Eric Topol’s 9 Steps Toward Better Health Care—We Add a 10th

There appear to be a growing number of revolutions in health care and the life sciences industry. Whether you’re considering the genomics revolution, the information revolution, or the empowered patient revolution, a strong need to “fix” our health care system – to address the various inefficiencies that cause costs to increase and that put quality of care at risk – seems to be at the root of these movements.

There appear to be a growing number of revolutions in health care and the life sciences industry. Whether you’re considering the genomics revolution, the information revolution, or the empowered patient revolution, a strong need to “fix” our health care system – to address the various inefficiencies that cause costs to increase and that put quality of care at risk – seems to be at the root of these movements.

Dr. Eric Topol, a cardiologist and scientist at the Scripps Research Institute, recently published a short article on “How to Change Medicine.” The article, which is excerpted from Dr. Topol’s book, The Creative Destruction of Medicine, provides nine key steps to changing health care delivery: from changing focus from populations to individual patients, to using genomic data to help “fit” treatments for each patient, to redesigning the way doctors are reimbursed.  

We agree with all of Dr. Topol’s suggestions, but suggest that there should be a 10^th step. Controlling the spiraling costs of drug development is essential to realizing the other changes to the U.S. health care system. Today, it costs more than $1 billion for the discovery and development of new treatments. Since “blockbuster” drugs are so called because they generate $1 billion or more in revenue, even an immensely successful drug may no longer be profitable (and blockbuster drugs are becoming increasingly rare). Some of Dr. Topol’s steps do hint at ways to address these costs:

• By changing health care’s focus from the population to the individual, tailored drug development could produce more effective drugs that work for smaller groups of patients, reducing clinical trial sizes, and cutting costs.
• Using genomic data to determine whether a drug benefits a certain patient should underlie the creation of companion diagnostics as well as tailored therapies; this pharmacogenomic approach would speed development (less time to market theoretically means sooner time to profit).
• “Step 7,” which advocates the rewarding of providers for frugal innovation (e.g., using treatments that improve outcomes and cut costs) can be applied to drug development that considers cost-effectiveness as well as efficacy when creating a new therapy.

Addressing health care costs without emphasizing the need to reduce R&D costs strikes us as akin to worrying about your grocery bill when your mortgage eats up the majority of your budget. Future posts on this blog will address drug development innovations that could help tame this billion-dollar monster, including “low-hanging” fruit (like smaller trials and targeted therapies) that could easily reduce costs in a short period of time.

Do you agree with Dr. Topol’s nine steps? Do you think that reducing drug development costs is a key factor in revolutionizing health care? Could there be enough “low-hanging” solutions to make a difference now? Please share your thoughts with us.