Past and  Now Innovations

Time present and time past

Are both perhaps present in the future

And time future continued in the time past.

T.S. Elliot (188-1965), Four Quartets – Burnt Norton

In the decades ahead, the pace of biomedical discovery will accelerate.  The state of the individual person will be characterized with increasing precision from the molecular level to the genomic level to the organ level and by interactions with medications, nutrients, the microbiome, therapeutic devices, and the environment.

Isaac Kohane, Jeffrey Drazen, and Edward Campion, “A Glimpse of the Next 100 years in Medicine,” New England Journal of Medicine, December 27, 2012

December 29,  2012 -  It’s that time of year-  to comment on 2012’s major innovations – and to speculate on innovations to come, in 2013 and thereafter.

So here's the lay of tmedical nnovation land,  in the words of  Cleveland Clinic investigators and Wall Street Journal writers.

·         Cleveland Clinic’s top 10 innovations for 2012.

1. Catheter-based renal denervation to control resistant hypertension: Resistant hypertension is high blood pressure that requires four or more medications to control, or high blood pressure that doesn't respond to medical treatment and remains elevated despite medication and lifestyle changes. Renal denervation, a new 40-minute procedure,  inserts a catheter-based probe into the femoral artery  and threading it into the renal artery near each kidney. The catheter probe delivers low-power radio-frequency energy to surrounding nerves. Disrupting the nerves has been shown to cause blood pressure levels to drop.

2. CT scans for early detection of lung cancer: In June, the New England Journal of Medicine published long-awaited data from the National Lung Screening Trial that validated the diagnostic use of low-dose spiral computer tomography as a screening tool for lung cancer. The scan is more effective than standard X-rays in detecting tumors, even small ones, earlier, when they are more treatable with surgery.

3. Concussion Management System for athletes: These tools establish an athlete's baseline cognitive and motor skills at the start of the athletic season. At the moment of contact, the tools can detect brain injuries right away. Afterward, the athlete's cognitive and motor skills are re-tested to see when it is safe for an athlete to return to his or her sport.

4. Medical apps for mobile devices: Thousands of software applications on the market let health professionals and consumers get medical resources on their smartphones and other mobile devices.

5. Increasing discovery with next-generation gene sequencing: New sequencing machines are smaller, faster and cheaper than previous versions used to sequence the human genome as part of the Human Genome Project.

6. Implantable device to treat complex brain aneurysms: A new FDA-approved device -- a flexible braid mesh tube -- is implanted directly into the carotid artery, the major blood vessel that supplies blood to the brain. The device redirects blood flow away from the aneurysm to the undamaged part of the blood vessel, allowing a clot to form, preventing the aneurysm from rupturing.

7. Active bionic prosthesis, wearable robotic devices: This lightweight, durable and computerized bionic leg uses microprocessors, sensors, a motor and a carbon-fiber spring to mimic natural motion. A battery-powered motor replaces the function of missing muscles and Bluetooth technology allows a person to adjust settings easily with a smartphone.

8. Harnessing big data to improve health care: Innovative companies are answering the call to begin mining massive amounts of medical information in a format that's easy to access and share, while at the same time assuring patient privacy.

9. SGLT2 inhibitors as diabetes therapy: A new class of drugs called sodium-glucose co-transporter 2 protein inhibitors reduce blood sugar by causing it to be excreted through urine. The once-a-day medication blocks the protein, and the return of high levels of glucose in the body. The SGLT2 inhibitors also contribute to weight loss.

10. Genetically modified mosquitoes to reduce disease threat: Researchers are exploring new ways to eradicate mosquito-borne diseases such as malaria, dengue, yellow fever and West Nile virus by creating sterile, re-engineered male mosquitoes to mate with wild female species.

·         Wall Street Journal’s six picks for  future innovations, "The Future of Medicine is Now, December 29-30, 2012

1. Growing a Heart - Getting A Kid's Heart to Pump

Surgeons at Boston Children's Hospital have developed a way to help children born with half a heart to essentially grow a whole one—by marshaling the body's natural capacity to heal and develop. About 1,000 babies are born in the U.S. each year with a condition called hypoplastic left-heart syndrome, the result of a genetic anomaly that leaves them without a functioning left ventricle, the heart's main pumping chamber. Without a surgical repair, the defect is almost always fatal.   A new surgical strategy has helped children grow half a heart into a whole one.  Surgeons at Boston Children’s  devises a technique strategy to open obstructed valves and repair other malformations to direct blood flow to the left ventricle instead of away from it. That triggers biological processes that promote the heart's growth.

2.      DNA Sequencing for Routine Checkups- Making DNA Analysis Quick and Inexpensive

Since the first sequencing of the human genome was completed in 2003 at a price tag of over $2 billion, the speed, price and accuracy of the technology have all improved. Illumina Inc. ILMN -1.19% has dropped its price for individual readouts to $5,000; earlier this year, Life Technologies introduced a sequencer it says can map the human genome for $1,000. The smallest machine is now desktop-size. New  sequencing devices,  designed to be even smaller and more affordable, are helping speed efforts to make gene sequencing a routine part of a visit to the doctor's office. DNA molecules are exceedingly long and complicated; that makes them hard to read.

3.      Matching a Tumor to a Drug - Targeting Tumors with Specialized Drugs

Understanding  the human genome poses a challenge: How to use that data to change the course of disease. Consider cancer. As seen through a gene-sequencing machine, some cancers can appear as at least a dozen different genetic diseases, some of which have been shown to respond uniquely to a specific drug. But how do cancer doctors quickly match a patient's tumor with a drug that targets it? One answer is a test developed by Foundation Medicine Inc., a Cambridge, Mass., startup. The test, launched last June, enables doctors to test a tumor sample for 280 different genetic mutations suspected of driving tumor growth. This changes "everything in terms of how we approach patients with cancer," says David Spigel, director of lung-cancer research at the Sarah Cannon Research Institute in Nashville, Tenn. He used the test in one patient with advanced disease and few apparent options. She turned out positive for an alteration in a gene targeted by several drugs currently in development. She was signed up for one of the studies. A short time later, "she's like a new person," he says. "She's off pain medicines. She gained her weight back."

4.      Letting Your Body Fight Cancer - Setting Antibodies Loose on Cancer

Few advances in cancer care are generating more enthusiasm than harnessing the power of the immune system to fight the disease.. Tom Stutz is one reason why. Last April, the 72-year-old retired lawyer was confined to a wheelchair, struggling for every breath, and required help with simple tasks such as eating, all because of a previously diagnosed skin cancer that had spread to his lungs and liver. "I was ready to check out, to be honest," he says.

That month, he began taking an experimental drug known as MK3475. Six weeks later, he started feeling better. Today, Mr. Stutz has jettisoned the wheelchair and regularly walks a 3.5-mile loop near his home in Los Angeles. "I feel terrific," says Mr. Stutz, who learned after a checkup in the fall that his tumors had shrunk by about 65% so far. For decades, cancer researchers have wondered why the immune system typically doesn't treat tumor cells as invaders and target them. Part of the mystery was recently solved: Tumors protect themselves by hijacking the body's natural brake for the immune system.MK3475, being developed by Merck & Co., is among a new category of drugs that release the brake, unleashing an army of immune cells to hunt down the cancer. A recent report from a trial in which Mr. Stutz participated said that of 85 patients who took the drug, 51% saw their tumors significantly shrink; in eight cases, the tumors couldn't be detected on imaging tests.One reason for the excitement is that most "solid" tumors—colon, lung, breast, prostate—use the same or a similar mechanism to hide from the immune system. Obstructing that mechanism may have a broad impact across a variety of malignancies.

5.  Health in the Palm of Your Hand - Performing your Own EKG at Home

There's a good chance that you already own one of the most ubiquitous health-care innovations: a smartphone. Last month, the FDA cleared a new iPhone add-on that lets doctors take an electrocardiogram just about anywhere. Other smartphone apps help radiologists read medical images and allow patients to track moles for signs of skin cancer. "I see the smartphone as one piece of how we're going to try to get health costs under control," says David Albert, the Oklahoma City-based inventor of the just-approved AliveCor electrocardiogram application. At $199, AliveCor consists of a case that snaps onto the iPhone, with electrodes on the back. It reads heart rhythms and relays the recording to an iPhone app, allowing physicians to read the data. Dr. Albert says a $99 version should be available soon that will let patients capture their own heart data, documenting sometimes-fleeting arrhythmias when they feel symptoms or tracking the success of lifestyle changes at curbing heart troubles.

6.      Rejigging Your Genes - Turning Gene Therapy into Reality

After years of controversy, gene therapy is poised to become a viable option for a variety of often life-threatening medical conditions, especially those resulting from a single defective gene. Last month, the European Union approved Glybera for treatment of a rare genetic disease, making it the first gene-therapy medicine approved in the Western world. The approval comes amid a flurry of research showing broader promise for the approach in a range of disorders, from a rare form of blindness to hemophilia to heart failure.Though outright cures are still elusive, gene therapy "is beginning to emerge as a meaningful clinical" strategy, says Stephen J. Russell, director of molecular medicine at the Mayo Clinic in Rochester, Minn.Gene therapy's tantalizing attraction is that a single treatment has the potential to cure lethal diseases by enabling normal genes to take over for defective ones. The treatment involves loading a functional gene onto a fragment of a deactivated virus that transports the gene to a cell's nucleus, where it is intended to take over.

Tweet:  2012’s major innovations and those now evolving can best be categorized as high-technology, information rich, and genomically guided.