#97 How We Can Defeat The Next Pandemic and The Future of Medicine: Dr. Eric Topol

What is discussed, and when

1. 0:00 – 5:00: Deep Medicine, Lynn Tomman
2. 5:00 – 10:00: mRNA Vaccines
3. 10:00 – 15:00: mRNA Vaccines, Operation Warp Speed
4. 15:00 – 20:00: Deep Medicine

Notable quotes from "#97 How We Can Defeat The Next Pandemic and The Future of Medicine: Dr. Eric Topol"

• Founder and director of scripts research and the author of three books the most recent of which is deep medicine how artificial intelligence will make medicine human again Dr…

  about Deep Medicine · at 0:32

• Actually been a big disappointment because one of the great aspects of these mRNA vaccines with Mna and fiser was that they were very suitable for fast tweaking so an Omicron…

  about mRNA Vaccines · at 9:15

• Not doing is it primarily a government funding issue that we need an equivalent of operation warp speed with its portfolio approach of funding different approaches is that what…

  about Operation Warp Speed · at 12:51

Who and what is mentioned in this episode?

People

• Dr. Eric Topol — Person · 6 mentions
• Scott Gottlieb — Person · 2 mentions
• Lynn Tomman — Person · 1 mention · first at 0:21
  Careers and now your host and board member of schools at Harvard Princeton and Columbia Lynn tomman hi everyone it's Lyn tomman welcome to another episode today I'm excited to…

Books & papers

• Deep Medicine — Book · 3 mentions · first at 0:37

Companies & orgs

• Scripps Research — Company · 2 mentions

Concepts & topics

• mRNA Vaccines — Concept · 2 mentions · first at 9:19
• Operation Warp Speed — Concept · 1 mention · first at 12:57

Full transcript with timestamps

0:00 welcome to the three takeaways podcast which features short memorable conversations with the world's best thinkers Business Leaders writers politicians scientists and other newsmakers each episode ends with the three key takeaways that person has learned over their lives and their careers and now your host and board member of schools at Harvard Princeton and Columbia Lynn tomman hi everyone it's Lyn tomman welcome to another episode today I'm excited to be with Dr Dr Eric toppel he's a cardiologist founder and director of scripts research and the author of three books the most recent of which is deep medicine how artificial intelligence will make medicine human again Dr toppel is one of my go-to sources on covid and Medicine along with former FDA commissioner Scott gotle Scott's also been a guest on three takeaways I think it was episode 59 I'm excited to find out what we can expect from Co next whether Dr toppel foresees

1:01 other pandemics and also how medicine will be transformed both by artificial intelligence and new discoveries and tools Dr toppel is unusual he's not only a doctor who had his own disease misdiagnosed and as a result suffered excruciating pain he's also at the Forefront of the movement to use artificial intelligence and precision medicine to transform Medical Care welcome Dr toppel and thanks so much for our convers ation today thank you Lynn and great to be with you great to be with you as well let's start with Co where are we in this pandemic the virus variant so far seemed to be milder although progressively more transmissible an infection what's the likelihood of a more noxious new variance in the months or years ahead of us well it's pretty likely first I would start off by saying there's an illusion that the are more mild but most of that's because we have a lot of vaccinations we have a lot of people

2:06 with natural immunity from infections so it may appear mild but if you just look at countries that had very little covid infections places like Taiwan and Hong Kong and China it's not at all these variants that we're seeing in the Omicron Family subvariants they are not necessarily Mild they can be very severe and lethal but the chance L of getting even worse Vine is high because we have a number of forces working against us one is that we have millions of amuno compromised people any one of whom could have this virus accelerate Evolution within them and then transmit it to others which is the leading theory of how Omicron got started and we have proof that that has occurred in other people but also we have a massive number of animal res reservoirs and we have spillover from animal reservoirs whether it's white tailed deer or pet hamsters or mink into people and then we see these recombinants or hybrid people that

3:14 have co-infections with Omicron and Delta or two different Omicron variants and so we're getting all these different things no less the fact that we have the world not containing the virus particularly in the United States so that's basically nurturing ground for more variants so the idea that the variant will just kind of get more and more mild over time and go away that couldn't be further from the truth it could get worse because we keep seeing more immune Escape of these variants and the more immun escape the more transmissible it is and the more problems that our vaccines and our immune system have to try to defend them what is the state of us data on covid pathetic it's pathetic because the CDC is so far behind and so incomplete we have data from the CDC in March and it's now June that's the latest data as far as how well of our vaccines are holding up and various key metrics we aren't really

4:19 able to capture cases anymore because a vast majority are being done at home or not doing tests at all so we only are seeing right now whatever case numbers there are it's unreliable compared to earlier times in the pandemic so we're relying mostly on hospitalizations but we don't even know regarding those hospitalizations are they in people who've had three shots four shots no shots I mean prior Co we have nothing so we're in the dark we're Flying Blind two and several months years into the pandemic which is incredible that we go all this time and we still can't get our data systems improved we are seeing some improved genomic surveillance and so we're tracking that better than we did earlier in the pandemic but as far as clinical medical data on the people who get covid and have adverse outcomes the data is very shy what should we be doing now for Co oh so much I think the interesting

5:22 thing Lynn is there so many layers of data which would be useful to everyone at the individual level so can you imagine where you could at your smartphone and you would see your individualized risk at that real time so for example not just the test positivity cases but also things like Wastewater surveillance the digital surveillance which is what is the resting heart rate in your region because as that goes up we know things are changing Mobility where you are all the different metrics that we know are important but we don't have any of that that we're telling people that it's up to you but we're not giving people the data which we could and you know we actually started at scripts research we started the first digital app here in the US called detect and that was mimicked by Germany and they have several hundred thousand people that monitor covid through their phone every day but we could do that but

6:21 there's no will and it's actually quite inexpensive it's passive all you have to do is have a wristband whether it's a Fitbit or a smartwatch or any brand and you start having resting heart rate and you can see where when there's a cluster of elevated resting heart rate that you know something's going on but that's just one of the metrics of many that we don't capture and provide to everyone it's really unfortunate that we're not aggressive to do this what else should we be doing to prepare for the next covid variant or assuming that it is more deadly well it not be more deadly but that's the worst case scenario is that it fully escapes our vaccines that's unlikely since it's still the virus it's still evolving but it there only so much it can evolve so I don't want to think that it's going to be going back to square one here with no immunity it's probably always be some but we're already seeing some reduction

7:20 in protection from severe outcomes used to be in Delta with a booster was 95% against hospitalizations and deaths and now now it's dropped down at least 10 even 15% points so we are seeing with these Omicron subvariant some issues with respect to the level of highest protection that we enjoyed that we're lucky we're not seeing that so it could drop down further what could we do well we saw today as far as the CDC report about ventilation and how we are not doing the things that we could do to get indoor places like schools and everywhere much better ventilation filtration of course we can use the masks that are KNN 95s or n95s which we don't I mean when I go to a grocery store now I see nobody essentially wearing a mask which is incredible where we have increased circulating levels of virus we also need to respect the virus which we don't right now in terms of indoor Gatherings and distance and

8:24 testing rapid testing to be sure that people are not infectious so for examp example A lot of people are taking Pax lvid right now because they got a breakthrough infection or they never got vaccinated but we think that if you take five days or PX of it you're good to go well if you test yourself after five days you may well be still infectious even out to day 10 or longer so testing is also important and everyone should rely as much as they can to help guide things with rapid tests the covid vaccines were developed remarkably rapidly the next time around if we need different vaccines or different Therapeutics for new covid variants how rapidly do you think we can create manufacture and distribute these how much faster than last time that's actually been a big disappointment because one of the great aspects of these mRNA vaccines with Mna and fiser was that they were very suitable for fast tweaking so an Omicron specific

9:28 vaccine we could have it in no time obviously we knew about Omicron in November and that was trouble because it was so different than the prior versions of the virus and here it is June July we have no Omicron specific vaccine and by the time we have that that was a ba1 form of Omicron and now we're already on to ba4 and five and who knows how well that's going to help so it isn't moving fast as we'd like on the one hand as you say in 10 months to go from sequencing the virus to having 75,000 people in Trials to prove 95% efficacy this is truly unprecedented it's probably the most momentous advance in the history of biom medicine really and think of the millions of people who would have died without such vaccines but in addition to that we also saw paage start from scratch essentially as a new molecule and within two years which typically takes at least 10 to 12 to 15 years years within two years we had that also

10:31 with very high near 90% efficacy in highrisk people against hospitalizations and deaths so we've hit it big with vaccines and at least one treatment a pill but the next ACT we haven't seen the next ACT we haven't seen vaccines come fast particularly what I'm interested in is a pan sov virus vaccine that would knock out all the future varant nasal vaccines we haven't aggressively pursued that we haven't medications particularly pills that can be easily taken rapidly we don't have others that are potent and safe so we aren't it's basically we kind of made this big bet and put all our eggs in one basket and we haven't yet done our operation War speed or anything aggressive to do things like that again and that's unfortunate because the longer time it takes us to do aggressive things put in resources the longer this pandemic will haunt us How likely are future pandemics besides or in addition to covid and if they're

11:36 likely how do you think we should be preparing well I think they're likely and we wrote in January 2021 Dennis BT and I wrote about how we could prepare for all these pandemics and have stockpiles of variant proof vaccines for the the families that are most likely to cause pandemics besides Corona virus and influenza and others because they can be sequenced and we can put forth vaccines that would knock out the whole family all the variants of these virus and we'd have a big stockpile so that we wouldn't have to wait 10 months that we'd have it ready to go we can do this but it takes allocation of the resources to do it we haven't even done it for Corona virus no less these other likely we know which viruses which pathogens are the ones that are most likely to cause pandemics and we know because of what happening with climate change and what we've done to our environment that we're going to

12:35 see more pandemics that's really unfortunate that's one of the things that we're not really prepared for right now but we know there's great innovations that lie ahead that we could be truly ready and prepared anticipate the pathogens and unfortunately we're not doing is it primarily a government funding issue that we need an equivalent of operation warp speed with its portfolio approach of funding different approaches is that what we need primarily for this pandemic yes because right now we can't even get a dollar more funding not just to do a pan sarico virus vaccine or new treatments or nasal vaccines in particular because that's perhaps the most imminent thing that would help us so these are things we need here and now in addition to being able to buy more of the things vaccines and drugs and Omicron specific vaccines we can't even do any of this stuff because there's a block in Congress to not allocate any

13:36 more funding against Co this fantasy that it's done when it couldn't be further from the truth we've got a long ways to go to get this contained and just when you think it is as has happened twice now in the pandemic once in July of 2021 where independence day was going to be declared from the virus that didn't happen very well and then another time it really good in May this year 2022 or April and then we got the subvariant of Alon so that feature that you're touching on about the unpredictability is what you plan for you plan for the worst and hope for the best but we're relying on hope that's not the way to go here mRNA vaccines were a huge advance and we're on the cusp of other enormous advances what does the future of medicine look like well never been more excited about where that can go and that's because we are seeing I think a series of breakthroughs like never before because of the

14:40 combination of information like genomics and artificial intelligence so for example to be able to get cures of a specific type of cancer like we just recently saw with coloral cancer for a specific mutation we've never seen anything quite like that that what we're seeing is taking accuracy to a very high level in diagnosis and in treatment and ultimately individualized medicine so I couldn't be more excited about where medicine is headed and unfortunately some of that sense of the public is lost because we're in such despair currently but in the background a lot of great advances are happening almost on a daily basis Eric I'm so sorry about your experiences as a patient can you tell us about that and how it's informed your work it's also important as Physicians that we experience things as patients because even though we may have better knowledge and better contexts the same sense of being roughed up can happen and

15:47 that's what happened with me I had a knee replacement total knee over five years ago and when I had that almost six years now I developed a complication that I never heard of the orth pus never mentioned called arthrofibrosis and that was devastating for me still is now six years later a major handicap for me because of as you alluded to when you introduced the session is that the unmitigated pain and U difficulty in managing it but it wasn't even described as a possible complication nor when it occurred was it diagnosed the orthopedist told me as I wrote about in deep medicine that I need to see an internist to get anti-depression medicines which is extraordinary I know patients all around the world experien this every day but it was enlightening to say the least to have to go through this myself with an orthopedist of course who I referred many patients to for the same operation that I had so I live in fear that I'd

16:51 have to go through the other knee someday because it's such a devastating complication for me to endure but at least I can do most things now that I want to not all but most and uh things could be worse I guess things can always be worse at any R it gives me enhanced respect for accuracy and diagnosis communication time with patients this is where AI likely will have its biggest impact which is the gift of time and of course I had no time I got the usual few minutes to see my doctor when I was in need and we need to restore that patient doctor relationship I think it's completely eroded overall there are some special bonds out there but when I started in medicine back in 1980 it was a precious relationship that was typical whereby there was trust and presence and time and all the things you'd want for empathy and communication and now that's the rare exception rather than the norm we've got to get that back and an

17:58 average doctor's appointment as you mentioned is very short now and doctors don't always have the time to listen or think about the rare diagnosis and he just assumed that yours was a more common diagnosis and misdiagnosed you with depression and you were actually saved by your wife yeah she did the research and found this condition and ultimately I was able to find a physical therapist who really knew how to handle this condition which was the opposite of the physical therapist that I was ordered to see by the orthopedist so yeah I mean it was just an extraordinary experience to have that and it motivated the book of deep medicine just because personal experience which I know is common A variation of what I've experienced of course not the same thing and we have to do better medicine has undergone a lot of attrition that it can get back to where it was which it's about Humanity it's about people bonding to people and

19:02 looking after and the greatest privilege I've had throughout my career is being able to look after patients and help provide their care and that's what it's all about but we kind of lost our way at some point before I asked for the three takeaways you'd like to leave the audience with today what should I have asked you that that I didn't I think you did a pretty good job in our short time together cover the bases Lynn I think the ability for us to get out of this pandemic is there and it's frustrating of course that we aren't taking it seriously enough and providing the resources so you did ask about that I've made a plea you I wrote about covid capitulation and it's just so vexing that we can't innovate out of this mess that we're in because I know it's possible Eric what are the three takeaways you'd like to leave the audience with I'm a very optimistic person you may not have gotten that from

19:57 our discussion but the first thing is that I do believe we have the path to a much higher level of both accuracy in medicine for diagnosis for individualized medicine that is understanding what's unique about each human being and to get the gift of time and restore the patient doctor relationship to where it should be and where it was even in my career so those three takeaways are kind of embedded in my excitement that we can get medicine back we have to and I think we know what is needed now we just have to take the actions and pursue this it's more than a worthy goal it's an essential one and I know eventually we'll get there thank you for all your work as a doctor thank you for founding the scripts research and thank you also for our conversation today this has been great all right really appreciate it Lyn thanks for having me if you enjoyed today's episode and would like to receive the show notes

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Questions about this episode

What is discussed in "#97 How We Can Defeat The Next Pandemic and The Future of Medicine: Dr. Eric Topol"?

In order: 0:00 Deep Medicine, Lynn Tomman; 5:00 mRNA Vaccines; 10:00 mRNA Vaccines, Operation Warp Speed; 15:00 Deep Medicine.

What is mentioned in this 3 Takeaways episode?

7 people, works and ideas are mentioned, including Dr. Eric Topol, Deep Medicine, mRNA Vaccines, Scott Gottlieb, Scripps Research, Lynn Tomman. Each one on this page links to its own page with every episode that mentions it.

How long is "#97 How We Can Defeat The Next Pandemic and The Future of Medicine: Dr. Eric Topol"?

The episode runs 21 min; the transcript is about 3,391 words in 21 timestamped sections.

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