This is a watershed moment in the history of medical care, where technology can be built into every aspect of patient therapy and analysis much quicker than ever before, reveals Josh Wolfe of Forbes/Wolfe Emerging Tech Report.
Dr. Eric Topol is a leader of genomic and wireless digital innovative technologies to reshape the future of medicine. He is a practicing cardiologist at Scripps in La Jolla, California, and widely credited for leading the Cleveland Clinic to become the #1 center for heart care.
While there, he also started a new medical school, led many worldwide clinical trials to advance care for patients with heart disease, and spearheaded the discovery of multiple genes that increase susceptibility for heart attacks.
Topol pioneered the development of many medications that are routinely used in medical practice including t-PA, Plavix, Angiomax, and ReoPro, and was the first physician to raise safety concerns on Vioxx. In 2009, along with Francis Collins and Harold Varmus, Topol was selected to be one of the country’s 12 “Rock Stars of Science” in GQ magazine.
He was elected to the Institute of Medicine of the National Academy of Sciences and is one of the top ten most cited researchers in medicine. His book The Creative Destruction of Medicine was published in 2012.
As a successful cardiologist, what inspired you to shift focus and move into genetics and wireless medicine?
I started the switch from pure cardiology to genetics back in the 90s. Throughout my career, I worked predominantly in heart attack treatment, but I eventually realized we needed to prevent the events that lead to heart disease in the first place—and that relates more to genetics.
I went to La Jolla towards the end of 2006 to start a genomics institute. I also started working on wireless technology projects. The two areas—wireless sensors and genomic sequencing—seem disparate, but essentially they’re both ways to digitize human beings.
In combination, they lead to a broader perspective about individualized medicine. Juxtaposing a genetics institute with a wireless medical institute gave us a real sense of how to integrate these complementary areas and push the field forward.
It often seems that the greatest innovations take place where two fields of science intersect. Would you agree?
Yes—great innovations occur by cross-fertilizing disparate areas. I started with medicine, then was influenced by genomics, and I now think about how engineering drives medicine.
The whole area of biosensors, portable miniature imaging, and information technologies in health care is a world that is just starting to blossom with opportunities.
What is your perspective on the state of medicine today? How far have we come?
In my book, I quote Voltaire. He said, “Doctors prescribe medicine of which they know little, to cure diseases of which they know less, and human beings of which they know nothing.” That’s from 250 years ago, but it still applies today, unfortunately. I’m not knocking the medical profession. We just didn’t have the tools until now.
We’re at a momentous time in medicine, because we’ve got new tools that allow us to sequence 6 billion letters of a person’s genome. Just a few years ago, this process was too laborious, expensive, and time-consuming to be realistic, but as of this year it can be done in 15 minutes.
And who expected that the smartphone could become life-changing for people? These have evolved into powerful minicomputers that we’re learning to use as a reservoir for all the human data on what makes us tick.
At the same time, using these new tools depends on connectivity and bandwidth and Internet. The smartest phone is not very smart without those factors. New capabilities in cloud and supercomputing—that is what has led us to this extraordinary time in medicine.
Let’s look ahead—in the next several years, what about medicine will be dramatically different than today?
I see three distinct areas where genetics should play a role. One area is the diagnosis of cancer. We’ll define each person’s cancer at the genomic level. Eventually, genomic unraveling will be routine for every patient with a new cancer diagnosis, or a cancer that’s relapsed.
Just as no two humans are genetically identical (even including identical twins), no two cancers in any two human beings are identical. By using genomic guidance, we can improve the outcome of every cancer patient.
The second area relates to idiopathic disease (that’s a fancy medical term we use when we don’t know the cause). Hundreds of thousands of Americans are walking around with serious, even life-threatening conditions, and they don’t have a diagnosis. We’re starting to do sequencing on these people to identify the root cause of each illness, with the goal of finding a molecular diagnosis that can lead to treatment.
The third area to be implemented more broadly is pharmacogenomics. Many common drugs are prescribed without regard to genomic markers that could indicate major side effects. These same markers could help determine correct dosage, or show whether the person will even respond to the drug. We’re not using that information effectively today.
What are some of the barriers to the adoption of genetic sequencing?
The biggest obstacle turns out to be the medical profession itself. Resistance to change is a common thread throughout the history of innovation.
For example, René Laennec invented the stethoscope in 1816. One would expect an immediate uptake, yet it took 20 years before stethoscopes were commonly accepted. That is still the average timespan to change a medical practice or ideation: 17 years, or more.
The medical community can be ultra-conservative with a strong resistance to change. There are always naysayers and strong resistance, and that’s why I decided to write a book aimed at the public, not at medical professionals.
With that in mind, how do you convince the long-established practitioners and administrators that using genetic sequencing is beneficial for all?
The radical shift to precision medicine is inevitable. Migrating from the current paternalism won’t be an easy transition, because medicine is much like a priesthood, historically anchored in the belief that the doctor has all the knowledge and the doctor knows best.
Will our older physicians, who have been in practice for several decades, be capable of promoting this shift? I’ve met some who will, but they’re not necessarily the norm or the majority.
Young physicians just coming out of medical school are digital natives—this stuff is natural for them, and they’re likely to help provide stewardship for this transition. Meanwhile, we’re losing precious time, waiting for this adoption to take hold. I hope to activate consumers and get them revved up about advances in genomics, in order to motivate physicians to get more educated in this area.
What about the role that companies need to play in accelerating this shift towards personalized medicine?
I am concerned whether they’re adaptable, just as I worry about the adaptability of older physicians.
Is the life science industry capable of morphing itself and leveraging newfound opportunities?
One positive example is Sanofi (SNY), a company that is now in Apple (AAPL) stores selling an application to monitor glucose through the iPhone. That shows great plasticity in a big pharma company and we’ll see more of that over time—this is just the most nascent level.
If you were an individual investor seeking a company positioned to take advantage of this health-care disruption, what kind of company might you look to invest in?
I’d search for companies that are leading the field in the application of sensors used to diagnose common conditions. There is no human condition that couldn’t be potentially transformed by having new data.
For example, why would we have a sleep lab in a hospital, where no one sleeps normally? Doctors do not need real-time data to diagnose sleep disorders or sleep apnea. I’d look for a company that has a user-friendly, inexpensive way to archive sleep data.
Is there a company making a sensor to track involuntary motor activity from Parkinson’s? Or think about depression—that’s a big one. Who is going to track tone of voice, inflection, and activity—and follow up with communication by text or phone to determine if somebody may be quantitatively depressed and potentially suicidal? That person may simply need a different drug or dosage.
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