Eric Topol Research Articles

The State of Artificial Intelligence in Precision Oncology: An Interview with Eric Topol

The State of Artificial Intelligence in Precision Oncology: An Interview with Eric Topol

Changes to the editorial board: new co-editor for EHJ.

All correspondence relating to this article should be sent to cardiopulse@unicatt.it. Marco Roffi, MD, is professor of medicine, vice-chair of cardiology, and director of the Interventional Cardiology Unit at the University Hospitals of Geneva, Switzerland. Following training in interventional cardiology with Bernard Meier at the University Hospital of Bern, Switzerland, and with Eric Topol at the Cleveland Clinic, United States, he worked alongside Thomas Lüscher in Zurich, Switzerland. He has been a member of the international editorial board of EHJ since 2013 and has held a wide range of roles across the ESC working to ensure the Society’s reach, authority, and impact (Figure 1). Filippo Crea created a team of EHJ co-editors with the task of being EHJ ambassadors across the continents. The purpose is to approach cardiologists from all over the world and introduce them to the Journal. The fact that EHJ is one of the leading cardiovascular journals worldwide may be a barrier to many cardiologists, especially for the younger generation. My job as EHJ co-editor for Western Europe will be to try to reduce the barriers in this part of the world. On behalf of the EHJ leadership, I would like to take the opportunity to thank William Wijns, who preceded me in this function, for all his work.

Medical terminology in an audiovisual product

Audiovisual translation (AVT) from English into other languages is gaining popularity both in the entertainment and professional realms. Besides language difficulties, an interpreter has to face cultural challenges and a lack of professional knowledge of a particular subject field. This paper examines medical AVT from English to Kazakh. Translation issues in this field have rarely been the focus of linguistic studies, with hardly any studies of the matter with Kazakh as a target language. During the Covid-19 pandemic, it is crucial to be aware of cutting-edge technology and treatment techniques that are available in English. The TEDMED oral report “The Wireless Future of Medicine” made by Eric Topol, a distinguished cardiologist and geneticist, and its voice-over translation provided by the Kazakhstan national bureau of translations were chosen as the material for this pilot study. Continuous sampling was used to select 95 terms and term phrases (T-units) in the source text that were further distributed into eight subject field groups. A standard classification was used to identify the translation technique in each case in the target text. As a result, frequency models were built for both subject groups and translation techniques. Groups related to medical procedures, medical devices, anatomy and physiology were the most frequent. There was a clear correlation between the subject field and dominant translation technique: equivalence prevailed in the fields connected with Kazakh medicine from nomadic times, while in other fields, there was an increase of techniques other than the equivalence.

Deep Medicine: Empathic Computation and Potential Healing in Klara and the Sun

The impact of AI technology on healthcare is an evolving issue in the medical humanities. Eric Topol, in Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again, observes that innovative technology gives medical professionals a framework through which they can nurture the “human bond,” allowing them to practice what he calls “deep medicine.” In Kazuo Ishiguro’s novel Klara and the Sun, the Nobel laureate envisions a world in which AI can work miracles. I argue that the AI protagonist’s empathetic interaction with humans and her endeavors in searching for a cure for her owner/friend performs a special version of deep medicine. The android, with her belief in faith, hope, love and her unwavering loyalty, stands in contrast to the lonely, despairing, and fickle human characters, offering to nourish and heal the dystopic and divided fictional universe that can very well be our future.

Is artificial intelligence really a future trend in health care?

Everyone who uses any digital platform in the daily routine has already been surprised by some sudden ad or product advertisement about which some information has been sought on the Internet. Coincidence? Of course not! This is just one example of how artificial intelligence is inserted into our daily lives. It is in the platforms for music streaming, movies, shopping for any product, in traffic applications, in the stock market. Each "like", each share, each post shows a pattern of consumer preference, a characteristic that can be used to direct advertisements in order to advertise or market a product to a specific target. This is already happening, it is not part of the future. Artificial intelligence is already part of our present. But how do these platforms manage to "guess" our preferences or tastes and hit exactly what we were looking for? In reality nothing is guessed, it is learned. Through computer modeling, these systems learn from the examples that we ourselves give them. We feed these systems on a daily basis. Just like children, who learn many things by example (languages, for instance) before they even go to school, these systems are also capable of learning. A child learns that a dog is different from a cat when it sees examples of several dogs and several cats. So a child can learn the differences between both animals. Algorithms learn the same way, through examples. This is what we call "machine learning," a sub-area of artificial intelligence (AI). It is an advance for society, but it must be applied with ethics and transparency (see the Netflix documentary Coded Bias). Moving away from the market sphere and thinking about health care, machine learning has also been widely employed, because these systems have the ability to learn using endless amount of patient and hospital data (Big Data). In this sense, AI-based systems have been developed aiming at improving patient care, from the organization of triage systems at clinics and hospitals, patient scheduling, organization of test result delivery, preventing errors in drug prescriptions, as well as predicting and assisting in disease diagnosis. The artificial intelligence literature in the medical field is already vast. In dentistry, research has focused on the use of convolutional neural networks (CNN) in dental radiology. Tools are produced for researchers and system developers that aim at assisting clinicians in imaging diagnosis, for example, of dental caries, periapical lesions, bone resorption, among other important outcomes. Some companies, in Brazil and worldwide, have already seen a potential market in the application of these neural networks, and are providing software to assist in the analysis of radiographic images. Far from being able to replace health professionals, this technology should be used to improve the work of dentists and bring more security in diagnosis. Trying to replace a health professional with artificial intelligence, especially in dentistry, is impossible and not productive at all (see Eric Topol's book Deep Medicine). Information technology as an ally will bring many benefits to dentistry, not only in radiology. The analysis of digital cohorts (electronic patient records) with machine learning algorithms can bring new insights to Science. Such algorithms are able to cross-reference thousands of predictive attributes with various endpoints to define which information is most relevant for qualitative analyses. It is the new advanced statistics. For this reason, it is especially important to emphasize the need to build a large-scale public dental dataset to make the clinical application of AI possible. The challenge now is to improve the quality of the datasets to build really accurate machine learning algorithms. Finally, it would be very useful for dentists if these developed machine learning systems become applications that could be widely available and spread to the dental community. The spectrum of AI is huge! Try doing a search today on some topic and wait for the algorithm to work! It will offer you all the information, based on the search example you yourself have offered! This is AI in our lives, no future, but a present! Keywords Artificial intelligence; Health care.

What accounts for the high cost of care? it's the people: a Q&A with Eric Topol, MD.

To mark the 25th anniversary of the journal, each issue in 2020 will include an interview with a healthcare thought leader. Because January is our annual health information technology issue, we turned to Eric Topol, MD, of Scripps Research.

High Hopes for "Deep Medicine"? AI, Economics, and the Future of Care.

In the much-celebrated book Deep Medicine, Eric Topol argues that the development of artificial intelligence for health care will lead to a dramatic shift in the culture and practice of medicine. In the next several decades, he suggests, AI will become sophisticated enough that many of the everyday tasks of physicians could be delegated to it. Topol is perhaps the most articulate advocate of the benefits of AI in medicine, but he is hardly alone in spruiking its potential to allow physicians to dedicate more of their time and attention to providing empathetic care for their patients in the future. Unfortunately, several factors suggest a radically different picture for the future of health care. Far from facilitating a return to a time of closer doctor-patient relationships, the use of medical AI seems likely to further erode therapeutic relationships and threaten professional and patient satisfaction.

The role of AI in diagnosing lung diseases

The role of AI in diagnosing lung diseases

The Future of Health Is Self-Production and Co-Creation Based on Apomediative Decision Support.

Cultural changes are needed in medicine if the benefits of technological advances are to benefit healthcare users. The Digital Health Manifesto of ‘medical futurist’ doctor Bertalan Meskó and ‘e-patient’ Dave deBronkart, The Patient Will See You Now by Eric Topol and The Patient as CEO by Robin Farmanfarmaian, are among the proliferating warnings of the approaching paradigm shift in medicine, resulting, above all, from technological advances that gives users independent access to exponentially increasing amounts of information about themselves. We question their messages only in suggesting they do not sufficiently shift the focus from ‘patient’ to ‘person’ and consequently fail to recognise the need for the credible, efficient, ethical and independent decision support that can ensure the ‘democratisation of knowledge’ is person empowering, not overpowering. Such decision support can ensure the ‘democratisation of decision,’ leading to higher quality decisions and fully-informed and preference-based consent to health provider actions. The coming paradigm will therefore be characterised by apomediative (‘direct-to-consumer’) decision support tools, engaged with by the person in the community to help them make health production decisions for themselves (including whether to consult a healthcare professional or provider), as well as intermediative (‘direct-from-clinician’) tools, delivered by a health professional in a ‘shared decision making’ or ‘co-creation of health’ process. This vision paper elaborates on the implementation of these preference-sensitive decision support tools through the technique of Multi-Criteria Decision Analysis.

Blood, sweat and tears in biotech — the Theranos story

Eric Topol extols a gripping account of the rise and fall of the US medical-testing company. Eric Topol extols a gripping account of the rise and fall of the US medical-testing company.

The Futurist and Historian Will See You Now.

Eric Topol's The Patient Will See You Now: The Future of Medicine is in Your Hands (2015) depicts a medical future in which the patient-doctor relationship is upended in the context of easily acquired and shared big data and the increasing computing power necessary to analyze such data. A chief obstacle to this future, in Topol's rendering, is the entrenched paternalism of the medical profession. But Topol's thought-provoking assessment misses other key potential obstacles to the rational and equitable implementation of this (or any) medical future and would benefit from a more nuanced telling of the history of attempts to empower patients in this country. Nancy Tomes's Remaking the American Patient: How Madison Avenue and Modern Medicine Turned Patients into Consumers (2016) traces the long history of patient consumerism in America. She points out that the history of attempts to inform and empower patients has often been characterized by the conflation of advertising with information, the inequitable distribution of access to information and care, and the prioritization of commercial over medical utility in the implementation of care. These remain critical obstacles to an ideal medical future, Topol's or otherwise.

ESC Congress 2017 in Barcelona: Where the World of Cardiology Came Together.

This summer brought cardiologists from all over the world to Barcelona, when the European Society of Cardiology (ESC) hosted ESC Congress 2017 in August 2017 (Figure 1). With 31 175 attendees from a record-breaking 153 countries and participants being able to choose from 780 sessions running in 28 parallel rooms, the 4.5-day event was 1 of the largest cardiovascular congresses ever. ESC’s call for abstracts attracted >10 804 submissions, of which 4514 (42%) were selected for oral or poster presentation. Interestingly, the country from which the most abstracts were submitted—and accepted—was not in Europe. It was Japan, which has held first place in abstract submissions for the last 7 years. The United States, Korea, and China were also among the top 10 abstract submitting countries—a fact that highlights the increasingly global character of this conference. Figure 1. The ESC Congress 2017 was hosted in Barcelona, Spain in August 2017 . For the educational component of ESC 2017 in Barcelona, >1574 faculty members from 74 countries had active roles. With ESC’s efforts to increase the role of women in the program, a record 24% of invited presenters were female, up from 20% in previous years. As is typical, 3 areas of the ESC Congress attracted particular interest. There was the regularly featured Congress Spotlight, which in 2017—in line with the 40th anniversary of the first percutaneous coronary intervention performed …

Eric Topol: innovator in cardiology and digital medicine

Eric Topol, Professor of Genomics and Director of the Scripps Translational Science Unit in La Jolla, San Diego, California, seems to have the perfect job. He combines one day a week in the clinic, imparting 30 years of knowledge as a leading cardiologist, with his real passion—research in what he sees as the greatest revolution medicine has ever seen. By this he means smart medicine, the era of big data, bioinformatics, and consumer genomics, enthusiastically articulated in his 2015 book The Patient Will See You Now. To truly look inside200 years ago, in 1816, French physician René Laennec rolled a sheet of paper into a tube to auscultate the chest of a young female patient with suspected tuberculosis. Laennec went on to make his first stethoscope from two pieces of hollowed wood: one was placed against the physician's ear; the other, with a funnel-shaped cone at the end, was placed on the patient's chest. Little did Laennec realise the scientific maelstrom that would greet this new diagnostic instrument, and indeed the parallels that could be drawn to the introduction of handheld ultrasound into clinical practice some 200 years later. Full-Text PDF

California Dreamin': the Future of Genomic Medicine.

The recent cold weather in St. Louis has me anticipating a trip in early March (3rd–4th) to sunny La Jolla, California, where I will attend and speak at the Future of Genomic Medicine (FOGM) IX meeting. As always, FOGM has a highly unique format that conveys the latest results from translational genomic (aka “precision”) medicine, with the goal of aiding clinicians and researchers in making clinical decisions of individual patients more precise and personal. The meeting informs participants about how next-generation sequencing methods and analytical computational analyses can be combined for clinically relevant studies ushering genomics into evidence-based medicine. The meeting also provides perspectives on the social impact of genomic medicine as told by journalists, media personalities, and advocates. In the session on cancer, I will discuss our newest technological advances to understand the changes in DNA alterations and RNA expression that occur during cancer progression and provide specific examples from patients on how these data can influence clinical care. The format of the meeting is a vibrant mixture of patient stories told by the patients themselves with the gentle coaxing of Dr. Eric Topol and faculty lectures that communicate current and cutting-edge approaches. The early morning introductory patient stories are always memorable and complement our vision at CSH Molecular Case Studies (MCS) to communicate important case studies in precision medicine. I was particularly moved by my colleague, Dr. Lukas Wartman, who discussed his own case with Dr. Topol at FOGM in 2012. Lukas was diagnosed with acute lymphoblastic leukemia (ALL) in 2003, and after being treated with a multidrug chemotherapy regimen, he suffered two relapses several years apart. At the time of the second relapse, he was able to enroll in a research study at Washington University School of Medicine, allowing next-generation sequencing of his bone marrow and ultimately identification of an apparent driver in the overexpression of FLT3, a druggable kinase target. By virtue of treatment with the corresponding therapy, Lukas was able to achieve complete remission and receive a lifesaving stem cell transplant. He has also written about his experience as both a patient and a cancer researcher in the inaugural issue of MCS. Another unique aspect of the meeting is the participants. Attendees are an interactive, inquisitive group composed of academic researchers, community physicians, physician–scientists, pharmaceutical and biotechnology researchers, and undergraduates from local STEM programs. I always enjoy this meeting because it illustrates the current excitement, reality, and promise of precision medicine, and supports the idea that there is value in understanding individual patients and their disease from an “N of 1” perspective. This notion, of course, stands in stark contrast to the typical “one size fits all” approach that medicine has pursued for years and acknowledges the individual nature of diseases with a genetic component. With the journal's launch in the autumn of 2015, I will attend this year's meeting with a new purpose in mind. Much like FOGM, the journal provides a forum for communicating the results of translational medicine across the community of medical research and practice. Our aim is to encourage sharing of patient data broadly and rapidly and to reinforce the value of communicating “N of 1” cases so that our collective knowledge becomes an N of many. Competing Interest Statement The author has declared no competing interest.

Future of the Smartphone for Patients and Healthcare Providers.

Future of the Smartphone for Patients and Healthcare Providers.

Disruptive Innovation in Laboratory Medicine

Over the last 5 decades, laboratory medicine has witnessed a remarkable wave of innovations that transformed the field from a peripheral to a central player in healthcare delivery. These advances enabled the introduction and performance of new tests on a large scale, some in a decentralized setting, in an accurate and a precise manner, thus leading to better diagnosis, more accurate prediction of disease prognosis, and improved patient management. This evolution was the result of both sustaining and disruptive innovation, the latter being a new concept, technology, product, or process that is at first inferior to an existing one but with time it improves, becomes superior to it, and eventually replaces it. Some examples of disruptive innovation in laboratory medicine include continuous flow analysis, dry reagents on dipsticks, pregnancy home testing, PCR, point-of-care testing, and use of MALDI-TOF mass spectrometry for pathogen identification. Although sustaining innovation steadily drives progress, paradigm shifts usually occur only with disruptive thinking. With the escalating cost of healthcare and the prediction that it will soon reach 20% of the annual GDP in the US, bold measures and disruptive approaches in delivering effective and economical clinical laboratory testing are more needed than ever. In this Q&A, a group of inventors, entrepreneurs, and cutting-edge scientists share their views on sustaining and disruptive innovation in laboratory medicine. Describe briefly the core technology or concept of your innovation. Eric Topol: Smartphones as the hub of medicine going forward, capable of performing routine laboratories (with suitable hardware additions), real-time, real-world biosensor data of most physiologic metrics, capability of doing a substantial part of the physical examination, and ultimately, assembly of a virtual medical assistant to process these multilayered medical data for each individual. All of this data collection and analytics would be supported by cloud computing and validated algorithms. Image Courtesy of XPRIZE Eugene …

Going mainstream: Online sharing of health data and test results with patients

Going mainstream: Online sharing of health data and test results with patients

Doctor's Orders: Healthcare Apps and Self-Monitoring

Eric Topol, a cardiologist at Scripps Clinic in La Jolla, discusses what IT professionals and software designers can to do increase acceptance of healthcare-related applications by both healthcare providers and patients.

Solving for X: Accelerators Could Speed Search for Rare Disease Therapies

David Mott, general partner at NEA, recalls a conversation he had at a conference 5 years ago with Dr. Eric Topol, director of the Scripps Translational Science Institute. Topol described how genomics advances were already making it possible to chop up big diseases into smaller ones. What if they could create an accelerator staffed with experienced drug developers who could perform fast validation of projects—or fast kill? Mott launched Cydan in April 2013 with $16 million from NEA, Pfizer Venture Investments, and Alexandria Venture Investments. In October 2013, Lundbeckfond Ventures, and Bay City Capital led an additional $10 million financing round with the prior investors.“The way science has evolved, we are beginning to understand these diseases at a genetic and molecular level,” says Mott. “We are trying to stop disease at its beginning. It is decreasing our expenses in drug development. It is changing its expense-to-risk ratio.”According to Mott, segmenting disease into separate subtypes is already being done in cancer, as with, for example, Crizotinib, an ALK inhibitor for non-small cell lung cancer that the FDA approved in 2011. “Lung cancer is not a single cancer but many different types of cancers that affect the lung,” says Mott. “There is a big crossover between rare genetic disease and targeted therapeutics in oncology.”Cydan will screen potential candidates from academic labs and patient foundations in the US and globally. According to Mott, once a compound is selected and passes a 12 month “de-risking” program, the money is already raised and a management team is in place, saving perhaps 6–12 months of downtime that would otherwise be spent in fundraising and setting up a startup infrastructure. The accelerator focuses on the crack between academic research and getting a company staffed and funded. “I think that crack is a very fruitful place to go drug hunting,” says Mott.“Patient foundations are very interested in Cydan’s model because we can ask key development questions that can enable rigorous go/no go decisions—and have capital on the table,” says Csimma. “They like the fact that we come to the table with a very objective approach because we are not asset centric.” Cydan looks for “assets” with well-characterized genetic etiology, usually animal data, or even clinical data in a different indication. Assets would also be backed up by global registries and natural history studies from patient foundations. Assets must provide meaningful clinical benefit for an unmet need and potential for an eventual spinout and/or expanded indications. Successful candidates can then transition smoothly to series A-supported development programs. The accelerator plans to launch up to five companies in 4 years. Cydan will also introduce early stage investors and academics or foundations.A year after their daughters’ diagnosis, the Spooners continue to work with doctors, including Dr. Virginia Kimonis in the division of Genetics and Metabolism at the University of California, Irvine, to research possible trial drugs. They are considering fundraising to support research opportunities. They are also working with the UMDF (United Mitochondrial Foundation) to stay informed about any drugs or therapies that become available for their disease and/or to treat similar symptoms. “We are not sure if our disease is progressive, so we are very concerned and needing to stay aware and open for treatments and hopefully one day a cure.” writes Christy Spooner.

A discussion with digital health pioneer Dr. Eric Topol

Digital health pioneer Dr. Eric Topol was the most influential physician executive in the United States in 2012, according to a national poll by Modern Healthcare . Topol is a professor of genomics and the Gary and Mary West Endowed Chair of Innovative Medicine at the Scripps Research Institute in