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2014 Commencement Address by Eric J. Topol, MD: “Machinations of the Machine Age”

News May 16, 2014

Dean Kaiser, Dean Feldman, Faculty, Proud Families, and Especially the Honored Graduates:
How hard you have worked to get to this culminating juncture and how proud you, your family and friends must be. I am honored to share this great moment of celebration with you.
You are graduating at an extraordinary time…a digital, computer, machine age that is providing exhilarating innovation…changes that most of us could not envision would happen this quickly…or ever. Oh, how I wish I could trade places with you! When I graduated medical school, the term digital referred to the rectal exam.
In the digital world, Google’s Driverless Cars have already travelled 700,000 miles without an accident. They can even now sense bicyclists and hand gestures better than humans. We’ve seen how quadriplegics can fully mind control their wheelchair or how a wounded soldier can move a prosthetic limb by thoughts.
For individuals who are blind, there are camera eye sensors that see things and transmit the information through a bone conduction earpiece. And there are smartphone-app connected hearing aids that provide better than normal human hearing. Your speech can not only be immediately translated but also made into your own voice speaking in a foreign language that you don’t know a single word!
These are all examples of artificial intelligence. More commonly you see this when you get recommendations from Amazon or Netflix. Or when you ask Siri to make your dinner reservation. When you get autofill on searches on Google and through apps like Google Now, one called SwiftKey reads your Twitter feeds and tells you to get flowers because your girlfriend is sad. Or the facial recognition programs like Facebook that automatically tags photos, and now in medicine unsupervised computer algorithms that can review images from a tumor to make the diagnosis and provide expected survival statistics.---better than pathologists. Computers can now read some types of facial expression, like pain, and identify an individual by facial recognition more accurately than people! Algorithms of pictures of a skin lesions have just been shown to be interpreted more accurately than by dermatologists.
The supercomputer IBM Watson can process 200 million pages of medical literature in 1 second. That’s pretty darn fast….even faster than some doctors think they can process information.
This all is remarkably intelligent. But at the same time, there’s so much unintelligent stuff happening in the digital and medical worlds—which, by the way, are only now starting to come together.

We have the National Security Agency monitoring all our phone calls and emails—from over 300 million people—to catch a few terrorists. Have you seen the cartoon of the little boy in the diner with President Obama. He says “My dad says you are monitoring all our phone calls” And the President says “He’s not your dad!”
What’s Up with What’s App? A company with 50 employees sold for $19 Billion? And there’s Google’s purchase of Deep Mind for $400 Million, Facebook’s buying Oculus Rift, where you sit with big black goggles watching a screen, for $2 Billion.

Or we have people walking around with Google Glass, saying OK Glass and making videos of us without our knowledge---very creepy, in certain places they are known as “Glassholes”.

And why are we compelled to tap “Agree” to download all apps, when none of us read anything and who knows what we agreed to? Talk about Informed Consent!
Or why can’t you wait for an email response so you text people to let them know you sent them an email? Oh I forgot, email is too slow so you just text everyone now?
That’s what’s unintelligent in the digital world.
But in medicine, we do mammograms for women every year from age 40 even though there are compelling data that only 5 per 1000 have any benefit over 10 years and over 600 are harmed by false positive results of the tests.

Or we do PSAs for prostate cancer, and the net harm to men is truly overwhelming for almost 250,000 men each year who undergo serial biopsies for a false positive test.

And why do we keep doing annual physicals when they have been shown to have no benefit but instead induce harm?

Recently, the American Heart Association put out new guidelines that suggest any man over the age of 62 should take a statin medicine for life! Without any evidence their “risk calculator” is valid.

And how about the end of the Pap smear, used since the 1940s, subjectively interpreted, since we can get the direct root cause story from a human papilloma virus HPV test.

Why do we still use a stethoscope—what was the medical icon but is now a relic--to listen to heart sounds—lub dub-- or bowel sounds when we could use a tiny, handheld ultrasound device to SEE everything immediately?, and by having that as part of our physical exam put in a dent in the 125 million ultrasound studies ordered every year.
So there’s a lot in flux. That’s what happens when are in a transitional state of maximum disruption. Like driverless cars, we’re moving to an era with doctorless patients…at least some of the time. To deal with that I hope that you all will become phenomenal digital doctors, with great plasticity, continually adapting to all these changes.

Instead of an intelligence IQ, I ask what is your DQ---your digital quotient?
Back in 1892, Emmet Densmore said “Medicine is not a science, it is empiricism founded on a network of blunders.” Now, in 2014, medicine is quickly becoming a real data science.
So here are my 5 DQ questions for you in this new, emerging era of medicine:
1. Can you see every patient as an individual—learn everything possible about what makes them tick with our new digital tools of sequencing, sensors, imaging?
2. Are you going to advocate patient generated data so each of your patients is using their smartphone or tablet to capture essential data, relevant to their medical condition?
3. Will you be fully supportive of activating your patients, getting them maximally engaged in the new form of consumer-driven health care that is just starting to take hold.
4. Will you share all your notes with your patients, treat them with the utmost respect as a partner for whom you will be giving advice, counsel, and most importantly providing exquisite communication, empathy, and compassion?
5. Will you keep up with all the new information thru new means, such as following trusted medical sources on Twitter? And challenge existing dogma and guidelines when it comes down to the unique patient in front of you?
If you can do this, you’ll have the highest DQ score--real not artificial intelligence —and you’ll have enormous success as the doctors of the future, and you’ll navigate just fine through this remarkably exciting yet frankly disruptive time in medicine. Getting the right balance of patient data science, consumer-driven health care and human touch will likely be your biggest challenge ahead.
Thank you for having me. Congratulations. And best of luck to all of you in your medical careers going forward.