Does pharma need a little creative destruction?
Dr Eric Topol of The Scripps Research Institute and Scripps Health speaks to us about the technological healthcare space, the challenges facing pharma and what he believes the future looks like.
The healthcare landscape has changed rapidly over the past century and today’s influx of technology is proving to be beneficial all round. From genetic testing to prevent diseases, to the enormous progress in drug manufacturing and the introduction of personalised medicines, it is clear the industry needs to stay on top of all these technological advances in order to keep up with current patient demands.
With a professional medical career spanning over three decades, we thought it was about time we interviewed Dr Eric Topol about his first-hand experience on the confluence of new technology and healthcare. Dr Topol also shares with us some of his thoughts on the challenges pharma faces, including the impact of negative media, and provides us with his broader views on the future of healthcare in the digital age.
To listen to the full interview, please click on the play button below, with a shortened transcript of some edited highlights shown in print below.
Quicklinks
0:15 – Dr Topol’s current areas of interest
0:57 – Highlights from a distinguished career
3:05 – The role for pharma in tackling the diabesity epidemic
5:02 – Segmenting major diseases into niche patient groups
6:24 – Translating genetic research into new therapeutic options
7:55 – Vioxx and lessons for the pharma-medic relationship
10:15 – Improving transparency and information exchange
13:26 – The most exciting healthcare technological advances
15:08 – What is the creative destruction of medicine?
Interview summary
PT: Eric thanks for taking the time to speak with me today. How would you summarise your current areas of interest?
ET: Well it really is digitising human beings, which takes the form of genomics as well as wireless sensors. These are the new tools where we have to be able to understand each individual at an unprecedented level and that are what excites me and really most of the efforts that we have in research are related to.
PT: In terms of your career, you have focused pretty heavily on the areas of cardiology and genetics or genomics. What would you say have been your personal highlights so far?
ET: Earlier in my career I worked on large scale clinical trials (as large as 40,000 patients in over 20 countries around the world) to try to come up with better treatments for heart attacks. That was a phase where we were able to improve the survival rates for patients presenting to a hospital in the early hours of a heart attack.
"But how can pharma adapt to these opportunities? By focusing on small trials to demonstrate hyper efficacy..."
I’ve also been involved in discovery teams of new genes and most recently trying to come up with a method for a blood test, and ultimately a sensor, that would pick up a heart attack days or weeks in advance, so that one could get the therapies to actually prevent it.
PT: There’s been a push on public health initiatives because we are facing this epidemic, in part that’s driven by the rise in obesity. What role do you see for pharma in tackling this epidemic?
ET: Well this has to be a multi-pronged attacked, because we’re in a mess right now in terms of not just the economic crisis, but an extremely worrisome diabesity epidemic. But how do we turn it around? We need radical changes and we need to exploit this digital infrastructure that has been built up, which is empowering consumers to a level that is truly unprecedented.
But how can pharma adapt to these opportunities? By focusing on small trials to demonstrate hyper efficacy and creating trials that may only involve tens or hundreds of individuals with overwhelming benefit. Plus we need a new regulatory system, which gets these drugs and interventions out much earlier, with electronic surveillance for safety.
PT: So it’s almost like segmenting these very large diseases into very distinct patient populations and treating them like more niche or orphan diseases?
ET: Exactly, this is really the concept that we need to have a whole new taxonomy of our disease classification on a molecular basis.
We need to start using biomarkers, genomic tags and sensor data to, as you say, identify very discrete populations of individuals where there can be striking benefit, rather than the way we have done trials all along. Large trials, with 10,000 plus patients usually demonstrate a 15% or 20% reduction, which typically means one or two patients per 100 are actually deriving benefit, and that’s just not going to cut it going forward.
"...we need to have a whole new taxonomy of our disease classification on a molecular basis."
PT: There’s been an amazing pace of discovery around the genetic causes of certain diseases. How do we translate that knowledge into development of novel therapeutics in the clinic?
ET: Well that’s a big challenge because understanding the importance of having great biologic pathways is one thing, but getting that to a drug in patients, and improving its efficacy and safety is a whole other tall order.
I think that we have seen that, in recent years, the life science industry and leading academic centres have built much more impressive and tight knit working relationships than we have seen before, so I’m hoping that it’s really going to pay off. It’s a little too early to know, but it’s now, when we’re starting to do whole genome sequencing and exome sequencing in large numbers of individuals, that we’re getting the insights to hopefully drive very successful new drug programmes.
PT: You played a very active role in bringing to prominence the side effects of Vioxx a few years back, which ultimately led to the drug being withdrawn from the market. What did that period teach you about the way the relationship has to be between pharma and the external research of medical experts?
ET: There needs to be a deeper commitment for disclosure of data and information. When there’s a liability of a drug, especially when it’s going to go to tens of millions of people, we start to have a serious problem and I think this has to be dealt with effectively. The idea that using genomics as a tool to make drugs more safe to deal with unanticipated side effects - that’s a really important direction to follow.
PT: What do you think the industry needs to do to reduce the likelihood of these things happening, and ultimately improve its interaction with the medical community and patients?
ET: By and large I think there’s a lot of spirit of innovation and desire to follow the noble mission of helping patients. Sometimes that on occasion gets lost, but we’re talking about one example.
"In recent years, the life science industry and leading academic centres have built much more impressive and tight knit working relationships than we have seen before..."
When something is not expected, or maybe something potentially disappointing comes up, there are now new opportunities to try to work around that and still make for very effective drug development. But it does mean throwing out essentially the old model of drug development and that’s something that I haven’t seen too many of the large pharma companies ready to do.
PT: What are the most exciting advances you are seeing in the technological healthcare space?
ET: It’s extraordinary really - I’ve never seen a part of medicine move this fast. Sitting in San Diego, where there are 150 wireless dedicated medical companies, I’ve seen a lot of technology. You see these sensor systems for all vital signs, for glucose to the phone, every possible metric you could imagine. It’s just so striking that we have this data now. In patients that I’ve never been able to get a few written blood pressure measurements from, I’m now getting hundreds. It’s refreshing to see that each individual now has a better window into the condition they’re trying to prevent or better treat. There’s also a new partnership, the highly empowered patient with a physician working to guide that individual, rather than being ‘the doctor knows best’ with all the data. It’s a sharing experience, and it’s very new.
PT: This year (Feb 2012) you published “The Creative Destruction of Medicine”, which looks at the digital revolution and how big data can actually change the way healthcare is delivered. How would you summarise the key message you’re trying to convey within that book?
ET: The ultimate message is that we have practiced medicine entirely on a population level, whether it’s drugs or a particular condition, or whether it’s mass screening.
Nowadays, we have new tools that with super conversance with the digital infrastructure we can actually practice highly individualised medicine, with a panoramic high definition comprehensive view of the essence of what makes each person tick. It is a fantastic opportunity and the word destruction in the title isn’t meant to be anything negative – think of it as reconstruction. Hopefully it’s something that will take us to a much higher plateau, where we’re much more efficient, precise, participatory, preventive – all these good things that we’ve been searching for, but finally we have the tools to accomplish.
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About the interviewee:
A practicing cardiologist at Scripps in La Jolla, California, Dr Topol is well known for leading the Cleveland Clinic to become the #1 center for heart care. While there he also started a new medical school, led many worldwide clinical trials to advance care for patients with heart disease, and spearheaded the discovery of multiple genes that increase susceptibility for heart attacks.
Since 2006, he has led the flagship NIH grant, supported Scripps Translational Science Institute and is a Co-Founder of the West Wireless Health Institute. He also serves as Chief Academic Officer of Scripps Health and Professor of Genomics at The Scripps Research Institute.
Dr Topol pioneered the clinical development of many medications that are routinely used in medical practice, including t-PA, Plavix, Angiomax, and ReoPro.
This year, Dr Topol was ranked as the most influential physician executive in the United States by Modern Healthcare.
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