Editorial — Precision Medicine
The gap between what your GP measures and what your biology is actually doing — and why the most important data about your health has never appeared on a results sheet. This is Topol’s argument, the German healthcare context, and the wrong problem. Here is what the evidence actually says — and what that means for the one body you have.
Eric Topol is not a wellness influencer. He is a cardiologist, a molecular medicine researcher, and the founder of one of the United States’ most productive translational research institutes. He has spent the better part of three decades building a case, peer-reviewed and published across thousands of papers, that the structure of modern medicine is fundamentally wrong.
Not wrong in the sense that doctors are incompetent. Wrong in the sense that the system was designed to respond to disease — and was never retooled to prevent it. In Topol’s framing, the average clinical encounter is a diagnostic protocol built for a population of sick people, applied to individuals who may not yet be sick. It catches what has already arrived. It is almost wholly blind to what is building.
“We are spending almost all of our resources on the 5% of people who are very sick, essentially ignoring the 95% who could be kept healthy.”
Eric Topol, MD — Scripps Research Translational Institute
This is not a fringe view. It is the intellectual foundation of precision medicine — the emerging consensus that chronic disease doesn’t arrive suddenly. It accretes. It compounds, slowly and measurably, over years or decades before a clinical threshold is crossed. By the time a diagnosis lands, the biology has already been in motion for a long time.
The corollary is confronting: the standard annual blood panel — roughly ten to fifteen markers, selected to catch overt pathology — is largely measuring the aftermath of a process that has been underway for years. It is reading the final chapter of a story that has already been written.
Those four numbers, taken together, define the gap Topol has been writing about since 2012. The system tests you infrequently, with too few markers, after the biology has already been in motion for years. It is not negligence. It is architecture. The architecture needs to change.
Topol’s central contribution to precision medicine is deceptively simple: the body is not the population average. It is one specific system, with its own specific baseline, its own specific trajectories, its own specific vulnerabilities. The only way to understand it is to measure it repeatedly, over time, and in enough dimensions to see the patterns that matter.
This is the N-of-1 principle. A trial conducted on a single individual, rather than inferred from a group. When you track enough biomarkers across multiple time points, you stop comparing yourself to reference ranges and start comparing yourself to yourself — at your best, at your worst, trending upward or down. The signal becomes personal and therefore actionable.
Two people can have identical total cholesterol readings. One is at negligible risk. The other is building toward a cardiovascular event. The difference lies in the ratio of particle sizes, the inflammatory markers, the insulin dynamics, the oxidative stress indicators — values that the standard panel does not capture. This is not a marginal distinction. It is the entire diagnostic picture.
Topol’s research group has quantified this specifically: in population studies of people considered “normal” by standard clinical criteria, comprehensive biomarker panels identify meaningful metabolic risk in roughly 40% of individuals. Those people are not sick. They are not receiving treatment. They do not yet have a diagnosis. But their blood is already telling a story that their last check-up never read.
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Get Your Biomarker BaselineThe methodological leap Topol describes is not about more data for its own sake. It is about measuring the right markers, in the right combination, across enough time to detect directionality. A single HbA1c reading tells you where you are today relative to a threshold. A series of readings over three years tells you whether you are improving, plateauing, or drifting toward a problem you don’t yet have a name for.
A result in the ‘normal’ range tells you almost nothing about trajectory. Someone whose fasting glucose has risen from 82 to 97 mg/dL over four years is still ‘normal’. They are also, by any reasonable reading of the evidence, heading somewhere that will not remain normal. The snapshot cannot show you this. Only the film can.
The markers that matter most for this kind of longitudinal reading are not the ones most commonly tested. Total cholesterol misses particle behaviour. Fasting glucose misses insulin dynamics. TSH alone misses thyroid conversion. The gaps are not random — they are structural artefacts of a system designed for diagnosis, not surveillance.
“The era of precision medicine is about taking data that is specific to you as an individual and using it to help make decisions about your health — that is the future of medicine.”
Eric Topol, MD — Deep Medicine, 2019
The statutory German health system — the GKV — offers a Gesundheitscheck every three years from age 35. The panel covers approximately ten markers: glucose, total cholesterol, kidney and liver function, and a few others. It is designed to screen for overt disease at population scale. It is not designed to build a personal health baseline, detect subclinical trends, or provide the kind of metabolic depth that modern preventive medicine considers necessary.
This is not a criticism of German medicine. It is a description of an inevitable gap between a statutory system designed for population health and the individualised surveillance that Topol and his peers argue is necessary. The two things serve different purposes. The GKV will catch your acute kidney failure. It will not tell you that your insulin sensitivity has been declining for five years.
Topol’s argument does not end with a critique. It ends with a programme. Measure more. Measure earlier. Measure repeatedly. Act on trends, not just thresholds. And critically — pair the data with expert interpretation that can contextualise what the numbers mean for this specific person, at this specific moment, against their own history.
For the majority of people in Germany, this programme does not currently exist within the statutory system. It requires either a private Arzt, a specialised clinic, or a dedicated service that handles the full stack: blood draw, accredited lab analysis, clinical review, and a personalised report that translates findings into action.
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This is precisely the kind of service Topol’s framework implies should exist. Not a replacement for your GP. Not a diagnostic clinic. A surveillance layer — a personal early-warning system that tracks the markers that matter, reviewed by clinicians who know what to look for, and translated into language you can actually act on.
The minimum comprehensive panel — the floor below which you are essentially still guessing — should include metabolic markers beyond glucose and HbA1c, a full cardiovascular panel including particle fractionation and hsCRP, hormonal axes including thyroid, sex hormones, and cortisol, nutritional markers including vitamin D, B12, iron, and ferritin, inflammation markers, and kidney and liver function across multiple indicators, not just the headline values.
This is what 39+ markers looks like in practice. It is not an exotic protocol. It is the minimum evidence-based panel that precision medicine researchers, Topol among them, argue should be the standard of care for anyone who wants to understand their own biology — not just their disease status.
“If you only measure what’s easy to measure, you will only find what is easy to find. But the things that are building quietly — the metabolic drift, the inflammatory signal, the hormonal imbalance — those require a different kind of attention.”
Eric Topol, MD — The Patient Will See You Now, 2015
Topol’s argument, in the end, is an argument for attention. For treating the body as the complex system it is, rather than a set of thresholds to be crossed before action becomes warranted. The evidence for this approach — more markers, more frequency, more contextualisation — has been building for two decades. The infrastructure to deliver it, at a price that is accessible rather than concierge-clinic exclusive, is only now becoming available.
39+ biomarkers. Accredited German labs. Clinician-reviewed action plan. Personal baseline tracked annually. €199/year — no referral, no waiting list.
Start Your Health BaselineSources & References
Topol EJ. High-performance medicine: the convergence of human and artificial intelligence. Nature Medicine, 2019.
Topol EJ. Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again. Basic Books, 2019.
Topol EJ. The Patient Will See You Now: The Future of Medicine Is in Your Hands. Basic Books, 2015.
Sonnenburg JL et al. Diet-induced alterations in gut microflora contribute to lethal pulmonary damage in TLR2/TLR4-deficient mice. Cell Host & Microbe, 2016.
Khera AV et al. Genome-wide polygenic scores for common diseases identify individuals with risk equivalent to monogenic mutations. Nature Genetics, 2018.
Gemeinsamer Bundesausschuss. Gesundheitsuntersuchungen für Erwachsene. G-BA, 2023.
Robert Koch-Institut. Gesundheitsberichterstattung des Bundes. Prevalenz chronischer Erkrankungen, 2022.