The Creative Destruction of Medicine

How the Digital Revolution Will Create Better Health Care

De: Eric Topol

Narrado por: Dick Hill

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

A Rx Prediction for Health Care

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.

Very interesting, but in someways very naive.

Where does The Creative Destruction of Medicine rank among all the audiobooks you’ve listened to so far?

Dr. Topol presents a very lively, and optimistic view of medicine and patterns that may advance it in the near future. The optimism espoused is very heavily dependent on technological advances (which is in many ways understandable), but the author doesn't address how to rid ourselves of our terrible health care delivery system. The role of non-scientists and non-clinical care givers in our current system.

What was one of the most memorable moments of The Creative Destruction of Medicine?

The ridiculous amount of bureaucracy organizations like the FDA represent, and still how many times corners get cut on the road to approval when the applicant has the money to pay.
The ridiculous concept of surrogate endpoints, and misleading statistics.

Was this a book you wanted to listen to all in one sitting?

No, I went a referred to some sources that Dr. Topol mentioned and I took a circuitous path.

Any additional comments?

Interesting points throughout the book, but also very disturbing that the health care industry has little resemblance to evidence based medicine.

Fantastic read for everyone in healthcare

Dr Topol talks about the practice of medicine in United States and how outdated it is and how advances in genomics, technology, digital monitoring are largely left out. He also gives a comprehensive overview of all of the above with lot of references and examples. I listened to it on my daily commute so it was impactful. I can imagine it getting a bit tedious for a reader.

Eric Topols insight into medicines future

Dr Topol describes a vision for medicine 10 years ago which is ironically coming into being because of an enormous population based disaster, COVID SARS2.
He argues against population based medicine assuming that large clinical trials do not target the correct patients, and genetics could facilitate that target. One would have to accept that the more we know about our genetic background, population medicine is NOT just intervention. We’re it not for our large investigative population based epidemiological studies many of our diseases would have taken years longer to assess causal associations. That said, treating whole populations for the protection of the few does not make sense and genotyping, as he proposes, is a very appropriate way to target intervention and perhaps drug development.

As a large proponent of big data, I would suggest Dr Topol is also advocating for large population based studies to sort through multi factorial health issues to look at best ways to ameliorate global health.

The book is very worthwhile reading/listening to and his insight from a decade before is prescient.

informative, but dry

enjoyed it for the most part, but somewhat dry. lots of science, very informative and enlightening