Ep. 20: Renowned thought leader visits Sanford Health

Dr. Eric Topol of Scripps Research discusses future of rural care and lessons learned from COVID-19

Sanford Health Innovations podcast series

Episode Transcript

Courtney Collen, Sanford Health News:

Welcome to this episode of our Innovations podcast series by Sanford Health. Dr. Eric Topol is a renowned American cardiologist, scientist and author. He is the founder, director and professor of molecular medicine at Scripps Research, and he is senior consultant at the division of cardiovascular diseases at Scripps Clinic in Southern California. Dr. Topol oversees a multimillion dollar grant on precision medicine, and he’s the principal investigator for an NIH grant, focusing on innovation and career training in medicine. Our moderator for this episode is Dr. Luis Garcia.

Dr. Luis Garcia (Host):

Thank you, Dr. Topol. I’m going to tell you, there are people that wait all their lives to have an opportunity like the one I’m having right now and they never get it. So I’m blessed and honored to be here today.

You know, you have been one of the most influential physicians in our industry, excellent clinician involving drug development, device development, molecular medicine research, one of the top 10 cited scientists in the world, three books. You advise the UK government on their national health system and all those accolades that I could take the hour that we have here to talk on that.

But I want, because we want to hear from you, but one of the things that I want to tell you is that what I have learned from you today is that besides all that you are a great human, you have great character and you have a great integrity. That’s what I learned today. So that leads me to my first question. Who is Eric Topol?

Dr. Eric Topol:

Well, first, let me say, how kind are you to say these things and I’m very appreciative and humbled. I try to reckon with this question, I’ve never had it before. Who am I, you know. But basically, you know, I as you might expect I have a wife now, 43 years as of yesterday. I have two great kids and three grandchildren, and then there’s what I do at work, which tends to get overemphasized. But as you say, I identify as a physician and as a person who’s trying to improve medicine. I’ve been working out for a long time. And sometimes many days I feel like I haven’t gotten very far, but I won’t keep, I won’t stop. I’ll just keep working until I can’t anymore.

Dr. Luis Garcia (Host):

Well, thank you. And I think the product of your efforts are, it is very tangible for us. I mean, it’s very notable and we appreciate that. You know, you, you mentioned family as a first description of you, and I know you’re a family man. Who was Eric Topol as a child, you know, as you’re growing up? Tell us about your family and your dreams about becoming somebody influential.

Dr. Eric Topol:

Yeah, well I didn’t come from medical family. My mother was a schoolteacher, my father, an accountant. And I really didn’t know that medicine was going to be in the cards until actually in college at University of Virginia. I worked at night shift just trying to make ends meet.

And I happened to be in the night shift as a respiratory technician. And those were the days where, you know, these were very primitive ventilators compared to what we had now, but I saw people in the intensive care unit, almost like a Lazarus, you know, resurrection, I thought they were to die and then they were, they would make it. And I said, “Wow, this is – this medicine thing is amazing.”

So that basically pushed me from what I was planning to do in life to become a physician. But I never really had aspired to be, you know, a leading-edge type force. It was more as a natural pushing hard on things that I believed in or worked hard to try to advocate.

Dr. Luis Garcia (Host):

And you know, a lot of young physicians-to-be, or a lot of children perhaps find themselves or will find themselves in a situation like yours, where you get the opportunities to seize an opportunity and you do it, and then you become really influential.

What would you tell those children right now that are the future of our country and of our world? What message would you tell them of encouragement of why is it important to get an education? Why is it important to take advantage of those opportunities and capitalize on them?

Dr. Eric Topol:

Well, I think the idea that is a limitless, what you can do, if you are really driven to what you’re passionate about that, you know, everyone has the talent and it’s the real matter of applying it, too. It doesn’t have to be kinds of things that I’ve worked on, or you’ve worked on, Luis, but many other people don’t ever find their niche in life. They don’t find the matchup of where they have something to offer. And that’s, I think unfortunate. That alignment of what you can do, that’s special and help people and make a difference.

You know, we’re lucky when we find those, but there’s too many people that have that latent or not-so-latent capability, that’s extraordinary, but they don’t really come to that realization or sometimes they do, but it’s, you know, much later in their life. So the sooner you can find what you are excited about, what you think may be a talent to nurture a particular quality that is burning inside you, go for it.

Of course, it doesn’t happen by accident. It’s not something that’s a natural gift. It means work. You have to really work at it, as well. So it’s a pairing of finding that kind inclination quality and then really going after it.

Dr. Luis Garcia (Host):

I appreciate that that insight, Dr. Topol. Yes, I’ve got to tell you, I feel so lucky that I’m in the medical field and that I love what I do. Right. Oftentimes we find somebody doing a job just because it is a job and not because it is a passion, right? So, realizing what your passion is and executing on it with hard work … I appreciate those comments.

When I talk to great leaders in this world, oftentimes they can identify a moment of uncertainty on their lives in which they had to make a decision. And that decision put you in a much different spot than you would have been if you would’ve taken the other side of the road. Did that ever happen to you?

Dr. Eric Topol:

Oh, actually several times. I live in uncertainties really. But the one I can recall, particularly since we’re talking about a kind of career path, I was at UC-San Francisco in my medical training. And I actually was planning to be a diabetologist because my father had type 1 diabetes and had gone blind by age 49 and I wanted to dedicate my life towards that. And in fact that was one of the reasons I picked UC-San Francisco. They had a first-rate diabetes division.

Anyway, my wife said when I was doing rotations and intersecting with cardiology said, “That’s what you’re really excited about. Can’t you tell?” And so she was the first one to note that I wasn’t at all excited about what I had purported to be. She helped sway me towards cardiology and that was a big, important decision where I was certain, but I was basically realigned with her support and insight.

Dr. Luis Garcia (Host):

Let me change up a little bit, the topic here, Dr. Topol. Sanford Health, we say that we aspire to be the premier rural health care system in the nation. We’re driven by the values that I’ve heard you reinforce and talk so much like restoring humanity in medicine, being about the patient, not being about compensation or reimbursement and really finding again the value and the art of being a physician and taking care of people in need. You articulate that very eloquently in your books. Do you want to share your thoughts about that?

Dr. Eric Topol:

Well, because I’m older, I’ve seen medicine change over the many decades and unfortunately it’s mostly for the bad. That is the emphasis on the patient-doctor relationship has been lost in most respects and the business of medicine has become the center so that term patient-centric is really useless compared to what is the reality.

Especially, as I got older, and naturally I became more frequently a patient and realized even from firsthand experience how this attrition has become so extraordinary. And that is, I think, ignited me to try to get us back and find all the other people that are willing to work together towards getting medicine back to where it was, which was that precious relationship that you had with your doctor, which was the person who had your back, the person who you should trust and whenever you talk, there was an attentiveness, there was just a real presence and you could relate your deepest concerns. Whereas now, of course, that is a rarity.

So I hope that in the future, that’s our biggest deficit right now that I think accounts for why there’s a global crisis of burnout and such severe depression among clinicians. And we can do this, we can get it back. I’m confident of that, but it isn’t going to be without a lot of effort and without solidarity in the medical community.

Dr. Luis Garcia (Host):

Well, one of the things Dr. Topol that I got out of your books was obviously the physician and clinician perspective is very important in patient care. But what about the patient perspective? And to your point that somehow, that art of medicine has been lost for the wrong incentives and oftentimes as physicians will say, “Well, my patients love me and I provide the best care in the world.” And interestingly, in one of your books, you bring the “word cloud” concept. Can you talk to us a little bit about that?

Dr. Eric Topol:

Yeah. I think the perception that our patients, “my patients love me” may be a little off because while there may be some physicians who truly have that, most don’t, and we saw that the word cloud you mentioned is from one leading medical center.

What are the two words that you think of from right coming out from your visit? And the words were not pretty you know, hurried and rushed and unconcerned and just devoid of the humanistic qualities that we need to exude. And that I think is the real problem.

That used to be the case that there was a love. It was bilateral. I mean, there were a lot of patients I just adore. I mean, no question about it. But the time that we have is so compromised that we don’t even have time to listen to a patient no less to do a proper exam and cultivate a relationship.

What I’m excited about with Sanford is that you could be the leader and pioneer reestablishing the care of the patient is about caring for the patient because there isn’t a health system in the United States that exudes that, or is the exemplar. And you can do that here.

Dr. Luis Garcia (Host):

Dr. Topol, thanks for pointing that out to us. And let me be honest with you. As I mentioned earlier in the podcast we’re driven by values. And during the pandemic, we took a special interest on learning how what our patients thinking of us as a health care system, and turns out that we are the most trusted health care system in our regions. And people understand by default that we have the greatest talent, but it is about that trust and it is about that relationship that that really makes the difference.

And the last couple of years have been so difficult for clinicians and health care providers. Right now, they feel that they’re devalued and the sense of being devalued comes precisely from what you’re seeing from their patients, perhaps not trusting their opinion, not trusting their insight because of all the myriad and amount of information that we get from untrusted sources. What are your thoughts about that?

Dr. Eric Topol:

Well, the bigger picture is there is more blurring of truth and lies and, you know, facts and fabrications than ever before and we have done as a country, little to ante up with the forces that are making this, that are consciously trying to blur and, you know, all the fake stuff.

And we have to work hard to get that trust back. And it’s across the board. I mean, all the revered institutions, including medicine has suffered from this. But we have a very strong anti-science faction in this country, more so than most other industrialized parts of the world. And we haven’t done anything really to cope with it, to counter it and take control and unfortunately it’s just gotten worse through the pandemic.

In this time of crisis, this would’ve been ideal time to really work against it. And in fact, knowing it was going to be an issue you could tell early on. But you know, it’s never too late. And I think that because there’s so much unreliable source of information for people because people get their punitive facts and news that often is questionable through so many varied sources. We have to have a central source that is known to be trusted that everyone can rely upon and that’s going to take effort. And we have no such thing, no such force at this point.

Dr. Luis Garcia (Host):

And I don’t want to miss the opportunity to speak about two instances in which your determination in which your adherence to science really have made a difference. And I have to ask you about your participation in COVID, that’s one thing and your participation with the UK government, with the United Kingdom government. But let me just ask you, how does it feel to get called on your personal phone by somebody telling you we want you to come and redefine the national health care system for the United Kingdom? That must be a super honor. How does that feel?

Dr. Eric Topol:

Well, yeah, it was kinda interesting that it happens, you know, from another country, rather than in your own country at the time. I was actually, I was thrilled to get that call and invitation. I didn’t know exactly what I was getting myself into, that I would go and have these, you know, 50 different people assigned to this for this review to help me. And it was obviously a big part, not just planning the national health service, but how well it would be received by the public, how would it be seen as a political, you know, football sort of thing? And so, it was a fascinating learning experience for me and made a lot of, you know, new friends from it.

But, you know, these days in the pandemic, it’s been gratifying because now there are people in our own government that are making contact and, you know, asking for input and it’s great to have a voice to have a chance to weigh in. I think that when you have at least a way, a channel, what you, you know, sometimes in the bubble that our government sits, they don’t really have enough insight about what is the problem out there. I think right now you know, the chance has increased throughout the pandemic of being able to give some, at least thoughts. Sometimes you could consider it advice and it’s fun for me.

Dr. Luis Garcia (Host):

And it’s just amazing. You shared a story with us earlier of how once again, your determination and your input really influenced the release of the vaccine and all the research that what’s going on behind the COVID vaccine. Do you want to share some thoughts about that?

Dr. Eric Topol:

Well, it’s interesting. I never realized the power of social media for me, at least, until I exercised it during the course of the pandemic. It started with the vaccine trials were, we knew they were ongoing, but the companies Pfizer, Moderna, J and J, AstraZeneca, and none of them would release their protocols, like they had something to hide.

So I basically started tweeting at these companies, “When are you going to release your protocol?” And finally, I got them, or whatever that happened, and one did it, you know, and then they all did it because they were all basically you know, undressed about this issue. And once you saw the protocols, then you started to see, “Oh my gosh, there’s a chance that these trials could be stopped early, really early before we knew the truth.”

And then of course there was a concern that the FDA was being subverted. And then the company’s interest was to get the vaccine. So you basically had alignment of the current administration that subverted the FDA and the companies all wanted to get the vaccines approved and get hundreds of millions of doses out there sold as quickly as possible but they didn’t have a plan to do it right.

So by social media, basically exposing the protocols and making them public and also for the research community to see, that was basically the ticket to, we cannot let this happen. If these trials stop after 30 patient events, and we are going to start giving vaccines to billions of people, something is going to be off here.

I think the extraordinary part of this knowing the protocols, being able to have precise readout that if this were to happen as the companies wanted, and as the administration wanted, we could be looking at premature dissemination of vaccines that were not proven, and this could be not knowing the results, but this could be a real setting for mistrust and also a backfire. I mean, we could have really good vaccines, but without validation, we could really see trouble. So, fortunately this got all fixed in the nick of time in October of 2020.

And we were very lucky. We had vaccines that had 95% efficacy, at least against the original strain. And we had it done right. The trials were finished and in just a mid-November, you know, we started to see the results. The companies acted properly and everything kind of fell into place. And we’re lucky about that. It could have gone a whole different route and whatever accusations people have made about “it was rushed.” They don’t have any idea about what rushed could have meant.

Dr. Luis Garcia (Host):

You know, on behalf of so many patients that needed, there’s so many patients that needed that. And there’s so many people that needed your leadership. Thank you for standing up for the right thing. So we appreciate that.

You know, Dr. Topol, in your books, you talk a lot about the future of medicine and how will augmented intelligence, machine learning and all that would influence medical care in the future? Where do you see medicine in 5, 10, 15 years down the road?

Dr. Eric Topol:

Well, one thing I’ll preface that by is that, every time I try to think where it’s going to be an X number of years, it’s multiplied by about three or four times – if not more. It doesn’t move like it should. And this is another flagrant example is that if we were to embrace AI (artificial intelligence) and go after it, in terms of doing the proper vital validation work, we could get there faster. But we’re not. We’re more – the medical community, more afraid of it than they are seeing the extraordinary potential.

But over time, we will see keyboard liberation. We will see reestablishment of really good communication during encounters between patients and clinicians. We will ultimately see remote patient care with much less use of hospitals than we do today. That will take longer, of course, because we have all sorts of reasons in this country to rely on hospitals that we shouldn’t be as much.

At any rate, there will be more changes ahead or at least opportunities for change. Whether we in the United States will adopt them as compared to other countries that are better poised because of their health systems –  that remains to be seen. But this is the most exciting time for medicine rather than certainly the last couple decades where we’ve seen degradation. This is the potential for an extraordinary turning point if we work at it.

Dr. Luis Garcia (Host):

Yeah. I love that last sentence, Dr. Topol. At Sanford, this is reassuring because we are investing a lot on the virtual aspect and the digital aspect for patient care for the right reasons. I’m going back to your comment of “this is exciting, and medicine is still beautiful, medicine is still good.”

We have so many people that have left the workforce and they might decide to come back or not, or so many people that are considering getting into the workforce of health care, but they’re hesitating because of what the last two years had done.

This is my last question: what would you tell those kids that are considering getting into medicine? Why should they get into our field and what is so precious about it that it should be their calling?

Dr. Eric Topol:

Well, there isn’t any question that the best is yet to come. I mean, we’ve hit a bottom that will only can get better now. But moreover there’s no profession that is more exciting, more rewarding than medicine.

The fact that you can truly care for another person for the most important part of their existence, their health, and you can help promote that. And you can have the trust of that person for a lifetime. I mean, there’s nothing like this. There’s no other profession like this. We are privileged to be part of it.

I think once we start to get this turning point established where the humanity is brought back in, it won’t happen. Like a light switch it’ll happen in phases. There will be a surge of interest to be part of this like never before.

Dr. Luis Garcia (Host):

I started my conversation with you highlighting what a great human being and leader you are and to all our listeners, I think they will agree with me that after the thoughts that you shared with us, that is exactly who you are. Thank you for everything you have done until now. I hope that you live until you are 200 years old, so we can continue to have your leadership and if not somehow, with the future of polygenics, and everything that we can clone you. So, but thank you for being here with us.

Dr. Eric Topol:

Thank you. You’re much too kind, but I really appreciate the chance to speak with you today.

Courtney Collen:

And our thanks to Dr. Eric Topol for his time. Find and hear more Sanford Health podcast series and episodes by clicking the link in the show notes, Sanford Health podcasts are also available on Apple, Spotify, or wherever you listen. For Sanford Health News, I’m Courtney
Collen. Thanks for being here.

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