Dr. Eric Topol on IBM's Watson, Twitter, and the "Medical Cocoon"

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MD+DI: What are the main factors behind what you term “the medical cocoon,” which slows the ability of technology to transform healthcare?

Topol: I think this whole concept is reminiscent of the Gutenberg printing press and the high priests. [Ed note: Before the advent of the printing press, reading was largely relegated to priests and to their educated patrons.]

The information era has gotten to a point now where a lot of data can be processed with algorithms, and we can extract big data sets that are meaningful for an individual patient. Any consumer will be able to get this information. It is going to be commonplace eventually; it is just a matter of when—not if.

There are so many different disciplines in medicine that are getting directly threatened by [advances in digital technology]. If you are an optometrist, you have patients who can get their eyes refracted using a smartphone. If you are a dermatologist, you have patients who could have skin lesions analyzed on their smartphone. And if you are an ENT (ear, nose, and throat)  doctor, you have patients who can analyze the whole oral cavity through the OScan. All of this is without the patients having to see a doctor.

There is, however, no Watson, no artificial intelligence that is going to replace the physician’s judgment, wisdom, and experience gained over the years. That is irreplaceable and it has become the precious aspect of the physician of the future.

MD+DI: The guys over at IBM have said that Watson should act more like a nurse who asks physicians if they remembered to go through all of the steps in a procedure. They have stressed that physicians are indispensible yet Watson will help them to be more objective and more educated than ever was possible before.

Topol: Exactly. Why wouldn’t every doctor want to have Watson’s support? Watson can comb through two million pages of content in three seconds. I don’t know any physician who can do that. If you have a challenging patient and you don’t know what is going on, why wouldn’t you access a supercomputer?

I think [clinical use of Watson] is going to become commonplace. Right now, it is only at a few cancer centers and Wellpoint, but tomorrow, it will be used across the board. That will be an expectation—that you would consult a supercomputer to look at all of the data up to the moment and you couldn’t possibly do that before. You didn’t have the time or the capability. There is just an absurd amount of information to try to process. No human being can do that in an acceptable unit of time.

But, go back to that physician who has got years of wisdom, savviness, experience, clinical judgment—that is something that Watson will never be able to replicate. Qualities like those are what separates the digital age and the true medical profession.

MD+DI: What are your thoughts on the regulatory environment with respect to drugs and devices? I’ve heard some anecdotal information that FDA has made some progress in speeding approvals of innovative products.

Topol: I actually admire the folks at FDA because I think they are on a noble mission and there are a lot of bright committed people there but I think it is kind of a bureapathic agency and that makes it very hard to get things done. There are not enough innovative ways [being implemented] to do clinical trials. 

There are various ways to streamline the clinical development of devices or drugs or diagnostic tests. The time lag from an innovation to actually helping patients is unnecessarily long.  

Also, in the wireless sensor world, we have got this FCC and FDA government bureaus working almost against each other, it seems, to try to get stuff out. Recently, they have tried to express that they are working together and hopefully, we will get over that. But that has been an unnecessary obstacle along the way. 

MD+DI: I had a similar conversation recently with Thomas Fogarty, MD who has had a change of heart recently with respect to the FDA and timelines. I’m paraphrasing, but he said that he thinks that the agency is responsive to the notion that innovative technology should be sped to the market because of its ability to improve the standard of care.

Topol: In recent times, I have also become more optimistic because I do believe they are trying. The problem, however, is that this past year, we have seen politicization of the FDA like we have never seen before—with this whole thing with the Plan B and so on. I think they are actually trying to rev things up to be more pro-innovation. But there are more drugs that have been approved in the last six months than there have been in many of the past years. So we are seeing genomically guided drugs get some accelerated handling. That is encouraging. That is just one area of medicine, but it speaks to the individualized era. It might even in itself help speed up the whole process.

The whole concept of having “overwhelming efficacy” of a device, or a drug, or a diagnostic test hasn’t been embraced enough. If we have that, learning about safety could be done on a conditional approval basis. If we were willing to let things go out into the real world under a probationary status, every single individual could be monitored electronically to watch the the device, the drug, the test in question. That would be a whole new way to expedite things in the future.

MD+DI: How do you think social media outlets like Twitter will play in the transformation of the healthcare paradigm?

Topol: Twitter has been for me an extraordinary way to get information that I would not otherwise see in the same time frame. I use it to find what I can consider highly relevant information in terms of my interests, whether they be in sensors, genomics, and individualized medicine, and the digital world. It is just so striking to have that crowdsourcing and mindsharing—that ability, in 140 characters, to even express an opinion and to get that exchange of ideas. Every significant paper that is published now has a Twitter instant reaction. It is great to see that. It is really all part of the democratization of information and medicine.