Smart cars that reduce accidents and injuries. Immunotherapy that helps kids beat cancer without chemo. Stents that harmlessly dissolve when their work is done. These are some of the innovations that will enhance healing and change healthcare in the coming year, according to a distinguished panel of doctors and researchers.
Cleveland Clinic today announced the Top 10 Medical Innovations of 2017 at a multi-media presentation that climaxed the 2016 Medical Innovation Summit.
Topping the 11th annual list is the harnessing of the microbiome, the gut bacteria swarming in all of us. Recent discoveries have revealed the power of microbes to prevent, diagnose and treat disease. The healthcare industry will soon be pouring resources into addressing the potential for new therapies, diagnostics, probiotics and other products.
Another powerful innovation is cellular immunotherapy, where cells are removed and reprogrammed to fight cancer. The re-engineering illustrates one of the emerging characteristics of medical innovation, according to Dr. Michael Roizen, the Chief Wellness Officer at Cleveland Clinic.
“The combinations that lead to innovation are much more unusual,” he said. “We used to develop a drug to treat a disease. Now, we’re combining devices, drugs and imagination. We’re altering patients’ T cells so that they will attack their cancer cells.”
Studies focused on leukemia have reported remission rates of 90 percent with immunotherapy, raising hopes that it could replace chemotherapy and its lifetime of side effects.
To identify and rank the most impactful innovations, Cleveland Clinic assembled a team of more than 100 doctors and researchers, many of them leaders in their fields. Led by Roizen, the team winnowed a list of nearly 200 nominations into a top 10 through discussion, debate and a triple elimination balloting process that sought the agreement of two different groups of experts voting independently of each other.
The panel does not identify a brand or a company behind the work, only the innovation and its chances of healing and extending life.
Here, in order of anticipated importance, are the Top 10 Medical Innovations of 2017:
1. Using the Microbiome to Prevent, Diagnose and Treat Disease
When it comes to life-saving potential and market opportunities, the gut is a gold mine. Trillions of bacteria making up communities in our body – the microbiome – are unlocking mysteries at a rapid pace as the market scrambles to address the possibilities.
The crux of the discovery, made within the last 10 years, is that our microbes have a mind of their own. The chemicals they emit interfere with the way food is digested, medicine is deployed, and even how a disease progresses.
Biotech companies once focused on the genomic market are pivoting to the potential of the microbiome to develop new diagnostics, new therapies, and “probiotic” products to prevent dangerous microbe imbalances.
With the National Microbiome Initiative accelerating research and development, experts believe 2017 is the year the microbiome cements itself as the healthcare industry’s most promising and lucrative frontier.
2. Diabetes Drugs that Reduce Cardiovascular Disease and Death
Nearly a decade ago, a wave of new diabetes drugs hit the market with promises of lowering blood sugar. They fell far short of blunting the scariest statistics for type 2 diabetes patients: Half will die from complications from cardiovascular disease, with the odds reaching 70 percent after their 65th birthdays.
In 2016, a couple of new medications began dropping the mortality rates considerably. Empaglifozin proved to modify the progression of heart disease by working with the kidney, while liraglutide has a comprehensive effect on many organs.
Given the positive results, experts predict 2017 will mark a complete shift in the lineup of medicines prescribed for diabetes patients, as well as a new wave of research into new avenues to target type 2 diabetes and its comorbidities. With the contribution of these new drugs, more patients will live to see the benefits.
3. Cellular Immunotherapy to Treat Leukemia and Lymphomas
In 2016, nearly 16,000 children and adolescents will be diagnosed with cancer, more than a quarter of them with leukemia. Yet there is good news coming for kids, families and adults fighting the deadly battle with leukemia, as well as with Non-Hodgkin lymphomas. One of the first cellular immunotherapies is about to hit the market, and early results suggest these diseases, even in advanced stages, may be curable.
Chimeric antigen receptor (CAR) T-cell therapies represent a type of immunotherapy where a patient’s immune system T-cells are removed and genetically reprogrammed to seek and destroy tumor cells. They seek out antigens, multiply, and attack and kill the foreign cancer cells, then often stick around to minimize chances of relapse.
Results of these cellular immunotherapies have been impressive. Some studies focusing on acute lymphoblastic leukemia (ALL) have reported a remission rate of 90 percent. The groundbreaking treatment is expected to be presented to the FDA in 2017 for treatment of ALL, which could trigger a wave of approvals for other blood cancers and lymphomas.
Cellular immunotherapy could one day replace chemotherapy and its lifetime of side effects. It gives a body a chance to prove resilience.
4. Liquid Biopsies to Find Circulating Tumor DNA
Oncologist have long dreamed of avoiding the subjective nature of reported signs and the hit-or-miss nature of biopsies. Their dreams maybe coming true. Blood tests known as “liquid biopsies” uncover signs of actual DNA, or cell-free circulating tumor DNA (ctDNA), which is shed from a tumor into the bloodstream. The advantage is that ctDNA is more than 100 times more abundant in the blood than tumor cells.
While studies are still underway, the market is adjusting to make way for this revolutionary cancer test. Annual sales are forecast to be $10 billion, and several companies are developing testing kits to hit the market this year.
The frontier of the liquid biopsy is wide open. It’s being hailed as a flagship technology of the federal government’s Cancer Moonshot Initiative. Experts believe it’s only a matter of time before catching and treating cancer is as routine as your annual checkup.
5. Automated Car Safety Features and Driverless Capabilities
With 38,300 fatal car crashes in 2015, automobile accidents remain a leading cause of death and disability, not to mention a major expense. Medical costs for one year alone total nearly $23 billion nationwide. Innovators in Detroit and in Silicon Valley believe these types of numbers can be wiped off the books for good, and soon.
New, automatic safety features promise to make a dent in dangerous car accidents. These range from collision warning systems to drowsiness alerts to adaptive cruise control. More are coming. Safety technology is expected to surge in 2017, a year before the U.S. Department of Transportation mandates the inclusion of backup cameras in all cars.
Meanwhile, there is a grander notion to remove all human error from vehicle transportation. The nation’s biggest software, private transportation, and auto manufacturing companies are making huge investments into driverless cars. Safety and legal questions remain, but 2017 is expected to be the year that driverless cars take a spin into the mainstream.
Could 2017 be the beginning of the end of car accidents? It will surely be a seminal year for the technology.
6. Fast Healthcare Interoperability Resources
The inefficiencies of doctors’ appointments and hospital stays have been the butt of jokes for decades. While sorting through bills or waiting on hold with insurance companies, patients are likely to ask, “Why can’t these offices talk with each other?” or “Why can’t the machines in the same hospital talk to each other?”
The answer for too many years has been, “It’s complicated.” In 2017, that excuse will be tossed out the window, fax machine and all.
Digital interoperability is complex in healthcare, which must weigh privacy, security and accuracy concerns. But in-house systems have become so diverse and convoluted, it’s hard for different systems to communicate and nearly impossible for new software companies to penetrate the industry.
2017 marks the year we finally make sense of the tangled web healthcare has woven. FHIR (Fast Healthcare Interoperability Resources) is a new tool soon to be released by an international committee called HL7. It will essentially function as an interpreter between two healthcare systems or offices that have developed their own languages. The first release will focus on clinical data, like images and medications, while the second will focus on administrative data, like billing and demographics.
There are huge implications for healthcare beyond the interoperability of their systems. Innovators and entrepreneurs everywhere can finally take a crack at building smart, data-driven technologies that can be built to a FHIR standard, allowing new technologies to be adopted anywhere.
FHIR not only marks a potential end of the frustration, it paves the way for a surge of life-saving health information technology.
7. Ketamine for Treatment-Resistant Depression
A loss of hope is a classic symptom of depression. Drugs and therapies have been developed to help balance or trigger serotonin, norepinephrine and other neurotransmitters. But for one-third of depressed patients, the medications don’t really work. Alternatives include electroconvulsive therapy or other intensive treatment options. Too often, the last resort is suicide.
In 2013, ketamine, a drug commonly used for anesthesia – and known in the 1960s as a party drug – was studied for its ability to target and inhibit the action of N-methyl-D-aspartate (“NMDA”) receptors of nerve cells. The results were overwhelmingly favorable. Initial studies indicated that 70 percent of treatment-resistant-depression (“TRD”) patients saw an improvement in symptoms within 24 hours of being injected with a low dose of ketamine. For the first time, there was a fast treatment for the severely depressed.
The studies triggered the FDA to grant Fast Track Status to the development of a new NMDA-receptor-targeting medications based on the ketamine profile. Some, like esketamine, received breakthrough status from the FDA, enhancing the probability that these new drugs will be available to patients in 2017.
With nearly 43,000 suicides a year in the U.S., the need for effective treatment looms large. In the medical community, hope has never been higher.
8. 3-D Visualization and Augmented Reality for Surgery
The surgeon is about to get a few new tools. Some might even call them superpowers.
For years, surgeons have relied on microscope oculars or other camera systems to operate. Even so, they typically depend on their own eyes and interpretations to execute the most precise of tasks with their heads down, peripheral vision limited, back and neck muscles strained. It’s not a great working environment.
This past year, two of the most intricate surgical practices, ophthalmology and neurology, began experimenting with technology that keeps surgeons’ heads up while immersing them in a high resolution, 3D visual representations of their subject. These stereoscopic systems also use data to generate visual templates for surgeons to execute certain tasks within a surgery. Experts and surgeons who have piloted the technology say the added comfort and visual information allow surgeons to operate more efficiently and effectively. Plus, medical residents have a clearer picture of what the surgeon is seeing and doing.
Along the same lines, software companies are building augmented reality glasses that display holographic images of human anatomy. Medical schools see the end of cadaver labs.
While the market is still growing and imaginations running wild, several hospitals will be adopting virtual reality tools in 2017, pushing the boundaries of surgical reality.
9. Self-administered HPV Test
In the mountains of Ecuador, over the rough terrain of Tanzania, or even in the rural communities in the US, there are women at significant risk of dying of cervical cancer and have no idea. Even worse, they have no real way of finding out.
Most sexually active woman contract the Human Papilloma Virus (HPV). Certain strains of HPV are responsible for 99 percent of cases of cervical cancer, the most common malignancy in women 35 years and younger.
Despite great strides in HPV prevention and treatment, the benefits are restricted to a narrow population – women with access to HPV tests and vaccines.
In 2017, an ambitious approach to expand the care will be launched. Scientists have developed self-administered HPV test kits that include a test tube, a swab, and a mail-in box. The idea is that women can administer their own test, mail a sample back to a lab and be alerted to dangerous strains of HPV.
Cervical cancer prevention is a “Millennium Development Goal” of the United Nations. Experts believe 2017 will be the year these tests are deployed on a large scale, representing the largest scale prevention strategy for cervical cancer to date.
10. Bioabsorbable Stents
Every year, 600,000 people have metal coronary stents put into their chests to treat coronary artery blockage. Most of the time, that stent stays there forever, long after its mission is complete. The stents may inhibit natural blood flow and cause other complications, like blood clots.
But what if the stents could just disappear? That is a long-sought goal researchers have finally met. This past July, the first bioabsorbable stent was approved in the United States. Made of a naturally dissolving polymer, the stent widens the clogged artery for two years before it is absorbed into the body in a manner similar to dissolvable sutures. The disappearing stent leaves behind a healthy natural artery. The patient is free to go off blood clotting medication and qualifies for a broader range of medical treatments.
Only one version of an absorbable stent has been FDA approved but more are coming. Experts believe the market potential will approach $2 billion in six years. While the full impact of vanishing stents is yet to be seen, 2017 is the year the technology becomes a game changer.