

“It is amazing how simple it is,” Topol said. We are using the Holter, an invention from 1949 with wires that won’t allow you to shower or exercise. You can only use it for a day and it is very expensive. You have to go to a hospital to get hooked up and back to a hospital to have it removed. This trial will show whether this patch can deliver better diagnostic information than the Holter. This is symbolic of creative destruction. We’ve been using the same technology for almost 70 years. This could be a better idea. 
We can do better.”

A wireless monitor that can track heart rhythms and report by smartphone will help physicians mange patients remotely and reduce visits to hospital emergency departments and unnecessary admissions, Topol said. Sensors can pick up conditions that could cause an asthma attack, warn the patient and preempt the attack. Sensors can monitor sleep patterns in the home.

“These technologies and these changes will not increase health care costs. They are ways to cut costs,” Topol said. “We’re spending $300 billion a year for prescription drugs and $100 billion is waste or the wrong drug or wrong dose for the person. We can do genomic screenings to match up the patient with a drug and dose that works and avoid serious side effects. There will be enormous savings every year.”

Why don’t we do many office visits with Skype? he asks.

“It would make in-person appointments less frequent and reduce costs,” Topol said. “For the patient, it would eliminate an hour’s wait after going through the hassle of driving and parking. With the use of sensors, all the data could be gathered in advance of the Skype call or in real time. You can have 10 minutes on a video link with streaming information. It is intimate and will increase the interaction. If widely used and properly reimbursed, it will make it easier for patients to have access to their doctors and it will give doctors a reach that is amplified.

“One study has shown that 62 percent of doctors refuse to communicate with patients by e-mail. I’ve been e-mailing my patients since the 90s. We have to get over this stuff. Studies by organizations like Kaiser have shown communication between doctors and patients improves efficiency and reduces need for office visits.”

Consumers have reacted strongly and positively to his message of “creative destruction,” Topol said.

“Whether we’re talking about the genome or blood pressure sensors or glucose readings on a smartphone, they want to be there. They want to consult with their doctor. They want a partnership,” he said. “These changes can make medicine so much more efficient and scientifically sound. We will have information and data on each individual patient we never had before. The data belongs to patients and they should own it. They should be our partner. The role of the doctor is changing and it means empathy and compassion are more critical now than ever.”

In an interview published by the website Medscape, Topol said the rise of technology and personalized medicine is inevitable.

“It’s just a matter of when. The question is: what is the plasticity of the medical community? What are the willingness and initiatives that could be taken on the physician’s side, or is this going to have to all be driven from the consumer’s side?,” Topol said. “It has to happen because we are in a situation that’s untenable and unsustainable in health care today. We can move to a whole new plateau where we have so much more data on each individual that we didn’t have before. Whether it’s high blood pressure or trying to prevent the progression from prediabetes to diabetes, we have new tools; there should be a new day in medicine if we are willing to accept that and try to catalyze this opportunity.”