A leading voice on the digital revolution in medicine, Dr. Topol talks about his text, The Creative Destruction of Medicine.
Cardiologist Eric Topol
Tavis: Dr. Eric Topol is a respected physician and health care executive who, for 15 years, has chaired the Department of Cardiovascular Medicine at the Cleveland Clinic. He is now director of the Scripps Translational Science Institute and author of the new book, “The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care.” Dr. Topol, good to have you on this program.
Dr. Eric Topol: Thanks, Tavis. Great to be with you.
Tavis: Let me jump right in. How will the digital revolution create better health care?
Topol: Well, you’re used to digitized books and videos, music. How about digitizing people? That is, getting the medical essence that we can get through sensors and through sequencing one’s genome, basically everything that makes you tick. At an individual level, we can really reshape the future of medicine, make it much more precise.
Tavis: Give me examples.
Topol: Well, let’s say I want to do your cardiogram and I want to use what is going to be the hub of medicine in the future, the Smart Phone. So I just have a little case in the back of my phone. It has a couple of sensors.
Topol: Put my fingers on the sensors to make a circuit with my heart and basically have my cardiogram right on the phone.
Tavis: I see it moving too, yeah.
Topol: So I can do your cardiogram if you like.
Topol: Would you like to do that? If you want to just put your fingers on it like I had?
Tavis: Both of these things here?
Topol: Yeah, like that, right, and there it is.
Tavis: Is it moving? Can you guys see it? Yeah.
Topol: Yeah, you have a nice, normal heart rhythm.
Tavis: Please tell me that’s good [laugh].
Topol: You have a heart rate of 88.
Tavis: So I’m doing okay then?
Topol: Yeah, you’re doing fine.
Tavis: Let me set this down.
Topol: I can tell you’re not too nervous here [laugh]. But I can learn look in your heart. I don’t need a stethoscope anymore. I’m a cardiologist. I’ve been a cardiologist for…
Tavis: Wait, how can you be a cardiologist without a stethoscope?
Topol: I know. Doesn’t that sound familiar?
Tavis: How is that possible?
Topol: Instead of listening to the heart, the lub-dub, here’s a device that you see everything with high-resolution ultrasound. It’s basically the size of a cell phone. Just pop this open and, if I want, I could go ahead and do a total ultrasound exam of your heart or I could do it of mine just right on this screen. I don’t know if you want to see that, but we could do it.
Topol: But basically then, you never want to use a stethoscope because that’s so relatively worthless. All you’re listening to is sound and here you can see everything.
Topol: Basically, the only things this requires is a little bit of gel on the tip of the probe and then just basically put this on here in just a second here have my heart. There it is. You can see the valves, you can see the chamber.
Tavis: Just turn it that way for just a second.
Topol: Can you see? So you can see the size of the heart, each of the cavities, whether there’s any fluid, which there isn’t. I mean, everything looks perfectly normal which is a good thing. Why would you ever listen to a heart again? The stethoscope for listening to the heart is over. It’s obsolete.
Topol: So that’s just another example of how medicine’s changing, digitizing the heart through a little tiny portable device. You basically can put this on any part of the body and get a great, beautiful ultrasound picture.
Tavis: Who ends up – I’m not naive in asking this question – but who ends up paying for this? I mean, it’s a wonderful thing to see that you can use a Smart Phone or a small device like this. Obviously, these things can be used anywhere. We’re in a TV studio and we’re, you know, using these instruments. I assume all the cost for this gets passed on to the patient, so help me understand…
Topol: That’s not a good assumption.
Tavis: Correct me then.
Topol: Because this could gut the cost.
Tavis: Okay, tell me.
Topol: That is, once you have this sensor, you don’t have to charge for doing the cardiogram.
Tavis: Fair enough.
Topol: You know how many echocardiograms, ultrasounds of the heart, are done each year in the United States? Over 20 million. They cost $800 each. Most of them are unnecessary, should be part of the physical exam. So there you would save an enormous amount just by putting this to replace the stethoscope. So it can gut costs. You know, I’ve got many more of these devices in the bag here that have that potential if we let it happen. We haven’t really done that yet.
Tavis: When you say if we let it happen, what’s stopping us?
Topol: Well, you know, we’re trying to lead the charge at Scripps Health to do this, but most medical communities and centers, this is change, this is foreign, this is threatening. So it’s very difficult to actualize these new ways of practicing medicine. Medicine is incredibly ritualistic.
Back in 1816 when the stethoscope was invented, it took 20 years before doctors would accept using the stethoscope, and that’s kind of what it is still today. You know, it’s a 15 or 20-year story to effect major changes in medicine.
Tavis: But what good reason is there, though, where our health is concerned for not embracing the best of what digital technology offers? I understand that people will get set in their ways, but we’re talking about peoples’ health here, saving lives and cutting costs.
Tavis: So I can’t imagine what the pushback about that would be.
Topol: Well, you know, I’ve been frustrated because I’ve seen this happening and it’s not just in these sensors and these kinds of little devices, but it’s also with sequencing the genome. I say, well, how are we gonna get this into reality? So that’s why I did this book because basically it’s an appeal to the consumers, to the public, that what we need right now is this Gutenberg moment in medicine where back in the 1400s and the high priests and nobody could read.
Now people can read because this is on your phone, this is on your tablet, and there’s no reason why – most people who can easily get up to speed will drive the future of medicine because it won’t happen from within. There aren’t enough physicians and the establishment is just too rigid to accept these profound changes.
Tavis: To your phrase now, Dr. Topol, about driving the future of medicine, does the patient have any say-so, any role, any agency that he or she can use to drive the future of medicine?
Topol: Right. I think that once you – let’s say you have high blood pressure which almost 70 million Americans have. You can get an app for your phone and get all your blood pressures right on your phone and you can track that better than ever before. All you got to do is press start.
Now all of a sudden, you are taking charge of an important diagnostic and then you can say to your physician, “I need some guidance because I got 11% of the time my blood pressures are out of range and this medicine that you prescribed for me just isn’t working or the dose needs to be increased.” Basically, it’s getting much more involved because it’s having one’s own data which wasn’t even possible just a few years ago.
Tavis: There are always advances that technology brings us, but you know the flip side. There are always challenges that come along with technology so that everything about technology isn’t great. For every good thing you could tell me, I could theoretically in the debate offer you something that is troubling about that development. Is the balance sufficient enough to warrant moving forward with these kinds of advances?
Topol: Well, you’re bringing up a great point. There are some tradeoffs. There’s the issues about privacy, security. There’s issues of could it actually lead to increased expense which you kind of touched on earlier rather than what it’s supposed to be doing, which is making things much more precise and preventive.
So these are important issues and I think what we have to do is validate that they’re really providing benefit and that that benefit is overwhelming, whatever the risk and the downside issues are. I think that can be done.
Tavis: Talk to me about the privacy issue. I was going to ask about that, but since you raised it, tell me what concerns you about the issue of privacy. I note in your book that most doctors don’t even communicate with their patients via email. We haven’t even gotten that far yet, you know.
Topol: Well, that basically tells you the whole problem. 68% of American physicians won’t email with their patients. That tells you something. But what we have is the issue of anything that’s digitized then is subject to breaches, hacking, leak, and this is a problem because, if it’s your valuable medical data, we’ve already seen this with electronic medical records in some of the nation’s top medical centers.
So this has to be brought down to the lowest level of risk. It never can be absolutely zero. On the other hand, we’ve got to maximize the benefit from having this data that’s so imminently portable and digital and useful. It’s really one of these risk-benefit stories.
Tavis: What makes you believe that all of this leads to better health, as your subtitle suggests, that this stuff leads to better health as opposed to just greater awareness? Because the two are not the same.
Topol: That’s right, absolutely, and I’m with you. So the big difference is people taking ownership. It’s their data and information. They didn’t have access to that before. So once that happens, that’s the biggest switch that’s ever occurred in the history of medicine. We’re talking about a major shakeup because it’s always the doctors. We had all the control of everything.
Now you’re gonna be in the driver’s seat and you’ll be now a new model with your doctor, your physician. You’ll say, “I’ve got this data information. Give me some guidance. Help me with your wisdom and your experience,” but you’re really the one who is pushing forward because you’ve had now a remarkable panoramic information about yourself.
Tavis: These advances are amazing to me and Dr. Topol has brought more of these gadgets with him. To see more of what he has brought to share with us, go to our website at pbs.org and you can engage us in conversation about these other gadgets he’s brought. For now, though, I thank him for coming on.
The book is called “The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care.” Dr. Topol, it’s been a fascinating conversation, and I enjoyed you bringing that bag with you. Thank you, sir.
Topol: Thanks for having me.
Tavis: Good to have you here.
Announcer: For more information on today’s show, visit Tavis Smiley at PBS.org.
Wade Hunt: There’s a saying that Dr. King had that he said there’s always the right time to do the right thing. I just try to live my life every day by doing the right thing. We know that we’re only about halfway to completely eliminate hunger and we have a lot of work to do. Walmart committed $2 billion to fighting hunger in the U.S. As we work together, we could stamp hunger out.
Announcer: The California Endowment. Health happens in neighborhoods. Learn more.
Announcer: And by contributions to your PBS station from viewers like you. Thank you.