Eric Topol

Eric J. Topol (born 1954) is an American cardiologist, geneticist, and digital medicine researcher. Before moving to Scripps in 2006, Topol served as chairman of cardiovascular medicine at Cleveland Clinic (1991-2005) and founded the Cleveland Clinic Lerner College of Medicine. Topol was one of the first researchers to question the cardiovascular safety of rofecoxib (Vioxx), culminating in the drug's ultimate withdrawal from the market. Topol's advocacy on the subject led to what the New York Times described as an "unusually public dispute" with the Cleveland Clinic's leadership over ties between the academic institution and the pharmaceutical industry, ultimately leading to Topol's departure from the Clinic after his administrative position as head of the Clinic's academic program was abolished.

Topol is the Founder and Director of the Scripps Translational Science Institute^[1] in La Jolla, California. He also serves as the Chief Academic Officer for Scripps Health, a professor of Genomics at The Scripps Research Institute, and a Senior Consultant at the Division of Cardiovascular Diseases at Scripps Clinic. He is editor-in-chief of Medscape and theheart.org. In 2012, he published a book called The Creative Destruction of Medicine which examined the impact of both the genomic and wireless revolutions on the health care system. In 2013, he appeared on the Colbert Report and examined the host Stephen Colbert using several devices featured in his book. His most recent book The Patient Will See You Now, published in 2015, explores how smartphones, big data, and technology are combining to democratize health care.

In 2016, Topol was awarded a $207M grant from the NIH to lead a significant part of the Precision Medicine Initiative, a one million American prospective research program.

Research and training

Topol's research career has been in two major areas: clinical development of new drugs and devices and genomics. Topol pioneered the development of many medications that are routinely used in medical practice including t-PA, Plavix, Angiomax, and ReoPro. He has led worldwide clinical trials in over 40 countries involving over 200,000 patients (First in series – GUSTO trials).^[2] His work in the genomics of heart attack has led to discovery of key genes (MEF2A deletion, Thrombospondin variants) which led to recognition by the American Heart Association top 10 research advances in 2001^[3] and 2003.^[4] He has over 1000 original peer reviewed publications, and has edited over 30 books, including the Textbook of Interventional Cardiology (6th ed - Elsevier), and the Textbook of Cardiovascular Medicine (3rd ed - Lippincott Williams & Wilkins).^[5]

His previous training was at the University of Rochester (medical school), University of California, San Francisco (internal medicine), and Johns Hopkins University (cardiology). Topol was a tenured Professor at the University of Michigan for 6 years. At age 36, Topol was named Chairman of Cardiovascular Medicine at the Cleveland Clinic, where he is widely credited with leading its cardiovascular program to the topmost position in the US.^[6] In 2002 he founded the Cleveland Clinic Lerner College of Medicine and in 2003 he became a Professor of Genetics at Case Western Reserve University while maintaining his primary appointment at Cleveland Clinic.

Topol departed from the Cleveland Clinic Lerner College of Medicine in 2006 following the removal of the Chief Academic Officer position, and continued on as a Professor of Genetics at Case Western Reserve University. He was then recruited by Scripps Health and The Scripps Research Institute in late 2006 to the post of Chief Academic Officer and Professor of Translational Genomics.^[7] In 2009, Topol worked with Gary and Mary West to create the West Wireless Health Institute, made possible by their philanthropic gift, and leads the field in developing, validating and accelerating wireless medicine.

Genetics and genomics

At the University of Virginia, Topol authored his baccalaureate thesis in 1975 entitled “Prospects for Genetic Therapy in Man” which concentrated on genetics, and received a BA degree With Highest Distinction. During his training at Johns Hopkins University, he was involved from the very first patient who was administered t-PA in 1984, a genetically engineered protein.^[8] But it was not until 1996 that he started the first dedicated cardiovascular gene bank while at Cleveland Clinic.^[9] This effort led to many discoveries in the genetics of cardiovascular disease, including the identification of key genes associated with heart attack. Both thrombospondin variants and the MEF2A deletion reports were recognized as top 10 advances by the American Heart Association in 2000 and 2004, as mentioned above. He was the Principal Investigator of the flagship National Institutes of Health Specialized Centers of Clinically Oriented Research (SCCOR) grant on the genomics of heart attack with a $17 million award in 2005. His work in genetics has been recognized by the American College of Cardiology with the Simon Dack Award and Lecture in 2005 and by the European Society of Cardiology by the Andreas Gruentzig Award and Lecture in 2004.^[10] In moving to Scripps in 2006, he started the Scripps Genomic Medicine program and recruited a large team to advance individualized medicine using genomic approaches.^[7] The group formed the Scripps Translational Science Institute,^[11] which presently includes Drs. Steven Steinhubl,^[12] Ali Torkamani,^[13] and Nathan Wineinger,^[14] and has multiple NIH funded projects on genomics of cancer, aging, cardiovascular disease, pharmacogenomics and diabetes. It is a major force in San Diego bringing together basic scientists and clinical investigators from Scripps Health and The Scripps Research Institute along with researchers from the Salk Institute, Sanford-Burnham Institute, the San Diego Supercomputer Center, and the Children’s Hospital of Philadelphia. Each year since 2007 Scripps Genomic Medicine and the Scripps Translational Science Institute put together a major program entitled “Future of Genomic Medicine” which attracts several hundred clinicians and scientists. In 2009, Topol led the team at Scripps to be the first center to perform routine genotyping of patients undergoing stenting for variants of the gene CYP2C19, the major gene implicated in Plavix metabolism.^[15] The first large scale prospective study of consumer genomics, known as the Scripps Genomic Health Initiative, was completed in 2010. Also in 2010, he initiated the Association for Genomic Medicine that is dedicated to training physicians in genomics.^[16]

Wireless medicine

Topol has been involved with wireless medicine since its inception. He was the first physician to serve on CardioNet's Medical Advisory Board in 1999, the first dedicated wireless medicine company that performs real-time ECG remote, continuous rhythm monitoring. In 2007 he joined the Board of Sotera Wireless that has developed the first continuous non-invasive blood pressure monitoring device, which also captures all vital signs. In 2008 he forged a new educational program with Qualcomm and Scripps Health to train physicians in wireless medicine, a 2-year clinician scholar program: STSI Wireless Health Scholar. At the 2009 International Wireless CTIA meeting, he gave the keynote address on wireless health, the first time this topic has ever been the subject of a CTIA plenary session: CTIA 2009 Keynote. Also in 2009, he served as Co-Founder with Gary and Mary West to form the West Wireless Health Institute that is dedicated to advancing health care and reducing costs through innovative wireless solutions. He is the Vice-Chairman of the Institute and its Chief Innovation Officer. He presented at TEDMED the rapid progress being made in this field: TEDMED 2009 Lecture. In addition, in early 2010 Topol gave a wireless medicine presentation at the Consumer Electronic Show: CES 2010 Keynote Highlight. He led the first trial with the GE Vscan device GE Reports, a pocket high resolution, mobile ultrasound imaging device, introduced in the US in 2010 "The Doctor Will “e” You Now" and is currently leading clinical trials of heart rhythm and heart failure monitoring wireless devices.

Vioxx

Topol gained prominence as the first physician researcher to raise questions about the safety of rofecoxib (Vioxx).^[17] Topol was highly critical of Merck's handling of safety issues related to Vioxx. In a 2004 New York Times editorial, he wrote that "Merck finally had to acknowledge the truth [about the drug's cardiovascular risks], but only by accident."^[18] Topol also authored an editorial in the New England Journal of Medicine, arguing that "neither Merck nor the FDA fulfilled its responsibilities to the public" and encouraging a "full Congressional review" of the situation.^[19]

In 2004, Bethany McLean, writing in Fortune, questioned Topol's own potential financial conflicts of interest. She reported that Topol served as a scientific advisor to a hedge fund which profited substantially by short selling Merck stock, which plummeted due to the concerns about Vioxx which Topol had publicized.^[20] Topol denied giving the hedge fund advance information, and subsequently severed his ties to industry, donating all such income directly to charity.^[21] In a 2005 JAMA commentary, Topol pointed to these allegations as an example of the complications that physicians can experience when associating with the investment industry, at the same time reiterating that "no true conflict of interest existed in this case."^[22]

In November 2005, Topol was subpoenaed in a class action lawsuit against Merck. He testified that Vioxx posed an "extraordinary risk", and that Raymond Gilmartin, former chief executive officer of Merck, had contacted the head of the Cleveland Clinic board to complain about Topol's work on Vioxx.^[23] Two days afterward, Topol was informed that the position as chief academic officer at the Cleveland Clinic had been abolished, and he was removed as provost of the Cleveland Clinic Lerner College of Medicine, which he had founded. The Clinic described the timing as coincidental.^[24] The New York Times described Topol's demotion as part of an "unusually public dispute" between Topol and the Cleveland Clinic's chief executive, Delos Cosgrove, and stated that Topol's criticism of Merck had focused scrutiny and criticism on the Clinic's deep and longstanding ties to the pharmaceutical and medical-device industries.^[21]

Honors

Topol was selected as one of the 12 “Rock Stars of Science” by GQ and the Geoffrey Beene Foundation in 2009.^[25] He was elected to the American Society for Clinical Investigation, the Association of American Physicians, and the Johns Hopkins Society of Scholars. In 2004, he was elected to the Institute of Medicine of the National Academy of Sciences.^[26] He was named Doctor of the Decade by the Institute for Scientific Information for being one of the top 10 most cited medical researchers. In 2011, Topol received the Hutchinson Medal from the University of Rochester in addition to giving the commencement speech for the School of Medicine and Dentistry. In 2012, Modern Healthcare ranked Topol as the most influential physician executive in the United States.^[27]

Bibliography

• Topol, Eric. The Patient Will See You Now: The Future of Medicine Is in Your Hands. New York: Basic Books, 2015 — ISBN 9780465054749 ^[28]
• Topol, Eric. The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. New York: Basic Books, 2012 — ISBN 9780465025503
• Topol, Eric J., and Paul S. Teirstein. Textbook of Interventional Cardiology. Philadelphia, PA: Elsevier, 2015 — ISBN 9780323340380

See also

• Full Genome Sequencing
• Exome Sequencing
• Personal genomics

References

External links

• Topol's profile at Scripps Translational Science Institute
• Topol's profile at Scripps Health
• Topol's talk at TEDMED 2009 conference
• Book - "The Creative Destruction of Medicine: How The Digital Revolution Will Create Better Health Care"
• Book - "The Patient Will See You Now: The Future of Medicine is in Your Hands"
• Roberts, Russ (April 1, 2013). "Topol on The Creative Destruction of Medicine". EconTalk. Library of Economics and Liberty. 
• "iDoctor: Could a smartphone be the future of medicine?". NBC News. January 24, 2013.  Video (08:51) Topol's interview by Nancy Snyderman for the television program Rock Center.

• Precision Medicine Initiative