Posted 10/07/11 on The Doctor Weighs In
Every year the Cleveland Clinic announces the top 10 innovations that their experts think will impact healthcare the most in the following year. Here are the winners for 2012:
#1 Catheter-based renal denervation for resistant high blood pressure
People with hypertension (HTN) are at risk for heart attacks, strokes, and kidney failure. When high blood pressure cannot be controlled with three or more medications, it is considered resistant. One-third of Americans have hypertension and 20-30% of these cases are considered resistant. High blood pressure is the leading risk factor for death worldwide – worse than cigarettes. Until the development of renal denervation, there was no effective treatment for resistant hypertension. In a small randomized controlled trial, the Simplicity HTN study, 39% achieved target blood pressures and 50% had some measurable benefit compared to the controls, treated only with high blood pressure mediations that had no change from their baseline blood pressures. Average decrease in systolic blood pressure was an astonishing 35 mm Hg with a 12 mm drop in diastolic blood pressures. The procedure takes about 40 minutes and is performed in a hospital’s catheterization lab. If the results hold up – and if there are no unintended consequences – this could be really BIG (which, of course, is why it won the #1 slot on this list).
#2 Low radiation-dose spiral CT to screen for lung cancer
This one surprised me. Screening for lung cancer is not a currently recommended practice. However, the Cleveland Clinic innovations team points out that a large scale, multicenter trial, known as the National Cancer Institute’s National Lung Screening Trial (NLST) screened current and former heavy smokers with either a standard chest x-ray or a spiral CT once a year for three years and then followed the patients for an additional 5 years. The study found that there were 20% fewer deaths due to lung cancer in the spiral CT group, presumably because the cancers were found when they were smaller and more treatable by surgery.
#3 Concussion Management System for athletes
We now all know the dangers of head trauma in athletes that participate in high impact sports, like American football. Repeated concussions have been associated with dementia later in life and second-impact injuries, a result of returning to a game before recovering from the first impact, can be fatal. Now there is a way to assess the magnitude of the impact of a sports-related head bang in order to determine whether the player should be removed from the game. The Concussion Management System consists of two parts: an assessment to determine baseline cognitive and motor skills and a special mouth guard that is embedded with technology that can measure and transmit, via Bluetooth, the energy delivered to the head by the impact. Removal of a head injured player should save lives and save neurons.
#4 Medical apps and mHealth
Apps, apps, are everywhere…and development and improvement of apps continues to grow at an exponential rate. Some apps target consumers (aka patients) others are geared for docs and other health professionals. mHealth frees everyone from the tyranny of the desktop and delivers needed health information and support to your fingertips – where most of us have our Smartphone’s most of the time. The Cleveland Clinic sums up the impact of this innovation nicely by saying, “As medical care costs rise, as more doctors handle patient workloads with reduced support staff, mHealth may well be the answer for delivery of the most immediate and comprehensive medical care in the twenty first century. [I heard the converse at the National Medical Home Summit in San Francisco recently: “Office visits are so 20thcentury!”]
#5 Increasing discovery with next-generation gene sequencing
Just like everything else in technology, gene-sequencing is getting faster, cheaper, and the machines are smaller. The Human Genome project that led to the first sequencing took 13 years and cost $2.7 billion. Now there are powerful sequencers available that can sequence the entire genome in 8 days for about $10,000. It is expected that next-generation sequencers will do the job in 15 minutes for about $1000.
#6 Implantable devices to treat complex brain aneurysms
A ruptured brain aneurysm, a weakened ballooning area in a brain’s blood vessel, can have devastating consequences, including stroke and death. Approximately one in fifteen people in the US will develop an aneurysm at some time in their life. Until now, if an aneurysm was discovered, it had to be treated with an open brain surgery. With the advent of these new implantable devices, catheter-based technology is used to deliver a blood diverting device to the site of the aneurysm, causing it to eventually shrink and no longer be at risk of rupturing. Patients can be discharged the day after the device is placed – saves lives, saves brain, saves dollars! Good deal.
#7 Active bionic prostheses: wearable bionic devices
There are somewhere between a half-million to a million amputees in the US. This number is expected to quadruple by 2050 because of military conflict and the ever-increasing incidence to Type 2 diabetes. Traditional prostheses function primarily as a cane, allowing an individual missing a lower limb to stand-up. New computerized bionic limbs with microprocessors and chips are said to rival the function of real legs, allowing folks using them to walk, run, and climb with the same speed and metabolic energy as individual with intact limbs. They can also be quite beautiful as I learned at the Health 2.0conference in San Francisco.
#8 Harnessing big data to improve healthcare
I love this one. What they are referring to is capturing the terabytes and petabytes (and whatever comes after that) of data that are generated each day by the health care system, stripping it of patient identifiers, and then analyzing it—using newly available technology—to discover new correlations that can benefit health care delivery as well as health. The Cleveland Clinic innovation team states that “a leading management consulting firm recently estimated that if the US healthcare industry were to effectively use the growing volume of big data to drive efficiency and quality, it would create more than $300 billion in value every year. Most of this would come from helping reduce health care expenditures by almost 8%.”
#9 A new treatment for diabetes: SGKLT2 inhibitors help you pee away glucose
Our kidneys help the body conserve glucose by blocking its excretion into the urine via sodium-glucose co-transport 2 proteins. This provided an evolutionary advantage in the distant past when food was scarce and unpredictable. It works against us in the Age of Obesity when more than 8% of the population has Type 2 diabetes. SGKLT2 inhibitors block the transport protein and allow glucose to be excreted in the urine. Clinical trials have shown that not only does this drug cause glucose levels to decline in diabetics, but blood pressure and weight also come down. If no major side effects turn up during the testing of this drug, it could be a great addition to the ever-expanding therapeutic armamentarium for diabetes.
#10 Genetically modified mosquitoes to reduce disease threat
Mosquito-borne diseases, such as malaria, dengue, and West Nile virus, cause misery and death around the world. It is estimated that 700 million people contract mosquito-borne diseases annually; 2 million will die as a result. The US is not immune. West Nile virus and dengue are both found within our borders. In a recent experiment, three million male mosquitoes, genetically engineered to be sterile, were released in the Cayman Islands. Because the females that mated with these males were unable to reproduce, there was a rapid 80% reduction in the mosquito population in the test area. This is pretty remarkable.
If you like reading about these innovations, I urge you to visit the 2012 Innovations website where you can learn more and view some lovely videos developed to describe the innovations. If you are really motivated, consider attending the 2012 Medical Innovation Summit in (where else?) Cleveland, Ohio on October 29-31, 2012.