Medicine has certainly progressed in the past 50 years, but the day when tricorders diagnose every ailment instantly and treatments are tailored to our DNA seems as far off as ever. Eric Topol is trying to bridge that gap. In his new book, The Creative Destruction of Medicine, Topol—the chief academic officer at Scripps Health—calls on patients to demand true digital medicine now. We talked to him about genetics, gadgets, and his vision of a Khan Academy for doctors.
Wired: Not many doctors get to take the stage at the Consumer Electronics Show, as you did in 2010. What was that like?
Eric Topol: It was a revelation. Normally people go to CES to learn about gizmos like HDTVs. And here I come to do a demo of wireless devices for health. The reaction was astounding: They began clapping when this little device I was holding showed an ultrasound of my heart on the big screen. It made me realize that consumers want to care about their health. They just need to get activated.
Wired: And that starts with this nifty concept you have of digitizing medicine.
Topol: Right. We understand digitizing a book, but what does it mean to digitize a human being? When I went to medical school, the term digital applied only to rectal exams. But today you can get a DNA sequence, you can get biosensors that record nearly every physiologic metric from blood pressure to brain waves, you can get a digital scan of any part of the body. These tools offer a window into each person that was unfathomable a few years ago.
Wired: But it’s not just the body; this scales up to the entire infrastructure of medicine.
Topol: That’s right. The digital world—the Internet and the cloud and supercomputing and social networking—is breaking medicine out of its cocoon. It’s a superconvergence we’ve seen in other walks of life but not in the health and medical sphere.
Wired: So what does digitized medicine get us?
Topol: We can start capturing people’s health data throughout their lives—all the little things that have lasting implications. For instance, we can track cumulative radiation exposure from every scan and x-ray. And consider the risk of drug interactions: Every year hundreds of thousands of Americans wind up in hospitals or worse because we didn’t match up the patient genomically with the right drug or dosage. Just capturing those things could save thousands of lives.
Wired: How do we make this happen now, rather than just waiting for a new, net-savvy generation of doctors?
Topol: We need a Khan Academy for doctors: captivating 15-minute videos on genomics, on wireless sensors, on advanced imaging, on health information systems. These things can revive the excitement they felt as premeds, when they first decided to go into this field. If we can get practicing physicians up to speed and really inspired, maybe we won’t have to wait a generation. I shudder to think about waiting 10 or 20 years for this transformation to occur.
Wired: But there are obstacles. For instance, many people in the tech world are afraid of running into bottlenecks getting FDA approval for new medical devices.
Topol: The FDA is moving very slowly, with considerable restraint and resistance. That’s one reason the technology is years behind where it should be. One example is a device called AliveCor. It’s a couple of sensors on a case that you can put on the back of an iPhone or a Droid phone to get your electrocardiogram and heart rhythm. It’s very inexpensive—less than $100. You can even send the results to your Facebook friends. In Europe it’s already approved and available today. But not in the US. A lot of these great, innovative ideas like sensors or rapid point-of-care geno-typing are moving slowly through the process with a considerable lack of support, as I see it. And these are largely just diagnostic tools, not therapeutics.
Wired: Meaning that they’re not doing anything to your body; they’re just taking information.
Topol: Exactly. A perfect example would be the glucose sensor that you can put on and get a reading every five minutes.
Wired: Which has likewise been hung up in FDA limbo.
Topol: Yeah. If you’re a diabetic and you’re using a glucose sensor, you have to carry your phone and another device, because the FDA doesn’t want glucose going through the phone. That’s really unfortunate; people would rather not pull out a glucose monitor in public. If it were in their phone, it would look like they’re just checking email.
Wired: But people with diabetes have many tools to manage their disease, and they’re self-tracking their care. You could argue that’s the epitome of digitizing medicine and giving people access to tools. They should feel empowered. But here’s what I call the diabetic’s paradox: When you survey them about these tools, they say they’re a source of frustration and anxiety—all these negative emotions. Giving them this responsibility and the tools seems to be a burden.
Topol: That’s an important issue. Will having more information induce fear and anxiety? I personally believe that if the information is easy to obtain and work with, most people would want to have it. For diabetes in particular, we know there’s a relationship between lack of glucose regulation and complications like blindness and kidney failure. So if you were diabetic and you knew that you could get your glucose in a tight, normal range just by adjusting your lifestyle, wouldn’t that be great? It could be rather seamless in your life. And you could look at your data and start to figure out what works in you: How much do exercise and certain foods help? What’s going on in your life that gets your glucose out of whack? But instead, what we have now requires finger sticks multiple times per day, the ranges are fuzzy and inexact, and the tools are horrible. As long as it doesn’t involve pain, as long as it’s simple to use out of the box, this will work. This will be better. That’s what we’re aiming for.
Wired: You write a lot about imaging—x-rays, CT scans, MRIs—and how that’s all gone digital. And that’s very much a two-edged sword, as you well know.
Topol: Absolutely. We are grossly overusing imaging in this country, and that’s really scary to me. The mass use of radiation scans is way out of line with any other place in the world. There are estimates that 2 to 3 percent of cancers in the US each year are engendered by exposure to repetitive imaging. So I present this as a shout-out to consumers. When you’re asked to have a CT scan or a nuclear scan, do you know how much radiation that involves? How many of those sorts of scans have you already had? Is it necessary? Is there an alternative? I don’t think many people know about that. We need tools that let us track our radiation exposure for ourselves, each of us. So that, I think, is an important part of how we can reboot the future of medicine.