The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care by Eric J. Topol

The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care Reviews

• 
  E-patient Dave

  I come from high tech, where there are zillions of innovations, few get any traction, and a small number change the world. This book is by far the best marriage I've seen of potent innovator thinking with medicine, social media, and information science.
  
  A lot of people are going to say this book is wacky, because it hits the nail on the head in a way that busts the paradigm into pieces. And that's the point: "creative destruction" is a somewhat disturbing term - the point (IMO) isn't destruction per se, it's more what I call "dis-integration" ... the valuable parts of an industry coming apart at the seams, in a way that enables creating new solutions to people's needs.
  
  I witnessed this in my first industry, typesetting, when desktop publishing came along. Before, several valuable assets were only available bundled into integrated systems: to publish anything fancier than typewriter, you needed a typesetting machine (tens of thousands of dollars), fonts ($100+ each), typesetting terminals (there were no PCs then), chemical processors.... with desktop publishing you have fonts on your computer, a printer that can print them (in a vast range of prices & quality), etc etc. All those value elements got blown apart into pieces and reassembled - creative destruction.
  
  But the book's not just about that - a view like that isn't useful if you don't know the flippin' field, because Creative Destruction is only possible if you know where the value actually is. He does. As one example, the whole idea of a large-scale clinical trial is pretty much doomed, long-term, because as we continue to identify *specifically* what's wrong in an individual patient, it'll be harder and harder to find lots of exact match patients for a trial, and besides, a large-scale trial with 70% efficacy just shows that such trials are a shotgun approach: you select a bunch of patients without knowing which ones are really a good fit for your treatment. An educated guess. The smarter medicine gets, the less useful clinical trials will be.
  
  I could go on for ages, but as I said at the top, IMO this is the smartest most dead-on book I've seen that blends innovator thinking with medicine.
• 
  Alistair

  An MD discovers the iPhone, gets completely carried away and declares it will disrupt most of the field of medicine (and gives a well-received TED talk along the way). Maybe I exaggerate slightly, but not much. The actual medical content was interesting to a software guy; the technical projections were much more naive.
• 
  Chris

  This book has a lot of promise but I found myself getting bogged down and skipping around after 80 pages or so. The chapters on biology and anatomy felt like I was reading a textbook. At times this book is written more for a doubting medical professional than a patient. A lot of good info in here but it needs the Malcolm Gladwell touch. The doctor has passion and I'd want him taking care of me but I couldn't "eat" the whole thing.
• 
  loafingcactus

  The book gives you all the pieces that will lead to a medical revolution. The revolution won't occur in hospitals or in legacy research tracks. You don't reposition yourself into a revolution. It also describes some aspects of how traditional medicine will be shifted in parallel with the revolution and what you can do to avoid being harmed by traditional medicine as it currently exists.
  
  For avoiding harm, I would suggest
  The Last Well Person: How to Stay Well Despite the Health-Care System for more. I find this book a little muddled by Topol's attraction to Quantified Self, which I find too easily aligns with traditional over-treatment and medicalization of health. The muddle extends to drawing a line between the repurposing and the revolution.
  
  However to criticize it as muddled is a little bit of back room quarterbacking since Topol is one of the first people to develop these ideas and they have been so much further developed in just the two years since the book was published that it is easy to forget that Topol was plowing totally new ground with this work.
• 
  Ben Z.

  This book was though-provoking.
  
  The author believes that healthcare is reaching a critical convergence with technology that will revolutionize how patients are treated, how doctors provide care, how drugs are developed, and how people maintain their health. Low-cost genomics, hand-held medical imaging devices, wireless sensors, cloud computing, social networking, and telemedicine are all examples of the rapidly evolving technologies transforming healthcare. These technologies will lead to the "digitizing" of a patient, resulting in personalized long-term care model that is vastly more effective and cost-effective. Real healthcare reform will be brought about by technology, not legislation.
  
  The author writes from his perspective as a practicing MD, resulting in read that gets "clinical" and long-winded in parts. Regardless, the book is required reading for those interested in the intersection of technology and medicine and how it could radically change the future.
• 
  James

  Current, predictive and a great business opportunity. Idiopathic therapies based on gnomic results. 4 years ago at the company I work for I was show how cancer is detected in cells. At that time you would see a spike indicating cancer and then they would seek out the matching therapy based on defined processes.
  
  However cancer and many other illnesses with their many mutations now requires very personalized medicines at times to be effective. DNA sequencing of the person is showing a better way as we head towards very specific DNA therapies to fix issues (Maybe I'm generalizing and taking a big leap here as I think this is a great step forward and this book helped me see this). This is a big step forward from the current marginalized benefits occurring with population based medicines. Society has a chance to really see changes in how medicine focuses on the person and realizes that each person is different.
• 
  Jack Reifenberg

  I appreciate Topol’s criticisms against the status quo in medicine. Makes me wonder how I’ll fare if I face similar challenges. It’s fun to be idealistic from the outside but who knows what’s going to happen once I’m really a cog in the machine.
  
  I also wonder how he’d react to Theranos, given all of chapters 7-9.
• 
  Fares

  Having been published in 2012, content and some points are already out of date. This speaks to the fast pace of developments, yet not fast enough (!) as medical advancement still lags quite a bit behind so many other fields!
• 
  Tiago

  Here is an interesting book by Eric Topol, a renowned cardiologist with a social network presence (I discovered him on Twitter). He starts with a critique of the population-based medicine paradigm and how medicine is resistant to change.
  
  Topol than states the case of a digitized human being, which is essentially representing the patient using data from heterogenous sources such as wireless sensors (from smart phones and smart watches, to patches and so on), genomics, imaging, and electronic medical records. This digitized patient will lead to a personalized/patient-centered medicine, changing drastically the current paradigm. That's the reason of the title 'Creative Destruction', which is a famous expression coined by Joseph Schumpeter.
  
  The book sometimes get too technical and it focuses a lot on genomics (one of the author's favorite topics). For someone outside the medical sciences like me it is a bit difficult to keep track with all the terms.
• 
  CatReader

  For a book written in 2012, this is an insightful look at how medicine is currently being practiced in 2020. Specifically, the sections about genome sequencing and other genetic testing (pharmacogenetics, etc.) that must have seemed fantastical and way out-of-reach to the average consumer in 2012 are now becoming increasingly ubiquitous and affordable in 2020. Telemedicine is picking up more and more marketshare, though a global pandemic that Dr. Topol couldn't have foreseen has been a huge driver of that. However, this book shows many signs of being dated -- many companies mentioned are now bankrupt, and the discussion of privacy seems a bit naive as well, especially in this maturing age of the Internet of Things and machine learning (which Dr. Topol would delve more fully into in his 2015 book The Patient Will See You Now, and even more so in his 2019 book Deep Medicine, both of which I'd recommend over this one for a for someone who wants to read one of Dr. Topol's books).
• 
  Karel Baloun

  Outstanding objective book predicting key aspects of a medical revolution this decade -- individualized, proactive wellness, led by people and distributed sensors and data rather than professional medical organizations.
  
  Positive and practical, far reaching and meticulously researched.
  
  Topol deserves admiration from pivoting from traditional cardiology (where he was well positioned) to leading a technological revolution towards a more humane and effective medical industry.
  
  Also gives medical professionals an inspiring vision for how their industry can evolve to lead the way, from the current situation where ossified curricula and resistance to even medical records result in medical mistakes being the 3rd largest cause of death in the US and new innovations taking an average of 17 years to reaching the median clinician.
• 
  Scott

  Eric Topol has created a compelling vision of technology enabled individualized medicine. I had the opportunity to talk with the president of the Massachusetts Medical Society, an oncologist, a few years back, who envisioned both doctor and patient receiving genetic profiles to highlight risks and targeted therapies. He, like Topol, sees the future of medicine as democratized information at the sub-genetic level guiding effective therapies. Technology is central to amassing huge amounts of data and simulating individual responses. Match.com on high speed rails.
• 
  Christopher Benassi

  Interesting overview on the convergence of wireless sensors, genomics, imaging, and medical records. Understanding how the fields of biology, physiology, and anatomy will technologically overlap presents an exciting opportunity for creative disruption. Overall, cool ideas-- but it felt a bit fragmented and idea-flow was difficult to follow at points
• 
  Fred Cheyunski

  Current/Potential Ways Digital Technology Can Help Improve Health Care and What It Will Take to Get There - In my estimation, this book is more about its subtitle than its title, i.e. about the current and potential ways digital technology can help improve health care in the near and longer term future. The figure in the introduction (page vii) is quite helpful and depicts the anticipated transformation from medicine today (what the author later calls "population medicine") to the new, individualized medicine enabled by "digitizing humans."
  
  In Part I of the book, "Setting the Foundation," the author spends 3 chapters summarizing the context for this change including current shortcomings along with the rise of the internet, increased bandwidth, mobile connectivity, and cloud computing to help provide solutions; he also describes the emerging data-driven, participatory, and empowered consumer culture that is accompanying the increasing adoption of digital technology. Within Part II, "Capturing Data," the author uses 5 chapters to explain wireless sensors as applied to physiology, genome sequencing to biology, and digital imaging / printing to anatomy as well as electronic health records, health information technology and their convergence in human data capture. Part III, "The Impact of Homo Digitus," finds the author addressing the impacts and implications of these digital applications for doctors, the Life Science Industry, and individuals.
  
  There are a number of interesting aspects to this book. It provides extensive information and allusions to visionaries such as Marshall McLuhan are inspiring. But one has to be ready to wade through many supporting cases and examples to get to what this reviewer considers "the nuggets" or the "ah-ha's" about what digital medicine will require and mean.
  
  Consider for example, an item from the chapter "Doctors with Plasticity?" on page 194: "With the individual's biologic and DNA sequence data in the EHR [electronic health record], the patient's PHR [personal health record] indicating all pharmacogenomic interactions, and with this information shared with the patient's pharmacist, prescriptions will eventually have a whole new look of precision. The need for in-person office visits [given medical data streaming from sensors] will be substantially reduced over time, along with those to emergency rooms."
  
  Other reviewer favorites include comments from the chapter "Rebooting the Life Science Industry" such as on page 213: "The effectiveness of the drug for patients carrying the gene variant could easily be monitored by continuous wireless sensor over an extended period of time (a week or a month) so as to be certain that the drug has a therapeutic effect and also to quantify the effect very precisely."
  
  To be sure, digital technology will have quite significant effects on health care related practices and industries in the coming years. Many advances are occurring and there is much potential for this technology. However, the author also acknowledges the massive resistance to change from all quarters as well as the need for consumers to help drive the extensive adoption that will be critical to reach the "tipping points" needed to make a difference.
  
  Hopefully, readers will take the time to absorb this book so as to be more able to incorporate digital technology in improving care as they can for themselves and others (e.g. creating /using a personal health record), thus cumulatively contributing to the over all improvement needed.
• 
  Harry Harman

  online medical communities such as PatientsLikeMe
  
  “Our cameras, our microphones, are becoming the eyes and ears of the web.”
  
  There are more mobile phones in the world than toothbrushes, and far more than toilets.
  
  the sea of content
  
  the throughput and cost of sequencing DNA has ratcheted down in a manner far exceeding Moore’s law.
  
  Illumina’s HiSeq or Life Technologies SOLiD 4, more than twenty-five gigabases (a giga is a billion) of sequence are generated per day.
  
  Lipitor is in the family of medicines known as statins, which inhibit the liver enzyme HMG CoA reductase and, in most patients, achieve substantial lowering of cholesterol levels in the blood.
  
  The push for “statins for all” has been dubbed “mass medicalization” and accounts for $26 billion a year of statin prescription costs.6 Instead of identifying the 1 person or 2 people out of every 100 who would benefit, the whole population with the criteria that were tested is deemed treatable with sufficient, incontrovertible statistical proof.
  
  You can even look up the data for the numbers needed to treat for many medicines on the website
  www.theNNT.com.
  
  What constitutes evidence-based medicine today is what is good for a large population, not for any particular individual.
  
  It turns out that at least 30 percent of people cannot normally metabolize Plavix to convert it to an active drug.
  
  So if a patient has a stent put in his coronary artery because of a blockage, and he carries an allele (alternative form) of the gene that does not allow the metabolism of Plavix, the risk of developing a blood clot of the stent is at least 300 percent greater.
  
  The convenience of a “one dose fits all”13 mentality could not be more advantageous for both physicians and the drug manufacturer.
  
  Proven overdiagnosis, representing unnecessary surgery, chemotherapy, or radiation. false-positive results, the emotional toll to the woman and her family after notification of an abnormal mammogram is considerable and impossible to quantify.
  
  I coined the term “litter-ature” to denote that too much of the medical literature is littered with misleading and false-positive findings.
• 
  Marta Hauenstein

  Thesis: Technologies and methods are (becoming) available to transform medicine from a system where doctors diagnose and treat issues according to their understanding of “standard” human functionality into a science that can identify exactly what is causing a problem in a particular individual and either prevent it or treat it accurately. With or without the doctors. This development is evident across the life science value chain, from new R&D methods, through diagnostics, better understanding of how humans function at a molecular level, availability of genetics and -omics data, electronic tracking functions, patient access to information, etc. This process will be accelerated by increased level of information among patients, who will demand individual-specific treatment.
  
  Interesting and well-founded analysis. Like any work that goes into too much detail about the current state of technology, this book (written almost 10 years ago) is already a bit out of date, but many of the ideas and predictions are very much in evidence today.
• 
  Marks54

  This book presents a tour of "Medicine" today with a focus on how the provision of health care and related services from health sciences (pharma and devices) are being influenced by the advent of digital technology - taken to include both digital developments in information technology as well as the reconfiguration of medical knowledge and practice around genomics, genetics, and related fields. The author is an accomplished cardiologist who is also an active researcher and very knowledgeable about the developments covered in the book. The book is well written and generally does a good job of translating some heavy technical materials into terms that readers have a better chance of understanding - although stretches of the book are rough sledding for non biomed researchers.
  
  The book is uneven but on the whole is very effective. I am convinced that technological change is radically altering the organization and practice of medicine, that these changes are becoming more pronounced and influential with the passage of time, and that these changes may lead to "better" health care. So far, so good.
  
  The book has limitations, however. The introductory chapter overdoes that scope of technological change and comes across as trying to sweep the reader of his/her feet with the extent of change and the vision of the author. There were lots of treatments like this during the Internet book around 2000 and they were all overblown, even if one grants the truly amazing extent of changes that occur.
  
  When the book moves into more detail on genetic research, applications of the human genome developments (as well as the other "omes"), and how all of this has affected doctors, patients, treatments, medical education, and the like, the book takes off and is hugely informative. In addition, the discussion of the impact of genetic research on pharmacology is astonishing and caught me by surprise - and I try to follow these things.
  
  A point of perspective that is worth noting concerns the emphasis of Topel's book on individualized rather than general population based medicine. The idea is that we should be looking towards a future where everyone's unique situation (really unique because of the complexity of individual genomes) as distinguished from a one size fits all approach. This approach makes very good sense in medicine but the individual versus global perspective is analogous to the distinction in technology between the basic internet on the one hand and localized information networks facilitated by GPS positioning data on the other. This reminds you of the customization that was featured in the movie "Minority Report". The focus on individualization in both information technology and health care is how technology and medicine are linked in the book.
  
  The impact really hit home with me personally given that within the past year, I had a direct experience with myself and family members and issues of genetics and surgery that brought these issues to light. The book resonates well with what I had spent the past year trying to decipher in the current health care situation.
  
  The case is not made, however, for all of these developments leading to better health care. It is not clear that all the diagnostics help outcomes comparable to their costs. It is not clear that incorporating knowledge of ones genetic make up and special conditions changes the treatment one receives. In some cases, yes, but in most others it is dubious. Even knowing ones full genetic makeup and conditions is clearly a mixed blessing - at least to date. The author raises these points but the emphasis is still on the brave new world arriving as we watch.
  
  Another issue not covered in the book is that possibility that much of our health care dilemma is not inherently technological at all. For example, much time is spent on how to produce electronic heath records systems and the benefits such systems can bring. However, one of the biggest problems working against the development of a technologically superior uniform records system is that hospitals still need to maintain parallel records to comply with state and Federal requirements, which makes the resulting records systems remain complex and non-integrated.
  
  At the same time, many of the critical problems of American health care are more political and ideological than technological. Anybody doubting this can take stock of the going on four year battle surrounding current legislation on US Health Care reform. Technology is often not the issue. At the same time, many of the technological changes raised in the book fall into the category of infrastructure - and the prospects for significant infrastructure investments in the current fiscal and monetary environment are doubtful. In terms of biomedical and pharma research, it is just not clear how the results are to justify the expenses involved. Some amazing episodes around the linkage of genetics and pharmacology are noted but the problem remains -- how are these limited successes going to change the entire system. I have no doubt that incremental change will change the system, but it is not so clear that the result will be as salutary as the author suggests. One can hope, while at the same time trying to work through the more basic political dimensions of sorting out the extent to which health care is a private market, a public market, or some sort of hybrid.
  
  Overall, these sorts of book tend to oversell their cases, especially when compared to the actual research. This book does not - or at least not excessively. Overall, well worth the time.
• 
  Bethany

  The topic of this book was intriguing, but I couldn't even make it through the entire thing. Topol ends the introduction with this: "This book is intended to arm consumers to move us forward." However, this has to be the least consumer-friendly book I've ever read. An average consumer would not be able to make it through the content. Furthermore, Topol does not put forth many new, thought-provoking ideas but simply summarizes ALL the recent examples he can find of technology and medicine intersecting, being sure to point out his distinguished connections and achievements along the way.
• 
  Mareike

  Eric Topol is one of the world's foremost experts on the impact digital advances and AI will have on medicine and I enjoyed his recent report as well as conference talks from him on advances. I think this book is a great first step for people to get acquainted with the developments that have poised medicine for a disruption - though parts of the medical establishment are being recalcitrant - and what this may mean. For me, personally, some things were new and interesting, but I also found the book a little repetitive in places. I am looking forward to reading 'Deep Medicine' soon.
• 
  Mikey Sklar

  Thank you Eric for showing us the future. I can't say enough good things about this book. If you are curious how wearable tech of n=1 will infiltrate the traditional shoot-by-the-hip world of clinical medicine then read this book!
• 
  GabeJauz

  this author is amazing
• 
  Andres

  An interesting book about how recent and still evolving technology can make a revolutionary change in the way medicine is taught, developed, practiced, and delivered.
  
  The author does a great job of quickly surveying the current technological norms, how relatively quickly they came about, and how their tapped and untapped powers have and will continue to become an important tool in the future of medicine, both for doctors and patients. The technologies discussed are half medicine and half access to information (meaning access to the internet, social networks, and smartphones). He figures that the increased ability to record patient data by means of sensors, combined with the ever more refined process of sequencing genomes, will lead to better matching patients to the drugs and procedures they need. This is in contrast to current practices, where drugs are approved for the millions that will in reality only help a few thousand and maybe hurt the rest, all approved by trials and tests that more often than not manipulate efficacy data to improve their chances for FDA acceptance.
  
  I really liked reading about all of this, and the author provides plenty of examples for new or potential technologies, citing the pros and cons of most everything. The only drawbacks to the book are the info-heavy paragraphs and chapters. There are a lot of dense statistical and/or dense techno-medico-jargon bumps in the road, especially in the "Biology" chapter. One other reviewer admits to having eyes glazing over at points, and that happened to me a lot (and I really like this stuff!). The problem is that a lot of it is delivered as punchlines to arguments about how great (or potentially great) this or that is (or might be). It lessens the impact greatly, unless you can understand everything at first blush.
  
  Taken as a whole, though, once you can see the big picture the author is painting, this is quite an exciting and eye opening book. A lot of the things that do exist are really neat, but maybe one too many times the author rhapsodizes about how great something is until you realize that he's talking about a technology that isn't around and won't be for quite some time. This happens a fair bit, actually, so be prepared to differentiate between ‘what is’ and ‘what might be’.
  
  All this digitizing of people’s genomes and medical information leads the author to next talk about digitizing medical records and making them more accessible to patients as well doctors outside a person’s health provider since portability will help a patient receive the most accurate treatment needed in case of emergency. While this process has already begun the author points out the growing pains that have yet to be solved.
  
  Topol’s ultimate argument is that all of this potential innovation won’t get off the ground as fast as it could if people/patients/consumers don’t actively push and pursue these technological avenues. After showing us what is he hopes people will become proactive and push for what is possible. The more information that can be collected about specific genes and drug interactions the more it will benefit everyone, and this kind of mass information will grow exponentially, and will become exponentially more useful (as one example).
  
  This is an informative book about the inevitable analog to digital change to medicine and health care.
  
  NB: I added and edited my initial terrible and incomplete review.
  
  
• 
  Liam

  As a person who was energized by the technological promises of the healthcare debate a few years ago, and as a software engineer who plans on developing healthcare-related software (this book was required reading for my department), I was really curious to see what this book had in store. The book seems to have two messages: changes are coming to healthcare, and we all need to do what we can to quicken these changes. I think the author did a fair job of convincing me of the former, and while I was already convinced of the latter, I don't think the book moved me too much in either direction in this case. It really helps if this is already a passion of yours.
  
  It seems like the author is one of a few people who understand both the complexities (and failures) of modern medicine in America as well as the technological advances happening both inside and outside this space that will "destroy" conventional practices. He speaks knowledgeably on both topics, but I have to say, my eyes glazed over while reading through the biology/anatomy chapters. The technology chapters however were really interesting for me to read. All in all, as someone who wants to help push the technology side to address the problems he mentions, this was an excellent read.
• 
  AGC

  Although this book is about how the current technology revolution is changing and will change healthcare, Topol still seems a bit behind. He writes about many cool gadgets, smartphone apps, the current research, and health databases, but not all of it. There's so much more out there that he does not mention as possible creative destructions.
  
  Topol focuses the most on individualized medicine, which almost requires that everyone undergo genomic sequencing, which he goes into some detail explaining about as well as the new technologies; he also pushes for genomics in medical schools. In time, this will be a great idea, as sequencing gets better.
  
  I think this book is ideal for the times we live in: another alternative about changing healthcare and keeping healthcare up to date with the technology. But as it seems with most healthcare writers, Topol projects it may take decades for the change to come. Hopefully it will be sooner.
• 
  Regan

  Overall a critical view of medicine today with an optimistic projection of the future. I'm sure in some areas his predictions will be spot on but in others I suspect he's dreaming. As I have Atul Gwande's new book Being Mortal on my bookshelf waiting to be read I felt like this book was surprisingly silent on end of life issues and even beyond that seemed to almost ignore the fact that for so much of what causes suffering in this world, the technology he was exploring will never have an answer. As much as the idea of continuous monitoring of our physical health will be beneficial there is a large patient population that won't take advantage of the simple tools we already have at our disposal. The area where I'm most optimistic (or perhaps most uninformed and this easily led along) is genomics - the idea that we can target the therapies we use based on genetic information is quite compelling.