Destroying Medicine to Rebuild It: Eric Topol on Patients Using Data

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In his new book, the cardiologist and director of the Scripps Translational Science Institute is on a tear to transform health using the latest tech.

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The emergency announcement on the transcontinental flight was terse and urgent: "Is there a doctor on board?" A passenger in distress was feeling intense pressure in his chest.

Eric Topol strode down the aisle to examine the passenger to see if he was having a heart attack, a diagnosis that normally would be tough at 35,000 feet. But Topol was armed with a prototype device that can take a person's electrocardiogram (ECG) using a smartphone. The director of the Scripps Translational Science Institute near San Diego, he had just demonstrated how it worked during a lecture in Washington, D.C.

"It's a case that fits over your iPhone with two built-in sensors connected to an app," says Topol, showing me the device, made by Oklahoma City-based AliveCor. "You put your fingers on the sensors, or put them up to your chest, and it works like an ECG that you read in real-time on your phone."

"So I put the sensors right on the man's chest," he continues, "and I could tell he was having a heart attack. I said to the pilot: 'Get this guy off the plane, this is the real deal.' And they made an emergency landing. My understanding is he did very well."

Eric Topol has turned on his AliveCor sensor and tells me to press my fingers on the two slim metal sensors on the back of his phone. Immediately my pulse hops across the screen.

I'm now sitting with Topol in his office just above the Pacific Ocean in La Jolla, California, as the sun sets and hang gliders soar over an impossibly idyllic beach. He has turned on his AliveCor sensor and tells me to press my fingers on the two slim metal sensors on the back of his phone. Immediately my pulse hops across the screen, settling in at a normal 70 beats per minute.

"I use it when I see patients," he says. "I don't do a formal cardiogram anymore. If you had some heart arrhythmia or you were prone to dizziness, lightheadedness, or pounding -- we'd give you one of these, you'd put it on your phone." He tells me the device has yet to be approved by the Food and Drug Administration (FDA) in the United States, but it's about to be approved in Europe.

"This can't come fast enough," he says with intensity, a tall, lean man who is big like a professional basketball player is big. His face is narrow with the perpetual half-smile of a physician wanting to convey both good humor and authority. "This device is ready right now to save people in ways that has never been possible before."

Topol speaks with the same ardor and edge that led him in 2004 to publicly challenge drug giant Merck about the safety of their then-multi-billion dollar pain drug, Vioxx. Vexed by their refusal to acknowledge a potentially fatal side effect of the drug for patients with heart disease, Topol also went head-to-head with the leadership of the Cleveland Clinic, where he then served as chair of the department of cardiology. The flap led to Merck pulling Vioxx from the market, and to Topol's departure from Cleveland Clinic.

Now Eric Topol has now written a book that calls for the "creative destruction" of the current medical paradigm, which he believes has failed to keep up with the digitized world of interactivity, social media, computers, apps, and advanced engineering and electronics. In the book, written in that same half-smile style of good humor and authority, Topol blasts current-day medicine as being archaic and wasteful, making his case with a compelling blend of statistics, anecdotes, and barbs aimed at health care's Ancien Régime.

If at times he seems a whiff too optimistic about the transforming impact of new medtech in the short term, he does a good job of explaining subtleties to a lay audience -- such as why some genetic testing for predicting disease is valid and useful, and why much is not.

I came away wondering, however, if there was going to be a Creative Destruction, Part II that delves more deeply into exactly how the destruction and rebooting Topol proposes will happen. As Thomas Kuhn wrote in The Structure of Scientific Revolutions, changing paradigms is not easy. "No part of the aim of [traditional] science is to call forth new sorts of phenomena," Kuhn wrote, "indeed those that will not fit the box are often not seen at all."

As Topol rightly points out, the barriers are formidable, from an FDA struggling to keep up with an explosion of new technologies to a reimbursement system for health care that favors expensive and complicated tests and procedures that utilize hospitals and massive infrastructure. Topol believes that consumers teaming up with innovators in the med-digital world are the key to forcing change, which is certainly true. But how exactly will this work?


Below are excerpts from the rest of my conversation with Eric Topol.

In your book you write about the need to destroy the current medical system and start over. What's wrong with how we do things now?

The current system is outmoded. Most important is how the medical community is failing to take advantage of radical new technologies that allow us to treat patients as individuals. Medicine is still all about treating populations, not people -- one-size-fits all treatments and diagnoses. We now have the capacity for digitizing human beings. We've never had the ability to measure blood pressure 24 hours a day, or heart rhythms whenever you're not feeling right, or blood glucose levels every minute. But it's even deeper than that, it's using data to get to the root cause of disease in individuals so you can prevent illnesses for the first time.

Can you give me some examples?

I have this device where I can measure my glucose every minute and download it to my phone -- you attach a sensor with a little needle and you wear it on your stomach, or under your arm. Seeing your glucose every minute on your phone, it really changes your lifestyle. You ask yourself, "Do I really need that piece of cake? No, because I don't want to stress out my pancreas."

So can you really see the spike of sugar. How quickly does it happen?

Oh, immediately. It's unbelievable -- you're chewing and minutes later it's there. This device is pretty important when the world has a billion pre-diabetics and 400 million diagnosed diabetics. If we could start getting people to use these monitors linked to their smartphones -- you know there are more cell phones than toilets or toothbrushes in the world? If we could get people to use this on a smartphone, even for a week, maybe we could get a handle on the diabetes epidemic.

One sensor that's ready now is the wearable blood pressure cuff.

How are you going to take blood pressure during sleep? Or when you're in an argument, or stressed? Soon you will be able to get your blood pressure anytime and have it on your phone. Seventy million Americans have high blood pressure. Half of them have poor control and they're sitting ducks for a heart attack or stroke. This is a big time game-changer.

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David Ewing Duncan is a journalist in San Francisco. He is also a television, radio, and film producer, and he has written eight books. His most recent e-book is entitled When I’m 164: The Science of Radical Life Extension, and What Happens If It Succeeds. More

Duncan's previous books include Experimental Man: What one man's body reveals about his future, your health, and our toxic world. He is a correspondent for Atlantic.com and the Chief Correspondent of public radio's Biotech Nation, broadcast on NPR Talk. He has been a commentator on NPR's Morning Edition, and a contributing editor for Wired, Discover and Conde Nast Portfolio. David has written for The New York Times, Fortune, National Geographic, Harper's, The Atlantic, and many other publications. He is a former special correspondent and producer for ABC Nightline, and correspondent for NOVA's ScienceNOW! He has won numerous awards including the Magazine Story of the Year from the American Association for the Advancement of Science. His articles have twice been cited in nominations for National Magazine Awards, and his work has appeared twice in The Best American Science and Nature Writing. He is the founding director of the Center of Life Science Policy at UC Berkeley, and a founder of the BioAgenda Institute. His website is www.davidewingduncan.com

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