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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.
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One solution, says Topol: disaggregate the data
by letting individuals or families control their
own medical information and store it securely,
using a personal cloud or digital wallet. He also
believes new legislation is needed. “Most of the
hackers who have done this have never been
caught and not much is being done to catch
them. This has to get on track — we need a
whole new model for how we store and protect
personal medical information.”
arlier this year, Topol co-wrote an
op-ed in The New York Times that
paints a terrifying yet very real
picture. In the last two years,
nearly 100 million patients in the U.S had
their information stolen from major health
insurers, including Anthem and Premera Blue
Cross. Because health data and other personal
information are typically stored in a central-
ized and unencrypted form, hackers can, in a
truly ironic twist, gain more ready access to
medical records than patients themselves.
“It’s unbelievable,” says Topol, who directs
the Scripps Translational Science Institute in
La Jolla, California. “There’s just a horrible
problem with security and very little atten-
tion is being paid to this profound problem.”
Medical records are incredibly valuable. On
the black market, they are worth roughly five
to ten times more than individual financial
information, in part because they are tied to
social security numbers, which are more
durable than credit card or bank account
numbers. Personal health information can
be used to purchase drugs or medical
equipment (which can then be resold) and file
fraudulent claims with insurance companies.
In the coming years, the transition from
paper to electronic records is expected to
only exacerbate the problem.
Propelling Medicine
into the Digital Age
Modernizing medicine
Cybersecurity in healthcare is just one facet
of Topol’s medical worldview. He also believes
strongly in the power of mobile and digital
technology and has incorporated them into his
own clinic. One of his favorites gadgets is the
Philips Lumify, a portable ultrasound probe
that connects to a smartphone — or, as Topol
calls it, the modern stethoscope.
“I use it in every patient I see in the clinic,” he
explains. “I don’t listen to the heart anymore
— I look at it. That’s kind of strange because I
was one of the biggest proponents of the heart
exam, and taught it to countless students and
trainees. But now it’s completely obsolete.”
Topol uses a variety of other devices, too.
He tests each tool on himself first, before
introducing it to his patients. “I still laugh,
because when I first got the Philips ultrasound
probe for my smartphone I did a headto-toe
exam of every organ in my body, including
all the arteries.”
It’s been five years since he first published his
manifesto on the future of medicine. Topol
says that progress has been slower than he
hoped, but some substantial changes are
unfolding nonetheless. “I think there’s been
a wake-up call among consumers that they
are entitled to have all of their medical data,
and some have become activated and are
demanding to have it.”
by Nicole M. Davis, Ph.D
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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
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
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”
“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.
…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.”
Institute as a professor of genomics. “I quickly
learned that San Diego is the wireless capital
of the world,” he says. “Here I was thinking we
were going to do genomic medicine and have
an institute dedicated to that, and we quickly
broadened our mission to include digital
medicine.”
Your body, your data
Today that blending of genomic and digital
medicine is ever clear. Topol and his colleagues
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.
Just as the Framingham Heart Study, which
began in 1948 by following some 5,000 adults
in Framingham, Massachusetts, uncovered key
insights about heart disease and its risk factors,
All of Us seeks to unearth new information
about a variety of illnesses, both common and
rare, and to “extend precision medicine to all
diseases.”
“We’ll have a million people with every
condition — all ancestries, all walks of life,”
says Topol. “It’s going to be fascinating what
we learn. Hopefully, we’ll get to that dream
of true prevention someday.”
With over $200 million in funding from the
National Institutes of Health, the Scripps
Translational Science Institute will handle
all of the project’s participant-facing activities,
from choosing and building mobile apps, to
creating and maintaining the website, to
collecting, maintaining, and sharing informa-
tion. Topol’s team will enroll roughly
one-third of the total participant pool and will
also oversee sensors, data privacy and security
for the entire program. Enrollment is set to
begin this year and is expected to last at least
three or four years.
Beyond the project’s impressive scale and scope,
it is also taking a progressive stance on partici-
pants’ 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.”
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