Eric Topol’s heroes include actress Angelina Jolie and businesswoman Elizabeth Holmes. He celebrates the autonomy with which Jolie evaluated the information about her genetic risk of cancer and made the decision to have a double mastectomy, as well as her impulse to go public with that decision. She chose to use her visibility and the Hollywood culture of beauty-worship to make her medical story headline news and to encourage other women to learn their genetic risks and make the relevant medical decisions. In publishing her story, Topol says, Jolie “symbolized the new era of medicine, whereby access to critical information about oneself — in this case genomic information — leads to the individual’s empowerment to make a pivotal choice that determines one’s fate.”
Holmes, the founder of a company that seeks to revolutionize the technology of blood tests, is another sort of hero, the technological visionary who finds new, digitally based ways to surmount traditional roadblocks to medical testing and get patients their results swiftly. Topol describes the experience of having a droplet of blood taken painlessly from his finger: “Over fifty tests were analyzed … and I got the results back in just a matter of minutes.”
In The Patient Will See You Now, Topol, a cardiologist and a pioneer in genetics and technology, builds on the arguments of his earlier book The Creative Destruction of Medicine. He argues that it is critical for people to know as much as possible about their bodies and their health, from their genetic codes to the moment-by-moment information that implanted sensors might transmit about their bloodstreams, their airways and their hearts. All this information in theory could be registered immediately; tracked to each individual’s cellphone; and used to stave off illness, avoid crises and initiate therapies at optimal moments.
The book is written in an exhortative, even urgent voice; as the subtitle suggests, “The Future of Medicine Is in Your Hands.” Topol urges readers to make use of technology, digital know-how and entrepreneurial creativity to learn as much as they can about their health, to know it all and own it all, and to manage it on their personal devices. “For just as Gutenberg democratized reading, so there is the chance that smartphones will democratize medicine. That will ultimately be achieved when each individual has unfettered, direct access to all of their own health data and information.”
And the obstacle? What stands most in the way, according to Topol, is an entrenched culture of medical paternalism, which he gleefully traces back to the original Hippocratic Oath. And for the most part, he blames this paternalism for problems large and small, from the long waits for medical appointments (and the long waits in doctors’ waiting rooms), to the barriers that divide people from their own lab results and medical records, to the medical errors that endanger patients in hospitals. The more that patients control their data, the author argues, the safer and more individualized medical care can become. Thus the vital importance of technological advances that allow quick and accurate access to that information and place it literally in the hands — or handhelds — of those seeking medical care, and not just in those of the providers.
The Patient Will See You Now is full of innovative thinking. Readers learn about devices that can measure body chemistry, organ function or medical risk, integrate that information instantly into a profile of their health, and offer answers to questions they didn’t even realize they ought to be asking. Topol’s argument is that these devices and this sort of patient involvement have the potential to revolutionize the practice of medicine, eliminating many of the abuses of medical paternalism by returning information — and the power that it brings — into the hands of patients. And he presents many intriguing scenarios in which technological creativity offers everything from telehealth (“My (Smartphone) Doctor”) to cheap, fast skin tests for diagnosing malaria.
But however exciting the technology, we have to keep in mind that devices, tests and therapies are all tools, with no inherent moral valence, and one of the recurring lessons of medical history is that exciting discoveries and promising therapies can also carry dangers, unexpected outcomes — physical, ethical and social. In addition to the issues of entrenched paternalism, many problems that inhibit good patient care reflect the uneasy intersection of market forces and medical practice, from productivity pressures applied to doctors by their institutions (see more patients, spend less time with each one) to paperwork overload (if you want to prescribe a drug that will cost us more, we’re going to make you spend a lot of time filling in forms and waiting on hold on the phone). The market plays a complicated role here, and new products and technologies are not guaranteed to make life easier or more convenient for either patient or doctor.
Any discussion of increasing, accumulating and analyzing personal medical data raises important questions about privacy and confidentiality. Topol takes on this issue, exploring the problems of identity theft and hacking and the question of whether your insurer should have access to all possible medical data. He believes that keeping patient records secure is possible, noting in particular that “anything that will better protect the genomic privacy of an individual should be pursued.” But the questions are huge and complicated, and if the changes that Topol describes are coming as quickly as he hopes, they’re going to require development of new technical and legal protections, so that we keep ourselves safe and healthy in every sense.
Topol sees a future in which “your smartphone will become central to labs, physical exams, and even medical imaging; and … you can have ICU-like intensive-care units monitoring in the safety, reduced expense, and convenience of your home.” This is a book full of technical wizardry and intriguing questions about the nature — and the future — of diagnosing, monitoring and healing.
Perri Klass reviewed this book for The Washington Post.