10 Questions: Q&A with Eric Topol

By Katherine Lagomarsino
Illustration by Lauren Crow

Eric Topol, a cardiologist, professor of genomics, and the director of the Scripps Translational Science Institute in La Jolla, California — as well as a member of Genome’s board of advisors — talks to us about his latest book, the growing roles of smartphones in health care, and why he no longer uses a stethoscope.

In your new book, The Patient Will See You Now, you write about democratized medicine. What is it and why is it important for patients?

It means medicine that is available to all people. In the context of the book, I am referring to the key data and information flowing directly to patients and a “flattening of the earth” such that much of health care can be delivered wherever there is a mobile signal.

Why is the U.S. healthcare industry so far behind when it comes to technology and information sharing?

Our health information systems are terribly fragmented unlike other countries that have all their citizens in a uniform data resource.

Can you talk about the power of the smartphone and why you think it is our century’s version of the Gutenberg press (the first movable type printing press, which revolutionized how the world received information)?

The medical smartphone will have the capabilities of aggregating, and with machine support, analyzing all of one’s medical data including that from sensors, labs (many performed via the smartphone itself), images, and directly connect with a doctor via telemedicine. Most routine diagnostic and monitoring functions will eventually be standard via consumer mobile devices. This is much the pre-Gutenberg press era when only the priests and elite had access to the written word and could read. So will be the case with consumers having direct access to all their medical data.

How far away are we from having our smartphones perform lab tests and medical scans?

We already can do blood glucose and cholesterol via a smartphone, and that’s just the beginning. Most routine lab tests have already been shown to be feasible, and much work has been done to set up handheld ultrasound and someday X-ray and MRI.

In the book you mention you have not used a stethoscope in several years. What do you use instead? Are there other medical instruments you think should be relegated to science museums?

That’s right. I have not used a stethoscope to listen to a patient’s heart in over four years because I do a handheld high-resolution ultrasound and get direct visualization of all the heart structure and function that I’d want and need to see. Other traditional devices like the Holter monitor [which monitors the electrical activity of the heart] and the blood pressure cuff are on their way out.

Many see the current cost of health care as unsustainable. Do you think technology is the answer to reducing healthcare costs?

That’s the hope, certainly. But it needs to be proven via rigorous clinical trials.

While there are benefits to being connected to your health through your smartphone, is there a danger of losing the doctor/patient relationship?

Doctors will never be replaced. It’s just that much of the straightforward stuff can be done through innovative hardware (like sensors and microfluidic chips) and software (like algorithms and machine learning), along with our pervasive connectivity and remarkable digital infrastructure. But the wisdom, experience, and knowledge of doctors is irreplaceable to provide guidance and the human touch for patients. It’s a new PPP, or patient-physician-partnership, model.

What advice would you give patients who are dealing with a doctor who is of the paternalistic, “doctor knows best” school of thought?

If they are happy, nothing needs to change. If they want to move to the model described in the book, it’s time to reconsider how their care is provided.

In your book, you write about “transferring responsibility for generating data, surveillance and much of disease management to patients.” But what about the patients who are too ill or too busy to do this?

Sure, this is not for everyone and it is never going to be mandated. It is an opt-in opportunity and there will be many exceptions and patient situations for which it won’t apply.

What is the most important thing you can do to be your own healthcare advocate?

Have all your data and information (or make sure it is accessible via your mobile device) and keep up with the most exciting phase of democratized medicinegoing forward.