The Creative Destruction of Medicine

This book merits five stars for content. I'd have shaved one away, because this was NOT an easy book to read. The topic, however, is so important that we'll leave a full array. In any event, if your life intersects with medicine in a major way, read it.Dr. Topol is an eminent cardiologist, geneticist, and medical researcher. Here, he argues that the practice of medicine is on the brink of massive structural change. The title attributes this to the digital revolution, but the book is at least as much about the impact of the science of genetics. The combination of these two will produce a medical approach far more closely targetted to the individual, far more precise, and -- ulimately -- far cheaper.A great deal of what Dr. Topol says is very informative and very convincing. Some of it is so "gee whiz" as to be offputting, and some of it sounds like science fiction. Much of what sounds like science fiction, however, is already in development. And some of it is already moving into current practice -- by patients as well as by doctors.This is very important reading for those who have heavy contact with the healthcare system. One of Dr. Topol's key points is that as information becomes much more readily available, patients will have to take on more responsibility for their own care -- no one doctor can make all the right decisions in every area, and no one knows a patient like the patient him or herself. There is a lot in this book that's essential knowledge for those with serious conditions (or those who are helping those with serious conditions). The rather horrifying chapter on medical errors stands out, but there is much, much more.My only problem with the book is that I found it a tough read. That's not so much because it was over-technical. The one instance in which that may be true is the section on the role of genomics in medicine, but that is a hard thing to explain, and not part of the general medical knowledge base -- Dr. Topol notes that at the last report, only 2 out of 150 U.S. medical schools had "more than a brief, cursory curriculum" devoted to genomics beyond simple Mendelian traits. My problem was with the overall approach, which is to throw lots and lots and LOTS of information at the reader, without enough explanation or linking together.Stylistic issues, however, should not deter readers: there's so much very important stuff in this book that it's worth a bit of a slog. Moreover, the readability problem may be with this (elderly) reviewer. Two generally favorable reviews didn't seem to find it a problem. See the Wall Street Journal review at [...]at [...]Anyway, read it.

Given all the havoc that has beset the medical market it is no surprise that Topol has called this a "Creative Destruction of Medicine". The medical system in place from (say) the mid-20th century forward, will not be able to handle the continual flow of retiring baby boomers, let alone senior citizens with ever increasing life expectancies. Like so many promises made over the past years, in its present form medicine will not be able to afford to honor the Medicare entitlement. So the current system must be replaced it with something else that will work.The only good news is that the cost of medicine can be greatly reduced through the aggressive introduction of advanced cutting-edge technology. Topol provides examples of where the injection of a little technology can substantively improve medicine, and at the same time do so at reduced costs. We might be seeing what others in the past have called "inflection points", where radical improvements and changes lead to measurably better patient outcomes.Changes on the cusp, are by no means painless. In the future you personally will be unlikely to get nearly as much one-on-one time with your doctor. Instead you will be seen by other medical professionals like physician assistants, nurse practitioners, and technologists of all stripes . In writing this, I remember the days when my dentist actually cleaned my teeth (!). Now a hygienist tends to that, with the dentist stopping by to take a quick look and shake hands.It would seem the dentists got to the answer faster than medical doctors were able to:Delegate anything and everything you can to less expensive staff so you can see more patients and reap the rewards of an expanded practice.

I learned of this doc from a news feature a while back on NBC nightly news and wanted to learn more about what he was doing. This book is not just about medicine. The first chapters are all about the proliferation technology in general and how it has changed the way we think and live.As a believer in holistic medicine and energy healing along with other alternative medicine, I was moved by Dr. Topol's willingness and courage to talk about the lies Big Pharma is telling us about the drugs millions are taking for cholesterol, as one example, that only do not work as promised, but can cause serious trouble. 7% of people who land in hospitals are there due to prescription drug side effects which are a leading cause of death. It's a complicated story driven by profit motives that appear to cause issues in which version of the truth the consumer will get so sales will cover billions in R&D costs. He also talks about doctors who may be more interested in selling you on the need for your heart surgery than getting you a cure that doesn't involve cracking your chest open. Hey, who will pay for all those big MRI machines if we don't keep those surgeries coming?Dr. Topol also believes that with proper support from technology, people with various illnesses can monitor themselves or be monitored remotely and stay out of our staph ridden hospitals. Much of such technology is still in development but future developments will arrive with the same lightning speed that will make your new PC obsolete the day you buy it. Remember, there's big money in medicine!This is a good read that should move all of us to consider that our health options and decisions should be in our own well informed hands. He gets a little technical here and there but altogether, Dr. Topol's heart is in the right place, giving information for our own personally managed good health.