COVID Update with Dr. Eric Topol, World-Renowned Physician-Scientist

COVID Update with Dr. Eric Topol, World-Renowned Physician-Scientist

Senator Frist talks to Dr. Eric Topol, Founder and Director of the Scripps Research Translational Institute, on how COVID affects the heart, when we might see an effective treatment, and the role AI and data can play in beating this virus.  Voted Most Influential Physician Executive in a national poll conducted by Modern Healthcare, Dr. Topol works on genomic and wireless digital technologies to reshape the future of medicine. He is a practicing cardiologist, a bestselling author and one of the top 10 most cited researchers in medicine.

Dr. Eric Topol:               Scientists love big challenges, and the entire life science community, AI, IT community, I mean everybody is on this because they know how big and important it is, but we don’t have the political support.

Senator Bill Fr…:           You’re listening to A Second Opinion, your trusted source engaging at the intersection of policy, medicine and innovation and rethinking American health. Dr. Eric Topol is the founder and director of the Scripps Research Translational Institute, voted the most influential position executive in America in the respected journal, Modern Healthcare, Dr. Topol works on genomic and wireless digital technologies to reshape the future of medicine. He’s a practicing cardiologist, an expert hospital administrator formerly at the Cleveland Clinic, an innovator and a futurist. He’s the best selling author in one of the top 10 most cited researchers in medicine in America.

Senator Bill Fr…:           In our far reaching conversation, we talk artificial intelligence, virtual healthcare, digital technology, the potential of technology and contact tracing, the power of science, how COVID will forever shape the delivery of health services. I’m your host, Senator Bill Frist. Welcome to A Second Opinion.

Senator Bill Fr…:           Eric we’ll start right in. COVID is upon us. It has changed the way we thought about the practice of medicine, the way we thought about getting our groceries, clearly everything moving closer to the home in a more distributed network. Our listeners and our viewers here concentrate on that intersection of innovation and you’re the world expert on innovation and health, and health and wellbeing and once again, you’re not just talking right about it, you’ve been there. You’ve been on the front line, the Cleveland Clinic and before that sort of rich history. And then that third second is policy, and throughout our conversation, feel free to throw anything about the policy itself.

Senator Bill Fr…:           COVID has changed the world and most people would say has accelerated things like telemedicine by three years, five years, already on a trajectory. You’ve been involved with it, I’ve been involved with it. But how has COVID changed where we are? We’re not going to come out of COVID, we have another probably 12 months of it. But what has it done. Has it accelerated our acceptance of technology, whether it’s in the payer world or the digital world or the artificial intelligence world? Are we going to be catching up where we were before?

Dr. Eric Topol:               That’s an interesting question. I try to be optimistic and think that it is going to have a lasting positive durable effect. Cannot make things too much worse than they are right now, so hopefully it’ll make it better. You already mentioned, I think the telemedicine acceleration is here, we still have to confront issues about the nationwide allowance rather than state guidance and regulatory oversight, also the reimbursement issues about that. But telemedicine as a way to not just protect patients and clinicians but also a way to efficiently care for people who otherwise might not seek care because they’re worried about going into a medical facility. So I think we’re now seeing an embracement of that, the likes that we would not have anticipated. It’s a good thing.

Dr. Eric Topol:               The AI is another interesting story. There hasn’t been that much AI incorporated into the daily practice of medicine yet, say for radiology imaging algorithms. Many are approved. Few other odds and ends, but not hold a major embracement. I think this might help accelerate that too. There’s lots of room for analytics and algorithms to improve inaccuracies and inefficiencies in medicine as it exists today. So I hope to see that too. I think the most striking thing of all Bill, is the the biotechnology, the meteoric type of improvements we’re seeing. We have never seen vaccine moving at this [inaudible] development. We have never seen drugs like for example, repurposing or remdesivir that quickly to at least get some efficacy and to have structural biology of every component of the darn virus.

Dr. Eric Topol:               The spike protein, the polymerase, the antibody. We have the atomic structure that’s going to help make vaccines and better drugs. We also have neutralizing antibodies that are being produced, many different neutralizing antibody programs. We’ve got convalescence sera. What really gets me is the science is just amazing, the publications are moving at a velocity I have never seen, both the peer review and the pre-prints. But unfortunately the policy is going in the other direction, instead of embracing science, instead of relying on that and biding time.

Senator Bill Fr…:           Obviously I spent 12 years in the policy arena, and I agree there is not a good understanding in the policy arena of the power of science, of the recognition that it is the answer to this virus. We can’t beat this virus without the science and the medicine. And do you think that the fact that you have 350 million people in this country who are scared, who are anxious, who understand that the only way this virus is going to be beat is a vaccine, or I think even more likely than any virals that you mentioned that are going be coming along the way, do you think coming out of this that the cultural mind shift, and I may be too optimistic as well, might change with an appreciation in Washington DC among our legislators and people at the executive branch that science really, really is important and vital, and in this case lifesaving? Do you think that’s the case or not?

Dr. Eric Topol:               It’s just I’ve never seen anything like it in my career where you need it more than ever and it’s basically abandoned or like in a separate orbit. And it’s a shame because this is a science problem. We can science our way out of it. As you know, Bill, scientists love big challenges, and the entire life science community, AI, IT community, I mean, everybody’s on this because they know how big and important it is. But we don’t have the political support, and we have this crazy stuff going on and we’re going to have reopened places. We’re not going to pay attention to the fact that we’re on this terrible plateau of 2000 deaths a day in this country, which is unacceptable and it’s going to get worse. And so, no one listens. I mean, the Johns Hopkins put out the criteria for reopening. As you know, it requires having a testing infrastructure and a tracing of contact. [crosstalk] We have nothing.

Senator Bill Fr…:           Now let’s talk about that. The testing as you and I know we need three to four, five times more testing that we’re doing, yet we’re told in Washington, “No, you’ve got enough.” So that’s one issue, but the one I want to ask you about is the one you just mentioned and that is the contact tracing. The hat that you wear so much of the time is the technology and the advances in technology with devices that you can move to your home and the aging in place, and my feeling is that a lot of us are marginalized. You write about them, I write about them, we talk about them, but the kind of things coming from the West Coast, and they’re not mainstream, and I think they may become a lot more mainstream. So that’s one issue. The other issue is the contact tracing. What is the potential? We know that Apple, Google, a lot of people are sitting back. The option is to go out and hire 300,000 people to do the contact tracing. Describe to me and our listeners what the potential of technology is in terms of contact tracing.

Dr. Eric Topol:               Yeah. This is so important, Bill. I’m so glad you brought this up because this is the big miss. The first big miss was we didn’t get the testing going, but right now we’ve got a significant single digit percent perhaps of people infected throughout the country where we’re going to be looking at a lot more over the months and as you mentioned at the outset, next year, year and a half, two years ahead. Now, we can’t get that testing up to the 5 million per day or more quickly, but what we can do is do digital surveillance. Now that’s not the same. In a minute, we’re going to get into smartphone contact tracing. They are different. Digital surveillance is we got a hundred million Americans or more with either a smartwatch or a risk fitness band, Fitbit or whatever. [inaudible]

Dr. Eric Topol:               We showed earlier this year and published that we could predict exactly where the flu or flu like illness was going to occur before the CDC using resting heart rate. Now, when we did that in Germany and China, they used that data to create an app, which they are now in Germany, over 500,000 people have their heart rate continuously monitored. If there’s an increase in resting heart rate in a cluster place, they know there’s a high chance it’s an outbreak that’s going to start there. We’re not doing that. It’s being done in China and in Germany with our data. And we launched an app called DETECT. And there’s no privacy issue. It’s de-identified data. We’re just trying to get a traffic map of people with resting heart rate and know where there could be an outbreak before it happens.

Dr. Eric Topol:               So that’s really promising. As you know, Bill, also was used the body temperature with [inaudible] That requires people taking their temperature a couple of times a day and it requires a smart thermometer and then they don’t have enough to dole out. But on the other hand, this smart watch, the DETECT study, any smartwatch, any fitness, we can capture that data.

Senator Bill Fr…:           This whole use of either watches or bands or fitness, because there’s so many out there and make so much sense, is we move from population mitigation or population assessment to individual containment and the individual, do you have it- do you not contact tracing from you. Does that fit more into the surveillance of a community and using a population standpoint or does it go more to the individual?

Dr. Eric Topol:               Well that’s really a community because any single person’s heart re-elevation, resting isn’t going to be indicative. But if it’s clustered in that zip code, in that community, in that neighborhood, then we know there’s an issue. But that gets to the other form of digital, which is what you mentioned, the smartphone clever app, not just Google Apple but also Singapore has traced together, MIT has one now, the UK is testing their own home-made smartphone at the Isle of Wight, over 140,000 people to validate it. The key problem there is that your phone would tell you if you’re going to have contact… avoid contact with someone who is infected. And that’s really helpful, but it hasn’t been validated. So we don’t know. I think the only validation study I’m aware of is in the UK where they’re trying to show that the human contact tracing, which is the reference standard, is the same or that the digital smartphone is better.

Dr. Eric Topol:               We just don’t know. Right now we do know that in Singapore where they asked all citizens to get on it, the app for contact… a lot of people didn’t want any part of it. So you have to have very high uptake in interest and you got to have validation. One thing you’re well aware is that we don’t have enough people. We need a workforce of hundreds of thousands of people. By the way, we could get them on board with 37 million people unemployed, but we’re not doing it. In the UK, they’re hiring over 10,000 quickly to do this throughout the country. So if we can show it’s validated, we should be doing that right now. Google and Apple will make it available for everyone for free. We can do it. It would be great.

Senator Bill Fr…:           Yeah. And I think just again for our listeners that contact tracing is if you are positive and you know you’re positive and it has to be by a test because symptoms can’t predict whether it’s positive or not. This is one of those rare viruses that you can pass on or transmit to the others when you’re not infected. So the only thing, and the reason why Dr. Topol and I both say testing so important is that that’s the only way you’re going to know. You don’t know who the enemy is, and you might be in the room with somebody who gives you the virus, but then the device is, the whole idea is that one device and another device, the Bluetooth technology goes about 10 feet and therefore you can very easily and the phones can be programmed that way, to detect who you’re within 10 feet of the Bluetooth technology by opting into this. And then you can say you have to be with them for 10 or 15 minutes before you get pinged.

Senator Bill Fr…:           It does mean that you have to get… And you just get a little ping that says, “Today you were around these people and this is where it was and therefore you need to watch out or go get a test or quarantine. It does come up. Then you mentioned the issue of the privacy issue and South Korea has used it, Singapore has used it, but the privacy issue in America, the privacy of a phone, even if you opt in, you know, telling somebody, yes it’s you where you are at what time and who you’ve been around, I don’t know if culturally we’re ready for it, but it certainly makes sense from a technology standpoint. The technology is so easy.

Dr. Eric Topol:               I totally agree. The point is we got a restlessness now. People want to get back to some semblance of a pre-COVID life. And sacrificing some privacy for some short term, whether it was a year or a matter of months or whatever, I think it’s a good trade off. The problem is you got to get these apps validated, and make sure that they’re not theory false positives. The problem of course is you started giving out messages of false positives. You got all sorts of, you know, anxious people out there. So if we can show it’s accurate, I think it could be a great solution for this country.

Senator Bill Fr…:           The false positives and negatives is so important in all this, and we can talk forever in this serology test. We haven’t figured it out yet. We’re getting pretty good I think in terms of the PCR test. But again, we just need a lot more tests. I am going to ask you a big question because it’s one that I struggle with, the COVID culture which will continue for a while, overall in innovation, in the year after COVID will there be a lot more innovation than the year before COVID, or will there be a lot less?

Dr. Eric Topol:               Well, I think the way we’re looking at now is we’re going to see a lot of COVID-tagged innovation, because it’s the entire priority of all the people working on the science and innovative sectors. But the problem is we’re going to lose a lot in the non-COVID world because labs are shut down, the whole shunt of effort and thinking and resources to this pandemic. So I think it’s a trade off that it’s unfortunate. People are not even interested in any science that’s not COVID-centric right now. So I think we’re applying our bright minds and our ingenuity where it ought to be, but we’re going to sacrifice some things because of that.

Senator Bill Fr…:           Let’s talk to a couple other things. So in the last month, two months, put your clinical hat back on, because I know you’ve never taken it off from the Cleveland Clinic and where you did so much there. And your cardiology, does COVID have a direct impact on the heart or is it just a lung? We know it’s a respiratory virus that goes deep in the lungs, 70 nanometers, huge infectious cascading occurs in the lung. Does it have a direct impact independent on the heart?

Dr. Eric Topol:               Yes, absolutely. So what we’ve learned, and that’s the other thing about this virus. This is a new virus and we’re learning every day, sometimes it seems like every hour about what this virus can do. So we thought it was just a lung target. Now we’ve learned it’s targeting every organ in the body. So you can get heart attacks and it simulates just like the heart attack, and you can get a myocarditis inflammation of the heart muscle. But also, it can get into the brain, it can get into the gut. We now have been seeing people with new onset type one autoimmune diabetes. So we have to think that the islet cells in the pancreas are getting hit by this virus.

Dr. Eric Topol:               So this virus is much more than a lung target. For example, we know it gets into the lining of the gut, and that’s why some people develop diarrhea. That’s why you can pick up the virus particles in the feces. That’s why through sewage analysis, we could know which community is starting to show virus particles. It’s going everywhere. Tomorrow there’s going to be a report that it shows up in the semen, in the men. It’s everywhere.

Senator Bill Fr…:           It’s been played, that vaccine is the answer. As you said, vaccines the fastest it’s ever been is four years of vaccine and we’re talking about doing it in six months and is it an over promise or not? And then we have to worry about manufacturing and distribution and all. Do you put more confidence now in the vaccine, which is more definitive, but there are a lot of people who don’t want to get vaccines out there as well and to test it the degree of safety is going to be hard if you’re going to be giving it to 300 million people, or do you put more in the antiviral of which you mentioned convalescent serum is one, antibodies is another, and then you got the remdesivir and the other sort of antivirals? Where do you put the most confidence? There’s no way really to know, but just your gut feeling.

Dr. Eric Topol:               I think it’s just a timing story. So if we can get the fatality rate down immediately, and not just with the first drug remdesivir, which has likely some benefit. I mean everything we know suggests that, but maybe not enough. We also have these interleukin six drugs that will block the hyper inflammatory phase and we need something there because that’s why people die in this late phase of respiratory distress. So I think we can get the fatality rate down in the months ahead. And this is so essential because not only do we have the convalescent sera from people who have recovered, not only do we have two different drug types, one that take down the virus replication and virus machinery, the other that works on the hyper inflammatory hyperimmune autoimmune type aspects. The other thing is, as you mentioned, these neutralizing antibodies are really exciting and they’re moving at warp speed.

Dr. Eric Topol:               So I believe before this year’s end, I mean, it’s just May, we’re going to see that the death rate from this condition is much reduced. And that’s what happened with HIV. We made progress. We didn’t get rid of it. We never had a vaccine.

Senator Bill Fr…:           Still don’t have one.

Dr. Eric Topol:               Still don’t have much. 35 years later we don’t have any vaccine. It’s probably likely because vaccine science has advanced so much. We will get a vaccine and hopefully it’ll be a whole lot better than the flu vaccines we’ve had. We’ve never had a coronavirus vaccine, and as you know, four different coronaviruses cause common colds. But I would say the chances of us knocking down that fatality, that’s going to be the big step we can see this year. And that’s the reason why we can’t have this live and let die approach like Sweden. We just can’t do that. And we have things right around the corner. And wouldn’t it be something if you have a relative, a friend who died unnecessarily because we weren’t patient enough to let science catch up?

Senator Bill Fr…:           Yeah. And that’s the big fear. And obviously in certain areas people are making that trade off unfortunately. Artificial intelligence, you’ve written again so much about it and we can get off COVID, we’ll keep coming back to COVID. Artificial intelligence, well you’ve written articles, books, you’re again, the expert on it. One of the thesis of your book was that we’re not as far enough along in terms of getting data back. Is it really going to work or not, a lot of optimism there. Where do you put artificial intelligence today? I’ve been involved with a company called IDX, which you’ve written about retinal scan autonomous, but then there was another retinal scan just two weeks ago that once he got out in the field and a lot of people had it, it worked well in the shops, but it just didn’t work out in the real world very well. So where are we today?

Dr. Eric Topol:               I think it’s exciting. We need it badly. No doctor, no human being can get their arms around all the data for each patient. It’s not possible anymore. And that data is exploding for each patient, whether it’s sensors, whether it’s genomes or microbiomes in every home, no less the electronic health records. So we need a way to deal with the data and there’s no better way. There’s no other way to do that, just have machine assist. But what you’re getting at is we have to do the rigorous studies. Like IDX did the prospective trial, it was the first trial in AI, in medicine to prove in a multicenter study that you could accurately diagnose diabetic retinopathy without an ophthalmologist, without even a doctor really. Just a cloud based algorithm with you could have the receptionist in a primary care office or now in grocery stores.

Dr. Eric Topol:               And that’s really important because diabetic retinopathy, half of people with diabetes don’t even get their eyes examined and it’s a preventable form of blindness. So there you see a big hit positive for AI. We don’t have enough of those. We don’t have a lot of prospective trials. Bill, the only clinical randomized trials are in colon polyps and they’re all in China, and there’s about five of them and they’re great. And you can pick up polyps that gastroenterologists miss. That’s great, but we have to do more randomized trials and prospective trials and nail this thing down. And then AI will become mainstream in every aspect of medicine. And the biggest thing of all is get rid of the darn keyboard. Get rid of making doctors and nurses and clinicians, data clerks, they don’t want to do that, they want to take care of patients. And we got to get this whole burnout and depression and all of this bad [inaudible 00:24:15]. We can fix that if we use voice AI, and that should be a high priority.

Senator Bill Fr…:           Yeah. Well, your book, then again, we’ll have all this on our website was Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again. That was your book. What year was that? Was that two years ago?

Dr. Eric Topol:               Last year. Last March. A year ago now. Yeah.

Senator Bill Fr…:           Last year. And then you’ve had a nature article in 2019, which was basically on the same thing. You communicate science well, innovation well, I’d like to think part of is the fact that you’re a cardiologist and in the middle of it and running one of the great hospitals at the time you were there, greatest number one hospital in America, the Cleveland Clinic. Where do you think that we’re going to be actually going in terms of this integration with artificial intelligence of the analytics of the big data? What is going to be the next biggest breakthrough that will have clinical applications? It may not be a breakthrough, but will it be the retinal scan end of things, the imaging end of artificial intelligence? Or will it be the institution’s support of just collecting data, mining deeply into electronic health records and picking up associations that we wouldn’t get otherwise? What [crosstalk]

Dr. Eric Topol:               Yeah, I actually think it’s going to cut across every aspect of medicine. And I think the one area that people don’t know yet is how much it’s going to give the power to patients and the things that can be done doctor-less. Already we have the Apple watch that can diagnose atrial fibrillation. We’re going to see very quickly the AI kits that you can get your urinary tract infection accurately diagnosed without having a culture or seeing a doctor. You’ll still have to connect with a doctor to get the antibiotic prescription, but that’s a big step. The same for children with ear infection and the list goes on. So the point being is that by decompressing the load of clinicians, and handing that over, sending that to patients more, that is a very efficient way to make healthcare delivery better.

Dr. Eric Topol:               So we’re not spending enough time thinking about the patient side. Everybody’s thinking about, “Well how can I make these films and these slides and whatever better for the doctor?” And we are going to do that. But there’s just infinite potential to take the non-serious, the non life threatening. So for example, another great one is skin rashes, skin lesions. One of the most common reasons people go to see a doctor. Well you can get really great algorithmic interpretation and it will tell you what it is with high accuracy. Why aren’t we getting the randomized studies or prospective studies to get that iced so we can… So there’s all the top 10 things about the most common reason a person goes to a doctor. There’s ways to help without having to go to a doctor. So we should be working on that.

Senator Bill Fr…:           Yeah, that brings me to, you and I are about the same age and we’ve been able to see the culture of medicine over time and how it’s changed and changing. As a little boy, my dad was a doctor and I used to go on rounds with him, literally not in the hospital, I did that, but also in people’s homes. 60 years ago, long time ago, but it was the day of the house call. And there’s something in me that connects telemedicine today to that. The fact that we would walk into a home, we go through the front door, you’d go through the living room, you would sit down. Either he’d sit on the edge of the bed and I’d stand over in the corner. I would watch him interact closely with that patient, looking into their eyes and the patient would smile, would feel better just because of the presence.

Senator Bill Fr…:           And although it’s really ironic, a little bit just like you and I are talking now, that the intimacy of just being able to talk back and forth through telemedicine, through virtual health that I can even imagine that being the first visit. If you’ve never seen a doctor but you have a 15-minute visit or a 20-minute visit coupled with some technology. So I write in my mind, and maybe it’s just because of my age, I think the virtual health really does go back to those old days of the intimacy in the home where the patient feels secure and safe and didn’t have to get in the car, drive two hours, sit in the waiting room, wait for an hour with a bunch of sick people and then see the doctor.

Senator Bill Fr…:           I don’t know, so telemedicine, give us some sort of summary. You’ve written so much about it and we talked a little bit about it. The culture of the doctor, we’ll start with doctors haven’t liked telemedicine. We went as far to tell a doc… I had to go from state to state and part of lawsuits to allow telemedicine, and doctors were threatened by it. Was it just reimbursement or was it privacy or is it just we think in the old days that you just have to touch, feel put a stethoscope on somebody. What about the culture?

Dr. Eric Topol:               You’ve mentioned some of the reasons. I think one of the biggest one’s the traditional and I embrace this. The essence of medicine is the human touch, laying on of hands and obviously we can’t do that connected like this. So it is missing a critical element. On the other hand, when I go to clinic now, I’d have to wear a mask, the patient would have to wear a mask. Not exactly what we would envision as ideal human connection. Whereas I could do that and look you in the eye and see your home in your background as a patient. So it is like a house call, there are some advantages. And here’s the big difference, that right now we’re still at this telemedicine 1.0 which is a video chat, but we’re going to very quickly get into 2.0 which is transferring objective data either during the visit or before.

Dr. Eric Topol:               Today of course you could take a picture of a skin lesion. But soon enough, you can send your cardiogram from your watch or your smartphone. You could send the results of your urinary tract infection AI kit or your child’s ear drum picture, any number of things. The point being is that telemedicine is going to be data exchange, not just a video chat. And you could do most of the exams. So if I give you a smartphone with Ultrasound Pro, you could examine any part of your body with AI guidance. It’s amazing actually. You can take a pro with your smartphone, get exquisite images of the heart or gallbladder, or the liver, you name the organ, with AI it will guide you. “Move the probe this way or turn it clockwise.” And send it while we’re having a discussion. So the exam part in the next iteration of telemedicine with sensors and imaging isn’t going to be, “I got to send you to a lab now, I got to send you to a scan.” We could do it in real time. And that’s I think pretty exciting.

Senator Bill Fr…:           How resistant are the doctors? I was on a call the other day with a doctor and I was talking to the policy and innovation. He was talking about clinical delivery and COVID. And seven weeks ago he basically said, I’d never done a telemedicine visit. I’d covered on a weekend and on the telephone, but I’d never done it because A, I wasn’t going to be reimbursed for it. We might put that B, but A, I didn’t think it would give me the same quality. I didn’t think I could do it. I wasn’t trained that way. I didn’t do it. He says, “Now I am absolutely sold on it. First of all, I get reimbursed a little bit, but I can actually spend more time with patients, and I am actually looking them in the eye and not sitting there typing on a computer.” That cultural change is a big change. And I think that may have been accelerated here.

Dr. Eric Topol:               I agree.

Senator Bill Fr…:           And what about the digital privacy world? I’m going to shift topics because I know we don’t have that much time, but privacy issues are always big and telemedicine that they were big in using electronic health records and aggregating data. People didn’t want their data shared. So it’s always been an issue out there. How has COVID affected privacy in our concept of privacy and health and healthcare?

Dr. Eric Topol:               Well, it hasn’t really done much at this juncture because we’re so far behind. But as testing does get broad scale and massive as it should have been back in January, no less [inaudible] but if we get there, then the positive tests of both the virus and the antibody and what’s done with that data and all the related things, that could be an issue for sure. The willingness for people to share their data without the thought that it’s some type of evil conspiracy problem, the cynicism [crosstalk] because we suffered a lot with the likes of Facebook and Tech Titans and invasion of privacy. And we hopefully can start to see a healing of that. It’s really been a problem. The other thing as you very well know is that we’ve had terrible breaches of electronic health records in this country, and health systems held hostage and all sorts of data being sold, medical data being sold.

Dr. Eric Topol:               So my view on that is we have to get the data to the ownership of the person or the family, and that will circumvent a lot of that concern. And I hope someday there will be a bipartisan support for the rights of the individual, which I think is a human right that they should own their data and share it. They will be happy to share it if they know that it’s theirs, which it rightfully is. They paid for it, it’s their body, it’s really important. And why is it at all these other places and they don’t have it?

Senator Bill Fr…:           Right now you do so well and you communicate. You did in academic world written thousand peer reviewed articles, unusual and typical issue is not going to understand about the significance of that but huge contributions to medicine, to clinical medicine, to research that you’ve done. You’re a futurist by instinct and in part by training, you’re always looking ahead at the next trend. Communication is so important today as we look to change culture, as we look to further what’s going to be a distributed healthcare system much more than past as we move from bricks and mortar much more to the home. What is the best way you have found to communicate?

Senator Bill Fr…:           You use Twitter, you use social media, you’ve written book after book, you’ve written more than a thousand articles that are peer reviewed and another thousand articles that are in journals like Nature and others. What have you learned in the communication field to share with all of our listeners and our viewers and me, given the fact a lot of it is cultural change and sharing of information. Is it Twitter, is it Facebook, is it articles, is it television, is a cable? What is it?

Dr. Eric Topol:               I wish I had learned a lot earlier in my career that the communication should be with the public level, but you shouldn’t be trying to use your inside baseball terms and trying to impress your peers. When I give a talk, it’s the same exact talk I give to a lay audience as I give to people that are into AI or whatever high science stuff. So one thing is keeping it at a level, which is anyone can understand it. Second, I do thank Twitter for keeping up and having quick reaction to… For example, a really good example that happened in the last couple of days, you probably saw this. Last week Bloomberg comes out with an article. Kids cannot transmit COVID-19. And I was like, “No, that’s wrong.”

Dr. Eric Topol:               There’s no reason that that could be true. Now it could be a lot less, could be there, but don’t make that statement. Well Twitter eventually quickly got to the bottom of that, where the people from various disciplines, whether it’s the pediatricians, whether it’s people in China, whether it’s people who are epidemiologists, we got straight and we found out that it was the media that screwed it up, not the scientist that published a report about this. So Twitter is now like the nervous system for life science and medical communications as I’ve learned. I’ve been on it for now 10 and a half years. I never thought I’d get on this thing, but as it turns out, I think there’s nothing quicker to get to the truth. Obviously there’s a lot of huey on that, they have to sort out the real and the not real. But if you want to get what’s going on right away and you want to see your, your fellow experts to either dissect it or acclaim it, that’s the way to go.

Senator Bill Fr…:           When I say democratization of healthcare, what does that mean to you?

Dr. Eric Topol:               Well, it means to get rid of the inequalities in every direction. Not just about underrepresented minorities, but also the whole idea that the doctor knows best and this idea that you can’t handle the truth, the paternalism in medicine. It’s leveling the playing field in every respect. And we have a long way to go on that one.

Senator Bill Fr…:           I’ve heard you speak on it and talk about it. The fact that you have 350 million people empowered, and again, obviously it’s global really, but everybody is empowered or can be empowered through social media. You can go directly to the sources as you said. That’s the positive side of it. Obviously there are a lot of negative sides with the false news that’s out there as well. But I love your approach because it really does show that you can touch everybody. And I think coming out of COVID, people are going to pay more attention to help. And people realize today if they hunker down, if they shelter in, it’s a huge sacrifice, a collective sacrifice, but it makes other people safer and it makes them safer. And I think we got a good shot at that same sort of, “It’s going to affect me and therefore I should take care of myself. I should eat better, I should try virtual health, I should make sure my blood pressure gets checked and the like.”

Senator Bill Fr…:           We’ll see. I’m kind of like you in like we opened being maybe too optimistic. Two quick questions of the big things that you’ve done outside, things like precision medicine, aware we did not say what it is just so our viewers will know. And then any of the other big things that you’ve done in terms of other big grants that have come through the NIH or over in the UK. Just comment on those because it touches on the policy world, this intersection of health and innovation and policy. But comment on those three things.

Dr. Eric Topol:               The term precision medicine is used a lot, but I actually prefer individualized because the precision term is not enough for precision. The individualized basically it’s about all the data layers of each person on medical essence, and as mentioned earlier, it’s with our genome or it’s our sensor or physiome or anatomy or our environment, our microbiome. All these different layers create the mosaic of what each of us are, our uniqueness. And if we factor that in, we can be much better in preventing illness and managing the illnesses that do occur. So I know that eventually this individualized, or if you prefer precision medicine will take hold. It’s still in the early days. And it isn’t to be confused with matching up just a drug, it’s much bigger than matching up things than in a drug.

Dr. Eric Topol:               As far as the UK, I was involved in the review of the National Health Service and that wrapped up last year, but it was very instructive. I learned so much about that system. I, like so many of us thought, “Oh, that’s just not a good health system.” And I learned, actually it’s a great health system relative to ours in so many respects. But I tried to help them with respect to integrating AI. They are the genomics capital of the world, and unlike the US or most countries, they have a health education wing of the health service which trains their doctors and clinicians. So first they train them to all be good in genomics, which we haven’t done at all in this country. Now they’re training them about digital and AI. So I wish we had that kind of wing of education training in this country. So those are a couple of recent experiences that I’ve had.

Senator Bill Fr…:           NIH funding, how important has that been either more recently or in the past to the infrastructure in this country in health and healing and healthcare and our training? And your biggest grant, I have no idea what it was, but what was it and how did it affect what you’re doing?

Dr. Eric Topol:               Well, we got over $200 million grant for the precision medicine initiative. It’s all of us program that we’re a significant player in, and that’s the million person Americans who are participating in this longterm, kind of like the Framingham study but on steroids in not just heart, but in every aspect of a person’s health. And we have about 350,000 people already in it. Certainly it keeps us busy, and that’s a very large grant. But to your real question is we couldn’t advance medicine and science in this country without the NIH, and we’re not still funding the NIH nearly as we should and could. I mean, when you start seeing trillions of dollars being taken out and sent to the NBA teams and the Harvard University and these companies that shouldn’t be asking for money, you say, “Wait a minute, why aren’t we investing at our medicine and science and health? We had all of these money in reserve. What are we doing here?”

Dr. Eric Topol:               I have enormous respect for Francis Collins, his leadership. We’d be in big trouble if he wasn’t still being the director of NIH. And obviously Tony [inaudible] she’s played a great role and in the recent months, and we are lucky to have the NIH and I hope we support it more in the years ahead.

Senator Bill Fr…:           Eric Topol, you’re an amazing guy and you call it right. And what I respect most, I think, is that you draw upon your past as a physician, a cardiologist, an administrator, a manager, an innovator and staying abreast, looking at the future and advising us in ways that we know will lift all Americans up, making a real point about the inequities in our system today. So thank you for everything that you do and thank you for being with us on A Second Opinion today. Appreciate it.

Dr. Eric Topol:               Thank you bill. And thanks for all that you’ve done to advance the whole country and medicine over your career.

Senator Bill Fr…:           Thank you. Thank you for being with us.

Senator Bill Fr…:           Thank you for tuning in to this special broadcast of a second opinion. As developments occur, we will continue to keep you up to date with episodes from trusted sources coming right to your phones. Make sure to subscribe to get the most current information on the COVID-19 pandemic. And be sure to listen to our regular Monday broadcast. This week we are joined by Dr. Joe Coughlin, Founder and Director of the MIT AgeLab, who explains why old age is made up.

Senator Bill Fr…:           This episode of A Second Opinion was produced by Todd Schlosser, the Motus Creative Group team and Snapshot Interactive. You can subscribe to A Second Opinion on Apple podcasts, Spotify, or wherever you are listening right now. You can also watch our interviews on YouTube and on our website, and be sure to rate and review a second opinion so we can continue to bring you great content. You can get more information about the show, its guests and sponsors at That’s A Second Opinion broadcast from Nashville, Tennessee, the nation Silicon Valley of health services where we engage at the intersection of policy, medicine, and innovation.