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“We Have to Find Our Way”: Eric Topol of Scripps on Connected Health

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is going to hurt the field and it’s going to be like these proton beams and robotic surgery, we’ve never had the data to support their use. We don’t want to go that way. We have to get these things validated and show that they change the outcomes of people [for] the better, and that the expense was well worth it.

X: It’s been nearly a decade of the NIH translational program and the 60 centers. Is there a way to measure results?

ET: The first funding group was in ’06, so it’s been eight years. [Scripps is] into our second five-year cycle, we just got renewal. The metrics are many: what papers did you publish, how were they cited, what impact did they have in changing practice in the field in a substantive way. There are a lot of other things coming into play, like what new collaborations were you able to develop with the life sciences industry. And new monies you brought into the programs because of these new paths that you built. It’s become clearer than ever before that we can’t survive without better collaboration with industry, especially with sequestration budgetary hits that are profound. Even without that, we’re not reaping the natural benefit of innovation.

The biggest line item in the entire NIH budget is these 60 centers. Hundreds of millions of dollars a year. What are the stories from each site and collectively to tell how they change medicine. It has to be bigger than grants, and publications. If you publish one paper and it markedly improves the lives of millions of people, that’s the whole story right there: a single discovery.

X: But we won’t see those products, or those improvements, for many years.

ET: We think at Scripps we’ve made several. For example, we were the first center to [replace] a real stethoscope [with] a high resolution ultrasound because you get so much more immediate information than with “lub-dub” or bowel sounds. We also were first to show a tiny band-aid could capture every heartbeat for two weeks instead of a monitor that had all these wires on it. We were also the first to start pharmacogenomics systematically for Plavix for all patients undergoing stent. I’m sure that has saved some major heart attacks.

But if it only gets implemented in Southern California, it’s not a big deal. One of my biggest frustrations [with translational] medicine: “translating” means [applying this data] to the real daily practice of medicine. But medicine moves so slowly. And you’ve seen how many years it takes to get from ideation to innovation to practice.

As you point out, it’s not easy. Sometimes you need to go downstream for a decade to see the impact of something. We’re very fortunate because Francis Collins, the NIH director, is masterful at communicating that [need for patience] to Congress and President Obama. It’s not an on-off switch for the most part. Takes some time to have independent replication and adoption. Some things we can speed up for sure, and hopefully it will change. I hope the consumer will drive the future and not wait for doctors.

X: Is academia the best place to create these translation centers?

ET: I think it’s ideal. It’s complementary to the pharma-biotech industry. And also device and diagnostics. You’ve got brilliant people on both sides, but their talents are very different. Why is pharma now turning to academic centers more than ever before? Why are they signing up these large multiyear agreements?

X: A lot of people in pharma are wondering that, too, because they haven’t produced much. Maybe because they’re desperate?

ET: I don’t think so. It’s because if you go through the history of where drugs come from, most of them start in academic centers. The idea is, let’s not wait and futz around, let’s accelerate this path. So as soon as you find this variant that prevents type 2 diabetes, for example, the idea is let’s run with it.

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