In the second part of a fascinating interview, Eric Topol reveals how AI can eliminate clinician burnout, his shock at receiving death threats and the despair of watching America’s ‘truly shameful’ response to the pandemic

 

One of the great innovators in cardiology and digital medicine, Eric Topol is a renowned American cardiologist, scientist and author of three bestseller books on the future of medicine. He is the founder and director of the Scripps Research Translational Institute and a professor of Molecular Medicine.

As a researcher, he has published over 1,200 peer-reviewed articles, with more than 285,000 citations, elected to the National Academy of Medicine, and is one of the top 10 most cited researchers in medicine. His principal scientific focus has been on the genomic and digital tools to individualize medicine.

 

What are you most excited about regarding the future of AI and medicine?

Artificial intelligence has so much more potential than just improving accuracy and streamlining. AI’s greatest gift will be to give clinicians the gift of time and get us back the human connection that we so crave and need. There’s a terrible burnout and depression among clinicians that can be greatly ameliorated, fixed and overcome if we had time with patients and could feel like we’re really caring for them. Right now, we’re not doing that because we have so little time.

It won’t happen by default because medicine is a business, and a very big business in the U.S. So we have to really go after it. That means we have to take on the overlords, the bean counters that want us to see more patients and read more scans, more slides etc. We have to say, no, we’re going to use this to fix medicine because it’s so terribly broken.

What do you consider your greatest achievement?

I’d like to think that it’s in helping to push for the future of medicine to be so much better than the present and the past. I’ve tried to do that in many different ways, whether that’s helping to train young people or undertaking research that constantly pushes in that direction. Writing the three books that I did took a lot out of me, but I thought it was worth it to try to really develop the path for how we can get to this far improved medicine that would get us what we all want and need. There’s been a lot of concern, especially during the pandemic, about how bad American medicine really is. But I think we can turn that around and I’m actually very optimistic. But it will take a will and a real deliberate, resolute effort which we still haven’t seen yet.

What’s been your biggest disappointment?

I guess the slowness with which change occurs. Or doesn’t occur. The fact we have all this great knowledge that gets developed, but doesn’t get implemented. It all takes too long and that’s just shameful. Things that could save a life or dramatically improve people’s health sit in a different orbit. It’s so frustrating to see it stay stuck in the research orbit and not helping people. Sadly it’s been a theme for all the years that I’ve been in medicine.

Are you more optimistic having seen how quickly things can happen when we really need them – like the COVID-19 vaccine?

Yes, I think a momentous lesson from this pandemic is that we went from discovering a virus on January 10th to essentially being able to give patients highly efficacious vaccines from very large trials, in the same year, on December 11. That’s just unbelievable. If we can do that, then we can do almost anything. It’s a cause for real optimism that we rallied and saw things move at unprecedented velocity with results that no-one would have predicted.

So this is going to get us out of the pandemic over the next year, but moreover it may provide a template of how, when you go after something with such intensity, that you can deliver. We might not always be so fortunate because this virus, however horrendous, turns out not to be so invincible, with a spike protein that’s the most ideal target one could ever imagine. But it should certainly inspire us for the future.

What’s your biggest regret ?

The one thing I regret was challenging Vioxx in 2001. (Topol was the first physician researcher to raise questions about the cardiovascular safety of COX-2 inhibitor rofecoxib (Vioxx). Pharmaceutical company Merck & Co eventually voluntarily withdrew Vioxx from the market).

It unwittingly became a major part of my career. But the reason I did it was because one of my trainees had looked at the data and found something very ugly was going on. Never having worked in drug safety before, I got involved to defend his effort and things escalated. But the reason I say I shouldn’t have got involved is that nothing happened. There was no justice, yet I basically put my career at risk with the repercussions hitting me in every possible way – financially and personally. I had to go through a federal subpoena deposition and it got really ugly because my family got sucked into it. I had death threats, people coming to our house and nailing things on the door. It was a truly awful time and I regret getting involved.

What keeps you awake at night?

The pandemic. More specifically, the horrific lack of response in this country. It gets me so agitated having to watch all these people die – colleagues of mine who have got long covid and are no better months later. It’s really hard to take because this was almost all largely preventable. But because we had such a pathetic administration, with Trump and his cronies taking down the CDC and FDA and all the things that they’ve done to segregate these public health agencies, it really has been abominable.

Are you more optimistic about the new administration?

Yes, I think things can only get better. I mean, this has been the worst episode in American history, if not global history. To have a president that could take down the third largest country in the world, one of the richest countries in the world, and end up with the worst performance of all. The translation of that performance is that we’re going to have hundreds of thousands of additional deaths because the spread has become so profound. It was basically a surrender, to let this thing rip and not aggressively manage the pandemic. It’s a challenge and it takes active effort but it just wasn’t done. A truly shameful episode in our history.

What’s the most important lesson life has taught you?

Well, my parents and my lineage died very young. My mother died of cancer, when she was just over 50, and my father died of all his diabetic complications far too young. As a kid, I remember going to all these funerals and my relatives dying too young so I’ve lived a life where I don’t take any day for granted. I try to live life to the fullest and that’s not just work, but also family.

What do you do to relax ?

I’ve got three grandchildren and I just love being with them and having fun with them and acting silly. It’s just great. We’re all here in our little social bubble and anytime I can be free, I make sure to spend time with them. We’re lucky here in San Diego that the weather’s nice so we can get outside and enjoy being together.

What’s your next big project?

Here at Scripps Research, a dedicated life science AI Institute – I’m trying to bring in the great minds of AI. That way, we can develop new models and new ways to assimilate multi-dimensional data that will change healthcare. It will mean that individuals can have their own virtual medical coach to help them prevent illness. Because I believe most illnesses, if you know your risks ahead of time, will ultimately be eminently preventable. So I’m busy assembling the team. We’ve already got a couple of people but I want to build a much bigger force. That’s what I’m striving for every day.

 

Part one of our exclusive interview with Eric Topol can be read here