February 3, 2020

Diseases

#91 – Eric Topol, M.D.: Can AI empower physicians and revolutionize patient care?

"If we lean on machines more. . .we can free up time with patients and we could get the doctor-patient relationship back to where it ought to be." —Eric Topol, M.D.

Read Time 19 minutes

In this episode, Dr. Eric Topol, founder and director of the Scripps Research Translational Institute, shares how artificial intelligences and deep learning is currently impacting medicine and how it could transform the healthcare industry not only in terms of the technological advancements, but also in restoring the patient-doctor relationship for better patient outcomes and experiences. We also discuss Eric’s rich and fascinating career in cardiology as well as his involvement as one of the first outspoken researchers to question the cardiovascular safety of Vioxx.

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We discuss:

  • Eric’s background and his source of interest in cardiology [3:15];
  • The US medical field’s resistance to technological change and learning from other healthcare models [11:30];
  • Eric’s mission at the Cleveland Clinic [20:45];
  • How Eric helped to elucidate the issues with Vioxx (and why he came to regret it) [30:00];
  • How Eric came to found one of the most influential research centers in the world [47:45];
  • How AI and deep learning is currently impacting medicine, and the future possibilities [56:45];
  • Gut microbiome—Its role in health, impact on glycemic response and fuel partitioning, and how deep learning could improve our research and treatment [1:18:00];
  • Why machines combined with human doctors is superior to one without the other [1:32:15];
  • How AI and machines can reinstate medicine as an attractive career (and alleviate physician burnout) [1:37:00];
  • Eric’s dream experiment [1:47:30] and;
  • More.

§

Eric’s background and his source of interest in cardiology [3:15]

  • Eric originally had an interest in medicine (endocrinology, specifically) as his father had type 1 diabetes
  • Intended to do a diabetologist residency at UC San Francisco but was inspired by UCSF cardiologist Dr. Kanu Chatterjee and Eric changed his path
  • Cardiology is a very broad discipline with many, many subspecialties
    • The downsided being that the general cardiologists, the ones who look out for the overall cardiovascular health of the patient and generally advocate against unnecessary procedures, don’t get enough “respect”, says Eric

A breakthrough in heart monitoring

  • Eric was part of the group that realized that patients did not have to be monitored in hospital to get a 12-lead cardiogram
  • In fact, even to this day, people are having to wear a Holter monitor which was created in 1950
  • But we are getting away from that and Eric sees this as the entry point to a bright future in wireless heart monitoring

“20 years ago was kind of the entry point – where we just first dedicated wireless company card units – and it’s just where we’re going to build from to ultimately eradicate the need for most hospital rooms, which is a pretty big deal and it’s probably the most transformative aspect of where we’re headed because that’s the number one item for healthcare cost” – Eric Topol, M.D. 

 

The US medical field’s resistance to technological change and learning from other healthcare models [11:30]

  • The medical field is generally resistant to change and it takes longer to adopt something new, exemplified by the lack of embracement of digitalization, which could lower costs 
  • Change only occurs when it is tied to markedly improved reimbursement…

{end of show notes preview}

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Eric Topol, M.D.

Dr. Eric Topol is a cardiologist, geneticist, and digital medicine researcher. Prior to moving to Scripps in 2006, Eric served as Chairman of cardiovascular medicine at the Cleveland, leading it to become the number one center for heart care and was the founder of a new school of medicine. At Scripps he was also the  founder and serving director of the Scripps Research Translational Institute. In 2019, he authored his third book, Deep Medicine, in which he submits that medicine has become void of human connection and argues that AI can empower physicians and revolutionize patient care. His principal scientific focus has been on the genomic and digital tools to individualize medicine. Topol was notably awarded an NIH prospective research grant and to be a lead in the All of US research program, which aims to make advancements in tailored, individual healthcare.  Eric is also the the editor-in-chief of Medscape. 

Twitter: @EricTopol

Disclaimer: This blog is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user's own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.
  1. Eric Topol’s unfortunate encounter with Big Pharma and the Cleveland clinic is telling. Trump is President because he’s like many “captains” of Industry. Money too often prevails over “truth”. We have entered a period where “in the end truth prevails” no longer holds.

  2. A lot to unpack here. Going in, I did not think this would be a particularly interesting episode, but boy was I wrong. This turned out to be one of my favorites ever, even towards the end when it got political. I’ll formulate some more thoughts this evening (as if anyone cares haha).

  3. Great stuff about the history of corruption in medicine, research, and Big Pharma, but I must say that Peter’s frequent interrupting of Eric was quite annoying–even though I’m sure he has plenty of respect for him, it came off as disrespectful.

  4. Dr. Attia,
    You talked over and interrupted Dr. Topol more than any other guest I’ve listened to. Just over an hour in I almost turned it off. Be mindful.

  5. The show notes say that “The VIGOR trial tested rofecoxib against another NSAID, naproxen, and found that, while the two groups had similar rates of CV-related deaths and overall mortality, Vioxx had a higher mortality rate”. This doesn’t appear to be what the study found. As far as I can see, it didn’t evaluate total mortality. Instead, it found that Vioxx increased the risk of “confirmed adjudicated thrombotic cardiovascular event” (MACE and a couple of other thrombotic outcomes, plus sudden unexpected death), and that the the annualized heart attack rates for both Vioxx and Celebrex were “significantly higher than that in the placebo group of a recent meta-analysis of 23 407 patients in primary prevention trials” (0.74%, 0.80%, and 0.52%, respectively).

  6. I’ve now listened to the whole episode. I agree with a couple of previous commenters inasmuch as there was more of Peter in this episode than in many, but I have to disagree that he was somehow interrupting Dr. Topol or inserting himself inappropriately. It sounded to me like a very natural, inquisitive dialog, a good cut-and-thrust that maybe came out of the two having more similar backgrounds than Peter has with most of his guests and Dr. Topol being not so much of a domain expert as someone like Dr. Walker or Peter’s orthopedic surgeon or urologist guests. All around, I thought it was an excellent episode.

  7. I am a T1D and spending a lot of time and energy trying to keep my BGL between the lines of normal. Would it be possible to get him back and ask more about the consequences of non-normal BGL? What evidence is he looking at that suggests it is not necessarily necessary to avoid the diabetic long-term complications? I know, just anecdotally, other T1D who have have it for decades with minimal complications. They say their control has not always been optimal either, especially as early on they didn’t even have BG meters. This question about what BGL I should be aiming for is really important to me. Would it be possible to explore this further – many thanks.

  8. Peter. In Canada we still have choices. You are right about the time to access care. I injured my knee while skiing. It was painful all the time and affected my sleep. I was told 6 months for an MRI and likely another 6 months for arthroscopic surgery. Instead I booked a private MRI…had an appointment in a few days ($400USD), had a consult with a surgeon a week later and had the surgery the following week. Cost of surgery was about $2500USD. Done. Rehab and back at it. Yes. Elitist because I could afford it but freed up a slot for someone else in the public system. But simply knowing that a major medical event won’t bankrupt you is great peace of mind.

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