It’s arrived: The Creative Destruction of Medicine – How the Digital Revolution Will Create Better Health Care, Eric Topol’s prescient view of the near future of medicine.

This book details how four areas of digital medicine – wireless sensors, genomics, imaging and health information – are about to undergo a super-convergence marking perhaps the most disruptive period in medicine’s history.  Topol describes a coalescence of “the rapidly maturing digital, nonmedical world of mobile devices, cloud computing, and social networking with the emerging digital medical world of genomics, biosensors, and advancing imaging.”  An overarching theme in The Creative Destruction of Medicine is the inevitable march from population medicine to the science of the individual.

So why is this book is important?

We need to see the future.  Only by understanding the future are we able to plan for the needs of our next medical generation.  I’d like to put The Creative Destruction of Medicine into the hands of every professional medical educator and ask ‘are we preparing the physicians for the work that lies ahead?’  If not, this book should serve as a starting point for a conversation surrounding medical education reform.

It emphasizes the expanding role of the patient.   Medicine is increasingly anchored to the individual.  Creative Destruction makes it very clear that consumers will drive many of the changes currently brewing in health care.  This is perhaps the first book accessible to patients that clearly characterizes the changing face of medicine.  Every patient should read this book in order to understand the rapidly evolving role in they play in their own care.

It brings elements of a manifesto.  Any book that describes the state of the medical profession as sclerotic or ossified should have your attention.  The Creative Destruction of Medicine is a call to action for doctors and patients alike.  We must see our world and our job as doctor and patient very differently.  In a profession so uncertain of its future, we need precisely the vision and critical dialog offered here.  The final chapter confronts the challenges facing the creative destruction and reads like a commencement address.  I read this twice.  Pure gold.

Eric Topol knows what he’s talking about.  And as a master clinician, researcher and communicator, Topol is the man perfectly positioned to tell this story.  It’s this authority and breadth of experience that makes The Creative Destruction of Medicine so plausible.

Buy five copies, read one and gift the other four.  I suspect that 150 years from now when historians are looking back at the most dramatic flexion point in medicine’s history they’ll reference this book as one of the first to identify the start of medicine’s creative destruction.

Join the dialog on Twitter at #CDoM

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I’ve been feeling a little uncertain recently.  I’ve got some new projects on the horizon that represent some very different directions for me.  So I read Uncertainty by Jonathan Fields.  It’s as if the book was written just for me.

Uncertainty is written to give you an understanding of your own creative process.  It offers daily practices and changes that will allow you to ‘reframe uncertainty, risk, and exposure as allies for creating and innovating on a level you never thought possible.’  Uncertainty challenges you to go to the next level without the restrictive feel of a ‘how to.’

Whether or not it was the author’s intention, I felt that Uncertainty is as much about balance as it is about creativity.  Fields frames a model for successful creation in the context of personal balance.  As we all know, any meaningful endeavor runs the risk of destroying other parts of your life.  But hour-to-hour and day-to-day balance is fuel for even greater ideas.  I’ve always understood this but never had the concept validated.  This made the book real for me.

Jonathan Fields is an interesting guy with a remarkable story.  Better than anyone he’s well suited to help us understand how to handle the fear that comes with transition.

I read books that create the opportunity for me to see or do things a bit better and Uncertainty does this.  And the timing was right for me.  I’ll list this as one of my more important personal growth reads of 2011.

Links to Uncertainty represent Amazon Affiliate links.

 

This week Seth Godin released We Are All Weird, the latest installment in The Domino Project.  Godin suggests that the mass market that defined us over the past couple of generations is dead.  Our cultural orientation toward the center of the bell curve (normal) is progressively giving way to fringe groups that lie away from the center.  The weird have forgone the comfort and efficiency of the norm in order to do what they want and what they think is right.  The rise of the weird has been facilitated by social networks and cheap tools of creativity working in a global economy.

While Godin frames Weird in the context of marketing, his message is applicable to medicine.  Our system has for years cultivated its young to think just as the generation before.  Disruption is discouraged.  We like things just as they are.

But for the first time in history, our global network has given a platform to those in medicine who might not have had a voice.  It has allowed those with divergent views to find one another.  I suspect that just as with mass marketing, the medical industrial complex will show fragmentation of its center based on smart solutions coming from the edge.  In the coming years real medical innovation may very well arise from the creative freedom of the private sector.  Academic medicine desperately needs the culture, energy and free range attitude found at places like the MIT Media Lab.

Jay Parkinson at the Stanford Summit/Medicine 2.0 Congress detailed his own unique story in medicine and captured beautifully the danger of uniform medical thinking.  While I may not always agree with Jay, he’s weird and smart, which is why I find him so relevant.  If you can get your hands on the Stanford Summit footage his remarks are worth your time.

So if you look at doctors up close, we’re all weird.  We’ve just been trained to look one way.

Pick up Seth Godin’s We Are All Weird and look for the corollaries in medicine.  It’s a quick read.  Then tell me if you don’t agree.

Links to We Are All Weird are Amazon affiliate links.

 

I recently read The Filter Bubble - What the Internet is hiding from you by Eli Pariser.  As you’re probably aware, Google looks at your search
history and takes it into consideration in subsequent queries.  While over time our search becomes refined and personalized, Pariser argues that this happens at the expense of making our world view increasingly myopic.  If you’re a card carrying member of the NRA, for example, you’re more likely to see content with conservative values than your liberal friend. This ‘filter bubble’ is facilitated by megasites like Google, Amazon and Facebook.  We also create our own bubb
les.

Pariser argues: “personalization filters serve up a kind of invisible autopropaganda, indoctrinating us with our own ideas, amplifying our desire for things that are familiar and leaving us oblivious to the dangers lurking in the dark territory of the unknown.”  Yikes.

The Filter Bubble offers passing lip service to the glaring reality that we’ve always lived by the filter.  As a child, The Boston Globe and Walter Cronkhite decided for us what was important.  And who would ever argue that the New York Times isn’t a filter?  Admittedly we can refine our inputs now like never before, the point remains that biased curation may not necessarily be a novel concept.

And Pariser makes certain assumptions about the searching public.  He sees the search world as made up of iterant intellectuals looking to create epic change for humanity.  In fact, most of us are just looking for a cheap flight.  While I like to see myself as something of a flaneur, I don’t consider my serendipity Google’s responsibility.

While filtration and curation will become increasingly important going forward, The Filter Bubble sheds light on the tension between our drive to create a refined signal and the need to see the world for what it is.  This book has made me think about the bubble that I have created for myself (in fact, when I finished the book I immediately felt the urge to renew my subscription to The Economist – love the way it renders on my iPad).

I found this quote to be important:

“Ultimately, democracy works only if we citizens are capable of thinking beyond our narrow self-interest. But to do so, we need a shared view of the world we cohabit. We need to come into contact with other peoples’ lives and needs and desires. The filter bubble pushes us in the opposite direction—it creates the impression that our narrow self-interest is all that exists. And while this is great for getting people to shop online, it’s not great for getting people to make better decisions together.”

Despite my spotty criticism,  The Filter Bubble is a very important book.  I highly recommend it.

The links to Amazon represent affiliate links.

 

Last week I read Enchantment by Guy Kawasaki.  Enchantment is a modern guide ‘the art of influence and persuasion’ that offers solid, practical advice on how work with people to get things done.  It’s a unique manifesto for personal conduct – a guide to the moral exertion of influence.

Read Enchantment.  Here’s why:

It’s written for everyone.  Enchantment is a roadmap for personal conduct in the new economy.  Yet the message of how to wield influence reaches well beyond the tech world where Kawasaki lives.  Unless you live under a rock, this book will help you think about how you work with people.

Easy voice.  Beyond its engaging content, Guy’s voice is easy and fluent.  At just a couple hundred pages you can get the message in a couple of evenings of reading.

The author’s lived the message. Books of this type are too often theoretical.  Enchantment is based on the hard-won experience of one of tech’s most visible influencers.  All of its advice is supported by solid experience and examples.

It’s real.  Enchantment is based in common sense, something desperately missing in our over-hyped, fast moving world.  It covers the waterfront from the appropriate, metered use of foul language to how to dress.  While you many not agree with all of it, Guy’s confident commitment to how to do things right is, by itself, enchanting.

In the end, this book’s core message is something that all of us should live by:  Be likeable, be trustworthy, have a great cause.

I’m working on it.

 

I recently read The Emperor of All Maladies, by Siddhartha Mukherjee,  a rich account of how modern medical science has come to understand and treat cancer.  Cancer, I learned, is largely a preoccupation of modern times.  Cancer was hardly a concern before the early 20th century when pneumonia and tuberculosis were the number one killers.  We now live long enough to witness this natural progression of what our genes ultimately have in store for us.  This book is cancer’s biography.

There are too many compelling subplots in Emperor to recount.  For me the story how William Halsted and his radical mastectomy set the stage for a century of surgical breast care is alone worth the read.  And every pediatric trainee should study the early history of ALL treatment and the work of Sydney Farber.  Throughout the author maintains a thread of his own story as an oncology fellow at the Dana Farber.  He uses this to pull us into the stories of several of his patients, a feature that made Emperor human.

Perhaps the most important part of the book comes in the final chapter.  After 450 pages detailing the 20^th century quest to ‘cure cancer’, it is suggested that cancer may well be stitched into our genome.  A natural derivative of aging and regeneration.  Through its intrinsic integration with natural processes Mukherjee lays the foundation for the idea that cancer may be an inevitable part of who we are.

Cancer, we have discovered, is stitched into our genome.  Oncogenes arise from mutations in essential genes that regulate the growth of cells. Mutations accumulate in these genes when DNA is damaged by carcinogens, but also by seemingly random errors in copying genes when cells divide. The former might be preventable, but the latter is endogenous. Cancer is a flaw in our growth, but this flaw is deeply entrenched in ourselves. We can rid ourselves of cancer, then, only as much as we can rid ourselves of the processes in our physiology that depend on growth—aging, regeneration, healing, reproduction…

It is possible that we are fatally conjoined to this ancient illness, forced to play its cat-and-mouse game for the foreseeable future of our species. But if cancer deaths can be prevented before old age, if the terrifying game of treatment, resistance, recurrence, and more treatment can be stretched out longer and longer, then it will transform the way we imagine this ancient illness. Given what we know about cancer, even this would represent a technological victory unlike any other in our history. It would be a victory over our own inevitability—a victory over our genomes.

Mukherjee is a beautiful writer.  He has the gift a written voice that can carry off science in a way that keeps you engaged.  His use of language had me re-reading sentences and paragraphs.  The length of Emperor was tolerable for just this reason.  I would recommend it for those deeply interested in cancer’s story.

The link above to The Emperor of All Maladies is an Amazon affiliate link.

 

Poke the Box is Seth Godin’s latest book/manifesto.  This is different from his other books in that it runs only 70 pages and is published as part of a new venture with Amazon called The Domino Project.  You may remember last year Seth Godin rocked the world by suggesting he was done with mainstream publishers.  This is where he’s landed.

Poke the Box is a short, 70 page manifesto about the importance of starting.  Godin makes the case that the ability to take initiative is a trait that consistently characterizes those who succeed.  The ability to begin creating is what separates the talkers from the doers.  Not making lists, planning, organizing, networking, or amassing followers.  Starting.  There are how-to steps here, just a foundation for taking a new approach to what you do.  This is a sequel to Linchpin.

I struggle with this myself.  Around the first of the year and well before I read Poke the Box I committed to spending a little less time around the water cooler and more time creating.  Thus I’ve been a little less visible on Twitter.  I’m desperately working to shut off distractions.  Poke the Box resonated with me.

Consider this quote about Godin’s friend and Twitter.  It’s worth processing:

Apparently, my friend has set the phone to chime every time one of the people he follows on Twitter posts something. This gives him the chance to read it and respond, making him, presumably, a truly valuable follower. He’s hoping that polishing his relationships in this way will act as a form of networking, making him more integrated into the Tweeters’ lives and perhaps businesses. All this polishing. Stand on an urban street corner and you can see it happening. Dozens of ostensibly busy people, staring at their palms and their fingers, polishing their relationships. The challenge is that it’s asymptotic. Twice as much polishing isn’t twice as good. Ten times as much polishing is definitely not ten times as good. Whether you’re polishing a piece of furniture or an idea, the benefits diminish quickly. The polishing turns into stalling. I wonder what would happen if instead of rushing to Twitter, my friend used that chime to do something original or provocative or important? What if the chime was his reminder not to polish, but to create?

In a way that only Godin can do he marries motivation with raw logic.  I would strongly suggest that if you are in the business of doing or creating, drop what you’re doing (temporarily) and read Poke the Box. It’s a quick read.

The Amazon link above is an affiliate link.

 

This week I muscled through Sherry Turkle’s Alone Together – Why We Expect More from Technology and Less from Each Other (Basic Books, 2011/Affiliate link).  It explores our increasingly perverse relationship with technology and how it impacts us psychologically.  This book falls into what I call the contratech genre, an evolving niche critical of technology’s runaway popularity.

Turkle’s message is that we are evolving to prefer technology over people.  We are expecting less from one another personally.  Alone Together is heavily laced with real-life examples drawn from Turkle’s work as a sociologist at MIT.  The first half of the book covers robotics and the latter half deals with social networking, simulation, email and other modern day preoccupations.

For its message, I found Alone Together lengthy and perhaps better positioned for an academic audience.  The book’s examples are supported by extensive quotes and vignettes which are interpreted in the tradition of psychoanalysis.  As someone who knows little about psychoanalysis, I found this exhausting at times.  The conclusion was perhaps the most engaging part of Alone Together.

Here’s a question worth thinking about:  Had this author been alive at the time of Gutenberg, would she have claimed that books lead us to expect more from paper than one another?  Technology elicits fear of the unknown.  And dystopian pessimism has a way of making headlines.

But Turkle suggests that “technologies, in every generation, present opportunities to reflect on our values and direction.”  Perhaps Alone Together marks a time of opportunity.  I believe that the issue of our evolving relationship with technology needs frank discussion.  As a technophile I’m excited about our future.  Yet as the father of two young children I have concerns that came through quite clearly in Alone Together.  This book made me think but it didn’t change my mind.  It left me wanting in some way.  I would not call this an easy read and would recommend it only for those seriously interested in a deep dive in technology and humanity.

I’m going to put Turkle on my list of people to invite to dinner.  Agree with her or not, her voice is important.  We’ll see if she accepts.

 

Last week I read Kevin Kelly’s What Technology Wants (Viking, 2010/Affiliate link).  Drawing from the fields of psychology, art, and science, What Technology Wants offers a dense but thought provoking look at the way technology advances.

The book centers around the expansion of what Kelly calls the technium.  This is a term he has coined to describe “the greater, global, massively interconnected system of technology vibrating around us.”  It’s the grand totality of machines, methods and engineering processes – a system that feeds off the accumulation of information and knowledge.  Critical to Kelly’s technium is the idea that it is a self-reinforcing system of creation.  This last point is critical to the book’s central theme which is technology evolves just like an organism.

“With minor differences, the evolution of the technium—the organism of ideas—mimics the evolution of genetic organisms.  The two share many traits: The evolution of both systems moves from the simple to the complex, from the general to the specific, from uniformity to diversity, from individualism to mutualism, from energy waste to efficiency, and from slow change to greater evolvability.  The way that a species of technology changes over time fits a pattern similar to a genealogical tree of species evolution.  But instead of expressing the work of genes, technology expresses ideas.”

Kelly offers ten universal tendencies that drive technology.  One of them is mutualism:

“The technium is moving toward increased symbiosis between humans and machines.  This is the subject of thrilling Hollywood sci-fi blockbusters, but it also plays out in a million small ways in real life.  It is very clear that we are creating a symbiotic memory with the web and Google-like technologies. When Google (or one of its descendants) is able to understand ordinary spoken questions and is living in a layer of our clothing, we will quickly absorb this tool into our minds. We will depend on it, and it will depend on us—both to continue to exist and to continue getting smarter, because the more people use it the smarter it gets ….We are just starting our journey of increasing mutualism between the technium and ourselves.  Mastering this commensalism, like adding with pen and paper, will take some education.  The most visible aspect of the exotropic trend toward mutualism is the way in which the technium increases the sociability between humans …. For the next 10 to 20 years, the socializing aspects of the technium will be one of its major traits and a major event for our culture.”

Heady stuff.

More and more I’m interested in the bigger picture of social media, technology and medicine – this book resonates with me.  What Technology Wants brings the long view to technology.  But unless you’re really interested in putting technology into the cosmic perspective, this won’t be a good read for you. What Technology Wants is heavy, orginal thinking.

 

A friend suggested she was tired of hearing about vaccines.  Her comment and our subsequent conversation seemed to reflect an important shift in parent sentiment: the conversation about vaccines is beginning to get somewhere.

While much of this was born of the MSM’s newfound realization that the vaccine-autism connection was cooked, some of this is due to the tireless of work of those like CHOP’s Dr. Paul Offit who work get the story right.

As part of his passionate agenda to expose vaccine truths he’s published Deadly Choices – How the Anti-vaccine Movement Threatens Us All (Basic Books, 2011) (affiliate link).  For those looking to understand the origins of anti-vaccine sentiment, read Deadly Choices.

What struck me is the deep history behind the anti-vaccine movement.  From Jenner’s smallpox fix to modern day MMR struggles, Offit draws fascinating corollaries surrounding immunization that seem to defy the generations.  Vaccine resistance was not born of Andrew Wakefield but broader concerns rooted in religion, individual liberty, fear and propaganda.  Deadly Choices puts the anti-vaccine movement in a historic sequence that reads like good suspense.  I couldn’t put it down.

And just for fun, I’ll bet you didn’t know this:  The Raggedy Ann doll is a derivative of the anti-vaccine movement.  In 1915, Johnny Gruelle, a cartoonist and illustrator in New York City, lost his daughter to congenital heart disease.  Despite the child’s cause of death, Gruelle blamed the smallpox vaccine.  In his daughter’s memory, he created a doll with red yarn for hair and floppy arms and legs—a symbol of children harmed by vaccines.  He called it Raggedy Ann.  Who knew?

Perhaps the most valuable chapter, titled “Dr. Bob,” addresses the myths and fallacies surrounding the alternate vaccine schedule as suggested by Bob Sears.  This formal evisceration of “Dr. Bob” and his harebrained scheme is worth the price of the book.  It should be required reading by every parent in America.  Concerning Bob Sears…

Although Sears is probably well meaning, one has to question the hubris of a man who decides to create his own vaccine schedule—someone who claims his schedule is better and safer than that recommended by the CDC and AAP.  It’s all the more amazing when one considers that Robert Sears has never published a paper on vaccine science; never reviewed a vaccine license application; never participated in the creation, testing, or monitoring of a vaccine; and never developed an expertise in any field that intersects with vaccines—specifically, virology, immunology, epidemiology, toxicology, microbiology, molecular biology, or statistics.  Yet he believes he can sit down at his desk and come up with a better schedule.

I have to add that Deadly Choices author, Paul Offit, should be seen as the ultimate child advocate.  Selflessly representing public health interests in the media, Offit individually works on behalf of children in a way that most of us should.  In a self-centered world that has too quickly forgotten the threat of deadly childhood disease, Offit’s is a passionate voice of reason.  It’s hard to measure the impact of his advocacy.

Despite the recent attention drawn to Andrew Wakefield’s fraudulent behavior, dialog surrounding vaccine truths can’t get enough light.  To understand the history behind vaccine hesitancy is to understand the patterns of resistance to future public health efforts.  Deadly Choices should be required reading by everyone concerned with the future of children’s health.

If you liked this then you might like these other vaccine-related posts on 33 charts: Vaccines, Autism and Firearms; Vaccines, Autism and the Failure of the Hive; Vaccine-Preventable Disease – The Forgotten Story; or When Autism Divides Neighbors.