BY PETER NOWAK, FINANCIAL POST JULY 5, 2012 1 Dr. Eric Topol, a self-professed "rebel" cardiologist, has become a polarizing figure in the medical profession. Some praise him for vocally trying to effect change while others vilify him as self-aggrandizing or out-of-touch with reality. Photograph by: Kevork Djansezian , Gettu Images The emergence of new technology has forced the entertainment business to adapt rapidly into a more consumer-friendly, digital-first operation. But could the same thing happen with the notoriously conservative and slow-moving health-care industry? Dr. Eric Topol, the renowned and self-professed "rebel" cardiologist, thinks the same principle — popular demand driving transformative change — will also bring about a revolution in how we manage our health. "Everything we do in medicine reflects the lack of appreciation of the individual," he says. "The medical community is incapable of effecting change in a reasonable time frame, so we really need to get the consumer base educated and activated." In his new book The Creative Destruction of Medicine, Dr. Topol details this coming digital revolution in health care. While it is perhaps the most important industry there is, it's also one of the last to adopt digital technologies to drive efficiencies.
The current state of medicine is population-based and treatments are created based on how they might affect a large group, he says. Such a system guarantees the majority of drugs will be ineffectual for many because it doesn't take into account the numerous biological differentiations in individuals. Fortunately, four emergent technologies — portable wireless sensors, personal genome sequencing, better digital imaging tools and ubiquitous electronic records — are converging to upend this antiquation, Dr. Topol says. Genome sequencing, in particular, holds tremendous promise because it will give individuals a full read of their own DNA, complete with a list of potential health conditions and the chances of developing them. With such a roadmap, people will be able to demand treatments tailored to their specific needs, as well as avoid harmful behaviours. With the price of sequencing heading toward less than $1,000 and the quality of assessments improving, Dr. Topol expects to see more than a million tests logged by the end of this year. Prices will continue to drop and quality will continue to get better, which means sequencing could soon become commonplace. Genomics will also combine with technologies that are already prevalent, such as wireless sensors and apps that work with mobile devices. Withings and iHealth, for example, already have a blood-pressure monitoring cuff that connects to smartphones, while AliveCor is an electrocardiogram app for the iPhone. Many more are in the pipe. Doctors are also the biggest users of smartphones, beating out all other professions, according to the Canadian Medical Association As a result, one of the first things Dr. Topol asks his older patients is what kind of phone they have. If it's an older model, he gives them an unusual prescription: "I tell them, 'You need to get a new phone.'" Dr. Topol also takes his own medicine, so to speak. All of his records are electronic and available to patients — no impossible-to-read handwriting — and he hasn't used a stethoscope in two years, instead opting for a handheld ultrasound monitor that takes real-time electrocardiogram readings of patients. He also doesn't prescribe Holter devices, a complicated mess of wires that monitors heart activity, preferring instead the compact iRhythm wireless device that sticks on to the skin like a band-aid and is then returned through the mail. "It's the Netflix of heart-rate monitoring," he says. Despite his progressiveness — or perhaps because of it — Dr. Topol has become a polarizing figure in the medical profession. Some praise him for vocally trying to effect change while others vilify him as self-aggrandizing or out-of-touch with reality. In 2004, he criticized the U.S. Food and Drug Administration and pharmaceutical maker Merck for allowing the heart drug Vioxx to go ahead. Dr. Topol said regulators ignored warning signs during tests that the drug could lead to an elevated risk of stroke, a factor that would later lead to its withdrawal. His views on the digital medicine revolution are no less controversial, with many doctors saying there are good reasons for their industry's conservatism. "If somebody makes a banking error, it's nothing that can't be corrected with another push of a button," says Calgary physician Dr. John Fernandes. "In medicine, we have patients' lives and livelihoods at stake." anada in particular may be late in adopting digital technology such as electronic health records — which many other nations instituted years ago — but it's now leap-frogging others, Dr. Fernandes says. Alberta's Netcare EHR, for example, is "the single best electronic health record system on the planet." Doctors are also the biggest users of smartphones, beating out all other professions, according to the Canadian Medical Association. They're not afraid of technology — they just need to know it works perfectly before adopting it. "They're not going to go and do some far-out experimentation on their patient population unless that's the last option available," says Bill Pascal, the CMA's chief technology officer. "They're looking for a solution to a problem and they want it to be convenient." In that vein, the digital revolution — particularly genomics — probably won't properly take hold for another 10 years or so, he adds. "There's just not good product out there." For Dr. Topol, that's not fast enough, especially when lives are at stake. With the industry moving at its typical slow speed, the onus is falling on consumers to demand change by taking digital technologies into their own hands. "That's totally unacceptable when you have something so important," he says. "This mandate of do no harm also means do no good."
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