In “The Creative Destruction of Medicine,’’ Eric Topol, a cardiologist and geneticist at Scripps Health and Scripps Research Institute in San Diego, argues that we are on the brink of a revolutionary transformation in which recent technological and scientific advances will enable the personalization of medicine in ways that would have seemed like science fiction only a short while ago.
The convergence of six major technological advances - cellphones, personal computers, the Internet, digital devices, genetic sequencing, and social networks - are, in Topol’s view, making the “creative destruction of medicine’’ inevitable.
Topol borrows the term from economist Joseph Schumpeter, who coined it to describe the way major innovations tend to prove disruptive, rendering existing systems and technologies obsolete, as a necessary step on the path to new and better ways of doing things.
The new technologies will, he argues, bring about radical changes in the ways scientific knowledge is processed and shared more quickly and broadly; patient data collected, with real-time monitoring and diagnosis; and treatment becomes increasingly individualized. He predicts much of this will be driven by patients and that doctors and others who might be inclined to resist these changes will be under pressure either to embrace, or at the very least, to step aside and not interfere with them. And these looming developments will improve not just patient care but the efficiency of the entire health care system.
One area Topol identifies as ripe for change involves how prescription medicines are used in the country, practices that run more than $300 billion a year. He cites studies showing that popular medications such as Lipitor and Crestor have been proven to benefit only 1 to 2 percent of patients taking them who do not already have heart disease. When it becomes possible to predict in advance which patients will benefit from these medicines, a large part of the $26 billion spent annually on them could be saved, to say nothing of preventing their sometimes serious adverse effects.
Plavix, a drug given to prevent blood clots (on which $9 billion was spent in 2010), is another example. It is now known that at least 30 percent of people are unable to convert it into its active form due to genetic mutations. Not only does giving it to someone who cannot metabolize it place that person at risk for developing a dangerous blood clot, it, too, wastes resources.
Genetic variability explains why some people respond well to certain medications while others do not or suffer adverse effects from them. While the genetic mutations that determine responsiveness to Plavix can be tested for (and are, in certain medical centers), many others that affect other medications remain unknown. It is likely that as more are discovered, genetic sequencing will become a routine part of how specific treatments are chosen for patients.
This runs against the current model of using data derived from population studies of groups of patients to inform treatment decisions. Currently, there is considerable pressure from insurers on physicians to adhere to guidelines based upon data from population studies, and those who do not are penalized under the banner of “pay for performance.’’ Yet biology is more complex than standardization allows for, and simply drawing straight lines through uneven scatters of data points doesn’t change this fact.
A small warning: This book is packed with information and so some spots may be slow going for the less quantitative among us. But Topol does an excellent job of explaining all, and his enthusiasm for the possibilities of what the future holds is infectious. It can only be hoped, as the convergence he so convincingly predicts materializes, that the barriers erected by the gatekeepers of yesterday’s paradigms will be easily dismantled so as not to impede the benefits it promises.Dennis Rosen, a pediatric pulmonologist, can be reached at firstname.lastname@example.org.