Digital health
Meet the multitalented Dr. Eric Topol
Prof. Eric Topol – regarded as one of the most famous physicians in the US – has rare visionary talents and research skills. He shook up the medical world with his meticulously researched The Creative Destruction of Medicine in 2012 and The Patient Will See You Now: The Future of Medicine is in Your Hands in 2014 on the immense potential of the Internet technologies and smartphones to democratize medicine and shift responsibility for health to patients. He also was among the first to blame heart attacks and strokes on the nonsteroidal anti-inflammatory drug Vioxx (rofecoxib), which had been approved by the US Food and Drug Administration (FDA) in 1999 and then were officially withdrawn in 2004 by Merck and Co. over safety concerns.
The New York-born cardiologist, geneticist and researcher into digital and tele-medicine was also the first doctor to give the anti-clotting drug tissue plasminogen activator (tPA) in 1984 and clopidogrel (Plavix) and other cardiovascular drugs to inhibit blood clots that could otherwise cause heart attacks and strokes.
Back in 1999, he was the first physician to serve on the advisory board of a pioneering wireless medicine company that remotely carried out continuously monitored electrocardiograms in real time.
Now the 61-year-old Jewish doctor born in the borough of Queens has finally made his first visit to Israel, as a highlighted guest at Rambam Medical Center’s “Summit on Digital Health in Cardiovascular Innovations – Health of Tomorrow” conference in Haifa. Health Minister MK Ya’acov Litzman was among those who greeted the participants.
Speaking on “Digitizing and Democratizing Medicine” on Tuesday, Topol (“no relation, he said, to famed Israeli actor Haim Topol) also granted an interview to The Jerusalem Post.
“This is the most exciting time in the history of medicine. Before, when we saw the patient, we had very little data and only a limited view of each individual. This has been changed, with digitization of the medical essence, physiology sensors, the analysis of the patient’s DNA microbiome,” and the widespread use of smartphones to diagnose, monitor and analyze his condition. There are now some two billion smartphone users around the world, including in the underdeveloped countries, which use smartphones heavily because landline infrastructure is frequently almost nonexistent.
“The third world will benefit from digitization and smartphone medicine even more than the first world,” he declared.
It will help non-paternalistic doctors and better-informed patients choose treatments that best respond and even predict what diseases they could develop in the future, he said.
The new system will be less costly than the old system. “Computer chips have become incredibly cheap. The devices cost less than $100 each, and they are getting smarter. There are already two billion transistors in our smartphones today.”
This means a “radical shift in the patient-doctor relationship; the doctor is no longer in charge,” continued the director of La Jolla, California’s Scripps Translational Science Institute, who in 2012 was voted the “most influential physician executive in the US.”
Topol recognized the arrival of the brave new world of medicine when he received via email an electrocardiogram from a patient who said his heart was in atrial fibrillation and asked him, “What should I do now?”
Instead of just making one visit to the doctor in his office, “every part of the patient’s body can be defined in an unprecedented way. The patient can generate his own medical data. You may do your own cardiogram by placing a finger on a smartphone, or your glucose can be continuously monitored with a noninvasive sensor on skin. Most parts of the body can be examined from home. You can diagnose diseases with a “BandAid” on your finger. You don’t have to go to a sleep lab to have your sleep patterns analyzed. Almost all lab work can be performed via your smartphones, without going to a health fund clinic or the hospital. All the devices have already been approved by the FDA.”
Topol has been a practicing cardiologist for three decades, but while he continues to touch patients’ bodies to diagnose conditions, but he hasn’t used a stethoscope to hear a heartbeat or breathing for six years. When Rene Laennec invented this tube device in 1816 to hear a heartbeat, he couldn’t have foreseen its great value to doctors and patients, said Topol, who pointed out that it was mistakenly named, as it doesn’t look into anything (“scope”), but actually hears sounds from inside the body (“phone”). It should have been named stethophone.
“I always touch the patient, but in a different way. I use a pocket ultrasound device that I hook up to a smartphone to do an immediate cardiogram. This increases the intimacy of the doctor-patient relationship. I also am in regular email contact with patients.”
Topol uses the term “molecular stethoscope” for technologies that look into the body at the molecular level. As an example, there are blood tests available to pregnant American and Israeli women for a few thousand dollars that can detect Down syndrome in fetuses without invasive amniocentesis. This year, over a million pregnant Americans have undergone such blood tests to detect this and other fetal chromosomal abnormalities.
Asked whether there will be a worldwide trend of hospitals closing down, Topol said this would not occur, “but in general, Western countries will not need more hospitals. I’m not saying we’ll need fewer doctors. There is an aging population. While we don’t need more hospitals, we will still need intensive care units, emergency rooms and surgical theaters, but other departments will be changed by technology.”
Most visits to the doctor will not take place.
“More will be done by video-chat and data-exchange platforms. Computers will interpret data that patients can discuss with doctors to get guidance. Diabetics will better be able to manage their conditions. Doctors will now be more advisers with the ability to oversee medical care, which will be democratized.”
Already, just by patients “having their own medical data at hand and generating things in the real world that stream into a smartphone, people already have an improved sense of wellbeing. They themselves can understand when their blood pressure goes up when they sleep or get excited,” Topol said.
“The body has an external wisdom. Patients never had such feedback before. According to most US polls, patients want to be more involved in their health decisions. But the use of smartphones for health is not obligatory. Only people who want to be copilots in their healthcare will use it. Many older people, but not all, will feel more comfortable when doctors rule the roost. But it would be worthwhile economically giving people smartphones free and teaching the elderly how to use them. It costs $2,000 for a single visit to an emergency room and $4,600 for one overnight stay in a hospital. Many of these can be avoided by early detection.”
YOUNGER PHYSICIANS, who are “digital natives,” understand the radical change that is coming. But middle-aged doctors “generally don’t like the idea of relinquishing their control,” Topol noted.
“They grew up in era of ‘Doctor Knows Best.’ Older US doctors are leaving the profession early because they are burned out, don’t like not being completely in charge of their practices or having increasing intervention from health maintenance organizations. But those who are unhappy are not displeased by the new era I am describing,” he said.
“When I wrote my books, I was personally worried about possible hostility from the medical profession, but most physicians now accept that major change is inevitable. Nobody said: ‘This Topol guy is crazy.’ It’s just a matter of how soon the new era will take hold.”
Today, he spends most of his time today doing research, but he also treats cardiology patients. He has a large team of 55 people in his Scripps Institute who do gene sequencing, analysis. There are doctors and nurses and other professionals. We are multidisciplinary and do a lot of exciting research.”
No medical technology is foolproof, but already there are over 12 million serious diagnostic errors a year in the US today. “The new system will actually reduce significant errors.”
Admitting that the US medical system wastes a huge $1 trillion a year (constituting one third of the 18% of the gross domestic product that it spends on healthcare, compared to about 8% in Israel), Topol said that digitization will reduce costs in the long run.
It used to take over twoand-a-half weeks to make an appointment with a doctor in the US. “Now you can instantly see the physician over your smartphone or even have him or her make a housecall that the health insurer covers. We just send him over in an Uber taxi.” He said that this is possible in urban areas, with doctors living in the same city as their patients, and not in the vast and low-populated rural America, where telemedicine can be most beneficial.
The Scripps researcher and clinician said that American medical schools are behind in teaching about the new era. Also, the effort to create electronic medical records in the US “has been a disaster, as doctors look at them rather than at patients, who don’t have access to their own data. The records don’t ‘talk’ to each other. The government put $40 billion into it, but it was a fiasco.”
He added that while Israel is a leader in many medical technologies, it is “behind somewhat” in introducing and advancing the use of smartphone and other digital apps.
RAMBAM MEDICAL Center director-general and interventional cardiologist Prof. Rafael Beyar hosted Topol, whom he previously met at cardiology conferences abroad. We gave him Rambam’s highest honor during the summit because of his great contributions to world medicine.”
Beyar continued, “Perhaps Israel lags in setting down regulations involving the use of digital medical devices. But we are advanced in developing hardware and software for digital medicine.” However, the use of this technology is not yet as widespread here as in the US.
“There will be house calls here again, too. Mobile health will arrive,” predicted Beyar, but it will not come immediately, because the professional unions are opposed.”
Indeed, noted the Scripps doctor, “this is my first visit to Israel. I thought of coming before, but it was in times that were very unstable here. I know Israelis and learned from them about their health system, as I trained quite a few Israeli cardiologists at Scripps and previously at the Cleveland Clinic,” where he was chairman of cardiovascular medicine from 1991 to 2005 and established the Cleveland Clinic Lerner College of Medicine. “We built it up to become the leading medical school in the US.
Topol eventually left the non-profit academic medical center in Ohio due to a clash over his attacks on Vioxx with management, which reportedly had close ties with the pharmaceutical industry.
“I got involved in Vioxx reluctantly. I thought it was egregious that a company that was very aware of the high risk of heart attacks and strokes in patients who took their drugs did not inform the authorities. And there were no criminal charges against anyone in the pharmaceutical company.”
What will be next in his series of learned but layman-accessible books?
“That’s a very good question. I don’t really know where I’m headed. Each book took me several years to write. I see myself as a futurist, but I don’t know yet what next big thing is on the horizon,” Topol said.