Sunday Book Review #79 – The Creative Destruction of Medicine

When I went to work for USAA Claims back in 1987, I remember there was talk about shifting from paper files to electronic files.  Because progress toward a paperless file was uneven and fitful, we sometimes disparaged it as a pipe dream, but eventually it was achieved.

There has been a lot of talk in the last decade about medicine finally shifting to paperless, electronic files, too, but as with insurance-claim files, progress seems halting.  There are reports, however, that the Obama stimulus and ObamaCare laws included spending to stimulate the efforts. 

While going paperless with insurance-claim files promised greater efficiencies, it has even greater promise in the medical arena.  Not only will electronic records improve efficiency, but it will also improve the quality of medicine because all medical providers will be able to coordinate their care and services.  In the current medical world, all too often each medical provider is in its own silo and operates blissfully ignorant of what other providers in their separate silos are doing.

The Creative Destruction of Medicine is subtitled “How the Digital Revolution Will Create Better Health Care,” and I thought it would provide me with a comprehensive discussion on the benefits of a paperless medical file.  Boy, was I wrong.  Instead, its author, Eric Topol, M.D. provides a fascinating survey of all the substantive ways that medicine is going to fundamentally change in the next decade or so because of what I call the computer age, but he call the digital age.

Topol begins his book by describing how the term “creative destruction” came about.  I have often heard it applied to the way that Manhattan tends to tear itself down and rebuild every decade or so.  Topol explains that the term actually originated with Austrian economist Joseph Schumpeter who used it to “denote transformation that accompanies radical innovation.”  Digital devices in the current world clearly qualify.

The following innovations are currently converging on medicine:

• Wireless sensors
• Genomics
• Imaging
• Information systems (this is what I thought the book was about)
• Mobile connectivity + bandwidth
• Internet
• Social networking
• Computing power

The first three chapters comprise Part One, “Setting the Foundation.”  Chapter One, titled “The Digital Landscape,” describes how much things have changed in such a short time and includes the following trivia:

• Who invented the cell phone?  Marty Cooper in 1973.
• Who invented the personal computer?  Michael Wise in 1975.  (Jobs and Wozniak didn’t produce their first until a year later.)

Isn’t it amazing that the inventors of two products that are dramatically changing the world are not idolized?

Chapter Two, titled “The Orientation of Medicine Today,” describes how today’s “evidence-based” medicine is designed to treat large populations instead of individuals, which is incredibly ineffective and wasteful.

Chapter Three, “To What Extend Are We Empowered” suggests that we (patients) aren’t, but we need to be.

The next five chapters comprise Part Two, “Capturing the Data.”  Chapter Four is titled “Physiology: Wireless Sensors,” and it discusses a wide assortment of applications for sensors implanted in the human body.

Chapter Five, “Biology: Sequencing the Genome,” provides an extensive list of practical uses based on sequencing an individual’s genome.  Author Topol is critical of the AMA’s lobbying against consumers having direct access to their genomic data.

Chapter Six, “Anatomy: From Imaging to Printing Organs,” describes revolutionary developments with imaging, such as a pocket-size, high-resolution ultrasound device.

Chapter Seven, “Electronic Health Records and Health Information Technology,” shows how medical information can be managed to minimize medical mistakes, which play an unimaginably large factor in causing unsatisfactory, avoidable outcomes. 

Chapter Eight, “The Convergence of Human Data Capture,” shows how all of these developments create a great synergy.

The final three chapters comprise Part Three, “The Impact of Homo Digitus.”  Chapter Nine, “Doctors with Plasticity,” explains why doctors tend to be inflexible and resist change. 

Chapter Ten, “Rebooting the Life Science Industry,” describes how this industry, which includes pharmaceutical companies, biotechnology, medical devices, and diagnostics, needs to shift from its business model of getting the FDA to approve drugs and services that are designed to fit general populations instead of specific individuals.

Chapter Eleven, “Homo Digitus and the Individual,” concludes the book by explaining how all of the converging innovations will enable medicine (a) to shift its focus from populations to individuals and (b) toward promoting prevention and precision.  Author Topol sees a steady demise of hospitals and clinics, much like the bricks and motor bookstores.  He also warns that there will be an adverse reaction from those who insist on the old ways, like reading a paper newspaper.  But like the doctor’s house call in antebellum days, that way will be “gone with the wind.”     

Topol makes numerous comparisons in his book to the revolutions in Tunisia and Egypt in the spring of 2011, and I question whether the situations are analogous.  He also is highly critical of medicine for not keeping up in these digital times.  As a lawyer, I suggest that he shouldn’t be so tough on his profession because it seems to me that medicine has advanced much more in these digital times than the legal profession has.  Nevertheless, I am hopeful that Topol is correct and that the practice of medicine takes off in flight just like the rest of the digital world already has.