While hailed many in the healthcare community, Eric Topol's book, "The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care," is not universally accepted by all medical professionals as an outline for the future of patient care. One of those detractors, Harvard Medical School professor emeritus of medicine and social medicine Arnold Relman, expressed doubt that patients would be as motivated to participate in their own care as the book portends in a panel discussion hosted on National Public Radio last week.
"I think however dazzling and impressive this new technology is, I don't think it's going to revolutionize the practice of medicine the way Eric suggests," Relman, a former editor-in-chief of the New England Journal of Medicine who became a physician in 1946, told NPR. "I think that medicine is not going to go away, and I think that we will still need the person-to-person contact between well-informed, compassionate doctors and their patients."
Despite himself calling the book a "tour de force of useful new information," Relman also took issue with Topol's points about genomic information enabling providers to deliver more personalized care. Diseases like asthma and diabetes, Relman said, are "multi-factorial" and thus, cannot be predicted by single gene mutations.
"I think there's a lot of over-enthusiasm and premature enthusiasm about what's called individualized or personalized medicine," he said. "I think [Topol] may be too enthusiastic about his predictions of what's going to happen in the future."
Topol countered that he thought Relman was taking the term "creative destruction" too literally. He said that despite the empowering nature of such information for patients, doctors' roles would remain just as vital, if not more so, in the future.
"Just like in the Middle Ages learning how to read. This is about consumers, the public, the individual having new insights and now a parity and getting out of this era of information asymmetry, where the doctors had the domain of the information," Topol said. "This is going to be a whole different look, and I don't think that in fact changes medicine, the need for it. It just creates a different model of partnership, of parity, and I think that's really important."
David Shaywitz, a physician-scientist and blogger for Forbes, said in a commentary this week that companies like Castlight Health that focus more directly on consumer issues such as costs and less on wellness efforts will be the real game changers.
"I've got to believe there's a middle ground here--opportunities for creating … digital health companies tackling problems serious enough to be worthwhile, but focused on an existing pain point, and grounded enough to achieve success and returns without requiring the wholescale reinvention of the entire healthcare system," Shaywitz wrote.