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The Patient Will See You Now: The Future of Medicine Is in Your Hands Paperback – October 25, 2016
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"Enlightenment Now: The Case for Reason, Science, Humanism, and Progress"
Is the world really falling apart? Is the ideal of progress obsolete? Cognitive scientist and public intellectual Steven Pinker urges us to step back from the gory headlines and prophecies of doom, and instead, follow the data: In seventy-five jaw-dropping graphs, Pinker shows that life, health, prosperity, safety, peace, knowledge, and happiness are on the rise. Learn more
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About the Author
Eric J. Topol, M.D., is professor of innovative medicine and the director of the Scripps Translational Science Institute in La Jolla, California. Trained at Johns Hopkins University, he conducted one of the first trials of a genetically engineered protein for treating heart attacks, was the founder of the world's first cardiovascular gene bank at the Cleveland Clinic, and was one of the first cardiologists to raise an alarm over the dangerous side-effects of Vioxx. The author of The Creative Destruction of Medicine, he is one of the ten most-cited working scientists, and was named Doctor of the Decade by the Institute for Scientific Information as well as a "rock star of science" by GQ. He lives with his family in La Jolla, California.
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The first section expands his assertion that paternalistic healthcare systems (personified by FDA, AMA, and traditionalists) is really behind the times and the notion "nothing about me without me" is increasingly becoming not only feasible but also demanded by the patients. Providing a detour explaining the evolution of interpretations of the Hippocrates oath, Topol uses that opportunity to take issue (yet again) with the AMA and the entire practice around guidelines. While arguing for increased access for patient-related information to the patients, Topol clearly acknowledges the difference in information and knowledge gaps and points out that mere access is not sufficient, but it is a critical step in rethinking patient engagement and direct participation. To further expand on these themes, Topol borrows Eisentien's characterization of printing press as a change agent and draws significant parallels with that transformation and smartphones, calling this the "Gutenberg moment". While a healthy skepticism is warranted in the claims of everything from holy wars to Renaissance to modern science and founding of american republic is attributed directly to the printing press, one cannot easily dismiss the "combinatorial intellectual activity" printing facilitated. Topol argues (successfully) further that the technology already exists to enable this remarkable period of creativity in healthcare. Using relatively recent episodes such as FDA v/s 23andme and Angelina Jolie's aggressive preventive measures, Topol provides a very informative and engaging view of how the healthcare system is clearly at an inflection point.
In the second section, Topol focuses primarily on the key enabling technologies that will make his vision of a democratized and personalized healthcare a reality. Moving beyond traditional logging devices, Topol paints a realistic vision of the technologies and the opportunities they are already creating such as from lab-on-a-chip to lab-in-body. Along the way, his insights on the failures of EMR systems (using OpenNotes as a contrast), potential of "pre-womb to tomb" predictive/diagnostic models is well worth the read. In fact, the chapter on the various -omics and their potential role (adapted from his famous paper in Cell) and examples on pre-diabetic and airway diseases in itself is worthy of investing in this book. A reader will also gain significant insights about some trailblazing companies like Theranos, QuantuMDx, etc. The discussion around how 3 of the 5 imaging technologies have already been miniaturized to hand-held devices is a clear indication of the realism embedded in Topol's assertions.
In the third section, Topol objectively analyses the import of these changes (cultural and technological) on how healthcare will be delivered and consumed. These discussions go beyond "disintermediation of doctors" and is a must-read for anyone interested in developing new service models. A few years ago, The Innovator's Prescription: A Disruptive Solution for Health Care, provided a radically new way to rethink service models - Topol's book does the same from the viewpoint of patient and the role of technology.
At times, Topol perhaps extends the patient advocacy too aggressively. For example, on a discussion crucifying Myriad and value of patents, he seem to dismiss the risk taken by private enterprises to generate these insights. While he fully acknowledges that information and knowledge gaps are critical, he uses a few hand-picked examples of how highly motivated individuals were able to be remarkably active with the diagnosis and treatment of their conditions (it is hard to say how generalizable these episodes are). Criticisms on AMA may also not be entirely fair and while there will always be "eminence-based medicine" as Topol characterizes it, there is no doubt that some of it needs to be modulated better with patient-centric approaches.
With the clarity of discussion aided by well-chosen examples and analogies bereft of needless cheer-leading, over 50 pages of notes/references, excellent diagrams accompanying some of the key concepts, Topol's book is well-poised to define the next big discussion on healthcare. With the aggressive growth of wearables and smartphones showing no signs of slowing down, wider acknowledgement of patient participation as key for healthcare outcomes, changing delivery models such as ACOs in the US, some of Topol's vision may become reality sooner than even he seem to hope for. Nevertheless, Topol has succeeded in providing a clear thought framework to assess and harness the role of mobile technology in reshaping healthcare ecosystems.
Would you like a few and wonderful sound bites from the first section (of three, that's as far as I've got on my flight home this afternoon)?
"No longer will MD stand for medical deity." Or,
"...smart, hyperconnected patients represent a serious challenge to medical paternalism."
Of course, that's what these are, just sound bites. Still, the author's hiding a treasury of gemstones in the open, a knowledge that we as patients need to have, and he has refrained from making the book unreadable just to look more intelligent, seem more scholarly, too his peers. I can't help but love it, both it's content and form. There's no style over substance here. There's no war between Wilson and House. Just and excellent mixture between truisms and truths. Just the way we normally intelligent but quite un-medical human beings need to have it.
Now, have a look at a few more of the gems just from the opening pages. Then download your own copy on to you Kindle or iPad and go hunting for more gems, as well as profound epiphanies that Toole elaborates over pages.
“Every patient is an expert in their own chosen field, namely themselves and their own life.” Or,
“...doctors consider themselves the most evolved of the human species.”
"...the power of the people is greater than the people in power.”
"...we’re not just talking medical empowerment. We’re talking medical emancipation."
And, if you didn't catch me at the beginning; yes, I am indeed only a patient, trying to manage my own life and not so much my death sentence.
Time to take on the paternalistic tendencies of medicine. We no longer need Eminence-Based Medicine; we need EVIDENCE based medicine. Options, not opinions. Let Eric Topol lead you on that venture.