Sunday, November 7, 2010

Medical Innovation as an Irresistible Force

When I started this blog four years ago, I intended it as a sequel to my book Innovation Driven Health Care (Jones and Bartlett, 2006). I argued medical innovation was an irresistible force, and in general, it made health care better and better.

What I failed to do was connect the dots, namely, that medical innovation is closely connected to every other innovation in society. In a new book, What Technology Wants (408 pages, Viking, $28), Kevin Kelly, former editor of Wired Magazine corrects my omission.

Kelly coins the term “technium” to describe the “global , massively interconnected system of technology “ extending “beyond shiny hardware to include culture, art, social institutions, and intellectual creations of all types.”

Think of the CT scan. It made its appearance in the early 70s and was based on the computerization of x-rays which permitted an inside look at slices of human organs. Policy experts, like Howard Hiatt, MD, dean of public health at Harvard and Joseph Califano, head of HEW, said its use ought to be limited until government could assess its value.

But the technology was so good, CT scans spread like a prairie wildfire, whipped by its usefulness in seeing inside the brain, body organs, and joints. It was an irresistible force and remains so today. A report released just last week indicates that early screening of heavy smokers can cut lung cancer death rates by 20%.

Consider the top ten innovations of 2011, so deemed by 60 Cleveland Clinic physicians. These innovations, all approved or about to be the FDA, are not pie-in-the-sky inventions. They are, or soon will be available for the medical profession to use, and they are all interconnected to advances in other realms in society.

Here are the Top 10:

1. Molecular imaging biomarker to detect early Alzheimer's Disease: A brain imaging compound called AV-45 will make it possible to detect earliest Alzheimer’s.

2. Targeted T-cell antibody for metastatic melanoma: An anti-cancer drug, ipilimumab, allows the immune system to more effectively fight advanced melanoma.

3. First cancer vaccine approved by the FDA: Provenge (Sipuleucel-T) the vaccine increases survival of prostate cancer by stimulating the immune system.

4. Statins for healthy individuals: Researchers have found statins drastically cut heart disease deaths for people with normal cholesterol but elevated C-reactive protein, a measure of heart inflammation.

5. Hepatitis C protease inhibiting drugs: Two drugs, boceprevir and telaprevir, target the hepatitis C virus and vastly improve cure rates.

6. Telehealth monitoring for individuals with heart failure: Implantable, small devices monitor, measure, and communicate pulmonary artery pressure, and in-home devices that record and send weight, blood pressure and heart rate data, reducing hospitalization.

7. Endoscopic weight-loss procedure: An incision-less option for bariatric surgery, uses two flexible endoscopes to pass instruments through the mouth, reducing the size of the stomach to a small pouch.

8. Exhaled nitric oxide, breath analysis for diagnosing asthma: A hand-held diagnostic testing device allows doctors to diagnose and manage asthma. The device measures exhaled nitric oxide, produced during asthmatic inflammatory attacks.

9. Oral disease modifying treatment for multiple sclerosis: Fingolimod is the first oral treatment available to MS patients, a major breakthrough in treatment that reduces attacks and brain lesions.

10. Capsule endoscopy for diagnosis of pediatric GI disorders: A safe and painless, pill-sized capsule takes hundreds of pictures and video clips of the inside of the digestive tract and transmits them to a data recorder during transit.


These innovations are connected to the interplay between body related computer technologies, information technology advances, and applications of technologies to the major chronic diseases afflicting humankind – Alzheimers, cancer, asthma, obesity, and degenerative neurological disease. News of these innovations is already spilling over in the Internet and being spread by social media technologies. You can keep good news down.

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