Episode 63: Eric Topol, M.D. – Cardiologist and prolific Long Covid author

Eric Topol is not only a practising cardiologist, he is also a scientist, prolific author and editor.  One of the loudest voices for Long Covid advocacy within medical and the mainstream media, Dr Topol studies his patients, patiently follows every study, publishes his findings, discusses with the US government, and is not letting up in his fight for progress in Long Covid research.

We discussed Topol’s review of the major findings, mechanisms and recommendations for Long Covid (published in Nature in March this year and written with Julia More Vogel and PLRC) in full in Episode 52. It is now the third most downloaded medical paper of 2023.  That suggests that this research, knowledge of this condition, and his work, is highly sought-after, but despite this Topol’s primary frustration is that this disease is not being treated with the emphasis or speed it warrants.

Critical of the NIH spending in their billion dollar promise to address Long Covid, Topol voices his frustrations at the slow pace of trials, the blinkered RECOVER programme and the lack of willingness to use digital trials and data technology, despite the size and global nature of this cohort.

In this episode we also delve into the use of Metformin which has proven benefits in Long Covid prevention.  Whilst it’s unclear at the moment as to how it works, the various pleiotropic effects of Metformin have been suggested to offer cardiovascular protection, beneficial effects on obesity, musculoskeletal and reproductive diseases, cancer, ageing, and potentially improve mitochondrial function. Whether it could be used to treat Long Covid, Topol thinks is a safe and simple thing to trial, and yet there is so little being trialled for treatment at this stage.

Topol believes that we now have good understanding of the mechanisms of Long Covid, with viral persistence being the key player, citing the Munich study which revealed spike protein in the brain. And he believes that we have pushed ahead in understanding the immunology of the disease, as presented by Professor Danny Altmann in his recent Nature review but for all the brilliant minds, the vast numbers of sufferers, and the existing funding, Topol does not believe that we are currently progressing as we need:

“It’s amazing that here we are, 2023, and we have nothing. And we have tens of millions of people who are affected. I know the medical community moves slowly but I've not seen anything quite this mismatched between desperate unmet need and action even when there's allocation of big funding.”

But he remains optimistic that, by using technology, we will eventually establish medication to both prevent and treat Long Covid.