Author: Eric Topol
This book is all about a radical panacea for our broken health care system. What the author proposes is a creatively destructive process, driven by digital devices and apps, that will result in the biggest shakeup in medical history (pages v-vi and 17). He explores how the global digital revolution will impact on healthcare, and he outlines how physicians can prepare themselves for the inevitable ‘transformation‘ that this ‘radical innovation‘ will bring about. The book envisions a paradigm shift that will affect everyone ‘from womb to tomb‘, and in very meticulous detail, it discusses the emergent digital face of medicine, and the technologies that are helping to shape it (page viii).
The author set out a very compelling case for changing how medicine is practiced today. By outlining several major healthcare failings, he justified the implementation of a digitally-driven system. The main imperfection he highlighted is the prevailing population-based approach to healthcare, a practice that is founded on ‘misleading‘ medical literature which, by reporting ‘false-positive findings‘, promote treatments which totally disregard individual variability (pages 25-32). The author further points out that many expert recommendations and guidelines are made with ‘no or minimal evidence‘, and these advocate ‘the inappropriate or overuse of medical procedures’, many of which are not performed with the patient’s best interests in mind (pages 23 and 35).
The foundation of the book’s arguments is the way digital technologies have transformed other industries, and the promise they hold for healthcare. He particularly referred to the convergence between the internet and the mobile phone, the pivotal breakthrough that is the driver behind the digital revolution. He went on to show how this convergence manifests as constant connectivity, collaboration, crowdsourcing, customized consumption, and cloud computing (pages 6-14). He also gave examples of how digital disruption has completely transformed ‘how we shop, travel, bank, invest, and consume information (pages 14-17). Deploring the fact that medicine ‘has thus far been largely unaffected, insulated, and almost compartmentalised‘ from the digital revolution going on in these other industries, he set out to show how healthcare will benefit from processes that will lead to the digitization of patients, enhance precision healthcare, and democratise medicine (pages v-x).
The author dedicates the majority of his book to elucidate the digital technologies that are at the cusp of revamping medical practice. The major innovation he emphasised are sensors, devices that are key to generating the data that powers digitization. The book gave several examples of these, such as headband sensors to monitor brain waves in sleep, online realtime cardiac monitoring, blood pressure telemonitoring, mood-quantifying sensors, digestible drug compliance monitoring sensors, and implantable nanosensors to detect early signs of heart attack and cancer (pages 63-74 and 162-165). Another significant field is the potential of genomics to enhance precision medicine. The book illustrated how this could accurately predict individual responses to specific drugs, for example checking for CYP2C19 gene variants before prescribing Plavix; BRAF mutations in malignant melanoma; and HER2-mutation in breast cancer (pages 89-103 103). Other related technologies the book discussed include epigenomics, metabolomics, and proteomics (pages 105-108).
The author did not underestimate the major obstacles that will hinder the massive adoption of digital technology he advocated. The main challenge he explored is the well-recognised ‘reluctance and resistance of physicians to change’; he underlined this retrogressive trait when he said medicine is ‘remarkably conservative to the point of being…sclerotic, even ossified‘. He also remarked that, ‘of all the professions represented on the planet, perhaps none is more resistant to change than physicians’ (pages vi and 177). He illustrated this reluctance with the startling example of how it took two decades for the stethoscope to become a standard medical tool (page 237). Warning that ‘doctors need to evolve, not just to survive, but to thrive in the world of digital medicine’, he urged them to ‘adjust to being a guiding force and partner to the patient’ (pages 179 and 259). He made many helpful recommendations to improve physician adoption of digital medicine, and these cover many fields such as medical education, teaching styles, social media networking, telemedicine, and virtual medicine (pages 180-195).
This book is not just an indicator of the future of medicine, but a mirror on the inadequate practices of the present. It urges doctors to learn the lessons of the past, and to quickly adapt to the changes that are inevitably impacting their profession. It highlights, with endless striking examples, how technological advances are restructuring not just healthcare, but society as a whole. It is a heavily researched book, the sheer number of citations and information almost threatening the flow of the narrative. It is also written by a doctor who is involved in the process, and he makes many helpful recommendations for doctors. The author discussed the negative effects these technologies will have on the intimacy of the doctor-patient relationship, but I felt he underestimated how significant these will be for doctors who see this relationship as the foundation of the profession.
This is an important resource for doctors, with profound insights that will guide their future practice. The list of beneficial technologies and practices is almost inexhaustible, an indicator of how far the digital revolution has come. It is inevitable that healthcare will follow in the path of other industries in digitising its practice; the lessons and recommendations in this book will be invaluable aids in this process, and I recommend it to all doctors.
Publisher, Place, Year: Basic Books, New York, 2012
Number of chapters: 11
Number of pages: 319
Star rating: 4