The Evangelist of Individualized Medicine

Eric Topol, a cardiologist and professor of genomics at the Scripps Research Institute, is a leading proponent of using DNA analysis and digital technologies to understand each patient as an individual. In addition to using these technologies with his own patients, he works as an advisor to companies including Illumina and Gilead Sciences, and he shares his insights through a Twitter feed that is required reading for those interested in the topic. In his book The Creative Destruction of Medicine, Topol describes how the ability to inexpensively sequence an individual genome, combined with new health applications made possible by wireless technology, can make medical care more customized and effective. He spoke to Business Reports senior editor Nanette Byrnes by phone from La Jolla, California.

Health data tracked on phones and devices is one way medicine can become more personal, you argue.

There are quite a number of devices for measuring blood pressure, heart rhythm, and blood glucose on a continuous basis. I can do a complete ultrasound of the body in high resolution with my smartphone, during [a] physical exam. You don’t have to send nearly as many patients for the $800 to $1,000 ultrasound test, and you can share it with the patient during the exam. With smartphones you can do an ear exam on a child, or an eye exam without an eye doctor, you can measure Parkinson’s tremor, voice, and gait and know whether you should take your medicine and at what dose. We’re heading toward being able to do your own medical selfie. Most people judge [self-monitoring] by things like Fitbit and step counting, and that’s so off base.

As you point out, this has coincided with increased use of a very different technology, genomic medicine.

There has been a remarkable drop in the cost of genome sequencing. The problem we have right now is a lot of these new drugs [being developed based on genomic analysis] are for rare conditions and are off-the-chart expensive. If you can achieve a cure with genome editing, then the question is what should that cost? What would it be worth to get a cure via gene editing instead of going through a perpetual, very expensive treatment with risks and side effects?

You are a proponent, but does anything concern you about this new medicine?

The biggest disappointment is security. Our medical data is being sold, hacked, breached. Over 100 million Americans have had their [medical] records hacked in the last year, versus maybe five million that have accessed their records online. That’s the vulnerability.

People don’t own their medical data, and they rightfully should. They are generating an ever increasing amount of data through their own devices. There’s no home for that data. There’s tremendous resistance from the medical community, but we need to embrace this shift in power to the patient.

Is it hard to make sense of so much data?

That’s the next problem, handling the data and processing it using artificial intelligence and deep learning. We are not nearly as far along as we should be. This is a bottleneck that can only move forward when the data is getting processed in real time with feedback to the individual by validated algorithms. Companies are working on this. The idea is to capture all this data (such as from sensors and imaging), enabling machine learning and predictive analytics, and giving individualized guidance based on that.

How long do you think it will be until that challenge is solved?

I am always unrealistic, hoping for things to change quickly. This will take time.