Dis­rup­tive doc tops list of 50 Most In­flu­enc­tial physi­cian ex­ces

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The eighth an­nual Mod­ern Health­care/Mod­ern Physi­cian rank­ing of the 50 Most In­flu­en­tial Physi­cian Ex­ec­u­tives is in­dica­tive of the trans­for­ma­tion the health­care in­dus­try is un­der­go­ing. A num­ber of the names that have ap­peared peren­ni­ally on the list are gone or moved down in the rank­ings (par­tic­u­larly those with Washington ad­dresses), and eight new names ap­pear this year—in­clud­ing Dr. Eric Topol, who de­buts at No. 1 on the strength of his book, The Creative Destruc­tion of Medicine: How the Dig­i­tal Rev­o­lu­tion Will Cre­ate Bet­ter Health Care.

While oth­ers de­bate ar­cane le­gal points and the philo­soph­i­cal slip­pery slopes per­tain­ing to the Pa­tient Pro­tec­tion and Af­ford­able Care Act, Topol in­stead writes about how “a pro­pi­tious con­ver­gence of a ma­tur­ing In­ter­net, ever-in­creas­ing band­width, near-ubiq­ui­tous con­nec­tiv­ity, and re­mark­able minia­ture pocket com­put­ers in the form of mo­bile phones” are tak­ing physi­cians and pa­tients where no one has gone be­fore.

Topol throws down the gaunt­let im­me­di­ately by open­ing his book with this quote by Voltaire: “Doc­tors pre­scribe medicine of which they know lit­tle, to cure dis­ease of which they know less, in hu­man be­ings of which they know noth­ing.” He later quotes Ge­orge Or­well, who called hos­pi­tals the “an­techam­ber to the tomb.”

“We need a jailbreak,” Topol writes. “Medicine is about to go through its big­gest shakeup in his­tory.”

Among his big­gest sup­port­ers is Dave deBronkart, bet­ter known in cy­berspace as “e-Pa­tient Dave,” a for­mer stage-four kid­ney-can­cer pa­tient and now a board mem­ber of the So­ci­ety for Par­tic­i­pa­tory Medicine. He says he likes the use of the phrase “creative destruc­tion,” a term pop­u­lar­ized by Aus­trian econ­o­mist Joseph Schum­peter’s book Cap­i­tal­ism, So­cial­ism and Democ­racy pub­lished in 1942.

“What Topol cor­rectly iden­ti­fies is that health­care is not shat­ter­ing or blow­ing up, but it’s be­ing un­bun­dled and the pieces are re­com­bin­ing in dif­fer­ent ways,” says deBronkart, who made waves re­cently by post­ing on his web­site a re­quest for pro­pos­als to re­move the skin can­cer cells from his jaw.

“He sees more clearly and pre­cisely what’s hap­pen­ing—in­clud­ing the un­der­ly­ing mech­a­nisms,” deBronkart adds. “The peo­ple who say, ‘No, no, hold back the tide’ will have an un­happy out­come.”

Topol says, at least par­tially be­cause “there isn’t a pat­tern in medicine for act­ing quickly,” he struc­tured his book more for public con­sump­tion rather than for his peers who have so far shown re­sis­tance to ge­nomic medicine, us­ing tech­nol­ogy such as wear­able body sen­sors and fail­ing to rec­og­nize that “the most ex­cit­ing time ever in the his­tory of medicine and health­care lies be­fore us.”

“The idea was that, con­sumers—if they were ed­u­cated about these pos­si­bil­i­ties—they would want them, they would drive this so much more,” Topol says. “It will be a joint part­ner­ship with physi­cians, health­care sys­tems, but hope­fully, in many ways, the lead­ing edge will be con­sumer be­cause it’s the pa­tient that has the most vi­tal in­ter­est in his or her fu­ture health.”

What pa­tients will re­al­ize first, ac­cord­ing to Topol, is that they will have ac­cess to in­for­ma­tion that they never had be­fore. This will in­clude data on their blood pres­sure, glu­cose lev­els, hearth rhythm, brain waves, even in­for­ma­tion on how as­pects of their genome will in­ter­act with the drugs their physi­cians are pre­scrib­ing—and this all will be avail­able on their smart­phones.

In his book, Topol talks about the re­sis­tance to al­low­ing pa­tients to have ac­cess to their own health­care data, writ­ing that “The Amer­i­can Med­i­cal As­so­ci­a­tion has lob­bied the gov­ern­ment hard for con­sumers not to have di­rect ac­cess to their ge­nomic data, that this must be me­di­ated through physi­cians.”

Ac­cord­ing to the AMA, how­ever, Topol has “mis­char­ac­ter­ized the AMA’s po­si­tion on di­rect-to-con­sumer ge­netic test­ing.”

“This test­ing can be a valu­able tool to aid in di­ag­nos­tic and ther­a­peu­tic de­ci­sions, and the AMA sup­ports the rights of pa­tients to ob­tain this in­for­ma­tion,” AMA Pres­i­dent-elect Dr. Jeremy Lazarus says in an e-mail. “Be­cause the re­sults of ge­netic tests are sel­dom straight­for­ward and the health con­di­tions they ad­dress are com­plex, they should be done with the guid­ance of a physi­cian, ge­netic coun­selor, or other ge­net­ics spe­cial­ist.”

With­out proper coun­sel­ing, Lazarus says, pa­tients may need­lessly spend money or mis­in­ter­pret test re­sults, which could lead to mak­ing “un­nec­es­sary or un­healthy life­style changes.”

Oth­ers, though, are viewing Topol’s book more pos­i­tively, and its pref­ace in­cludes words of praise from for­mer Na­tional In­sti­tutes of Health di­rec­tor Dr. Elias Zer­houni,

10. Robert Wah

CMO, Com­puter Sci­ences Corp., Falls Church, Va.; board chair­man, Amer­i­can Med­i­cal As­so­ci­a­tion

9. Reed Tuck­son

Ex­ec­u­tive vice pres­i­dent and chief of med­i­cal af­fairs, Unit­edHealth Group, Min­netonka, Minn.

2. Gary Ka­plan

Chair­man and CEO, Virginia Ma­son Med­i­cal Cen­ter, Seat­tle

5. Richard Gil­fil­lan

Di­rec­tor, CMS Cen­ter for Medi­care & Med­i­caid In­no­va­tion, Bal­ti­more

7. Bar­bara Paul

Se­nior vice pres­i­dent and CMO, Com­mu­nity Health Sys­tems, Franklin, Tenn.

4. Farzad Mostashari

Na­tional co­or­di­na­tor for health­care in­for­ma­tion tech­nol­ogy, ONC, Washington

12. Charles Soren­son

Pres­i­dent and CEO, In­ter­moun­tain Health­care, Salt Lake City

6. Kelvin Baggett

Se­nior vice pres­i­dent and CMO, Tenet Health­care Corp., Dal­las

13. Ge­orges Ben­jamin

Ex­ec­u­tive di­rec­tor, Amer­i­can Public Health As­so­ci­a­tion, Washington

11. Su­san Tur­ney

Pres­i­dent and CEO, MGMA-ACMPE, En­gle­wood, Colo.

8. Lanny Copeland

CMO, LifePoint Hos­pi­tals, Brent­wood, Tenn.

3. John Nose­wor­thy

Pres­i­dent and CEO, Mayo Clinic, Rochester, Minn.

22. Wi­ley "Chip" Souba Act­ing di­rec­tor, Dart­mouth In­sti­tute for Health Pol­icy & Clin­i­cal Prac­tice, Le­banon, N.H.

23. Prem Reddy Founder and chair­man, Prime Health­care Ser­vices, On­tario, Calif.

24. Ralph de la Torre Chair­man and CEO, Stew­ard Health Care Sys­tem, Bos­ton

25. John Halamka CIO, Beth Is­rael Dea­coness Med­i­cal Cen­ter and Har­vard Med­i­cal School, Bos­ton

18. David Nash Found­ing dean, Jef­fer­son School of Pop­u­la­tion Health, Philadel­phia

19. Peter Pronovost Di­rec­tor, Qual­ity and Safety Re­search Group, Johns Hop­kins Medicine, Bal­ti­more

20. John Koster Pres­i­dent and CEO, Prov­i­dence Health & Ser­vices, Ren­ton, Wash.

21. Jonathan Per­lin Pres­i­dent of clin­i­cal ser­vices and CMO, HCA, Nashville

14. Robert Wachter Chief of hospi­tal medicine, UCSF Med­i­cal Cen­ter, San Fran­cisco

15. David Pryor Ex­ec­u­tive vice pres­i­dent, As­cen­sion Health Al­liance, St. Louis

16. Regina Ben­jamin U.S. sur­geon gen­eral, U.S. Public Health Ser­vice, Rockville, Md.

17. Larry Wel­lik­son CEO, So­ci­ety of Hospi­tal Medicine, Philadel­phia

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