Until very recently, if you were to ask most doctors, they would tell you there were only two kinds of medicine: the quack kind, and the evidence-based kind. The former is baseless, and the latter based on the best information human effort could buy, with carefully controlled double-blind trials, hundreds of patients, and clear indicators of success. Well, Eric Topol isn't most doctors, and he suggests you entertain the notion of a third kind of medicine, one that will make the evidence-based state-of-the-art stuff look scarcely better than an alchemist trying to animate a homunculus in a jar.
It turns out that plenty of new medicines - although tested with what seem like large trials - actually end up revealing most of their problems only once they get out in the real world, with millions of people with all kinds of conditions mixing them with everything in the pharmacopeia. The unexpected interactions of drugs, patients, and diseases can be devastating. And the clear indicators of success often turn out to be minimal, often as small as one fewer person dying out of a hundred (or even a thousand), and often at exorbitant cost.
How can we avoid these dangerous interactions and side-effects? How can we predict which person out of a hundred will be helped by a new drug, and which fatally harmed? And how can we avoid having to need costly drugs in the first place? It sure isn't by doing another 400-person trial.
As Topol argues in The Creative Destruction of Medicine, it's by bringing the era of big data to the clinic, laboratory, and hospital, with wearable sensors, smartphone apps, and whole-genome scans providing the raw materials for a revolution. Combining all the data those tools can provide will give us a complete and continuously updated picture of every patient, changing everything from the treatment of disease, to the prolonging of health, to the development of new treatments. As revolutionary as the past 20 years in personal technology and medicine have been - remember phones the sizes of bricks that only made calls, or when the most advanced "genotyping" we could do involved discerning blood types and Rh-factors? - Topol makes it clear that we haven't seen a thing yet. With an optimism matched only by a realism gained through 25 years in a tough job, Topol proves the ideal guide to the medicine of the future - medicine he himself is deeply involved in creating.
©2012 Eric Topol (P)2012 Tantor
The US is behind a number of countries when it comes to use of medical information technology (IT). Physicians in the US have been notorious for being late adaptors of new technology and IT. Eric Topol, MD, in his book The Creative Destruction of Medicine, addresses issues surrounding the digital revolution and building the health system of the future. This is a thoughtful, intelligent book which walks the novice through what is possible, the tests and images available, what is to potentially come into wide use, and why we should care. There is a tipping point (my term) on the horizon that will change health care in the USA forever. The digital revolution that is turning higher education upside down, revolutionizing the retail sector, and upending banking and finance is on the cusp of changing how we maintain wellness in the country. Negatively, Topol allocates long passages to genetic decoding, imaging, and other methodology. That can be very interesting to general readers, but I really wanted more information and speculation about what is to come as a result of digital influence on the practice of medicine. Some parts of the books are a little, but then I am a grown up and benefit without being entertained. I don’t mind “lots of words and no pictures.” The Dick Hill reading is very good.
This book is for the most part a rant on the inadequacies of medical science. If I wanted a book on that subject I would have bought one.
I wanted a book that goes in depth on how the digital revolution is making health care better.
A very negative book too, just keeps on complaining over and over.
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