The Creative Destruction of Medicine

December 1, 2011
The director of the Scripps Translational Science Institute suggests that in the not-too-distant future DNA testing and sequencing may become available on a smartphone. The former chairman of cardiovascular medicine at the Cleveland Clinic and founder of its cardiovascular gene bank, Topol looks to a future in which genomics will be one of the major tools of innovative, individualized medicine. "What constitutes evidence-based medicine today is what is good for a large population," he writes, "not for any particular individual." Not so in the future. The author is aware of instances in which pharmaceutical companies attempt to violate the principle of evidence-based medicine by suppressing negative results. In fact, Topol was the first to reveal "significant heart attack and stroke concerns for both Vioxx and Celebrex," information he published in the New England Journal of Medicine. As a result of his whistle-blowing, he was forced out of his position at the Clinic in 2004, when the two drugs were finally removed from the market. The author explains how "the large-scale randomized, double-blind, placebo-controlled clinical trial performed under the most rigorous conditions" will be superseded by individualized medicine. Sequencing the human genome opened up major new areas of preventative medicine; in the future these procedures will be able to identify medications that will benefit, or be injurious to, a small portion of the population who carry a specific genetic mutation, rather than the population at large. Topol weaves useful knowledge about how to evaluate the choices open to patients into this exciting account of the revolutionary changes we can expect.

(COPYRIGHT (2011) KIRKUS REVIEWS/NIELSEN BUSINESS MEDIA, INC. ALL RIGHTS RESERVED.)

December 1, 2011
Modern medicine needs a makeover. Topol, of the Scripps Research Institute, believes the process begins with embracing the digital world. His plan involves genomics, wireless biosensors, advanced imaging of the body, and highly developed health-information technology. Smart phones will tie these elements together to make health care individualized, efficient, and accessible. Topol foresees a future medical landscape characterized by virtual house calls, remote monitoring, and a lessened need for hospitals. Pharmacogenomics will pinpoint differences in the genetic profile of individuals that allows for development of drugs that maximize benefit without unanticipated side effects. Social networks will flex their muscles when it comes to medical news and breakthroughs in the life sciences. Digitizing health care could have a down-side, however: a digital dystopia characterized by depersonalization; an Internet crammed with medical data that might be accurate, misleading, or dangerous; the risk of privacy breaches; and the genesis of cyberchondriacs. Integrating sophis-ticated digital devices into the everyday practice of medicine is not the same as giving every doctor a rudimentary Star Trek medical tricorder. But it's close.(Reprinted with permission of Booklist, copyright 2011, American Library Association.)