Past and Now Innovations
present and time past
both perhaps present in the future
time future continued in the time past.
Elliot (188-1965), Four Quartets – Burnt Norton
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.
Kohane, Jeffrey Drazen, and Edward Campion, “A Glimpse of the Next 100 years in
Medicine,” New England Journal of
Medicine, December 27, 2012
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
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
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
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
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.
Sequencing for Routine Checkups- Making DNA Analysis Quick and Inexpensive
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
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.
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
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
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
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
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.
major innovations and those now evolving can best be categorized as high-technology,
information rich, and genomically guided.
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