Countdown to 2012's medical top 10

MEDICAL TECHNOLOGY:The Cleveland Clinic has just brought out its annual list of technologies that are predicted to make big noise in 2012 – here's the top 10

IT MAY SEEM a little early for a list of 2012 predictions. But with the shops mentioning Christmas before we have even been spooked by Halloween, perhaps it’s time to start anticipating the medical breakthroughs that could have a big impact next year.

The Cleveland Clinic in the US has just brought out its annual list of emerging technologies in medicine, where doctors highlight approaches they think will soon be making new shapes in their fields.

“These are the technologies that our leading clinicians think will break through in 2012,” says Chris Coburn, executive director of Cleveland Clinic Innovations, the venture arm of the Ohio clinic.

“There is no requirement for these technologies [on the list] to tie to Cleveland Clinic in any way; the clinicians who work here are arbiters of innovation – they can use new technology from anywhere in the world and we are tapping into that continuing reconnaissance,” says Coburn, who is in Dublin this week for the MedinIreland medical technology and healthcare expo 2011 being hosted by Enterprise Ireland.

More generally, Cleveland Clinic has links with several Irish groups and agencies, including the Centre for Innovation in Surgical Technology at the Royal College of Surgeons in Ireland, Enterprise Ireland, the IDA and individual companies.

But back to the top 10: what was in the envelope this year when the final list was announced?

10 Genetically modified mosquitoes to reduce disease threat

Manipulating the DNA of insects could offer a route to tackling mosquito-borne disease. A recent trial in the Cayman Islands involved releasing millions of re-engineered sterile male mosquitoes to mate with females and so reduce the population of disease “vectors”.

If successful, the approach could have enormous implications for the burden of diseases such as malaria and Dengue fever, says Coburn. “The feeling is that it represented a chance to help so many people, we needed to address it.”

9 New diabetes therapy

Many medications aim to tackle diabetes by targeting the hormone insulin, but SGLT2 inhibitors can help reduce blood sugar by causing it to be excreted during urination.

“The view is that this is a real shift in the treatment of diabetes – this is not going to be a cure but an adjunct and it will, in the panel’s view, dramatically improve the management of the disease for a lot of folks,” says Coburn.

A number of such inhibitors are in trials and it’s thought that approval may be granted for one even before 2012, he adds.

8 Harnessing data to improve healthcare

Healthcare data needs advanced technologies to efficiently process it in reasonable time and allow organisations to create, collect, search, and share data while still ensuring privacy.

“The feeling of our panel is that the ‘big data’ concept has arrived: the tools are present to manipulate these giant datasets in a way that clinical management can be improved,” says Coburn.

7 Active bionic prosthesis: wearable robotic devices

Over the last decade, space-age plastics and carbon-fibre composites have been engineered to help restore function in prosthetic limbs. And now comes the computerised bionic leg, complete with microprocessors and computer chips, where the wearer can adjust settings using a smartphone.

“The active sensing that these intelligent prostheses have can dramatically change their profile,” says Coburn.

“The panel felt we had reached the point where these smart replacement limbs represent a step-function increase in the quality of care.”

6 Implantable device to treat complex brain aneurysms

A new minimally invasive procedure can treat brain aneurysms, where a weak area in an artery wall results in balloon-like bulging or widening. This procedure doesn’t require open surgery: instead it implants a flexible, braided mesh tube into the artery by catheter so the device can block off large, giant, or wide-necked aneurysms.

“The tortuous anatomy of the vasculature of the brain means that when there’s an aneurysm it’s frequently life threatening or life ending,” says Coburn. “Now these new minimally invasive procedures allow the clinicians to get at the aneurysm without opening up the skull, and that is a big issue.”

5 Next-generation gene sequencing

Faster and cheaper ways to read or “sequence” a patient’s genetic information will help make it more useful in the clinical setting.

“The advancement in machine designs for sequencing has so much lowered the cost, by next year there will be a breakthrough that relates to the ability to use this for clinical assessment and management,” says Coburn.

4 Medical apps for mobile devices

Software applications on mobile devices can replace bulky medical references and offer information rapidly at fingertips, and in some cases they even let doctors and patients track symptoms.

“Speaking about this in the month of Steve Jobs’ passing seems only appropriate,” says Coburn. “[Medical apps] are here to stay, this is the future – the only debate for the panel was whether this was something where we could see a clear breakthrough. But they felt critical mass had been achieved in terms of these apps.”

3 Concussion management for athletes

Head injuries are a major concern in sports including American football, boxing, ice hockey and rugby. Special patient management tools have been developed that detect brain injuries at the moment of contact and provide patient-specific guidance about when athletes can return to play.

“It has reached a crescendo in the US, there is a lot of studies going on. This technology includes instrumented mouth guards and helmets, and it’s also important to have the baseline analysis that goes with it,” says Coburn.

“The feeling of our panel was it is still a little bit early, but it looks like 2012 will be a breakthrough year because there is such an intense amount of study going on and technology being developed.”

2 CT scans for early detection of lung cancer

A new CT scan, known as spiral CT, can be used to build up a three-dimensional image of the lungs, helping identify tumours early, and when they are are smaller and more treatable by surgery.

“Early detection makes a huge difference, and the panel felt these CT scans had a dramatic improvement on survival where this was picked up – this screening identified patients very early in the disease progression,” says Coburn.

1 Controlling resistant hypertension with renal denervation

A new technique to address high blood pressure physically disrupts nerves in the kidney because hyperactivity of the sympathetic nervous system serving the kidneys is associated with some forms of hypertension, or chronic high blood pressure.

Currently in clinical trials, the procedure involves introducing the device into the femoral artery in the upper thigh and then into the renal artery and delivering radio-frequency energy to disrupt the nerves, explains Coburn.

“The clinical world is gaining far more precise understandings of how to modulate the activities of the body by neural stimulation across a broad spectrum, and this one has reached a stage of effectiveness – there is a lot of excitement about it.

“This is absolutely a game changer,” says Coburn. “The debate on this was would it be in 2012 or this could slip into 2013, but the panel thought it was a significant change as it relates to the management of hypertension .”

For more on the top 10 list for 2012, and for lists of predictions from previous years and how they fared, see clevelandclinic.org