After 14 years as chief of cardiovascular medicine at the Cleveland Clinic, Eric Topol moved to La Jolla, Calif., in 2006 to become director of the Scripps Translational Science Institute, which was established to apply genetic discoveries to personalized medicine. Three years later, he helped launch the West Wireless Health Institute, for which he is vice chairman and which is investigating use of wireless technology in the delivery of health care.  

 The convergence of these two fields—genomics, marked by the rapidly plummeting cost of sequencing a person's entire genetic code, and wireless, with its flurry of innovative health-care apps—led Dr. Topol to write "The Creative Destruction of Medicine," a book that offers an illuminating perspective on the coming digitization of health care. It's also a reminder that while medicine is one of the globe's premier drivers of innovation, it is also a conservative culture that now finds itself buffeted by transformational change. 

Following are some excerpts of an interview with Dr Topel by The Wall Street Journal's Ron Winslow:  

"Eric Topol advocates the transformative power of technology like the MinIon, a disposable device being developed to sequence parts of an individual's DNA; a mobile patient monitor enabled by an iPhone app; the Zio patch, worn above the heart to check for irregular heartbeats; and a contact lens embedded with a chip to measure eye pressure for people with or at risk of glaucoma. There are two levels: 

• One is that in medicine, everything we do essentially is at the population level. Whether it's mass screening or giving the same medication to all people with a particular diagnosis, this doesn't recognize the individuality of people. I think it's fundamentally flawed. We now have the tools to do much better.
• The other is this analog world medicine lives in. The field has resisted a truly remarkable digital infrastructure to the nth degree. It hasn't really embraced genomics, wireless biosensors or advanced imaging that could be used to make medicine more precise. Or social networking. The digital world has been in a separate orbit from our medical cocoon, and it's time the boundaries be taken down."

 Furtheromore, Dr Topel explains that the ability to sequence the human genome is finally making a difference, but it's far beyond that. By applying biosensors to the body, we can measure any physiologic metric—blood pressure, glucose, oxygen concentration in the blood—and send the data wirelessly through smartphones to doctors. That means you have this panoramic, high-definition, relatively comprehensive view of a patient that doctors can use to assess and manage disease, and that patients can use to help maintain their health and direct their own care.  That is the essence of digitizing a human being. For medical purposes, it's getting all the essential data, and it will be the information to radically transform the future of medicine. Many of these things could be adapted today.

The DNA Capsule

The Personalization of Medicine and Health:

We're all essentially surgically connected to our smartphones, and we're still in the early stages of realizing their medical potential. But they should be a real threat to the medical profession.  You can get an add-on to a smartphone which does eye refraction and your prescriptionis gets text to get your glasses made. If you're an optometrist, you might be worried about that. Or you can get your skin lesion scanned and get a text back quickly that there's nothing to worry about. If you're a dermatologist, that's a big part of your practice. You will be able to take a DNA sequence on a USB port and pop it into your smartphone and get data out of it. It just goes on and on.   For example,  let's say you want to prevent a child from ever having an asthma attack. You would know genomically from their DNA sequence that they're predisposed to asthma. Then you would apply a biosensor that could be worn to detect the early signs of an asthma attack and send data to the doctor through a smartphone before it occurred. Then medications could be used to ward off an asthma attack. Using the DNA sequence, the drugs would be matched up to the child's biologic basis for asthma, predicting responsiveness and the absence of significant side effects. With digital tools, if you're seeing someone who has high blood pressure and blood-sugar problems, a lot of the data that's relevant could be sent through the Web before or during the visit. That's different from today, when you and your doctor don't have data available during the visit. But the other thing to consider is that in the future, many office visits will not be in person; they will be "house calls" through Skype and FaceTime and other video links. When you have this type of rich data on an individual, there's a tendency to treat the scan or treat the DNA or treat the sensor data output rather than the patient. But it can actually increase the intimacy. I use a portable pocket ultrasound device instead of a stethoscope to listen to the heart, and I share it with the patient in real time. "Look at your valve, look at your heart-muscle strength." So they're looking at it with me. Normally a patient is tested by an ultrasonographer who is not allowed to tell them anything. They have to call the doctor and ask, "What did it show?"  

 The fact that consumers will have this ability to have themselves—their genome sequence, their lab tests, their tissues—digitized on their smartphones and their social networks will reboot the way doctors interact with patients.  The skepticism is healthy, but we're already seeing remarkable effects in the precise management of cancer, in demystifying life-threatening and heretofore unknown conditions and matching drugs with a patient's genomic data.