Al Gore on Medicine's Inconvenient Truths

Al Gore on Medicine's Inconvenient Truths

; Al Gore

Disclosures

March 07, 2014

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Editor's Note: In this exclusive interview, former Vice President Al Gore speaks with Medscape Editor-in-Chief Eric Topol, MD, about what he believes to be the most stunning advances in the practice of medicine. Mr. Gore talks specifically about the promise of precision medicine, the pros and cons of fetal genome sequencing, the healthcare race that the United States is currently running with China, and why health policy has failed to adequately address the problem of antibiotic resistance.

He also discusses Twitter and digital medicine, the microbiome, and his decision to become a vegan.

The Future of Medicine

Eric J. Topol, MD: Hello. I'm Eric Topol, Editor-in-Chief of Medscape. Joining me today for a Medscape One-on-One is former Vice President Al Gore. We're really thrilled to have you as part of our own version of Dos Equis' most interesting people in the world, as applied to medicine. It's really terrific to have a chance to talk with you and get into your phenomenal book, The Future: Six Drivers of Global Change, especially the part that discusses the reinvention of life and death.

It's really very interesting that you delve so much into medicine because you're known, of course, for your efforts in climate change and energy. But you really discuss this topic of biomedicine and genomics in a large way. How do you keep up with all of this stuff?

Al Gore: Well, first of all, thank you for doing this interview, and congratulations on your 7th annual Future of Genomics conference. Thank you for helping me with the chapter in which I delved into life sciences and genomics and their related fields. I've spent 8 years researching in an effort to get my arms around these 6 drivers of global change, and the stunning advances in the life sciences and related fields were really surprising to me.

I used to have a lot of hearings in Congress, when I was in the House and Senate, on some of the early breakthroughs in genetic engineering and related fields. I remember when Dolly [the sheep] was cloned and the debate on the bioethics of cloning and the like. Then, when I was in the White House, I kept that collection of issues under my purview, but after leaving public service and trying to serve in a new and different way, I checked back in on the advances in life sciences that had been made since I last took an in-depth look, and I was really amazed. It was helpful to me to learn from your book, The Creative Destruction of Medicine, and from our talks.

Dr. Topol: Thanks. I'm amazed at what you covered in this section. But I've got to ask you -- you have these diagrams. These diagrams are amazing; they're really intricate. How do you come up with these things?

Figure.

Diagram from The Future: Six Drivers of Global Change

Mr. Gore: Yes, somebody said it looked a little like the Unabomber's diagrams, but I never intended to put them in the book itself. The diagrams that begin each chapter began as an organizing tool for me to map out the relationships between the different topics and subtopics. My editor at Random House, Jon Meacham, was quite taken with them and he said, "We've got to put these in the book." They're not for everyone, but I must say that a lot of readers, students in particular, have given me very positive feedback on those diagrams.

Antibiotic Resistance, Special Interests, and Precision Medicine

Dr. Topol: It kind of gives us a little sense of the workings of your mind. I want to get into some of the topics you delve into. The first one, in terms of genomic medicine, is precision -- precision healthcare and precision medicine. I want to talk about something you discuss in the book, about how the US may have the most difficulty in making the transition to precision medicine because of the imbalance of power and unhealthy corporate control. What are your thoughts on that?

Mr. Gore: In another chapter of this book, I write extensively about what has happened to the balance of power -- political power, decision-making power, economic power -- inside the United States. The US rose to be the most powerful and respected nation in the world for a lot of reasons, but maybe the main one is that we made better decisions over time than any other country because we had a free flow of ideas and a focus on values. We maintained the ability of people who felt strongly about the deepest human values to speak up and gather agreement from others who also shared that commitment, and then have an influence on the shaping of public policy. But over time, for a variety of reasons, chiefly the influence of money in our political system, corporate interests and other powerful organized special interests have come to dominate the decision-making processes in our country. I hope that doesn't sound like a politically radical statement. I think, unfortunately, that it's pretty widely agreed upon across the ideological spectrum now, and it's really a shame.

Let me give you a quick example of what I mean. Antibiotics have been such a wonderful blessing for humankind, and our policy that guides the use of antibiotics should be dominated by the public interest. Let's not overuse them. Let's use them appropriately. Let's allocate sufficient R&D to continue discovering new antibiotics even if they don't necessarily shape up as a big profit center for the companies that develop them.

But what are we doing instead? Well, 80% of the antibiotics used in the United States today are fed to livestock in subtherapeutic doses, which inoculates the bacteria against antibiotics. And now there are proven examples of bacteria that are vulnerable to antibiotics in humans, that jump to livestock. The bacteria are then dosed constantly with the antibiotics and become immune to them. Then they jump back to humans. Now, there are other factors that have contributed to the looming threat of a post-antibiotic world, but that's one of the main ones. Public policy should address that. It's a no-brainer, but because of the dominance of wealthy special interests, it's just not even considered politically possible.

Dr. Topol: It's amazing. It really is. It's so sad. Giving antibiotics so broadly is the opposite of what should be done. We're so imprecise.

Getting back to precision medicine, the promise of genomics, sensors, and other related things could change medicine, but do you think it's going to wind up being done outside of the US because of some of these obstacles we have?

Mr. Gore: I hope not, but at this point we are likely to see the new models that unlock the potential for precision medicine or individualized medicine develop first in other countries.

The powerful presence of pharmaceutical companies, device manufacturers, hospitals, caregivers, and also insurance companies has such control over the development of policy and the making of political decisions, that any new models that are introduced here in the US to unlock this potential for precision medicine -- but impinge on the profit centers of these organized interests -- will encounter tremendous political resistance. Our democracy has been hacked, and public policy makers and elected officials now feel as if they have to spend the majority of their time catering to the wishes of these powerful interests because they provide the money that determines the outcome of elections and primaries. Of course, there are a lot of good people trapped in a bad system; there are exceptions to that rule.

The Influence of Insurers on Health Policy

Dr. Topol: While we're on the subject of special interests, I do want to get your further comments on the insurance industry because you have a section in the book on insurance companies. And you talk about how legislators, with exceptions, are no longer serving the public interest because they are so dependent on campaign contributions from these corporate interests and are so vulnerable to their lobbying.

Health insurers are a powerful force. Are they part of the problem or part of the solution?

Mr. Gore: Right now, I would say they're more a part of the problem than a part of the solution. We are beginning to see the emergence within the insurance industry of some adaptations to the new realities of precision medicine. It's just now starting, but not where the public policy makers and politicians are concerned.

 
The average member of Congress is told on the day that he or she arrives in Washington, DC, that they have to spend between 4 and 5 hours every single day on the telephone or at cocktail parties begging rich and powerful people and [special] interests for campaign contributions.
 

Let me break it down into a very simple comparison. In 1976, a long time ago, when I first went to the US Congress, I had the luxury of being able to spend almost all of my time talking with my constituents in town hall meetings and individual meetings, taking their ideas back to the nation's capital, finding out facts there, sharing them back home. It gave me such a thrill to be a part of this majestic design that our founders bequeathed to us.

That's what happened back then. Here's what happens today. The average member of Congress is told on the day that he or she arrives in Washington, DC, that they have to spend between 4 and 5 hours every single day on the telephone or at cocktail parties begging rich and powerful people and [special] interests for campaign contributions. Now, it's just human nature that if you spend more than half of your working hours begging powerful people for money, you're going to begin to think more and more about how they will react to what you do and say. So now you have these interests actually writing the exact words of amendments to laws and of the laws and regulations themselves. And all of the work of Congress is distorted by that. I wish I was overstating this but I'm not.

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