The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care [Hardcover]

For a book that has pages of endorsements from key authors and influential physicians, this book fails to meet the expectations - particularly in defining remarkably new disruptive ideas. Despite an excellent set-up and problem definition, this book ends up reading like a well-organized collection of articles from magazines such as Wired.

The premise of Topol is a compelling one - the developments and the relative maturity of mobile devices, PCs, Internet, genome sequencing and social media, provides a potential inflection point in the field of medicine. In the initial chapters that borrows heavily from themes established by Clay Shirky (for example, Cognitive Surplus: How Technology Makes Consumers into Collaborators, and those similar to ones defined in Hamlet's BlackBerry: Building a Good Life in the Digital Age and The Third Screen: Marketing to Your Customers in a World Gone Mobile, Topol abstracts 4 key trends (4 C's) that are setting up the stage for the "Ds" - destructive trends. While the ideas themselves are not new, Topol condenses the ideas from various authors to clearly characterize the innovation potential in medicine. Topol also makes some astute observations on the use of guidelines and the limitations of population-based clinical trials. While this first part alone is worth the book, the rest of the book fails to live up to the excellent framing.

The disappointment mostly stems from a lack of new ideas that could do full justice to the tagline of the book - instead of offering new ideas, for the most part, Topol provides an assessment of well-cited relatively new business models (23andme, patient-like me, Hello health, Vscan, etc) - across a variety of themes in physiology, biology, anatomy, and electronic health records. Mixing anecdotes from his own experience, popular literature (science and general news magazines), and academic papers, Topol is able to provide a credible assessment of the cited business models and use them as a context to define some important questions (but often fails to fully address them).

Topol glosses over issues related to who will pay for these services once they are established - this, perhaps is an important oversight in the book - the lack of discussion on how the value captured by either the patient or provider through these technologies be converted to a sustainable business model. Topol also fails to explain how the higher level of IT infrastructure can be justified in terms of the actual health outcomes that can be attributed to those (in fact, Topol himself argues that increased access to information doesn't necessarily empower patients correctly). At times, he gets carried away describing his observations - for example, he wonders if the increasing use of supplements is a "rebellion against conventional medicine". Topol chooses to ignore analyzing other stakeholders such as pharmacies, nutritionists whose roles and business models have significant disruptive potential from the trends he outlines. While the line between "medicine" and "healthcare delivery" are blurring, a sharper focus on either would've tremendously helped a reader.

Despite these 'issues' and a general lack of provocative new ideas, Topol provides an excellent characterization of the potential of disruptive technologies. One wishes that he would have used his unique experiences and reputation to put forward provocative ideas or perhaps build on the themes by an endorser of this book - The Innovator's Prescription: A Disruptive Solution for Health Care. Despite being an informative read, this book is not very likely to inspire a reader familiar with the trends in this field and the author's reputation as a thought leader. For someone new to this field, this is a remarkably comprehensive introduction to the key trends that could impact healthcare/medicine.

Every revolution shows the incumbents in poor light - they look foolish, stubborn and indecisive. Eric Topol shows how breakthrough growth in mobile phones, wireless technologies and genomics, and their convergence is revolutionizing Medicine and Healthcare but the current 'high priests' whether it is doctors or the bureaucracy dont seem to be getting it. Nevertheless the flow seems to be irreversible as informed consumers empower themselves and push for new solutions that will provide better care, cheaper and more effective medicines, and democratize the healthcare system.

Topols' stories about the shortcomings on the current system are scary and he is very tough on the members of his profession. Other players in the ecosystem like the Pharma companies also do not escape his sharp criticism. He will not be making many friends with this book - however it will be tremendously useful to the readers in multiple ways - as an individual on how to plan for your healthcare, as a student on planning your career, as an investor or entrepreneur for understanding opportunities that would create revolutionary wealth!. For people in the healthcare profession this should be a wake up call.

I would urge all to read this book.

Dr. Eric Topol's book is an excellent review of what the promise of technology holds for the US Healthcare system. His background as a geneticist and a cardiologist as well as a highly regarded research scientist informs this book with the promise of the future, and it is the near future at that. Not something decades away. The advent of the empowered patient (by technology as close as their cell phone) extends the opportunity and methodology for significant reductions in the cost of health care for us all---without a reduction in quality. For instance, cell phones with a "lab on a chip" enabling individuals to substantially reduce the cost and compliance of monitoring one's blood work for glucose, cholesterol, etc. while empowering the patient to be more aware and in control.

His review of genetics was a little dense, but as readers we must all bear in mind how difficult it is to condense such a complex subject into a chapter of one book providing enough information for the lay person to become excited about the possibilities in front of us without speaking totally over our heads. The promise of pharmacogenomics is here today. Enabling an oncologist to test a cancer tumor for genetic markers that indicate which of several chemotherapy drugs would be most efficacious for a particular patient. The "wrinkle" in the system is that insurance company awareness and subsequent payments are running behind the speeding train of "Star Trek" medicine. I do believe we will as a society work this out.

As a health care professional, I highly recommend this book for nurses, physicians, administrators as well as interested lay people. There are so many cost pressures coming with health care reform, it is easy to get caught up in thinking that quality of care is doomed to decline. This book opened my eyes to the possibilities in front of us today and many hopes in front of us within the next 5 years. It truly lifted my spirits to read it.

Thank you Dr. Topol.