Keywords: Participatory medicine, patient empowerment, personal health records, health data .
Citation: Quinlan C. Book review: The Creative Destruction of Medicine. J Participat Med. 2013 Jul 3; 5:e27.
Published: July 3, 2013.
Competing Interests: The author has declared that no competing interests exist.
Medicine has historically been a science, a craft, an art practiced upon patients by specially trained, even magical, beings called Doctor. That’s been conventional wisdom since soon after the discovery of fire (bringing the necessity for the first burn salve). As wisdom went, it worked pretty well throughout history. Sick? Seek out the trained expert, and do what he says.
As the 20th century counted down, and the digital revolution hit its stride, it seemed as though the world was on the verge of a reinvention. In the last decade-plus, you’d be challenged to find an industry that had not been completely retooled by the digital revolution, except for healthcare. Eric Topol, a cardiologist and technology developer, believes that this most human of human endeavors — medicine and medical care — is ripe for a reboot.
The Creative Destruction of Medicine could, in lesser hands, have been either a slim volume of ephemera or a brick of impenetrability. Luckily, Topol is as talented at communicating as he is at the practice of medicine. (He is a member of the Institute of Medicine, and one of the Rock Stars of Science, as listed by GQ magazine). The new paradigm for medicine that he draws in the book could, if fully realized, deliver better health, faster and at lower cost, than at any time in human history.
The book is divided into three sections:
- Setting the Foundation, where Topol draws a picture of the digital landscape and the current medical-practice model, asking if and how much consumers are empowered and engaged;
- Capturing the Data, where the promise of a fully-realized “quantified self” could deliver what I’ve taken to calling snowflake medicine — personalized, targeted treatments created for individual patients — by leveraging the human genome and data-crunching; and
- The Impact of Homo Digitus, where Topol calls for a reboot of medical education, life science research (pharma and biotech), and the adoption of an opportunity-ready mindset by all parts of the healthcare continuum, including patients.
In the first section, Topol sketches the landscape of medical history, talking about how medicine has landed in a volume vs value conundrum. Technology has now made diagnostic and treatment options available that hadn’t even been dreamed of less than a generation ago. Medicine that focuses on a population model — creating treatments and protocols that work in a majority of people diagnosed with the disease in question — is what results from traditional research methods of large-volume studies with control groups, placebos, and incremental improvements over other treatment options.
Topol offers the opinion — one that I share — that this approach to medical research is so 20th century. Population medicine is still being practiced even though personalized medicine is available for a rising number of illnesses and conditions. Dr. Topol wonders why the digital revolution’s promise is still undelivered in medicine. The tools and the technology are there, and a cursory look at the digital communication landscape tells us that patients — consumers of healthcare — are ready, willing, and very able to interact and contribute to their care using digital tools. It seems that the only thing preventing medicine from leveraging the digital revolution to revolutionize public health is medicine itself. Or more specifically, the thinking of those who are at the levers of power: large health systems, big pharma, and the FDA.
In the second section, focused on the data available using 21st century technology in the health/medicine space, Topol does a better job of telling the story of bioscience than any writer I’ve read in my lifetime. He shares the past, present, and his vision of the future of genomic medicine and the possibilities presented by the ability both to sequence an individual’s genomic makeup and create a targeted, personalized treatment for that individual’s cancer, heart disease, or other condition. One paragraph, from page 113, hit me between the eyes:
By November 2008, Nature dedicated a whole issue [to] personal genomics; its cover featured a human genome inside a container labeled ‘Break Glass When Ready’ and ‘Your Life in Your Hands: Instructions for the Personal Genome Age.’ One of its articles, ‘Misdirected Precaution,’ pointed out that personal genome tests are ‘blurring the boundary between experts and lay people.’ And its authors stated, ‘We welcome a shift from genetic protectionism to a situation in which individuals become experts on, and active governors of, their genomes.
If that isn’t a perfectly stated participatory medicine approach to genomics, I don’t know what could be.
After calling for the breaking of health data silos through the wide adoption of personal health records (amen, sir, amen), Dr. Topol spends the last section of the book painting a picture of the world of what he calls homo digitus: the digitally-empowered human. In the first paragraph of that section, he says:
Of all the professions represented on the planet, perhaps none is more resistant to change than physicians. If there were ever a group defined by lacking plasticity, it would first apply to doctors.
Topol believes that the successful 21st-century medical industry will embrace digital tools, genomic pharmacology, and personalized medicine. This will include a complete reset of the life science industry — big pharma and its research — which has to include a close watch of the move by some pharma companies to patent human genes (ie, the Association for Molecular Pathology v Myriad Genetics, Inc. case under review by the US Supreme Court). He points out that one of the major hurdles to clear in drug development is the difference between showing that a drug has potential and proving that potential in real, live patients. Topol believes that crowdsourcing information via wiki-medicine will accelerate that process, along with solid clinical development and innovative digital tracking of new products.
The Creative Destruction of Medicine is a book that can help create the world it envisions. An important part of that work includes the absorption and spreading of its idea-virus by people like the members of the Society for Participatory Medicine. If you haven’t read this book yet, what are you waiting for?
- Topol E. The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. New York: Basic Books; 2012. ↩
Copyright: © 2013 Casey Quinlan. Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the author, with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.