THE CREATIVE DESTRUCTION OF MEDICINE

The director of the Scripps Translational Science Institute suggests that in the not-too-distant future DNA testing and sequencing may become available on a smartphone.

The former chairman of cardiovascular medicine at the Cleveland Clinic and founder of its cardiovascular gene bank, Topol looks to a future in which genomics will be one of the major tools of innovative, individualized medicine. “What constitutes evidence-based medicine today is what is good for a large population,” he writes, “not for any particular individual.” Not so in the future. The author is aware of instances in which pharmaceutical companies attempt to violate the principle of evidence-based medicine by suppressing negative results. In fact, Topol was the first to reveal “significant heart attack and stroke concerns for both Vioxx and Celebrex,” information he published in the New England Journal of Medicine. As a result of his whistle-blowing, he was forced out of his position at the Clinic in 2004, when the two drugs were finally removed from the market (Celebrex is now back on the market). The author explains how “the large-scale randomized, double-blind, placebo-controlled clinical trial performed under the most rigorous conditions” will be superseded by individualized medicine. Sequencing the human genome opened up major new areas of preventative medicine; in the future these procedures will be able to identify medications that will benefit, or be injurious to, a small portion of the population who carry a specific genetic mutation, rather than the population at large.

Topol weaves useful knowledge about how to evaluate the choices open to patients into this exciting account of the revolutionary changes we can expect.