Dr. Eric Topol, Director of the Scripps Translational Science Institute

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Mark Masselli: This is Conversations on Healthcare. I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret with Martin Luther King Day behind us I have been
thinking quite a lot about the dream of equality in this country and in some ways we
have come so far and yet it still seems we have far to go but at least we are starting to
see some meaningful parity with the passage of the H ealthcare Law.

Margaret Flinter: So many p eople who struggled in the past to afford health coverage
due to near poverty or pre - existing conditions now covered and not just covered but
covered with good insurance making a big difference in their lives and for that matter
millions of lives around the country.

Mark Masselli: There is a notable drop in the number of people who put off accessin g
healthcare services due to the cost or lack of coverage, it’s the first time those numbers
have gone down since the Commonwealth Fund began tracking those n umbers.

Margaret Flinter: Well I think it’s important to know too though that the study show ed
folks who live closer to the poverty line still have trouble paying all their medical bills and
that’s primarily due t o the plans with higher “ out of pocket cost ” but even those numbers
showed some improvement.

Mark Masselli: As we know Margaret the best pathway to better health is facilitating
access to preventative care and with millions of Americans newly covered under the
Healthcare Law we should continu e to see some steady improvement.

Margaret Flinter: How we access care in general is also changing Mark. We have a
new area of healthcare where televisits will be very sufficient to fill many of our
healthcare needs. Smartphone apps can track most of our essential health data, all this
hopefully serving to help patients be more empowered in their own care and that’s
something our guest today is one of the worlds sought leaders.

M ark Masselli: Dr. Topol is a practicing Cardiologist and a Director of Scripps
Translational Science Institute so champion of the P otential for Genomics and
Telemedicine to reshape the future of healthcare. He will be chatting with us about his
newest book The Patient Will See You Now.

Margaret Flinter: Well it’s always a pleasure to hear from Dr. Tolpol and Lorie
Robertson will be checking in. She is always on a hunt for misstatements spoken about
health reform in the public domain.

Mark Masselli: But no matter what the topic you can hear all of your shows by going to
chcradio.com.

Margaret Flinter: And if you have comments, email us at [email protected] , find us
on Facebook or Tw itter. We would love hearing from you. Now we get to our interview
with Dr. Tolpol in just a moment.
Mark Masselli: But first here is our producer Marianne O’Hare with this week’s headline
news.
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Marianne O’Hare: I am Marianne O’Hare with these Healthcare Headlines. What you
pay depends on where you live as tens of millions of Americans gain insurance coverage under the Affordable Care Act. Rates do vary widely across the country while insurance rates in Colorado actually went down slightly, largely due to more choices for those purchasing insurance. Folks in Alaska saw an average 30% hike in co s t f or
Standard Silver Plans on the exchange. It turns out Sun Belt states turn to hav e rates
on the lower end of the spectrum on average. A milestone on the Ebola outbreaks
schools have reopened last week across the small West African country of Guinea one of the hardest hit Ebola hotspots. S o far the disease has been largely contained t o that
region of the African continent. More than 20,000 have been infected; roughly half of
those patients have died. One of the challenges for scientist battling this current
outbreak of Ebola , t he genetic structure has changed about 3% from its 1970s genetic
makeup. The mutation makes drug development a little more uncertain. China is confirming at least 15 serious c ases of Bird Flu in recent weeks three of whom have
died, the rest are critical and while China is beginning to look to renewable energy as a
replacement for current fossil fuel use air quality continues to deteriorate across the
country to a multiple times a legal limit for breathing . T oxic air in China is believed to be
responsible for 750,000 deaths per year and smoking is a choice at least to an
estimated 450,000 deaths per year in the US you know online financial site WalletHub
did an analysis showing smoking cost. The American economy is some $300 billion plus dollars per year the average smoker if they smoke and survive over a lifetime will
have spent about $1.2 million on cigarettes and will incur an average of $150,000 in
medical bills and will lose an average of $200,000 of lifetime earnings due to smoking
related illness . I am Marianne O’Hare with these Healthcare Headlines.
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Margaret Flinter: We are speaking today with Dr T opol, Cardiologist and Director
Scripps Translational Science Institute in LaJolla California an expert on the use of telemedicine in Genomics in Healthcare. Dr. Topol has written several critically
acclaimed books including the Creative Destruction of M edicine and most recently T he
P atient W ill S ee Y ou N ow, T he F uture of M edicine I s i n Y our H ands. He earned his
medical degree at the University of Rochester where he was awarded the highest honor
the Hutchinson Medal for his contributions. Dr Topol welcome back to the
Conversations on Healthcare.

Dr Topol : Thank you.

Mark Masselli: It’s been about three years since you joined us on the show and so
much has changed over this short time since we chatted the Discipline of Genomics in
telemedicine have exploded in areas that you say are poised to be the two biggest
game changers in healthcare. Yo ur new book just recently published T he P atient W ill
S ee Y ou N ow y ou will examine how far we have come in putting the power of
healthcare into consumer ’ s hand s and tell our liste ners what have been some of the
most exciting developments in the Medicalization of Smartphones.

Dr Topol: Okay it’s really been an extraordinary jump in the technology where what was
a smartphone that changed our everyday lives i t has now become capable of a hub - hub
medicine that is not just that you could capture all your censor data like your vital signs
to your labs, do imaging but also of course things like your physical exam , being able to
summon a doctor treat immediately through your video secured link or even to your
home so it’s become a little device that could really transform medicine, it could
democratize medicine by super empowering consumers.

Margaret Flinter: Well Dr Topol it’s like in the space we are entering in the world of
healthcare as a kin the development of the Gutenberg Press which democratize access
to the written word and you know that there is a long standing tradition of what one
could call paternalism but as yo u said the free flow of information from patient to
providers has the potential to democratize healthcare in a way never seen so expand
down that a little bit for us.

Dr Topol: Well for all these years millennia the doctors have been in control and
patients didn’t have access to their own data, well that’s going to change drastically
because now everything is digitized but now patients are generating their data. That
data is going to th eir phones that they own about their own body . W hat’s going to
happen in the short term is that we have a whole new model where the patient will see
now that he is much more in charge than ever before and in fact access to information
not just themselves but for example cost data you know cost data has been an
unmentionable part of medicine but now that all that data will be accessible through
ones mobile device so these things are all happening at once. It’s happening quickly
and of course we have this p aternalism that you mentioned and this of course has to
give way to this altered I think very improved model. Now your point about Gutenberg
and democratization of information and reading I do think that this has the parallel of all
time in medicine becau se we go from the medical community, controlling everything to a
whole different lock ward to bottoms up a great inversion of how medicine is practiced.

Mark Masselli: You know we just recently had entrepreneur an Angel Investor Esther
Dyson on th e show talking about what she looks for when investing in health technology
and she said she thinks non - invasive censors hold the promise for disrupting the status
quo in healthcare. It’s going to generate a lot of data all that needs to be secured to
trav el through it, that’s an area that still needs some work. Tell our listeners where we
are in this to make sure that the information is secured.

Dr Topol: You brought up t w o critical points, one is about privacy and security of the
data which we do not have safeguard in any way. There has been great white papers
written by the White House but no action has been taken to control the data, to prevent
it s sale. Right now the medical data which is so precious and n eeds to be preserved as
private, we don’t have that nail down at all that has to get or write it. The other thing
that you brought out is about the analytical side and (inaudible 09:19) case I talked
about how we are pissed at analytics and then we are th at is we hoard all data, bake
data but we do very little processing and analytics of data and part of that is we don’t
have the t alent to write all the articles and they are going to do all this great analytics
and we have right now for example Esther Dyson is right that the censors whether they
are variable or other ways that we can track ones owned information and how is that
going to get processed and ultimately how is that going to be used for predictive
analytics to prevent and preempt illne ss which is certainly possible and so we are way
behind in the analytics, we are way behind in the security and priva cy, we have got to
work on that, that’s what’ s holding us back right now.

Margaret Flinter: I would like you to take a closer look at telemedicine and the promises
holds for increasing patients direct access to a provider and are we seeing with the
diverging of telemedicine and virtual business but you see telemedicine is a game
changer and I would like for you to just paint a picture for us if you would how practices
will need to change to embrace this promise of telemedicine?

Dr Topol: Yeah I think the telemedicine is just one dimension to this mobile device
makeover and that is because it takes so long to get an appointment with a primary care
doctor if the average is over two to three weeks, in some cities as much as 6 weeks well
that’s not going to work you know this whole content of instead of there is an app for
that, there is an over for that and that is this whole thing about you can get what you
want immediately and if it’s 2 o’clock in the morning and you need to get a coun se l you
can do that now and now that doesn’t mean to undermine your primary care doctor but
if the mismatch of demand and supply is profound and part of it is financial that is it
costs the same to get an immediate video console as it does it for a co - pay but if you go
to the doctor and wait several weeks and you get your answers to your ques tions on an
immediate basis and not only that but telemedicine is going to get enriched because
you can do a lot of the physical exam yourself, you can do all this data accumulation
about yourself on the relevant condition and so we are not talking about j ust two people
having a vide o chat , we are talking about actually reviewing of information about the
person or the child or whatever so this is very exciting area. We are not geared off for
this, none of the medical schools in United States 140 schools teach their student how
to be good telemedical doctors . S omeday that’s going to be part of every medical
practice.

Mark Masselli: We are speaking to Dr Topol Director of the Scripps Translational
Institute LaJolla California. Dr Topol has a new book T he P atient W ill S ee Y ou N ow the
future of medicine is in your hands. Now let’s take a look at the role of Genomics t hat’s
increasing the playing of role in tailored protocols for treating things like cancer in fact if

you sight the case of Angelina Jolie who lost her mother to ovarian cancer and s he had
herself tested for the BRCA gene which increases the likelihood of both breast and
ovarian cancer and chose to take a proactive approach . Can you tell us why you find
her case so compelling?

Dr. Topol: She is a real sign of all times. That famous offbeat that she wrote My
Choice, her choice of having this mutation screening and then after finding that she had
one of the serious mutations to have the bilateral mastectomy and her choice of trying
to teach the world about her whole situation each individual gets to make the call. This
isn’t for everyone but the point is there is an opportunity of having an access to their
information. She is also going to undergo ovarian removal, a need or not a light weight
decision so the fact that she is such a immense public figure you know you can have
your own genome sequence and over the next few years millions of people are going to
have their genome sequence and that’s going to help in making choices for each of
those individuals.

Margaret Flinter: I guess th at the question is, is it possible to do this a pps and ever
having in person contact or having a relationship with the primary care provider of
hypertension would lend itself to being diagnosed because you checked your own blood
pressure certainly the physical exam one could use the stethoscope component of the
Smartphone, one could do a micro drop of blood pretty soo n and get all of their lipid
panel and so forth I guess as a cardiologist are you comfortable with thinking that all this
can happen outside of ever needing to see the person ? A re we really moving to a place
for all of this can be done remotely?

Dr Topol: Well not all of it, so much of it the fact that the intimacy of the human touch
factor between a doctor and a patient I don’t believe that’s ever going to get lost but I do
think it’s going to be decompressed so the fact that you can offload bac k to the patient
all of this data collection and for example you mentioned hypertension Margaret well
there will be a watc h or ways to get blood pressure , e very heartbeat going to your
phone and while you are sleeping, while you are in traffic times when everyone had that
measurement before these are not things that doctors have that context but the
consumers do and that’s what’s a whole different look here so basically you have go
this consumer patient armed with their information and then we c ome together for
providing guidance , th e wisdom and experience of the doctor . T hat is so much of the
doctor’s work today besides having to fill out forms, collecting data that the person
eventually will do almost all their routine lab test s themselves.

Mark Masselli: Dr To pol we recently had Dr Erik Virre on the show, the Medical Director
of the Xprize Competition. We are getting closer to that ever handheld diagnostic tool
that really puts the power of healthcare management in the han ds of consumers a nd
you also know that things are changing in medical school arena as well for instance
medical students at Mount Sinai in New York are no longer being given stethoscopes
but instead are being trained to use Smartphones with censors. I don’t know how we
are going to recognize them as physicians without their stethoscope around their neck .
T ell us not only about the cultural changes that are going on within medicine but the

revolution in technology , how is it going to assist clinicians in the task and the
implications for training new providers ?

Dr Topol: Well this is all part of this across the board revolution a n d stethoscope which
is the icon of medicine and as you pointed out Mark it’s how you identify healthcare
professionals. It’s an obsolete 200 year old analog now recording anything.

Margaret Flinter: But I love my stethoscope.

Dr Topol: I know but it’s worthless basically listening to sound I mean I used to teach on
round I mean I loved it, that time was strange you know they all just slipping in the
second hea r t panel you think.

Margaret Flinter: That’s galloping.

Dr Topol: Yeah, yeah all that stuff. It’s all a bunch of a past tense you know it’s like you
can se e everything with a high resolut ion ultrasound you can carry in your pocket and
once you see everything you say why would I ever listen to that stuff, that is so old
because we order 130 million ultrasound studies a year in this country which is well over
$100 billion , if we just do this as part of our physical exam w e wouldn’t have to order too
many of those studies.

Mark Masselli: Well we just had Steven Brill on the line last week on the show and he
would agree with you. There is too much, too much.

Dr Topol: Yeah I know Steven is right on, on me but in fact in his book that just came
out I mean he didn’t really get into this whole side of the innovation which is of course
that’s what it was really to me so extraordinary, so remarkable that we can ha rness
things that exist today and have drastic reductions in cost but we are not doing it
because of the profound resistance within the medical community.

Margaret Flinter: We could go on for hours with you but let me see if I can wrap up with
the question that is always front in center in my mind on this. All of this makes perfect
sense particularly around single isolated issues for patients but when people and
particularly we would say perhaps people w ho are most familiar wit h people who are
lower income and confronted with lots of different complex challenges in their lives
present it’s really for an issue it’s for an entire kind of multiplicity of issues, what’s the
solution out there for complexity in healthcare, there is complexes treating hypertension
or rashes or those things which are often put forward when we talk about telemedicine
and e - councils and (inaudible 18:13) it’s when you wrap al l that up, w rap it in the context
of people’s emotional life’ s, their health habits, chronic illness as well as preventive care
needs that things get kind of sticky. What do you see out there, is that the place where
the provider still sort of has a place for separating things out with people and helping
them get hands alone many issues not just single issue?

Dr Topol: Right I mean this is as you are alluding to another simple matter I do want to
just touch on the poor and the digital divide for a moment because you mentioned that
Margaret and that is it may wind up being f ar more prudent to give people smartphones
who don’t have to end service contract because that’s a total minor cost compared to
$45 00 a night in the hospital and all the other things that are involved with emerging
over this in our healthcare system today in fact we have just done a r andomized trial we
gave half the people the device and service contract so there is a digital divide that
exist. There is a problem around the world without access to care but there is a new
way of collecting data information for each individual and what I have learned is that
p atients are really eager to have their data that you know a n d all the surveys indicate
80% to 90% would like to have their data information but the precious involvement to
review that with a doctor will never be lost. It’s just that it’s a different way they are
going forward. It’s something that it’s an evolving way of partnership and to me that’s
exciting if we let it happen.

Mark Masselli: We have bee n speaking today with Dr Topol Cardiologist and Director of
Scripps Translational Science Instit ute LaJolla California . Dr Topol’s new book is out
T he P atient W ill S ee Y ou N ow the future of medicine is in your hands. You could learn
more about his work by going to www.stsiweb.org or you can follow him on Twitter
@Eric Topol. Dr Topol thank you so much for joining us on Conversations on Healthcare.

Dr Topol: Well thanks so much for having me.
Mark Masselli: Conversations on Healthcare we want our audience to be truly in the
know when it comes to the facts about healthcare reform and policy. Lori Robertson is
an award winning journalist and managing editor of FactCheck.Org a non - parti san , non -
profit consumer advocate for voters that aim to reduce the level of deception in US polit ics. Lori what have you got for us this week?
Lori Robertson: Well do retiring members of Congress get free medical care for life?
No they don’t . Attained email about “ House Minority Leader Nancy Pelosi “ makes that
false claim and also a great way to exaggerate what Pelosi could receive as a pension.
We will stick with the healthcare claim. Members of Congress don’t receive free healthcare while they are in office or upon retirement. Under the Affordable Care Act beginning in 201 4 insurance coverage for members of Congress switched from the F ederal E mployee’s H ealth B enefits P rogram that’s the government’ s employer
sponsored private insurance market for federal employees to the healthcare market places created by the law. Under both systems workers and the government both pay
for insurance coverage. Like most employers sponsored plans the government pays a
certain percentage of premiums , in this case 72% and the workers pay the rest. That’s
still the case for congressional retirees. They don’t get free insurance. They pay the
same share of premi ums as active federal employees. According to the office of
person ne l management retirees will be eligible to purchase insurance through the
F ederal Employee’s H ealth B enefit P rogram if they meet certain criteria. They must be
eligible for retirement and they must have been continuously enrolled in one of the

government’s employer sponsored health plans for 5 years before retirement and that’s
my FactCheck for this week. I am Lori Robertson, Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country’s
major political players and is a project of the Anna Bird Public Policy C e nter at the
University of Pennsylvania. If you have a fact that you would like checked email us at
Chc radio.com. We will have FactCheck.org ’s Lori Robertson check it out for you here
on Conversations on Healthcare.

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Each week conversations highlight’s a bright idea about how to make wellness a part of
our communities in everyday lives. It’s a known fact that the current generation of
American children is more obese than any previous generation and out of Washington
D C Community Health Center Unity Healthcare a pediatrician was in a quandary over
how to tackle this growing health scourge. He began with the unique solution targeted
to a teen patient whose body mass index or BMI had already landed her in the obese
categ ory. What he did was write a prescription for getting off the bus one stop earlier on
the way to school. Dr. Robert Zarr of Unity Community Health Center understood that
without motivation to move more , kids just might not do it. The patient complied wi th the
prescription and his move from the obese down to the overweight category , certainly an
improvement. He then decided to expand this program by working with the DC Parks
Department mapping out all the potential walks and play area kids have within the city ’s
parks mapping 380 of them so far.

How to get there? Parking, is parking available if someone’s going to drive bike racks.

Dr. Zarr writes park prescriptions on a special prescription pad in English and Spanish
with the words R x for outdoor ac tivity and a schedule slot that asks , “W hen and where
w ill you play outside this week?”

"I like to listen and find out what it is my patients like to do and then gauge the parks I
prescribe based on their interests, based on the things they're willing to do."

He wants to make the prescription for outer activity adaptable for all of his patients and
adaptable for pediatricians around the country. His plan to create an app for his parks
database where providers and patients like and use it and one day he w ould like to be
able to track his patients activities in the parks. Rx for outer activity, partnering
clinicians, park administrators, patients and the familie s to move more, yielding fitter,
healthier young people. Now that’s a bright idea.

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Margaret Flinter: This is Conversations on Healthcare. I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli. Peace in health.

Conversations on Healthcare broadcast from the campus of WESU at Wesleyan
University.
Streaming live at wesufm.org and brought to you by the community health center.