Baylor College of Medicine Graduates were treated yesterday to a commencement address fit for 2012 by Dr Eric Topol, Director of the Scripps Translational Science Institute and author of the Creative Destruction of Medicine.
With a nod to how mobile video consultations will “reshape how we do office visits” it warns these digital natives to prepare “for what will undoubtedly be considered its biggest shakeup in history”. I hope the road rises to meet them.
President Klotman, Faculty, Proud Families, and Honored Graduates:
How honored I am to share this great moment and celebration with you—to be here at one of the finest medical schools on the planet with a storied heritage of training leaders of medicine for more than 100 years. How hard you have worked to get to this culminating juncture and how proud you, your family and friends must be.
33 years ago I was in your shoes. Most of you hadn’t been born! It was the analog era—no such thing as a personal computer or Internet or cell phone. Bandwidth was related to a wristwatch and Clouds were something in the sky. Google wasn’t even a word, no less a verb. No things digital. When I was in medical school, the term “digital” was reserved for the rectal examination. You are the next generation of leading physicians and scientists in a new era of medicine….And you are all digital natives.
You sleep with your cell phone and prize it right up there with food and water. You can’t even wait for an email response so you text people to let them know you sent them an email. You even look up drug and medical information on your phone. While the little mobile devices are just the user interface of a digital infrastructure of pervasive connectivity, ever-expanding bandwidth, cloud and supercomputing—they have changed how you communicate, read, study, listen to music, take pictures and movies. You can download a book or a movie in seconds. You are either connected virtually all the time or have separation anxiety when you’re disconnected. So much stimulation. So easy to be distracted. Multiple screens, streams, and tasks at once. We have evolved to a new species of man. We are Homo distractus!
But the hyper-connectivity can help us keep up in medicine. Lifelong learning. Really important. How do you go about that in today’s Zettabyte big ginormous data world? I used to think Twitter was all about Lady Gaga and when Ashton Kutcher went to the bathroom, but now I rely on it for immediately knowing the best articles and links in my area of interest—digital medicine. Through Twitter, I’ve made some great new friends— some I’ve just had the chance meet for the first time in Houston, like Dr. Bryan Vatarbedian, a pediatric gastroenterologist here at Baylor. None of us have the time to scour through hundreds of websites and journals….by using social networking we can enlist an army of virtual colleagues to help us.
It was a joy for me—yesterday— to be able to give each of the graduates a copy of my Creative Destruction of Medicine book. It’s about how the digital revolution will change medicine. So, naturally, I wanted to provide that in the form of a digital “soft” rather than hard copy—but the world isn’t quite ready for that. No way to gift a digital book yet—and I couldn’t have signed it. And this is symbolic for the transition we in medicine will be seeing over the next several years…. The medical world isn’t quite ready for what will undoubtedly be considered its biggest shakeup in history.
Why do I say that? Today we can digitize a newspaper, book, magazine or a movie—but we’re well on our way to the most transformative accomplishment of all—digitizing human beings.
You are being digitized when you register on Facebook and unwittingly create a social graph or hit the Like button. Or when you do a Google search. Or when you buy something from Amazon or a major retail store. This is the early, pixilated, non-medical version of getting digitized. When you can sequence a whole human genome or track every vital sign and physiologic metric continuously via wearable biosensors, then we make quantum steps forward to understanding the essence of what makes each individual tick. The science of individuality and a new practice of precision medicine compared with today’s population medicine. In old mass medicine we treat all patients with the same diagnosis with the same drug, at the same dose, and we do screening tests for all patients for a condition even though only a tiny fraction are even at risk. To illustrate where we need to go…where we can go— I want to present 3 patients—3 individuals— to you.
The first patient’s name is Nicholas Volker and he lives in Milwaukee—no HIPAA violation, his story won a Pulitzer prize. At the age of 5 he was about to die. He had been in the Children’s Hospital at the Medical College of Wisconsin for almost 2 years, without a diagnosis, constantly septic, intermittently in a hyperbaric chamber, and withstood over 100 surgical operations. As his medical team was about to give up, the lead pediatrician suggested maybe they should sequence Nicholas’s DNA and find out what was the cause of his idiopathic—yes the fancy medical word for “we don’t know”—condition. This resulted in identifying the precise root cause gene mutation and led to a cord blood transplant that was curative. Now Nicholas is 7 years old and an incredibly healthy young boy.
Some people think that the 13 years and $3 billion dollars it took to do the first human genome sequence has not panned out. The world-renowned sequencing center here at Baylor, led by Dr. Richard Gibbs with Dr. James Lupski and their team, has led similar efforts to unravel serious, life-threatening diseases. For example, the Beery family twins Noah and Alexis, from San Diego, had a severe, debilitating movement disorder which not only was cracked by the Baylor team, but also the right treatment could be defined by DNA sequencing of the family. Now Noah and Alexis are outstanding student athletes. I want to emphasize in the case of the Beery’s that the mother, Retta, without any science background, was the individual who drove the whole process. Citizen science is a powerful and growing movement. Remember the impact of Gutenburg and the printing press in the Middle Ages—When high priests were the only individuals who could read the bible. Then quickly people learned to read and the world changed. Forever. That it just waiting to happen in medicine. Already so many patients have turned to on-line health social networks like Patients Like Me or Cure Together to get information they cannot get from their doctors—information from virtual patients with like conditions. Digitizing human beings in a digital world can help spawn a consumer-driven health revolution.
Now the second patient who is from my clinic. He is 62 years old, an investment manager who has high blood pressure, the heart arrhythmia atrial fibrillation, and had a stent placed 5 years ago for a blocked coronary artery. He came to see me last week . After saying hello and taking his history, I reviewed with him the graph of over 200 blood pressures he had taken via his cell phone attachment in the past couple of weeks. Only 8% of the measurements were out of target range, and minimally so – his BP was in pretty good control. This was the same patient I couldn’t get to take his blood pressure until he got an app for his phone, which made it fun. With everything immediately graphed, archived, and sendable to anyone—even to his Facebook friends. Then, I asked him to put his fingers on the 2 sensors on the back of my iPhone case so I could do his electrocardiogram—ECG—that was normal. And free, by the way. Then instead of using a stethoscope to listen to his heart, I used a portable pocket-sized high-resolution ultrasound device and within a minute I could see every heart structure—the heart muscle thickness and function, the valves, the size of the 4 chambers. Why would I ever listen for lub-dub when I can see everything? I haven’t used a stethoscope for over 2 years to listen to a patient’s heart. After that we reviewed the band-aid patch that had been mailed to him, and which he had worn for 2 weeks, and captured every heart beat. And he could exercise and shower and lead his normal, vigorous life. And then mail the patch back. It showed no sign of the atrial fibrillation, which was good news. It is like the Netflix model applied to heart rhythm monitoring and another great example of digital innovations that are happening all around us in every walk of medicine.
Pretty soon we will be able to measure just about everything remotely, continuously if need be, from blood pressure to brain waves to eye pressure—relayed and displayed on a smartphone. In between checking your email and surfing the Web, are your ready to check all your vital signs on your smartphone ? Talk about ‘Know Thyself.” Are you ready for a new culture of cyberchondriacs? The wireless digital revolution will eventually change the need for hospitalizations—the place that George Orwell called the antechamber to the tomb—and reshape how we do office visits—using Skype, FaceTime and video links to do electronic house calls in many cases.
OK, now the last—the third patient. That patient is me. Last October, one memorable Sunday night in Arizona before giving a Monday morning lecture, I suddenly developed severe abdominal pain and back pain. Something I had never had before. I was writhing in pain and vomiting. I did ‘t know what it was, but surely the worst pain I ‘d ever experienced in my life. By far. Somehow in the morning it started to pass just as I was about to cancel the lecture—something I had never done before.
When I got back to San Diego, I was diagnosed by abdominal CAT scan to have 2 large kidney stones in my left ureter. Over the next 2 weeks I couldn’t pass them and had intermittent renal colic. Ultimately I had to undergo general anesthesia twice—the first time to try lithotripsy. And the second time, right after Christmas, to have the stones dug out. What an ordeal. After the second trip to the operating room, I had a stent placed from my left kidney to my bladder to keep the ureter from closing off.
But the pain from the stent was viscous, almost as bad as the renal colic. For the next 6 days I had to void between 80 to 100 times per day, and each time I was doubled over in pain. I tried to reach my urologist—I called his cell phone, I texted him, I called his office, and emailed him. No response. No response each day to every method of communication. I desperately needed reassurance for why I was hurting and wanted to get rid of the pain or the stent or both. But I couldn’t reach my doctor.
When I finally saw him after 6 days of torture, he was not even apologetic. He had little to say except “let’s get the stent out, that will make you feel better.” Why do I relate this story? Because even though we have this exciting time in medicine—radical innovation—we need doctors with compassion, with empathy, bedside manner who are great communicators, who have healing touch. And those qualities will be all the more important in the digital medical era when we need to avoid treating the scan, the DNA, the lab test, and the biosensor data—to treat the patient. What it is all about. The individual—who will have more information about himself or herself than ever before. And your role with be progressively morphed into providing guidance, wisdom, experience on how to transform data and information to knowledge and judgment. A new emerging partnership in medicine without the historic information asymmetry. Without the high priests, paternalism, and Doctor Knows Best attitude.
I hope these 3 patients have given you as much perspective as they’ve given me. And perhaps the most important message I can convey this evening is that there is one thing more important than your profession—that is your family. Despite the demands and challenges that you will face, don’t be distracted. Don’t be Homo distractus. Your family is and always will be your highest priority in life. Before you know it, you’ll be in the parent seats watching with tears of pride.
Let me close with heartfelt congratulations for all you have achieved. At Baylor, you rightfully have on your website that you’re “inventing the future of medicine.” You are indeed the future leaders in medicine and I want to encourage you to Think Big and Act Bigger. You are so fortunate to be starting your medical career at this most momentous moment. All the best to each of you as you take on the noble mission and ultimate privilege of caring for the health of your fellow individual.
Eric Topol MD, 22 May 2012