I visited cardiologist Eric Topol at the Scripps Green Hospital in La Jolla, California, one day this summer. He’d had a busy morning seeing patients and, by about noon, was claiming to have already saved the medical system thousands of dollars using his iPhone and a pocket-sized ultrasound machine. Then he pointed to the stethoscope in his pocket and said he hasn’t used it in three years. “I should just throw it out,” he said. “This is basically a worthless icon of medicine.”
Topol is perhaps the most prominent advocate in the U.S. of how digital technology can lead to less expensive health care, and he invited me to see the savings in action. As we lope toward the exam room, Topol, slightly hunched and repeatedly turning to deal with questions flying at him from his staff, seems a little rattled by the commotion and barrage of demands, but a calm sets in the moment he enters the exam room. He folds his arms across his chest as a young colleague updates him on the patient’s history. Topol introduces himself to the 85-year-old man, who has been tiring easily as of late, and then the doctor immediately pulls out his iPhone.
Topol, who since 2007 has aggressively promoted digitizing medicine, does not check his e-mail, Google a fact, or call a pharmacy. Rather he slips what looks like a protective case onto the phone. The outside of the case has two oval, metal pads that are electrodes, and Topol asks his patient to place his thumbs on them.
“He’s bradyacardic without any good reason to be bradyacardic,” Topol says to his colleague, Hashim Khan, watching as a graph of blips rollercoasters across his phone’s screen. He looks at me. “We save $100 for every one of these we do.”
The add-on to the iPhone is a $199 version of a hospital-grade electrocardiogram machine that sells for much more. By getting the reading of the heart rhythm himself, Topol says, he’s saved the patient from going to a special station with a trained technician who will spend 15 minutes hooking up wires.
Moments later, Khan pulls out a Vscan, an ultrasound device made by GE Healthcare that resembles a large flip phone. With Topol looking on, Khan squirts gel on the man’s chest and then scans his heart’s chambers with a wand attached to the device. “His function looks actually not so bad,” says Topol, adding that most doctors charge $600 to perform an ultrasound using a $350,000 machine. But Topol bills nothing when it’s done as part of a routine physical exam like this. “There are 125 million ultrasound studies done in the United States each year,” says Topol, shaking his head. He says “probably 80 percent” of those could be done with the Vscan at no extra charge.
Topol is a doctor on a mission and not for the first time. A decade ago, he was at the center of another battle over medical evidence and billionaire profits. That one, involving the pain medication Vioxx, ended with the $2.5-billion-a-year drug pulled off the market after Topol and others raised safety concerns. In 2007, when Topol arrived at Scripps, he began rabble-rousing again, this time by proselytizing against what he calls the American practice of selling “medicine by the yard” or of favoring technologies that raise revenues.
Topol, who heads Scripps Translational Science Institute, has many irons in the fire. A “Wellderly” study underway is expected to analyze the genomes of 2,000 healthy people over 85, hunting for clues to explain why they won the health lottery. Another study led by Topol asks whether ZioPatch, a Band-Aid sized heart monitor that people wear for up to two weeks, can more readily detect heart arrhythmias than the clunky Holter monitor used for 50 years. The Holter monitor relies on wires attached to different parts of the chest sending signals to a device worn around the neck or on the hip.
Ultimately, Topol predicts, digital technology will lead to “the hyperpersonalization of health care” and innovations that save billions upon billions of dollars. “For the first time perhaps in the history of technology in medicine, we can see that you can improve the outcome for patients and reduce costs,” he tells me.
Topol cemented his Dr. Digital reputation in 2011 when he used his iPhone to diagnose a passenger’s heart attack on a commercial flight from D.C. to San Diego, forcing the plane to land in Indianapolis. But not everyone believes that smaller, cheaper, easier-to-use technologies will save money. Skeptics say that Topol fails to take into account that more data—even if it’s reliable—simply leads to more medical interventions, many of which may be unnecessary.
Consider sleep labs. Topol says smartphone add-ons that measure oxygen use and pulses can diagnose sleep apnea without requiring someone to spend a night in a sleep lab, which costs thousands of dollars. “Talk about putting them out of business,” says Topol. “We can do a screening test which is basically free through a smart phone.”
But Steven Poceta, a neurologist at Scripps who specializes in sleep disorders, says Topol overstates his case. “We almost never put someone in the sleep lab to ‘screen’ them,” says Poceta, noting that portable diagnostic machines long have allowed inexpensive home tests. What’s more, sleep apnea is “widely underdiagnosed,” so smartphone detection—which Poceta welcomes—may drive up health-care costs. “As a matter of business, the bigger number being screened will uncover more of those who need the expert and the sleep lab,” he says.
Although Topol is inclined to dismiss his critics as backwards-thinking, he agrees that each new device will have to earn its spot in the armamentarium. “You need to prove to the medical community that it really does lower cost and improve outcome,” he says. “We don’t want to have this phase of wireless and unplugged medicine be left in the realm of the unvalidated innovations. That’s not going to help anyone.”
He’s spearheading a new study called “Wired for Health” that will gauge the economic value of three commercial wireless devices (AliveCor, the Withings blood pressure monitor, and an iPhone glucose meter) in 200 patients with diabetes, hypertension and heart-rhythm disorders, the type of chronically ill patients who account for about 80 percent of all medical bills nationwide. The controlled study will give the devices to only half the participants and will assess whether actively tracking their health reduces health-care costs.
Another of Topol’s projects, a collaboration with Caltech, aims to put a wireless sensor into an artery. The sensor would be about a third of the size of a grain of sand, and will stay put and potentially detect an imminent heart attack. If it works better, it could prevent heart attacks—an outcome that Topol says doesn’t require a cost-effectiveness study.
“You know what the cost of having a heart attack is?” asks Topol, incredulous at the notion that anyone would need evidence to prove this point.
This story was updated on September 9 to correct details about the ZioPatch research, Topol’s Caltech collaboration, and the price of an ultrasound machine.