Moving Beyond Imprecision in Medicine

“Medicine today is in a sorry state,” said Eric Topol, MD, director of the Scripps Translational Science Institute, but he also claimed that there is “no more exciting time in medicine.”

During a general session at America’s Health Insurance Plans’ Institute & Expo, held June 7-9 in Austin, Texas, Topol explained the buzz behind precision medicine and why it is needed to combat the harms of imprecision in medicine.

For example, mass screenings introduce risk to patients that is “greatly in excess of the benefit,” he said. “If these were drugs, they would never be approved, and yet we still use these tactics in a mass way.”

There are issues with drugs, as well, with research showing that 75% of people don’t respond to the top-grossing drugs in the United States. Medical errors still account for the third or fourth leading cause of death (depending on the research used), and each year, 12 million Americans are given serious misdiagnoses that have downstream effects. These are the results of a healthcare system with a total economic burden of more than $3.4 trillion.

“This isn’t exactly a bargain, I think you would agree,” Topol said.

The concept of patient-centered medicine was first introduced in 1969, but we are just now getting the tools that can be used to implement patient-centered medicine in a real way.

Smartphones can help accomplish a much better understanding of individuals, Topol said. “Name a physiology of a human being, we can track it with a sensor.” Heart rate, blood pressure, glucose, and more can be monitored and the technology keeps getting better.

One of the potential uses that Topol finds exciting is using a smartphone for an ultrasound. These provide high-quality, high-resolution images of any part of the body except for the brain. With this sort of technology, “why would you ever listen to the heart with a stethoscope?” Topol asked. The answer, mostly, is reimbursement.

“[The smartphone] is getting medicalized,” Topol said. “We are just in the early times of seeing what it can do.”

Another advancement for precision medicine is a project Scripps is working on with the Precision Medicine Initiative and other partners, called All of Us. The program is a historic effort to gather data from 1 million people with the goal of accelerating health research and enabling individualized prevention, treatment, and care.

The program will give participants back the data that they’ve never had access to before. It might not be right for all people, but for certain people, this could be a big motivating factor for their care.

“We’re basically engendering 1 million citizen scientists,” Topol said.