How medicine will be Topol'd

By Brian Dolan

Creative Destruction MedicineAt the very beginning of Dr. Eric Topol's book, The Creative Destructive of Medicine, and throughout its chapters, he invokes the name of Austrian economist Joseph Schumpeter, who is credited with popularizing the term "creative destruction." Topol's book argues that medicine will inevitably be "Schumpetered", and as he told MobiHealthNews in a recent interview, he believes this creative destruction will be rather swift. What's more, he believes it needs to be.

Dr. Topol contends that the creative destruction of medicine requires four key ingredients: wireless sensors, genomics, imaging, and HIT. He organized his book largely around these four. While he's clearly passionate about the first three, Topol admits that healthcare information technology, while "not unimportant" is still boring and much more like the "operating system" that the "tools" of wireless sensors, genomics and imaging will run on.

"The super convergence [of all four] will lead to the high definition digitization of man for the first time," Topol told MobiHealthNews. "It will be much more participatory since it will include things like the individual's DNA and the individual's health records on that individual's phone. This is information about them, not about a population. So, they will have to be engaged."

The problem is consumers don't know about wireless sensors, Topol says. Neither do doctors. That's why Topol wrote his book.

"I think this is all inevitable," he said. "The only question is: Is this a slower paced story than the one I am predicting? I don't think so. We are on track to read every vital sign and mood now."

Topol believes that we are currently in the "wearable sensor" phase of wireless health. "The next phase, though, will be nanosensors embedded in the blood to detect specific things," he said. One application for this technology is for preventing diabetes, according to Topol. "It takes about five years to develop diabetes," he said. "If it takes five years, why can't we detect that process? Currently we have medicines but we don't know when the immune system is under attack. It's not a constant attack, it's episodic, but a nanosensor could detect that." Topol believes that wearable and nanosensors will lead to constant surveillance of vital signs and specific targets in the bloodstream. These could help predict heart attacks a week or two out.

For digital health to succeed, however, Topol believes there needs to be a consumer health revolution. Topol's vision for the creative destruction of medicine, relies heavily on a consumers or patients rising up, thanks to the power of their social networks, to demand these new digital health tools from their physicians. The advent of direct-to-consumer advertising in pharmaceuticals could provide some inspiration for how the creative destruction might come from outside the system. (Topol noted he is and was against DTC drug marketing.)

It won't start with physicians. Topol pointed out that it takes about 17 years for a new medical technology to go from being accepted to being a part of routine care. "We can't wait 17 years," Topol said. "So, we can't let the medical community drive it."

Online health communities like PatientsLikeMe and CureTogether -- where hundreds of thousands of patients trust their virtual peers more than they trust their doctor -- are already disrupting medicine today, Topol said. A movement is happening in these online health communities, but some surveys show almost 90 percent of physicians have never heard of them.

"It is an expression of a consumer health revolution that is just budding," Topol said. "It's in its nascent phase, but it is happening right now. I think the consumer-savvy base is waking up. There is a reset here. This digitization of human beings will make a parody out of doctor knows best. We need partnerships. We need physicians working and guiding individuals. Each individual will have a much more precise view of himself or herself biologically, physiologically, anatomically, to work in partnership with physicians."

At that point, it's much more likely that we will look back and say that medicine as we knew it was -- not "Schumpetered" -- but Topol'd.

Dr. Topol's The Creative Destruction of Medicine is on sale here. (It makes for a great read for anyone interested in this industry.)