In Conversation With Dr. Eric Topol

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  • Techonomy16 conference in Half Moon Bay, California, Wednesday, November 9, 2016. (Photo by Paul Sakuma Photography) www.paulsakuma.com

  • Techonomy16 conference in Half Moon Bay, California, Wednesday, November 9, 2016. (Photo by Paul Sakuma Photography) www.paulsakuma.com

  • Techonomy16 conference in Half Moon Bay, California, Wednesday, November 9, 2016. (Photo by Paul Sakuma Photography) www.paulsakuma.com

  • Techonomy16 conference in Half Moon Bay, California, Wednesday, November 9, 2016. (Photo by Paul Sakuma Photography) www.paulsakuma.com

Speaker

Eric Topol
Chief Academic Officer, Scripps

Interviewer

David Kirkpatrick
Founder and CEO, Techonomy


Dr. Eric Topol visits with David Kirkpatrick at the Ritz-Carlton, Half Moon Bay during Techonomy Health.

Kirkpatrick: Eric Topol is one of the great pundits and thinkers, a doctor who is a cardiologist who has given tremendous thought to what’s possible if we step back and look at healthcare as an integrated digitally-oriented system. His most recent bestselling book is “The Patient Will See You Now.” He’s written a ton about this stuff. He is really such a great thinker about this and inspiring to a number of us and we’re honored to have him. So and I really think it’s great to have you at the end here because you’ve been listening to everything. I’d love you to comment on anything you’ve heard and tell us, again, going back to my opening comments about making this into a movement, what are the prospects of that? So that’s maybe what I want to talk to you about and anything else that you want to focus in on because you have so many interesting thoughts on this.

Topol: Well, when we get to the movement thing that will be interesting. I heard a lot of great stuff this morning. I think it was really very interesting, great perspective, obviously really the cognoscenti are in the room here. But one topic I think that’s setting the stage for this transformation is this ability to digitize human beings and we have lots of different ways we can do that. There hasn’t been much talk about genomics.

Kirkpatrick: I wanted to get there but it hasn’t come up.

Topol: There’s a paper that just came out this morning from Harvard which basically showed in two very large cohorts followed over many years you could predict cancer and heart disease with 4–13-fold risk with no family history.

Kirkpatrick: Just from genetic information?

Topol: Just from genetic information. So this whole idea that sequencing has not been helpful, this refutes that. But so genomics, sequencing, we talked about imaging, all these different tools that we didn’t have before. And all these tools generate data that is imminently portable and moreover that it can be for the large part consumer, patient, person generated. So that’s a basic part of the foundation here. Now the thing that really gets me going as far as the data story, which you’ve touched on many different ways this morning, is owning the data. It’s not enough accessing, it’s not enough controlling. It’s has to be owned. And let me try to make that story have a little bit more color to it. Firstly, it is owned today by doctors, hospitals, and health systems.

Kirkpatrick: The data about you?

Topol: Yes. The only place it isn’t is in the state of New Hampshire and they don’t even know that they actually legally own the data there. But the reason why, everyone has your data, whether it could be mobile apps, it could be data brokers, you name it, everyone except you has your data. And you paid for it, it’s services that you paid for and you need it. And this stuff about fax machines and all this other crap, but the point is that the privacy/security is porous. I mean, over 100 million Americans have had their medical data, EMRs, hacked this year, in the past 12 months. And less than 5 million have ever accesses, ever, their electronic medical records. So we have a terrible mismatch and that has to get fixed and that can be fixed through such solutions as blockchain, personal cloud. We have technological solutions but we also have to have a governmental solution. And you, in your opening remarks you got to that. You said that you don’t think that in the new administration that that’s likely. But actually I’ve talked in a bipartisan group of Congress and I was surprised how strong support there was among Republicans also.

Kirkpatrick: For what exactly?

Topol: For data ownership, a civil right, a new civil right.

Kirkpatrick: Really?

Topol: Yes.

Kirkpatrick: That’s regulation, baby.

Topol: I know but what it also is is decentralization.

Kirkpatrick: All right, I hope you’re right. Wouldn’t that be nice?

Topol: And right now, you know, the government is our biggest payer and it actually fulfills the—the data have to be shared, obviously. And the whole idea about the joint stewardship and all that sort of thing, that’s fine. But that’s a really important thing to watch over the years and the reason to watch it is people are going to be generating more data than was ever in the cockamamie electronic medical record. And soon that mass is just overriding what is this and we’ve already, I think we’ve beaten up this EMR which has really got a lot of shaky stuff because of the wrong purposes for what it is created for. I mean, there are important things to echo one of the other physicians that you need. As a physician you need that to refer back to when the patient comes back or for making recommendations, whatever. But for the most part, the way it’s set up today, EPIC, Cerner, Allscripts, and these various proprietary platforms are not going to last because they don’t take the patient’s/person’s generated data, they don’t have sequence, there’s going to be more and more the case, and over time either they will erode or they’ll have to adapt.

Kirkpatrick: When you see a possibility that we could move towards a legal right to own your medical data, is that partly because of the cyber threat environment that maybe has pushed the awareness of some of the risks, that maybe’s there some idea that somehow it could be beneficial for the individual to own it? I could see some logic to that, is that part of the reason why it might be happening?

Topol: You actually hit on this with your tech background. So everyone that you talk to, cyber security experts, the gurus in this, the first thing you do to prevent hacking and breach of data is to decentralize it.

Kirkpatrick: Also people are going to be much more concerned about protecting it if they own it and they control it.

Topol: Exactly and it’s their right to own it. The fact is, right now I’m involved with this precision medicine initiative which hopefully is going to hold up, it’s an Obama thing, so hopefully. But the point about that is everybody’s really fixated on the EMR. Well the reason that’s a problem is because there’s a lot of EMRs out there. You don’t just go to one provider and have that electronic record. And we’ve already talked about the lack of interoperability and all that sort of thing. So the problem is you as a person, and that’s true person-centered, which that concept was brought up in 1969, we haven’t even come close to that. We’re so far away. But that should be the way to decentralize the data and give it to the rightful owner, the person, who has the most vested interest and that person can quickly electronically share whatever they feel is appropriate to whomever, whenever and that’s the way it should be, not the paternalistic, doctor-controlled, the thinking that patients can’t handle the truth, we’re in that right now. We’ve got to get over that because they can handle the truth. In fact, indeed they need to. And so many studies have borne out that people do very well having their medical data, whatever is in there.

Kirkpatrick: That’s great. I’m glad you’re confident that that’s a movement that may be beginning.

Topol: It may take a while.

Kirkpatrick: But let me ask you going back to this movement question, this is a room of very influential and engaged people in this universe, what can we do collectively to push for that likelihood to be great? Because I think there’s hardly going to be any dispute that that would be beneficial.

Topol: Yes and I think Rick commented about that this morning about is it coming from the edges, from the inside, where is this going to come from? Because eventually it has to change, it has to adapt to a whole new everything really. I mean, this is the ultimate creative destruction of healthcare and medicine that is inevitable. It’s just a matter of is it in this decade or is it going to be forestalled for quite a long time?

Kirkpatrick: Or could it come from other countries that are more behind and leapfrogged by maybe India and shame us into doing it eventually.

Topol: In some ways that’s already happened and we can get back to that. But this week I had a really fascinating meeting, which I was kind of struck by. So there was this group which I had read about back in February called the Health Transformational Alliance, HTA. And the CEO of that is a guy named Rob Andrews, who actually was a congressman for many years. And he has assembled, just since February there were 20 companies, now there’s almost 40 and their goal is to get to a very large proportion of self-employer large companies.

Kirkpatrick: So, these are employers who have a lot of insured individuals?

Topol: Yes, they have already somewhere, several million, several billion, over $25 billion of healthcare costs per year and they move really fast. They doubled everything in just eight months. And he also told me, the various companies that they’re in discussions with, but if you just look at the list that’s out there, including the likes of IBM, Coca-Cola, really big companies, so these companies have the vested interest in fixing this mess. And they’re not getting the response from Aetna and Blue Cross and United. So, what we’re talking about here is not about electronic records, we’re talking about that they demand the medicine is changed for their employees and their families. So, for example, they’re working with this Geisinger company called xG, it was a Geisinger derivative, and Steele, who was the CEO of Geisinger, moved with Earl Steinberg to form this company called xG. Now why is that important? Well, they’re starting with diabetes, back pain, to avoid spinal fusions that are unnecessary, and also to other things, and the third one—these are just the first three that they’re rolling out to all of these employers. And all of the employers are sharing all the medical data from all their employees and families, not to help the hacking and breach problem, so again, have to be very careful with that data. So, we’re seeing something bubbling up from the big companies in this country.

Kirkpatrick: In order to create a movement, in effect. It’s not a bottom up, the type that I was thinking of.

Topol: Yes, I actually had met with some of the large employers, AT&T, GE, IBM, I kept hearing the same story, “We’re spending several billion dollars a year for healthcare. We can’t do this. We have to come up with a new way.” And now, they are hyper-motivated and this is the only thing I’ve seen that gives that power of lots of large companies working together for a common purpose. And they pay a yearly, a one-time fee to join this thing and for these large companies it’s pretty nominal. So, we’ll see what happens. That’s one way. Now, it could be any one of these large companies just breaks out on their own. That could be an important—

Kirkpatrick: And how would that—to do what exactly?

Topol: Okay, there’s a list of a hundred things a company could do today if they decided to do it. It works much better in companies that don’t have unions that actually have control of their employee base. And I think you know, 170 million people in America are employee health connected, that’s how they get their healthcare. So, it’s a very dominant part.

Kirkpatrick: Trying to make retiree medical here.

Topol: Yes, there you go. So what we’re talking about here is that could be the way. I think there are some large companies that are part of this HTA, and some that are not, that are right on the brink of saying, “We’re going to do all of these things.” They’re all evidence based. And we could go through certain examples to show how they’re markedly cost saving. There’s a list of hundreds of, you haven’t heard probably, this choosing wisely initiative, but it was done by all of the medical societies and it says all the things that we shouldn’t do anymore which are being done every day.

Kirkpatrick: Give an example.

Topol: Like, you shouldn’t do a CT scan for this, or MRI for that, or you shouldn’t do a spinal fusion, hundreds of things. Every medical society, essentially, gave away their things that should be considered taboo which are being done every day in this country.

Kirkpatrick: Wasting money and possibly causing more ill health.

Topol: Yes, and they admitted it. But, see, there’s no teeth in that. This was published by American Board of Internal Medicine Foundation and it crossed all the surgical specialties too and the problem with it, really, is that there’s no teeth and so who’s going to make the choosing wisely come alive. And this was volunteered with evidence from the medical community. That’s only part of the list. Somebody commented about the Tesla and, “I can’t afford a Tesla.” Okay, I get that. But we’re not talking about Teslas here, we’re talking about cheap chips. We’re talking about stuff that you can buy, like an electrocardiogram for your smartphone for $69 dollars or less with algorithms.

Kirkpatrick: Well, you mentioned this idea of testing for the genetic information that would show susceptibility to a hundred different commonly used drugs and you said a $10 dollar chip could be used to test everyone but we don’t even do that.

Topol: It’s unbelievable.

Kirkpatrick: To avoid unfavorable drug interactions.

Topol: Yes, over the last several years we have amalgamated an amazing amount of drug DNA interaction knowledge, unequivocal knowledge that we don’t use today in medicine. And, so, you could make a chip for a couple of dollars that would screen all the known FDA labeled genomic variants so that people don’t take drugs that are going to potentially have serious side effects, some even associated with fatality, or drugs that aren’t going to work in them. That’s just remarkable. So, that’s just an example of how a big employer could say, “We’re going to have the chip made, we’re going to screen everybody in our employee base, and they’re not going to get drugs that don’t work and they’re not going to get drugs that cause side effects.” And, you know, we’re talking about one of the top five leading causes of death in this country of medication errors, medication side effects. It’s a serious problem that’s not been adequately acknowledged or addressed.

Kirkpatrick: Who had some thoughts, questions, comments? Okay, please identify yourself again.

Pamar: Arundhati Parmar, editor at MedCity News. Just wondering, given what happened last night there certainly is going to be some changes to the Obamacare model which I feel sort of accelerated this move to adopting technology to reduce costs. So, when that change happens, and who knows how long it’s going to take and what shape it’s going take, do you think the focus on the costs and the use of technology to sort of provide care in a different model outside the hospital, is that going to fundamentally change or has that horse sort of left the barn?

Topol: No, I think the horse left the barn if we accept that Moore’s law will come to medicine. This is something that I still find remarkable because these chips, whether you’re going to do DNA interrogation or whether you’re going to do physiologic monitors or you’re going to do your smartphone labs, instead of the ridiculous amount of cost of going to a central or hospital lab, all of these things can be done so incredibly cheaply. And, so, we haven’t taken advantage of that. We’ve rejected it because we’re stuck in this high, big ticket item, incumbents that rule the roost, paternalistic. Most doctors don’t think that patients should be able to do these things on their own. They reject the idea that they could have algorithms that interpret their electrocardiogram, interpret their child’s eardrum possible infection, interpret their sleep apnea data that they do in a $1 dollar add-on to their phone. That’s not only challenging control—

Kirkpatrick: As opposed to a $4,000 dollar overnight stay in the hospital.

Topol: Yes, this is challenging control of doctors that they have enjoyed since long before Hippocrates, actually.

Kirkpatrick: Do all the doctors in the room agree with that? Who disagrees with what he just said. Anybody?

Audience 1: Historically true. So, just to comment to that point, with the new doctors being trained now that are in their twenties, half of their life has been connected, aren’t they going to demand these things now?

Topol: Yes, we have the best hope but if we wait for them we may not, some of us may not be here.

[LAUGHTER]

Topol: So, that’s a problem. Why do we have to wait when every day there’s people that are suffering unnecessarily and wasting, wasting, wasting. I mean, we’re talking about over $1 trillion dollars a year in this country, unequivocal waste because we’re not adopting the technologies. And this other thing about, “Oh, technology de-personalizes medicine.” That is not true. What is true is that electronic health record has been a veritable disaster with a keyboard, and not connecting with the patient, but that’s not technology. That’s anti-technology. That’s a farce.

Kirkpatrick: So, instead of a keyboard, what should it be?

Topol: Prakash? Where is he? He mentioned it.

Audience 1: He’s outside.

Topol: You have natural language processing of the whole interaction.

Kirkpatrick: Just record the whole thing.

Topol: Yes, and the doctor is transparent about the interpretation. It’s all there and discussed like it should be, openly. That is then transcribed, edited by the patient, first, to make sure it’s accurate because it’s amazing how much inaccurate stuff is in the medical record when you finally get to it. If you can get to it.

Kirkpatrick: Which you can’t.

Topol: Yes, and then it goes machine learning for the doctors so the doctors don’t have to put a lot of time into it to make sure that basically, every time he does one of these it’s just getting smarter and smarter about him signing off on it. And we have no keyboard, everything is in the transaction and then, by the way, that’s already being done in telemedicine. That’s one of the attractive aspects of telemedicine because it’s a digital encounter and all of that could be archived.

Kirkpatrick: I was amazed, I just got a new GP in New York City. I’m 63 years old, I’ve had the other doctor who was retiring for thirty-some years, the new doctor did not ask me anything about my previous records. He didn’t even want them. I mean, I couldn’t believe it. I realize next time I see him I’m going to say, “You’ve got to get my records for God’s sake.” But that just is so astonishing. Does that astonish you? Is that just the way it is?

Audience 2: Well, if you’re healthy. He says, “Have you had any medical problems?” And if you say, “No.”

Kirkpatrick: Okay, well I told him about a few little things, but c’mon. There’s like reams of paper about me. He should at least be curious to know where it is, don’t you think?

Topol: Yes.

Audience 3: Yes, the doctor. Definitely.

Audience 4: There is a serious problem with that and if you harm the bleeding edge of inoperability, which we are, and you can pre-stage the fetch from other healthcare organizations based upon an appointment schedule and pull in all of the continuity care documents which include the problems, meds, allergies, and immunizations, from anywhere somebody’s been seen and you can put that in front of the physician for an encounter. Let’s say someone comes in for bronchitis and they have an appointment and you pull that in. You’re going to see so many conflicting diagnosis, so many conflicting and outdated medications, so many conflicting allergies, and conflicting immunizations records, that it actually becomes a very low signal to noise ratio. So, that reflects the fact that we’re at an inflection point between an era where data didn’t flow freely and an era where data does flow.

Kirkpatrick: So, the data is just so bad they’d rather not have it.

Audience 4: It’s not necessarily that it’s bad, it’s the amount of time it takes to rationalize, reconcile, harmonize, process, analyze, and apply the data is so long—

Kirkpatrick: One thing I noticed was he was giving me new immunizations without even asking me whether I had them or not. I don’t think this is a bad doctor by the way.

[LAUGHTER]

Audience 4: I’m not arguing for the virtue of what I’m describing, I’m just describing where we are in that inflection point. Five years from now, hopefully, there will be much better ways of rationalizing, normalizing, interpreting, using the machine to actually generate something that is quickly useable for that physician to help in your care. But we’re not there yet.

Topol: We could be though. We could be but a lot of this stuff is just summarily dismissed by the incumbent health systems and physicians. I mean, we have a lot of resistance. Reimbursement was touched on many times this morning. That’s part of it. Control is part of it. Education and training is part of it. But the resistance is profound. The reason why this is the last frontier, and the reason why only now Apple, IBM, Qualcomm, Microsoft, Facebook, all of the rest of the tech, Amazon eventually is going to get in here, is they’ve realized that this is the last frontier that’s going to go through the biggest change. They know. It’s not just the FDA regulatory, it’s the resistance of this sclerotic medical community which is very controlling. And it’s going to be interesting to see, even in the political front, how do you repeal Obama Care because it’s the same parties. It’s the insurers, it’s all the different lobbying forces, how that’s going to happen, even though it’s been it’s been sworn it’s going to happen. Because it’s the same medical community we’re trying to change right now with this advent of remarkable technology that the rest of the world, every other sector, is adopting and we are largely resistant. And it’s reflected by, for example, doctors today, 70% of American doctors today don’t want the patients to get their office notes. That says a lot right there. And that’s been constant for years, every time it’s been looked at. And there may be projects like OpenNotes, that’s wonderful, but that’s a tiny minority of people. If you said, “I’d like to get my copy of my notes that I paid for, for my visit, about my body,” you can’t get it.

Kirkpatrick: Is that a fear of liability, primarily?

Topol: Oh, yes, that’s another part of the control and fact that doctors don’t want to email, don’t want to communicate with their patients through today’s technology because, partly, they might have something in that email that makes them liable. But we already do know that if you have a good relationship with patients it doesn’t matter what you put in your email. If you have trust they’re not going to sue you. But there’s not enough time to actually establish trust. We’ve got seven-minute visits. How much trust can you—twelve minutes for a new patient, that’s going to engender a lot of trust. That’s a real problem.

Rick: Around the point about the adoption cycle in healthcare. So, today, we put billion dollar machines in the air with hundreds of people flying over millions of citizens and they fly by themselves. We were able to do that because people were motivated to make that happen. So, data-driven machines exist today, we’re about to do that with autonomous cars driving through our neighborhoods. So, the idea that someone in healthcare has to look at the data in order to interpret it. For a lot of stuff, yes, but for a lot of other stuff, no. And for an autonomous car there is no one sitting in the back of it with a remote controller or leaning forward and popping the wheel this way and that way based on data. It’s data-driven. It’s running itself.

Topol: And as best as we can tell, far safer than human driving.

Kirkpatrick: Bob, real quick and then I want to hear something from Walter. But Bob first.

Bob: So, getting back to your point about unnecessary tests being ordered and resistance to that, I’m curious why you think insurers haven’t clamped down and for physicians it seems one motivator is physicians end up with $200,000 dollars of debt, or whatever, from med school therefore they order lots of fancy tests. I mean, how do we tackle that?

Topol: Okay, well the insurers, I think they get it now. So, they’re going to try to differentiate from one another by true, going into this major change, cost cutting technology but they’re slow in moving. These are mammoth organizations and so they do it in tiny pilots and they take a long time. As far as the debt issues of education, I mean, education is the only other thing like healthcare that is just so far behind and all this replication of transferring information and knowledge. That could also go obviously through a much more economical model that wouldn’t result in these ridiculous amounts of debt. So, hopefully someday that will be seen as well.

Kirkpatrick: Walter, do you have anything you wanted to chime in?

Walter: First of all, what Rick said was interesting about the planes. It’s also interesting that 94% of Americans do not believe that computers actually fly these planes. And we actually participate in that by putting actors with like hats, you know, like pilots who are only actors.

But cannot touch the machine or something would happen. And this is the time now for the role for bringing machines in because basically we have now one million genomes sequenced between the U.S. and China and 80,000 interpreted. All the rest are waiting for an invitation which could be between six and eight months. So, the historical rate of these genomes, by 2023 they are going like this and the price is going down. We’ll have one billion genomes sequenced yet we are running out of humans. It’s time for the machine to take center stage because basically it’s number crunching.

Kirkpatrick: That’s a nice way to say it.

Topol: Another point that both Walter De Brouwer and Rick brought up about machines, but what unfortunately we do in medicine, we always talk about it’s the man versus machine and never really see the synergy that really exists because the machines can do so many things so much better. And I think this is something that is so largely missing. It’s tied into that unwillingness to change and the loss of control and even for a lot of doctors to think that a machine could do part of their job better, it’s heresy.

Kirkpatrick: Well, you will all shortly receive a copy of the Techonomy magazine which we haven’t yet distributed but there’s pile for anybody who’s not going to be at the conference this afternoon out on the table. And at the bottom of that cover it says, “Towards a world where people and machines converge.” Because we have concluded, not just from our work in healthcare, from our work with Accenture around AI and all kinds of other stuff, this is happening whether we like it or not, whether Trump is elected or not, no matter what, the computers and people are moving closer together in ways that are so complex and so exciting and so interesting that it cannot be stopped.

Topol: Yes, just another example, we have a piece coming out about what we call the information specialist and this was touched on this morning. It’s been shown by AI, you can read pathologists slides better by a computer, you can read X-rays and radiologic images across the board better by machines than by expert human specialists. And so you start to wonder. You know, IBM keeps saying, “We’re not trying to take the place of radiologists or pathologists.” But the tools are there. These doctors that are in those specialties that practice in that way, they have to start thinking of what they’re going to do next. In JAMA we try, soon it will be out, to discuss where medicine—that’s just an example. But, yes, this convergence is happening and a lot of those things, for example, when it’s been unequivocally proven you can do better, certain activities, tasks, with a machine than a doctor, it’s going to change. It has to change.

Kirkpatrick: Okay, John? And then we’re going to have to wrap shortly but I want to hear a few more voices before we do.

John: Yes, I just want to agree with Eric that battling the ossified infrastructure as it is, is really painful so I led at scale the release of lab results directly to patients, I led the email initiative, I led the health record, I’ve led the OpenNotes, I have led all of these at scale and met the resistances he’s talking about even within an enlightened organization. What I’d like to say is we have to be, and I’d like to add to that because I do agree, what I’d like to add to that is we need to be careful not to blame the victim because if you look at the fact that 50% of primary physicians today are burned out. They are burned out with too much work and not enough time already. And we come in and say, “Hey, I’ve got this great new stream of data coming from a body sensor. How would you like to see it?” It’s like, “No.” So, what we have the luxury of doing in our institution, we can take doctors out of clinic and they still get paid when they’re not seeing patients and we help upgrade their skills. And we have had more than a few doctors, much more than a few doctors, break down and cry and say, “I was ready to quit medicine. Thank you for saving my career by helping me get through my day without layering on this other stuff.” We are in a crisis mode. We’re overregulated and we have a tremendous amount of time pressure especially in primary care, but in general. And, so, I want to say we need to be very careful not to blame the victim in this ossification.

Topol: This is a really critical point you’re bring up John, and that is the fact that there is this burnout. It’s not just among physicians and it’s profound, it’s also among nurses as documented this week in the Wall Street Journal. It’s across the board. But part of that, and by the way, you can look at every city in this country and, in fact, the labor force for healthcare is higher than retail. It’s heading—it’s unsustainable, just the labor force no less. But if we use technology we can actually reduce the burden for doctors, nurses, all healthcare workers. You’ve done it at Kaiser to some extent. It can be done even more.

John: We haven’t, we have much more work to do than we’ve done so far.

Topol: And it’s leading edge sort of institutions, there’s only a few that fulfill that model. So, physician burn out is central. We have a potential solution for this and for the doctor shortage and all of this sort of thing, but again we’re getting in the way of our own future. That’s really a big, possible part of this. Just one last thing, just to bring it back, you asked about how can we get the movement going. It could happen, if it doesn’t happen from companies, it could actually happen at the consumer base. Their power, if there was a Health Spring mounting, you know, “We’re not going to take it anymore,” you could see that in the next couple of years.

Kirkpatrick: A Health Spring, okay.

Topol: Well, we don’t rule out the power of the public.

Kirkpatrick: Speaking of a Health Spring, can you talk at all about your interaction with Zuckerberg since he’s going to be here tomorrow and it might lead me to some questions to ask him? Not that I don’t have a list this long already but you said you spent some interesting time with him, I think it might be a fun way to end to hear you tell about that.

Topol: Well, he was very interested in this project we’re working on, actually it’s a Qualcomm-supported project, which is a nanosensor put into the blood stream to sense a heart attack days or a couple weeks before it actually happens. We have a gene signature, we have a sensor, and now we have to go through an incredible amount of regulatory issues to prove it.

Kirkpatrick: This is what you’re working on?

Topol: Yes, and Mark wanted one implanted in himself.

Kirkpatrick: Just for the fun of it?

Topol: Well, he said, “It’s really cool. It’s neat.” And he wanted us to come and talk to him and tell him, “When is it ready?”

Kirkpatrick: Is this public information or should you not be saying this?

Topol: Well, I think he’s very into the cool science. He just wanted to talk about it. And it was set up for a half hour. This was a few years ago. And we had a great discussion. I never could finish a sentence because he always said, “Got it,” just before I got halfway through.

But at the end of the day, he thought it was terrific and the engineer that was working on the project and I, he said, “Well, if you would quit your current position and work on this full time,” he said, “I’d like to invest in this.” I couldn’t do that. So, anyway, we left it at that. He said whenever it’s ready he’d like to be one of the people to try it and he really is—that stuff with the Chan Zuckerberg large support, philanthropy of future medicine, it’s terrific. We sure need it and you can tell that he wants to see the kind of technology we’re talking about here this morning.

Transcription by RA Fisher Ink

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