Episode Transcript
Courtney Collen, Sanford Health News:
欢迎来到桑福德健康公司创新播客系列节目。2022世界杯巴西阵容埃里克·托波尔博士是美国著名的心脏病学家、科学家和作家。他是斯克里普斯研究中心的创始人、主任和分子医学教授，他是南加州斯克里普斯诊所心血管疾病部门的高级顾问。托波尔博士负责监督一项数百万美元的精准医疗拨款，他是一项NIH拨款的首席研究员，主要研究医学领域的创新和职业培训。本集主持人是路易斯·加西亚医生。
Dr. Luis Garcia (Host):
Thank you, Dr. Topol. I’m going to tell you, there are people that wait all their lives to have an opportunity like the one I’m having right now and they never get it. So I’m blessed and honored to be here today.
你一直是我们行业最有影响力的医生之一，优秀的临床医生，涉及药物开发，设备开发，分子医学研究，世界十大被引用的科学家之一，三本著作。你为英国政府的国家卫生系统提供建议，以及所有那些我可以在这里花一个小时来谈论的荣誉。
But I want, because we want to hear from you, but one of the things that I want to tell you is that what I have learned from you today is that besides all that you are a great human, you have great character and you have a great integrity. That’s what I learned today. So that leads me to my first question. Who is Eric Topol?
Dr. Eric Topol:
Well, first, let me say, how kind are you to say these things and I’m very appreciative and humbled. I try to reckon with this question, I’ve never had it before. Who am I, you know. But basically, you know, I as you might expect I have a wife now, 43 years as of yesterday. I have two great kids and three grandchildren, and then there’s what I do at work, which tends to get overemphasized. But as you say, I identify as a physician and as a person who’s trying to improve medicine. I’ve been working out for a long time. And sometimes many days I feel like I haven’t gotten very far, but I won’t keep, I won’t stop. I’ll just keep working until I can’t anymore.
Dr. Luis Garcia (Host):
Well, thank you. And I think the product of your efforts are, it is very tangible for us. I mean, it’s very notable and we appreciate that. You know, you, you mentioned family as a first description of you, and I know you’re a family man. Who was Eric Topol as a child, you know, as you’re growing up? Tell us about your family and your dreams about becoming somebody influential.
Dr. Eric Topol:
我不是从医的我母亲是一名教师，父亲是一名会计。在弗吉尼亚大学上大学之前，我真的不知道医学会成为一种可能。我上夜班只是为了维持生计。
And I happened to be in the night shift as a respiratory technician. And those were the days where, you know, these were very primitive ventilators compared to what we had now, but I saw people in the intensive care unit, almost like a Lazarus, you know, resurrection, I thought they were to die and then they were, they would make it. And I said, “Wow, this is – this medicine thing is amazing.”
So that basically pushed me from what I was planning to do in life to become a physician. But I never really had aspired to be, you know, a leading-edge type force. It was more as a natural pushing hard on things that I believed in or worked hard to try to advocate.
Dr. Luis Garcia (Host):
And you know, a lot of young physicians-to-be, or a lot of children perhaps find themselves or will find themselves in a situation like yours, where you get the opportunities to seize an opportunity and you do it, and then you become really influential.
What would you tell those children right now that are the future of our country and of our world? What message would you tell them of encouragement of why is it important to get an education? Why is it important to take advantage of those opportunities and capitalize on them?
Dr. Eric Topol:
Well, I think the idea that is a limitless, what you can do, if you are really driven to what you’re passionate about that, you know, everyone has the talent and it’s the real matter of applying it, too. It doesn’t have to be kinds of things that I’ve worked on, or you’ve worked on, Luis, but many other people don’t ever find their niche in life. They don’t find the matchup of where they have something to offer. And that’s, I think unfortunate. That alignment of what you can do, that’s special and help people and make a difference.
You know, we’re lucky when we find those, but there’s too many people that have that latent or not-so-latent capability, that’s extraordinary, but they don’t really come to that realization or sometimes they do, but it’s, you know, much later in their life. So the sooner you can find what you are excited about, what you think may be a talent to nurture a particular quality that is burning inside you, go for it.
Of course, it doesn’t happen by accident. It’s not something that’s a natural gift. It means work. You have to really work at it, as well. So it’s a pairing of finding that kind inclination quality and then really going after it.
Dr. Luis Garcia (Host):
I appreciate that that insight, Dr. Topol. Yes, I’ve got to tell you, I feel so lucky that I’m in the medical field and that I love what I do. Right. Oftentimes we find somebody doing a job just because it is a job and not because it is a passion, right? So, realizing what your passion is and executing on it with hard work … I appreciate those comments.
When I talk to great leaders in this world, oftentimes they can identify a moment of uncertainty on their lives in which they had to make a decision. And that decision put you in a much different spot than you would have been if you would’ve taken the other side of the road. Did that ever happen to you?
Dr. Eric Topol:
哦，实际上好几次了。我真的生活在不确定之中。但我能回忆起的，尤其是当我们谈论职业道路时，我在加州大学旧金山分校接受医学培训。我本来打算成为一名糖尿病专家，因为我父亲患有1型糖尿病，49岁时就失明了，我想把我的一生都奉献给这一事业。事实上，这也是我选择加州大学旧金山分校的原因之一。他们有一流的糖尿病部门。
Anyway, my wife said when I was doing rotations and intersecting with cardiology said, “That’s what you’re really excited about. Can’t you tell?” And so she was the first one to note that I wasn’t at all excited about what I had purported to be. She helped sway me towards cardiology and that was a big, important decision where I was certain, but I was basically realigned with her support and insight.
Dr. Luis Garcia (Host):
我换个话题，托波尔博士。2022世界杯巴西阵容桑福德医疗，我们说我们渴望成为全国最好的农村医疗保健系统。我们被我听到你强调和谈论的价值观所驱使就像在医学中恢复人性，关注病人，而不是补偿或补偿真正重新找到作为医生的价值和艺术照顾有需要的人。你在你的书里说得很清楚。你想谈谈你的看法吗?
Dr. Eric Topol:
Well, because I’m older, I’ve seen medicine change over the many decades and unfortunately it’s mostly for the bad. That is the emphasis on the patient-doctor relationship has been lost in most respects and the business of medicine has become the center so that term patient-centric is really useless compared to what is the reality.
Especially, as I got older, and naturally I became more frequently a patient and realized even from firsthand experience how this attrition has become so extraordinary. And that is, I think, ignited me to try to get us back and find all the other people that are willing to work together towards getting medicine back to where it was, which was that precious relationship that you had with your doctor, which was the person who had your back, the person who you should trust and whenever you talk, there was an attentiveness, there was just a real presence and you could relate your deepest concerns. Whereas now, of course, that is a rarity.
所以我希望在未来，这是我们现在最大的赤字，我认为这解释了为什么在临床医生中有一个全球性的倦怠危机和如此严重的抑郁症。我们能做到，我们能把它找回来。我对此很有信心，但如果没有大量的努力和医学界的团结，这是不可能的。
Dr. Luis Garcia (Host):
Well, one of the things Dr. Topol that I got out of your books was obviously the physician and clinician perspective is very important in patient care. But what about the patient perspective? And to your point that somehow, that art of medicine has been lost for the wrong incentives and oftentimes as physicians will say, “Well, my patients love me and I provide the best care in the world.” And interestingly, in one of your books, you bring the “word cloud” concept. Can you talk to us a little bit about that?
Dr. Eric Topol:
Yeah. I think the perception that our patients, “my patients love me” may be a little off because while there may be some physicians who truly have that, most don’t, and we saw that the word cloud you mentioned is from one leading medical center.
What are the two words that you think of from right coming out from your visit? And the words were not pretty you know, hurried and rushed and unconcerned and just devoid of the humanistic qualities that we need to exude. And that I think is the real problem.
That used to be the case that there was a love. It was bilateral. I mean, there were a lot of patients I just adore. I mean, no question about it. But the time that we have is so compromised that we don’t even have time to listen to a patient no less to do a proper exam and cultivate a relationship.
What I’m excited about with Sanford is that you could be the leader and pioneer reestablishing the care of the patient is about caring for the patient because there isn’t a health system in the United States that exudes that, or is the exemplar. And you can do that here.
Dr. Luis Garcia (Host):
Dr. Topol, thanks for pointing that out to us. And let me be honest with you. As I mentioned earlier in the podcast we’re driven by values. And during the pandemic, we took a special interest on learning how what our patients thinking of us as a health care system, and turns out that we are the most trusted health care system in our regions. And people understand by default that we have the greatest talent, but it is about that trust and it is about that relationship that that really makes the difference.
过去的几年对临床医生和卫生保健提供者来说非常困难。现在，他们觉得自己被贬低了这种被贬低的感觉恰恰来自于你从他们的病人身上看到的，也许不相信他们的意见，不相信他们的见解因为我们从不可信的来源获得了无数的信息。你对此有什么看法?
Dr. Eric Topol:
从更大的角度来看，真相和谎言比以往任何时候都更加模糊，你知道，事实和捏造比以往任何时候都更加模糊，我们作为一个国家，几乎没有对制造这一切的力量付出什么，这些力量有意识地试图模糊，你知道，所有虚假的东西。
我们必须努力工作，重获信任。而且是全面的。我的意思是，所有受人尊敬的机构，包括医学，都遭受了这一点。但我们国家有一个非常强大的反科学派别，比世界上大多数工业化国家都要多。我们没有做任何事情来应对它，对抗它，并控制它，不幸的是，疫情使情况变得更糟。
In this time of crisis, this would’ve been ideal time to really work against it. And in fact, knowing it was going to be an issue you could tell early on. But you know, it’s never too late. And I think that because there’s so much unreliable source of information for people because people get their punitive facts and news that often is questionable through so many varied sources. We have to have a central source that is known to be trusted that everyone can rely upon and that’s going to take effort. And we have no such thing, no such force at this point.
Dr. Luis Garcia (Host):
And I don’t want to miss the opportunity to speak about two instances in which your determination in which your adherence to science really have made a difference. And I have to ask you about your participation in COVID, that’s one thing and your participation with the UK government, with the United Kingdom government. But let me just ask you, how does it feel to get called on your personal phone by somebody telling you we want you to come and redefine the national health care system for the United Kingdom? That must be a super honor. How does that feel?
Dr. Eric Topol:
Well, yeah, it was kinda interesting that it happens, you know, from another country, rather than in your own country at the time. I was actually, I was thrilled to get that call and invitation. I didn’t know exactly what I was getting myself into, that I would go and have these, you know, 50 different people assigned to this for this review to help me. And it was obviously a big part, not just planning the national health service, but how well it would be received by the public, how would it be seen as a political, you know, football sort of thing? And so, it was a fascinating learning experience for me and made a lot of, you know, new friends from it.
But, you know, these days in the pandemic, it’s been gratifying because now there are people in our own government that are making contact and, you know, asking for input and it’s great to have a voice to have a chance to weigh in. I think that when you have at least a way, a channel, what you, you know, sometimes in the bubble that our government sits, they don’t really have enough insight about what is the problem out there. I think right now you know, the chance has increased throughout the pandemic of being able to give some, at least thoughts. Sometimes you could consider it advice and it’s fun for me.
Dr. Luis Garcia (Host):
这太神奇了。你早些时候与我们分享了一个故事，你的决心和投入再次影响了疫苗的发布和所有有关COVID疫苗背后的研究。你想分享一下你的想法吗?
Dr. Eric Topol:
嗯,这很有趣。我从未意识到社交媒体对我的力量，至少直到我在疫情期间使用它。从疫苗试验开始，我们知道他们还在进行，但是辉瑞，Moderna, J和J，阿斯利康这些公司，没有一家会公布他们的方案，好像他们有什么要隐瞒的。
So I basically started tweeting at these companies, “When are you going to release your protocol?” And finally, I got them, or whatever that happened, and one did it, you know, and then they all did it because they were all basically you know, undressed about this issue. And once you saw the protocols, then you started to see, “Oh my gosh, there’s a chance that these trials could be stopped early, really early before we knew the truth.”
当然，还有人担心FDA被颠覆了。然后公司的兴趣是获得疫苗。所以你基本上可以看到当前政府的联合推翻了FDA所有的公司都想让疫苗获得批准让数以亿计的疫苗尽快销售出去但是他们没有一个正确的计划。
So by social media, basically exposing the protocols and making them public and also for the research community to see, that was basically the ticket to, we cannot let this happen. If these trials stop after 30 patient events, and we are going to start giving vaccines to billions of people, something is going to be off here.
I think the extraordinary part of this knowing the protocols, being able to have precise readout that if this were to happen as the companies wanted, and as the administration wanted, we could be looking at premature dissemination of vaccines that were not proven, and this could be not knowing the results, but this could be a real setting for mistrust and also a backfire. I mean, we could have really good vaccines, but without validation, we could really see trouble. So, fortunately this got all fixed in the nick of time in October of 2020.
我们非常幸运。我们有95%有效的疫苗，至少对原始毒株有效。我们做得很好。试验结束了，就在11月中旬，我们开始看到结果。公司运作正常，一切都步入正轨。我们很幸运。它本可以走完全不同的路线，不管人们怎么指责它“太匆忙了”。他们根本不知道"匆忙"是什么意思。
Dr. Luis Garcia (Host):
You know, on behalf of so many patients that needed, there’s so many patients that needed that. And there’s so many people that needed your leadership. Thank you for standing up for the right thing. So we appreciate that.
You know, Dr. Topol, in your books, you talk a lot about the future of medicine and how will augmented intelligence, machine learning and all that would influence medical care in the future? Where do you see medicine in 5, 10, 15 years down the road?
Dr. Eric Topol:
Well, one thing I’ll preface that by is that, every time I try to think where it’s going to be an X number of years, it’s multiplied by about three or four times – if not more. It doesn’t move like it should. And this is another flagrant example is that if we were to embrace AI (artificial intelligence) and go after it, in terms of doing the proper vital validation work, we could get there faster. But we’re not. We’re more – the medical community, more afraid of it than they are seeing the extraordinary potential.
But over time, we will see keyboard liberation. We will see reestablishment of really good communication during encounters between patients and clinicians. We will ultimately see remote patient care with much less use of hospitals than we do today. That will take longer, of course, because we have all sorts of reasons in this country to rely on hospitals that we shouldn’t be as much.
At any rate, there will be more changes ahead or at least opportunities for change. Whether we in the United States will adopt them as compared to other countries that are better poised because of their health systems – that remains to be seen. But this is the most exciting time for medicine rather than certainly the last couple decades where we’ve seen degradation. This is the potential for an extraordinary turning point if we work at it.
Dr. Luis Garcia (Host):
Yeah. I love that last sentence, Dr. Topol. At Sanford, this is reassuring because we are investing a lot on the virtual aspect and the digital aspect for patient care for the right reasons. I’m going back to your comment of “this is exciting, and medicine is still beautiful, medicine is still good.”
我们有很多人已经离开了劳动力市场他们可能会决定回来或不回来，或者有很多人正在考虑进入医疗保健行业，但他们在犹豫，因为过去两年所做的事情。
This is my last question: what would you tell those kids that are considering getting into medicine? Why should they get into our field and what is so precious about it that it should be their calling?
Dr. Eric Topol:
好吧，毫无疑问，最好的还在后面。我是说，我们已经触底了，现在只会越来越好。而且，没有什么职业比医学更令人兴奋，更有回报了。
事实上，你可以真正关心另一个人最重要的部分，他们的存在，他们的健康，你可以帮助促进这一点。你可以得到那个人的信任一辈子。我是说，没有比这更好的了。没有其他的职业像这样。我们有幸成为其中的一员。
我认为一旦我们开始建立这个转折点，让人性回归，它就不会发生。就像电灯开关一样，它会分阶段发生。参与其中的兴趣将空前高涨。
Dr. Luis Garcia (Host):
I started my conversation with you highlighting what a great human being and leader you are and to all our listeners, I think they will agree with me that after the thoughts that you shared with us, that is exactly who you are. Thank you for everything you have done until now. I hope that you live until you are 200 years old, so we can continue to have your leadership and if not somehow, with the future of polygenics, and everything that we can clone you. So, but thank you for being here with us.
Dr. Eric Topol:
Thank you. You’re much too kind, but I really appreciate the chance to speak with you today.
Courtney Collen:
And our thanks to Dr. Eric Topol for his time. Find and hear more Sanford Health podcast series and episodes by clicking the link in the show notes, Sanford Healthpodcastsare also available on Apple, Spotify, or wherever you listen. For Sanford Health News, I’m Courtney
Collen. Thanks for being here.
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Posted InCorporate Services & Administration,Expert Q&A,Innovations,Leadership in Health Care,Physicians and APPs
