By Matthew Holt

Eric Topol was once a lowly (well not that lowly) cardiology professor at the University of Michigan, but he’s now without question the leading renaissance man in health care technology. Virtually every week sees him on some big stage disgnosing his own heart murmur with an iPhone app or showing off how his sleep brain waves and his genome interact or don’t.

His new book, The Creative Destruction of Medicine is a tour de force romp through basically every type of cool new medical technology. He covers the Cloud/Web/Wireless/Sensor phenomenon from both a social, transactional and diagnostic  point of view–leaning heavily on his connection to the West Wireless Health Institute which he helped persuade Gary & Mary West to fund. He’s the creator of a new medical school program at Scripps focusing on the genomics and proteomics revolution, and the book covers in great detail the evolution of the human genome project and its impact on disease discovery (coming eventually) and matching patients to the right drug (available more or less now). Finally he was of course the head of Cardiology at the Cleveland Clinic where he not only was heavily involved in the testing of tPA (the drug that built Genetech) but also in unveiling the problems with Vioxx not limited to the drug itself but also concerning Merck’s behavior at the time. (Remember Dodgeball?)

In fact if not for Merck putting pressure on Cleveland Clinic to get him fired (or at least Cleveland Clinic reacting as if that happened), Topol may not have become the medical renaissance man he is today. The San Diego air clearly agrees with him. And we’d all be much poorer for that.

I’d encourage everyone to read the book. It’s a remarkable and relatively in depth (for a speed read) analysis of the state of the art in three areas in medicine (IT, genomics & clinical/disease) and it has several very interesting ideas–all with a strong dash of health services research and cost-effectiveness analysis mixed in.

I come from a pretty strong background on the IT side, so I’m judging the other sections by the currency of what Topol said about that. His analysis of the development of the cell phone/Internet is comprehensive but also very current indeed. The book is smoking hot off the press and includes numerous products that are either just out or not on the market yet (AliveCor), and only one or two times when recent facts have overtaken him and look like poor choices (e.g. he features fading physician community Sermo which has just lost its CEO rather than QuantiaMD). Of course that’s the problem with a book about something that’s changing so fast, but in general his work on the IT side is very recent and relevant. The genomics and disease chapters required a little more concentration and the fast skimming reader (i.e. me) might get a tad lost in the DNA letter sequences, but the general gist is important and clear.

So what does he say? The brief synopsis is that medicine has been aimed at curing average diseases among average people, and therefore most treatments are ineffective. Worse, most clinical trials have to have huge numbers of people in them to see the difference in a small number of people. Topol and I recently tweeted back and forth about the mid-1990s GUSTO trial which showed that using tPA instead of Streptokinase saved just over 1 in a hundred heart attack victims at about 5 times the total cost. Topol defended the use of tPA then, and still does but points out that what we thought were big numbers in the 1990s ($2,200 a dose versus a few hundred) are dwarfed by say use of cancer drugs that can exceed $100K for a course and may only extend life a few months on average. So clearly playing by the old rules with the new medicine is unsustainable.

What Topol calls the creative destruction of medicine (getting all Schumpterian on us) is that we need to use the three tools of IT, genomics and clincal effectiveness research (i.e. big data) to blow up the current way we accumlate medical knowledge and make decisions over treatments and drugs. And also to lower the cost.

Instead we should allow the use of drugs identified as being likely positive for people with specific genotypes much earlier in the process, and we should be using wireless (and implantable/swallowable) sensors and other Health 2.0 tools to measure as much as we can about what’s happening to the patients in those smaller cohorts–which would still be much bigger numbers for people with particular diseases than those in the current broken clinical trial model.

It’s this personalization of the clinical trial model and its extension into everyday care that’s probably the biggest idea in this book but it’s one among many.

All in all this is a great read and points the way to lots of possibilities for the future of medicine. Which doesn’t mean that they’ll all happen, but it would for sure be good if most of them did!

(I wish the “Too clever by three quarters” title was mine but it was said first I think by Briitish critic Melvyn Bragg about actor, director, and medical doctor Jonathan Miller)