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20/20 82 Eric Topol, MD, is not your average gadget guy. As a renowned cardiologist, he has made hand-held medical devices and mobile technology an essential part of his proverbial black bag, exchanging conventional items, like the stethoscope, for newer, slicker tools that can quickly deliver high-resolution images of a patient’s heart — right in the exam room. As an acclaimed researcher and institutional leader, he has also helped push the frontiers of genomic sequencing and the application of genomic information to medicine. In his 2012 book, The Creative Destruction of Medicine, and the subsequent The Patient Will See You Now in 2015, Topol makes the case for wider adoption of digital technology by both medical professionals and patients, as well as a broader acceptance of the kind of data-driven, patient-empowered medicine it enables. His newest area of concern: the privacy and security of personal medical information. Propelling Medicine into the Digital Age E by Nicole M. Davis, Ph.D arlier this year, Topol co-wrote an Modernizing medicine op-ed in The New York Times that Cybersecurity in healthcare is just one facet paints a terrifying yet very real of Topol’s medical worldview. He also believes picture. In the last two years, strongly in the power of mobile and digital technology and has incorporated them into his their information stolen from major health own clinic. One of his favorites gadgets is the insurers, including Anthem and Premera Blue Philips Lumify, a portable ultrasound probe Cross. Because health data and other personal that connects to a smartphone — or, as Topol information are typically stored in a central- calls it, the modern stethoscope. ized and unencrypted form, hackers can, in a “I use it in every patient I see in the clinic,” he truly ironic twist, gain more ready access to explains. “I don’t listen to the heart anymore medical records than patients themselves. — I look at it. That’s kind of strange because I “It’s unbelievable,” says Topol, who directs was one of the biggest proponents of the heart the Scripps Translational Science Institute in exam, and taught it to countless students and La Jolla, California. “There’s just a horrible trainees. But now it’s completely obsolete.” problem with security and very little atten- Topol uses a variety of other devices, too. tion is being paid to this profound problem.” He tests each tool on himself first, before Medical records are incredibly valuable. On introducing it to his patients. “I still laugh, the black market, they are worth roughly five because when I first got the Philips ultrasound to ten times more than individual financial probe for my smartphone I did a headto-toe information, in part because they are tied to exam of every organ in my body, including social security numbers, which are more One solution, says Topol: disaggregate the data durable than credit card or bank account by letting individuals or families control their numbers. Personal health information can own medical information and store it securely, It’s been five years since he first published his be used to purchase drugs or medical using a personal cloud or digital wallet. He also manifesto on the future of medicine. Topol equipment (which can then be resold) and file believes new legislation is needed. “Most of the says that progress has been slower than he fraudulent claims with insurance companies. hackers who have done this have never been hoped, but some substantial changes are In the coming years, the transition from caught and not much is being done to catch unfolding nonetheless. “I think there’s been paper to electronic records is expected to them. This has to get on track — we need a a wake-up call among consumers that they only exacerbate the problem. whole new model for how we store and protect are entitled to have all of their medical data, personal medical information.” and some have become activated and are all the arteries.” demanding to have it.” 83 20/20 nearly 100 million patients in the U.S had The role of the individual patient is also being exerted in ways that once seemed unimaginable. One example: the design of clinical trials. “Patients are being consulted to find out what is important to them, what are the right end points, rather than just assuming we as doctors know the answers to these questions,” explains Topol. Patients can now sit in the driver’s seat when it comes to collecting their own health information, fueled by the proliferation of mobile health applications. There are smartphone apps that help measure heart rhythm, detect sleep apnea, and even diagnose a child’s ear infection. Medical research has gone mobile, too, propelled by open-source software that enables researchers to easily develop and customize smartphone apps suited to their specific areas of interest. “The technology is way out in front of its adoption 84 in medical practice,” says Topol. “But you can see where it’s headed. It’s an inevitable arc.” The making of a visionary Topol has always been fascinated by technology and medicine. As a college senior at the University of Virginia in 1975, he wrote a thesis called “Prospects for Genetic Therapy in Man,” decades before gene therapy became a realizable goal. But he was not always drawn to cardiology. When he began medical school, he intended to become an endocrinologist, motivated by his father’s struggle with juvenile (or insulin-dependent) diabetes. Then he met Kanu Chatterjee, who ran the cardiac care unit at the University of California San Francisco, where Topol was training in internal medicine. “He was one of the most impressive physicians at the bedside, and he really took me under his wing,” says Topol. “I completely changed route.” Topol’s immersion in the world of digital technology didn’t come until decades later, when he moved to the San Diego area in 2006 after being recruited to join Scripps Health as chief academic officer and the Scripps Research Institute as a professor of genomics. “I quickly insights about heart disease and its risk factors, learned that San Diego is the wireless capital All of Us seeks to unearth new information of the world,” he says. “Here I was thinking we about a variety of illnesses, both common and were going to do genomic medicine and have rare, and to “extend precision medicine to all an institute dedicated to that, and we quickly diseases.” broadened our mission to include digital medicine.” “We’ll have a million people with every condition — all ancestries, all walks of life,” Your body, your data says Topol. “It’s going to be fascinating what Today that blending of genomic and digital we learn. Hopefully, we’ll get to that dream medicine is ever clear. Topol and his colleagues of true prevention someday.” are helping to lead a massive new research program that aims to recruit more than a million volunteers of all ages to participate in a long-term health study. Because of its size, the effort will have the statistical power needed to identify contributions from genes and environmental factors. The project, known as All of Us, falls under the sweeping Precision Medicine Initiative launched by President Barack Obama in 2015. With over $200 million in funding from the National Institutes of Health, the Scripps Translational Science Institute will handle Topol on… …his new favorite medical device “I have a new gadget I’ve been playing with that I really like. It’s a watch. You press start and then it gets your blood pressure through your wrist, and sends the data to your cell phone. It’s not exactly a fashion statement, but it’s remarkably useful because I can use it while I’m driving in traffic or when I’m having a heated discussion. And I don’t have to carry around a blood pressure cuff.” …the term “precision medicine” from choosing and building mobile apps, to “I can live with it, but I much prefer ‘individualized’ because it has a double entendre. One is that the individual is driving it — to me, that’s fundamental. They’re generating data; they’re taking charge. And then the other is that we can define that individual in unprecedented fashion. Those two concepts together shape what I consider to be individualized medicine. creating and maintaining the website, to collecting, maintaining, and sharing information. Topol’s team will enroll roughly one-third of the total participant pool and will also oversee sensors, data privacy and security Just as the Framingham Heart Study, which for the entire program. Enrollment is set to began in 1948 by following some 5,000 adults begin this year and is expected to last at least in Framingham, Massachusetts, uncovered key three or four years. Beyond the project’s impressive scale and scope, it is also taking a progressive stance on participants’ data. “Perhaps the most important thing about this it that all participants — no longer called ‘subjects’ — get their data,” says Topol. “Until recently, medical researchers thought the data belonged to the researcher, but that’s changing. Again, it’s a reflection of our times.” …the role of physicians in the modern medical era “The way I envision it is that over time, doctors will accommodate the fact that they can do better with machines, just as patients will. And they will have a lot of their rote work compressed so they can spend more time with patients, and not with keyboards. We’ll still need human guidance, compassion, and wisdom — those won’t come from any computer program.” 85 20/20 all of the project’s participant-facing activities,
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