On medicine, with Dr. Eric Topol

What It Covers

Cardiologist Eric Topol joins Drug Story host Thomas Getz to examine why pharmacogenomics has failed to reach clinical practice 20 years after the Human Genome Project, how the Vioxx scandal exposed pharmaceutical accountability gaps, and what evidence-based longevity science actually supports versus what supplement sellers promote.

Key Questions Answered

• •Pharmacogenomics Gap: Over 150 FDA-approved drugs carry genomic labels that could guide safer dosing or prevent fatal reactions, yet most physicians never order genetic testing before prescribing. The barrier is logistical: tests take up to two weeks and are rarely covered by insurance, making genomic-informed prescribing impractical in standard clinical workflows.
• •Stevens-Johnson Syndrome Risk: One in four patients who develop Stevens-Johnson syndrome — a potentially fatal toxic skin reaction — can die from it. The anticonvulsant carbamazepine (Tegretol) is a known trigger, and several countries legally require genomic screening before prescribing it. The US does not, leaving patients exposed to a preventable, life-threatening risk.
• •Aspirin Reassessment: Current evidence indicates that adults over 70 without established cardiovascular disease — no prior stent, bypass, or heart attack — face a bleeding risk that outweighs any cardiac benefit from low-dose aspirin. Patients in this demographic should consult their physician about discontinuing routine aspirin use rather than continuing based on outdated guidance.
• •Longevity Credibility Test: Topol identifies a practical filter for evaluating longevity experts: anyone actively selling supplements, peptides, or protein products has a financial conflict that undermines their scientific credibility. He estimates the number of researchers genuinely working on healthspan extension without commercial product sales fits on one hand.
• •Multimodal AI for Prevention: Lifestyle factors — sleep, diet, exercise, social connection, time in nature — now have substantially stronger randomized trial backing than a decade ago. Topol argues these remain insufficient alone, and that combining proteomic biomarkers, genetic data, environmental exposures, and multimodal AI represents the next layer for predicting and preventing cancer, heart disease, and Alzheimer's.