Books: The Patient Will See You Now

Topol-The Patient

Einstein once said, “The most important decision we make is whether we believe we live in a friendly or a hostile universe.”  I suspect that readers of Eric Topol’s latest book, The Patient Will See You Now, might be polarized along these lines as well.  The ideas expressed might fill some with fright, while others, with delight.

Dr.  Eric Topol, a cardiologist, geneticist, and researcher from The Scripps Institute and editor-in-chief of Medscape, attempts to get readers up to speed on the rapidly developing innovations in healthcare.  That’s a daunting task, considering how many individuals and companies are experimenting in this space and how quickly progress is being made.

He begins the book by making a convincing argument that the digital age, with the cell phone being its best emissary, is bringing about revolution in society and healthcare akin to when the Gutenberg press was invented, which made reading accessible to the masses. Just as education was democratized, he argues, so is healthcare becoming democratized. In the not-so-distant future, patients will have all healthcare knowledge at their fingertips and as a society, we will move away from the paternalistic paradigm of traditional medicine.

Increasing accessibility to health information is fostering increased patient engagement and helping to drive innovations and advances forward.  He devotes a chapter to discussing the influential role that Angelina Jolie has played as a change agent in shaping the patient’s role in the future of healthcare, with her courageous decision to preemptively have a bilateral mastectomy to prevent breast cancer, after finding out that she is a carrier for the BRCA1 gene.  His point was driven home with the actress’ announcement this week that she has now also undergone a prophylactic bilateral salpingo-oophorectomy (removal of the fallopian tubes and ovaries) to prevent ovarian cancer.

In this information age, patients are more knowledgeable about their personal health, the medical research out there, and their options.  In Dr. Topol’s opinion, healthcare organizations need to move towards transparency at all levels, with regard to clinical information, medical knowledge and research, and that (with consent and precautions to protect privacy), this information should be aggregated to create what he calls “massive open online medicine” (MOOM).  Aggregating and applying machine learning to this data has enormous potential to prevent and cure disease and cut healthcare costs.

Particularly interesting was his description of an individual’s “geographic information system” (GIS), which is a comprehensive health “map” of a patient, looking not just at their genome, but other “-omes”, such as demographics (phenome), vital signs (physiome), anatomy (anatome), DNA/RNA (transcriptome), proteins and metabolites (proteome and metabolome), microbes (microbiome), DNA packaging (epigenome), and the environment (exposome).  Treatments of the future are likely to be very individualized based on a patient’s unique GIS.

He discusses some other fascinating innovations (too numerous to list), including the plethora of smartphone apps and wearable devices, a variety of diagnostic tests being done via mobile devices, the rise of telehealth services, genetic testing and research, the quest for transparent, fully interoperable, and secure medical records, and new tools to decrease morbidity and mortality related to medical errors.

This was an information-dense, engaging read.  For those interested in the healthcare innovation space, it’s a must-read.

What I most appreciated was his optimistic view of the future of medicine in the digital age.  Clearly, Dr. Topol believes we live in a hopeful, friendly universe.