The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care
by Eric Topol
Basic Books, 303 pp., $27.99
Spectacular advances in the scientific understanding of life processes since World War II have vastly increased the ability of physicians to diagnose, treat, and prevent disease. Nevertheless, even today there is much about the cause of most common diseases and their prevention or treatment that remains unknown. However, the huge and constantly expanding store of information in the medical literature is still mainly the province of physicians, who make most of the decisions about the use of health care resources. As always, patients depend largely on their physicians for counsel and treatment.
A new book by Dr. Eric Topol predicts that this is all about to change. He sees an exciting new era created by the increasing application of digital technology and computers to the study of human biology and health care, which he predicts will cause the “creative destruction” of medicine. Medical care will no longer be controlled by physicians. Neither will medical information be based on the results of studies of large populations, which Topol says give less precise information than do studies of individual patients. Instead, patients will largely manage their own care, based on their access to detailed and digitized information in the world’s medical literature and to information about their own bodily functions and individual genetic makeup.
Thus, Topol heralds the coming of “personalized” medicine, in which the convergence of digitized information from all these sources will enable patients to make most of the decisions now reserved to physicians. There will be a parity of knowledge between patient and doctor, which he calls the “democratization” of medical information.
According to Topol, patients will receive, in real time, continuous information about their own physiology, biochemistry, and general health generated by microchip wireless sensors embedded in, or attached to, their body. They will know about their genetically determined diseases, their risks of contracting diseases, and their probable response to therapeutic drugs, as determined by the variations in their fully sequenced genome. All of this vast store of information will be made instantly available and interpreted by their smart phone. Many health care decisions would be made or suggested by computers, some by patients themselves, and far fewer by physicians.
Physicians would continue to manage surgical procedures and the treatment of serious injuries. Even here, however, their direct hands-on activities would be limited to their control of robots, aided by electronic imaging. The result of all these changes, Topol says, will be better and probably less expensive clinical care. There will be much less use of hospitals and physicians’ offices, more rational, safe, and effective use of drugs and medical devices, and greater success in the prevention of disease and disability.
How much credence should be given to this description of a coming medical revolution? Although Topol’s account sounds like hyperbole, it cannot be easily dismissed, for he bears impressive credentials. He has had a distinguished …